195 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Secretary shall give priority to those appli-
cants— 
‘‘(1) who propose to target geographic areas— 
‘‘(A) with a high percentage of residents 
who are eligible for health insurance but are 
uninsured or underinsured; and 
‘‘(B) with a high percentage of families for 
whom English is not their primary language. 
‘‘(2) with experience in providing health or 
health-related social services to individuals who are 
underserved with respect to such services; and 
‘‘(3) with documented community activity and 
experience with community health workers. 
‘‘(e) COLLABORATION WITH ACADEMIC INSTITU-
TIONS.—The Secretary shall encourage community health 
worker programs receiving funds under this section to col-
laborate with academic institutions, including minority- 
serving institutions. Nothing in this section shall be con-
strued to require such collaboration. 
‘‘(f) QUALITY ASSURANCE
AND COST-EFFECTIVE-
NESS.—The Secretary shall establish guidelines for assur-
ing the quality of the training and supervision of commu-
nity health workers under the programs funded under this 
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section and for assuring the cost-effectiveness of such pro-
grams. 
‘‘(g) MONITORING.—The Secretary shall monitor 
community health worker programs identified in approved 
applications and shall determine whether such programs 
are in compliance with the guidelines established under 
subsection (f). 
‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 
provide technical assistance to community health worker 
programs identified in approved applications with respect 
to planning, developing, and operating programs under the 
grant. 
‘‘(i) REPORT TO CONGRESS.— 
‘‘(1) IN
GENERAL.—Not later than 4 years 
after the date on which the Secretary first awards 
grants under subsection (a), the Secretary shall sub-
mit to Congress a report regarding the grant 
project. 
‘‘(2) CONTENTS.—The report required under 
paragraph (1) shall include the following: 
‘‘(A) A description of the programs for 
which grant funds were used. 
‘‘(B) The number of individuals served. 
‘‘(C) An evaluation of— 
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‘‘(i) the effectiveness of these pro-
grams; 
‘‘(ii) the cost of these programs; and 
‘‘(iii) the impact of the project on the 
health outcomes of the community resi-
dents. 
‘‘(D) Recommendations for sustaining the 
community health worker programs developed 
or assisted under this section. 
‘‘(E) Recommendations regarding training 
to enhance career opportunities for community 
health workers. 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) COMMUNITY HEALTH WORKER.—The term 
‘community health worker’ means an individual who 
promotes health or nutrition within the community 
in which the individual resides— 
‘‘(A) by serving as a liaison between com-
munities and health care agencies; 
‘‘(B) by providing guidance and social as-
sistance to community residents; 
‘‘(C) by enhancing community residents’ 
ability to effectively communicate with health 
care providers; 
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‘‘(D) by providing culturally and linguis-
tically appropriate health or nutrition edu-
cation; 
‘‘(E) by advocating for individual and com-
munity health, including dental, oral, mental, 
and environmental health, or nutrition needs; 
and 
‘‘(F) by providing referral and followup 
services. 
‘‘(2) COMMUNITY SETTING.—The term ‘commu-
nity setting’ means a home or a community organi-
zation located in the neighborhood in which a partic-
ipant resides. 
‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means— 
‘‘(A) a unit of State, territorial, local, or 
tribal government (including a federally recog-
nized tribe or Alaska native villages); or 
‘‘(B) a community-based organization. 
‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 
The term ‘medically underserved community’ means 
a community— 
‘‘(A) that has a substantial number of in-
dividuals who are members of a medically un-
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derserved population, as defined by section 
330(b)(3); and 
‘‘(B) a significant portion of which is a 
health professional shortage area as designated 
under section 332. 
‘‘(5) SUPPORT.—The term ‘support’ means the 
provision of training, supervision, and materials 
needed to effectively deliver the services described in 
subsection (b), reimbursement for services, and 
other benefits. 
‘‘(6) TARGET POPULATION.—The term ‘target 
population’ means women of reproductive age, re-
gardless of their current childbearing status and 
children under 21 years of age. 
‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$15,000,000 for each of fiscal years 2008, 2009, 2010, 
2011, and 2012.’’. 
SEC. 507. EXCEPTION FOR CITIZENS OF FREELY ASSOCI-
ATED STATES. 
