382 
‘‘(C) be a private nonprofit healthcare fa-
cility which has contracted with, or is otherwise 
funded by, a governmental agency to provide 
healthcare services to low income individuals 
not eligible for assistance under title XVIII or 
title XIX of the Social Security Act, where rev-
enue from such contracts constitute at least 10 
percent of the facility’s operating revenues over 
the prior 3 fiscal years; or 
‘‘(D) be a nonprofit small rural healthcare 
facility (as determined by the Secretary). 
‘‘(3) PRIORITY.—In making payments under 
this section, the Secretary shall give priority to eligi-
ble healthcare entities that are federally qualified 
health centers (as defined in section 1905(l)(2)(B) 
of the Social Security Act), or other similar entities 
at least 50 percent of the patients of which are mi-
nority or low-income individuals. 
‘‘(c) MEETING ADDITIONAL SPECIFIC CRITERIA.— 
Healthcare facilities that are generally eligible for assist-
ance under this subtitle under subsection (b) may apply 
for the specific programs described in this subtitle and 
must meet any additional criteria for participation in such 
programs.
383 
‘‘(d) ASSISTANCE AVAILABLE.—Capital financing as-
sistance available under this subtitle shall include loan 
guarantees, interest rate subsidies, matching loans and di-
rect grants. Healthcare facilities determined to be gen-
erally eligible for assistance under this subtitle may apply 
for and receive more than one type of assistance under 
this subtitle. 
‘‘SEC. 2952A. APPLICATION FOR ASSISTANCE. 
‘‘(a) IN GENERAL.—No healthcare facilities may re-
ceive assistance for a qualifying project under this subtitle 
unless the healthcare facility— 
‘‘(1) has filed with the Secretary, in a form and 
manner specified by the Secretary, with the advice 
and approval of the Trust Fund Board (as described 
in section 2972C(d)), an application for assistance 
under this subtitle; 
‘‘(2) establishes in its application (for its most 
recent cost reporting period) that it meets the cri-
teria for general eligibility under this subtitle; 
‘‘(3) includes a description of the project, in-
cluding the community in which it is located, and 
describes utilization and services characteristics of 
the project and the healthcare facility, and the pa-
tient population that is to be served;
384 
‘‘(4) describes the extent to which the project 
will include the financial participation of State and 
local governments if assistance is granted under this 
subtitle, and all other sources of financing sought 
for the project; and 
‘‘(5) establishes, to the satisfaction of the Sec-
retary and the Trust Fund Board, that the project 
meets the additional criteria for each type of capital 
financing assistance for which it is applying. 
‘‘(b) CRITERIA FOR APPROVAL.—The Secretary, with 
the approval of the Trust Fund Board, shall determine 
for each application for assistance under this subtitle— 
‘‘(1) whether the healthcare facility meets the 
general eligibility criteria under section 2972(b); 
‘‘(2) whether the healthcare facility meets the 
specific eligibility criteria of each type of assistance 
for which it has applied, including whether the 
healthcare facility meets any criteria for priority 
consideration for the type of assistance for which it 
has applied; 
‘‘(3) whether the capital project for which as-
sistance is being requested is a qualifying project 
under this subtitle; and
385 
‘‘(4) whether funds are available, pursuant to 
the limitations of each program, to fully fund the re-
quest for assistance. 
‘‘(c) PRIORITY OF APPLICATIONS.—In addition to 
meeting the criteria otherwise described in this subtitle, 
at the discretion of the Trust Fund Board, the Secretary 
shall give preference to those applications for qualifying 
projects that— 
‘‘(1)(A) are necessary to bring existing safety 
net healthcare facilities into compliance with accredi-
tation standards of fire and life safety, seismic, or 
other related Federal, State or local regulatory 
standards; 
‘‘(B) improve the provision of essential services 
such as emergency medical and trauma services, 
AIDS and infectious disease, perinatal, burn, pri-
mary care, and other services which the Trust Fund 
Board may designate; or 
‘‘(C) provide access to otherwise unavailable es-
sential health services to the indigent and other 
needy persons within the healthcare facility’s terri-
torial area; 
‘‘(2) include specific State or local governmental 
or other non-Federal assurances of financial support
386 
if assistance for a qualifying project is granted 
under this subtitle; and 
‘‘(3) are unlikely to be financed without assist-
ance granted under this subtitle. 
‘‘(d) SUBMISSION OF APPLICATIONS.—Applications 
under this subtitle shall be submitted to the Secretary 
through the Trust Fund Board. If two or more healthcare 
facilities join in the project, the application shall be sub-
mitted by all participating healthcare facilities jointly. 
Such applications shall set forth all of the descriptions, 
plans, specifications, and assurances as required by this 
subtitle and contain other such information as the Trust 
Fund Board shall require. 
‘‘(e) OPPORTUNITY FOR APPEAL.—The Trust Fund 
Board shall afford a healthcare facility applying for a loan 
guarantee under this section an opportunity for a hearing 
if the guarantee is denied. 
‘‘(f) APPLICATIONS
FOR
AMENDMENTS.—Amend-
ment of an approved application shall be subject to ap-
proval in the same manner as an original application. 
‘‘SEC. 2952B. PUBLIC SERVICE RESPONSIBILITIES. 
‘‘(a) IN GENERAL.—Any healthcare facility accepting 
capital financing assistance under this subtitle shall 
agree—
387 
‘‘(1) to make the services of the facility or por-
tion thereof to be constructed, acquired, or modern-
ized available to all persons; and 
‘‘(2) to provide a significant volume of services 
to persons unable to pay therefore, consistent with 
other provisions of this Act and the amount of as-
sistance received under this subtitle. 
‘‘(b) ENFORCEMENT.—The Director of the Office for 
Civil Rights of the Department of Health and Human 
Services shall be given the power to enforce the public 
service responsibilities described in this section. 
‘‘SEC. 2952C. HEALTH SAFETY NET INFRASTRUCTURE 
TRUST FUND. 
‘‘(a) CREATION OF TRUST FUND.—There is estab-
lished in the Treasury of the United States a trust fund 
to be known as the Health Safety Net Infrastructure 
Trust Fund, consisting of such amounts as may be trans-
ferred, appropriated, or credited to such Trust Fund as 
provided in this subtitle. 
‘‘(b) AUTHORIZATION
OF
APPROPRIATIONS
TO 
TRUST FUND.—There are authorized to be appropriated 
to the Trust Fund such sums as may be necessary to carry 
out the purposes of this subtitle. 
‘‘(c) EXPENDITURES FROM TRUST FUND.—Amounts 
in the Trust Fund shall be available, pursuant to appro-
388 
priations Acts, only for making expenditures to carry out 
the purposes of this subtitle. 
‘‘(d) BOARD OF TRUSTEES; COMPOSITION; MEET-
INGS; DUTIES.— 
‘‘(1) IN GENERAL.—There shall be created a 
Health Safety Net Infrastructure Trust Fund Board 
of Trustees composed of the Secretary of Health and 
Human Services, the Secretary of the Treasury, the 
Assistant Secretary for Health, the Director of the 
Office of Minority Health, and the Administrator of 
the Centers for Medicare and Medicaid Services (all 
serving in their ex officio capacities), and 5 public 
members who shall be appointed for 4 year terms by 
the President, from the following categories— 
‘‘(A) one chief health officer from a State; 
‘‘(B) one chief executive officer of a 
healthcare facility that meets the general eligi-
bility criteria of this subtitle; 
‘‘(C) one representative of the financial 
community; and 
‘‘(D) two additional public or consumer 
representatives. 
‘‘(2) DUTIES.—The Board of Trustees shall 
meet no less than quarterly and shall have the re-
sponsibility to approve implementing regulations, to
389 
establish criteria, and to recommend and approve ex-
penditures by the Secretary under the programs set 
forth in this subtitle. 
‘‘(3) MANAGING TRUSTEE.—The Secretary of 
the Treasury shall serve as the Managing Trustee of 
the Trust Fund, and shall be responsible for the in-
vestment of funds. The provisions of subsections (b) 
through (e) of section 1817 of the Social Security 
Act shall apply to the Trust Fund and the Managing 
Trustee of the Trust Fund in the same manner as 
they apply to the Federal Hospital Insurance Trust 
Fund and the Managing Trustee of that Trust 
Fund. 
