I
104TH CONGRESS
1ST SESSION
H. R. 2411
To provide assistance for the establishment of community rural health net-
works in chronically underserved areas, to provide incentives for providers
of health care services to furnish services in such areas, and for other
purposes.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 27, 1995
Mr. ROBERTS (for himself, Mr. STENHOLM, Mr. GUNDERSON, and Mr.
POSHARD) introduced the following bill; which was referred to the Com-
mittee on Commerce, and in addition to the Committees on Ways and
Means and the Judiciary, for a period to be subsequently determined by
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned
A BILL
To provide assistance for the establishment of community
rural health networks in chronically underserved areas,
to provide incentives for providers of health care services
to furnish services in such areas, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Rural Health Development Act’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—GRANTS TO ENCOURAGE ESTABLISHMENT OF
COMMUNITY RURAL HEALTH NETWORKS
Sec. 101. Assistance for implementation of access plans for chronically under-
served areas.
Sec. 102. Technical assistance grants for networks.
Sec. 103. Development grants for networks.
Sec. 104. Definitions.
TITLE II—INCENTIVES FOR HEALTH PROFESSIONALS TO
PRACTICE IN RURAL AREAS
Subtitle A—National Health Service Corps Program
Sec. 201. National Health Service Corps loan repayments excluded from gross
income.
Sec. 202. Study regarding designation as health professional shortage area; al-
location of Corps members among shortage areas.
Sec. 203. Other provisions regarding National Health Service Corps.
Subtitle B—Incentives Under Other Programs
Sec. 211. Additional payments under medicare for physicians’ services fur-
nished in shortage areas.
Sec. 212. Development of model State scope of practice law.
TITLE III—ASSISTANCE FOR INSTITUTIONAL PROVIDERS
Subtitle A—Hospital-Affiliated Primary Care Centers
Sec. 301. Hospital-affiliated primary care centers.
Subtitle B—Assistance to Rural Providers Under Medicare
Sec. 311. Establishment of rural emergency access care hospitals.
Sec. 312. Coverage of and payment for services.
Sec. 313. Effective date.
Subtitle C—Demonstration Projects to Encourage Primary Care and Rural-
Based Graduate Medical Education
Sec. 321. State and consortium demonstration projects.
Sec. 322. Goals for projects.
Sec. 323. Definitions.
TITLE IV—MEDICARE PAYMENT METHODOLOGIES
Sec. 401. Telemedicine services.
Sec. 402. HMO-risk contract program.
TITLE V—HOSPITAL ANTITRUST FAIRNESS
Sec. 501. Antitrust exemption.
Sec. 502. Requirements.
Sec. 503. Definition.
TITLE VI—FINANCING
Sec. 601. Increase in medicare part B premium for individuals with high in-
come.
Sec. 602. Termination of certain grant programs.
TITLE I—GRANTS TO ENCOUR-
AGE 
ESTABLISHMENT 
OF
COMMUNITY RURAL HEALTH
NETWORKS
SEC. 101. ASSISTANCE FOR DEVELOPMENT OF ACCESS
PLANS FOR CHRONICALLY UNDERSERVED
AREAS.
(a) AVAILABILITY OF FINANCIAL ASSISTANCE TO IM-
PLEMENT ACTION PLANS TO INCREASE ACCESS.—
(1) IN GENERAL.—The Secretary shall provide
grants (in amounts determined in accordance with
paragraph (3)) over a 3-year period to an eligible
State for the development of plans to increase access
to health care services during such period for resi-
dents of areas in the State that are designated as
chronically underserved areas in accordance with
subsection (b).
(2) ELIGIBILITY REQUIREMENTS.—A State is
eligible to receive grants under this section if the
State submits to the Secretary (at such time and in
such form as the Secretary may require) assurances
that the State has developed (or is in the process of
developing) a plan to increase the access of residents
of a chronically underserved area to health care serv-
ices that meets the requirements of subsection (c),
together with such other information and assurances
as the Secretary may require.
