295 
of the customary or other charge and any limitation 
under section 1861(v)(1)(U), or 
‘‘(2) the amount of payment provided for under 
the prospective payment system for covered OPD 
services under section 1833(t).’’. 
(3) EXEMPTION FROM 30-PERCENT REDUCTION 
IN
REIMBURSEMENT
FOR
BAD
DEBT.—Section 
1861(v)(1)(T) 
of 
such 
Act 
(42 
U.S.C. 
1395x(v)(1)(T)) is amended by inserting ‘‘(other 
than for a rural community hospital)’’ after ‘‘In de-
termining such reasonable costs for hospitals’’. 
(c) BENEFICIARY COST-SHARING FOR OUTPATIENT 
SERVICES.—Section 1834(n) of such Act (as added by 
subsection (b)(2)) is amended— 
(1) by redesignating paragraphs (1) and (2) as 
subparagraphs (A) and (B), respectively; 
(2) by inserting ‘‘(1)’’ after ‘‘(n)’’; and 
(3) by adding at the end the following: 
‘‘(2) The amounts of beneficiary cost-sharing for out-
patient services furnished in a rural community hospital 
under this part shall be as follows: 
‘‘(A) For items and services that would have 
been paid under section 1833(t) if provided by a 
hospital, the amount of cost-sharing determined 
under paragraph (8) of such section. 
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‘‘(B) For items and services that would have 
been paid under section 1833(h) if furnished by a 
provider or supplier, no cost-sharing shall apply. 
‘‘(C) For all other items and services, the 
amount of cost-sharing that would apply to the item 
or service under the methodology that would be used 
to determine payment for such item or service if pro-
vided by a physician, provider, or supplier, as the 
case may be.’’. 
(d) CONFORMING AMENDMENTS.— 
(1) PART
A
PAYMENT.—Section 1814(b) of 
such Act (42 U.S.C. 1395f(b)) is amended in the 
matter preceding paragraph (1) by inserting ‘‘other 
than inpatient hospital services furnished by a rural 
community hospital,’’ after ‘‘critical access hospital 
services,’’. 
(2) PART
B
PAYMENT.—Section 1833(a) of 
such Act (42 U.S.C. 1395l(a)) is amended— 
(A) in paragraph (2), in the matter before 
subparagraph (A), by striking ‘‘and (I)’’ and in-
serting ‘‘(I), and (K)’’; 
(B) by striking ‘‘and’’ at the end of para-
graph (8); 
(C) by striking the period at the end of 
paragraph (9) and inserting ‘‘; and’’; and 
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(D) by adding at the end the following: 
‘‘(10) in the case of outpatient services fur-
nished by a rural community hospital, the amounts 
described in section 1834(n).’’. 
(3) TECHNICAL AMENDMENTS.— 
(A) CONSULTATION
WITH
STATE
AGEN-
CIES.—Section 1863 of such Act (42 U.S.C. 
1395z) is amended by striking ‘‘and (dd)(2)’’ 
and inserting ‘‘(dd)(2), (mm)(1), and (iii)(1)’’. 
(B) 
PROVIDER
AGREEMENTS.—Section 
1866(a)(2)(A) 
of 
such 
Act 
(42 
U.S.C. 
1395cc(a)(2)(A)) is amended by inserting ‘‘sec-
tion 1834(n)(2),’’ after ‘‘section 1833(b),’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after October 1, 2009. 
SEC. 
525. 
MEDICARE 
REMOTE 
MONITORING 
PILOT 
PROJECTS. 
(a) PILOT PROJECTS.— 
(1) IN
GENERAL.—Not later than 9 months 
after the date of enactment of this Act, the Sec-
retary of Health and Human Services (in this sec-
tion referred to as the ‘‘Secretary’’) shall conduct 
pilot projects under title XVIII of the Social Secu-
rity Act for the purpose of providing incentives to 
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home health agencies to utilize home monitoring and 
communications technologies that— 
(A) enhance health outcomes for Medicare 
beneficiaries; and 
(B) reduce expenditures under such title. 
