SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Health Care Safety Net Improvement Act’’.
(b) TABLE OF CONTENTS.—The table of contents for
this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—CONSOLIDATED HEALTH CENTER PROGRAM
AMENDMENTS
Sec. 101. Health centers.
Sec. 102. Migratory and seasonal agricultural workers.
TITLE II—RURAL HEALTH
Subtitle A—Rural Health Care Services Outreach, Rural Health Network De-
velopment, and Small Health Care Provider Quality Improvement Grant
Programs
Sec. 201. Grant programs.
Subtitle B—Telehealth Grant Consolidation
Sec. 211. Short title.
Sec. 212. Consolidation and reauthorization of provisions.
Subtitle C—Mental Health Services Telehealth Program and Rural
Emergency Medical Service Training and Equipment Assistance Program
Sec. 221. Programs.
TITLE III—NATIONAL HEALTH SERVICE CORPS PROGRAM
Sec. 301. National Health Service Corps.
Sec. 302. Designation of health professional shortage areas.
Sec. 303. Assignment of Corps personnel.
Sec. 304. Priorities in assignment of Corps personnel.
Sec. 305. Cost-sharing.
Sec. 306. Eligibility for Federal funds.
Sec. 307. Facilitation of effective provision of Corps services.
Sec. 308. Authorization of appropriations.
Sec. 309. National Health Service Corps Scholarship Program.
Sec. 310. National Health Service Corps Loan Repayment Program.
Sec. 311. Obligated service.
Sec. 312. Private practice.
Sec. 313. Breach of scholarship contract or loan repayment contract.
Sec. 314. Authorization of appropriations.
Sec. 315. Grants to States for loan repayment programs.
Sec. 316. Demonstration grants to States for community scholarship programs.
TITLE IV—ADDITIONAL PROVISIONS
Sec. 401. Community access demonstration program.
Sec. 402. Expanding availability of dental services.
Sec. 403. Study regarding barriers to participation of farmworkers in health
programs.
Sec. 404. Eligibility of certain entities for grants.
Sec. 405. Conforming amendments.
TITLE 
I—CONSOLIDATED
HEALTH CENTER PROGRAM
AMENDMENTS
SEC. 101. HEALTH CENTERS.
(a) INCREASE OF AUTHORIZATION OF APPROPRIA-
TIONS FROM $802,124,000 FOR FISCAL YEAR 1997 TO
$1,293,000,000 
FOR
FISCAL
YEAR
2002.—Section
330(l)(1) of the Public Health Service Act (42 U.S.C.
254b(l(1))) is amended by striking ‘‘$802,124,000’’ and
all that follows and inserting ‘‘$1,293,000,000 for fiscal
year 2002, and such sums as may be necessary for each
of the fiscal years 2003 through 2006.’’.
(b) ADDITIONAL AMENDMENTS.—Section 330 of the
Public Health Service Act (42 U.S.C. 254b) is amended—
(1) in subsection (b)(1)(A)—
(A) in clause (i)(III)(bb), by striking
‘‘screening for breast and cervical cancer’’ and
inserting ‘‘appropriate cancer screening’’;
(B) in clause (ii), by inserting ‘‘(including
specialty referral when medically indicated)’’
after ‘‘medical services’’; and
(C) in clause (iii), by inserting ‘‘housing,’’
after ‘‘social,’’;
(2) in subsection (b)(2)—
(A) by redesignating subparagraphs (A)
and (B) as subparagraphs (B) and (C), respec-
tively; and
(B) by inserting before subparagraph (B)
(as so redesignated) the following:
‘‘(A) behavioral and mental health and
substance abuse services;’’;
(3) in subsection (c)(1)—
(A) in subparagraph (B)—
(i) in the heading, by striking ‘‘COM-
PREHENSIVE SERVICE DELIVERY’’ and in-
serting ‘‘MANAGED CARE’’;
(ii) in the matter preceding clause (i),
by striking ‘‘network or plan’’ and all that
follows to the period and inserting ‘‘man-
aged care network or plan.’’; and
(iii) in the matter following clause (ii),
by striking ‘‘Any such grant may include’’
and all that follows through the period;
and
(B) by adding at the end the following:
‘‘(C) 
PRACTICE
MANAGEMENT
NET-
WORKS.—The Secretary may make grants to
health centers that receive assistance under this
section to enable the centers to plan and de-
velop practice management networks that will
enable the centers to—
‘‘(i) reduce costs associated with the
provision of health care services;
‘‘(ii) improve access to, and avail-
ability of, health care services provided to
individuals served by the centers;
‘‘(iii) enhance the quality and coordi-
nation of health care services; or
‘‘(iv) improve the health status of
communities.
‘‘(D) USE OF FUNDS.—The activities for
which a grant may be made under subpara-
graph (B) or (C) may include the purchase or
lease of equipment, which may include data and
information systems (including paying for the
costs of amortizing the principal of, and paying
the interest on, loans for equipment), the provi-
sion of training and technical assistance related
to the provision of health care services on a pre-
paid basis or under another managed care ar-
rangement, and other activities that promote
the development of practice management or
managed care networks and plans.’’;
(4) in subsection (d)—
(A) by striking the subsection heading and
inserting ‘‘LOAN GUARANTEE PROGRAM.—’’;
(B) in paragraph (1)—
(i) in subparagraph (A), by striking
‘‘the principal and interest on loans’’ and
all that follows through the period and in-
serting ‘‘the principal and interest on loans
made by non-Federal lenders to health cen-
ters, funded under this section, for the
costs of developing and operating managed
care networks or plans described in sub-
section (c)(1)(B), or practice management
networks described in subsection (c)(1)(C),
and for the costs of acquiring or leasing
buildings, or purchasing or leasing equip-
ment.’’;
(ii) in subparagraph (B)—
(I) in clause (i), by striking ‘‘or’’;
(II) in clause (ii), by striking the
period and inserting ‘‘; or’’; and
(III) by adding at the end the
following:
‘‘(iii) to refinance a loan to the center
or centers, if the Secretary determines
that—
‘‘(I) such refinancing will result
in more favorable terms;
‘‘(II) the savings resulting from
the refinancing will be beneficial to
both the center (or centers) and the
Government; and
‘‘(III) the center (or centers) can
demonstrate an ability to repay the
refinanced loan equal to or greater
than the ability of the center (or cen-
ters) to repay the original loan on the
date the original loan was made.’’;
and
(iii) by adding at the end the fol-
lowing:
‘‘(D) PROVISION DIRECTLY TO NETWORKS
OR PLANS.—At the request of health centers re-
ceiving assistance under this section, loan guar-
antees provided under this paragraph may be
made directly to networks or plans that are at
least majority controlled and, as applicable, at
least majority owned by those health centers.’’;
and
(C)(i) by striking paragraphs (6) and (7);
and
(ii) by redesignating paragraph (8) as
paragraph (6);
(5) in subsection (e)—
(A) in paragraph (1), by adding at the end
the following:
‘‘(C) OPERATION
OF
NETWORKS
AND
PLANS.—
‘‘(i) IN
GENERAL.—The Secretary
may make grants to health centers that re-
ceive assistance under this section, or at
the request of the health centers, directly
to a network or plan (as described in sub-
paragraphs (B) and (C) of subsection
(c)(1)) that is at least majority controlled
and, as applicable, at least majority owned
by such health centers receiving assistance
under this section, for the costs associated
with the operation of such network or plan,
including the purchase or lease of equip-
ment (including the costs of amortizing the
principal of, and paying the interest on,
loans for equipment).