(a) IN GENERAL.—Section 402(a)(2) of the Personal 
Responsibility and Work Opportunity Reconciliation Act 
of 1996 (8 U.S.C. 1612(a)(2)) is amended by adding at 
the end the following: 
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‘‘(M) EXCEPTION FOR CITIZENS OF FREE-
LY ASSOCIATED STATES.—With respect to eligi-
bility for benefits for the specified Federal pro-
grams described in paragraph (3), paragraph 
(1) shall not apply to any individual who law-
fully resides in the United States (including ter-
ritories and possessions of the United States) in 
accordance with— 
‘‘(i) section 141 of the Compact of 
Free Association between the Government 
of the United States and the Government 
of the Federated States of Micronesia, ap-
proved by Congress in the Compact of 
Free Association Amendments Act of 
2003; 
‘‘(ii) section 141 of the Compact of 
Free Association between the Government 
of the United States and the Government 
of the Republic of the Marshall Islands, 
approved by Congress in the Compact of 
Free Association Amendments Act of 
2003; or 
‘‘(iii) section 141 of the Compact of 
Free Association between the Government 
of the United States and the Government 
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of Palau, approved by Congress in Public 
Law 99–658 (100 Stat. 3672).’’. 
(b) MEDICAID EXCEPTION.—Section 402(b)(2) of the 
Personal Responsibility and Work Opportunity Reconcili-
ation Act of 1996 (8 U.S.C. 1612(b)(2)) is amended by 
adding at the end the following: 
‘‘(G) MEDICAID
EXCEPTIONS
FOR
CITI-
ZENS OF FREELY ASSOCIATED STATES.—With 
respect to eligibility for benefits for the pro-
grams defined in subparagraphs (A) and (C) of 
paragraph (3) (relating to Medicaid), paragraph 
(1) shall not apply to any individual who law-
fully resides in the United States (including ter-
ritories and possessions of the United States) in 
accordance with a Compact of Free Association 
referred to in subsection (a)(2)(M).’’. 
(c) QUALIFIED ALIEN.—Section 431(b) of the Per-
sonal Responsibility and Work Opportunity Reconciliation 
Act of 1996 (8 U.S.C. 1641(b)) is amended— 
(1) in paragraph (6), by striking ‘‘or’’ at the 
end; 
(2) in paragraph (7), by striking the period at 
the end and inserting ‘‘; or’’; and 
(3) by adding at the end the following: 
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‘‘(8) an individual who lawfully resides in the 
United States (including territories and possessions 
of the United States) in accordance with a Compact 
of 
Free 
Association 
referred 
to 
in 
section 
402(a)(2)(M).’’. 
(d) FINANCIAL TREATMENT UNDER MEDICAID.— 
Section 1108 of the Social Security Act (42 U.S.C. 1308) 
is amended— 
(1) in subsection (f), by striking ‘‘subsection 
(g)’’ and inserting ‘‘subsections (g) and (h)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(h) The limitations of subsections (f) and (g) shall 
not apply with respect to medical assistance provided to 
an individual described in section 431(b)(8) of the Per-
sonal Responsibility and Work Opportunity Reconciliation 
Act of 1996.’’. 
(e) INCREASED FMAP.—The third sentence of sec-
tion 1905(b) of the Social Security Act (42 U.S.C. 
1396d(b)) is amended by inserting before the period at 
the end the following: ‘‘and for services furnished to indi-
viduals described in section 431(b)(8) of the Personal Re-
sponsibility and Work Opportunity Reconciliation Act of 
1996’’. 
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SEC. 508. MEDICARE GRADUATE MEDICAL EDUCATION. 
(a) CLARIFICATION OF CONGRESSIONAL INTENT RE-
GARDING THE COUNTING OF RESIDENTS IN A NONHOS-
PITAL SETTING.— 
(1) D-GME.—Section 1886(h)(4)(E) of the So-
cial Security Act (42 U.S.C. 1395ww(h)(4)(E)) is 
amended by adding at the end the following new 
sentences: ‘‘For purposes of the preceding sentence, 
the term ‘all, or substantially all, of the costs for the 
training program’ means the stipends and benefits 
provided to the resident and other amounts, if any, 
as determined by the hospital and the entity oper-
ating the nonhospital setting. The hospital is not re-
quired to pay the entity any amounts other than 
those determined by the hospital and the entity in 
order for the hospital to be considered to have in-
curred all, or substantially all, of the costs for the 
training program in that setting.’’. 
