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(2) by redesignating such section as section
1203;
(3) by inserting such section after section 1202;
and
(4) in section 1203 (as so redesignated)—
(A) by redesignating subsection (c) as sub-
section (d); and
(B) by inserting after subsection (b) the
following new subsection:
‘‘(c) DEMONSTRATION PROGRAM REGARDING TELE-
COMMUNICATIONS.—
‘‘(1) LINKAGES
FOR
RURAL
FACILITIES.—
Projects under subsection (a)(1) shall include dem-
onstration projects to establish telecommunications
between rural medical facilities and medical facilities
that have expertise or equipment that can be utilized
by the rural facilities through the telecommuni-
cations.
‘‘(2) MODES
OF
COMMUNICATION.—The Sec-
retary shall ensure that the telecommunications
technologies demonstrated under paragraph (1) in-
clude (interactive) video telecommunications (static
video imaging transmitted through the telephone
system), and facsimiles transmitted through such
system.’’.
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(b) CONFORMING AMENDMENT.—Section 1203 of the
Public Health Service Act, as redesignated by subsection
(a)(2) of this section, is amended in the heading for the
section by striking ‘‘ESTABLISHMENT’’ and all that fol-
lows and inserting ‘‘PROGRAMS FOR RURAL AREAS.’’.
SEC. 504. FUNDING.
Title XII of the Public Health Service Act, as amend-
ed by the preceding provisions of this subtitle, is amend-
ed—
(1) by inserting after subpart III of part B the
following:
‘‘PART C—FUNDING’’;
(2) by transferring section 1235 to part C (as
so added); and
(3) in such section, by striking subsections (a)
and (b) and inserting the following:
‘‘(a) 
EMERGENCY
MEDICAL
SERVICES
GEN-
ERALLY.—
‘‘(1) IN GENERAL.—For the purpose of carry-
ing out section 1201 other than with respect to trau-
ma care, there are authorized to be appropriated
$2,000,000 for fiscal year 1994, and such sums as
may be necessary for each of the fiscal years 1995
and 1996.
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‘‘(2) STATE OFFICES.—For the purpose of car-
rying out section 1202, there are authorized to be
appropriated $3,000,000 for fiscal year 1994, and
such sums as may be necessary for each of the fiscal
years 1995 and 1996.
‘‘(3) CERTAIN
TELECOMMUNICATIONS
DEM-
ONSTRATIONS.—For the purpose of carrying out sec-
tion 1203(c), there are authorized to be appro-
priated $10,000,000 for fiscal year 1994, and such
sums as may be necessary for each of the fiscal
years 1995 and 1996.
‘‘(b) TRAUMA CARE AND CERTAIN OTHER ACTIVI-
TIES.—
‘‘(1) IN GENERAL.—For the purpose of carry-
ing out part B, section 1201 with respect to trauma
care, and section 1203 (other than subsection (c) of
such section), there are authorized to be appro-
priated $60,000,000 for fiscal year 1994, and such
sums as may be necessary for each of the fiscal
years 1995 and 1996.
‘‘(2) ALLOCATION OF FUNDS BY SECRETARY.—
‘‘(A) For the purpose of carrying out sub-
part I of part B, section 1201 with respect to
trauma care, and section 1203 (other than sub-
section (c) of such section), the Secretary shall
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make available 10 percent of the amounts ap-
propriated for a fiscal year under paragraph
(1).
‘‘(B) For the purpose of carrying out sec-
tion 1203 (other than subsection (c) of such
section), the Secretary shall make available 10
percent of the amounts appropriated for a fiscal
year under paragraph (1).
‘‘(C)(i) For the purpose of making allot-
ments under section 1221(a), the Secretary
shall, subject to subsection (c), make available
80 percent of the amounts appropriated for a
fiscal year under paragraph (1).
‘‘(ii) Amounts paid to a State under sec-
tion 1221(a) for a fiscal year shall, for the pur-
poses for which the amounts were paid, remain
available for obligation until the end of the fis-
cal year immediately following the fiscal year
for which the amounts were paid.’’.
SEC. 505. CONFORMING AMENDMENTS.
