‘‘(A) INITIAL BASIS.—Under such system
the Secretary shall provide for computation of
a standard prospective payment amount (or
amounts) as follows:
‘‘(i) Such amount (or amounts) shall
initially be based on the most current au-
dited cost report data available to the Sec-
retary and shall be computed in a manner
so that the total amounts payable under
the system for fiscal year 2001 shall be
equal to the total amount that would have
been made if the system had not been in
effect and if section 1861(v)(1)(L)(ix) had
not been enacted.
‘‘(ii) For fiscal year 2002 and for
each subsequent fiscal year, such amount
(or amounts) shall be equal to the amount
(or amounts) determined under this para-
graph for the previous fiscal year, updated
under subparagraph (B).
Each such amount shall be standardized in a
manner that eliminates the effect of variations
in relative case mix and area wage adjustments
among different home health agencies in a
budget neutral manner consistent with the case
mix and wage level adjustments provided under
paragraph (4)(A). Under the system, the Sec-
retary may recognize regional differences or dif-
ferences based upon whether or not the services
or agency are in an urbanized area.’’.
(b) ELIMINATION OF REPORT.—Section 302(c) of the
Medicare, Medicaid, and SCHIP Balanced Budget Refine-
ment Act of 1999 (Appendix F, 113 Stat. 1501A–360),
as enacted into law by section 1000(a)(6) of Public Law
106–113, and as amended by section 501(b) of BIPA (114
Stat. 2763A–529), is repealed.
(c) EFFECTIVE DATE.—The amendments made by
this section shall take effect as if included in the amend-
ments made by section 501 of BIPA (114 Stat. 2763A–
529) .
SEC. 112. PERMANENT INCREASE FOR HOME HEALTH
SERVICES FURNISHED IN A RURAL AREA.
(a) IN GENERAL.—Section 1895 of the Social Secu-
rity Act (42 U.S.C. 1395fff), as amended by section 504
of BIPA (114 Stat. 2763A–531), is amended by adding
at the end the following new subsection:
‘‘(f) INCREASE
FOR SERVICES FURNISHED
IN
A
RURAL AREA.—
‘‘(1) IN GENERAL.—In the case of home health
services furnished in a rural area (as defined in sec-
tion 1886(d)(2)(D)) on or after April 1, 2001, the
Secretary shall increase the payment amount other-
wise made under this section for such services by 10
percent.
‘‘(2) WAIVER OF BUDGET NEUTRALITY.—The
Secretary shall not reduce the standard prospective
payment amount (or amounts) under this section ap-
plicable to home health services furnished during a
period to offset the increase in payments resulting
from the application of paragraph (1).’’.
(b) CONFORMING
AMENDMENT.—Section 508 of
BIPA (114 Stat. 2763A–533) is repealed.
(c) EFFECTIVE DATE.—The amendments made by
this section shall take effect as if included in the enact-
ment of BIPA.
Subtitle C—Rural Health Clinic
Improvements
SEC. 121. IMPROVEMENT IN RURAL HEALTH CLINIC REIM-
BURSEMENT.
Section 1833(f) of the Social Security Act (42 U.S.C.
1395l(f)) is amended—
(1) in paragraph (1), by striking ‘‘, and’’ at the
end and inserting a semicolon;
(2) in paragraph (2)—
(A) by striking ‘‘in a subsequent year’’ and
inserting ‘‘in 1989 through 2001’’; and
(B) by striking the period at the end and
inserting a semicolon; and
(3) by adding at the end the following new
paragraphs:
‘‘(3) in 2002, at $79 per visit; and
‘‘(4) in a subsequent year, at the limit estab-
lished under this subsection for the previous year in-
creased by the percentage increase in the MEI (as
so defined) applicable to primary care services (as so
defined) furnished as of the first day of that year.’’.
SEC. 122. EXCLUSION OF CERTAIN RURAL HEALTH CLINIC
SERVICES 
AND 
FEDERALLY 
QUALIFIED
HEALTH CENTER SERVICES FROM THE PRO-
SPECTIVE PAYMENT SYSTEM FOR COVERED
SKILLED NURSING FACILITY SERVICES.