‘‘(ii) CERTAIN REQUIREMENTS.—Sub-
section (j) applies with respect to grants
under clause (i) to the same extent and in
the same manner as such subsection ap-
plies with respect to grants under subpara-
graph (A) or (B), except to the extent that
as applied to clause (i) the Secretary
waives any requirement under subsection
(j) on the basis that the requirement is not
necessary with respect to the purposes for
which grants under clause (i) are made.’’;
and
(B) in paragraph (5)—
(i) in subparagraph (A), by inserting
‘‘subparagraphs (A) and (B) of’’ after
‘‘any fiscal year under’’;
(ii) by redesignating subparagraphs
(B) and (C) as subparagraphs (C) and
(D), respectively; and
(iii) by inserting after subparagraph
(A) the following:
‘‘(B) NETWORKS AND PLANS.—The total
amount of grant funds made available for any
fiscal year under paragraph (1)(C) and sub-
paragraphs (B) and (C) of subsection (c)(1) to
a health center shall be determined by the Sec-
retary, but may not exceed 2 percent of the
total amount appropriated under this section
for such fiscal year.’’;
(6) in subsection (h)—
(A) in paragraph (1), by striking ‘‘home-
less children and children at risk of homeless-
ness’’ and inserting ‘‘homeless children and
youth and children and youth at risk of home-
lessness’’;
(B)(i) by redesignating paragraph (4) as
paragraph (5); and
(ii) by inserting after paragraph (3) the
following:
‘‘(4) TEMPORARY
CONTINUED
PROVISION
OF
SERVICES TO CERTAIN FORMER HOMELESS INDIVID-
UALS.—If any grantee under this subsection has
provided services described in this section under the
grant to a homeless individual, such grantee may,
notwithstanding that the individual is no longer
homeless as a result of becoming a resident in per-
manent housing, expend the grant to continue to
provide such services to the individual for not more
than 12 months.’’; and
(C) in paragraph (5)(C) (as redesignated
by subparagraph (B)), by striking ‘‘and residen-
tial treatment’’ and inserting ‘‘, risk reduction,
outpatient treatment, residential treatment, and
rehabilitation’’;
(7) in subsection (j)(3)—
(A) in subparagraph (E)—
(i) in clause (i)—
(I) by striking ‘‘(i)’’ and insert-
ing ‘‘(i)(I)’’;
(II) by striking ‘‘plan; or’’ and
inserting ‘‘plan; and’’; and
(III) by adding at the end the
following:
‘‘(II) has or will have a contrac-
tual or other arrangement with the
State agency administering the pro-
gram under title XXI of such Act (42
U.S.C. 1397aa et seq.) with respect to
individuals who are State children’s
health 
insurance 
program 
bene-
ficiaries; or’’; and
(D) in subparagraph (L), by striking the
period at the end and inserting ‘‘; and’’; and
(E) by adding at the end the following sub-
paragraph:
‘‘(M) the center encourages persons receiv-
ing or seeking health services from the center to
participate in any public or private (including
employer-offered) health programs or plans for
which the persons are eligible.’’;
(8) by striking subsection (k) and inserting the
following:
‘‘(k) TECHNICAL ASSISTANCE.—The Secretary shall
establish a program through which the Secretary shall
provide technical and other assistance to eligible entities
to assist such entities to meet the requirements of para-
graphs (2) and (3) of subsection (j) and in developing
plans for, and operating health centers. Services provided
through the program may include necessary technical and
nonfinancial assistance, including fiscal and program man-
agement assistance, training in program management,
operational and administrative support, and the provision
of information to the entities of the variety of resources
available under this title and how those resources can be
best used to meet the health needs of the communities
served by the entities.’’;
(9)(A) in subsection (l) (as amended by sub-
section (a) of this section), by striking ‘‘(l) AUTHOR-
IZATION’’;
(B) by transferring such undesignated sub-
section to the end of the section;
(C) by redesignating subsections (m) through
(q) as subsections (l) through (p), respectively; and
(D) in the subsection transferred by subpara-
graph (B), by inserting ‘‘(q) AUTHORIZATION’’ be-
fore ‘‘OF APPROPRIATIONS.—’’; and
(10) in subsection (q) (as transferred and re-
designated by paragraph (9)), in paragraph (2)—
(A) in subparagraph (A), by striking
‘‘(j)(3)(G)(ii)’’ and inserting ‘‘(j)(3)(H)’’; and
(B) by striking subparagraph (B) and in-
serting the following:
‘‘(B) DISTRIBUTION OF GRANTS.—For fis-
cal year 2002 and each of the following fiscal
years, the Secretary, in awarding grants under
this section, shall ensure that the proportion of
the amount made available under each of sub-
sections (g), (h), and (i), relative to the total
amount appropriated to carry out this section
for that fiscal year, is equal to the proportion
of the amount made available under that sub-
section for fiscal year 2001, relative to the total
amount appropriated to carry out this section
for fiscal year 2001.’’.
(c) TELEMEDICINE; INCENTIVE GRANTS REGARDING
COORDINATION AMONG STATES.—
(1) IN GENERAL.—The Secretary of Health and
Human Services may make grants to State profes-
sional licensing boards to carry out programs under
which such licensing boards of various States co-
operate to develop and implement State policies that
will reduce statutory and regulatory barriers to tele-
medicine.
(2) AUTHORIZATION OF APPROPRIATIONS.—For
the purpose of carrying out paragraph (1), there are
authorized to be appropriated $10,000,000 for fiscal
year 2002, and such sums as may be necessary for
each of the fiscal years 2002 through 2006.
SEC. 102. MIGRATORY AND SEASONAL AGRICULTURAL
WORKERS.
Section 330(g) of the Public Health Service Act (42
U.S.C. 254b(g)) is amended—
(1) in paragraph (2)—
(A) in subparagraph (A), by inserting
‘‘and seasonal agricultural worker’’ after ‘‘agri-
cultural worker’’; and
(B) in subparagraph (B), by striking ‘‘and
members of their families’’ and inserting ‘‘and
seasonal agricultural workers, and members of
their families,’’; and
(2) in paragraph (3)(A), by striking ‘‘on a sea-
sonal basis’’.
TITLE II—RURAL HEALTH
Subtitle 
A—Rural 
Health 
Care
Services Outreach, Rural Health
Network 
Development, 
and
Small 
Health 
Care 
Provider
Quality 
Improvement 
Grant
Programs
SEC. 201. GRANT PROGRAMS.
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,
AND SMALL HEALTH CARE PROVIDER QUAL-
ITY IMPROVEMENT GRANT PROGRAMS.
‘‘(a) PURPOSE.—The purpose of this section is to
provide grants for expanded delivery of health care serv-
ices in rural areas, for the planning and implementation
of integrated health care networks in rural areas, and for
the planning and implementation of small health care pro-
vider quality improvement activities.
‘‘(b) DEFINITIONS.—
‘‘(1) DIRECTOR.—The term ‘Director’ means
the Director specified in subsection (d).
‘‘(2) FEDERALLY QUALIFIED HEALTH CENTER;
RURAL
HEALTH
CLINIC.—The terms ‘Federally
qualified health center’ and ‘rural health clinic’ have
the meanings given the terms in section 1861(aa) of
the Social Security Act (42 U.S.C. 1395x(aa)).
‘‘(3) 
HEALTH
PROFESSIONAL
SHORTAGE
AREA.—The term ‘health professional shortage area’
means a health professional shortage area des-
ignated under section 332.
‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.—
The term ‘medically underserved community’ has the
meaning given the term in section 799B.
‘‘(5) 
MEDICALLY
UNDERSERVED
POPU-
LATION.—The term ‘medically underserved popu-
lation’ has the meaning given the term in section
330(b)(3).
‘‘(c) PROGRAM.—The Secretary shall establish, under
section 301, a small health care provider quality improve-
ment grant program.
‘‘(d) ADMINISTRATION.—
‘‘(1) PROGRAMS.—The rural health care serv-
ices outreach, rural health network development, and
small health care provider quality improvement
grant programs established under section 301 shall
be administered by the Director of the Office of
Rural Health Policy of the Health Resources and
Services Administration, in consultation with State
offices of rural health or other appropriate State
government entities.
‘‘(2) GRANTS.—
‘‘(A) IN GENERAL.—In carrying out the
programs described in paragraph (1), the Di-
rector may award grants under subsections (e),
(f), and (g) to expand access to, coordinate, and
improve the quality of essential health care
services, and enhance the delivery of health
care, in rural areas.
‘‘(B) TYPES
OF
GRANTS.—The Director
may award the grants—
‘‘(i) to promote expanded delivery of
health care services in rural areas under
subsection (e);
‘‘(ii) to provide for the planning and
implementation of integrated health care
networks in rural areas under subsection
(f); and
‘‘(iii) to provide for the planning and
implementation of small health care pro-
vider quality improvement activities under
subsection (g).