(2) IME.—Section 1886(d)(5)(B)(iv) of the So-
cial Security Act (42 U.S.C. 1395ww(d)(5)(B)(iv)) is 
amended by adding at the end the following new 
sentences: ‘‘For purposes of the preceding sentence, 
the term ‘all, or substantially all, of the costs for the 
training program’ means the stipends and benefits 
provided to the resident and other amounts, if any, 
as determined by the hospital and the entity oper-
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ating the nonhospital setting. The hospital is not re-
quired to pay the entity any amounts other than 
those determined by the hospital and the entity in 
order for the hospital to be considered to have in-
curred all, or substantially all, of the costs for the 
training program in that setting.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on January 1, 
2008. 
(b) CLARIFICATION OF ELIGIBILITY OF A NONRURAL 
HOSPITAL THAT HAS A TRAINING PROGRAM WITH AN 
INTEGRATED RURAL TRACK.— 
(1) IN
GENERAL.—Section 1886(h)(4)(H) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(h)(4)(H)) is amended— 
(A) in clause (iv), by inserting ‘‘(as defined 
in clause (v))’’ after ‘‘an integrated rural 
track’’; and 
(B) by adding at the end the following new 
clause: 
‘‘(v) DEFINITION
OF
ACCREDITED 
TRAINING PROGRAM WITH AN INTEGRATED 
RURAL
TRACK.—For purposes of clause 
(iv), the term ‘accredited training program 
with an integrated rural track’ means an 
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accredited medical residency training pro-
gram located in an urban area which offers 
a curriculum for all residents in the pro-
gram that includes the following character-
istics: 
‘‘(I) A minimum of 3 block 
months of rural rotations. During 
such 3 block months, the resident is 
in a rural area for 4 weeks or a 
month. 
‘‘(II) A stated mission for train-
ing rural physicians. 
‘‘(III) A minimum of 3 months of 
obstetrical training, or an equivalent 
longitudinal experience. 
‘‘(IV) A minimum of 4 months of 
pediatric training that includes neo-
natal, 
ambulatory, 
inpatient, 
and 
emergency experiences through rota-
tions, or an equivalent longitudinal ex-
perience. 
‘‘(V) A minimum of 2 months of 
emergency medicine rotations, or an 
equivalent longitudinal experience.’’. 
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(2) EFFECTIVE DATE.—The amendments made 
by this subsection apply with respect to— 
(A) payments to hospitals under section 
1886(h) of the Social Security Act (42 U.S.C. 
1395ww(h)) for cost reporting periods begin-
ning on or after January 1, 2008; and 
(B) payments to hospitals under section 
1886(d)(5)(B)(v) of such Act (42 U.S.C. 
1395ww(d)(5)(B)(v)) for discharges occurring 
on or after January 1, 2008. 
SEC. 509. HIV/AIDS REDUCTION IN RACIAL AND ETHNIC MI-
NORITY COMMUNITIES. 
(a) EXPANDED FUNDING.—The Secretary, in col-
laboration with the Director of the Office of Minority 
Health, the Director of the Centers for Disease Control 
and Prevention, the Administrator of the Health Re-
sources and Services Administration, and the Adminis-
trator of the Substance Abuse and Mental Health Services 
Administration, shall provide funds and carry out activi-
ties to expand the Minority HIV/AIDS Initiative. 
(b) USE OF FUNDS.—The additional funds made 
available under this section may be used, through the Mi-
nority AIDS Initiative, to support the following activities: 
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(1) Providing technical assistance and infra-
structure support to reduce HIV/AIDS in minority 
populations. 
(2) Increasing minority populations’ access to 
HIV/AIDS prevention and care services. 
(3) Building strong community programs and 
partnerships to address HIV prevention and the 
health care needs of specific racial and ethnic minor-
ity populations. 
(c) PRIORITY INTERVENTIONS.—Within the racial 
and ethnic minority populations referred to in subsection 
(b), priority in conducting intervention services shall be 
given to— 
(1) women; 
(2) youth; 
(3) men who engage in homosexual activity; 
(4) persons who engage in intravenous drug 
abuse; 
(5) homeless individuals; and 
(6) individuals incarcerated or in the penal sys-
tem. 
(d) AUTHORIZATION OF APPROPRIATIONS.—For car-
rying out this section, there are authorized to be appro-
priated $610,000,0000 for fiscal year 2008 and such sums 
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as may be necessary for each of fiscal years 2009 through 
2012. 