‘‘SEC. 2952D. ADMINISTRATION. 
‘‘(a) IN GENERAL.—The Administrator of the Cen-
ters for Medicare and Medicaid Services shall serve as Sec-
retary of the Board of Trustees and shall administer the 
programs under this subtitle. 
‘‘(b) LIMITATION ON ADMINISTRATIVE EXPENSES.— 
Not more than 5 percent of the funds annually appro-
priated to the Trust Fund may be available for adminis-
tration of the Trust Fund or programs under this subtitle.
390 
‘‘Subchapter B—Loan Guarantees 
‘‘SEC. 2953. PROVISION OF LOAN GUARANTEES TO SAFETY 
NET HEALTHCARE FACILITIES. 
‘‘(a) IN GENERAL.—The Safety Net Infrastructure 
Trust Fund will provide a Federal guarantee of loan re-
payment, including guarantees of repayment of refi-
nancing loans, to non-Federal lenders making loans to eli-
gible healthcare facilities for healthcare facility replace-
ment (either by construction or acquisition), moderniza-
tion and renovation projects, and capital equipment acqui-
sition. 
‘‘(b) PURPOSES.—The loan guarantee program shall 
be designed by the Trust Fund Board with the goal of 
rebuilding and maintaining the essential health services of 
healthcare facilities eligible for assistance under this sub-
title. 
‘‘SEC. 2953A. ELIGIBLE LOANS. 
‘‘(a) IN GENERAL.—Loan guarantees under this 
chapter are available for loans made to eligible healthcare 
facilities for replacement facilities (either newly con-
structed or acquired), modernization and renovation of ex-
isting facilities, and for capital equipment acquisition. 
‘‘(b) LOAN GUARANTEE MUST BE ESSENTIAL TO 
BOND FINANCING.—Eligible healthcare facilities must 
demonstrate that a Federal loan guarantee is essential to
391 
obtaining bond financing from non-Federal lenders at a 
reasonably affordable rate of interest. 
‘‘(c) ADDITIONAL ELIGIBILITY CRITERIA FOR LOAN 
GUARANTEES.—In order to be eligible for assistance 
under this chapter, a healthcare facility must demonstrate 
that the following criteria are met: 
‘‘(1) The healthcare facility has evidence of an 
ability to meet debt service. 
‘‘(2) The assistance, when considered with other 
resources available to the project, is necessary and 
will restore, improve, or maintain the financial or 
physical soundness of the healthcare facility. 
‘‘(3) The applicant agrees to assume the public 
service responsibilities described in section 2952B. 
‘‘(4) The project is being, or will be, operated 
and managed in accordance with a management-im-
provement-and-operating plan which is designed to 
reduce the operating costs of the project, which has 
been approved by the Trust Fund Board, and which 
includes— 
‘‘(A) a detailed maintenance schedule; 
‘‘(B) a schedule for correcting past defi-
ciencies in maintenance, repairs, and replace-
ments;
392 
‘‘(C) a plan to upgrade the project to meet 
cost-effective energy efficiency standards pre-
scribed by the Trust Fund Board; 
‘‘(D) a plan to improve financial and man-
agement control systems; 
‘‘(E) a detailed annual operating budget 
taking into account such standards for oper-
ating costs in the area as may be determined by 
the Trust Fund Board; and 
‘‘(F) such other requirements as the Trust 
Fund Board may determine. 
‘‘(5) The application includes stringent provi-
sions for continued State or local support of the pro-
gram, both with respect to operating and financial 
capital. 
‘‘(6) The terms, conditions, maturity, security 
(if any), and schedule and amount of repayments 
with respect to the loan are sufficient to protect the 
financial interests of the United States and are oth-
erwise reasonable and in accord with regulation, in-
cluding a determination that the rate of interest 
does not exceed such annual percentage on the prin-
cipal obligation outstanding as the Trust Fund 
Board determines to be reasonable, taking into ac-
count the range of interest rates prevailing in the
393 
private market for similar loans and the risks as-
sumed by the United States. 
‘‘(7) The healthcare facility must meet such 
other additional criteria as the Secretary may im-
pose. 
‘‘(d) STATE OR LOCAL PARTICIPATION.—Projects in 
which State or local governmental entities participate in 
the form of first guarantees of part or all of the total loan 
value shall be given a preference for loan guarantees under 
this chapter. 
‘‘SEC. 2953B. GUARANTEE ALLOTMENTS. 
‘‘(a) IN GENERAL.—$150,000,000 shall be annually 
allocated within the Trust Fund to the loan guarantee pro-
gram established by this chapter in order to create a cu-
mulative reserve in support of loan guarantees. 
‘‘(b) LOAN GUARANTEES FOR RURAL HEALTHCARE 
FACILITIES.—At least 20 percent of the dollar value of 
loan guarantees made under this program during any 
given year shall be allocated for eligible rural healthcare 
facilities, to the extent a sufficient number of applications 
are made by such healthcare facilities. 
‘‘(c) GUARANTEES
FOR SMALL LOANS.—At least 
$200,000,000 of the annual dollar value of loan guaran-
tees made under the program shall be reserved for loans
394 
of under $50,000,000, if there are a sufficient number of 
applicants for loans of that size. 
‘‘(d) SPECIAL RULE FOR REFINANCING LOANS.— 
Not more than 20 percent of the amount allocated each 
year to the loan guarantee program established by this 
chapter may be allocated to guarantee refinancing loans 
during the year. 
‘‘SEC. 2953C. TERMS AND CONDITIONS OF LOAN GUARAN-
TEES. 
‘‘(a) IN GENERAL.—The principal amount of the 
guaranteed loan, when added to any Federal grant assist-
ance made under this subtitle, may not exceed 95 percent 
of the total value of the project, including land. 
‘‘(b) GUARANTEES PROVIDED MAY NOT SUPPLANT 
OTHER FUNDS.—Guarantees provided under this chapter 
may not be used to supplant other forms of State or local 
support. 
‘‘(c) RIGHT
TO
RECOVER
FUNDS.—The United 
States shall be entitled to recover from any applicant 
healthcare facility the amount of payments made pursuant 
to any loan guarantee under this chapter, unless the Trust 
Fund Board for good cause waives its right of recovery, 
and the United States shall, upon making any such pay-
ment pursuant to any such loan guarantee be subrogated 
to all of the rights of the recipients of the payments.
395 
‘‘(d) MODIFICATION OF TERMS.—Loan guarantees 
made under this chapter shall be subject to further terms 
and conditions as the Trust Fund Board determines to 
be necessary to assure that the purposes of this Act will 
be achieved, and any such terms and conditions may be 
modified by the Trust Fund Board to the extent that it 
determines such modifications to be consistent with the 
financial interest of the United States. 
‘‘(e) TERMS ARE INCONTESTABLE ABSENT FRAUD 
OR MISREPRESENTATION.—Any loan guarantee made by 
the Trust Fund Board pursuant to this chapter shall be 
incontestable in the hands of an applicant on whose behalf 
such guarantee is made, and as to any person who makes 
or contracts to make a loan to such applicant in reliance 
thereon, except for fraud or misrepresentation on the part 
of such applicant or other person. 
‘‘SEC. 2953D. PREMIUMS FOR LOAN GUARANTEES. 
‘‘(a) IN GENERAL.—The Trust Fund Board shall de-
termine a reasonable loan insurance premium which shall 
be charged for loan guarantees under this chapter, taking 
into account the availability of the reserves created under 
section 2953B. Premium charges shall be payable in cash 
to the Trust Fund Board, either in full upon issuance, 
or annually in advance. In addition to the premium charge 
herein provided for, the Trust Fund Board is authorized
396 
to charge and collect such amount as it may deem reason-
able for the appraisal of a property or project offered for 
insurance and for the inspection of such property or 
project. 