‘‘(e) RURAL HEALTH CARE SERVICES OUTREACH
GRANTS.—
‘‘(1) GRANTS.—The Director may award grants
to eligible entities to promote rural health care serv-
ices outreach by expanding the delivery of health
care services to include new and enhanced services
in rural areas. The Director may award the grants
for periods of not more than 3 years.
‘‘(2) ELIGIBILITY.—To be eligible to receive a
grant under this subsection for a project, an
entity—
‘‘(A) shall be a rural public or private enti-
ty;
‘‘(B) shall represent a consortium com-
posed of members—
‘‘(i) that include 3 or more health
care providers; 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, in
consultation with the appropriate State office of
rural health or another appropriate State entity,
shall prepare and submit to the Secretary an appli-
cation, at such time, in such manner, and containing
such information as the Secretary may require,
including—
‘‘(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 underserved pop-
ulations in the local community or region to be
served;
‘‘(C) a description of how the local commu-
nity or region to be served will be involved in
the development and ongoing operations of the
project;
‘‘(D) a plan for sustaining the project after
Federal support for the project has ended; and
‘‘(E) a description of how the project will
be evaluated.
‘‘(f) 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;
‘‘(ii) expand access to, coordinate, and
improve the quality of essential health care
services; and
‘‘(iii) strengthen the rural health care
system as a whole.
‘‘(B) GRANT PERIODS.—The Director may
award such a rural health network development
grant for implementation activities for a period
of 3 years. The Director may also award such
a rural health network development grant for
planning activities for a period of 1 year, to as-
sist in the development of an integrated health
care network, if the proposed participants in
the network do not have a history of collabo-
rative efforts and a 3-year grant would be inap-
propriate.
‘‘(2) ELIGIBILITY.—To be eligible to receive a
grant under this subsection, an entity—
‘‘(A) shall be a rural public or private enti-
ty;
‘‘(B) shall represent a network composed
of participants—
‘‘(i) that include 3 or more health
care providers; 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 grant
for planning activities) for the same or a simi-
lar 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 Secretary an appli-
cation, at such time, in such manner, and containing
such information as the Secretary 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—
‘‘(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;
‘‘(E) a plan for sustaining the project after
Federal support for the project has ended; and
‘‘(F) a description of how the project will
be evaluated.
‘‘(g) SMALL HEALTH CARE PROVIDER QUALITY IM-
PROVEMENT GRANTS.—
‘‘(1) GRANTS.—The Director may award grants
to provide for the planning and implementation of
small health care provider quality improvement ac-
tivities. The Director may award the grants for peri-
ods of 1 to 3 years.
‘‘(2) ELIGIBILITY.—To be eligible for a grant
under this subsection, an entity—
‘‘(A)(i) shall be a rural public or rural non-
profit private health care provider or provider
of health care services, such as a critical access
hospital or a rural health clinic; or
‘‘(ii) shall be another rural provider or net-
work of small rural providers identified by the
Secretary 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) APPLICATIONS.—To be eligible to receive a
grant under this subsection, an eligible entity, in
consultation with the appropriate State office of
rural health, another appropriate State entity, or a
hospital association, shall prepare and submit to the
Secretary an application, at such time, in such man-
ner, and containing such information as the Sec-
retary 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 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
across the continuum of care as a result of the
activities carried out by the entity;
‘‘(E) a plan for sustaining the project after
Federal support for the project has ended; and
‘‘(F) a description of how the project will
be evaluated.
‘‘(4) EXPENDITURES FOR SMALL HEALTH CARE
PROVIDER
QUALITY
IMPROVEMENT
GRANTS.—In
awarding a grant under this subsection, the Director
shall ensure that the funds made available through
the grant will be used to provide services to resi-
dents of rural areas. The Director shall award not
less than 50 percent of the funds made available
under this subsection to providers located in and
serving rural areas.
‘‘(h) GENERAL REQUIREMENTS.—
‘‘(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, except that such
funds may be expended for minor renovations
relating to the installation of equipment.
‘‘(2) COORDINATION WITH OTHER AGENCIES.—
The Secretary 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.
‘‘(3) PREFERENCE.—In awarding grants under
this section, the Secretary shall give preference to
entities that—
‘‘(A) are located in health professional
shortage areas or medically underserved com-
munities, or serve medically underserved popu-
lations; or
‘‘(B) propose to develop projects with a
focus on primary care, and wellness and preven-
tion strategies.
‘‘(i) REPORT.—Not later than September 30, 2005,
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 (e), (f), and (g).
‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There
are authorized to be appropriated to carry out this section
$40,000,000 for fiscal year 2002, and such sums as may
be necessary for each of fiscal years 2003 through 2006.’’.
Subtitle B—Telehealth Grant
Consolidation
SEC. 211. SHORT TITLE.
This subtitle may be cited as the ‘‘Telehealth Grant
Consolidation Act of 2001’’.
SEC. 212. CONSOLIDATION AND REAUTHORIZATION OF
PROVISIONS.
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. 330I. TELEHEALTH NETWORK AND TELEHEALTH RE-
SOURCE CENTERS GRANT PROGRAMS.
‘‘(a) DEFINITIONS.—In this section:
‘‘(1) DIRECTOR; OFFICE.—The terms ‘Director’
and ‘Office’ mean the Director and Office specified
in subsection (c).
‘‘(2) FEDERALLY QUALIFIED HEALTH CENTER
AND RURAL HEALTH CLINIC.—The term ‘Federally
qualified health center’ and ‘rural health clinic’ have
the meanings given the terms in section 1861(aa) of
the Social Security Act (42 U.S.C. 1395x(aa)).
‘‘(3) FRONTIER COMMUNITY.—The term ‘fron-
tier community’ means an area with fewer than 6
residents per square mile, based on the latest popu-
lation data published by the Bureau of the Census.
‘‘(4) MEDICALLY
UNDERSERVED
AREA.—The
term ‘medically underserved area’ has the meaning
given the term ‘medically underserved community’ in
section 799B.
‘‘(5) 
MEDICALLY
UNDERSERVED
POPU-
LATION.—The term ‘medically underserved popu-
lation’ has the meaning given the term in section
330(b)(3).
‘‘(6) TELEHEALTH SERVICES.—The term ‘tele-
health services’ means services provided through
telehealth technologies.
‘‘(7) TELEHEALTH TECHNOLOGIES.—The term
‘telehealth technologies’ means technologies relating
to the use of electronic information, and tele-
communications technologies, to support and pro-
mote, at a distance, health care, patient and profes-
sional health-related education, health administra-
tion, and public health.
‘‘(b) PROGRAMS.—The Secretary shall establish,
under section 301, telehealth network and telehealth re-
source centers grant programs.
‘‘(c) ADMINISTRATION.—
‘‘(1) ESTABLISHMENT.—There is established in
the Health and Resources and Services Administra-
tion an Office for the Advancement of Telehealth.
The Office shall be headed by a Director.
‘‘(2) DUTIES.—The telehealth network and tele-
health resource centers grant programs established
under section 301 shall be administered by the Di-
rector, in consultation with the State offices of rural
health, State offices concerning primary care, or
other appropriate State government entities.
‘‘(d) GRANTS.—
‘‘(1) TELEHEALTH
NETWORK
GRANTS.—The
Director may, in carrying out the telehealth network
grant program referred to in subsection (b), award
grants to eligible entities for projects to demonstrate
how telehealth technologies can be used through tele-
health networks in rural areas, frontier communities,
and medically underserved areas, and for medically
underserved populations, to—
‘‘(A) expand access to, coordinate, and im-
prove the quality of health care services;
‘‘(B) improve and expand the training of
health care providers; and
‘‘(C) expand and improve the quality of
health information available to health care pro-
viders, and patients and their families, for deci-
sionmaking.
‘‘(2) 
TELEHEALTH
RESOURCE
CENTERS
GRANTS.—The Director may, in carrying out the
telehealth resource centers grant program referred
to in subsection (b), award grants to eligible entities
for projects to demonstrate how telehealth tech-
nologies can be used in the areas and communities,
and for the populations, described in paragraph (1),
to establish telehealth resource centers.