(2) SITE REQUIREMENTS.— 
(A) URBAN AND RURAL.—The Secretary 
shall conduct the pilot projects under this sec-
tion in both urban and rural areas. 
(B) SITE IN A SMALL STATE.—The Sec-
retary shall conduct at least 3 of the pilot 
projects in a State with a population of less 
than 1,000,000. 
(3) DEFINITION OF HOME HEALTH AGENCY.— 
In this section, the term ‘‘home health agency’’ has 
the meaning given that term in section 1861(o) of 
the Social Security Act (42 U.S.C. 1395x(o)). 
(b) MEDICARE BENEFICIARIES WITHIN THE SCOPE 
OF PROJECTS.—The Secretary shall specify the criteria 
for identifying those Medicare beneficiaries who shall be 
considered within the scope of the pilot projects under this 
section for purposes of the application of subsection (c) 
and for the assessment of the effectiveness of the home 
health agency in achieving the objectives of this section. 
Such criteria may provide for the inclusion in the projects 
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of Medicare beneficiaries who begin receiving home health 
services under title XVIII of the Social Security Act after 
the date of the implementation of the projects. 
(c) INCENTIVES.— 
(1) PERFORMANCE
TARGETS.—The Secretary 
shall establish for each home health agency partici-
pating in a pilot project under this section a per-
formance target using one of the following meth-
odologies, as determined appropriate by the Sec-
retary: 
(A) ADJUSTED HISTORICAL PERFORMANCE 
TARGET.—The Secretary shall establish for the 
agency— 
(i) a base expenditure amount equal 
to the average total payments made to the 
agency under parts A and B of title XVIII 
of the Social Security Act for Medicare 
beneficiaries determined to be within the 
scope of the pilot project in a base period 
determined by the Secretary; and 
(ii) an annual per capita expenditure 
target for such beneficiaries, reflecting the 
base expenditure amount adjusted for risk 
and adjusted growth rates. 
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(B) COMPARATIVE
PERFORMANCE
TAR-
GET.—The Secretary shall establish for the 
agency a comparative performance target equal 
to the average total payments under such parts 
A and B during the pilot project for comparable 
individuals in the same geographic area that 
are not determined to be within the scope of the 
pilot project. 
(2) INCENTIVE.—Subject to paragraph (3), the 
Secretary shall pay to each participating home care 
agency an incentive payment for each year under the 
pilot project equal to a portion of the Medicare sav-
ings realized for such year relative to the perform-
ance target under paragraph (1). 
(3) LIMITATION ON EXPENDITURES.—The Sec-
retary shall limit incentive payments under this sec-
tion in order to ensure that the aggregate expendi-
tures under title XVIII of the Social Security Act 
(including incentive payments under this subsection) 
do not exceed the amount that the Secretary esti-
mates would have been expended if the pilot projects 
under this section had not been implemented. 
(d) WAIVER AUTHORITY.—The Secretary may waive 
such provisions of titles XI and XVIII of the Social Secu-
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rity Act as the Secretary determines to be appropriate for 
the conduct of the pilot projects under this section. 
(e) REPORT TO CONGRESS.—Not later than 5 years 
after the date that the first pilot project under this section 
is implemented, the Secretary shall submit to Congress a 
report on the pilot projects. Such report shall contain a 
detailed description of issues related to the expansion of 
the projects under subsection (f) and recommendations for 
such legislation and administrative actions as the Sec-
retary considers appropriate. 
(f) EXPANSION.—If the Secretary determines that 
any of the pilot projects under this section enhance health 
outcomes for Medicare beneficiaries and reduce expendi-
tures under title XVIII of the Social Security Act, the Sec-
retary may initiate comparable projects in additional 
areas. 
(g) INCENTIVE PAYMENTS HAVE NO EFFECT ON 
OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen-
tive payment under this section— 
(1) shall be in addition to the payments that a 
home health agency would otherwise receive under 
title XVIII of the Social Security Act for the provi-
sion of home health services; and 
(2) shall have no effect on the amount of such 
payments. 
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SEC. 526. RURAL HEALTH QUALITY ADVISORY COMMISSION 
AND DEMONSTRATION PROJECTS. 