‘‘(b) PAYMENT IN ADVANCE.—In the event that the 
principal obligation of any loan accepted for insurance 
under this chapter is paid in full prior to the maturity 
date, the Trust Fund Board is authorized in its discretion 
to require the payment by the borrower of an adjusted 
premium charge in such amount as the Board determines 
to be equitable, but not in excess of the aggregate amount 
of the premium charges that the healthcare facility would 
otherwise have been required to pay if the loan had contin-
ued to be insured until maturity date. 
‘‘(c) TRUST FUND BOARD MAY WAIVE PREMIUMS.— 
The Trust Fund Board may in its discretion partially or 
totally waive premiums charged for loan insurance under 
this section for financially distressed healthcare facilities 
(as described by the Secretary). 
‘‘SEC. 2953E. PROCEDURES IN THE EVENT OF LOAN DE-
FAULT. 
‘‘(a) IN GENERAL.—Failure of the borrower to make 
payments due under or provided by the terms of a loan 
accepted for insurance under this chapter shall constitute 
a default.
397 
‘‘(b) ASSIGNMENT OF DEFAULTED LOANS.—If a de-
fault continues for 30 days, then, upon the lender’s trans-
fer to the Trust Fund Board of all its rights and interests 
arising under the defaulted loan or in connection with the 
loan transaction, the lender shall be entitled to debentures 
which, together with a certificate of claim, are equal in 
value to the amount the lender would have received if, on 
the date of transfer, the borrower had repaid the loan in 
full, together with the amount of necessary expenses in-
curred by the lender in connection with the default. 
‘‘(c) FORECLOSURE BY LENDER.—Subject to the ap-
proval of the Trust Fund Board, or as provided in regula-
tions, the lender may foreclose on the property securing 
the defaulted loan. 
‘‘(d) FORECLOSURE BY TRUST FUND BOARD.—The 
Trust Fund Board is authorized to— 
‘‘(1) acquire possession of and title to any prop-
erty securing a defaulted loan by voluntary convey-
ance in extinguishment of the indebtedness, or 
‘‘(2) institute proceedings for foreclosure on the 
property securing any such defaulted loan and pros-
ecute such proceedings to conclusion. 
‘‘(e) HANDLING AND DISPOSAL OF PROPERTY; SET-
TLEMENT OF CLAIMS.—
398 
‘‘(1) PAYMENT FOR CERTAIN EXPENSES.—Not-
withstanding any other provision of law relating to 
the acquisition, handling, or disposal of real and 
other property by the United States, the Trust Fund 
Board shall also have power, for the protection of 
the interests of the Trust Fund, to pay out of the 
Trust Fund all expenses or charges in connection 
with, and to deal with, complete, reconstruct, rent, 
renovate, modernize, insure, make contracts for the 
management of, or establish suitable agencies for 
the management of, or sell for cash or credit or lease 
in its discretion, any property acquired by the Trust 
Fund under this section. 
‘‘(2) 
SETTLEMENT
OF
CLAIMS.—Notwith-
standing any other provision of law, the Trust Fund 
Board shall also have the power to pursue to final 
collection by way of compromise or otherwise all 
claims assigned and transferred to the Trust Fund 
in connection with the assignment, transfer, and de-
livery provided for in this section, and at any time, 
upon default, to foreclose or refrain from foreclosing 
on any property secured by any defaulted loan as-
signed and transferred to or held by the Trust 
Fund.
399 
‘‘(3) 
LIMITATIONS
ON
AUTHORITY.—Sub-
sections (a) and (b) shall not be construed to apply 
to any contract for hazard insurance, or to any pur-
chase or contract for services or supplies on account 
of such property if the amount thereof does not ex-
ceed $1,000. 
‘‘(f) REGULATIONS.—The Trust Fund Board shall 
propose and the Secretary shall promulgate regulations 
governing procedures in the event of a default on a loan 
accepted for insurance under this chapter. 
‘‘Subchapter C—Grants for Urgent Capital 
Needs 
‘‘SEC. 2956. PROVISION OF GRANTS. 
‘‘(a) IN GENERAL.—The Trust Fund Board shall 
make available $400,000,000 in direct grants annually. 
The Secretary, with the approval of the Trust Fund 
Board, shall make direct grants to eligible healthcare fa-
cilities with urgent capital needs. 
‘‘(b) PURPOSES.—Direct grants shall be available to 
eligible healthcare facilities for 3 types of projects: 
‘‘(1) Emergency certification and licensure 
grants would be available to eligible healthcare facili-
ties that are threatened with closure or loss of ac-
creditation or certification of a facility or of essential 
services as a result of life or safety code violations
400 
or similar facility or equipment failures. Such grants 
would provide limited funding for repair and renova-
tion where failure to fund would disrupt the provi-
sion of essential public health services such as emer-
gency care. 
‘‘(2) Emergency grants would be available for 
capital renovation, expansion, or replacement nec-
essary to the maintenance or expansion of essential 
safety and health services such as obstetrics, 
perinatal, emergency and trauma, primary care and 
preventive health services. 
‘‘(3) Planning grants would be available to eli-
gible healthcare facilities who require pre-approval 
assistance to meet regulatory requirements related 
to management and finance in order to apply for 
loans, loan guarantees, and interest subsidies under 
this subtitle. 
‘‘(c) 
PRIORITY
TO
FINANCIALLY
DISTRESSED 
HEALTHCARE FACILITIES.—Priority for direct grants 
under this section would be given to financially distressed 
healthcare facilities (as described by the Secretary). 
‘‘(d) APPLICATION PROCESS.—The Secretary, with 
the approval of the Trust Fund Board, shall create an 
expedited application process for direct grants.
401 
‘‘SEC. 2956A. ELIGIBLE PROJECTS. 
‘‘(a) MATCHING GRANTS.— 
‘‘(1) LIMITATION ON AMOUNT.—Grants for cap-
ital expenditures by eligible healthcare facilities will 
be limited to $25,000,000. 
‘‘(2) MATCHING REQUIREMENT.—At least half 
of the projects funded in a year must receive at least 
50 percent of their funding from State or local 
sources. The remaining projects funded during the 
year could be financed up to 90 percent with a com-
bination of Federal grants and loans. 
‘‘(3) RESERVATION FOR RURAL HEALTHCARE 
FACILITIES.—No less than 20 percent of the grant 
funds in any given year would be reserved for rural 
healthcare facilities, provided that a sufficient num-
ber of applications are approved. 
‘‘(b) PLANNING GRANTS.—Applicants who can dem-
onstrate general qualification for the direct matching loan, 
loan guarantee, or interest subsidy programs under this 
subtitle or eligibility for mortgage insurance under section 
242 of the National Housing Act will be eligible for a 
grant of up to $500,000 to assist in implementation of 
key budgetary and financial systems as well as manage-
ment and governance restructuring.’’.
402 
SEC. 702. ESTABLISHMENT OF ALEJANDRO GARCIA NA-
TIONAL CENTER FOR SOCIAL WORK RE-
SEARCH. 
Title V of the Public Health Service Act (42 U.S.C. 
290aa et seq.) is amended by adding at the end the fol-
lowing: 
‘‘PART J—ALEJANDRO GARCIA NATIONAL 
CENTER FOR SOCIAL WORK RESEARCH 
‘‘SEC. 597. PURPOSE OF CENTER. 
‘‘The general purpose of the Alejandro Garcia Na-
tional Center for Social Work Research (referred to in this 
part as the ‘Center’) is the conduct and support of, and 
dissemination of targeted research on social work methods 
and outcomes related to problems of significant social con-
cern. The Center shall promote research and training de-
signed to inform social work practice, thus increasing the 
knowledge base which promotes a healthier America. In 
addition, the Center shall provide policymakers with em-
pirically-based research information to better understand 
complex social issues and make informed funding decisions 
about service effectiveness and cost efficiency. 
‘‘SEC. 597A. SPECIFIC AUTHORITIES. 
‘‘(a) IN GENERAL.—To carry out the purpose de-
scribed in section 597, the Director of the Center may pro-
vide research training and instruction and establish, in the 
Center and in other nonprofit institutions, research
403 
traineeships and fellowships in the study and investigation 
of the prevention of disease, health promotion, the associa-
tion of socioeconomic status, gender, ethnicity, age, and 
geographical location and health, the social work care of 
persons with and families of individuals with acute and 
chronic illnesses, child abuse, neglect, and youth violence, 
and child and family care to address problems of signifi-
cant social concern especially in underserved populations 
and underserved geographical areas. 
