I

103D CONGRESS

1ST SESSION H. R. 1774

To amend the Public Health Service Act to establish a program of grants

for rural health outreach.

IN THE HOUSE OF REPRESENTATIVES

APRIL 21, 1993

Mr. GUNDERSON (for himself, Mr. SLATTERY, Mr. ROBERTS, Ms. SNOWE, Mr.

EMERSON, Mr. THOMAS of Wyoming, and Mr. STENHOLM) introduced

the following bill; which was referred to the Committee on Energy and

Commerce

A BILL

To amend the Public Health Service Act to establish a

program of grants for rural health outreach.

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 Outreach

5 Grants Amendments Act’’.
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1 SEC. 2. ESTABLISHMENT OF PROGRAM OF GRANTS FOR

2 RURAL HEALTH OUTREACH.

3 Title III of the Public Health Service Act (42 U.S.C.

4 241 et seq.) is amended by adding at the end the following

5 new part:

6 ‘‘PART P—RURAL HEALTH OUTREACH GRANT

7 PROGRAM

8 ‘‘SEC. 399B. RURAL HEALTH OUTREACH GRANT PROGRAM.

9 ‘‘(a) IN GENERAL.—The Secretary may make grants

10 to demonstrate new and innovative models of outreach and

11 health care services delivery in rural areas that lack basic

12 health services. Grants will be awarded for one of the fol13 lowing: direct provision of health services to rural popu14 lations (especially for those who are not currently receiving

15 those services), or to enhance access to and utilization of

16 existing available services.

17 ‘‘(b) MISSIONS OF THE OUTREACH PROJECTS.—

18 Projects under subsection (a) should be designed to ad19 dress the needs of a wide range of populations living in

20 rural communities including, but not limited to, the poor,

21 farmers, farm workers, senior citizens, individuals with

22 disabilities, pregnant women, infants, adolescents, and

23 rural populations with special health care needs. The pro24 gram could include projects to:

25 ‘‘(1) Provide, enhance, or revitalize emergency

26 medical services in rural communities.
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1 ‘‘(2) Provide ambulatory health and/or mental

2 health services in health professional shortage areas

3 and in frontier areas.

4 ‘‘(3) Enhance the health and safety of farmers

5 through direct health services for farm families, and

6 migrant and seasonal farm workers.

7 ‘‘(4) Provide direct health services to enhance

8 health care services to senior citizens.

9 ‘‘(5) Provide direct health services that will re10 duce infant mortality in rural communities.

11 ‘‘(c) COMPOSITION OF PROGRAM.—

12 ‘‘(1) CONSORTIUM ARRANGEMENTS.—Participa13 tion in the program established in subsection (a) re14 quires the formation of consortium arrangements

15 among three or more separate and distinct entities

16 to carry out an outreach project.

17 ‘‘(2) CERTAIN REQUIREMENTS.—

18 ‘‘(A) A consortium under paragraph (1)

19 must be composed of three or more existing

20 health care providers or a combination of three

21 or more health care and social service providers.

22 Consortium members may include such entities

23 as: hospitals, public health agencies, home

24 health providers, mental health centers, rural

25 health clinics, social service agencies, health
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1 profession(s) schools, educational institutions,

2 emergency medical centers/providers, and com3 munity and migrant health centers.

4 ‘‘(B) All public and private entities, both

5 nonprofit and for-profit may participate as

6 members of a consortium arrangement under

7 paragraph (1).

8 ‘‘(C) A grant under subsection (a) will be

9 made to only one entity in a consortium under

10 paragraph (1). The grant recipient must be a

11 nonprofit or public entity which meets one of

12 the following requirements:

13 ‘‘(i) Applicants must be located out14 side of a Metropolitan Statistical Area as

15 defined by the Federal Government.

16 ‘‘(ii) Applicant must be located in a

17 rural census tract. (This provision applies

18 to counties that are technically classified

19 as Metropolitan Statistical Areas or con20 sidered as part of a Metropolitan Statis21 tical Area but large parts of the counties

22 are rural.) Organizations located in the

23 rural areas of the counties mentioned pre24 viously are eligible for participation in the

25 program.
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1 ‘‘(d) REVIEW CRITERIA.—An outreach application

2 under this section may be evaluated based on the following

3 criteria:

4 ‘‘(1) The extent to which the applicant has pro5 posed a new and innovative approach to health care

6 in the rural area. Services shall be directed as popu7 lation groups that are unserved or underserved.

8 ‘‘(2) The extent to which the applicant has jus9 tified and documented the needs for the project and

10 developed measurable goals for meeting the needs.

11 ‘‘(3) The extent to which the applicant has

12 clearly defined the roles and responsibilities for each

13 member of the consortium and developed a workable

14 plan for managing the consortium’s activities.

15 ‘‘(4) The level of local commitment and involve16 ment with the project, including the extent of cost

17 participation by the applicant and/or other organiza18 tions.

19 ‘‘(5) The feasibility of the project to continue

20 after Federal grant support is completed.

21 ‘‘(6) The extent of the evaluation component.

22 ‘‘(e) HOW PROJECT FUNDS ARE TO BE EX23 PENDED.—
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1 ‘‘(1) Grantees under subsection (a) will be re2 quired to use at least 85 percent of the total amount

3 awarded for outreach and care services.

4 ‘‘(2) 60 percent of funds must be spent in rural

5 areas. This provision is designed accordingly—when

6 a consortium is purchasing goods and services, pri7 ority should be given to purchases in rural areas.

8 ‘‘(3) Grant funds may not be used for purchase,

9 construction, or renovation of real property or to

10 support the delivery of inpatient services.

11 ‘‘(4) Grant funds may be used for equipment

12 and vehicles when such equipment is essential to

13 carrying out the outreach project.

14 ‘‘(5) Individual grant awards will be limited to

15 a total amount of $300,000 per year. Projects will

16 be federally funded for three years.

17 ‘‘(6) Applicants must demonstrate that existing

18 levels of institutional and other support are not re19 duced or supplanted by the availability of these

20 grant funds.

21 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For the

22 purpose of carrying out this section, there are authorized

23 to be appropriated $25,000,000 for fiscal year 1994, and

24 such sums as may be necessary for each fiscal year there25 after.’’.
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