In the Senate of the United States, 

September 24 (legislative day, September 17), 2008. 

Resolved, That the bill from the House of Representatives (H.R. 1343) entitled ‘‘An Act to amend the Public 

Health Service Act to provide additional authorizations of appropriations for the health centers program under section 

330 of such Act, and for other purposes.’’, do pass with the 

following 

AMENDMENT: 

Strike all after the enacting clause and insert the 

following: 

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Health Care Safety Net 

3 Act of 2008’’. 

4 SEC. 2. COMMUNITY HEALTH CENTERS PROGRAM OF THE 

5 PUBLIC HEALTH SERVICE ACT. 

6 (a) ADDITIONAL AUTHORIZATIONS OF APPROPRIA7 TIONS FOR THE HEALTH CENTERS PROGRAM OF PUBLIC

8 HEALTH SERVICE ACT.—Section 330(r) of the Public 
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1 Health Service Act (42 U.S.C. 254b(r)) is amended by 

2 amending paragraph (1) to read as follows: 

3 ‘‘(1) IN GENERAL.—For the purpose of carrying 

4 out this section, in addition to the amounts author5 ized to be appropriated under subsection (d), there 

6 are authorized to be appropriated— 

7 ‘‘(A) $2,065,000,000 for fiscal year 2008; 

8 ‘‘(B) $2,313,000,000 for fiscal year 2009; 

9 ‘‘(C) $2,602,000,000 for fiscal year 2010; 

10 ‘‘(D) $2,940,000,000 for fiscal year 2011; 

11 and 

12 ‘‘(E) $3,337,000,000 for fiscal year 2012.’’. 

13 (b) STUDIES RELATING TO COMMUNITY HEALTH CEN14 TERS.— 

15 (1) DEFINITIONS.—For purposes of this sub16 section— 

17 (A) the term ‘‘community health center’’ 

18 means a health center receiving assistance under 

19 section 330 of the Public Health Service Act (42 

20 U.S.C. 254b); and 

21 (B) the term ‘‘medically underserved popu22 lation’’ has the meaning given that term in such 

23 section 330. 

24 (2) SCHOOL-BASED HEALTH CENTER STUDY.— 
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1 (A) IN GENERAL.—Not later than 2 years 

2 after the date of enactment of this Act, the 

3 Comptroller General of the United States shall 

4 issue a study of the economic costs and benefits 

5 of school-based health centers and the impact on 

6 the health of students of these centers. 

7 (B) CONTENT.—In conducting the study 

8 under subparagraph (A), the Comptroller Gen9 eral of the United States shall analyze— 

10 (i) the impact that Federal funding 

11 could have on the operation of school-based 

12 health centers; 

13 (ii) any cost savings to other Federal 

14 programs derived from providing health 

15 services in school-based health centers; 

16 (iii) the effect on the Federal Budget 

17 and the health of students of providing Fed18 eral funds to school-based health centers and 

19 clinics, including the result of providing 

20 disease prevention and nutrition informa21 tion; 

22 (iv) the impact of access to health care 

23 from school-based health centers in rural or 

24 underserved areas; and 
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1 (v) other sources of Federal funding for 

2 school-based health centers. 

3 (3) HEALTH CARE QUALITY STUDY.— 

4 (A) IN GENERAL.—Not later than 1 year 

5 after the date of enactment of this Act, the Sec6 retary of Health and Human Services (referred 

7 to in this Act as the ‘‘Secretary’’), acting through 

8 the Administrator of the Health Resources and 

9 Services Administration, and in collaboration 

10 with the Agency for Healthcare Research and 

11 Quality, shall prepare and submit to the Com12 mittee on Health, Education, Labor, and Pen13 sions of the Senate and the Committee on En14 ergy and Commerce of the House of Representa15 tives a report that describes agency efforts to ex16 pand and accelerate quality improvement activi17 ties in community health centers. 

