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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Rural Health Outreach
Grants Amendments Act’’.
SEC. 2. ESTABLISHMENT OF PROGRAM OF GRANTS FOR
RURAL HEALTH OUTREACH.
Title III of the Public Health Service Act (42 U.S.C.
241 et seq.) is amended by adding at the end the following
new part:
‘‘PART P—RURAL HEALTH OUTREACH GRANT
PROGRAM
‘‘SEC. 399B. RURAL HEALTH OUTREACH GRANT PROGRAM.
‘‘(a) IN GENERAL.—The Secretary may make grants
to demonstrate new and innovative models of outreach and
health care services delivery in rural areas that lack basic
health services. Grants will be awarded for one of the fol-
lowing: direct provision of health services to rural popu-
lations (especially for those who are not currently receiving
those services), or to enhance access to and utilization of
existing available services.
‘‘(b) MISSIONS
OF
THE OUTREACH PROJECTS.—
Projects under subsection (a) should be designed to ad-
dress the needs of a wide range of populations living in
rural communities including, but not limited to, the poor,
farmers, farm workers, senior citizens, individuals with
disabilities, pregnant women, infants, adolescents, and
rural populations with special health care needs. The pro-
gram could include projects to:
‘‘(1) Provide, enhance, or revitalize emergency
medical services in rural communities.
‘‘(2) Provide ambulatory health and/or mental
health services in health professional shortage areas
and in frontier areas.
‘‘(3) Enhance the health and safety of farmers
through direct health services for farm families, and
migrant and seasonal farm workers.
‘‘(4) Provide direct health services to enhance
health care services to senior citizens.
‘‘(5) Provide direct health services that will re-
duce infant mortality in rural communities.
‘‘(c) COMPOSITION OF PROGRAM.—
‘‘(1) CONSORTIUM ARRANGEMENTS.—Participa-
tion in the program established in subsection (a) re-
quires the formation of consortium arrangements
among three or more separate and distinct entities
to carry out an outreach project.
‘‘(2) CERTAIN REQUIREMENTS.—
‘‘(A) A consortium under paragraph (1)
must be composed of three or more existing
health care providers or a combination of three
or more health care and social service providers.
Consortium members may include such entities
as: hospitals, public health agencies, home
health providers, mental health centers, rural
health clinics, social service agencies, health
profession(s) schools, educational institutions,
emergency medical centers/providers, and com-
munity and migrant health centers.
‘‘(B) All public and private entities, both
nonprofit and for-profit may participate as
members of a consortium arrangement under
paragraph (1).
‘‘(C) A grant under subsection (a) will be
made to only one entity in a consortium under
paragraph (1). The grant recipient must be a
nonprofit or public entity which meets one of
the following requirements:
‘‘(i) Applicants must be located out-
side of a Metropolitan Statistical Area as
defined by the Federal Government.
‘‘(ii) Applicant must be located in a
rural census tract. (This provision applies
to counties that are technically classified
as Metropolitan Statistical Areas or con-
sidered as part of a Metropolitan Statis-
tical Area but large parts of the counties
are rural.) Organizations located in the
rural areas of the counties mentioned pre-
viously are eligible for participation in the
program.
‘‘(d) REVIEW CRITERIA.—An outreach application
under this section may be evaluated based on the following
criteria:
‘‘(1) The extent to which the applicant has pro-
posed a new and innovative approach to health care
in the rural area. Services shall be directed as popu-
lation groups that are unserved or underserved.
‘‘(2) The extent to which the applicant has jus-
tified and documented the needs for the project and
developed measurable goals for meeting the needs.
‘‘(3) The extent to which the applicant has
clearly defined the roles and responsibilities for each
member of the consortium and developed a workable
plan for managing the consortium’s activities.
‘‘(4) The level of local commitment and involve-
ment with the project, including the extent of cost
participation by the applicant and/or other organiza-
tions.
‘‘(5) The feasibility of the project to continue
after Federal grant support is completed.
‘‘(6) The extent of the evaluation component.
‘‘(e) HOW
PROJECT
FUNDS
ARE
TO
BE
EX-
PENDED.—
‘‘(1) Grantees under subsection (a) will be re-
quired to use at least 85 percent of the total amount
awarded for outreach and care services.
‘‘(2) 60 percent of funds must be spent in rural
areas. This provision is designed accordingly—when
a consortium is purchasing goods and services, pri-
ority should be given to purchases in rural areas.
‘‘(3) Grant funds may not be used for purchase,
construction, or renovation of real property or to
support the delivery of inpatient services.
‘‘(4) Grant funds may be used for equipment
and vehicles when such equipment is essential to
carrying out the outreach project.
‘‘(5) Individual grant awards will be limited to
a total amount of $300,000 per year. Projects will
be federally funded for three years.
‘‘(6) Applicants must demonstrate that existing
levels of institutional and other support are not re-
duced or supplanted by the availability of these
grant funds.
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated $25,000,000 for fiscal year 1994, and
such sums as may be necessary for each fiscal year there-
after.’’.