‘‘(b) STIPENDS AND ALLOWANCES.—The Director of 
the Center may provide individuals receiving training and 
instruction or traineeships or fellowships under subsection 
(a) with such stipends and allowances (including amounts 
for travel and subsistence and dependency allowances) as 
the Director determines necessary. 
‘‘(c) GRANTS.—The Director of the Center may make 
grants to nonprofit institutions to provide training and in-
struction and traineeships and fellowships under sub-
section (a). 
‘‘SEC. 597B. ADVISORY COUNCIL. 
‘‘(a) DUTIES.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish an advisory council for the Center that shall ad-
vise, assist, consult with, and make recommenda-
tions to the Secretary and the Director of the Center
404 
on matters related to the activities carried out by 
and through the Center and the policies with respect 
to such activities. 
‘‘(2) GIFTS.—The advisory council for the Cen-
ter may recommend to the Secretary the acceptance, 
in accordance with section 231, of conditional gifts 
for study, investigations, and research and for the 
acquisition of grounds or construction, equipment, or 
maintenance of facilities for the Center. 
‘‘(3) OTHER
DUTIES
AND
FUNCTIONS.—The 
advisory council for the Center— 
‘‘(A)(i) may make recommendations to the 
Director of the Center with respect to research 
to be conducted by the Center; 
‘‘(ii) may review applications for grants 
and cooperative agreements for research or 
training and recommend for approval applica-
tions for projects that demonstrate the prob-
ability of making valuable contributions to 
human knowledge; and 
‘‘(iii) may review any grant, contract, or 
cooperative agreement proposed to be made or 
entered into by the Center; 
‘‘(B) may collect, by correspondence or by 
personal investigation, information relating to
405 
studies that are being carried out in the United 
States or any other country and, with the ap-
proval of the Director of the Center, make such 
information available through appropriate publi-
cations; and 
‘‘(C) may appoint subcommittees and con-
vene workshops and conferences. 
‘‘(b) MEMBERSHIP.— 
‘‘(1) IN GENERAL.—The advisory council shall 
be composed of the ex officio members described in 
paragraph (2) and not more than 18 individuals to 
be appointed by the Secretary under paragraph (3). 
‘‘(2) EX
OFFICIO
MEMBERS.—The ex officio 
members of the advisory council shall include— 
‘‘(A) the Secretary of Health and Human 
Services, the Director of NIH, the Director of 
the Center, the Director of the Office of Behav-
ioral and Social Sciences Research, the Chief 
Social Work Officer of the Veterans’ Adminis-
tration, the Assistant Secretary of Defense for 
Health Affairs, the Associate Director of Pre-
vention Research at the National Institute of 
Mental Health, the Director of the Centers for 
Disease Control and Prevention, the Director of 
the Division of Epidemiology and Services Re-
406 
search, the Assistant Secretary of Health and 
Human Services for the Administration for 
Children and Families, the Assistant Secretary 
of Education for the Office of Educational Re-
search and Improvement, the Assistant Sec-
retary of Housing and Urban Development for 
Community Planning and Development, and the 
Assistant Attorney General for Office of Justice 
Programs (or the designees of such officers); 
and 
‘‘(B) such additional officers or employees 
of the United States as the Secretary deter-
mines necessary for the advisory council to ef-
fectively carry out its functions. 
‘‘(3) APPOINTED
MEMBERS.—The Secretary 
shall appoint not to exceed 18 individuals to the ad-
visory council, of which— 
‘‘(A) not more than two-thirds of such in-
dividual shall be appointed from among the 
leading representatives of the health and sci-
entific disciplines (including public health and 
the behavioral or social sciences) relevant to the 
activities of the Center, and at least 7 such in-
dividuals shall be professional social workers
407 
who are recognized experts in the area of clin-
ical practice, education, policy, or research; and 
‘‘(B) not more than one-third of such indi-
viduals shall be appointed from the general 
public and shall include leaders in fields of pub-
lic policy, law, health policy, economics, and 
management. 
The Secretary shall make appointments to the advi-
sory council in such a manner as to ensure that the 
terms of the members do not all expire in the same 
year. 
‘‘(4) COMPENSATION.—Members of the advi-
sory council who are officers or employees of the 
United States shall not receive any compensation for 
service on the advisory council. The remaining mem-
bers shall receive, for each day (including travel 
time) they are engaged in the performance of the 
functions of the advisory council, compensation at 
rates not to exceed the daily equivalent of the annual 
rate in effect for an individual at grade GS–18 of 
the General Schedule. 
‘‘(c) TERMS.— 
‘‘(1) IN GENERAL.—The term of office of an in-
dividual appointed to the advisory council under sub-
section (b)(3) shall be 4 years, except that any indi-
408 
vidual appointed to fill a vacancy on the advisory 
council shall serve for the remainder of the unex-
pired term. A member may serve after the expiration 
of the member’s term until a successor has been ap-
pointed. 
‘‘(2) REAPPOINTMENTS.—A member of the ad-
visory council who has been appointed under sub-
section (b)(3) for a term of 4 years may not be re-
appointed to the advisory council prior to the expira-
tion of the 2-year period beginning on the date on 
which the prior term expired. 
‘‘(3) VACANCY.—If a vacancy occurs on the ad-
visory council among the members under subsection 
(b)(3), the Secretary shall make an appointment to 
fill that vacancy not later than 90 days after the 
date on which the vacancy occurs. 
‘‘(d) CHAIRPERSON.—The chairperson of the advi-
sory council shall be selected by the Secretary from among 
the members appointed under subsection (b)(3), except 
that the Secretary may select the Director of the Center 
to be the chairperson of the advisory council. The term 
of office of the chairperson shall be 2 years. 
‘‘(e) MEETINGS.—The advisory council shall meet at 
the call of the chairperson or upon the request of the Di-
rector of the Center, but not less than 3 times each fiscal
409 
year. The location of the meetings of the advisory council 
shall be subject to the approval of the Director of the Cen-
ter. 
‘‘(f) ADMINISTRATIVE PROVISIONS.—The Director of 
the Center shall designate a member of the staff of the 
Center to serve as the executive secretary of the advisory 
council. The Director of the Center shall make available 
to the advisory council such staff, information, and other 
assistance as the council may require to carry out its func-
tions. The Director of the Center shall provide orientation 
and training for new members of the advisory council to 
provide such members with such information and training 
as may be appropriate for their effective participation in 
the functions of the advisory council. 
‘‘(g) COMMENTS AND RECOMMENDATIONS.—The ad-
visory council may prepare, for inclusion in the biennial 
report under section 597C— 
‘‘(1) comments with respect to the activities of 
the advisory council in the fiscal years for which the 
report is prepared; 
‘‘(2) comments on the progress of the Center in 
meeting its objectives; and 
‘‘(3) recommendations with respect to the fu-
ture direction and program and policy emphasis of 
the center.
410 
The advisory council may prepare such additional reports 
as it may determine appropriate. 
‘‘SEC. 597C. BIENNIAL REPORT. 
‘‘The Director of the Center, after consultation with 
the advisory council for the Center, shall prepare for inclu-
sion in the biennial report under section 403, a biennial 
report that shall consist of a description of the activities 
of the Center and program policies of the Director of the 
Center in the fiscal years for which the report is prepared. 
The Director of the Center may prepare such additional 
reports as the Director determines appropriate. The Di-
rector of the Center shall provide the advisory council of 
the Center an opportunity for the submission of the writ-
ten comments described in section 597B(g). 
‘‘SEC. 597D. QUARTERLY REPORT. 
‘‘The Director of the Center shall prepare a quarterly 
report to Congress with a summary of findings and policy 
implications from research conducted or supported 
through the Center. 
‘‘SEC. 597E. AUTHORIZATION OF APPROPRIATIONS. 
