IIB 

110TH CONGRESS 

2D SESSION H. R. 1343 

IN THE SENATE OF THE UNITED STATES 

JUNE 5, 2008 

Received; read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Health Centers Re3 newal Act of 2008’’. 

4 SEC. 2. ADDITIONAL AUTHORIZATIONS OF APPROPRIA5 TIONS FOR HEALTH CENTERS PROGRAM. 

6 Section 330(r)(1) of the Public Health Service Act 

7 (42 U.S.C. 254b(r)(1)) is amended to read as follows: 

8 ‘‘(1) IN GENERAL.—For the purpose of car9 rying out this section, in addition to the amounts 

10 authorized to be appropriated under subsection (d), 

11 there are authorized to be appropriated— 

12 ‘‘(A) for fiscal year 2008, $2,213,020,000; 

13 ‘‘(B) for fiscal year 2009, $2,451,394,400; 

14 ‘‘(C) for fiscal year 2010, $2,757,818,700; 

15 ‘‘(D) for fiscal year 2011, $3,116,335,131; 

16 and 

17 ‘‘(E) for fiscal year 2012, 

18 $3,537,040,374.’’. 

19 SEC. 3. RECOGNITION OF HIGH POVERTY AREAS. 

20 (a) IN GENERAL.—Section 330(c) of the Public 

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

22 adding at the end the following new paragraph: 

23 ‘‘(3) RECOGNITION OF HIGH POVERTY

24 AREAS.— 


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1 ‘‘(A) IN GENERAL.—In making grants 

2 under this subsection, the Secretary may recog3 nize the unique needs of high poverty areas. 

4 ‘‘(B) HIGH POVERTY AREA DEFINED.—For 

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

6 poverty area’ means a catchment area which is 

7 established in a manner that is consistent with 

8 the factors in subsection (k)(3)(J), and the pov9 erty rate of which is greater than the national 

10 average poverty rate as determined by the Bu11 reau of the Census.’’. 

12 (b) EFFECTIVE DATE.—The amendment made by 

13 subsection (a) shall apply to grants made on or after Jan14 uary 1, 2009. 

15 SEC. 4. LIABILITY PROTECTIONS FOR HEALTH CENTER 

16 VOLUNTEER PRACTITIONERS. 

17 (a) IN GENERAL.—Section 224 of the Public Health 

18 Service Act (42 U.S.C. 233) is amended— 

19 (1) in subsection (g)(1)(A)— 

20 (A) in the first sentence, by striking ‘‘or 

21 employee’’ and inserting ‘‘employee, or (subject 

22 to subsection (k)(4)) volunteer practitioner’’; 

23 and 


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1 (B) in the second sentence, by inserting 

2 ‘‘and subsection (k)(4)’’ after ‘‘subject to para3 graph (5)’’; and 

4 (2) in each of subsections (g), (i), (j), (k), (l), 

5 and (m)— 

6 (A) by striking the term ‘‘employee, or 

7 contractor’’ each place such term appears and 

8 inserting ‘‘employee, volunteer practitioner, or 

9 contractor’’; 

10 (B) by striking the term ‘‘employee, and 

11 contractor’’ each place such term appears and 

12 inserting ‘‘employee, volunteer practitioner, and 

13 contractor’’; 

14 (C) by striking the term ‘‘employee, or any 

15 contractor’’ each place such term appears and 

16 inserting ‘‘employee, volunteer practitioner, or 

17 contractor’’; and 

18 (D) by striking the term ‘‘employees, or 

19 contractors’’ each place such term appears and 

20 inserting ‘‘employees, volunteer practitioners, or 

21 contractors’’. 

22 (b) APPLICABILITY; DEFINITION.—Section 224(k) of 

23 the Public Health Service Act (42 U.S.C. 233(k)) is 

24 amended by adding at the end the following paragraph: 


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1 ‘‘(4)(A) Subsections (g) through (m) apply with re2 spect to volunteer practitioners beginning with the first 

3 fiscal year for which an appropriations Act provides that 

4 amounts in the fund under paragraph (2) are available 

5 with respect to such practitioners. 