18 (B) CONTENT.—The report under subpara19 graph (A) shall focus on— 

20 (i) Federal efforts, as of the date of en21 actment of this Act, regarding health care 

22 quality in community health centers, in23 cluding quality data collection, analysis, 

24 and reporting requirements; 
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1 (ii) identification of effective models 

2 for quality improvement in community 

3 health centers, which may include models 

4 that— 

5 (I) incorporate care coordination, 

6 disease management, and other services 

7 demonstrated to improve care; 

8 (II) are designed to address mul9 tiple, co-occurring diseases and condi10 tions; 

11 (III) improve access to providers 

12 through non-traditional means, such as 

13 the use of remote monitoring equip14 ment; 

15 (IV) target various medically un16 derserved populations, including unin17 sured patient populations; 

18 (V) increase access to specialty 

19 care, including referrals and diagnostic 

20 testing; and 

21 (VI) enhance the use of electronic 

22 health records to improve quality; 

23 (iii) efforts to determine how effective 

24 quality improvement models may be adapt25 ed for implementation by community health 
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1 centers that vary by size, budget, staffing, 

2 services offered, populations served, and 

3 other characteristics determined appropriate 

4 by the Secretary; 

5 (iv) types of technical assistance and 

6 resources provided to community health cen7 ters that may facilitate the implementation 

8 of quality improvement interventions; 

9 (v) proposed or adopted methodologies 

10 for community health center evaluations of 

11 quality improvement interventions, includ12 ing any development of new measures that 

13 are tailored to safety-net, community-based 

14 providers; 

15 (vi) successful strategies for sustaining 

16 quality improvement interventions in the 

17 long-term; and 

18 (vii) partnerships with other Federal 

19 agencies and private organizations or net20 works as appropriate, to enhance health 

21 care quality in community health centers. 

22 (C) DISSEMINATION.—The Administrator of 

23 the Health Resources and Services Administra24 tion shall establish a formal mechanism or mech25 anisms for the ongoing dissemination of agency 
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1 initiatives, best practices, and other information 

2 that may assist health care quality improvement 

3 efforts in community health centers. 

4 (4) GAO STUDY ON INTEGRATED HEALTH SYS5 TEMS MODEL FOR THE DELIVERY OF HEALTH CARE

6 SERVICES TO MEDICALLY UNDERSERVED AND UNIN7 SURED POPULATIONS.— 

8 (A) STUDY.—The Comptroller General of 

9 the United States shall conduct a study on inte10 grated health system models of at least 15 sites 

11 for the delivery of health care services to medi12 cally underserved and uninsured populations. 

13 The study shall include an examination of— 

14 (i) health care delivery models spon15 sored by public or private non-profit enti16 ties that— 

17 (I) integrate primary, specialty, 

18 and acute care; and 

19 (II) serve medically underserved 

20 and uninsured populations; and 

21 (ii) such models in rural and urban 

22 areas. 

23 (B) REPORT.—Not later than 1 year after 

24 the date of the enactment of this Act, the Comp25 troller General of the United States shall submit 
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1 to Congress a report on the study conducted 

2 under subparagraph (A). The report shall in3 clude— 

4 (i) an evaluation of the models, as de5 scribed in subparagraph (A), in— 

6 (I) expanding access to primary, 

7 preventive, and specialty services for 

8 medically underserved and uninsured 

9 populations; and 

10 (II) improving care coordination 

11 and health outcomes; 

12 (III) increasing efficiency in the 

13 delivery of quality health care; and 

14 (IV) conducting some combination 

15 of the following services— 

16 (aa) outreach activities; 

17 (bb) case management and 

18 patient navigation services; 

19 (cc) chronic care manage20 ment; 

21 (dd) transportation to health 

22 care facilities; 

23 (ee) development of provider 

24 networks and other innovative 

25 models to engage local physicians 
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1 and other providers to serve the 

2 medically underserved within a 

3 community; 

4 (ff) recruitment, training, 

5 and compensation of necessary 

6 personnel; 

7 (gg) acquisition of technology 

8 for the purpose of coordinating 

9 care; 

10 (hh) improvements to pro11 vider communication, including 

12 implementation of shared infor13 mation systems or shared clinical 

14 systems; 

15 (ii) determination of eligi16 bility for Federal, State, and local 

17 programs that provide, or finan18 cially support the provision of, 

19 medical, social, housing, edu20 cational, or other related services; 

21 (jj) development of preven22 tion and disease management 

23 tools and processes; 

24 (kk) translation services; 
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1 (ll) development and imple2 mentation of evaluation measures 

3 and processes to assess patient 

4 outcomes; 

5 (mm) integration of primary 

6 care and mental health services; 