(a) RURAL HEALTH QUALITY ADVISORY COMMIS-
SION.— 
(1) 
ESTABLISHMENT.—Not 
later 
than 
months after the date of the enactment of this sec-
tion, the Secretary of Health and Human Services 
(in this section referred to as the ‘‘Secretary’’) shall 
establish a commission to be known as the Rural 
Health Quality Advisory Commission (in this section 
referred to as the ‘‘Commission’’). 
(2) DUTIES OF COMMISSION.— 
(A) NATIONAL
PLAN.—The Commission 
shall develop, coordinate, and facilitate imple-
mentation of a national plan for rural health 
quality improvement. The national plan shall— 
(i) identify objectives for rural health 
quality improvement; 
(ii) identify strategies to eliminate 
known gaps in rural health system capacity 
and improve rural health quality; and 
(iii) provide for Federal programs to 
identify opportunities for strengthening 
and aligning policies and programs to im-
prove rural health quality. 
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(B) 
DEMONSTRATION
PROJECTS.—The 
Commission shall design demonstration projects 
to test alternative models for rural health qual-
ity improvement, including with respect to both 
personal and population health. 
(C) MONITORING.—The Commission shall 
monitor progress toward the objectives identi-
fied pursuant to paragraph (1)(A). 
(3) MEMBERSHIP.— 
(A) NUMBER.—The Commission shall be 
composed of 11 members appointed by the Sec-
retary. 
(B) SELECTION.—The Secretary shall se-
lect the members of the Commission from 
among individuals with significant rural health 
care and health care quality expertise, including 
expertise in clinical health care, health care 
quality research, population or public health, or 
purchaser organizations. 
(4) CONTRACTING AUTHORITY.—Subject to the 
availability of funds, the Commission may enter into 
contracts and make other arrangements, as may be 
necessary to carry out the duties described in para-
graph (2). 
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304 
(5) STAFF.—Upon the request of the Commis-
sion, the Secretary may detail, on a reimbursable 
basis, any of the personnel of the Office of Rural 
Health Policy of the Health Resources and Services 
Administration, the Agency for Health Care Quality 
and Research, or the Centers for Medicare & Med-
icaid Services to the Commission to assist in car-
rying out this subsection. 
(6) REPORTS TO CONGRESS.—Not later than 1 
year after the establishment of the Commission, and 
annually thereafter, the Commission shall submit a 
report to the Congress on rural health quality. Each 
such report shall include the following: 
(A) An inventory of relevant programs and 
recommendations for improved coordination and 
integration of policy and programs. 
(B) An assessment of achievement of the 
objectives identified in the national plan devel-
oped under paragraph (2) and recommenda-
tions for realizing such objectives. 
(C) Recommendations on Federal legisla-
tion, regulations, or administrative policies to 
enhance rural health quality and outcomes. 
(b) RURAL
HEALTH
QUALITY
DEMONSTRATION 
PROJECTS.— 
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(1) IN
GENERAL.—Not later than 270 days 
after the date of the enactment of this section, the 
Secretary, in consultation with the Rural Health 
Quality Advisory Commission, the Office of Rural 
Health Policy of the Health Resources and Services 
Administration, the Agency for Healthcare Research 
and Quality, and the Centers for Medicare & Med-
icaid Services, shall make grants to eligible entities 
for 5 demonstration projects to implement and 
evaluate methods for improving the quality of health 
care in rural communities. Each such demonstration 
project shall include— 
(A) alternative community models that— 
(i) will achieve greater integration of 
personal and population health services; 
and 
(ii) 
address 
safety, 
effectiveness, 
patient- or community-centeredness, timeli-
ness, efficiency, and equity (the six aims 
identified by the Institute of Medicine of 
the National Academies in its report enti-
tled ‘‘Crossing the Quality Chasm: A New 
Health System for the 21st Century’’ re-
leased on March 1, 2001); 
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health care providers, rural health care researchers, 
and private and non-profit groups (including na-
tional associations) which are undertaking similar 
efforts. 
(4) EXPEDITED WAIVERS.—The Secretary shall 
expedite the processing of any waiver that— 
(A) is authorized under title XVIII or XIX 
of the Social Security Act (42 U.S.C. 1395 et 
seq.); and 
(B) is necessary to carry out a demonstra-
tion project under this subsection. 
