(3) the feasibility of implementing diabetes edu-
cation and medical nutrition therapy services in 
rural health clinics; and 
(4) to the extent practical, analyze existing 
health outcomes and cost savings attributed to dia-
betes education and medical nutrition therapy serv-
ices provided by federally qualified health centers 
and the potential health outcomes and cost savings 
if those services are offered in rural health clinics. 
SEC. 6. RURAL HEALTH CLINIC PROVIDER RETENTION 
DEMONSTRATION PROJECT. 
(a) IN GENERAL.—The Secretary shall establish a 
demonstration project under which States are awarded 
grants to examine whether health care professionals can 
be recruited or retained to work in underserved rural areas 
by providing such professionals with medical malpractice 
subsidies. 
(b) DURATION; SCOPE.—The demonstration project 
shall be conducted— 
(1) for a 3-year period, beginning not later than 
January 1, 2011; and 
(2) in not more than 5 States. 
(c) STATE APPLICATION.—A State that desires to re-
ceive a grant under the demonstration project shall submit 
to the Secretary an application at such time, in such man-
VerDate Nov 24 2008 
00:23 Oct 22, 2009
Jkt 089200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H3896.IH
H3896
jbell on DSKDVH8Z91PROD with BILLS
ner, and containing such information as the Secretary may 
require, including adequate assurances that the State— 
(1) promotes the establishment and continued 
maintenance of rural health clinics within the State; 
and 
(2) is working to improve access to primary 
care and other health care services for rural resi-
dents of the State. 
(d) STATE SELECTION.—In awarding grants to 
States under this section, the Secretary shall— 
(1) ensure the participation of States with a di-
verse selection of rural health clinics, including clin-
ics with 3 or less full-time equivalent physicians, 
physician assistants, and nurse practitioners; 
(2) ensure the participation of States that 
maintain both provider-based and independent rural 
health clinics; 
(3) give preference to States with existing 
State-funded medical malpractice subsidy programs; 
and 
(4) give preference to States with 15 or more 
rural health clinics. 
(e) DISTRIBUTION OF GRANT FUNDS BY STATES TO 
RURAL HEALTH CLINICS.— 
VerDate Nov 24 2008 
00:23 Oct 22, 2009
Jkt 089200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H3896.IH
H3896
jbell on DSKDVH8Z91PROD with BILLS
(1) IN GENERAL.—A State awarded a grant 
under the demonstration project shall, acting 
through the State Office of Rural Health, select not 
less than 5 rural health clinics to receive grant funds 
for the purpose of subsidizing medical malpractice 
insurance costs for health care professionals em-
ployed by such clinics. 
(2) RURAL HEALTH CLINIC APPLICATION.—A 
rural health clinic that desires to receive a grant 
from the State under the demonstration project shall 
submit to the State Office of Rural Health an appli-
cation at such time, in such manner, and containing 
such information as the Secretary may require, in-
cluding assurances that the clinic shall— 
(A) provide access to health care services 
for all individuals, regardless of ability to pay; 
(B) establish a sliding fee scale for low-in-
come patients; 
(C) make health care services available to 
individuals for not less than 20 hours per week; 
and 
(D) meet any other requirements estab-
lished by the Secretary to ensure proper and ef-
ficient use of grant funds. 
VerDate Nov 24 2008 
00:23 Oct 22, 2009
Jkt 089200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H3896.IH
H3896
jbell on DSKDVH8Z91PROD with BILLS
(3) 
REQUIRED
CLINIC
PARTICIPATION.—A 
State awarded a grant under the demonstration 
project shall provide grant funds to at least 1 pro-
vider-based rural health clinic and at least 1 inde-
pendent rural health clinic. 
(4) DISTRIBUTION OF GRANT FUNDS.— 
(A) IN GENERAL.—Subject to paragraph 
(B), a State shall provide each rural health clin-
ic participating in the demonstration project 
with the lesser of— 
(i) $5,000; or 
(ii) 50 percent of the aggregate cost 
of malpractice insurance purchased by 
each physician, physician assistant, nurse 
practitioner, and certified nurse midwife 
(or purchased by the rural health clinic on 
behalf of each physician, physician assist-
ant, nurse practitioner, and certified nurse 
midwife) who, on a weekly basis, provides 
patient care services at the rural health 
clinic for an average of not less than— 
(I) 20 hours per week; or 
(II) 80 percent of the operational 
hours of the clinic. 
VerDate Nov 24 2008 
00:23 Oct 22, 2009
Jkt 089200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H3896.IH
H3896
jbell on DSKDVH8Z91PROD with BILLS
(B) SPECIAL RULE FOR OBSTETRICS AND 
GYNECOLOGY.—Subject to subparagraph (C), in 
the case of a rural health clinic participating in 
the demonstration project that provides obstet-
rical services, a State shall provide such clinic 
with the lesser of— 
(i) $10,000; or 
(ii) 50 percent of the aggregate cost 
of malpractice insurance purchased by 
each physician, physician assistant, nurse 
practitioner, and certified nurse midwife 
(or purchased by the rural health clinic on 
behalf of each physician, physician assist-
ant, nurse practitioner, and certified nurse 
midwife) who provides obstetrical services 
at the rural health clinic. 