7 and 

8 (nn) carrying out other ac9 tivities that may be appropriate 

10 to a community and that would 

11 increase access by the uninsured 

12 to health care, such as access ini13 tiatives for which private entities 

14 provide non-Federal contributions 

15 to supplement the Federal funds 

16 provided through the grants for 

17 the initiatives; and 

18 (ii) an assessment of— 

19 (I) challenges, including barriers 

20 to Federal programs, encountered by 

21 such entities in providing care to 

22 medically underserved and uninsured 

23 populations; and 

24 (II) advantages and disadvan25 tages of such models compared to other 
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1 models of care delivery for medically 

2 underserved and uninsured popu3 lations, including— 

4 (aa) quality measurement 

5 and quality outcomes; 

6 (bb) administrative effi7 ciencies; and 

8 (cc) geographic distribution 

9 of federally-supported clinics com10 pared to geographic distribution 

11 of integrated health systems. 

12 (5) GAO STUDY ON VOLUNTEER ENHANCE13 MENT.— 

14 (A) IN GENERAL.—Not later than 6 months 

15 after the date of enactment of this Act, the 

16 Comptroller General of the United States shall 

17 conduct a study, and submit a report to Con18 gress, concerning the implications of extending 

19 Federal Tort Claims Act (chapter 171 of title 28, 

20 United States Code) coverage to health care pro21 fessionals who volunteer to furnish care to pa22 tients of health centers. 

23 (B) CONTENT.—In conducting the study 

24 under subparagraph (A), the Comptroller Gen25 eral of the United States shall analyze— 
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1 (i) the potential financial implications 

2 for the Federal Government of such an ex3 tension, including any increased funding 

4 needed for current health center Federal 

5 Tort Claims Act coverage; 

6 (ii) an estimate of the increase in the 

7 number of health care professionals at 

8 health centers, and what types of such pro9 fessionals would most likely volunteer given 

10 the extension of Federal Tort Claims Act 

11 coverage; 

12 (iii) the increase in services provided 

13 by health centers as a result of such an in14 crease in health care professionals, and in 

15 particular the effect of such action on the 

16 ability of health centers to secure specialty 

17 and diagnostic services needed by their un18 insured and other patients; 

19 (iv) the volume of patient workload at 

20 health centers and how volunteer health care 

21 professionals may help address the patient 

22 volume; 

23 (v) the most appropriate manner of ex24 tending such coverage to volunteer health 

25 care professionals at health centers, includ-
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1 ing any potential difference from the mech2 anism currently used for health care profes3 sional volunteers at free clinics; 

4 (vi) State laws that have been shown to 

5 encourage physicians and other health care 

6 providers to provide charity care as an 

7 agent of the State; and 

8 (vii) other policies, including legisla9 tive or regulatory changes, that have the po10 tential to increase the number of volunteer 

11 health care staff at health centers and the fi12 nancial implications of such policies, in13 cluding the cost savings associated with the 

14 ability to provide more services in health 

15 centers rather than more expensive sites of 

16 care. 

17 (c) RECOGNITION OF HIGH POVERTY.— 

18 (1) IN GENERAL.—Section 330(c) of the Public 

19 Health Service Act (42 U.S.C. 254b(c)) is amended by 

20 adding at the end the following new paragraph: 

21 ‘‘(3) RECOGNITION OF HIGH POVERTY.— 

22 ‘‘(A) IN GENERAL.—In making grants 

23 under this subsection, the Secretary may recog24 nize the unique needs of high poverty areas. 
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1 ‘‘(B) HIGH POVERTY AREA DEFINED.—For 

2 purposes of subparagraph (A), the term ‘high 

3 poverty area’ means a catchment area which is 

4 established in a manner that is consistent with 

5 the factors in subsection (k)(3)(J), and the pov6 erty rate of which is greater than the national 

7 average poverty rate as determined by the Bu8 reau of the Census.’’. 

9 (2) EFFECTIVE DATE.—The amendment made by 

10 paragraph (1) shall apply to grants made on or after 

11 January 1, 2009. 

12 SEC. 3. NATIONAL HEALTH SERVICE CORPS. 

13 (a) FUNDING.— 

14 (1) REAUTHORIZATION OF NATIONAL HEALTH

15 SERVICE CORPS PROGRAM.—Section 338(a) of the 

16 Public Health Service Act (42 U.S.C. 254k(a)) is 

17 amended by striking ‘‘2002 through 2006’’ and insert18 ing ‘‘2008 through 2012’’. 

