110TH CONGRESS 
2D SESSION 
H. R. 1343 
AN ACT 
To amend the Public Health Service Act to provide additional 
authorizations of appropriations for the health centers 
program under section 330 of such Act, 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. 
This Act may be cited as the ‘‘Health Centers Re-
newal Act of 2008’’. 
SEC. 2. ADDITIONAL AUTHORIZATIONS OF APPROPRIA-
TIONS FOR HEALTH CENTERS PROGRAM. 
Section 330(r)(1) of the Public Health Service Act 
(42 U.S.C. 254b(r)(1)) is amended to read as follows: 
‘‘(1) IN
GENERAL.—For the purpose of car-
rying out this section, in addition to the amounts 
authorized to be appropriated under subsection (d), 
there are authorized to be appropriated— 
‘‘(A) for fiscal year 2008, $2,213,020,000; 
‘‘(B) for fiscal year 2009, $2,451,394,400; 
‘‘(C) for fiscal year 2010, $2,757,818,700; 
‘‘(D) for fiscal year 2011, $3,116,335,131; 
and 
‘‘(E) 
for 
fiscal 
year 
2012, 
$3,537,040,374.’’. 
SEC. 3. RECOGNITION OF HIGH POVERTY AREAS. 
(a) IN GENERAL.—Section 330(c) of the Public 
Health Service Act (42 U.S.C. 254b(c)) is amended by 
adding at the end the following new paragraph: 
‘‘(3) 
RECOGNITION
OF
HIGH
POVERTY 
AREAS.—
‘‘(A) IN
GENERAL.—In making grants 
under this subsection, the Secretary may recog-
nize the unique needs of high poverty areas. 
‘‘(B) HIGH POVERTY AREA DEFINED.—For 
purposes of subparagraph (A), the term ‘high 
poverty area’ means a catchment area which is 
established in a manner that is consistent with 
the factors in subsection (k)(3)(J), and the pov-
erty rate of which is greater than the national 
average poverty rate as determined by the Bu-
reau of the Census.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to grants made on or after Jan-
uary 1, 2009. 
SEC. 4. LIABILITY PROTECTIONS FOR HEALTH CENTER 
VOLUNTEER PRACTITIONERS. 
(a) IN GENERAL.—Section 224 of the Public Health 
Service Act (42 U.S.C. 233) is amended— 
(1) in subsection (g)(1)(A)— 
(A) in the first sentence, by striking ‘‘or 
employee’’ and inserting ‘‘employee, or (subject 
to subsection (k)(4)) volunteer practitioner’’; 
and
(B) in the second sentence, by inserting 
‘‘and subsection (k)(4)’’ after ‘‘subject to para-
graph (5)’’; and 
(2) in each of subsections (g), (i), (j), (k), (l), 
and (m)— 
(A) by striking the term ‘‘employee, or 
contractor’’ each place such term appears and 
inserting ‘‘employee, volunteer practitioner, or 
contractor’’; 
(B) by striking the term ‘‘employee, and 
contractor’’ each place such term appears and 
inserting ‘‘employee, volunteer practitioner, and 
contractor’’; 
(C) by striking the term ‘‘employee, or any 
contractor’’ each place such term appears and 
inserting ‘‘employee, volunteer practitioner, or 
contractor’’; and 
(D) by striking the term ‘‘employees, or 
contractors’’ each place such term appears and 
inserting ‘‘employees, volunteer practitioners, or 
contractors’’. 
(b) APPLICABILITY; DEFINITION.—Section 224(k) of 
the Public Health Service Act (42 U.S.C. 233(k)) is 
amended by adding at the end the following paragraph:
‘‘(4)(A) Subsections (g) through (m) apply with re-
spect to volunteer practitioners beginning with the first 
fiscal year for which an appropriations Act provides that 
amounts in the fund under paragraph (2) are available 
with respect to such practitioners. 
‘‘(B) For purposes of subsections (g) through (m), 
the term ‘volunteer practitioner’ means a practitioner who, 
with respect to an entity described in subsection (g)(4), 
meets the following conditions: 
‘‘(i) In the State involved, the practitioner is a 
licensed physician, a licensed clinical psychologist, or 
other licensed or certified health care practitioner. 
‘‘(ii) At the request of such entity, the practi-
tioner provides services to patients of the entity, at 
a site at which the entity operates or at a site des-
ignated by the entity. The weekly number of hours 
of services provided to the patients by the practi-
tioner is not a factor with respect to meeting condi-
tions under this subparagraph. 
‘‘(iii) The practitioner does not for the provision 
of such services receive any compensation from such 
patients, from the entity, or from third-party payors 
(including reimbursement under any insurance pol-
icy or health plan, or under any Federal or State 
health benefits program).’’.