‘‘For the purpose of carrying out this part, there is 
authorized to be appropriated $30,000,000 for each of the 
fiscal years 2006 through 2010.’’.
411 
SEC. 703. ANNIE DODGE WAUNEKA AND SUSAN LAFLESCHE- 
PICOTTE NATIVE AMERICAN HEALTH AND 
WELLNESS FOUNDATION. 
(a) IN GENERAL.—The Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.) is 
amended by adding at the end the following: 
‘‘TITLE 
VIII—ANNIE 
DODGE 
WAUNEKA 
AND 
SUSAN 
LAFLESCHE-PICOTTE NATIVE 
AMERICAN 
HEALTH 
AND 
WELLNESS FOUNDATION 
‘‘SEC. 801. DEFINITIONS. 
‘‘In this title: 
‘‘(1) BOARD.—The term ‘Board’ means the 
Board of Directors of the Foundation. 
‘‘(2) 
COMMITTEE.—The 
term 
‘Committee’ 
means the Committee for the Establishment of the 
Annie Dodge Wauneka and Susan Laflesche-Picotte 
Native American Health and Wellness Foundation 
established under section 802(f). 
‘‘(3) FOUNDATION.—The term ‘Foundation’ 
means the Annie Dodge Wauneka and Susan 
Laflesche-Picotte Native American Health and 
Wellness Foundation established under section 802. 
‘‘(4) SECRETARY.—The term ‘Secretary’ means 
the Secretary of Health and Human Services.
412 
‘‘(5) SERVICE.—The term ‘Service’ means the 
Indian Health Service of the Department of Health 
and Human Services. 
‘‘SEC. 
802. 
ANNIE 
DODGE 
WAUNEKA 
AND 
SUSAN 
LAFLESCHE-PICOTTE 
NATIVE 
AMERICAN 
HEALTH AND WELLNESS FOUNDATION. 
‘‘(a) IN GENERAL.—As soon as practicable after the 
date of enactment of this title, the Secretary shall estab-
lish, under the laws of the District of Columbia and in 
accordance with this title, the Annie Dodge Wauneka and 
Susan Laflesche-Picotte Native American Health and 
Wellness Foundation. 
‘‘(b) PERPETUAL
EXISTENCE.—The Foundation 
shall have perpetual existence. 
‘‘(c) NATURE OF CORPORATION.—The Foundation— 
‘‘(1) shall be a charitable and nonprofit feder-
ally chartered corporation; and 
‘‘(2) shall not be an agency or instrumentality 
of the United States. 
‘‘(d) PLACE OF INCORPORATION AND DOMICILE.— 
The Foundation shall be incorporated and domiciled in the 
District of Columbia. 
‘‘(e) DUTIES.—The Foundation shall— 
‘‘(1) encourage, accept, and administer private 
gifts of real and personal property, and any income
413 
from or interest in such gifts, for the benefit of, or 
in support of, the mission of the Service; 
‘‘(2) undertake and conduct such other activi-
ties as will further the health and wellness activities 
and opportunities of Native Americans; and 
‘‘(3) participate with and assist Federal, State, 
and tribal governments, agencies, entities, and indi-
viduals in undertaking and conducting activities that 
will further the health and wellness activities and op-
portunities of Native Americans. 
‘‘(f) COMMITTEE FOR THE ESTABLISHMENT OF THE 
ANNIE
DODGE
WAUNEKA
AND
SUSAN
LAFLESCHE- 
PICOTTE NATIVE AMERICAN HEALTH AND WELLNESS 
FOUNDATION.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish the Committee for the Establishment of the 
Annie Dodge Wauneka and Susan Laflesche-Picotte 
Native American Health and Wellness Foundation 
to assist the Secretary in establishing the Founda-
tion. 
‘‘(2) DUTIES.—Not later than 180 days after 
the date of enactment of this section, the Committee 
shall— 
‘‘(A) carry out such activities as are nec-
essary to incorporate the Foundation under the
414 
laws of the District of Columbia, including act-
ing as incorporators of the Foundation; 
‘‘(B) ensure that the Foundation qualifies 
for and maintains the status required to carry 
out this section, until the Board is established; 
‘‘(C) establish the constitution and initial 
bylaws of the Foundation; 
‘‘(D) provide for the initial operation of 
the Foundation, including providing for tem-
porary or interim quarters, equipment, and 
staff; and 
‘‘(E) appoint the initial members of the 
Board in accordance with the constitution and 
initial bylaws of the Foundation. 
‘‘(g) BOARD OF DIRECTORS.— 
‘‘(1) IN
GENERAL.—The Board of Directors 
shall be the governing body of the Foundation. 
‘‘(2) POWERS.—The Board may exercise, or 
provide for the exercise of, the powers of the Foun-
dation. 
‘‘(3) SELECTION.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the number of members of the 
Board, the manner of selection of the members 
(including the filling of vacancies), and the
415 
terms of office of the members shall be as pro-
vided in the constitution and bylaws of the 
Foundation. 
‘‘(B) REQUIREMENTS.— 
‘‘(i) NUMBER
OF
MEMBERS.—The 
Board shall have at least 11 members, who 
shall have staggered terms. 
‘‘(ii) INITIAL VOTING MEMBERS.—The 
initial voting members of the Board— 
‘‘(I) shall be appointed by the 
Committee not later than 180 days 
after the date on which the Founda-
tion is established; and 
‘‘(II) shall have staggered terms. 
‘‘(iii) QUALIFICATION.—The members 
of the Board shall be United States citi-
zens who are knowledgeable or experienced 
in Native American health care and related 
matters. 
‘‘(C) COMPENSATION.—A member of the 
Board shall not receive compensation for service 
as a member, but shall be reimbursed for actual 
and necessary travel and subsistence expenses 
incurred in the performance of the duties of the 
Foundation.
416 
‘‘(h) OFFICERS.— 
‘‘(1) IN GENERAL.—The officers of the Founda-
tion shall be— 
‘‘(A) a secretary, elected from among the 
members of the Board; and 
‘‘(B) any other officers provided for in the 
constitution and bylaws of the Foundation. 
‘‘(2) SECRETARY.—The secretary of the Foun-
dation shall serve, at the direction of the Board, as 
the chief operating officer of the Foundation. 
‘‘(3) ELECTION.—The manner of election, term 
of office, and duties of the officers of the Founda-
tion shall be as provided in the constitution and by-
laws of the Foundation. 
‘‘(i) POWERS.—The Foundation— 
‘‘(1) shall adopt a constitution and bylaws for 
the management of the property of the Foundation 
and the regulation of the affairs of the Foundation; 
‘‘(2) may adopt and alter a corporate seal; 
‘‘(3) may enter into contracts; 
‘‘(4) may acquire (through a gift or otherwise), 
own, lease, encumber, and transfer real or personal 
property as necessary or convenient to carry out the 
purposes of the Foundation; 
‘‘(5) may sue and be sued; and
417 
‘‘(6) may perform any other act necessary and 
proper to carry out the purposes of the Foundation. 
‘‘(j) PRINCIPAL OFFICE.— 
‘‘(1) IN GENERAL.—The principal office of the 
Foundation shall be in the District of Columbia. 
‘‘(2) ACTIVITIES; OFFICES.—The activities of 
the Foundation may be conducted, and offices may 
be maintained, throughout the United States in ac-
cordance with the constitution and bylaws of the 
Foundation. 
‘‘(k) SERVICE OF PROCESS.—The Foundation shall 
comply with the law on service of process of each State 
in which the Foundation is incorporated and of each State 
in which the Foundation carries on activities. 
‘‘(l) LIABILITY
OF OFFICERS, EMPLOYEES, AND 
AGENTS.— 
‘‘(1) IN GENERAL.—The Foundation shall be 
liable for the acts of the officers, employees, and 
agents of the Foundation acting within the scope of 
their authority. 
‘‘(2) PERSONAL LIABILITY.—A member of the 
Board shall be personally liable only for gross neg-
ligence in the performance of the duties of the mem-
ber. 