‘‘(e) GRANT PERIODS.—The Director may award
grants under this section for periods of not more than 4
years.
‘‘(f) ELIGIBLE ENTITIES.—
‘‘(1) TELEHEALTH NETWORK GRANTS.—
‘‘(A) GRANT RECIPIENT.—To be eligible to
receive a grant under subsection (d)(1), an enti-
ty shall be a nonprofit entity.
‘‘(B) TELEHEALTH NETWORKS.—
‘‘(i) IN GENERAL.—To be eligible to
receive a grant under subsection (d)(1), an
entity shall demonstrate that the entity
will provide services through a telehealth
network.
‘‘(ii) NATURE
OF
ENTITIES.—Each
entity participating in the telehealth net-
work may be a nonprofit or for-profit enti-
ty.
‘‘(iii) COMPOSITION OF NETWORK.—
The telehealth network shall include at
least 2 of the following entities (at least 1
of which shall be a community-based
health care provider):
‘‘(I) 
Community 
or 
migrant
health centers or other Federally
qualified health centers.
‘‘(II) Health care providers, in-
cluding pharmacists, in private prac-
tice.
‘‘(III) Entities operating clinics,
including rural health clinics.
‘‘(IV) Local health departments.
‘‘(V) Nonprofit hospitals, includ-
ing community access hospitals.
‘‘(VI) 
Other 
publicly 
funded
health or social service agencies.
‘‘(VII) Long-term care providers.
‘‘(VIII) Providers of health care
services in the home.
‘‘(IX) Providers of outpatient
mental health services and entities op-
erating outpatient mental health fa-
cilities.
‘‘(X) Local or regional emergency
health care providers.
‘‘(XI) Institutions of higher edu-
cation.
‘‘(XII) Entities operating dental
clinics.
‘‘(2) 
TELEHEALTH
RESOURCE
CENTERS
GRANTS.—To be eligible to receive a grant under
subsection (d)(2), an entity shall be a nonprofit enti-
ty.
‘‘(g) APPLICATIONS.—To be eligible to receive a
grant under subsection (d), an eligible entity, in consulta-
tion with the appropriate State office of rural health or
another appropriate State entity, shall prepare and submit
to the Secretary an application, at such time, in such man-
ner, and containing such information as the Secretary may
require, including—
‘‘(1) a description of the project that the eligi-
ble entity will carry out using the funds provided
under the grant;
‘‘(2) a description of the manner in which the
project funded under the grant will meet the health
care needs of rural or other populations to be served
through the project, or improve the access to serv-
ices of, and the quality of the services received by,
those populations;
‘‘(3) evidence of local support for the project,
and a description of how the areas, communities, or
populations to be served will be involved in the devel-
opment and ongoing operations of the project;
‘‘(4) a plan for sustaining the project after Fed-
eral support for the project has ended;
‘‘(5) information on the source and amount of
non-Federal funds that the entity will provide for
the project;
‘‘(6) information demonstrating the long-term
viability of the project, and other evidence of institu-
tional commitment of the entity to the project; and
‘‘(7) in the case of an application for a project
involving a telehealth network, information dem-
onstrating how the project will promote the integra-
tion of telehealth technologies into the operations of
health care providers, to avoid redundancy, and im-
prove access to and the quality of care.
‘‘(h) TERMS; CONDITIONS; MAXIMUM AMOUNT OF
ASSISTANCE.—The Secretary shall establish the terms
and conditions of each grant program described in sub-
section (b) and the maximum amount of a grant to be
awarded to an individual recipient for each fiscal year
under this section. The Secretary shall publish, in a publi-
cation of the Health Resources and Services Administra-
tion, notice of the application requirements for each grant
program described in subsection (b) for each fiscal year.
‘‘(i) PREFERENCES.—
‘‘(1) TELEHEALTH
NETWORKS.—In awarding
grants under subsection (d)(1) for projects involving
telehealth networks, the Secretary shall give pref-
erence to an eligible entity that meets at least 1 of
the following requirements:
‘‘(A) ORGANIZATION.—The eligible entity
is a rural community-based organization or an-
other community-based organization.
‘‘(B) SERVICES.—The eligible entity pro-
poses to use Federal funds made available
through such a grant to develop plans for, or to
establish, telehealth networks that provide men-
tal health, public health, long-term care, home
care, preventive, or case management services.
‘‘(C) COORDINATION.—The eligible entity
demonstrates how the project to be carried out
under the grant will be coordinated with other
relevant federally funded projects in the areas,
communities, and populations to be served
through the grant.
‘‘(D) NETWORK.—The eligible entity dem-
onstrates that the project involves a telehealth
network that includes an entity that—
‘‘(i) provides clinical health care serv-
ices, or educational services for health care
providers and for patients or their families;
and
‘‘(ii) is—
‘‘(I) a public school;
‘‘(II) a public library;
‘‘(III) an institution of higher
education; or
‘‘(IV) a local government entity.
‘‘(E) CONNECTIVITY.—The eligible entity
proposes 
a 
project 
that 
promotes 
local
connectivity within areas, communities, or pop-
ulations to be served through the project.
‘‘(F) INTEGRATION.—The eligible entity
demonstrates that health care information has
been integrated into the project.
‘‘(2) TELEHEALTH
RESOURCE
CENTERS.—In
awarding grants under subsection (d)(2) for projects
involving telehealth resource centers, the Secretary
shall give preference to an eligible entity that meets
at least 1 of the following requirements:
‘‘(A) PROVISION OF SERVICES.—The eligi-
ble entity has a record of success in the provi-
sion of telehealth services to medically under-
served areas or medically underserved popu-
lations.
‘‘(B) COLLABORATION
AND
SHARING
OF
EXPERTISE.—The eligible entity has a dem-
onstrated record of collaborating and sharing
expertise with providers of telehealth services at
the national, regional, State, and local levels.
‘‘(C) BROAD
RANGE
OF
TELEHEALTH
SERVICES.—The eligible entity has a record of
providing a broad range of telehealth services,
which may include—
‘‘(i) a variety of clinical specialty serv-
ices;
‘‘(ii) patient or family education;
‘‘(iii) health care professional edu-
cation; and
‘‘(iv) rural residency support pro-
grams.
‘‘(j) DISTRIBUTION OF FUNDS.—
‘‘(1) IN GENERAL.—In awarding grants under
this section, the Director shall ensure, to the great-
est extent possible, that such grants are equitably
distributed among the geographical regions of the
United States.
‘‘(2) TELEHEALTH
NETWORKS.—In awarding
grants under subsection (d)(1) for a fiscal year, the
Director shall ensure that—
‘‘(A) not less than 50 percent of the funds
awarded shall be awarded for projects in rural
areas; and
‘‘(B) the total amount of funds awarded
for such projects for that fiscal year shall be
not less than the total amount of funds award-
ed for such projects for fiscal year 2001 under
section 330A (as in effect on the day before the
date of enactment of the Health Care Safety
Net Improvement Act).
‘‘(k) USE OF FUNDS.—
‘‘(1) TELEHEALTH NETWORK PROGRAM.—The
recipient of a grant under subsection (d)(1) may use
funds received through such grant for salaries,
equipment, and operating or other costs, including
the cost of—
‘‘(A) developing and delivering clinical tele-
health services that enhance access to commu-
nity-based health care services in rural areas,
frontier communities, or medically underserved
areas, or for medically underserved populations;
‘‘(B) developing and acquiring, through
lease or purchase, computer hardware and soft-
ware, audio and video equipment, computer net-
work equipment, interactive equipment, data
terminal equipment, and other equipment that
furthers the objectives of the telehealth network
grant program;
‘‘(C)(i) developing and providing distance
education, in a manner that enhances access to
care in rural areas, frontier communities, or
medically underserved areas, or for medically
underserved populations; or
‘‘(ii) mentoring, precepting, or supervising
health care providers and students seeking to
become health care providers, in a manner that
enhances access to care in the areas and com-
munities, or for the populations, described in
clause (i);
‘‘(D) developing and acquiring instruc-
tional programming;
‘‘(E)(i) providing for transmission of med-
ical data, and maintenance of equipment; and
‘‘(ii) providing for compensation (including
travel expenses) of specialists, and referring
health care providers, who are providing tele-
health services through the telehealth network,
if no third party payment is available for the
telehealth services delivered through the tele-
health network;
‘‘(F) developing projects to use telehealth
technology to facilitate collaboration between
health care providers;
‘‘(G) collecting and analyzing usage statis-
tics and data to document the cost-effectiveness
of the telehealth services; and
‘‘(H) carrying out such other activities as
are consistent with achieving the objectives of
this section, as determined by the Secretary.