SEC. 510. GRANTS FOR RACIAL AND ETHNIC APPROACHES 
TO COMMUNITY HEALTH. 
(a) PURPOSE.—It is the purpose of this section to 
provide for the awarding of grants to assist communities 
in mobilizing and organizing resources in support of effec-
tive and sustainable programs that will reduce or eliminate 
disparities in health and health care experienced by racial 
and ethnic minority individuals. 
(b) AUTHORITY.—The Secretary, acting through the 
Director of the Centers for Disease Control and Preven-
tion, in consultation with the Office of Minority Health, 
shall award grants to eligible entities to assist in design-
ing, implementing, and evaluating culturally and linguis-
tically appropriate, evidence-based, and community-driven 
sustainable strategies to eliminate racial and ethnic health 
and health care disparities. 
(c) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant under this section, an entity shall— 
(1) represent a coalition— 
(A) whose principal purpose is to develop 
and implement interventions to reduce or elimi-
nate a health or health care disparity in a tar-
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geted racial or ethnic minority group in the 
community served by the coalition; and 
(B) that includes— 
(i) at least 3 members selected from 
among— 
(I) public health departments; 
(II) community-based organiza-
tions; 
(III) university and research or-
ganizations; 
(IV) Indian tribes, tribal organi-
zations, urban Indian organizations, 
national or regional Indian organiza-
tions, or the Indian Health Service; 
(V) organizations serving Native 
Hawaiians; 
(VI) organizations serving Pacific 
Islanders; and 
(VII) interested public or private 
health care providers or organizations 
as deemed appropriate by the Sec-
retary; and 
(ii) at least 1 member from a commu-
nity-based organization that represents the 
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targeted racial or ethnic minority group; 
and 
(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require, which shall 
include— 
(A) a description of the targeted racial or 
ethnic populations in the community to be 
served under the grant; 
(B) a description of at least 1 health dis-
parity that exists in the racial or ethnic tar-
geted populations, including infant mortality, 
breast and cervical cancer screening and man-
agement, cardiovascular disease, diabetes, child 
and adult immunization levels, HIV/AIDS, hep-
atitis B, tuberculosis, or asthma, or other 
health priority areas as designated by the Sec-
retary; and 
(C) a demonstration of a proven record of 
accomplishment of the coalition members in 
serving and working with the targeted commu-
nity. 
(d) SUSTAINABILITY.—The Secretary shall give pri-
ority to an eligible entity under this section if the entity 
agrees that, with respect to the costs to be incurred by 
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211 
the entity in carrying out the activities for which the grant 
was awarded, the entity (and each of the participating 
partners in the coalition represented by the entity) will 
maintain its expenditures of non-Federal funds for such 
activities at a level that is not less than the level of such 
expenditures during the fiscal year immediately preceding 
the first fiscal year for which the grant is awarded. 
(e) NONDUPLICATION.—Funds provided through this 
grant program should supplement, not supplant, existing 
Federal funding, and the funds should not be used to du-
plicate the activities of the other health disparity grant 
programs in this Act. 
(f) TECHNICAL ASSISTANCE.—The Secretary may, 
either directly or by grant or contract, provide any entity 
that receives a grant under this section with technical and 
other non-financial assistance necessary to meet the re-
quirements of this section. 
(g) DISSEMINATION.—The Secretary shall encourage 
and enable grantees to share best practices, evaluation re-
sults, and reports using the Internet, conferences, and 
other pertinent information regarding the projects funded 
by this section, including the outreach efforts of the Office 
of Minority Health and the Centers for Disease Control 
and Prevention. Such information shall be publicly avail-
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able, and posted on the Internet website of relevant Gov-
ernment agencies. 
(h) ADMINISTRATIVE
BURDENS.—The Secretary 
shall make every effort to minimize duplicative or unneces-
sary administrative burdens on grantees. 