SEC. 5. LIABILITY PROTECTIONS FOR HEALTH CENTER 
PRACTITIONERS PROVIDING SERVICES IN 
EMERGENCY AREAS. 
Section 224(g) of the Public Health Service Act (42 
U.S.C. 233(g)) is amended— 
(1) in paragraph (1)(B)(ii), by striking ‘‘sub-
paragraph (C)’’ and inserting ‘‘subparagraph (C) 
and paragraph (6)’’; and 
(2) by adding at the end the following para-
graph: 
‘‘(6)(A) Subject to subparagraph (C), paragraph 
(1)(B)(ii) applies to health services provided to individuals 
who are not patients of the entity involved if, as deter-
mined under criteria issued by the Secretary, the following 
conditions are met: 
‘‘(i) The services are provided by a contractor, 
volunteer practitioner (as defined in subsection 
(k)(4)(B)), or employee of the entity who is a physi-
cian or other licensed or certified health care practi-
tioner and who is otherwise deemed to be an em-
ployee for purposes of paragraph (1)(A) when pro-
viding services with respect to the entity. 
‘‘(ii) The services are provided in an emergency 
area (as defined in subparagraph (D)), with respect 
to a public health emergency or major disaster de-
scribed in subparagraph (D), and during the period
for which such emergency or disaster is determined 
or declared, respectively. 
‘‘(iii) The services of the contractor, volunteer 
practitioner, or employee (referred to in this para-
graph as the ‘out-of-area practitioner’) are provided 
under an arrangement with— 
‘‘(I) an entity that is deemed to be an em-
ployee for purposes of paragraph (1)(A) and 
that serves the emergency area involved (re-
ferred to in this paragraph as an ‘emergency- 
area entity’); or 
‘‘(II) a Federal agency that has respon-
sibilities regarding the provision of health serv-
ices in such area during the emergency. 
‘‘(iv) The purposes of the arrangement are— 
‘‘(I) to coordinate, to the extent prac-
ticable, the provision of health services in the 
emergency area by the out-of-area practitioner 
with the provision of services by the emergency- 
area entity, or by the Federal agency, as the 
case may be; 
‘‘(II) to identify a location in the emer-
gency area to which such practitioner should re-
port for purposes of providing health services, 
and to identify an individual or individuals in
the area to whom the practitioner should report 
for such purposes; and 
‘‘(III) to verify the identity of the practi-
tioner and that the practitioner is licensed or 
certified by one or more of the States. 
‘‘(v) With respect to the licensure or certifi-
cation of health care practitioners, the provision of 
services by the out-of-area practitioner in the emer-
gency area is not a violation of the law of the State 
in which the area is located. 
‘‘(B) In issuing criteria under subparagraph (A), the 
Secretary shall take into account the need to rapidly enter 
into arrangements under such subparagraph in order to 
provide health services in emergency areas promptly after 
the emergency begins. 
‘‘(C) Subparagraph (A) applies with respect to an act 
or omission of an out-of-area practitioner only to the ex-
tent that the practitioner is not immune from liability for 
such act or omission under the Volunteer Protection Act 
of 1997. 
‘‘(D) For purposes of this paragraph, the term ‘emer-
gency area’ means a geographic area for which— 
‘‘(i) the Secretary has made a determination 
under section 319 that a public health emergency 
exists; or
‘‘(ii) a presidential declaration of major disaster 
has been issued under section 401 of the Robert T. 
Stafford Disaster Relief and Emergency Assistance 
Act.’’. 
SEC. 6. DEMONSTRATION PROJECT FOR INTEGRATED 
HEALTH SYSTEMS TO EXPAND ACCESS TO 
PRIMARY AND PREVENTIVE SERVICES FOR 
THE MEDICALLY UNDERSERVED. 
Part D of title III of the Public Health Service Act 
(42 U.S.C. 259b et seq.) is amended by adding at the end 
the following new subpart: 
‘‘Subpart XI—Demonstration Project for Integrated 
Health Systems to Expand Access to Primary 
and Preventive Services for the Medically Un-
derserved 
‘‘SEC. 340H. DEMONSTRATION PROJECT FOR INTEGRATED 
HEALTH SYSTEMS TO EXPAND ACCESS TO 
PRIMARY AND PREVENTIVE CARE FOR THE 
MEDICALLY UNDERSERVED. 
‘‘(a) ESTABLISHMENT OF DEMONSTRATION.— 
‘‘(1) IN GENERAL.—Not later than January 1, 
2009, the Secretary shall establish a demonstration 
project (hereafter in this section referred to as the 
‘demonstration’) under which up to 30 qualifying in-
tegrated health systems receive grants for the costs
of their operations to expand access to primary and 
preventive services for the medically underserved. 