6 ‘‘(B) For purposes of subsections (g) through (m), 

7 the term ‘volunteer practitioner’ means a practitioner who, 

8 with respect to an entity described in subsection (g)(4), 

9 meets the following conditions: 

10 ‘‘(i) In the State involved, the practitioner is a 

11 licensed physician, a licensed clinical psychologist, or 

12 other licensed or certified health care practitioner. 

13 ‘‘(ii) At the request of such entity, the practi14 tioner provides services to patients of the entity, at 

15 a site at which the entity operates or at a site des16 ignated by the entity. The weekly number of hours 

17 of services provided to the patients by the practi18 tioner is not a factor with respect to meeting condi19 tions under this subparagraph. 

20 ‘‘(iii) The practitioner does not for the provision 

21 of such services receive any compensation from such 

22 patients, from the entity, or from third-party payors 

23 (including reimbursement under any insurance pol24 icy or health plan, or under any Federal or State 

25 health benefits program).’’. 


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1 SEC. 5. LIABILITY PROTECTIONS FOR HEALTH CENTER 

2 PRACTITIONERS PROVIDING SERVICES IN 

3 EMERGENCY AREAS. 

4 Section 224(g) of the Public Health Service Act (42 

5 U.S.C. 233(g)) is amended— 

6 (1) in paragraph (1)(B)(ii), by striking ‘‘sub7 paragraph (C)’’ and inserting ‘‘subparagraph (C) 

8 and paragraph (6)’’; and 

9 (2) by adding at the end the following para10 graph: 

11 ‘‘(6)(A) Subject to subparagraph (C), paragraph 

12 (1)(B)(ii) applies to health services provided to individuals 

13 who are not patients of the entity involved if, as deter14 mined under criteria issued by the Secretary, the following 

15 conditions are met: 

16 ‘‘(i) The services are provided by a contractor, 

17 volunteer practitioner (as defined in subsection 

18 (k)(4)(B)), or employee of the entity who is a physi19 cian or other licensed or certified health care practi20 tioner and who is otherwise deemed to be an em21 ployee for purposes of paragraph (1)(A) when pro22 viding services with respect to the entity. 

23 ‘‘(ii) The services are provided in an emergency 

24 area (as defined in subparagraph (D)), with respect 

25 to a public health emergency or major disaster de26 scribed in subparagraph (D), and during the period 


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1 for which such emergency or disaster is determined 

2 or declared, respectively. 

3 ‘‘(iii) The services of the contractor, volunteer 

4 practitioner, or employee (referred to in this para5 graph as the ‘out-of-area practitioner’) are provided 

6 under an arrangement with— 

7 ‘‘(I) an entity that is deemed to be an em8 ployee for purposes of paragraph (1)(A) and 

9 that serves the emergency area involved (re10 ferred to in this paragraph as an ‘emergency11 area entity’); or 

12 ‘‘(II) a Federal agency that has respon13 sibilities regarding the provision of health serv14 ices in such area during the emergency. 

15 ‘‘(iv) The purposes of the arrangement are— 

16 ‘‘(I) to coordinate, to the extent prac17 ticable, the provision of health services in the 

18 emergency area by the out-of-area practitioner 

19 with the provision of services by the emergency20 area entity, or by the Federal agency, as the 

21 case may be; 

22 ‘‘(II) to identify a location in the emer23 gency area to which such practitioner should re24 port for purposes of providing health services, 

25 and to identify an individual or individuals in 


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1 the area to whom the practitioner should report 

2 for such purposes; and 

3 ‘‘(III) to verify the identity of the practi4 tioner and that the practitioner is licensed or 

5 certified by one or more of the States. 

6 ‘‘(v) With respect to the licensure or certifi7 cation of health care practitioners, the provision of 

8 services by the out-of-area practitioner in the emer9 gency area is not a violation of the law of the State 

10 in which the area is located. 

11 ‘‘(B) In issuing criteria under subparagraph (A), the 

12 Secretary shall take into account the need to rapidly enter 

13 into arrangements under such subparagraph in order to 

14 provide health services in emergency areas promptly after 

15 the emergency begins. 