(5) DEMONSTRATION
PROJECT
SITES.—The 
Secretary shall ensure that the 5 demonstration 
projects funded under this subsection are conducted 
at a variety of sites representing the diversity of 
rural communities in the Nation. 
(6) DURATION.—Each demonstration project 
under this subsection shall be for a period of 4 
years. 
(7) INDEPENDENT
EVALUATION.—The Sec-
retary shall enter into an arrangement with an enti-
ty that has experience working directly with rural 
health systems for the conduct of an independent 
evaluation of the program carried out under this 
subsection. 
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(8) REPORT.—Not later than one year after the 
conclusion of all of the demonstration projects fund-
ed under this subsection, the Secretary shall submit 
a report to the Congress on the results of such 
projects. The report shall include— 
(A) an evaluation of patient access to care, 
patient outcomes, and an analysis of the cost 
effectiveness of each such project; and 
(B) recommendations on Federal legisla-
tion, regulations, or administrative policies to 
enhance rural health quality and outcomes. 
(c) APPROPRIATION.— 
(1) IN GENERAL.—Out of funds in the Treas-
ury not otherwise appropriated, there are appro-
priated to the Secretary to carry out this section 
$30,000,000 for the period of fiscal years 2010 
through 2014. 
(2) AVAILABILITY.— 
(A) IN
GENERAL.—Funds appropriated 
under paragraph (1) shall remain available for 
expenditure through fiscal year 2014. 
(B) REPORT.—For purposes of carrying 
out subsection (b)(8), funds appropriated under 
paragraph (1) shall remain available for ex-
penditure through fiscal year 2015. 
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(3) RESERVATION.—Of the amount appro-
priated under paragraph (1), the Secretary shall re-
serve— 
(A) $5,000,000 to carry out subsection (a); 
and 
(B) $25,000,000 to carry out subsection 
(b), of which— 
(i) 2 percent shall be for the provision 
of technical assistance to grant recipients; 
and 
(ii) 5 percent shall be for independent 
evaluation under subsection (b)(7). 
SEC. 527. RURAL HEALTH CARE SERVICES. 
Section 330A of the Public Health Service Act (42 
U.S.C. 254c) is amended to read as follows: 
‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 
RURAL HEALTH NETWORK DEVELOPMENT, 
DELTA RURAL DISPARITIES AND HEALTH 
SYSTEMS DEVELOPMENT, AND SMALL RURAL 
HEALTH CARE PROVIDER QUALITY IMPROVE-
MENT GRANT PROGRAMS. 
‘‘(a) PURPOSE.—The purpose of this section is to 
provide for grants— 
‘‘(1) under subsection (b), to promote rural 
health care services outreach; 
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‘‘(2) under subsection (c), to provide for the 
planning and implementation of integrated health 
care networks in rural areas; 
‘‘(3) under subsection (d), to assist rural com-
munities in the Delta Region to reduce health dis-
parities and to promote and enhance health system 
development; and 
‘‘(4) under subsection (e), to provide for the 
planning and implementation of small rural health 
care provider quality improvement activities. 
‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH 
GRANTS.— 
‘‘(1) GRANTS.—The Director of the Office of 
Rural Health Policy of the Health Resources and 
Services Administration may award grants to eligible 
entities to promote rural health care services out-
reach by expanding the delivery of health care serv-
ices to include new and enhanced services in rural 
areas. The Director may award the grants for peri-
ods of not more than 3 years. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a 
grant under this subsection for a project, an enti-
ty— 
‘‘(A) shall be a rural public or rural non-
profit private entity, a facility that qualifies as 
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a rural health clinic under title XVIII of the 
Social Security Act, a public or nonprofit entity 
existing exclusively to provide services to mi-
grant and seasonal farm workers in rural areas, 
or a tribal government whose grant-funded ac-
tivities will be conducted within federally recog-
nized tribal areas; 
‘‘(B) shall represent a consortium com-
posed of members— 
‘‘(i) that include 3 or more independ-
ently owned health care entities; and 
‘‘(ii) that may be nonprofit or for- 
profit entities; and 
‘‘(C) shall not previously have received a 
grant under this subsection for the same or a 
similar project, unless the entity is proposing to 
expand the scope of the project or the area that 
will be served through the project. 