‘‘(2) RULE
OF
CONSTRUCTION.—Nothing in 
this section shall be construed as authorizing grants 
to be made or used for the costs of specialty care or 
hospital care furnished by an integrated health sys-
tem. 
‘‘(b) APPLICATION.—Any integrated health system 
desiring to participate in the demonstration shall submit 
an application in such manner, at such time, and con-
taining such information as the Secretary may require. 
‘‘(c) CRITERIA FOR SELECTION.—In selecting inte-
grated health systems to participate in the demonstration 
(hereafter in this section referred to as ‘participating inte-
grated health systems’), the Secretary shall ensure rep-
resentation of integrated health systems that are located 
in a variety of States (including the District of Columbia 
and the territories and possessions of the United States) 
and locations within States, including rural areas, inner- 
city areas, and frontier areas. 
‘‘(d) DURATION.—Subject to the availability of ap-
propriations, the demonstration shall be conducted (and 
operating grants be made to each participating integrated 
health system) for a period of 3 years. 
‘‘(e) REPORTS.—
‘‘(1) IN GENERAL.—The Secretary shall submit 
to the appropriate committees of the Congress in-
terim and final reports with respect to the dem-
onstration, with an interim report being submitted 
not later than 3 months after the demonstration has 
been in operation for 24 months and a final report 
being submitted not later than 3 months after the 
close of the demonstration. 
‘‘(2) CONTENT.—Such reports shall evaluate 
the effectiveness of the demonstration in providing 
greater access to primary and preventive care for 
medically underserved populations, and how the co-
ordinated approach offered by integrated health sys-
tems contributes to improved patient outcomes. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) IN GENERAL.—There is authorized to be 
appropriated $25,000,000 for each of the fiscal 
years 2009, 2010, and 2011 to carry out this sec-
tion. 
‘‘(2) CONSTRUCTION.—Nothing in this section 
shall be construed as requiring or authorizing a re-
duction in the amounts appropriated for grants to 
health centers under section 330 for the fiscal years 
referred to in paragraph (1). 
‘‘(g) DEFINITIONS.—For purposes of this section:
‘‘(1) FRONTIER
AREA.—The term ‘frontier 
area’ has the meaning given to such term in regula-
tions promulgated pursuant to section 330I(r). 
‘‘(2) INTEGRATED HEALTH SYSTEM.—The term 
‘integrated health system’ means a health system 
that— 
‘‘(A) has a demonstrated capacity and 
commitment to provide a full range of primary 
care, specialty care, and hospital care in both 
inpatient and outpatient settings; and 
‘‘(B) is organized to provide such care in 
a coordinated fashion. 
‘‘(3) QUALIFYING
INTEGRATED
HEALTH
SYS-
TEM.— 
‘‘(A) IN GENERAL.—The term ‘qualifying 
integrated health system’ means a public or pri-
vate nonprofit entity that is an integrated 
health system that meets the requirements of 
subparagraph (B) and serves a medically under-
served population (either through the staff and 
supporting resources of the integrated health 
system or through contracts or cooperative ar-
rangements) by providing—
‘‘(i) required primary and preventive 
health and related services (as defined in 
paragraph (4)); and 
‘‘(ii) as may be appropriate for a pop-
ulation served by a particular integrated 
health system, integrative health services 
(as defined in paragraph (5)) that are nec-
essary for the adequate support of the re-
quired primary and preventive health and 
related services and that improve care co-
ordination. 
‘‘(B) OTHER
REQUIREMENTS.—The re-
quirements of this subparagraph are that the 
integrated health system— 
‘‘(i) will make the required primary 
and preventive health and related services 
of the integrated health system available 
and accessible in the service area of the in-
tegrated health system promptly, as appro-
priate, and in a manner which assures con-
tinuity; 
‘‘(ii) will demonstrate financial re-
sponsibility by the use of such accounting 
procedures and other requirements as may 
be prescribed by the Secretary;
‘‘(iii) provides or will provide services 
to individuals who are eligible for medical 
assistance under title XIX of the Social 
Security Act or for assistance under title 
XXI of such Act; 
‘‘(iv) has prepared a schedule of fees 
or payments for the provision of its serv-
ices consistent with locally prevailing rates 
or charges and designed to cover its rea-
sonable costs of operation and has pre-
pared a corresponding schedule of dis-
counts to be applied to the payment of 
such fees or payments, which discounts are 
adjusted on the basis of the patient’s abil-
ity to pay; 
‘‘(v) will assure that no patient will be 
denied health care services due to an indi-
vidual’s inability to pay for such services; 
‘‘(vi) will assure that any fees or pay-
ments required by the system for such 
services will be reduced or waived to enable 
the system to fulfill the assurance de-
scribed in clause (v); 
‘‘(vii) provides assurances that any 
grant funds will be expended to supple-