SEC. 511. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 
(a) CLARIFICATION
OF PAYMENT
FOR CLINICAL 
LABORATORY TESTS FURNISHED BY CRITICAL ACCESS 
HOSPITALS.— 
(1) IN GENERAL.—Section 1834(g)(4) of the 
Social Security Act (42 U.S.C. 1395m(g)(4)) is 
amended— 
(A) in the heading, by striking ‘‘NO BENE-
FICIARY COST-SHARING’’ and inserting ‘‘TREAT-
MENT OF’’; and 
(B) by adding at the end the following new 
sentence: ‘‘For purposes of the preceding sen-
tence and section 1861(mm)(3), clinical diag-
nostic laboratory services furnished by a critical 
access hospital shall be treated as being fur-
nished as part of outpatient critical access serv-
ices without regard to whether— 
‘‘(A) the individual with respect to whom 
such services are furnished is physically present 
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in the critical access hospital at the time the 
specimen is collected; 
‘‘(B) such individual is registered as an 
outpatient on the records of, and receives such 
services directly from, the critical access hos-
pital; or 
‘‘(C) payment is (or, but for this sub-
section, would be) available for such services 
under the fee schedule established under section 
1833(h).’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to cost reporting peri-
ods beginning on or after October 1, 2008. 
(b) ELIMINATION OF ISOLATION TEST FOR COST- 
BASED AMBULANCE REIMBURSEMENT.— 
(1) IN
GENERAL.—Section 1834(l)(8) of the 
Social Security Act (42 U.S.C. 1395m(l)(8)) is 
amended— 
(A) in subparagraph (B)— 
(i) by striking ‘‘owned and’’; and 
(ii) by inserting ‘‘(including when 
such services are provided by the entity 
under an arrangement with the hospital)’’ 
after ‘‘hospital’’; and 
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(B) by striking the comma at the end of 
subparagraph (B) and all that follows and in-
serting a period. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to services furnished 
on or after January 1, 2008. 
(c) PROVISION OF A MORE FLEXIBLE ALTERNATIVE 
TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT 
REQUIREMENT.— 
(1) IN
GENERAL.—Section 1820(c)(2) of the 
Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 
amended— 
(A) in subparagraph (B)(iii), by striking 
‘‘provides not more than’’ and inserting ‘‘sub-
ject to subparagraph (F), provides not more 
than’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(F) ALTERNATIVE TO 25 INPATIENT BED 
LIMIT REQUIREMENT.— 
‘‘(i) IN GENERAL.—A State may elect 
to treat a facility, with respect to the des-
ignation of the facility for a cost reporting 
period, as satisfying the requirement of 
subparagraph (B)(iii) relating to a max-
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imum number of acute care inpatient beds 
if the facility elects, in accordance with a 
method specified by the Secretary and be-
fore the beginning of the cost reporting pe-
riod, to meet the requirement under clause 
(ii). 
‘‘(ii) ALTERNATE
REQUIREMENT.— 
The requirement under this clause, with 
respect to a facility and a cost reporting 
period, is that the total number of inpa-
tient bed days described in subparagraph 
(B)(iii) during such period will not exceed 
7,300. For purposes of this subparagraph, 
an individual who is an inpatient in a bed 
in the facility for a single day shall be 
counted as one inpatient bed day. 
‘‘(iii) WITHDRAWAL OF ELECTION.— 
The option described in clause (i) shall not 
apply to a facility for a cost reporting pe-
riod if the facility (for any two consecutive 
cost reporting periods during the previous 
5 cost reporting periods) was treated under 
such option and had a total number of in-
patient bed days for each of such two cost 
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reporting periods that exceeded the num-
ber specified in such clause.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to cost reporting peri-
ods beginning on or after the date of the enactment 
of this Act. 
SEC. 512. COVERAGE OF MARRIAGE AND FAMILY THERA-
PIST SERVICES AND MENTAL HEALTH COUN-
SELOR SERVICES UNDER PART B OF THE 
MEDICARE PROGRAM. 
(a) COVERAGE OF SERVICES.— 
(1) IN
GENERAL.—Section 1861(s)(2) of the 
Social Security Act (42 U.S.C. 1395x(s)(2)) is 
amended— 
(A) in subparagraph (Z), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (AA), by inserting 
‘‘and’’ at the end; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(BB) marriage and family therapist services 
(as defined in subsection (ccc)(1)) and mental health 
counselor 
services 
(as 
defined 
in 
subsection 
(ccc)(3));’’. 
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217 
(2) DEFINITIONS.—Section 1861 of such Act 
(42 U.S.C. 1395x) is amended by adding at the end 
the following new subsection: 
‘‘Marriage and Family Therapist Services; Marriage and 
Family Therapist; Mental Health Counselor Serv-
ices; Mental Health Counselor 
‘‘(ccc)(1) The term ‘marriage and family therapist 
services’ means services performed by a marriage and 
family therapist (as defined in paragraph (2)) for the diag-
nosis and treatment of mental illnesses, which the mar-
riage and family therapist is legally authorized to perform 
under State law (or the State regulatory mechanism pro-
vided by State law) of the State in which such services 
are performed, as would otherwise be covered if furnished 
by a physician or as an incident to a physician’s profes-
sional service, but only if no facility or other provider 
charges or is paid any amounts with respect to the fur-
nishing of such services. 