‘‘(2) TELEHEALTH RESOURCE CENTERS.—The
recipient of a grant under subsection (d)(2) may use
funds received through such grant for salaries,
equipment, and operating or other costs for—
‘‘(A) providing technical assistance, train-
ing, and support, and providing for travel ex-
penses, for health care providers and a range of
health care entities that provide or will provide
telehealth services;
‘‘(B) disseminating information and re-
search findings related to telehealth services;
‘‘(C) 
promoting 
effective 
collaboration
among telehealth resource centers and the Of-
fice;
‘‘(D) conducting evaluations to determine
the best utilization of telehealth technologies to
meet health care needs;
‘‘(E) promoting the integration of the tech-
nologies used in clinical information systems
with other telehealth technologies;
‘‘(F) fostering the use of telehealth tech-
nologies to provide health care information and
education for health care providers and con-
sumers in a more effective manner; and
‘‘(G) implementing special projects or
studies under the direction of the Office.
‘‘(l) PROHIBITED USES OF FUNDS.—An entity that
receives a grant under this section may not use funds
made available through the grant—
‘‘(1) to acquire real property;
‘‘(2) for expenditures to purchase or lease
equipment, to the extent that the expenditures would
exceed 40 percent of the total grant funds;
‘‘(3) in the case of a project involving a tele-
health network, to purchase or install transmission
equipment (such as laying cable or telephone lines,
or purchasing or installing microwave towers, sat-
ellite dishes, amplifiers, or digital switching equip-
ment);
‘‘(4) to pay for any equipment or transmission
costs not directly related to the purposes for which
the grant is awarded;
‘‘(5) to purchase or install general purpose
voice telephone systems;
‘‘(6) for construction, except that such funds
may be expended for minor renovations relating to
the installation of equipment; or
‘‘(7) for expenditures for indirect costs (as de-
termined by the Secretary), to the extent that the
expenditures would exceed 10 percent of the total
grant funds.
‘‘(m) COLLABORATION.—In providing services under
this section, an eligible entity shall collaborate, if feasible,
with entities that—
‘‘(1)(A) are private or public organizations, that
receive Federal or State assistance; or
‘‘(B) are public or private entities that operate
centers, or carry out programs, that receive Federal
or State assistance; and
‘‘(2) provide telehealth services or related activi-
ties.
‘‘(n) COORDINATION WITH OTHER AGENCIES.—The
Secretary shall coordinate activities carried out under
grant programs described in subsection (b), to the extent
practicable, with Federal and State agencies and nonprofit
organizations that are operating similar programs, to
maximize the effect of public dollars in funding meri-
torious proposals.
‘‘(o) OUTREACH ACTIVITIES.—The Secretary shall
establish and implement procedures to carry out outreach
activities to advise potential end users of telehealth serv-
ices in rural areas, frontier communities, medically under-
served areas, and medically underserved populations in
each State about the grant programs described in sub-
section (b).
‘‘(p) TELEHEALTH.—It is the sense of Congress that,
for purposes of this section, States should develop reci-
procity agreements so that a provider of services under
this section who is a licensed or otherwise authorized
health care provider under the law of 1 or more States,
and who, through telehealth technology, consults with a
licensed or otherwise authorized health care provider in
another State, is exempt, with respect to such consulta-
tion, from any State law of the other State that prohibits
such consultation on the basis that the first health care
provider is not a licensed or authorized health care pro-
vider under the law of that State.
‘‘(q) REPORT.—Not later than September 30, 2005,
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-
section (b).
‘‘(r) AUTHORIZATION OF APPROPRIATIONS.—There
are authorized to be appropriated to carry out this
section—
‘‘(1) for grants under subsection (d)(1),
$40,000,000 for fiscal year 2002, and such sums as
may be necessary for each of fiscal years 2003
through 2006; and
‘‘(2) for grants under subsection (d)(2),
$20,000,000 for fiscal year 2002, and such sums as
may be necessary for each of fiscal years 2003
through 2006.’’.
Subtitle C—Mental Health Services
Telehealth Program and Rural
Emergency 
Medical 
Service
Training and Equipment Assist-
ance Program
SEC. 221. PROGRAMS.
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-
tion 212) is further amended by adding at the end the
following:
‘‘SEC. 330J. RURAL EMERGENCY MEDICAL SERVICE TRAIN-
ING AND EQUIPMENT ASSISTANCE PROGRAM.
‘‘(a) GRANTS.—The Secretary, acting through the
Administrator of the Health Resources and Services Ad-
ministration (referred to in this section as the ‘Secretary’)
shall award grants to eligible entities to enable such enti-
ties to provide for improved emergency medical services
in rural areas.
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant
under this section, an entity shall—
‘‘(1) be—
‘‘(A) a State emergency medical services
office;
‘‘(B) a State emergency medical services
association;
‘‘(C) a State office of rural health;
‘‘(D) a local government entity;
‘‘(E) a State or local ambulance provider;
or
‘‘(F) any other entity determined appro-
priate by the Secretary; and
‘‘(2) prepare and submit to the Secretary an
application at such time, in such manner, and con-
taining such information as the Secretary may re-
quire, that includes—
‘‘(A) a description of the activities to be
carried out under the grant; and
‘‘(B) an assurance that the eligible entity
will comply with the matching requirement of
subsection (e).
‘‘(c) USE OF FUNDS.—An entity shall use amounts
received under a grant made under subsection (a), either
directly or through grants to emergency medical service
squads that are located in, or that serve residents of, a
nonmetropolitan statistical area, an area designated as a
rural area by any law or regulation of a State, or a rural
census tract of a metropolitan statistical area (as deter-
mined under the most recent Goldsmith Modification,
originally published in a notice of availability of funds in
the Federal Register on February 27, 1992, 57 Fed. Reg.
6725), to—
‘‘(1) recruit emergency medical service per-
sonnel;
‘‘(2) recruit volunteer emergency medical serv-
ice personnel;
‘‘(3) train emergency medical service personnel
in emergency response, injury prevention, safety
awareness, and other topics relevant to the delivery
of emergency medical services;
‘‘(4) fund specific training to meet Federal or
State certification requirements;
‘‘(5) develop new ways to educate emergency
health care providers through the use of technology-
enhanced educational methods (such as distance
learning);
‘‘(6) acquire emergency medical services equip-
ment, including cardiac defibrillators;
‘‘(7) acquire personal protective equipment for
emergency medical services personnel as required by
the Occupational Safety and Health Administration;
and
‘‘(8) 
educate 
the 
public 
concerning
cardiopulmonary resuscitation, first aid, injury pre-
vention, safety awareness, illness prevention, and
other related emergency preparedness topics.
‘‘(d) PREFERENCE.—In awarding grants under this
section the Secretary shall give preference to—
‘‘(1) applications that reflect a collaborative ef-
fort by 2 or more of the entities described in sub-
paragraphs (A) through (F) of subsection (b)(1);
and
‘‘(2) applications submitted by entities that in-
tend to use amounts provided under the grant to
fund activities described in any of paragraphs (1)
through (5) of subsection (c).
‘‘(e) MATCHING REQUIREMENT.—The Secretary may
not award a grant under this section to an entity unless
the entity agrees that the entity will make available (di-
rectly or through contributions from other public or pri-
vate entities) non-Federal contributions toward the activi-
ties to be carried out under the grant in an amount equal
to 25 percent of the amount received under the grant.