16 ‘‘(C) Subparagraph (A) applies with respect to an act 

17 or omission of an out-of-area practitioner only to the ex18 tent that the practitioner is not immune from liability for 

19 such act or omission under the Volunteer Protection Act 

20 of 1997. 

21 ‘‘(D) For purposes of this paragraph, the term ‘emer22 gency area’ means a geographic area for which— 

23 ‘‘(i) the Secretary has made a determination 

24 under section 319 that a public health emergency 

25 exists; or 


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1 ‘‘(ii) a presidential declaration of major disaster 

2 has been issued under section 401 of the Robert T. 

3 Stafford Disaster Relief and Emergency Assistance 

4 Act.’’. 

5 SEC. 6. DEMONSTRATION PROJECT FOR INTEGRATED 

6 HEALTH SYSTEMS TO EXPAND ACCESS TO 

7 PRIMARY AND PREVENTIVE SERVICES FOR 

8 THE MEDICALLY UNDERSERVED. 

9 Part D of title III of the Public Health Service Act 

10 (42 U.S.C. 259b et seq.) is amended by adding at the end 

11 the following new subpart: 

12 ‘‘Subpart XI—Demonstration Project for Integrated 

13 Health Systems to Expand Access to Primary 

14 and Preventive Services for the Medically Un15 derserved 

16 ‘‘SEC. 340H. DEMONSTRATION PROJECT FOR INTEGRATED 

17 HEALTH SYSTEMS TO EXPAND ACCESS TO 

18 PRIMARY AND PREVENTIVE CARE FOR THE 

19 MEDICALLY UNDERSERVED. 

20 ‘‘(a) ESTABLISHMENT OF DEMONSTRATION.— 

21 ‘‘(1) IN GENERAL.—Not later than January 1, 

22 2009, the Secretary shall establish a demonstration 

23 project (hereafter in this section referred to as the 

24 ‘demonstration’) under which up to 30 qualifying in25 tegrated health systems receive grants for the costs 


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1 of their operations to expand access to primary and 

2 preventive services for the medically underserved. 

3 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

4 this section shall be construed as authorizing grants 

5 to be made or used for the costs of specialty care or 

6 hospital care furnished by an integrated health sys7 tem. 

8 ‘‘(b) APPLICATION.—Any integrated health system 

9 desiring to participate in the demonstration shall submit 

10 an application in such manner, at such time, and con11 taining such information as the Secretary may require. 

12 ‘‘(c) CRITERIA FOR SELECTION.—In selecting inte13 grated health systems to participate in the demonstration 

14 (hereafter in this section referred to as ‘participating inte15 grated health systems’), the Secretary shall ensure rep16 resentation of integrated health systems that are located 

17 in a variety of States (including the District of Columbia 

18 and the territories and possessions of the United States) 

19 and locations within States, including rural areas, inner20 city areas, and frontier areas. 

21 ‘‘(d) DURATION.—Subject to the availability of ap22 propriations, the demonstration shall be conducted (and 

23 operating grants be made to each participating integrated 

24 health system) for a period of 3 years. 

25 ‘‘(e) REPORTS.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall submit 

2 to the appropriate committees of the Congress in3 terim and final reports with respect to the dem4 onstration, with an interim report being submitted 

5 not later than 3 months after the demonstration has 

6 been in operation for 24 months and a final report 

7 being submitted not later than 3 months after the 

8 close of the demonstration. 

9 ‘‘(2) CONTENT.—Such reports shall evaluate 

10 the effectiveness of the demonstration in providing 

11 greater access to primary and preventive care for 

12 medically underserved populations, and how the co13 ordinated approach offered by integrated health sys14 tems contributes to improved patient outcomes. 

15 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— 

16 ‘‘(1) IN GENERAL.—There is authorized to be 

17 appropriated $25,000,000 for each of the fiscal 

18 years 2009, 2010, and 2011 to carry out this sec19 tion. 

20 ‘‘(2) CONSTRUCTION.—Nothing in this section 

21 shall be construed as requiring or authorizing a re22 duction in the amounts appropriated for grants to 

23 health centers under section 330 for the fiscal years 

24 referred to in paragraph (1). 