‘‘(2) The term ‘marriage and family therapist’ means 
an individual who— 
‘‘(A) possesses a master’s or doctoral degree 
which qualifies for licensure or certification as a 
marriage and family therapist pursuant to State 
law; 
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218 
‘‘(B) after obtaining such degree has performed 
at least 2 years of clinical supervised experience in 
marriage and family therapy; and 
‘‘(C) in the case of an individual performing 
services in a State that provides for licensure or cer-
tification of marriage and family therapists, is li-
censed or certified as a marriage and family thera-
pist in such State. 
‘‘(3) The term ‘mental health counselor services’ 
means services performed by a mental health counselor (as 
defined in paragraph (4)) for the diagnosis and treatment 
of mental illnesses which the mental health counselor is 
legally authorized to perform under State law (or the 
State regulatory mechanism provided by the State law) of 
the State in which such services are performed, as would 
otherwise be covered if furnished by a physician or as inci-
dent to a physician’s professional service, but only if no 
facility or other provider charges or is paid any amounts 
with respect to the furnishing of such services. 
‘‘(4) The term ‘mental health counselor’ means an 
individual who— 
‘‘(A) possesses a master’s or doctor’s degree in 
mental health counseling or a related field; 
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219 
‘‘(B) after obtaining such a degree has per-
formed at least 2 years of supervised mental health 
counselor practice; and 
‘‘(C) in the case of an individual performing 
services in a State that provides for licensure or cer-
tification of mental health counselors or professional 
counselors, is licensed or certified as a mental health 
counselor or professional counselor in such State.’’. 
(3) PROVISION
FOR
PAYMENT
UNDER
PART 
B.—Section 1832(a)(2)(B) of such Act (42 U.S.C. 
1395k(a)(2)(B)) is amended by adding at the end 
the following new clause: 
‘‘(v) marriage and family therapist 
services and mental health counselor serv-
ices;’’. 
(4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 
of such Act (42 U.S.C. 1395l(a)(1)) is amended— 
(A) by striking ‘‘and (V)’’ and inserting 
‘‘(V)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (W) with respect 
to marriage and family therapist services and 
mental health counselor services under section 
1861(s)(2)(BB), the amounts paid shall be 80 
percent of the lesser of the actual charge for 
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220 
the services or 75 percent of the amount deter-
mined for payment of a psychologist under sub-
paragraph (L)’’. 
(5) EXCLUSION
OF
MARRIAGE
AND
FAMILY 
THERAPIST SERVICES AND MENTAL HEALTH COUN-
SELOR SERVICES FROM SKILLED NURSING FACILITY 
PROSPECTIVE
PAYMENT
SYSTEM.—Section 
1888(e)(2)(A)(ii) 
of 
such 
Act 
(42 
U.S.C. 
1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar-
riage and family therapist services (as defined in 
section 1861(ccc)(1)), mental health counselor serv-
ices (as defined in section 1861(ccc)(3)),’’ after 
‘‘qualified psychologist services,’’. 
(6) INCLUSION
OF
MARRIAGE
AND
FAMILY 
THERAPISTS AND MENTAL HEALTH COUNSELORS AS 
PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Sec-
tion 1842(b)(18)(C) of such Act (42 U.S.C. 
1395u(b)(18)(C)) is amended by adding at the end 
the following new clauses: 
‘‘(vii) A marriage and family therapist (as de-
fined in section 1861(ccc)(2)). 
‘‘(viii) A mental health counselor (as defined in 
section 1861(ccc)(4)).’’. 
(b) COVERAGE OF CERTAIN MENTAL HEALTH SERV-
ICES PROVIDED IN CERTAIN SETTINGS.— 
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221 
(1) RURAL HEALTH CLINICS AND FEDERALLY 
QUALIFIED
HEALTH
CENTERS.—Section 
1861(aa)(1)(B) of the Social Security Act (42 
U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 
by a clinical social worker (as defined in subsection 
(hh)(1)),’’ and inserting ‘‘, by a clinical social worker 
(as defined in subsection (hh)(1)), by a marriage 
and family therapist (as defined in subsection 
(ccc)(2)), or by a mental health counselor (as de-
fined in subsection (ccc)(4)),’’. 