‘‘(f) EMERGENCY MEDICAL SERVICES.—In this sec-
tion, the term ‘emergency medical services’—
‘‘(1) means resources used by a qualified public
or private nonprofit entity, or by any other entity
recognized as qualified by the State involved, to de-
liver medical care outside of a medical facility under
emergency conditions that occur—
‘‘(A) as a result of the condition of the pa-
tient; or
‘‘(B) as a result of a natural disaster or
similar situation; and
‘‘(2) includes services delivered by an emer-
gency medical services provider (either compensated
or volunteer) or other provider recognized by the
State involved that is licensed or certified by the
State as an emergency medical technician or its
equivalent (as determined by the State), a registered
nurse, a physician assistant, or a physician that pro-
vides services similar to services provided by such an
emergency medical services provider.
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) IN GENERAL.—There are authorized to be
appropriated to carry out this section such sums as
may be necessary for each of fiscal years 2002
through 2006.
‘‘(2) ADMINISTRATIVE COSTS.—The Secretary
may use not more than 10 percent of the amount
appropriated under paragraph (1) for a fiscal year
for the administrative expenses of carrying out this
section.
‘‘SEC. 330K. MENTAL HEALTH SERVICES DELIVERED VIA
TELEHEALTH.
‘‘(a) DEFINITIONS.—In this section:
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means a public or nonprofit private telehealth
provider network that offers services that include
mental health services provided by qualified mental
health providers.
‘‘(2) QUALIFIED
MENTAL
HEALTH
PROFES-
SIONALS.—The term ‘qualified mental health profes-
sionals’ refers to providers of mental health services
reimbursed under the medicare program carried out
under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) who have additional training in
the treatment of mental illness in children and ado-
lescents or who have additional training in the treat-
ment of mental illness in the elderly.
‘‘(3) SPECIAL POPULATIONS.—The term ‘spe-
cial populations’ refers to the following 2 distinct
groups:
‘‘(A) Children and adolescents in mental
health underserved rural areas or in mental
health underserved urban areas.
‘‘(B) Elderly individuals located in long-
term care facilities in mental health under-
served rural areas or in mental health under-
served urban areas.
‘‘(4) 
TELEHEALTH.—The 
term 
‘telehealth’
means the use of electronic information and tele-
communications technologies to support long dis-
tance clinical health care, patient and professional
health-related education, public health, and health
administration.
‘‘(b) PROGRAM AUTHORIZED.—
‘‘(1) IN
GENERAL.—The Secretary, acting
through the Director of the Office for the Advance-
ment of Telehealth of the Health Resources and
Services Administration, shall award grants to eligi-
ble entities to establish demonstration projects for
the provision of mental health services to special
populations as delivered remotely by qualified mental
health professionals using telehealth and for the pro-
vision of education regarding mental illness as deliv-
ered remotely by qualified mental health profes-
sionals and qualified mental health education profes-
sionals using telehealth.
‘‘(2) POPULATIONS
SERVED.—The Secretary
shall award the grants under paragraph (1) in a
manner that distributes the grants so as to serve eq-
uitably the populations described in subparagraphs
(A) and (B) of subsection (a)(4).
‘‘(c) USE OF FUNDS.—
‘‘(1) IN GENERAL.—An eligible entity that re-
ceives a grant under this section shall use the grant
funds—
‘‘(A) for the populations described in sub-
section (a)(3)(A)—
‘‘(i) to provide mental health services,
including diagnosis and treatment of men-
tal illness, in public elementary and public
secondary schools as delivered remotely by
qualified mental health professionals using
telehealth; and
‘‘(ii) to collaborate with local public
health entities to provide the mental health
services; and
‘‘(B) for the populations described in sub-
section (a)(3)(B)—
‘‘(i) to provide mental health services,
including diagnosis and treatment of men-
tal illness, in long-term care facilities as
delivered remotely by qualified mental
health professionals using telehealth; and
‘‘(ii) to collaborate with local public
health entities to provide the mental health
services.
‘‘(2) OTHER USES.—An eligible entity that re-
ceives a grant under this section may also use the
grant funds to—
‘‘(A) pay telecommunications costs; and
‘‘(B) pay qualified mental health profes-
sionals on a reasonable basis as determined by
the Secretary for services rendered.
‘‘(3) PROHIBITED
USES.—An eligible entity
that receives a grant under this section shall not use
the grant funds to—
‘‘(A) purchase or install transmission
equipment (other than such equipment used by
qualified mental health professionals to deliver
mental health services using telehealth under
the project involved); or
‘‘(B) build upon or acquire real property.
‘‘(d) 
EQUITABLE
DISTRIBUTION.—In 
awarding
grants under this section, the Secretary shall ensure, to
the greatest extent possible, that such grants are equitably
distributed among geographical regions of the United
States.
‘‘(e) APPLICATION.—An entity that desires a grant
under this section shall submit an application to the Sec-
retary at such time, in such manner, and containing such
information as the Secretary determines to be reasonable.
‘‘(f) REPORT.—Not later than 4 years after the date
of enactment of the Health Care Safety Net Improvement
Act, the Secretary shall prepare and submit to the appro-
priate committees of Congress a report that shall evaluate
activities funded with grants under this section.
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There
are authorized to be appropriated to carry out this section,
$20,000,000 for fiscal year 2002 and such sums as may
be necessary for fiscal years 2003 through 2006.’’.
TITLE III—NATIONAL HEALTH
SERVICE CORPS PROGRAM
SEC. 301. NATIONAL HEALTH SERVICE CORPS.
(a) IN GENERAL.—Section 331 of the Public Health
Service Act (42 U.S.C. 254d) is amended—
(1) by adding at the end of subsection (a)(3)
the following:
‘‘(E)(i) The term ‘behaviorial and mental health
professionals’ means health service psychologists, li-
censed clinical social workers, licensed professional
counselors, marriage and family therapists, psy-
chiatric nurse specialists, and psychiatrists.
‘‘(ii) The term ‘graduate program of behavioral
and mental health’ means a program that trains
behavorial and mental health professionals.’’;
(2) in subsection (b)—
(A) in paragraph (1), by striking ‘‘health
professions’’ and inserting ‘‘health professions,
including schools at which graduate programs
of behavioral and mental health are offered,’’;
and
(B) in paragraph (2), by inserting ‘‘behav-
ioral and mental health professionals,’’ after
‘‘dentists,’’; and
(3) by striking subsection (c) and inserting the
following:
‘‘(c)(1) The Secretary may reimburse an applicant
for a position in the Corps (including an individual consid-
ering entering into a written agreement pursuant to sec-
tion 338D) for the actual and reasonable expenses in-
curred in traveling to and from the applicant’s place of
residence to an eligible site to which the applicant may
be assigned under section 333 for the purpose of evalu-
ating such site with regard to being assigned at such site.
The Secretary may establish a maximum total amount
that may be paid to an individual as reimbursement for
such expenses.
‘‘(2) The Secretary may also reimburse the applicant
for the actual and reasonable expenses incurred for the
travel of 1 family member to accompany the applicant to
such site. The Secretary may establish a maximum total
amount that may be paid to an individual as reimburse-
ment for such expenses.
‘‘(3) In the case of an individual who has entered into
a contract for obligated service under the Scholarship Pro-
gram or under the Loan Repayment Program, the Sec-
retary may reimburse such individual for all or part of
the actual and reasonable expenses incurred in trans-
porting the individual to the site of the individual’s assign-
ment under section 333. The Secretary may establish a
maximum total amount that may be paid to an individual
as reimbursement for such expenses.’’.
(b) DEMONSTRATION PROJECTS.—Section 331 of the
Public Health Service Act (42 U.S.C. 254d) is amended—
(1) by redesignating subsection (i) as subsection
(j); and
(2) by inserting after subsection (h) the fol-
lowing:
‘‘(i)(1) In carrying out subpart III, the Secretary
may, in accordance with this subsection, carry out dem-
onstration projects in which individuals who have entered
into a contract for obligated service under the Loan Re-
payment Program receive waivers under which the individ-
uals are authorized to satisfy the requirement of obligated
service through providing clinical service that is not full-
time.
