I 
116TH CONGRESS 
1ST SESSION H. R. 4898 
To amend the Public Health Service Act to establish a rural health center 
innovation awards program and a rural health department enhancement 
program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 29, 2019 
Mr. KUSTOFF of Tennessee (for himself, Mr. DAVID P. ROE of Tennessee, and 
Ms. KUSTER of New Hampshire) introduced the following bill; which was 
referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to establish a rural 
health center innovation awards program and a rural 
health department enhancement program, 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 ‘‘Rural Health Innova-
tion Act of 2019’’. 
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SEC. 2. RURAL HEALTH CENTER INNOVATION AWARDS 
PROGRAM. 
Subpart I of part D of title III of the Public Health 
Service Act (42 U.S.C. 254b et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 330N. RURAL HEALTH CENTER INNOVATION AWARDS 
PROGRAM. 
‘‘(a) DEFINITIONS.—In this section: 
‘‘(1) COVERED RURAL AREA.—The term ‘cov-
ered rural area’ means a rural area— 
‘‘(A) that is located not less than 30 min-
utes by automobile from the nearest emergency 
department, using the speed limit of the most 
direct route to such emergency department; or 
‘‘(B) from which an individual cannot ac-
cess an emergency department by road. 
‘‘(2) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means an entity that— 
‘‘(A) is a Federally qualified health center; 
‘‘(B) is a rural health clinic; or 
‘‘(C) agrees (as a condition of receiving a 
grant under this section) to establish such a 
center or clinic, including a hospital that agrees 
(as such a condition) to convert to a Federally 
qualified health center. 
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‘‘(3) FEDERALLY
QUALIFIED
HEALTH
CEN-
TER.—The term ‘Federally qualified health center’ 
has the meaning given such term in section 
1861(aa) of the Social Security Act. 
‘‘(4) RURAL AREA.—The term ‘rural area’ has 
the meaning given such term in section 330J(e). 
‘‘(5) RURAL HEALTH CLINIC.—The term ‘rural 
health clinic’ has the meaning given such term in 
section 1861(aa) of the Social Security Act. 
‘‘(b) ESTABLISHMENT.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Administrator of the Health Resources 
and Services Administration, shall establish a grant 
program to be known as the ‘Rural Health Center 
Innovation Awards program’ to award grants to eli-
gible entities that submit an application in accord-
ance with subsection (c) to enable such entities to 
establish or maintain a Federally qualified health 
center or rural health clinic that— 
‘‘(A) serves individuals in a covered rural 
area as a walk-in urgent care center and as a 
triage center or staging facility for necessary 
air or ambulance transport to an emergency de-
partment; and 
‘‘(B) includes— 
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‘‘(i) professional clinical staff, includ-
ing physicians, physician interns, residents, 
nurse practitioners, physician assistants, 
nurse midwives, or other health care pro-
viders providing walk-in urgent care and 
emergency triage; and 
‘‘(ii) resources, including laboratories, 
x-ray machines, and cardiac monitors. 
‘‘(2) PERMISSIBLE
USES
OF
FUNDS.—The 
funds of a grant awarded under this section may be 
used to— 
‘‘(A) expand the hours of operation of a 
Federally qualified health center or rural health 
clinic; 
‘‘(B) pay for the costs of construction and 
renovation of a Federally qualified health center 
or rural health clinic; or 
‘‘(C) carry out any other activity for the 
purposes described in paragraph (1). 
‘‘(c) APPLICATIONS AND SELECTION.— 
‘‘(1) IN GENERAL.—An eligible entity seeking a 
grant under this section shall submit to the Sec-
retary an application at such time, in such manner, 
and containing such information as the Secretary 
may reasonably require. 
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‘‘(2) START
UP
CENTERS
AND
CLINICS.—An 
application submitted under paragraph (1) by an eli-
gible entity that is not a Federally qualified health 
center, or a rural health clinic, on the date on which 
the entity submits the application under paragraph 
(1) shall include in such application a demonstration 
of the costs of the equipment and staffing needed to 
establish the center or clinic. 
‘‘(3) EXPEDITED REVIEW.—The Secretary shall 
establish a process for expediting the review of any 
application submitted under paragraph (1) for a 
grant under this section from an eligible entity that 
plans to use the funds of the grant to serve individ-
uals in a covered rural area in which a hospital has 
closed in the 7 years preceding the date on which 
the entity submitted the application. 
‘‘(d) GRANT PERIOD AND AMOUNTS.— 
‘‘(1) PERIOD.—Each grant awarded under this 
section shall be for a period of 5 years. 
‘‘(2) AMOUNT.— 
‘‘(A) IN
GENERAL.—A grant awarded 
under this section to an eligible entity shall not 
exceed— 
‘‘(i) for the first year of the grant— 
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‘‘(I) $500,000 if the entity is a 
Federally qualified health center, or a 
rural health clinic, on the date on 
which the award is made; and 
‘‘(II) $750,000 if the entity is 
using the grant to establish a Feder-
ally qualified health center or a rural 
health clinic; and 
‘‘(ii) for each of the third through 
fifth years of the grant, $500,000. 