‘‘(3) APPLICATIONS.—To be eligible to receive a 
grant under this subsection, an eligible entity shall 
prepare and submit to the Director an application at 
such time, in such manner, and containing such in-
formation as the Director may require, including— 
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‘‘(A) a description of the project that the 
eligible entity will carry out using the funds 
provided under the grant; 
‘‘(B) a description of the manner in which 
the project funded under the grant will meet 
the health care needs of rural populations in 
the local community or region to be served; 
‘‘(C) a plan for quantifying how health 
care needs will be met through identification of 
the target population and benchmarks of service 
delivery or health status, such as— 
‘‘(i) quantifiable measurements of 
health status improvement for projects fo-
cusing on health promotion; or 
‘‘(ii) benchmarks of increased access 
to primary care, including tracking factors 
such as the number and type of primary 
care visits, identification of a medical 
home, or other general measures of such 
access; 
‘‘(D) a description of how the local com-
munity or region to be served will be involved 
in the development and ongoing operations of 
the project; 
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‘‘(E) a plan for sustaining the project after 
Federal support for the project has ended; 
‘‘(F) a description of how the project will 
be evaluated; 
‘‘(G) the administrative capacity to submit 
annual performance data electronically as speci-
fied by the Director; and 
‘‘(H) other such information as the Direc-
tor determines to be appropriate. 
‘‘(c) RURAL
HEALTH
NETWORK
DEVELOPMENT 
GRANTS.— 
‘‘(1) GRANTS.— 
‘‘(A) IN
GENERAL.—The Director may 
award rural health network development grants 
to eligible entities to promote, through planning 
and implementation, the development of inte-
grated health care networks that have combined 
the functions of the entities participating in the 
networks in order to— 
‘‘(i) achieve efficiencies and economies 
of scale; 
‘‘(ii) expand access to, coordinate, and 
improve the quality of the health care de-
livery system through development of orga-
nizational efficiencies; 
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‘‘(iii) implement health information 
technology to achieve efficiencies, reduce 
medical errors, and improve quality; 
‘‘(iv) coordinate care and manage 
chronic illness; and 
‘‘(v) strengthen the rural health care 
system as a whole in such a manner as to 
show a quantifiable return on investment 
to the participants in the network. 
‘‘(B) GRANT PERIODS.—The Director may 
award such a rural health network development 
grant— 
‘‘(i) for a period of 3 years for imple-
mentation activities; or 
‘‘(ii) for a period of 1 year for plan-
ning activities to assist in the initial devel-
opment of an integrated health care net-
work, if the proposed participants in the 
network do not have a history of collabo-
rative efforts and a 3-year grant would be 
inappropriate. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a 
grant under this subsection, an entity— 
‘‘(A) shall be a rural public or rural non-
profit private entity, a facility that qualifies as 
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315 
a rural health clinic under title XVIII of the 
Social Security Act, a public or nonprofit entity 
existing exclusively to provide services to mi-
grant and seasonal farm workers in rural areas, 
or a tribal government whose grant-funded ac-
tivities will be conducted within federally recog-
nized tribal areas; 
‘‘(B) shall represent a network composed 
of participants— 
‘‘(i) that include 3 or more independ-
ently owned health care entities; and 
‘‘(ii) that may be nonprofit or for- 
profit entities; and 
‘‘(C) shall not previously have received a 
grant under this subsection (other than a 1- 
year grant for planning activities) for the same 
or a similar project. 
