HR 1343 RFS 
of their operations to expand access to primary and 
preventive services for the medically underserved. 
‘‘(2) RULE
OF
CONSTRUCTION.—Nothing in 
this section shall be construed as authorizing grants 
to be made or used for the costs of specialty care or 
hospital care furnished by an integrated health sys-
tem. 
‘‘(b) APPLICATION.—Any integrated health system 
desiring to participate in the demonstration shall submit 
an application in such manner, at such time, and con-
taining such information as the Secretary may require. 
‘‘(c) CRITERIA FOR SELECTION.—In selecting inte-
grated health systems to participate in the demonstration 
(hereafter in this section referred to as ‘participating inte-
grated health systems’), the Secretary shall ensure rep-
resentation of integrated health systems that are located 
in a variety of States (including the District of Columbia 
and the territories and possessions of the United States) 
and locations within States, including rural areas, inner- 
city areas, and frontier areas. 
‘‘(d) DURATION.—Subject to the availability of ap-
propriations, the demonstration shall be conducted (and 
operating grants be made to each participating integrated 
health system) for a period of 3 years. 
‘‘(e) REPORTS.— 
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HR 1343 RFS 
‘‘(1) IN GENERAL.—The Secretary shall submit 
to the appropriate committees of the Congress in-
terim and final reports with respect to the dem-
onstration, with an interim report being submitted 
not later than 3 months after the demonstration has 
been in operation for 24 months and a final report 
being submitted not later than 3 months after the 
close of the demonstration. 
‘‘(2) CONTENT.—Such reports shall evaluate 
the effectiveness of the demonstration in providing 
greater access to primary and preventive care for 
medically underserved populations, and how the co-
ordinated approach offered by integrated health sys-
tems contributes to improved patient outcomes. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) IN GENERAL.—There is authorized to be 
appropriated $25,000,000 for each of the fiscal 
years 2009, 2010, and 2011 to carry out this sec-
tion. 
‘‘(2) CONSTRUCTION.—Nothing in this section 
shall be construed as requiring or authorizing a re-
duction in the amounts appropriated for grants to 
health centers under section 330 for the fiscal years 
referred to in paragraph (1). 
‘‘(g) DEFINITIONS.—For purposes of this section: 
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HR 1343 RFS 
‘‘(1) FRONTIER
AREA.—The term ‘frontier 
area’ has the meaning given to such term in regula-
tions promulgated pursuant to section 330I(r). 
‘‘(2) INTEGRATED HEALTH SYSTEM.—The term 
‘integrated health system’ means a health system 
that— 
‘‘(A) has a demonstrated capacity and 
commitment to provide a full range of primary 
care, specialty care, and hospital care in both 
inpatient and outpatient settings; and 
‘‘(B) is organized to provide such care in 
a coordinated fashion. 
‘‘(3) QUALIFYING
INTEGRATED
HEALTH
SYS-
TEM.— 
‘‘(A) IN GENERAL.—The term ‘qualifying 
integrated health system’ means a public or pri-
vate nonprofit entity that is an integrated 
health system that meets the requirements of 
subparagraph (B) and serves a medically under-
served population (either through the staff and 
supporting resources of the integrated health 
system or through contracts or cooperative ar-
rangements) by providing— 
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HR 1343 RFS 
‘‘(i) required primary and preventive 
health and related services (as defined in 
paragraph (4)); and 
‘‘(ii) as may be appropriate for a pop-
ulation served by a particular integrated 
health system, integrative health services 
(as defined in paragraph (5)) that are nec-
essary for the adequate support of the re-
quired primary and preventive health and 
related services and that improve care co-
ordination. 
‘‘(B) OTHER
REQUIREMENTS.—The re-
quirements of this subparagraph are that the 
integrated health system— 
‘‘(i) will make the required primary 
and preventive health and related services 
of the integrated health system available 
and accessible in the service area of the in-
tegrated health system promptly, as appro-
priate, and in a manner which assures con-
tinuity; 
‘‘(ii) will demonstrate financial re-
sponsibility by the use of such accounting 
procedures and other requirements as may 
be prescribed by the Secretary; 
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HR 1343 RFS 
‘‘(iii) provides or will provide services 
to individuals who are eligible for medical 
assistance under title XIX of the Social 
Security Act or for assistance under title 
XXI of such Act; 
‘‘(iv) has prepared a schedule of fees 
or payments for the provision of its serv-
ices consistent with locally prevailing rates 
or charges and designed to cover its rea-
sonable costs of operation and has pre-
pared a corresponding schedule of dis-
counts to be applied to the payment of 
such fees or payments, which discounts are 
adjusted on the basis of the patient’s abil-
ity to pay; 
‘‘(v) will assure that no patient will be 
denied health care services due to an indi-
vidual’s inability to pay for such services; 
‘‘(vi) will assure that any fees or pay-
ments required by the system for such 
services will be reduced or waived to enable 
the system to fulfill the assurance de-
scribed in clause (v); 
‘‘(vii) provides assurances that any 
grant funds will be expended to supple-
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HR 1343 RFS 
ment, and not supplant, the expenditures 
of the integrated health system for primary 
and preventive health services for the 
medically underserved; and 
‘‘(viii) submits to the Secretary such 
reports as the Secretary may require to de-
termine compliance with this subpara-
graph. 
‘‘(C) TREATMENT
OF
CERTAIN
ENTI-
TIES.—The term ‘qualifying integrated health 
system’ may include a nurse-managed health 
clinic if such clinic meets the requirements of 
subparagraphs (A) and (B) (except those re-
quirements that have been waived under para-
graph (4)(B)). 
‘‘(4) REQUIRED
PRIMARY
AND
PREVENTIVE 
HEALTH AND RELATED SERVICES.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the term ‘required primary 
and preventive health and related services’ 
means basic health services consisting of— 
‘‘(i) health services related to family 
medicine, internal medicine, pediatrics, ob-
stetrics, or gynecology that are furnished 
by physicians where appropriate, physician 
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