Title XII of the Public Health Service Act, as amend-
ed by the preceding provisions of this subtitle, is amend-
ed—
(1) in section 1203(b), by striking ‘‘1214(c)(1)’’
and inserting ‘‘1224(c)(1)’’;
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(2) in section 1211(b)(3), by striking ‘‘1213(c)’’
and inserting ‘‘1223(c)’’;
(3) in section 1221—
(A) in subsection (a)—
(i) by striking ‘‘1218’’ and inserting
‘‘1228’’; and
(ii) by striking ‘‘1217’’ and inserting
‘‘1227’’; and
(B) in subsection (b)—
(i) by striking ‘‘1233’’ and inserting
‘‘1242’’; and
(ii) by striking ‘‘1213’’ and inserting
‘‘1223’’;
(4) in section 1222—
(A) in subsection (a)—
(i) in paragraph (1), by striking
‘‘1211(a)’’ and inserting ‘‘1221(a)’’; and
(ii) in paragraph (2)(A), by striking
‘‘1211(c)’’ and inserting ‘‘1221(c)’’; and
(B) 
in 
subsection 
(b), 
by 
striking
‘‘1211(a)’’ and inserting ‘‘1221(a)’’;
(5) in section 1223—
(A) 
in 
subsection 
(a), 
by 
striking
‘‘1211(b)’’ and inserting ‘‘1221(b)’’;
(B) in subsection (b)—
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(i) in paragraph (1), by striking
‘‘1211(a)’’ and inserting ‘‘1221(a)’’; and
(ii) in paragraph (3), by striking
‘‘1211(a)’’ and inserting ‘‘1221(a)’’; and
(C) 
in 
subsection 
(d), 
by 
striking
‘‘1211(a)’’ and inserting ‘‘1221(a)’’;
(6) in section 1224—
(A) in each of subsections (a) through (c),
by striking ‘‘1211(a)’’ and inserting ‘‘1221(a)’’;
and
(B) 
in 
subsection 
(b), 
by 
striking
‘‘1213(a)(7)’’ and inserting ‘‘1223(a)(7)’’;
(7) in section 1225—
(A) in subsection (a)—
(i) by striking ‘‘1211(a)’’ and insert-
ing ‘‘1221(a)’’; and
(ii) by striking ‘‘1233’’ and inserting
‘‘1242’’; and
(B) 
in 
subsection 
(b), 
by 
striking
‘‘1211(b)’’ and inserting ‘‘1221(b)’’;
(8) in section 1226, in each of subsections (a)
through (c), by striking ‘‘1211(a)’’ and inserting
‘‘1221(a)’’;
(9) in section 1227—
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(A) by striking ‘‘1211(a)’’ and inserting
‘‘1221(a)’’; and
(B) by striking ‘‘1214’’ and inserting
‘‘1224’’;
(10) in section 1228—
(A) in each of subsections (a) through (c),
by striking ‘‘1211(a)’’ each place such term ap-
pears and inserting ‘‘1221(a)’’;
(B) in subsection (b), in each of para-
graphs 
(2)(A) 
and 
(3)(A), 
by 
striking
‘‘1232(a)’’ and inserting ‘‘1235(a)’’; and
(C) in subsection (c)(2)—
(i) by striking ‘‘1232(b)(3)’’ and in-
serting ‘‘1235(b)(3)’’; and
(ii) by striking ‘‘1217’’ and inserting
‘‘1227’’;
(11) in section 1229(a), by striking ‘‘1211(a)’’
each place such term appears and inserting
‘‘1221(a)’’;
(12) in section 1230(a), by striking ‘‘1211(a)’’
each place such term appears and inserting
‘‘1221(a)’’;
(13) in section 1231—
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(A) in each of subsections (a) and (b), by
striking ‘‘1211(a)’’ each place such term ap-
pears and inserting ‘‘1221(a)’’; and
(B) in each of subsections (a) and (b), by
striking ‘‘1211(b)’’ and inserting ‘‘1221(b)’’;
(14) in section 1232, by striking ‘‘1211’’ and
inserting ‘‘1221’’;
(15) in section 1241—
(A) in the matter preceding paragraph (1),
by striking ‘‘this title’’ and inserting ‘‘this
part’’; and
(B) in paragraph (1), by striking ‘‘1213’’
and inserting ‘‘1223’’;
(16) in section 1242—
(A) in each of subsections (a) and (b), by
striking ‘‘1211’’ each place such term appears
and inserting ‘‘1221’’;
(B) in subsection (b)—
(i) by striking ‘‘part B’’ and inserting
‘‘subpart II’’; and
(ii) by striking ‘‘1214(c)(1)’’ and in-
serting ‘‘1224(c)(1)’’; and
(C) in subsection (c), by striking ‘‘1213’’
and inserting ‘‘1223’’; and
(17) in section 1251(c)(1)—
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(A) by striking ‘‘1211(a)’’ and inserting
‘‘1221(a)’’;
(B) by striking ‘‘1218(a)(2)’’ and inserting
‘‘1228(a)(2)’’; and
(C) by striking ‘‘part B’’ and inserting
‘‘subpart II’’.
Subtitle B—Extension of Special
Treatment Rules for Medicare-
Dependent, Small Rural Hos-
pitals
SEC. 511. EXTENSION OF SPECIAL TREATMENT RULES FOR
MEDICARE-DEPENDENT, SMALL RURAL HOS-
PITALS.
(a) IN GENERAL.—
(1) DETERMINATION OF PAYMENT AMOUNT.—
Section 1886(b)(3)(D) of the Social Security Act (42
U.S.C. 1395ww(b)(3)(D)) is amended by striking
‘‘March 31, 1993,’’ and inserting ‘‘March 31,
1994,’’.
(2) ELIGIBILITY
FOR
DESIGNATION.—Section
1886(d)(5)(G)(i) 
of 
such 
Act 
(42 
U.S.C.