‘‘(B) CONSIDERATIONS.—In determining 
the amount of a grant under this section for an 
eligible entity for each year after the first year 
in which the grant is awarded, the Secretary 
shall, subject to subparagraph (A)(ii), consider 
the number of patients treated, and the type of 
treatment provided, by the entity in the prior 
year. 
‘‘(e) REPORTING.— 
‘‘(1) IN
GENERAL.—Not later than 3 years 
after the date of enactment of this section, the Sec-
retary shall report to the committees described in 
paragraph (2) on the grant program under this sec-
tion, including— 
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‘‘(A) an assessment of the success of the 
program, challenges with respect to the pro-
gram, and any action for regulatory flexibility 
or legislative authority needed to improve the 
program; 
‘‘(B) any savings to Federal health care 
programs; 
‘‘(C) any increase in access to care; and 
‘‘(D) any increase in utilization of health 
services in covered rural areas. 
‘‘(2) COMMITTEES.—The committees described 
in this paragraph are— 
‘‘(A) the Committee on Health, Education, 
Labor, and Pensions, and the Committee on Fi-
nance, of the Senate; and 
‘‘(B) the Committee on Energy and Com-
merce, and the Committee on Ways and Means, 
of the House of Representatives. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
$25,000,000 for each of fiscal years 2020 through 2024.’’. 
SEC. 3. RURAL HEALTH DEPARTMENT ENHANCEMENT PRO-
GRAM. 
Subpart I of part D of title III of the Public Health 
Service Act (42 U.S.C. 254b et seq.), as amended by sec-
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tion 2, is further amended by adding at the end the fol-
lowing: 
‘‘SEC. 330O. RURAL HEALTH DEPARTMENT ENHANCEMENT 
PROGRAM. 
‘‘(a) DEFINITIONS.—In this section: 
‘‘(1) COVERED RURAL AREA.—The term ‘cov-
ered rural area’ has the meaning given the term in 
section 330N(a). 
‘‘(2) RURAL HEALTH DEPARTMENT.—The term 
‘rural health department’ means a health depart-
ment that is located in a covered rural area. 
‘‘(b) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Administrator of the Health Resources and 
Services Administration, shall award grants, on a competi-
tive basis, to rural health departments that submit an ap-
plication in accordance with subsection (c) to enhance 
such departments and enable them to provide individuals 
in covered rural areas with emergency services, triage and 
transport to emergency departments, primary care serv-
ices, and other services similar to services provided by 
emergency departments. 
‘‘(c) APPLICATIONS.—A rural health department 
seeking a grant under this section shall submit an applica-
tion to the Secretary at such time, in such manner, and 
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department shall be in an amount that for a year 
does not exceed $500,000. 
‘‘(3) CONSIDERATIONS.—The Secretary shall 
determine the amount awarded to a rural health de-
partment through a grant under this section for a 
year in accordance with the following: 
‘‘(A) For the first year of the award, the 
amount shall be based on the amount the rural 
health department estimates for the cost of 
equipment and staffing needed to set up the ac-
tivities and services supported under this sec-
tion, as specified in the application under sub-
section (c). 
‘‘(B) For the second through fifth years of 
the award, the amount shall be based on the 
number of patients treated, and the type of 
treatment provided, by the department in the 
prior year. 
‘‘(e) USE OF FUNDS.— 
‘‘(1) IN GENERAL.—A rural health department 
receiving a grant under this section shall use the 
funds awarded through the grant to provide the 
services and carry out the activities described in sub-
section (b) at a facility that is located in a covered 
rural area, including by— 
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‘‘(A) obtaining additional medical equip-
ment and resources necessary for providing the 
services and activities described in subsection 
(b), such as laboratories, x-ray machines, and 
cardiac monitors; 
‘‘(B) hiring additional providers to provide 
the services and carry out the activities de-
scribed in subsection (b), such as physician in-
terns, residents, nurse practitioners, physician 
assistants, and nurse midwives, which hiring 
may be through a partnership described in 
paragraph (2)(A); and 
‘‘(C) providing outreach to the community 
regarding the services and activities of the rural 
health department as supported under this sec-
tion. 
‘‘(2) LIMITATIONS.— 
‘‘(A) PARTNERSHIPS.—Not more than 3 
percent of the funds awarded through a grant 
under this section for a year may be used to-
wards the rural health department entering into 
a partnership with an academic medical center 
to assist with the hiring described in paragraph 
(1)(B). 
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‘‘(B) COMMUNITY
OUTREACH.—For each 
of the first 2 years of a grant awarded under 
this section, not more than 3 percent of the 
funds may be used by the rural health depart-
ment receiving the grant for the outreach de-
scribed in paragraph (1)(C). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$25,000,000 for each of fiscal years 2020 through 2024.’’. 
Æ 
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