‘‘(m) RESTRICTIONS.—
418 
‘‘(1) LIMITATION
ON
SPENDING.—Beginning 
with the fiscal year following the first full fiscal year 
during which the Foundation is in operation, the ad-
ministrative costs of the Foundation shall not exceed 
10 percent of the sum of— 
‘‘(A) the amounts transferred to the Foun-
dation under subsection (o) during the pre-
ceding fiscal year; and 
‘‘(B) donations received from private 
sources during the preceding fiscal year. 
‘‘(2) APPOINTMENT AND HIRING.— 
‘‘(A) IN GENERAL.—The appointment of 
officers and employees of the Foundation shall 
be subject to the availability of funds. 
‘‘(B) KNOWLEDGE OF RESERVATION GOV-
ERNANCE
AND
SOCIAL
LIFE.—The Secretary 
shall encourage the Foundation to hire individ-
uals who have an extensive knowledge of res-
ervation governance and social life. 
‘‘(3) STATUS.—A member of the Board or offi-
cer, employee, or agent of the Foundation shall not 
by reason of association with the Foundation be con-
sidered to be an officer, employee, or agent of the 
United States.
419 
‘‘(n) AUDITS.—The Foundation shall comply with 
section 10101 of title 36, United States Code, as if the 
Foundation were a corporation under part B of subtitle 
II of that title. 
‘‘(o) FUNDING.— 
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
subsection (e)(1) $1,000,000 for each fiscal year, as 
adjusted to reflect changes in the Consumer Price 
Index for all-urban consumers published by the De-
partment of Labor. 
‘‘(2) TRANSFER
OF
DONATED
FUNDS.—The 
Secretary shall transfer to the Foundation funds 
held by the Department of Health and Human Serv-
ices under the Act of August 5, 1954 (42 U.S.C. 
2001 et seq.), if the transfer or use of the funds is 
not prohibited by any term under which the funds 
were donated. 
‘‘SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. 
‘‘(a) PROVISION OF SUPPORT BY SECRETARY.—Sub-
ject to subsection (b), during the 5-year period beginning 
on the date on which the Foundation is established, the 
Secretary— 
‘‘(1) may provide personnel, facilities, and other 
administrative support services to the Foundation;
420 
‘‘(2) may provide funds to reimburse the travel 
expenses of the members of the Board; and 
‘‘(3) shall require and accept reimbursements 
from the Foundation for— 
‘‘(A) services provided under paragraph 
(1); and 
‘‘(B) funds provided under paragraph (2). 
‘‘(b) REIMBURSEMENT.—Reimbursements accepted 
under subsection (a)(3)— 
‘‘(1) shall be deposited in the Treasury of the 
United States to the credit of the applicable appro-
priations account; and 
‘‘(2) shall be chargeable for the cost of pro-
viding services described in subsection (a)(1) and 
travel expenses described in subsection (a)(2). 
‘‘(c) CONTINUATION OF CERTAIN SERVICES.—The 
Secretary may continue to provide facilities and necessary 
support services to the Foundation after the termination 
of the 5-year period specified in subsection (a) if the facili-
ties and services— 
‘‘(1) are available; and 
‘‘(2) are provided on reimbursable cost basis.’’. 
(b) TECHNICAL AMENDMENTS.—The Indian Self-De-
termination and Education Assistance Act is amended—
421 
(1) by redesignating title V (as added by sec-
tion 1302 of the American Indian Education Foun-
dation Act of 2000) (25 U.S.C. 458bbb et seq.)) as 
title VII; 
(2) by redesignating sections 501, 502, and 503 
(as added by section 1302 of the American Indian 
Education Foundation Act of 2000) as sections 701, 
702, and 703, respectively; and 
(3) in subsection (a)(2) of section 702 and 
paragraph (2) of section 703 (as redesignated by 
paragraph (2)), by striking ‘‘section 501’’ and in-
serting ‘‘section 701’’. 
Subtitle B—Rural and Underserved 
Urban America Telehealth Pro-
grams 
SEC. 711. INCREASING TYPES OF ORIGINATING TELE-
HEALTH SITES AND FACILITATING THE PRO-
VISION OF TELEHEALTH SERVICES ACROSS 
STATE LINES. 
(a) INCREASING TYPES OF ORIGINATING SITES.— 
Section 1834(m)(4)(C)(ii) of the Social Security Act (42 
U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the 
end the following: 
‘‘(VI) A skilled nursing facility 
(as defined in section 1819(a)).
422 
‘‘(VII) An assisted-living facility 
(as defined by the Secretary). 
‘‘(VIII) A board-and-care home 
(as defined by the Secretary). 
‘‘(IX) A county or community 
health clinic (as defined by the Sec-
retary). 
‘‘(X) A community mental health 
center 
(as 
described 
in 
section 
1861(ff)(2)(B)). 
‘‘(XI) A facility operated by the 
Indian Health Service or by an Indian 
tribe, tribal organization, or an urban 
Indian organization (as such terms 
are defined in section 4 of the Indian 
Health Care Improvement Act (25 
U.S.C. 1603)) directly, or under con-
tract or other arrangement. 
‘‘(XII) A site in a State in which 
the respective State medical board has 
adopted a formal policy regarding li-
censing or certification requirements 
for providers at distant sites who do 
not have a license to practice medicine 
at the originating site.’’.
423 
(b) EXPANDING
ELIGIBILITY
FOR
REIMBURSE-
MENT.—Section 1834(m)(4)(C)(i)(I) of the Social Secu-
rity Act (42 U.S.C. 1395m(m)(4)(C)(i)(I)) is amended by 
striking ‘‘rural’’. 
SEC. 712. STRENGTHENING TELEHEALTH SERVICES IN 
RURAL AND UNDERSERVED URBAN AMERICA. 
Subpart I of part D of title III of the Public Health 
Service Act (42 U.S.C. 254b et seq.) is amended— 
(1) in section 330L— 
(A) by redesignating subsection (b) as sub-
section (c); and 
(B) by inserting after subsection (a) the 
following: 
‘‘(b) CONFERENCE.—Within 1 year of the date of en-
actment of the Telehealth Improvement Act of 2004, the 
Secretary shall convene a conference of State licensing 
boards, local telehealth projects, health care practitioners, 
and patient advocates to promote interstate licensure for 
telehealth projects.’’; and 
(2) by adding at the end the following: 
‘‘SEC. 330M. INTEGRATIVE ELDERCARE TELEHEALTH DEM-
ONSTRATION PROJECT. 
‘‘(a) PURPOSES.—The purposes of this section are to 
encourage the creation of programs to—
424 
‘‘(1) evaluate the use of telehealth services in 
an integrative eldercare setting; 
‘‘(2) eliminate fragmented service delivery while 
promoting enhanced continuity of care and more 
simplified access to services; 
‘‘(3) develop community-based options that pro-
mote patient independence and leverage telehealth 
services and equipment to enable the use of the most 
cost-effective, least restrictive care settings; and 
‘‘(4) promote access for elderly patients in rural 
and underserved urban areas to improvements in 
medical technology and training across an integrated 
spectrum of care; and to make health care services 
more flexible and responsive to the diverse and 
changing needs of elderly patients in rural areas. 
‘‘(b) GRANTS AUTHORIZED.— 
‘‘(1) IN GENERAL.—The Director may award 
grants to eligible providers for projects to dem-
onstrate how telehealth technologies can be used 
through telehealth networks in rural areas, frontier 
communities, and medically underserved areas, and 
for medically underserved populations, to— 
‘‘(A) expand access to, coordinate, and im-
prove the quality of health care services;
425 
‘‘(B) improve and expand the training of 
health care providers; and 
‘‘(C) expand and improve the quality of 
health information available to health care pro-
viders, and patients and their families, for deci-
sionmaking. 
‘‘(2) GRANT
PERIOD.—The Director shall 
award grants under this subsection for a period of 
up to 4 years. 
‘‘(3) NUMBER OF GRANTS.—Not to exceed 20 
grants shall be awarded under this subsection, of 
which at least 1⁄2 shall be dedicated to providing 
services in rural communities. 
