239 
‘‘(A) IN
GENERAL.—The Director may 
award rural health network development grants 
to eligible entities to promote, through planning 
and implementation, the development of inte-
grated health care networks that have combined 
the functions of the entities participating in the 
networks in order to— 
‘‘(i) achieve efficiencies and economies 
of scale; 
‘‘(ii) expand access to, coordinate, and 
improve the quality of the health care de-
livery system through development of orga-
nizational efficiencies; 
‘‘(iii) implement health information 
technology to achieve efficiencies, reduce 
medical errors, and improve quality; 
‘‘(iv) coordinate care and manage 
chronic illness; and 
‘‘(v) strengthen the rural health care 
system as a whole in such a manner as to 
show a quantifiable return on investment 
to the participants in the network. 
‘‘(B) GRANT PERIODS.—The Director may 
award such a rural health network development 
grant— 
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‘‘(i) for a period of 3 years for imple-
mentation activities; or 
‘‘(ii) for a period of 1 year for plan-
ning activities to assist in the initial devel-
opment of an integrated health care net-
work, if the proposed participants in the 
network do not have a history of collabo-
rative efforts and a 3-year grant would be 
inappropriate. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a 
grant under this subsection, an entity— 
‘‘(A) shall be a rural public or rural non-
profit private entity, a facility that qualifies as 
a rural health clinic under title XVIII of the 
Social Security Act, a public or nonprofit entity 
existing exclusively to provide services to mi-
grant and seasonal farm workers in rural areas, 
or a tribal government whose grant-funded ac-
tivities will be conducted within federally recog-
nized tribal areas; 
‘‘(B) shall represent a network composed 
of participants— 
‘‘(i) that include 3 or more independ-
ently owned health care entities; and 
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‘‘(ii) that may be nonprofit or for- 
profit entities; and 
‘‘(C) shall not previously have received a 
grant under this subsection (other than a 1- 
year grant for planning activities) for the same 
or a similar project. 
‘‘(3) APPLICATIONS.—To be eligible to receive a 
grant under this subsection, an eligible entity, in 
consultation with the appropriate State office of 
rural health or another appropriate State entity, 
shall prepare and submit to the Director an applica-
tion at such time, in such manner, and containing 
such information as the Director may require, in-
cluding— 
‘‘(A) a description of the project that the 
eligible entity will carry out using the funds 
provided under the grant; 
‘‘(B) an explanation of the reasons why 
Federal assistance is required to carry out the 
project; 
‘‘(C) a description of— 
‘‘(i) the history of collaborative activi-
ties carried out by the participants in the 
network; 
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‘‘(ii) the degree to which the partici-
pants are ready to integrate their func-
tions; and 
‘‘(iii) how the local community or re-
gion to be served will benefit from and be 
involved in the activities carried out by the 
network; 
‘‘(D) a description of how the local com-
munity or region to be served will experience in-
creased access to quality health care services 
across the continuum of care as a result of the 
integration activities carried out by the net-
work, including a description of— 
‘‘(i) return on investment for the com-
munity and the network members; and 
‘‘(ii) other quantifiable performance 
measures that show the benefit of the net-
work activities; 
‘‘(E) a plan for sustaining the project after 
Federal support for the project has ended; 
‘‘(F) a description of how the project will 
be evaluated; 
‘‘(G) the administrative capacity to submit 
annual performance data electronically as speci-
fied by the Director; and 
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‘‘(H) other such information as the Direc-
tor determines to be appropriate. 
‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS-
TEMS DEVELOPMENT GRANTS.— 
‘‘(1) GRANTS.—The Director may award grants 
to eligible entities to support reduction of health dis-
parities, improve access to health care, and enhance 
rural health system development in the Delta Re-
gion. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a 
grant under this subsection, an entity shall be a 
rural public or rural nonprofit private entity, a facil-
ity that qualifies as a rural health clinic under title 
XVIII of the Social Security Act, a public or non-
profit entity existing exclusively to provide services 
to migrant and seasonal farm workers in rural 
areas, or a tribal government whose grant-funded 
activities will be conducted within federally recog-
nized tribal areas. 
‘‘(3) APPLICATIONS.—To be eligible to receive a 
grant under this subsection, an eligible entity shall 
prepare and submit to the Director an application at 
such time, in such manner, and containing such in-
formation as the Director may require, including— 
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‘‘(A) a description of the project that the 
eligible entity will carry out using the funds 
provided under the grant; 
‘‘(B) an explanation of the reasons why 
Federal assistance is required to carry out the 
project; 
‘‘(C) a description of the manner in which 
the project funded under the grant will meet 
the health care needs of the Delta Region; 
‘‘(D) a description of how the local com-
munity or region to be served will experience in-
creased access to quality health care services as 
a result of the activities carried out by the enti-
ty; 
‘‘(E) a description of how health dispari-
ties will be reduced or the health system will be 
improved; 
‘‘(F) a plan for sustaining the project after 
Federal support for the project has ended; 
‘‘(G) a description of how the project will 
be evaluated including process and outcome 
measures related to the quality of care provided 
or how the health care system improves its per-
formance; 
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‘‘(H) a description of how the grantee will 
develop an advisory group made up of rep-
resentatives of the communities to be served to 
provide guidance to the grantee to best meet 
community need; and 
‘‘(I) other such information as the Director 
determines to be appropriate. 
‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL-
ITY IMPROVEMENT GRANTS.— 
‘‘(1) GRANTS.—The Director may award grants 
to provide for the planning and implementation of 
small rural health care provider quality improvement 
activities. The Director may award the grants for 
periods of 1 to 3 years. 
‘‘(2) ELIGIBILITY.—To be eligible for a grant 
under this subsection, an entity— 
‘‘(A) shall be— 
‘‘(i) a rural public or rural nonprofit 
private health care provider or provider of 
health care services, such as a rural health 
clinic; or 
‘‘(ii) another rural provider or net-
work of small rural providers identified by 
the Director as a key source of local care; 
and 
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‘‘(B) shall not previously have received a 
grant under this subsection for the same or a 
similar project. 
‘‘(3) PREFERENCE.—In awarding grants under 
this subsection, the Director shall give preference to 
facilities that qualify as rural health clinics under 
title XVIII of the Social Security Act. 
‘‘(4) APPLICATIONS.—To be eligible to receive a 
grant under this subsection, an eligible entity shall 
prepare and submit to the Director an application at 
such time, in such manner, and containing such in-
formation as the Director may require, including— 
‘‘(A) a description of the project that the 
eligible entity will carry out using the funds 
provided under the grant; 
‘‘(B) an explanation of the reasons why 
Federal assistance is required to carry out the 
project; 
‘‘(C) a description of the manner in which 
the project funded under the grant will assure 
continuous quality improvement in the provision 
of services by the entity; 
‘‘(D) a description of how the local com-
munity or region to be served will experience in-
creased access to quality health care services as 
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a result of the activities carried out by the enti-
ty; 
‘‘(E) a plan for sustaining the project after 
Federal support for the project has ended; 
‘‘(F) a description of how the project will 
be evaluated including process and outcome 
measures related to the quality of care pro-
vided; and 
‘‘(G) other such information as the Direc-
tor determines to be appropriate. 
‘‘(f) GENERAL REQUIREMENTS.— 
‘‘(1) PROHIBITED USES OF FUNDS.—An entity 
that receives a grant under this section may not use 
funds provided through the grant— 
‘‘(A) to build or acquire real property; or 
‘‘(B) for construction. 
‘‘(2) COORDINATION WITH OTHER AGENCIES.— 
The Director shall coordinate activities carried out 
under grant programs described in this section, to 
the extent practicable, with Federal and State agen-
cies and nonprofit organizations that are operating 
similar grant programs, to maximize the effect of 
public dollars in funding meritorious proposals. 
‘‘(g) REPORT.—Not later than September 30, 2014, 
the Secretary shall prepare and submit to the appropriate 
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committees of Congress a report on the progress and ac-
complishments of the grant programs described in sub-
sections (b), (c), (d), and (e). 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) The term ‘Delta Region’ has the meaning 
given to the term ‘region’ in section 382A of the 
Consolidated Farm and Rural Development Act (7 
U.S.C. 2009aa). 
‘‘(2) The term ‘Director’ means the Director of 
the Office of Rural Health Policy of the Health Re-
sources and Services Administration. 
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$40,000,000 for fiscal year 2012, and such sums as may 
be necessary for each of fiscal years 2013 through 2016.’’. 
SEC. 427. COMMUNITY HEALTH CENTER COLLABORATIVE 
ACCESS EXPANSION. 
Section 330 of the Public Health Service Act (42 
U.S.C. 254b) is amended by adding at the end the fol-
lowing: 
‘‘(t) MISCELLANEOUS PROVISIONS.— 
‘‘(1) RULE OF CONSTRUCTION WITH RESPECT 
TO RURAL HEALTH CLINICS.— 
‘‘(A) IN GENERAL.—Nothing in this sec-
tion shall be construed to prevent a community 
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health center from contracting with a federally 
certified rural health clinic (as defined by sec-
tion 1861(aa)(2) of the Social Security Act) for 
the delivery of primary health care services that 
are available at the rural health clinic to indi-
viduals who would otherwise be eligible for free 
or reduced cost care if that individual were able 
to obtain that care at the community health 
center. Such services may be limited in scope to 
those primary health care services available in 
that rural health clinic. 
‘‘(B) ASSURANCES.—In order for a rural 
health clinic to receive funds under this section 
through a contract with a community health 
center under paragraph (1), such rural health 
clinic shall establish policies to ensure— 
‘‘(i) nondiscrimination based upon the 
ability of a patient to pay; and 
‘‘(ii) the establishment of a sliding fee 
scale for low-income patients.’’. 
SEC. 428. FACILITATING THE PROVISION OF TELEHEALTH 
SERVICES ACROSS STATE LINES. 
(a) IN GENERAL.—For purposes of expediting the 
provision of telehealth services, for which payment is made 
under the Medicare program, across State lines, the Sec-
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