with a clearly defined local need to increase access to and 
improve the quality of health care services through activi-
ties which— 
(1) develop or strengthen coordination of serv-
ices to allow all individuals, including the uninsured 
and low-income, to receive efficient and higher qual-
ity care and to gain entry into and receive services 
from a comprehensive system of medical, dental, 
pharmaceutical, and behavioral health care; 
(2) develop efficient and sustainable infrastruc-
ture for a health care delivery system characterized 
by effective collaboration, information sharing, and 
clinical and financial coordination among all types of 
providers of care in the community; and 
(3) develop or strengthen activities related to 
providing coordinated care for individuals with 
chronic conditions. 
SEC. 3. GRANTS TO STRENGTHEN THE EFFECTIVENESS, EF-
FICIENCY, AND COORDINATION OF SERVICES. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this Act referred to as the ‘‘Sec-
retary’’) shall award grants to assist in the development 
of integrated health care delivery systems to serve defined 
communities of individuals— 
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(1) to improve the efficiency of and coordina-
tion among the providers providing services through 
such systems; 
(2) to assist local communities in developing 
programs targeted toward preventing and managing 
chronic diseases; and 
(3) to expand and enhance the services provided 
through such systems. 
(b) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant under this section, an entity shall be an entity 
that— 
(1) represents a balanced consortium— 
(A) whose principal purpose is to ensure 
the sustainable capacity for the provision of a 
broad range of coordinated services for all resi-
dents within a community defined in the enti-
ty’s grant application as described in paragraph 
(2); and 
(B) that includes at least one of each of 
the following providers that serve the commu-
nity (unless such provider does not exist within 
the community, declines or refuses to partici-
pate, or places unreasonable conditions on their 
participation)— 
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(i) a Federally qualified health center 
(as defined in section 1861(aa) of the So-
cial Security Act (42 U.S.C. 1395x(aa))); 
(ii) rural health clinics and rural 
health networks (as defined in sections 
1861(aa) and 1820(d) of the Social Secu-
rity 
Act, 
respectively 
(42 
U.S.C. 
1395x(aa), 1395i–4(d))); 
(iii) a hospital with a low-income utili-
zation rate that is greater than 25 percent 
(as defined in section 1923(b)(3) of the 
Social Security Act (42 U.S.C. 1396r- 
4(b)(3))) or a critical access hospital (as 
defined in section 1820(c)(2) of the Social 
Security Act (42 U.S.C. 1395i–4(c)(2))); 
(iv) a public health department; and 
(v) an interested public or private sec-
tor health care provider or an organization 
that has traditionally served the medically 
uninsured and low-income individuals; and 
(2) submits to the Secretary an application, in 
such form and manner as the Secretary shall pre-
scribe, that— 
(A) clearly defines the community to be 
served; 
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(B) identifies the providers who will par-
ticipate in the community coalition under the 
grant and specifies each provider’s contribution 
to the care of individuals in the community; 
(C) describes the activities that the appli-
cant and the community coalition propose to 
perform under the grant to further the objec-
tives of this section; 
(D) demonstrates that it is an established 
coalition with ability to build on the current 
system for serving the community by involving 
providers who have traditionally provided a sig-
nificant volume of care for uninsured and low- 
income individuals for that community; 
(E) demonstrates the coalition’s ability to 
develop coordinated systems of care that either 
directly provide or ensure the prompt provision 
of a broad range of high-quality, accessible 
services, including, as appropriate, primary, sec-
ondary, and tertiary services as well as phar-
macy, substance abuse, behavioral health and 
oral health services, in a manner that ensures 
continuity of care in the community; 
(F) provides evidence of community in-
volvement, including the business community, in 
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the development, implementation, and direction 
of the system of care that the coalition proposes 
to ensure; 
(G) demonstrates the coalition’s ability to 
ensure that participating individuals are en-
rolled in health care coverage programs, both 
public and private, for which the individuals are 
eligible; 
(H) presents a plan for leveraging other 
sources of revenue, which may include State 
and local sources and private grant funds, and 
integrating current and proposed new funding 
sources in a manner to ensure long-term sus-
tainability of the system of care; 
(I) describes a plan for evaluation of the 
activities carried out under the grant, including 
measurement of progress toward the goals and 
objectives of the program and the use of evalua-
tion findings to improve system performance; 
(J) 
demonstrates 
fiscal 
responsibility 
through the use of appropriate accounting pro-
cedures and management systems; 
(K) demonstrates commitment to serve the 
community without regard to the ability of an 
individual or family to pay by arranging for or 
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providing free or reduced charge care for the 
poor; and 
(L) includes such other information as the 
Secretary may prescribe. 