19 (2) SCHOLARSHIP AND LOAN REPAYMENT PRO20 GRAMS.—Subsection (a) of section 338H of such Act 

21 (42 U.S.C. 254q) is amended by striking ‘‘appro22 priated $146,250,000’’ and all that follows through 

23 the period and inserting the following: ‘‘appro24 priated— 

25 ‘‘(1) for fiscal year 2008, $131,500,000; 
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1 ‘‘(2) for fiscal year 2009, $143,335,000; 

2 ‘‘(3) for fiscal year 2010, $156,235,150; 

3 ‘‘(4) for fiscal year 2011, $170,296,310; and 

4 ‘‘(5) for fiscal year 2012, $185,622,980.’’. 

5 (b) ELIMINATION OF 6-YEAR DEMONSTRATION RE6 QUIREMENT.—Section 332(a)(1) of the Public Health Serv7 ice Act (42 U.S.C. 254e(a)(1)) is amended by striking ‘‘Not 

8 earlier than 6 years’’ and all that follows through ‘‘purposes 

9 of this section.’’. 

10 (c) ASSIGNMENT TO SHORTAGE AREA.—Section 

11 333(a)(1)(D)(ii) of the Public Health Service Act (42 

12 U.S.C. 254f(a)(1)(D)(ii)) is amended— 

13 (1) in subclause (IV), by striking ‘‘and’’; 

14 (2) in subclause (V), by striking the period at the 

15 end and inserting ‘‘; and’’; and 

16 (3) by adding at the end the following: 

17 ‘‘(VI) the entity demonstrates 

18 willingness to support or facilitate 

19 mentorship, professional development, 

20 and training opportunities for Corps 

21 members.’’. 

22 (d) PROFESSIONAL DEVELOPMENT AND TRAINING.— 

23 Subsection (d) of section 336 of the Public Health Service 

24 Act (42 U.S.C. 254h–1) is amended to read as follows: 

25 ‘‘(d) PROFESSIONAL DEVELOPMENT AND TRAINING.— 
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1 ‘‘(1) IN GENERAL.—The Secretary shall assist 

2 Corps members in establishing and maintaining pro3 fessional relationships and development opportunities, 

4 including by— 

5 ‘‘(A) establishing appropriate professional 

6 relationships between the Corps member involved 

7 and the health professions community of the geo8 graphic area with respect to which the member 

9 is assigned; 

10 ‘‘(B) establishing professional development, 

11 training, and mentorship linkages between the 

12 Corps member involved and the larger health 

13 professions community, including through dis14 tance learning, direct mentorship, and develop15 ment and implementation of training modules 

16 designed to meet the educational needs of offsite 

17 Corps members; 

18 ‘‘(C) establishing professional networks 

19 among Corps members; or 

20 ‘‘(D) engaging in other professional develop21 ment, mentorship, and training activities for 

22 Corps members, at the discretion of the Sec23 retary. 

24 ‘‘(2) ASSISTANCE IN ESTABLISHING PROFES25 SIONAL RELATIONSHIPS.—In providing such assist-
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1 ance under paragraph (1), the Secretary shall focus 

2 on establishing relationships with hospitals, with aca3 demic medical centers and health professions schools, 

4 with area health education centers under section 751, 

5 with health education and training centers under sec6 tion 752, and with border health education and train7 ing centers under such section 752. Such assistance 

8 shall include assistance in obtaining faculty appoint9 ments at health professions schools. 

10 ‘‘(3) SUPPLEMENT NOT SUPPLANT.—Such efforts 

11 under this subsection shall supplement, not supplant, 

12 non-government efforts by professional health provider 

13 societies to establish and maintain professional rela14 tionships and development opportunities.’’. 