(2) 
HOSPICE
PROGRAMS.—Section 
1861(dd)(2)(B)(i)(III) of such Act (42 U.S.C. 
1395x(dd)(2)(B)(i)(III)) is amended by inserting ‘‘or 
one marriage and family therapist (as defined in 
subsection (ccc)(2))’’ after ‘‘social worker’’. 
(c) AUTHORIZATION
OF MARRIAGE
AND FAMILY 
THERAPISTS TO DEVELOP DISCHARGE PLANS FOR POST- 
HOSPITAL SERVICES.—Section 1861(ee)(2)(G) of the So-
cial Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended 
by inserting ‘‘marriage and family therapist (as defined 
in subsection (ccc)(2)),’’ after ‘‘social worker,’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to services furnished 
on or after January 1, 2008. 
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222 
SEC. 513. ESTABLISHMENT OF RURAL COMMUNITY HOS-
PITAL (RCH) PROGRAM. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x), as amended by section 512, 
is amended by adding at the end of the following new sub-
section: 
‘‘Rural Community Hospital; Rural Community Hospital 
Services 
‘‘(ddd)(1) The term ‘rural community hospital’ 
means a hospital (as defined in subsection (e)) that— 
‘‘(A) is located in a rural area (as defined in 
section 1886(d)(2)(D)) or treated as being so lo-
cated pursuant to section 1886(d)(8)(E); 
‘‘(B) subject to paragraph (2), has less than 51 
acute care inpatient beds, as reported in its most re-
cent cost report; 
‘‘(C) makes available 24-hour emergency care 
services; 
‘‘(D) subject to paragraph (3), has a provider 
agreement in effect with the Secretary and is open 
to the public as of January 1, 2008; and 
‘‘(E) applies to the Secretary for such designa-
tion. 
‘‘(2) For purposes of paragraph (1)(B), beds in a 
psychiatric or rehabilitation unit of the hospital which is 
a distinct part of the hospital shall not be counted. 
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223 
‘‘(3) Subparagraph (1)(D) shall not be construed to 
prohibit any of the following from qualifying as a rural 
community hospital: 
‘‘(A) A replacement facility (as defined by the 
Secretary in regulations in effect on January 1, 
2008) with the same service area (as defined by the 
Secretary in regulations in effect on such date). 
‘‘(B) A facility obtaining a new provider num-
ber pursuant to a change of ownership. 
‘‘(C) A facility which has a binding written 
agreement with an outside, unrelated party for the 
construction, reconstruction, lease, rental, or financ-
ing of a building as of January 1, 2008. 
‘‘(4) Nothing in this subsection shall be construed as 
prohibiting a critical access hospital from qualifying as a 
rural community hospital if the critical access hospital 
meets the conditions otherwise applicable to hospitals 
under subsection (e) and section 1866. 
‘‘(5) Nothing in this subsection shall be construed as 
prohibiting a rural community hospital participating in 
the demonstration program under Section 410A of the 
Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173; 117 Stat. 
2313) from qualifying as a rural community hospital if 
the rural community hospital meets the conditions other-
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224 
wise applicable to hospitals under subsection (e) and sec-
tion 1866.’’. 
(b) PAYMENT.— 
(1) INPATIENT
HOSPITAL
SERVICES.—Section 
1814 of the Social Security Act (42 U.S.C. 1395f) 
is amended by adding at the end the following new 
subsection: 
‘‘Payment for Inpatient Services Furnished in Rural 
Community Hospitals 
‘‘(m) The amount of payment under this part for in-
patient hospital services furnished in a rural community 
hospital, other than such services furnished in a psy-
chiatric or rehabilitation unit of the hospital which is a 
distinct part, is, at the election of the hospital in the appli-
cation referred to in section 1861(ddd)(1)(E)— 
‘‘(1) 101 percent of the reasonable costs of pro-
viding such services, without regard to the amount 
of the customary or other charge, or 
‘‘(2) the amount of payment provided for under 
the prospective payment system for inpatient hos-
pital services under section 1886(d).’’. 
(2) OUTPATIENT SERVICES.—Section 1834 of 
such Act (42 U.S.C. 1395m) is amended by adding 
at the end the following new subsection: 
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