‘‘(c) USE OF FUNDS.—Grants awarded pursuant to 
subsection (b) may be used for activities including— 
‘‘(1) improving access to coordinated health 
care services at the lowest intensity and resource 
level of care consistent with quality health care serv-
ices and optimal patient outcomes, improving the 
quality of such care, increasing patient satisfaction 
with such care, and reducing the cost of such care 
through advanced telecommunication technologies; 
‘‘(2) developing effective care management 
practices and educational curricula to train health 
care professionals, paraprofessionals, and caregivers,
426 
including family members, and to increase the gen-
eral level of competency of such individuals through 
such training; and 
‘‘(3) developing curricula to train health care 
professionals, paraprofessionals, and caregivers, in-
cluding 
family 
members, 
serving 
integrative 
eldercare patients in the use of telecommunications. 
‘‘(d) APPLICATIONS.—To be eligible to receive a 
grant under subsection (b), an eligible provider, in con-
sultation with the appropriate State office of rural health 
or another appropriate State entity, shall prepare and sub-
mit to the Director an application, at such time, in such 
manner, and containing such information as the Director 
may require, including— 
‘‘(1) a description of the project that the eligi-
ble entity will carry out using the funds provided 
under the grant; 
‘‘(2) a description of the manner in which the 
project funded under the grant will meet the health 
care needs of rural or other populations to be served 
through the project, or improve the access to serv-
ices of, and the quality of the services received by, 
those populations; 
‘‘(3) evidence of local support for the project, 
and a description of how the areas, communities, or
427 
populations to be served will be involved in the devel-
opment and ongoing operations of the project; 
‘‘(4) a plan for sustaining the project after Fed-
eral support for the project has ended; 
‘‘(5) information on the source and amount of 
non-Federal funds that the entity will provide for 
the project; 
‘‘(6) information demonstrating the long-term 
viability of the project, and other evidence of institu-
tional commitment of the entity to the project; 
‘‘(7) in the case of an application for a project 
involving a telehealth network, information dem-
onstrating how the project will promote the integra-
tion of telehealth technologies into the operations of 
health care providers, to avoid redundancy, and im-
prove access to and the quality of care; and 
‘‘(8) other such information as the Director de-
termines to be appropriate. 
‘‘(e) REPORT.— 
‘‘(1) FINAL REPORT.—Not later than 9 months 
after the date of termination of the last grant to be 
awarded under this section, the Director shall sub-
mit to Congress a final report—
428 
‘‘(A) describing the results of the programs 
funded by grants awarded pursuant to this sec-
tion; and 
‘‘(B) evaluating the impact of the use of 
telehealth services in an integrative eldercare 
setting on— 
‘‘(i) access to care for patients served 
by integrative eldercare programs; and 
‘‘(ii) the quality of, patient satisfac-
tion with, and the cost of, such care. 
‘‘(2) ENSURING ACCESS TO QUALITY CARE.—In 
conducting the evaluation under paragraph (1)(B), 
the Director shall— 
‘‘(A) give special consideration to the im-
pact of programs funded under this section on 
face-to-face access to medical providers; and 
‘‘(B) develop specific measures to evaluate 
the quality of care provided to those partici-
pating in such programs to ensure that tele-
health augments the plan of care. 
‘‘(f) ELIGIBLE PROVIDER.—The term ‘eligible pro-
vider’ means a consortia of home and facility-based care 
providers that includes providers from no less than 2 of 
the following: 
‘‘(1) An adult congregate care facility.
429 
‘‘(2) A continuing care retirement community. 
‘‘(3) An assisted living facility. 
‘‘(4) An Alzheimer’s facility. 
‘‘(5) An institutional hospice facility. 
‘‘(6) A residential care facility. 
‘‘(7) An adult foster home. 
‘‘(8) A State-licensed nursing home, including a 
skilled nursing facility, an intermediate care facility, 
licensed home health provider or other health care 
provider that the Director deems appropriate and 
consistent with the purposes of this section. 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) DIRECTOR; OFFICE.—The terms ‘Director’ 
and ‘Office’ mean the Director of the Office for the 
Advancement of Telehealth and the Office for the 
Advancement of Telehealth. 
‘‘(2) INTEGRATIVE ELDERCARE.—The term ‘in-
tegrative eldercare’ includes case management and 
coordination of care for elderly patients recovering 
from acute illness or coping with chronic disease at 
the lowest intensity and resource level of care con-
sistent with quality health care services and optimal 
patient outcomes.
430 
‘‘(3) TELEHEALTH SERVICES.—The term ‘tele-
health services’ means services provided through 
telehealth technologies. 
‘‘(4) TELEHEALTH TECHNOLOGIES.—The term 
‘telehealth technologies’ means technologies relating 
to the use of electronic information, and tele-
communications technologies, to support and pro-
mote, at a distance, health care, patient and profes-
sional health-related education, health administra-
tion, and public health. 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to the Office for the Ad-
vancement of Telehealth to carry out this section 
$30,000,000 for fiscal year 2006 and such sums as may 
be necessary for each of fiscal years 2007 through 2009. 
‘‘SEC. 330N. AMERICAN INDIAN AND ALASKA NATIVE TELE-
HEALTH DEMONSTRATION PROJECT. 
‘‘(a) PURPOSE.—The purpose of this section is to 
evaluate the use of telehealth services in areas under the 
jurisdiction of Indian tribes or tribal organizations, includ-
ing efforts to develop more effective case management for 
chronic and acute disease and preventive health care pro-
grams. 
‘‘(b) GRANTS AUTHORIZED.—
431 
‘‘(1) IN GENERAL.—The Director may award 
grants to eligible providers, individually or as part of 
a network of eligible providers, for the provision of 
telehealth services to improve patient care, prevent 
health care complications, improve patient outcomes, 
and achieve efficiencies in the delivery of care to pa-
tients who reside in areas under the jurisdiction of 
Indian tribes or tribal organizations. 
‘‘(2) GRANT
PERIOD.—The Director shall 
award grants under this section for a period of up 
to 4 years. 
‘‘(3) NUMBER OF GRANTS.—Not to exceed 20 
grants shall be awarded under this section, of which 
at least 1⁄2 shall be dedicated to providing services 
in rural communities. 
‘‘(c) USE OF FUNDS.—Grants awarded under this 
section may be used for activities including— 
‘‘(1) improving access to care for home care pa-
tients served by eligible providers, improving the 
quality of such care, increasing patient satisfaction 
with such care, and reducing the cost of such care 
through advanced telecommunication technologies; 
‘‘(2) developing effective telehealth management 
practices and educational curricula to train health 
professionals and paraprofessionals and increase
432 
their general level of competency through such train-
ing; and 
‘‘(3) developing curricula to train health care 
professionals and paraprofessionals serving patients 
of eligible providers in the use of telecommuni-
cations. 
‘‘(d) COLLABORATION.—The Director shall ensure 
that eligible providers receiving grants under this section 
collaborate to enable comparisons across programs and to 
share relevant, de-identified information to better facili-
tate program performance evaluation. 
‘‘(e) APPLICATIONS.—To be eligible to receive a grant 
under subsection (b), 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 application, at such time, in such manner, and 
containing such information as the Director may require, 
including— 
‘‘(1) a description of the project that the eligi-
ble entity will carry out using the funds provided 
under the grant; 
‘‘(2) a description of the manner in which the 
project funded under the grant will meet the health 
care needs of rural or other populations to be served 
through the project, or improve the access to serv-
433 
ices of, and the quality of the services received by, 
those populations; 
‘‘(3) evidence of local support for the project, 
and a description of how the areas, communities, or 
populations to be served will be involved in the devel-
opment and ongoing operations of the project; 
‘‘(4) a plan for sustaining the project after Fed-
eral support for the project has ended; 
‘‘(5) information on the source and amount of 
non-Federal funds that the entity will provide for 
the project; 
‘‘(6) information demonstrating the long-term 
viability of the project, and other evidence of institu-
tional commitment of the entity to the project; 
‘‘(7) in the case of an application for a project 
involving a telehealth network, information dem-
onstrating how the project will promote the integra-
tion of telehealth technologies into the operations of 
health care providers, to avoid redundancy, and im-
prove access to and the quality of care; and 
‘‘(8) other such information as the Director de-
termines to be appropriate. 