15 (e) ELIGIBILITY OF THE DISTRICT OF COLUMBIA AND

16 TERRITORIES FOR THE STATE LOAN REPAYMENT PRO17 GRAM.— 

18 (1) IN GENERAL.—Section 338I(h) of the Public 

19 Health Service Act (42 U.S.C. 254q–1(h)) is amended 

20 by striking ‘‘several States’’ and inserting ‘‘50 States, 

21 the District of Columbia, the Commonwealth of Puer22 to Rico, the United States Virgin Islands, Guam, 

23 American Samoa, Palau, the Marshall Islands, and 

24 the Commonwealth of the Northern Mariana Islands’’. 
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1 (2) AUTHORIZATION OF APPROPRIATIONS.—Sec2 tion 338I(i)(1) of such Act (42 U.S.C. 254q–1(i)(1)) 

3 is amended by striking ‘‘2002’’ and all that follows 

4 through the period and inserting ‘‘2008, and such 

5 sums as may be necessary for each of fiscal years 

6 2009 through 2012.’’. 

7 SEC. 4. REAUTHORIZATION OF RURAL HEALTH CARE PRO8 GRAMS. 

9 Section 330A(j) of the Public Health Service Act (42 

10 U.S.C. 254c(j)) is amended by striking ‘‘$40,000,000’’ and 

11 all that follows through the period and inserting 

12 ‘‘$45,000,000 for each of fiscal years 2008 through 2012.’’. 

13 SEC. 5. REAUTHORIZATION OF PRIMARY DENTAL HEALTH 

14 WORKFORCE PROGRAMS. 

15 Section 340G(f) of the Public Health Service Act (42 

16 U.S.C. 256g(f)) is amended— 

17 (1) by striking ‘‘$50,000,000’’ and inserting 

18 ‘‘$25,000,000’’; and 

19 (2) by striking ‘‘2002’’ and inserting ‘‘2008’’. 

20 SEC. 6. EMERGENCY RESPONSE COORDINATION OF PRI21 MARY CARE PROVIDERS. 

22 (a) IN GENERAL.—Subtitle B of title XXVIII of the 

23 Public Health Service Act (42 U.S.C. 300hh–10 et seq.) is 

24 amended by adding at the end the following: 
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1 ‘‘SEC. 2815. EMERGENCY RESPONSE COORDINATION OF PRI2 MARY CARE PROVIDERS. 

3 ‘‘The Secretary, acting through Administrator of the 

4 Health Resources and Services Administration, and in co5 ordination with the Assistant Secretary for Preparedness 

6 and Response, shall 

7 ‘‘(1) provide guidance and technical assistance to 

8 health centers funded under section 330 and to State 

9 and local health departments and emergency man10 agers to integrate health centers into State and local 

11 emergency response plans and to better meet the pri12 mary care needs of populations served by health cen13 ters during public health emergencies; and 

14 ‘‘(2) encourage employees at health centers fund15 ed under section 330 to participate in emergency 

16 medical response programs including the National 

17 Disaster Medical System authorized in section 2812, 

18 the Volunteer Medical Reserve Corps authorized in 

19 section 2813, and the Emergency System for Advance 

20 Registration of Health Professions Volunteers author21 ized in section 319I.’’. 

22 (b) SENSE OF THE CONGRESS.—It is the Sense of Con23 gress that the Secretary of Health and Human Services, to 

24 the extent permitted by law, utilize the existing authority 

25 provided under the Federal Tort Claims Act for health cen26 ters funded under section 330 of the Public Health Service 
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1 Act (42 U.S.C. 254b) in order to establish expedited proce2 dures under which such health centers and their health care 

3 professionals that have been deemed eligible for Federal Tort 

4 Claims Act coverage are able to respond promptly in a co5 ordinated manner and on a temporary basis to public 

6 health emergencies outside their traditional service area 

7 and sites, and across State lines, as necessary and appro8 priate. 

9 SEC. 7. REVISION OF THE TIMEFRAME FOR THE RECOGNI10 TION OF CERTAIN DESIGNATIONS IN CERTI11 FYING RURAL HEALTH CLINICS UNDER THE 

12 MEDICARE PROGRAM. 

13 (a) IN GENERAL.—The second sentence of section 

14 1861(aa)(2) of the Social Security Act (42 U.S.C. 

15 1395x(aa)(2)) is amended by striking ‘‘3-year period’’ and 

16 inserting ‘‘4-year period’’ in the matter in clause (i) pre17 ceding subclause (I). 

18 (b) EFFECTIVE DATE.—The amendment made by sub19 section (a) shall take effect on the date of the enactment 

20 of this Act. 

Attest: 

Secretary. 

110TH CONGRESS 

2D SESSION H.R. 1343 

AMENDMENT