(3) AMOUNT OF ASSISTANCE.—
(A) IN
GENERAL.—Subject to subpara-
graph (B), the amount of assistance provided to
a State under this subsection with respect to
any plan during a 3-year period shall be equal
to—
(i) for the first year of the period, an
amount equal to 100 percent of the
amounts expended by the State during the
year to implement the plan described in
paragraph (1) (as reported to the Sec-
retary in accordance with such require-
ments as the Secretary may impose);
(ii) for the second year of the period,
an amount equal to 50 percent of the
amounts expended by the State during the
year to implement the plan; and
(iii) for the third year of the period,
an amount equal to 33 percent of the
amounts expended by the State during the
year to implement the plan.
(B) AGGREGATE
PER
PLAN
LIMIT.—The
amount of assistance provided to a State under
this subsection with respect to any plan may
not exceed $100,000 during any year of the 3-
year period for which the State receives assist-
ance.
(b) DESIGNATION OF AREAS.—
(1) DESIGNATION BY GOVERNOR.—In accord-
ance with the guidelines developed under paragraph
(2), the Governor of a State may designate an area
in the State as a chronically underserved area for
purposes of this section upon the request of a local
official of the area or upon the Governor’s initiative.
(2) GUIDELINES FOR DESIGNATION.—
(A) DEVELOPMENT BY SECRETARY.—Not
later than 1 year after the date of the enact-
ment of this Act, the Secretary shall develop
guidelines for the designation of areas as chron-
ically underserved areas under this section.
(B) FACTORS CONSIDERED IN DEVELOP-
MENT
OF
GUIDELINES.—In developing guide-
lines under paragraph (1), the Secretary shall
consider the following factors:
quirements of this section if the Secretary finds that the
plan was developed with the participation of health care
providers and facilities and residents of the area that is
the subject of the plan, together with such other require-
ments as the Secretary may impose.
(d) AUTHORIZATION
OF APPROPRIATIONS.—There
are authorized to be appropriated for assistance under this
section $10,000,000 for each of the first 3 fiscal years
beginning after the date on which the Secretary develops
guidelines for the designation of areas as chronically un-
derserved areas under subsection (b)(2).
SEC. 102. TECHNICAL ASSISTANCE GRANTS FOR NET-
WORKS.
(a) IN GENERAL.—The Secretary shall make funds
available under this section to provide technical assistance
(including information regarding eligibility for other Fed-
eral programs) and advice for entities described in sub-
section (b) seeking to establish or enhance a community
rural health network in an underserved rural area.
(b) ENTITIES ELIGIBLE TO RECEIVE FUNDS.—The
following entities are eligible to receive funds for technical
assistance under this section:
(1) An entity receiving a grant under section
103.
(2) A State or unit of local government.
(3) An entity providing health care services (in-
cluding health professional education services) in the
area involved.
(c) USE OF FUNDS.—
(1) IN GENERAL.—Funds made available under
this section may be used—
(A) for planning a community rural health
network and the submission of the plan for the
network to the Secretary under section 103(c)
(subject to the limitation described in para-
graph (2));
(B) to provide assistance in conducting
community-based needs and prioritization, iden-
tifying existing regional health resources, and
developing networks, utilizing existing local pro-
viders and facilities where appropriate;
(C) to provide advice on obtaining the
proper balance of primary and secondary facili-
ties for the population served by the network;
(D) to provide assistance in coordinating
arrangements for tertiary care;
(E) to provide assistance in recruitment
and retention of health care professionals;
(F) to provide assistance in coordinating
the delivery of emergency services with the pro-
vision of other health care services in the area
served by the network;
(G) to provide assistance in coordinating
arrangements for mental health and substance
abuse treatment services; and
(H) to provide information regarding the
area or proposed network’s eligibility for Fed-
eral and State assistance for health care-related
activities, together with information on funds
available through private sources.
