I 

111TH CONGRESS 

1ST SESSION H. R. 2599 

To provide for the establishment of the Rural Health Quality Advisory 

Commission, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 21, 2009 

Ms. HERSETH SANDLIN (for herself, Mr. WALDEN, and Mr. POMEROY) introduced the following bill; which was referred to the Committee on Energy 

and Commerce 

A BILL 

To provide for the establishment of the Rural Health Quality 

Advisory Commission, 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, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Rural Health Quality 

5 Advisory Commission Act of 2009’’. 

6 SEC. 2. RURAL HEALTH QUALITY ADVISORY COMMISSION 

7 AND DEMONSTRATION PROJECTS. 

8 (a) RURAL HEALTH QUALITY ADVISORY COMMIS9 SION.— 


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1 (1) ESTABLISHMENT.—Not later than 6 

2 months after the date of the enactment of this sec3 tion, the Secretary of Health and Human Services 

4 (in this section referred to as the ‘‘Secretary’’) shall 

5 establish a commission to be known as the Rural 

6 Health Quality Advisory Commission (in this section 

7 referred to as the ‘‘Commission’’). 

8 (2) DUTIES OF COMMISSION.— 

9 (A) NATIONAL PLAN.—The Commission 

10 shall develop, coordinate, and facilitate imple11 mentation of a national plan for rural health 

12 quality improvement. The national plan shall— 

13 (i) identify objectives for rural health 

14 quality improvement; 

15 (ii) identify strategies to eliminate 

16 known gaps in rural health system capacity 

17 and improve rural health quality; and 

18 (iii) provide for Federal programs to 

19 identify opportunities for strengthening 

20 and aligning policies and programs to im21 prove rural health quality. 

22 (B) DEMONSTRATION PROJECTS.—The 

23 Commission shall design demonstration projects 

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1 ity improvement, including with respect to both 

2 personal and population health. 

3 (C) MONITORING.—The Commission shall 

4 monitor progress toward the objectives identi5 fied pursuant to paragraph (1)(A). 

6 (3) MEMBERSHIP.— 

7 (A) NUMBER.—The Commission shall be 

8 composed of 11 members appointed by the Sec9 retary. 

10 (B) SELECTION.—The Secretary shall se11 lect the members of the Commission from 

12 among individuals with significant rural health 

13 care and health care quality expertise, including 

14 expertise in clinical health care, health care 

15 quality research, population or public health, or 

16 purchaser organizations. 

17 (4) CONTRACTING AUTHORITY.—Subject to the 

18 availability of funds, the Commission may enter into 

19 contracts and make other arrangements, as may be 

20 necessary to carry out the duties described in para21 graph (2). 

22 (5) STAFF.—Upon the request of the Commis23 sion, the Secretary may detail, on a reimbursable 

24 basis, any of the personnel of the Office of Rural 

25 Health Policy of the Health Resources and Services 


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1 Administration, the Agency for Health Care Quality 

2 and Research, or the Centers for Medicare & Med3 icaid Services to the Commission to assist in car4 rying out this subsection. 

5 (6) REPORTS TO CONGRESS.—Not later than 1 

6 year after the establishment of the Commission, and 

7 annually thereafter, the Commission shall submit a 

8 report to the Congress on rural health quality. Each 

9 such report shall include the following: 

10 (A) An inventory of relevant programs and 

11 recommendations for improved coordination and 

12 integration of policy and programs. 

13 (B) An assessment of achievement of the 

14 objectives identified in the national plan devel15 oped under paragraph (2) and recommenda16 tions for realizing such objectives. 

17 (C) Recommendations on Federal legisla18 tion, regulations, or administrative policies to 

19 enhance rural health quality and outcomes. 