‘‘(3) APPLICATIONS.—To be eligible to receive a 
grant under this subsection, 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 applica-
tion at such time, in such manner, and containing 
such information as the Director may require, in-
cluding— 
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‘‘(A) a description of the project that the 
eligible entity will carry out using the funds 
provided under the grant; 
‘‘(B) an explanation of the reasons why 
Federal assistance is required to carry out the 
project; 
‘‘(C) a description of— 
‘‘(i) the history of collaborative activi-
ties carried out by the participants in the 
network; 
‘‘(ii) the degree to which the partici-
pants are ready to integrate their func-
tions; and 
‘‘(iii) how the local community or re-
gion to be served will benefit from and be 
involved in the activities carried out by the 
network; 
‘‘(D) a description of how the local com-
munity or region to be served will experience in-
creased access to quality health care services 
across the continuum of care as a result of the 
integration activities carried out by the net-
work, including a description of— 
‘‘(i) return on investment for the com-
munity and the network members; and 
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‘‘(ii) other quantifiable performance 
measures that show the benefit of the net-
work activities; 
‘‘(E) a plan for sustaining the project after 
Federal support for the project has ended; 
‘‘(F) a description of how the project will 
be evaluated; 
‘‘(G) the administrative capacity to submit 
annual performance data electronically as speci-
fied by the Director; and 
‘‘(H) other such information as the Direc-
tor determines to be appropriate. 
‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS-
TEMS DEVELOPMENT GRANTS.— 
‘‘(1) GRANTS.—The Director may award grants 
to eligible entities to support reduction of health dis-
parities, improve access to health care, and enhance 
rural health system development in the Delta Re-
gion. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a 
grant under this subsection, an entity shall be a 
rural public or rural nonprofit private entity, a facil-
ity that qualifies as a rural health clinic under title 
XVIII of the Social Security Act, a public or non-
profit entity existing exclusively to provide services 
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to migrant and seasonal farm workers in rural 
areas, or a tribal government whose grant-funded 
activities will be conducted within federally recog-
nized tribal areas. 
‘‘(3) APPLICATIONS.—To be eligible to receive a 
grant under this subsection, an eligible entity shall 
prepare and submit to the Director an application at 
such time, in such manner, and containing such in-
formation as the Director may require, including— 
‘‘(A) a description of the project that the 
eligible entity will carry out using the funds 
provided under the grant; 
‘‘(B) an explanation of the reasons why 
Federal assistance is required to carry out the 
project; 
‘‘(C) a description of the manner in which 
the project funded under the grant will meet 
the health care needs of the Delta Region; 
‘‘(D) a description of how the local com-
munity or region to be served will experience in-
creased access to quality health care services as 
a result of the activities carried out by the enti-
ty; 
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319 
‘‘(E) a description of how health dispari-
ties will be reduced or the health system will be 
improved; 
‘‘(F) a plan for sustaining the project after 
Federal support for the project has ended; 
‘‘(G) a description of how the project will 
be evaluated including process and outcome 
measures related to the quality of care provided 
or how the health care system improves its per-
formance; 
‘‘(H) a description of how the grantee will 
develop an advisory group made up of rep-
resentatives of the communities to be served to 
provide guidance to the grantee to best meet 
community need; and 
‘‘(I) other such information as the Director 
determines to be appropriate. 
‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL-
ITY IMPROVEMENT GRANTS.— 
‘‘(1) GRANTS.—The Director may award grants 
to provide for the planning and implementation of 
small rural health care provider quality improvement 
activities. The Director may award the grants for 
periods of 1 to 3 years. 
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‘‘(2) ELIGIBILITY.—To be eligible for a grant 
under this subsection, an entity— 
‘‘(A) shall be— 
‘‘(i) a rural public or rural nonprofit 
private health care provider or provider of 
health care services, such as a rural health 
clinic; or 
‘‘(ii) another rural provider or net-
work of small rural providers identified by 
the Director as a key source of local care; 
and 
‘‘(B) shall not previously have received a 
grant under this subsection for the same or a 
similar project. 
‘‘(3) PREFERENCE.—In awarding grants under 
this subsection, the Director shall give preference to 
facilities that qualify as rural health clinics under 
title XVIII of the Social Security Act. 