(2) LIMITATION ON AMOUNT AVAILABLE FOR
DEVELOPMENT OF NETWORK.—The amount of fi-
nancial assistance available for activities described in
paragraph (1) may not exceed $50,000 and may not
be available for a period of time exceeding 1 year.
(d) USE OF RURAL HEALTH OFFICES.—In carrying
out this section with respect to entities in rural areas, the
Secretary shall make funds available through the State of-
fices of rural health or through appropriate entities des-
ignated by such offices.
(e) AUTHORIZATION
OF APPROPRIATIONS.—There
are authorized to be appropriated $10,000,000 for each
of fiscal years 1996 through 2000 to carry out this sec-
tion. Amounts appropriated under this section shall be
available until expended.
SEC. 103. DEVELOPMENT GRANTS FOR NETWORKS.
(a) IN GENERAL.—The Secretary shall provide finan-
cial assistance to eligible entities for the purpose of provid-
ing for the development and implementation of community
rural health networks (as defined in section 104). In pro-
viding such assistance, the Secretary shall give priority to
eligible entities that will carry out such purpose in States
that have developed a plan under section 101.
(b) ELIGIBLE ENTITIES.—
(1) IN GENERAL.—An entity is eligible to re-
ceive financial assistance under this section only if
the entity meets the requirements of subparagraphs
(A) through (C) as follows:
(A) The entity—
(i) is based in a rural area;
(ii) is described in paragraph (2), (3),
or (4) of section 102(b); or
(iii) is a hospital-affiliated primary
care center (as defined in section 104).
(B) The entity is undertaking to develop
and implement a community rural health net-
work in one or more underserved rural areas
(as defined in section 104) with the active par-
ticipation of at least 3 health care providers or
facilities in the area.
(C) The entity has consulted with the local
governments of the area to be served by the
network and with individuals who reside in the
area.
(2) COORDINATION WITH PROVIDERS OUTSIDE
OF AREA PERMITTED.—Nothing in this section shall
be construed as preventing an entity that coordi-
nates the delivery of services in an underserved rural
area with an entity outside the area from qualifying
for financial assistance under this section, or as pre-
venting an entity consisting of a consortia of mem-
bers located in adjoining States from qualifying for
such assistance.
(3) PERMITTING
ENTITIES
NOT
RECEIVING
FUNDING FOR DEVELOPMENT OF PLAN TO RECEIVE
FUNDING FOR IMPLEMENTATION.—An entity that is
eligible to receive financial assistance under this sec-
tion may receive assistance to carry out activities de-
scribed in subsection (c)(1)(B) notwithstanding that
the entity does not receive assistance to carry out
activities described in subsection (c)(1)(A).
(c) USE OF FUNDS.—
(1) IN
GENERAL.—Financial assistance made
available to eligible entities under this section may
be used only—
(A) for the development of a community
health network and the submission of the plan
for the network to the Secretary; and
(B) after the Secretary approves the plan
for the network, for activities to implement the
network, including (but not limited to)—
(i) establishing information systems,
including telecommunications,
(ii) recruiting health care providers,
(iii) providing services to enable indi-
viduals to have access to health care serv-
ices, including transportation and language
interpretation services (including interpre-
tation services for the hearing-impaired),
and
(iv) establishing and operating a com-
munity health advisor program described
in paragraph (2).
(2) COMMUNITY HEALTH ADVISOR PROGRAM.—
(A) PROGRAM DESCRIBED.—In paragraph
(1), a ‘‘community health advisor program’’ is
a program under which community health advi-
sors carry out the following activities:
(i) Collaborating efforts with health
care providers and related entities to facili-
tate the provision of health services and
health-related social services.
(ii) Providing public education on
health promotion and disease prevention
and efforts to facilitate the use of available
health services and health-related social
services.
(iii) Providing health-related counsel-
ing.
(iv) Making referrals for available
health services and health-related social
services.