‘‘(2) A waiver described in paragraph (1) may be pro-
vided by the Secretary only if—
‘‘(A) the entity for which the service is to be
performed—
‘‘(i) has been approved under section 333A
for assignment of a Corps member; and
‘‘(ii) has requested in writing assignment
of a health professional who would serve less
than full time;
‘‘(B) the Secretary has determined that assign-
ment of a health professional who would serve less
than full time would be appropriate for the area
where the entity is located;
‘‘(C) a Corps member who is required to per-
form obligated service has agreed in writing to be
assigned for less than full-time service to an entity
described in subparagraph (A);
‘‘(D) the entity and the Corps member agree in
writing that the less than full-time service provided
by the Corps member will not be less than 16 hours
of clinical service per week;
‘‘(E) the Corps member agrees in writing that
the period of obligated service pursuant to section
338B will be extended so that the aggregate amount
of less than full-time service performed will equal the
amount of service that would be performed through
full-time service under section 338C; and
‘‘(F) the Corps member agrees in writing that
if the Corps member begins providing less than full-
time service but fails to begin or complete the period
of obligated service, the method stated in 338E(c)
for determining the damages for breach of the indi-
vidual’s written contract will be used after con-
verting periods of obligated service or of service per-
formed into their full-time equivalents.’’.
SEC. 
302. 
DESIGNATION 
OF 
HEALTH 
PROFESSIONAL
SHORTAGE AREAS.
(a) IN GENERAL.—Section 332 of the Public Health
Service Act (42 U.S.C. 254e) is amended—
(1) in subsection (a)—
(A) in paragraph (1), by inserting after
the first sentence the following: ‘‘All Federally
qualified health centers and rural health clinics,
as defined in section 1861(aa) of the Social Se-
curity Act (42 U.S.C. 1395x(aa)), that meet the
requirements of section 334 shall be automati-
cally designated as having such a shortage. Not
earlier than 6 years after such date of enact-
ment, and every 6 years thereafter, each such
center or clinic shall demonstrate that the cen-
ter or clinic meets the applicable requirements
of the Federal regulations, issued after the date
of enactment of this Act, that revise the defini-
tion of a health professional shortage area for
purposes of this section.’’; and
(B) in paragraph (3), by striking ‘‘340(r))
may be a population group’’ and inserting
‘‘330(h)(4)), seasonal agricultural workers (as
defined in section 330(g)(3)) and migratory ag-
ricultural workers (as so defined)), and resi-
dents of public housing (as defined in section
3(b)(1) of the United States Housing Act of
1937 (42 U.S.C. 1437a(b)(1))) may be popu-
lation groups’’;
(2) in subsection (b)(2), by striking ‘‘with spe-
cial consideration to the indicators of’’ and all that
follows through ‘‘services.’’ and inserting a period;
and
(3) in subsection (c)(2)(B), by striking ‘‘XVIII
or XIX’’ and inserting ‘‘XVIII, XIX, or XXI’’.
(b) REGULATIONS.—
(1) REPORT.—
(A) IN
GENERAL.—The Secretary shall
submit the report described in subparagraph
(B) if the Secretary, acting through the Admin-
istrator of the Health Resources and Services
Administration, issues—
(i) a regulation that revises the defini-
tion of a health professional shortage area
for purposes of section 332 of the Public
Health Service Act (42 U.S.C. 254e); or
(ii) a regulation that revises the
standards concerning priority of such an
area under section 333A of that Act (42
U.S.C. 254f–1).
(B) REPORT.—On issuing a regulation de-
scribed in subparagraph (A), the Secretary shall
prepare and submit to the Committee on En-
ergy and Commerce of the House of Represent-
atives and the Committee on Health, Edu-
cation, Labor, and Pensions of the Senate a re-
port that describes the regulation.
(2) EFFECTIVE
DATE.—Each regulation de-
scribed in paragraph (1)(A) shall take effect 180
days after the committees described in paragraph
(1)(B) receive a report referred to in paragraph
(1)(B) describing the regulation.
(c) SCHOLARSHIP
AND LOAN REPAYMENT PRO-
GRAMS.—The Secretary of Health and Human Services,
in consultation with organizations representing individuals
in the dental field and organizations representing publicly
funded health care providers, shall develop and implement
a plan for increasing the participation of dentists and den-
tal hygienists in the National Health Service Corps Schol-
arship Program under section 338A of the Public Health
Service Act (42 U.S.C. 254l) and the Loan Repayment
Program under section 338B of such Act (42 U.S.C.
254l–1).
(d) SITE DESIGNATION PROCESS.—
(1) IMPROVEMENT
OF
DESIGNATION
PROC-
ESS.—The Administrator of the Health Resources
and Services Administration, in consultation with
appropriate State and territorial dental directors,
dental societies, and other interested parties, shall
revise the criteria on which the designations of den-
tal health professional shortage areas are based so
that such criteria provide a more accurate reflection
of oral health care need, particularly in rural areas.
(2) PUBLIC
HEALTH
SERVICE
ACT.—Section
332 of the Public Health Service Act (42 U.S.C.
254e) is amended by adding at the end the fol-
lowing:
‘‘(i) DISSEMINATION.—The Administrator of the
Health Resources and Services Administration shall dis-
seminate information concerning the designation criteria
described in subsection (b) to—
‘‘(1) the Governor of each State;
‘‘(2) the representative of any area, population
group, or facility selected by any such Governor to
receive such information;
‘‘(3) the representative of any area, population
group, or facility that requests such information;
and
‘‘(4) the representative of any area, population
group, or facility determined by the Administrator to
be likely to meet the criteria described in subsection
(b).’’.
(e) GAO STUDY.—Not later than February 1, 2005,
the Comptroller General of the United States shall submit
to the Congress a report on the appropriateness of the
criteria, including but not limited to infant mortality rates,
access to health services taking into account the distance
to primary health services, the rate of poverty and ability
to pay for health services, and low birth rates, established
by the Secretary of Health and Human Services for the
designation of health professional shortage areas and
whether the deeming of Federally qualified health centers
and rural health clinics as such areas is appropriate and
necessary.
SEC. 303. ASSIGNMENT OF CORPS PERSONNEL.
Section 333 of the Public Health Service Act (42
U.S.C. 254f) is amended—
(1) in subsection (a)—
(A) in paragraph (1)—
(i) in the matter before subparagraph
(A), by striking ‘‘(specified in the agree-
ment described in section 334)’’;
(ii) in subparagraph (A), by striking
‘‘nonprofit’’; and
(iii) by striking subparagraph (C) and
inserting the following:
‘‘(C) the entity agrees to comply with the
requirements of section 334; and’’; and
(B) in paragraph (3), by adding at the end
‘‘In approving such applications, the Secretary
shall give preference to applications in which a
nonprofit entity or public entity shall provide a
site to which Corps members may be as-
signed.’’; and
(2) in subsection (d)—
(A) in paragraphs (1), (2), and (4), by
striking ‘‘nonprofit’’ each place it appears; and
(B) in paragraph (1)—
(i) in the second sentence—
(I) in subparagraph (C), by strik-
ing ‘‘and’’ at the end; and
(II) by striking the period and
inserting ‘‘, and (E) developing long-
term plans for addressing health pro-
fessional shortages and improving ac-
cess to health care.’’; and
(ii) by adding at the end the fol-
lowing: ‘‘The Secretary shall encourage en-
tities that receive technical assistance
under this paragraph to communicate with
other communities, State Offices of Rural
Health, State Primary Care Associations
and Offices, and other entities concerned
with site development and community
needs assessment.’’.
SEC. 304. PRIORITIES IN ASSIGNMENT OF CORPS PER-
SONNEL.