‘‘(4) APPLICATIONS.—To be eligible to receive a 
grant under this subsection, an eligible entity shall 
prepare and submit to the Director an application at 
such time, in such manner, and containing such in-
formation as the Director may require, including— 
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‘‘(A) a description of the project that the 
eligible entity will carry out using the funds 
provided under the grant; 
‘‘(B) an explanation of the reasons why 
Federal assistance is required to carry out the 
project; 
‘‘(C) a description of the manner in which 
the project funded under the grant will assure 
continuous quality improvement in the provision 
of services by the entity; 
‘‘(D) a description of how the local com-
munity or region to be served will experience in-
creased access to quality health care services as 
a result of the activities carried out by the enti-
ty; 
‘‘(E) a plan for sustaining the project after 
Federal support for the project has ended; 
‘‘(F) a description of how the project will 
be evaluated including process and outcome 
measures related to the quality of care pro-
vided; and 
‘‘(G) other such information as the Direc-
tor determines to be appropriate. 
‘‘(f) GENERAL REQUIREMENTS.— 
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322 
‘‘(1) PROHIBITED USES OF FUNDS.—An entity 
that receives a grant under this section may not use 
funds provided through the grant— 
‘‘(A) to build or acquire real property; or 
‘‘(B) for construction. 
‘‘(2) COORDINATION WITH OTHER AGENCIES.— 
The Director shall coordinate activities carried out 
under grant programs described in this section, to 
the extent practicable, with Federal and State agen-
cies and nonprofit organizations that are operating 
similar grant programs, to maximize the effect of 
public dollars in funding meritorious proposals. 
‘‘(g) REPORT.—Not later than September 30, 2012, 
the Secretary shall prepare and submit to the appropriate 
committees of Congress a report on the progress and ac-
complishments of the grant programs described in sub-
sections (b), (c), (d), and (e). 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) The term ‘Delta Region’ has the meaning 
given to the term ‘region’ in section 382A of the 
Consolidated Farm and Rural Development Act (7 
U.S.C. 2009aa). 
‘‘(2) The term ‘Director’ means the Director of 
the Office of Rural Health Policy of the Health Re-
sources and Services Administration. 
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‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$40,000,000 for fiscal year 2010, and such sums as may 
be necessary for each of fiscal years 2011 through 2014.’’. 
SEC. 528. COMMUNITY HEALTH CENTER COLLABORATIVE 
ACCESS EXPANSION. 
Section 330 of the Public Health Service Act (42 
U.S.C. 254b) is amended by adding at the end the fol-
lowing: 
‘‘(s) MISCELLANEOUS PROVISIONS.— 
‘‘(1) RULE OF CONSTRUCTION WITH RESPECT 
TO RURAL HEALTH CLINICS.— 
‘‘(A) IN GENERAL.—Nothing in this sec-
tion shall be construed to prevent a community 
health center from contracting with a federally 
certified rural health clinic (as defined by sec-
tion 1861(aa)(2) of the Social Security Act) for 
the delivery of primary health care services that 
are available at the rural health clinic to indi-
viduals who would otherwise be eligible for free 
or reduced cost care if that individual were able 
to obtain that care at the community health 
center. Such services may be limited in scope to 
those primary health care services available in 
that rural health clinic. 
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‘‘(B) ASSURANCES.—In order for a rural 
health clinic to receive funds under this section 
through a contract with a community health 
center under paragraph (1), such rural health 
clinic shall establish policies to ensure— 
‘‘(i) nondiscrimination based upon the 
ability of a patient to pay; and 
‘‘(ii) the establishment of a sliding fee 
scale for low-income patients.’’. 
SEC. 529. FACILITATING THE PROVISION OF TELEHEALTH 
SERVICES ACROSS STATE LINES. 
(a) IN GENERAL.—For purposes of expediting the 
provision of telehealth services, for which payment is made 
under the Medicare program, across State lines, the Sec-
retary of Health and Human Services shall, in consulta-
tion with representatives of States, physicians, health care 
practitioners, and patient advocates, encourage and facili-
tate the adoption of provisions allowing for multistate 
practitioner practice across State lines. 
(b) DEFINITIONS.—In subsection (a): 
(1) TELEHEALTH
SERVICE.—The term ‘‘tele-
health service’’ has the meaning given that term in 
subparagraph (F) of section 1834(m)(4) of the So-
cial Security Act (42 U.S.C. 1395m(m)(4)). 
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