20 (b) RURAL HEALTH QUALITY DEMONSTRATION

21 PROJECTS.— 

22 (1) IN GENERAL.—Not later than 270 days 

23 after the date of the enactment of this section, the 

24 Secretary, in consultation with the Rural Health 

25 Quality Advisory Commission, the Office of Rural 


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1 Health Policy of the Health Resources and Services 

2 Administration, the Agency for Healthcare Research 

3 and Quality, and the Centers for Medicare & Med4 icaid Services, shall make grants to eligible entities 

5 for 5 demonstration projects to implement and 

6 evaluate methods for improving the quality of health 

7 care in rural communities. Each such demonstration 

8 project shall include— 

9 (A) alternative community models that— 

10 (i) will achieve greater integration of 

11 personal and population health services; 

12 and 

13 (ii) address safety, effectiveness, 

14 patient- or community-centeredness, timeli15 ness, efficiency, and equity (the six aims 

16 identified by the Institute of Medicine of 

17 the National Academies in its report enti18 tled ‘‘Crossing the Quality Chasm: A New 

19 Health System for the 21st Century’’ re20 leased on March 1, 2001); 

21 (B) innovative approaches to the financing 

22 and delivery of health services to achieve rural 

23 health quality goals; and 

24 (C) development of quality improvement 

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1 tems and professionals (such as workforce sup2 port structures, quality monitoring and report3 ing, clinical care protocols, and information 

4 technology applications). 

5 (2) ELIGIBLE ENTITIES.—In this subsection, 

6 the term ‘‘eligible entity’’ means a consortium 

7 that— 

8 (A) shall include— 

9 (i) at least one health care provider or 

10 health care delivery system located in a 

11 rural area; and 

12 (ii) at least one organization rep13 resenting multiple community stakeholders; 

14 and 

15 (B) may include other partners such as 

16 rural research centers. 

17 (3) CONSULTATION.—In developing the pro18 gram for awarding grants under this subsection, the 

19 Secretary shall consult with the Administrator of the 

20 Agency for Healthcare Research and Quality, rural 

21 health care providers, rural health care researchers, 

22 and private and non-profit groups (including na23 tional associations) which are undertaking similar 

24 efforts. 


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1 (4) EXPEDITED WAIVERS.—The Secretary shall 

2 expedite the processing of any waiver that— 

3 (A) is authorized under title XVIII or XIX 

4 of the Social Security Act (42 U.S.C. 1395 et 

5 seq.); and 

6 (B) is necessary to carry out a demonstra7 tion project under this subsection. 

8 (5) DEMONSTRATION PROJECT SITES.—The 

9 Secretary shall ensure that the 5 demonstration 

10 projects funded under this subsection are conducted 

11 at a variety of sites representing the diversity of 

12 rural communities in the Nation. 

13 (6) DURATION.—Each demonstration project 

14 under this subsection shall be for a period of 4 

15 years. 

16 (7) INDEPENDENT EVALUATION.—The Sec17 retary shall enter into an arrangement with an enti18 ty that has experience working directly with rural 

19 health systems for the conduct of an independent 

20 evaluation of the program carried out under this 

21 subsection. 

22 (8) REPORT.—Not later than one year after the 

23 conclusion of all of the demonstration projects fund24 ed under this subsection, the Secretary shall submit 


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1 a report to the Congress on the results of such 

2 projects. The report shall include— 

3 (A) an evaluation of patient access to care, 

4 patient outcomes, and an analysis of the cost 

5 effectiveness of each such project; and 

6 (B) recommendations on Federal legisla7 tion, regulations, or administrative policies to 

8 enhance rural health quality and outcomes. 

9 (c) APPROPRIATION.— 

10 (1) IN GENERAL.—Out of funds in the Treas11 ury not otherwise appropriated, there are appro12 priated to the Secretary to carry out this section 

13 $30,000,000 for the period of fiscal years 2010 

14 through 2014. 

15 (2) AVAILABILITY.— 

16 (A) IN GENERAL.—Funds appropriated 

17 under paragraph (1) shall remain available for 

18 expenditure through fiscal year 2014. 

19 (B) REPORT.—For purposes of carrying 

20 out subsection (b)(8), funds appropriated under 

21 paragraph (1) shall remain available for ex22 penditure through fiscal year 2015. 

23 (3) RESERVATION.—Of the amount appro24 priated under paragraph (1), the Secretary shall re25 serve— 


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1 (A) $5,000,000 to carry out subsection (a); 

2 and 

3 (B) $25,000,000 to carry out subsection 

4 (b), of which— 

5 (i) 2 percent shall be for the provision 

6 of technical assistance to grant recipients; 

7 and 

8 (ii) 5 percent shall be for independent 

9 evaluation under subsection (b)(7). 

Æ 


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