(c) LIMITATIONS.— 
(1) IN GENERAL.—An eligible entity may re-
ceive a grant under this section for 3 consecutive fis-
cal years and may receive such a grant award for 2 
additional years if— 
(A) the eligible entity submits to the Sec-
retary a request for a grant for such additional 
years; 
(B) the Secretary determines that current 
performance justifies the granting of such a re-
quest; and 
(C) the Secretary determines that granting 
such request is necessary to further the objec-
tives described in subsection (a). 
(d) PRIORITIES.—In awarding grants under this sec-
tion, the Secretary— 
(1) may accord priority to applicants that dem-
onstrate the greatest extent of unmet need in the 
community for a more coordinated system of care; 
and 
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(2) shall accord priority to applicants that best 
promote the objectives of this section, taking into 
consideration the extent to which the applicant— 
(A) identifies a community whose geo-
graphical area has a high or increasing percent-
age of individuals who are uninsured or low-in-
come; 
(B) demonstrates that the applicant has 
included in its community coalition providers, 
support systems, and programs that have a tra-
dition of serving individuals and families in the 
community who are uninsured or earn below 
200 percent of the Federal poverty level; 
(C) shows evidence that the proposed coali-
tion activities would expand utilization of pre-
ventive and primary care services for uninsured 
and underinsured individuals and families in 
the community, including pharmaceuticals, be-
havioral and mental health services, oral health 
services, or substance abuse services; 
(D) proposes approaches that would im-
prove coordination between health care pro-
viders and appropriate social service providers; 
(E) demonstrates collaboration with State 
and local governments; 
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(F) demonstrates that the applicant makes 
use of non-Federal contributions to the greatest 
extent possible; or 
(G) demonstrates likelihood that the pro-
posed activities will lead to sustainable inte-
grated delivery system as additional efforts of 
health systems development evolve. 
(e) USE OF FUNDS.— 
(1) USE BY GRANTEES.— 
(A) IN GENERAL.—Except as provided in 
paragraphs (2) and (3), a grantee may use 
amounts provided under this section only for— 
(i) direct expenses associated with 
achieving the greater integration of a 
health care delivery system so that the sys-
tem either directly provides or ensures the 
provision of a broad range of culturally 
competent services, including as appro-
priate primary, secondary, and tertiary 
care and oral health, substance abuse, be-
havioral and mental health, and pharma-
ceutical services; and 
(ii) direct patient care and service ex-
pansions to fill identified or documented 
gaps within an integrated delivery system. 
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(B) SPECIFIC USES.—The following are ex-
amples of purposes for which a grantee may use 
grant funds under this section, when such use 
meets the conditions stated in subparagraph 
(A): 
(i) Increases in outreach activities and 
closing gaps in health care service, includ-
ing referral to specialty services and pre-
scription drugs and conducting ongoing 
outreach to health disparity populations. 
(ii) Improvements to care manage-
ment and delivery of patient-centered care, 
including patient navigation services. 
(iii) Improvements to coordination of 
transportation to health care facilities. 
(iv) Development of provider networks 
and other innovative models to engage phy-
sicians in voluntary efforts to serve the 
medically underserved within a community. 
(v) Recruitment, training, and com-
pensation of necessary personnel. 
(vi) Acquisition of technology for the 
purpose of coordinating care and improv-
ing provider communication, including im-
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plementation of shared information sys-
tems or shared clinical systems. 
(vii) Development of common proc-
esses such as mechanisms for determining 
eligibility 
for 
the 
programs 
provided 
through the system, common identification 
cards, sliding scale discounts, and moni-
toring and tracking of outcomes. 
(viii) Development of specific preven-
tion and disease management tools and 
processes. 
(ix) Language access services. 
(x) Facilitating the involvement of 
community organizations to provide better 
access to high-quality health care services 
to individuals at risk for or who have 
chronic diseases or cancer. 
(xi) Helping patients overcome bar-
riers within the health care system to en-
sure prompt diagnostic and treatment res-
olution of an abnormal finding of cancer or 
chronic disease. 
(2) DIRECT PATIENT CARE LIMITATION.—Not 
more than 20 percent of the funds provided under 
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a grant awarded under this section may be used for 
providing direct patient care and services. 
(3) RESERVATION
OF
FUNDS
FOR
NATIONAL 
PROGRAM PURPOSES.—The Secretary may use not 
more than 7 percent of funds appropriated to carry 
out this section for providing technical assistance to 
grantees, obtaining assistance of experts and con-
sultants, holding meetings, developing of tools, dis-
seminating of information, and evaluation. 
(f) REPORTING BY GRANTEE.—A grantee under this 
section shall report to the Secretary annually regarding— 
(1) progress in meeting the goals and measur-
able objectives set forth in the grant application sub-
mitted by the grantee under subsection (b); and 
(2) the extent to which activities conducted by 
such grantee have— 
(A) improved the effectiveness, efficiency, 
and coordination of services for uninsured and 
low-income individuals in the community served 
by such grantee, using commonly accepted out-
come measures; 
(B) resulted in the provision of better qual-
ity health care for individuals and families in 
the community served; and 
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