(C) AMOUNT OF OBSTETRICAL CARE.—The 
Administrator of the Office of Rural Health 
Policy of the Health Resources and Services 
Administration shall develop standards for the 
amount of obstetrical care that a rural health 
clinic would have to provide in order to qualify 
for a grant under subparagraph (B). 
(f) REPORTING.— 
VerDate Nov 24 2008 
00:23 Oct 22, 2009
Jkt 089200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H3896.IH
H3896
jbell on DSKDVH8Z91PROD with BILLS
(1) ANNUAL
EVALUATIONS
AND
REPORTS.— 
The Secretary, acting through the Administrator of 
the Office of Rural Health Policy of the Health Re-
sources and Services Administration, shall provide 
for an annual evaluation of the demonstration 
project and submit to Congress a report on the sta-
tus of the project. 
(2) FINAL
EVALUATION
AND
REPORT.—Not 
later than 12 months after completion of the dem-
onstration project, the Secretary, acting through the 
Administrator of the Office of Rural Health Policy 
of the Health Resources and Services Administra-
tion, shall prepare and submit to Congress a final 
report and evaluation of the project. The report shall 
include— 
(A) an assessment of the effectiveness of 
the project at recruiting and retaining health 
care professionals in underserved rural areas; 
(B) an assessment of the feasibility and ef-
ficacy of an expansion of the project to all 
States; and 
(C) an evaluation of the project in com-
parison with an expansion of coverage under 
chapter 171 of title 28, United States Code 
(commonly referred to as the ‘‘Federal Tort 
VerDate Nov 24 2008 
00:23 Oct 22, 2009
Jkt 089200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H3896.IH
H3896
jbell on DSKDVH8Z91PROD with BILLS
serting before the last sentence the following: ‘‘A facility 
that is in operation, that qualifies as a rural health clinic 
under this title or title XIX and that subsequently fails 
to satisfy the requirement in clause (i) that the clinic is 
not located in an urbanized area, shall, with respect to 
services furnished on or after the date of enactment of 
the Rural Health Clinic Patient Access and Improvement 
Act of 2009, be considered, for purposes of this title and 
title XIX, as still satisfying such requirement if it is deter-
mined that the clinic is located in an area defined by the 
State and certified by the Secretary as rural.’’. 
SEC. 8. MEDICARE ADVANTAGE PLAN PAYMENTS. 
(a) IN GENERAL.—Section 1857(e) of the Social Se-
curity Act (42 U.S.C. 1395w–27(e)) is amended by adding 
at the end the following: 
‘‘(4) MINIMUM PAYMENT RATE FOR SERVICES 
FURNISHED BY A RURAL HEALTH CLINIC.—A con-
tract under this section between a Medicare Advan-
tage organization and the Secretary for the offering 
of a Medicare Advantage plan shall require the orga-
nization to provide for a payment rate under the 
plan for rural health clinic services furnished to en-
rollees of the plan (whether or not the services are 
furnished pursuant to an agreement between the or-
VerDate Nov 24 2008 
00:23 Oct 22, 2009
Jkt 089200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H3896.IH
H3896
jbell on DSKDVH8Z91PROD with BILLS
ganization and a rural health clinic) that is not less 
than— 
‘‘(A) the applicable payment rate estab-
lished under part A or part B (which includes 
the payment of an interim rate and a subse-
quent cost reconciliation) with respect to the 
rural health clinic for such rural health clinic 
services; or 
‘‘(B) if the rural health clinic determines 
appropriate, 103 percent of the applicable in-
terim payment rate established under part A or 
part B with respect to the rural health clinic for 
such rural health clinic services.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to Medicare Advantage contract 
years beginning on or after January 1, 2010. 
SEC. 9. SENSE OF THE SENATE REGARDING ADEQUACY OF 
NETWORK-BASED HEALTH PLANS. 
It is the sense of the Senate that network-based 
health plans shall— 
(1) be expected to provide a pool of health care 
professionals that is adequate to meet the needs of 
enrollees residing in rural and frontier areas; 
(2) ensure that enrollees residing in rural and 
frontier areas that have been designated by the Fed-
VerDate Nov 24 2008 
00:23 Oct 22, 2009
Jkt 089200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H3896.IH
H3896
jbell on DSKDVH8Z91PROD with BILLS
eral Government or a State government as lacking 
an adequate number of health care professionals are 
provided with reasonable access to an in-network 
provider; 
(3) make every effort to include as part of their 
provider network any State-licensed or certified 
health care professionals (particularly primary care 
and mental health professionals) that are available 
in many underserved rural and frontier areas; and 
(4) recognize that reliance on a physician-only 
network, or forcing enrollees to travel for more than 
30 minutes to receive primary care or mental health 
services from a network provider, does not constitute 
an ‘‘adequate’’ network. The following distances 
should be used as guidelines in determining dis-
tances that correspond to a 30-minute travel time: 
(A) Under normal conditions with primary 
roads available: 20 miles. 
(B) In mountainous terrain or in areas 
with only secondary roads available: 15 miles. 
(C) In flat terrain or in areas connected by 
interstate highways: 25 miles. 
Æ 
VerDate Nov 24 2008 
00:23 Oct 22, 2009
Jkt 089200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6301
E:\BILLS\H3896.IH
H3896
jbell on DSKDVH8Z91PROD with BILLS