1395ww(d)(5)(G)(i)) is amended by striking ‘‘March
31, 1993,’’ and inserting ‘‘March 31, 1994,’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall take effect as if included in the enact-
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ment of section 6003(f) of the Omnibus Budget Reconcili-
ation Act of 1989.
Subtitle C—Outreach Grants
Program
SEC. 521. ESTABLISHMENT OF PROGRAM OF GRANTS FOR
RURAL HEALTH OUTREACH.
Title III of the Public Health Service Act (42 U.S.C.
241 et seq.) is amended by adding at the end the following
part:
‘‘PART O—RURAL HEALTH OUTREACH PROGRAM.
‘‘SEC. 399J. RURAL HEALTH OUTREACH GRANT PROGRAM.
‘‘(a) IN GENERAL.—The Secretary may make grants
to demonstrate new and innovative models of outreach and
health care services delivery in rural areas that lack basic
health services. Grants will be awarded for one of the fol-
lowing: direct provision of health services to rural popu-
lations (especially for those who are not currently receiving
those services), or to enhance access to and utilization of
existing available services.
‘‘(b) MISSIONS
OF
THE OUTREACH PROJECTS.—
Projects under subsection (a) should be designed to ad-
dress the needs of a wide range of populations living in
rural communities including, but not limited to, the poor,
farmers, farm workers, senior citizens, individuals with
disabilities, pregnant women, infants, adolescents, and
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rural populations with special health care needs. The pro-
gram could include projects to:
‘‘(1) Provide, enhance, or revitalize emergency
medical services in rural communities.
‘‘(2) Provide ambulatory health and/or mental
health services in health professional shortage areas
and in frontier areas.
‘‘(3) Enhance the health and safety of farmers
through direct health services for farm families, and
migrant and seasonal farm workers.
‘‘(4) Provide direct health services to enhance
health care services to senior citizens.
‘‘(5) Provide direct health services that will re-
duce infant mortality in rural communities.
‘‘(c) COMPOSITION OF PROGRAM.—
‘‘(1) CONSORTIUM ARRANGEMENTS.—Participa-
tion in the program established in subsection (a) re-
quires the formation of consortium arrangements
among three or more separate and distinct entities
to carry out an outreach project.
‘‘(2) CERTAIN REQUIREMENTS.—
‘‘(A) A consortium under paragraph (1)
must be composed of three or more existing
health care providers or a combination of three
or more health care and social service providers.
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Consortium members may include such entities
as hospitals, public health agencies, home
health providers, mental health centers, rural
health clinics, social service agencies, health
professional schools, educational institutions,
emergency medical centers/providers, and com-
munity and migrant health centers.
‘‘(B) All public and private entities, both
nonprofit and for-profit may participate as
members of a consortium arrangement under
paragraph (1).
‘‘(C) A grant under subsection (a) will be
made to only one entity in a consortium under
paragraph (1). The grant recipient must be a
nonprofit or public entity which meets one of
the following requirements:
‘‘(i) The applicant must be located
outside of a Metropolitan Statistical Area
as defined by the Federal Government.
‘‘(ii) The applicant must be located in
a rural census tract.
‘‘(d) REVIEW CRITERIA.—An outreach application
under this section shall be evaluated based on the follow-
ing criteria:
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‘‘(1) The extent to which the applicant has pro-
posed a new and innovative approach to health care
in the rural area. Services shall be directed to popu-
lation groups that are unserved or underserved.
‘‘(2) The extent to which the applicant has jus-
tified and documented the needs for the project and
developed measurable goals for meeting the needs.
‘‘(3) The extent to which the applicant has
clearly defined the roles and responsibilities for each
member of the consortium and developed a workable
plan for managing the consortium’s activities.
‘‘(4) The level of local commitment and involve-
ment with the project, including the extent of cost
participation by the applicant and/or other organiza-
tions.
‘‘(5) The feasibility of the project to continue
after Federal grant support is completed.
‘‘(6) The extent of the evaluation component.
‘‘(e) HOW
PROJECT
FUNDS
ARE
TO
BE
EX-
PENDED.—
‘‘(1) Grantees under subsection (a) will be re-
quired to use at least 85 percent of the total amount
awarded for outreach and care services.
‘‘(2) 60 percent of funds must be spent in rural
areas.
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‘‘(3) Grant funds may not be used for purchase,
construction, or renovation of real property or to
support the delivery of inpatient services.
‘‘(4) Grant funds may be used for equipment
and vehicles when such equipment is essential to
carrying out the outreach project.
‘‘(5) Individual grant awards will be limited to
a total amount of $300,000 per year for not to ex-
ceed 3 years.
‘‘(6) Applicants must demonstrate that existing
levels of institutional and other support are not re-
duced or supplanted by the availability of these
grant funds.
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated $25,000,000 for fiscal year 1994, and
such sums as may be necessary for each fiscal year there-
after.’’.
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