25 ‘‘(g) DEFINITIONS.—For purposes of this section: 


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1 ‘‘(1) FRONTIER AREA.—The term ‘frontier 

2 area’ has the meaning given to such term in regula3 tions promulgated pursuant to section 330I(r). 

4 ‘‘(2) INTEGRATED HEALTH SYSTEM.—The term 

5 ‘integrated health system’ means a health system 

6 that— 

7 ‘‘(A) has a demonstrated capacity and 

8 commitment to provide a full range of primary 

9 care, specialty care, and hospital care in both 

10 inpatient and outpatient settings; and 

11 ‘‘(B) is organized to provide such care in 

12 a coordinated fashion. 

13 ‘‘(3) QUALIFYING INTEGRATED HEALTH SYS14 TEM.— 

15 ‘‘(A) IN GENERAL.—The term ‘qualifying 

16 integrated health system’ means a public or pri17 vate nonprofit entity that is an integrated 

18 health system that meets the requirements of 

19 subparagraph (B) and serves a medically under20 served population (either through the staff and 

21 supporting resources of the integrated health 

22 system or through contracts or cooperative ar23 rangements) by providing— 


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1 ‘‘(i) required primary and preventive 

2 health and related services (as defined in 

3 paragraph (4)); and 

4 ‘‘(ii) as may be appropriate for a pop5 ulation served by a particular integrated 

6 health system, integrative health services 

7 (as defined in paragraph (5)) that are nec8 essary for the adequate support of the re9 quired primary and preventive health and 

10 related services and that improve care co11 ordination. 

12 ‘‘(B) OTHER REQUIREMENTS.—The re13 quirements of this subparagraph are that the 

14 integrated health system— 

15 ‘‘(i) will make the required primary 

16 and preventive health and related services 

17 of the integrated health system available 

18 and accessible in the service area of the in19 tegrated health system promptly, as appro20 priate, and in a manner which assures con21 tinuity; 

22 ‘‘(ii) will demonstrate financial re23 sponsibility by the use of such accounting 

24 procedures and other requirements as may 

25 be prescribed by the Secretary; 


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1 ‘‘(iii) provides or will provide services 

2 to individuals who are eligible for medical 

3 assistance under title XIX of the Social 

4 Security Act or for assistance under title 

5 XXI of such Act; 

6 ‘‘(iv) has prepared a schedule of fees 

7 or payments for the provision of its serv8 ices consistent with locally prevailing rates 

9 or charges and designed to cover its rea10 sonable costs of operation and has pre11 pared a corresponding schedule of dis12 counts to be applied to the payment of 

13 such fees or payments, which discounts are 

14 adjusted on the basis of the patient’s abil15 ity to pay; 

16 ‘‘(v) will assure that no patient will be 

17 denied health care services due to an indi18 vidual’s inability to pay for such services; 

19 ‘‘(vi) will assure that any fees or pay20 ments required by the system for such 

21 services will be reduced or waived to enable 

22 the system to fulfill the assurance de23 scribed in clause (v); 

24 ‘‘(vii) provides assurances that any 

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1 ment, and not supplant, the expenditures 

2 of the integrated health system for primary 

3 and preventive health services for the 

4 medically underserved; and 

5 ‘‘(viii) submits to the Secretary such 

6 reports as the Secretary may require to de7 termine compliance with this subpara8 graph. 

9 ‘‘(C) TREATMENT OF CERTAIN ENTI10 TIES.—The term ‘qualifying integrated health 

11 system’ may include a nurse-managed health 

12 clinic if such clinic meets the requirements of 

13 subparagraphs (A) and (B) (except those re14 quirements that have been waived under para15 graph (4)(B)). 