(a) IN GENERAL.—Section 1888(e) of the Social Se-
curity Act (42 U.S.C. 1395yy(e)) is amended—
(1) in paragraph (2)(A)(i)(II), by striking
‘‘clauses (ii) and (iii)’’ and inserting ‘‘clauses (ii),
(iii), and (iv)’’; and
(2) by adding at the end of paragraph (2)(A)
the following new clause:
‘‘(iv) EXCLUSION OF CERTAIN RURAL
HEALTH
CLINIC
SERVICES
AND
FEDER-
ALLY QUALIFIED HEALTH CENTER SERV-
ICES.—Services described in this clause
are—
‘‘(I) rural health clinic services
(as defined in section 1861(aa)(1))
that would be described in clause (ii)
if such services were not furnished by
an individual affiliated with a rural
health clinic; and
‘‘(II) Federally qualified health
center services (as defined in section
1861(aa)(3)) that would be described
in clause (ii) if such services were not
furnished by an individual affiliated
with a Federally qualified health cen-
ter.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to services furnished on or after
January 1, 2002.
TITLE II—RURAL GRANT AND
LOAN PROGRAMS FOR INFRA-
STRUCTURE, 
TECHNOLOGY,
AND TELEHEALTH
SEC. 201. CAPITAL INFRASTRUCTURE REVOLVING LOAN
PROGRAM.
(a) IN GENERAL.—Part A of title XVI of the Public
Health Service Act (42 U.S.C. 300q et seq.) is amended
by adding at the end the following new section:
‘‘CAPITAL INFRASTRUCTURE REVOLVING LOAN PROGRAM
‘‘SEC. 1603. (a) AUTHORITY TO MAKE AND GUAR-
ANTEE LOANS.—
‘‘(1) AUTHORITY TO MAKE LOANS.—The Sec-
retary may make loans from the fund established
under section 1602(d) to any rural entity for
projects for capital improvements, including—
‘‘(A) the acquisition of land necessary for
the capital improvements;
‘‘(B) the renovation or modernization of
any building;
‘‘(C) the acquisition or repair of fixed or
major movable equipment; and
‘‘(D) such other project expenses as the
Secretary determines appropriate.
‘‘(2) AUTHORITY TO GUARANTEE LOANS.—
‘‘(A) IN
GENERAL.—The Secretary may
guarantee the payment of principal and interest
for loans made to rural entities for projects for
any capital improvement described in paragraph
(1) to any non-Federal lender.
‘‘(B) INTEREST SUBSIDIES.—In the case
of a guarantee of any loan made to a rural enti-
ty under subparagraph (A), the Secretary may
pay to the holder of such loan and for and on
behalf of the project for which the loan was
made, amounts sufficient to reduce by not more
than 3 percent of the net effective interest rate
otherwise payable on such loan.
‘‘(b) AMOUNT OF LOAN.—The principal amount of
a loan directly made or guaranteed under subsection (a)
for a project for capital improvement may not exceed
$5,000,000.
‘‘(c) FUNDING LIMITATIONS.—
‘‘(1) GOVERNMENT
CREDIT
SUBSIDY
EXPO-
SURE.—The total of the Government credit subsidy
exposure under the Credit Reform Act of 1990 scor-
ing protocol with respect to the loans outstanding at
any time with respect to which guarantees have been
issued, or which have been directly made, under sub-
section (a) may not exceed $50,000,000 per year.
‘‘(2) TOTAL AMOUNTS.—Subject to paragraph
(1), the total of the principal amount of all loans di-
rectly made or guaranteed under subsection (a) may
not exceed $250,000,000 per year.
‘‘(d) 
CAPITAL
ASSESSMENT
AND
PLANNING
GRANTS.—
‘‘(1) NONREPAYABLE
GRANTS.—Subject to
paragraph (2), the Secretary may make a grant to
a rural entity, in an amount not to exceed $50,000,
for purposes of capital assessment and business
planning.
‘‘(2) LIMITATION.—The cumulative total of
grants awarded under this subsection may not ex-
ceed $2,500,000 per year.
‘‘(e) TERMINATION OF AUTHORITY.—The Secretary
may not directly make or guarantee any loan under sub-
section (a) or make a grant under subsection (d) after
September 30, 2006.’’.