(v) Improving the ability of individ-
uals to use health services and health-relat-
ed social services under Federal, State,
and local programs through assisting indi-
viduals in establishing eligibility under the
programs.
(vi) Providing outreach services to in-
form the community of the availability of
the services provided under the program.
(B) COMMUNITY
HEALTH
ADVISOR
DE-
FINED.—In subparagraph (A), the term ‘‘com-
munity health advisor’’ means, with respect to
a community health advisor program, an indi-
vidual—
(i) who has demonstrated the capacity
to carry out one or more of the activities
carried out under the program; and
(ii) who, for not less than one year,
has been a resident of the community in
which the program is to be operated.
(3) LIMITATIONS ON ACTIVITIES FUNDED.—Fi-
nancial assistance made available under this section
may not be used for any of the following:
(A) For a telecommunications system un-
less such system is coordinated with, and does
not duplicate, a system existing in the area.
(B) For construction or remodeling of
health care facilities.
(4) LIMITATION ON AMOUNT AVAILABLE FOR
DEVELOPMENT OF NETWORK.—The amount of fi-
nancial assistance available for activities described in
paragraph (1)(A) may not exceed $50,000 and may
not be made available for a period of time exceeding
1 year.
(d) APPLICATION.—
(1) IN GENERAL.—No financial assistance shall
be provided under this section to an entity unless
the entity has submitted to the Secretary, in a time
and manner specified by the Secretary, and had ap-
proved by the Secretary an application.
(2) INFORMATION
TO
BE
INCLUDED.—Each
such application shall include—
(A) a description of the community rural
health network, including service area and ca-
pacity, and
(B) a description of how the proposed net-
work will utilize existing health care facilities in
a manner that avoids unnecessary duplication.
(e) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—There are authorized to be
appropriated $100,000,000 for each of fiscal years
1996 through 2000 to carry out this section.
Amounts appropriated under this section shall be
available until expended.
(2) ANNUAL LIMIT ON ASSISTANCE TO GRANT-
EE.—The amount of financial assistance provided to
an entity under this section during a year may not
exceed $250,000.
SEC. 104. DEFINITIONS.
(a) IN GENERAL.—
(1) COMMUNITY RURAL HEALTH NETWORK.—
For purposes of this title, the term ‘‘community
rural health network’’ means a formal cooperative
arrangement between participating hospitals, physi-
cians, and other health care providers which—
(A) is located in an underserved rural
area;
(B) furnishes health care services to indi-
viduals residing in the area; and
(C) is governed by a board of directors se-
lected by participating health care providers
and residents of the area.
(2) HOSPITAL-AFFILIATED PRIMARY CARE CEN-
TER.—
(A) IN GENERAL.—For purposes of this
title, the term ‘‘hospital-affiliated primary care
center’’ means a distinct administrative unit of
a community hospital (as defined in subpara-
graph (B)) meeting the following requirement:
(i) The unit is located in, or adjacent
to, the hospital.
(ii) The unit delivers primary health
services, as defined in paragraph (1) of
section 330(b) of the Public Health Service
Act to a catchment area determined by the
hospital and approved by the Secretary.
(iii) The unit provides referrals to
providers of supplemental health services,
as defined in paragraph (2) of such sec-
tion.
(iv) The services of the unit are deliv-
ered through a primary care group practice
(as defined in subparagraph (C)).
(v) To the extent practicable, primary
health services in the community hospital
are delivered only through the unit.
(vi) Qualified personnel trained in
triage are placed in the unit, the emer-
gency room, and the outpatient department
to screen and direct patients to the appro-
priate location for care.
(vii) Each patient of the unit has an
identified member of the group practice re-
sponsible for continuous management of
the patient, including emergency services
and referrals of the patients for inpatient
or outpatient services.
(viii) To the extent practicable, excess
facilities and equipment in or owned by the
community hospital are covered for use in
the unit.