‘‘(f) REPORT.— 
‘‘(1) FINAL REPORT.—Not later than 9 months 
after the date of termination of the last grant to be
434 
awarded under this section, the Director shall sub-
mit to Congress a final report— 
‘‘(A) describing the results of the programs 
funded by grants awarded pursuant to this sec-
tion; and 
‘‘(B) evaluating the impact of telehealth 
services in an institutional long-term care set-
ting on— 
‘‘(i) access to care for patients of eli-
gible providers; and 
‘‘(ii) the quality of, patient satisfac-
tion with, and the cost of, such care. 
‘‘(2) ENSURING ACCESS TO QUALITY CARE.—In 
conducting the evaluation under paragraph (1)(B), 
the Director shall— 
‘‘(A) give special consideration to the im-
pact of programs funded under this section on 
face-to-face access to medical providers; and 
‘‘(B) develop specific measures to evaluate 
the quality of care provided to those partici-
pating in such programs to ensure that tele-
medicine augments the plan of care. 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) DIRECTOR; OFFICE.—The terms ‘Director’ 
and ‘Office’ mean the Director of the Office for the
435 
Advancement of Telehealth and the Office for the 
Advancement of Telehealth. 
‘‘(2) ELIGIBLE PROVIDER.—The term ‘eligible 
provider’ includes any public or private nonprofit 
health care provider a majority of whose patient 
practice is Native American or any Indian tribe or 
tribal organization that provides health care services 
for its members. 
‘‘(3) INDIAN TRIBE.—The term ‘Indian tribe’ 
has the meaning given such term in section 4 of the 
Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450b). 
‘‘(4) NATIVE
AMERICAN.—The term ‘Native 
American’ means a member of an Indian tribe, a 
Native Hawaiian (as defined in section 338K(c)), or 
a Native American Pacific Islander. 
‘‘(5) NATIVE AMERICAN PACIFIC ISLANDER.— 
The term ‘Native American Pacific Islander’ means 
an individual who is indigenous to a United States 
territory or possession located in the Pacific Ocean. 
‘‘(6) TRIBAL ORGANIZATION.—The term ‘tribal 
organization’ has the meaning given such term in 
section 4 of the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450b).
436 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$30,000,000 for fiscal year 2006 and such sums as may 
be necessary for each of fiscal years 2007 through 2009. 
‘‘SEC. 330O. ORAL HEALTH TELEHEALTH DEMONSTRATION 
PROJECT. 
‘‘(a) PURPOSE.—The purpose of this section is to 
evaluate the use of telehealth services to expand access 
to oral health services and improve oral health outcomes 
among rural and underserved urban patients. 
‘‘(b) GRANTS AUTHORIZED.— 
‘‘(1) IN GENERAL.—The Director is authorized 
to award competitive grants to eligible providers, in-
dividually or as part of a network of eligible pro-
viders, for the provision of oral health services to im-
prove patient care, prevent health care complica-
tions, improve patient outcomes, and achieve effi-
ciencies in the delivery of oral health care to patients 
who reside in rural areas. 
‘‘(2) GRANT
PERIOD.—The Director shall 
award grants under this section for a period of up 
to 4 years. 
‘‘(3) NUMBER
OF
GRANTS.—The number of 
grants awarded under this section shall not exceed 
10 grants.
437 
‘‘(c) USE OF FUNDS.—Grants awarded pursuant to 
subsection (b) may be used for activities including— 
‘‘(1) improving access to care for rural and un-
derserved urban patients served by eligible providers, 
improving the quality of that care, increasing patient 
satisfaction with that care, and reducing the cost of 
that care through advanced telecommunication tech-
nologies; 
‘‘(2) developing effective oral telehealth care 
management practices and educational curricula to 
train oral health professionals and paraprofessionals 
and increase their general level of competency 
through that training; and 
‘‘(3) developing curricula to train health care 
professionals and paraprofessionals, serving rural 
and underserved urban patients in the use of tele-
communications. 
‘‘(d) APPLICATIONS.—To be eligible to receive a 
grant under subsection (b), an eligible entity, in consulta-
tion with the appropriate State office of rural health or 
another appropriate State entity, shall prepare and submit 
to the Director an application, at such time, in such man-
ner, and containing such information as the Director may 
require, including—
438 
‘‘(1) a description of the project that the eligi-
ble entity will carry out using the funds provided 
under the grant; 
‘‘(2) a description of the manner in which the 
project funded under the grant will meet the health 
care needs of rural or other populations to be served 
through the project, or improve the access to serv-
ices of, and the quality of the services received by, 
those populations; 
‘‘(3) evidence of local support for the project, 
and a description of how the areas, communities, or 
populations to be served will be involved in the devel-
opment and ongoing operations of the project; 
‘‘(4) a plan for sustaining the project after Fed-
eral support for the project has ended; 
‘‘(5) information on the source and amount of 
non-Federal funds that the entity will provide for 
the project; 
‘‘(6) information demonstrating the long-term 
viability of the project, and other evidence of institu-
tional commitment of the entity to the project; 
‘‘(7) in the case of an application for a project 
involving a telehealth network, information dem-
onstrating how the project will promote the integra-
tion of telehealth technologies into the operations of
439 
health care providers, to avoid redundancy, and im-
prove access to and the quality of care; and 
‘‘(8) other such information as the Director de-
termines to be appropriate. 
‘‘(e) REPORT.— 
‘‘(1) FINAL REPORT.—Not later than 9 months 
after the date of termination of the last grant to be 
awarded under this section, the Director shall sub-
mit to Congress a final report— 
‘‘(A) describing the results of the programs 
funded by grants awarded pursuant to this sec-
tion; and 
‘‘(B) including an evaluation of the impact 
of the use of oral telehealth services on— 
‘‘(i) access to oral health care for 
rural patients; and 
‘‘(ii) the quality of, patient satisfac-
tion with, and the cost of, that care. 
‘‘(2) ENSURING ACCESS TO QUALITY CARE.—In 
conducting the evaluation under paragraph (1)(B), 
the Director shall— 
‘‘(A) give special consideration to the im-
pact of programs funded under this section on 
face-to-face access to medical providers; and
440 
‘‘(B) develop specific measures to evaluate 
the quality of care provided to those partici-
pating in such programs to ensure that tele-
medicine augments the plan of care. 
‘‘(f) DEFINITION OF ELIGIBLE PROVIDER.—In this 
section the term ‘eligible provider’ includes dentists, 
periodontists, orthodontists, dental and oral health clinics, 
and schools of dentistry and oral health, where a majority 
of the patient population resides in a rural area, and may 
include other rural oral health providers that the Director 
deems appropriate. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$30,000,000 for fiscal year 2006 and such sums as may 
be necessary for each of fiscal years 2007 through 2009.’’. 
SEC. 713. JOINT WORKING GROUP ON TELEHEALTH. 
(a) IN GENERAL.— 
(1) REPRESENTATION OF RURAL AREAS.—The 
Secretary of Health and Human Services shall es-
tablish, within the Health Resources and Services 
Administration Office for the Advancement of Tele-
health, and under the leadership of the Director of 
the Office for the Advancement of Telehealth, a 
Joint Working Group on Telehealth. In establishing 
such Group, the Secretary shall ensure that all rel-
441 
evant Federal agencies are represented and that 
input from relevant industry groups, including rep-
resentatives of rural areas and medically under-
served areas, is fully considered. 
(2) MISSION.—The mission of the Joint Work-
ing Group on Telehealth is— 
(A) to identify, monitor, and coordinate 
Federal telehealth projects, data sets, and pro-
grams; 
(B) to analyze— 
(i) how telehealth systems are expand-
ing access to health care services, edu-
cation, and information; 
(ii) the clinical, educational, or admin-
istrative efficacy and cost-effectiveness of 
telehealth applications; and 
(iii) the quality of the telehealth serv-
ices delivered; and 
(C) to make further recommendations for 
coordinating Federal and State efforts to in-
crease access to health services, education, and 
information in rural and medically underserved 
areas. 
(3) ANNUAL REPORTS.—Not later than 2 years 
after the date of enactment of this Act, and each