(b) RURAL ENTITY DEFINED.—Section 1624 of the
Public Health Service Act (42 U.S.C. 300s–3) is amended
by adding at the end the following new paragraph:
‘‘(15)(A) The term ‘rural entity’ includes—
‘‘(i) a rural health clinic, as defined in sec-
tion 1861(aa)(2) of the Social Security Act;
‘‘(ii) any medical facility with at least 1,
but less than 50 beds that is located in—
‘‘(I) a county that is not part of a
metropolitan statistical area; or
‘‘(II) a rural census tract of a metro-
politan statistical area (as determined
under the most recent modification of the
Goldsmith Modification, originally pub-
lished in the Federal Register on February
27, 1992 (57 Fed. Reg. 6725));
‘‘(iii) a hospital that is classified as a
rural, regional, or national referral center under
section 1886(d)(5)(C) of the Social Security
Act; and
‘‘(iv) a hospital that is a sole community
hospital 
(as 
defined 
in 
section
1886(d)(5)(D)(iii) of the Social Security Act).
‘‘(B) For purposes of subparagraph (A), the
fact that a clinic, facility, or hospital has been geo-
graphically reclassified under the medicare program
under title XVIII of the Social Security Act shall not
preclude a hospital from being considered a rural en-
tity under clause (i) or (ii) of subparagraph (A).’’.
(c) CONFORMING AMENDMENTS.—Section 1602 of
the Public Health Service Act (42 U.S.C. 300q–2) is
amended—
(1) in subsection (b)(2)(D), by inserting ‘‘or
1603(a)(2)(B)’’ after ‘‘1601(a)(2)(B)’’; and
(2) in subsection (d)—
(A) in paragraph (1)(C), by striking ‘‘sec-
tion 1601(a)(2)(B)’’ and inserting ‘‘sections
1601(a)(2)(B) and 1603(a)(2)(B)’’; and
(B) in paragraph (2)(A), by inserting ‘‘or
1603(a)(2)(B)’’ after ‘‘1601(a)(2)(B)’’.
SEC. 202. HIGH TECHNOLOGY ACQUISITION GRANT AND
LOAN PROGRAM.
Subpart I of part D of title III of the Public Health
Service Act (42 U.S.C. 241 et seq.), as amended by section
1501 of the Children’s Health Act of 2000 (Public Law
106–310; 114 Stat. 1146), is amended by adding at the
end the following section:
‘‘SEC. 330I. HIGH TECHNOLOGY ACQUISITION GRANT AND
LOAN PROGRAM.
‘‘(a) ESTABLISHMENT
OF
PROGRAM.—The Sec-
retary, acting through the Director of the Office of Rural
Health Policy of the Health Resources and Services Ad-
ministration, shall establish a high technology acquisition
grant and loan program for the purpose of—
‘‘(1) improving the quality of health care in
rural areas through the acquisition of advanced med-
ical technology;
‘‘(2) fostering the development of the networks
described in section 330A;
‘‘(3) promoting resource sharing between urban
and rural facilities; and
‘‘(4) improving patient safety and outcomes
through the acquisition of high technology, including
software, information services, and staff training.
‘‘(b) GRANTS AND LOANS.—Under the program es-
tablished under subsection (a), the Secretary, acting
through the Director of the Office of Rural Health Policy,
may award grants and make loans to any eligible entity
(as defined in subsection (d)(1)) for any costs incurred
by the eligible entity in acquiring eligible equipment and
services (as defined in subsection (d)(2)).
‘‘(c) LIMITATIONS.—
‘‘(1) IN GENERAL.—Subject to paragraph (2),
the total amount of grants and loans made under
this section to an eligible entity may not exceed
$100,000.
‘‘(2) FEDERAL SHARING.—
‘‘(A) GRANTS.—The amount of any grant
awarded under this section may not exceed 70
percent of the costs to the eligible entity in ac-
quiring eligible equipment and services.
‘‘(B) LOANS.—The amount of any loan
made under this section may not exceed 90 per-
cent of the costs to the eligible entity in acquir-
ing eligible equipment and services.
‘‘(d) DEFINITIONS.—In this section:
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means a hospital, health center, or any other
entity that the Secretary determines is appropriate
that is located in a rural area or region.
‘‘(2) ELIGIBLE EQUIPMENT AND SERVICES.—
The 
term 
‘eligible 
equipment 
and 
services’
includes—
‘‘(A) unit dose distribution systems;
‘‘(B) software, information services, and
staff training;
‘‘(C) wireless devices to transmit medical
orders;
‘‘(D) clinical health care informatics sys-
tems, including bar code systems designed to
avoid medication errors and patient tracking
systems;
‘‘(E) telemedicine technology; and