16 ‘‘(4) REQUIRED PRIMARY AND PREVENTIVE

17 HEALTH AND RELATED SERVICES.— 

18 ‘‘(A) IN GENERAL.—Except as provided in 

19 subparagraph (B), the term ‘required primary 

20 and preventive health and related services’ 

21 means basic health services consisting of— 

22 ‘‘(i) health services related to family 

23 medicine, internal medicine, pediatrics, ob24 stetrics, or gynecology that are furnished 

25 by physicians where appropriate, physician 


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1 assistants, nurse practitioners, and nurse 

2 midwives; 

3 ‘‘(ii) diagnostic laboratory services 

4 and radiologic services; 

5 ‘‘(iii) preventive health services, in6 cluding prenatal and perinatal care; appro7 priate cancer screening; well-child services; 

8 immunizations against vaccine-preventable 

9 diseases; screenings for elevated blood lead 

10 levels, communicable diseases, and choles11 terol; pediatric eye, ear, and dental 

12 screenings to determine the need for vision 

13 and hearing correction and dental care; 

14 and voluntary family planning services; 

15 ‘‘(iv) emergency medical services; and 

16 ‘‘(v) pharmaceutical services, behav17 ioral, mental health, and substance abuse 

18 services, preventive dental services, and re19 cuperative care, as may be appropriate. 

20 ‘‘(B) EXCEPTION.—In the case of an inte21 grated health system serving a targeted popu22 lation, the Secretary shall, upon a showing of 

23 good cause, waive the requirement that the in24 tegrated health system provide each required 

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1 ice under this paragraph if the Secretary deter2 mines one or more such services are inappro3 priate or unnecessary for such population. 

4 ‘‘(5) INTEGRATIVE HEALTH SERVICES.—The 

5 term ‘integrative health services’ means services that 

6 are not included as required primary and preventive 

7 health and related services and are associated with 

8 achieving the greater integration of a health care de9 livery system to improve patient care coordination so 

10 that the system either directly provides or ensures 

11 the provision of a broad range of culturally com12 petent services. Integrative health services include 

13 but are not limited to the following: 

14 ‘‘(A) Outreach activities. 

15 ‘‘(B) Case management and patient navi16 gation services. 

17 ‘‘(C) Chronic care management. 

18 ‘‘(D) Transportation to health care facili19 ties. 

20 ‘‘(E) Development of provider networks 

21 and other innovative models to engage local 

22 physicians and other providers to serve the 

23 medically underserved within a community. 

24 ‘‘(F) Recruitment, training, and compensa25 tion of necessary personnel. 


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1 ‘‘(G) Acquisition of technology for the pur2 pose of coordinating care. 

3 ‘‘(H) Improvements to provider commu4 nication, including implementation of shared in5 formation systems or shared clinical systems. 

6 ‘‘(I) Determination of eligibility for Fed7 eral, State, and local programs that provide, or 

8 financially support the provision of, medical, so9 cial, housing, educational, or other related serv10 ices. 

11 ‘‘(J) Development of prevention and dis12 ease management tools and processes. 

13 ‘‘(K) Translation services. 

14 ‘‘(L) Development and implementation of 

15 evaluation measures and processes to assess pa16 tient outcomes. 

17 ‘‘(M) Integration of primary care and men18 tal health services. 

19 ‘‘(N) Carrying out other activities that 

20 may be appropriate to a community and that 

21 would increase access by the uninsured to 

22 health care, such as access initiatives for which 

23 private entities provide non-Federal contribu24 tions to supplement the Federal funds provided 

25 through the grants for the initiatives. 


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1 ‘‘(6) SPECIALTY CARE.—The term ‘specialty 

2 care’ means care that is provided through a referral 

3 and by a physician or nonphysician practitioner, 

4 such as surgical consultative services, radiology serv5 ices requiring the immediate presence of a physician, 

6 audiology, optometric services, cardiology services, 

7 magnetic resonance imagery (MRI) services, comput8 erized axial tomography (CAT) scans, nuclear medi9 cine studies, and ambulatory surgical services. 

10 ‘‘(7) NURSE-MANAGED HEALTH CLINIC.—The 

11 term ‘nurse-managed health clinic’ means a nurse12 practice arrangement, managed by advanced practice 

13 nurses, that provides care for underserved and vul14 nerable populations and is associated with a school, 

15 college, or department of nursing or an independent 

16 nonprofit health or social services agency.’’. 

Passed the House of Representatives June 4, 2008. 

Attest: LORRAINE C. MILLER, 

Clerk. 


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