Section 333A of the Public Health Service Act (42
U.S.C. 254f–1) is amended—
(1) in subsection (a)(1)(A), by striking ‘‘, as de-
termined in accordance with subsection (b)’’;
(2) by striking subsection (b);
(3) in subsection (c), by striking the second
sentence;
(4) in subsection (d)—
(A) 
by 
redesignating 
paragraphs 
(1)
through (3) as paragraphs (2) through (4), re-
spectively;
(B) by inserting before paragraph (2) (as
redesignated by subparagraph (A)) the fol-
lowing:
‘‘(1) PROPOSED LIST.—The Secretary shall pre-
pare and publish a proposed list of health profes-
sional shortage areas and entities that would receive
priority under subsection (a)(1) in the assignment of
Corps members. The list shall contain the informa-
tion described in paragraph (2), and the relative
scores and relative priorities of the entities submit-
ting applications under section 333, in a proposed
format. All such entities shall have 30 days after the
date of publication of the list to provide additional
data and information in support of inclusion on the
list or in support of a higher priority determination
and the Secretary shall reasonably consider such
data and information in preparing the final list
under paragraph (2).’’;
(C) in paragraph (2) (as redesignated by
subparagraph (A)), in the matter before sub-
paragraph (A)—
(i) by striking ‘‘paragraph (2)’’ and
inserting ‘‘paragraph (3)’’;
(ii) by striking ‘‘prepare a list of
health professional shortage areas’’ and in-
serting ‘‘prepare and, as appropriate, up-
date a list of health professional shortage
areas and entities’’; and
(iii) by striking ‘‘for the period appli-
cable under subsection (f)’’;
(D) by striking paragraph (3) (as redesig-
nated by subparagraph (A)) and inserting the
following:
‘‘(3) NOTIFICATION OF AFFECTED PARTIES.—
‘‘(A) ENTITIES.—Not later than 30 days
after the Secretary has added to a list under
paragraph (2) an entity specified as described
in subparagraph (A) of such paragraph, the
Secretary shall notify such entity that the entity
has been provided an authorization to receive
assignments of Corps members in the event
that Corps members are available for the as-
signments.
‘‘(B) INDIVIDUALS.—In the case of an in-
dividual obligated to provide service under the
Scholarship Program, not later than 3 months
before the date described in section 338C(b)(5),
the Secretary shall provide to such individual
the names of each of the entities specified as
described in paragraph (2)(B)(i) that is appro-
priate for the individual’s medical specialty and
discipline.’’; and
(E) by striking paragraph (4) (as redesig-
nated by subparagraph (A)) and inserting the
following:
‘‘(4) REVISIONS.—If the Secretary proposes to
make a revision in the list under paragraph (2), and
the revision would adversely alter the status of an
entity with respect to the list, the Secretary shall no-
tify the entity of the revision. Any entity adversely
affected by such a revision shall be notified in writ-
ing by the Secretary of the reasons for the revision
and shall have 30 days to file a written appeal of the
determination involved which shall be reasonably
considered by the Secretary before the revision to
the list becomes final. The revision to the list shall
be effective with respect to assignment of Corps
members beginning on the date that the revision be-
comes final.’’;
(5) by striking subsection (e) and inserting the
following:
‘‘(e) LIMITATION
ON NUMBER
OF ENTITIES OF-
FERED AS ASSIGNMENT CHOICES IN SCHOLARSHIP PRO-
GRAM.—
‘‘(1) DETERMINATION
OF
AVAILABLE
CORPS
MEMBERS.—By April 1 of each calendar year, the
Secretary shall determine the number of participants
in the Scholarship Program who will be available for
assignments under section 333 during the program
year beginning on July 1 of that calendar year.
‘‘(2) DETERMINATION
OF
NUMBER
OF
ENTI-
TIES.—At all times during a program year, the
number of entities specified under subsection
(c)(2)(B)(i) shall be—
‘‘(A) not less than the number of partici-
pants determined with respect to that program
year under paragraph (1); and
‘‘(B) not greater than twice the number of
participants determined with respect to that
program year under paragraph (1).’’;
(6) by striking subsection (f); and
(7) by redesignating subsections (c), (d), and
(e) as subsections (b), (c), and (d) respectively.
SEC. 305. COST-SHARING.
Subpart II of part D of title III of the Public Health
Service Act (42 U.S.C. 254d et seq.) is amended by strik-
ing section 334 and inserting the following:
‘‘SEC. 334. CHARGES FOR SERVICES BY ENTITIES USING
CORPS MEMBERS.
‘‘(a) AVAILABILITY OF SERVICES REGARDLESS OF
ABILITY TO PAY OR PAYMENT SOURCE.—An entity to
which a Corps member is assigned shall not deny re-
quested health care services, and shall not discriminate in
the provision of services to an individual—
‘‘(1) because the individual is unable to pay for
the services; or
‘‘(2) because payment for the services would be
made under—
‘‘(A) the medicare program under title
XVIII of the Social Security Act (42 U.S.C.
1395 et seq.);
‘‘(B) the medicaid program under title
XIX of such Act (42 U.S.C. 1396 et seq.); or
‘‘(C) the State children’s health insurance
program under title XXI of such Act (42
U.S.C. 1397aa et seq.).
‘‘(b) CHARGES FOR SERVICES.—The following rules
shall apply to charges for health care services provided by
an entity to which a Corps member is assigned:
‘‘(1) IN GENERAL.—
‘‘(A) 
SCHEDULE
OF
FEES
OR
PAY-
MENTS.—Except as provided in paragraph (2),
the entity shall prepare a schedule of fees or
payments for the entity’s services, consistent
with locally prevailing rates or charges and de-
signed to cover the entity’s reasonable cost of
operation.
‘‘(B) SCHEDULE OF DISCOUNTS.—Except
as provided in paragraph (2), the entity shall
prepare a corresponding schedule of discounts
(including, in appropriate cases, waivers) to be
applied to such fees or payments. In preparing
the schedule, the entity shall adjust the dis-
counts on the basis of a patient’s ability to pay.
‘‘(C) USE
OF
SCHEDULES.—The entity
shall make every reasonable effort to secure
from patients fees and payments for services in
accordance with such schedules, and fees or
payments shall be sufficiently discounted in ac-
cordance with the schedule described in sub-
paragraph (B).
‘‘(2) SERVICES TO BENEFICIARIES OF FEDERAL
AND FEDERALLY ASSISTED PROGRAMS.—In the case
of health care services furnished to an individual
who is a beneficiary of a program listed in sub-
section (a)(2), the entity—
‘‘(A) shall accept an assignment pursuant
to section 1842(b)(3)(B)(ii) of the Social Secu-
rity Act (42 U.S.C. 1395u(b)(3)(B)(ii)) with re-
spect to an individual who is a beneficiary
under the medicare program; and
‘‘(B) shall enter into an appropriate agree-
ment with—
‘‘(i) the State agency administering
the program under title XIX of such Act
with respect to an individual who is a ben-
eficiary under the medicaid program; and
‘‘(ii) the State agency administering
the program under title XXI of such Act
with respect to an individual who is a ben-
eficiary under the State children’s health
insurance program.
‘‘(3) COLLECTION OF PAYMENTS.—The entity
shall take reasonable and appropriate steps to collect
all payments due for health care services provided by
the entity, including payments from any third party
(including a Federal, State, or local government
agency and any other third party) that is responsible
for part or all of the charge for such services.’’.
SEC. 306. ELIGIBILITY FOR FEDERAL FUNDS.
Section 335(e)(1)(B) of the Public Health Service
Act (42 U.S.C. 254h(e)(1)(B)) is amended by striking
‘‘XVIII or XIX’’ and inserting ‘‘XVIII, XIX, or XXI’’.
SEC. 307. FACILITATION OF EFFECTIVE PROVISION OF
CORPS SERVICES.
(a) HEALTH PROFESSIONAL SHORTAGE AREAS.—
Section 336 of the Public Health Service Act (42 U.S.C.
254h–1) is amended—
(1) in subsection (c), by striking ‘‘health man-
power’’ and inserting ‘‘health professional’’; and
(2) in subsection (f)(1), by striking ‘‘health
manpower’’ and inserting ‘‘health professional’’.
(b) TECHNICAL AMENDMENT.—Section 336A(8) of
the Public Health Service Act (42 U.S.C. 254i(8)) is
amended by striking ‘‘agreements under’’.
SEC. 308. AUTHORIZATION OF APPROPRIATIONS.
Section 338(a) of the Public Health Service Act (42
U.S.C. 254k(a)) is amended—
(1) by striking ‘‘(1) For’’ and inserting ‘‘For’’;
(2) by striking ‘‘1991 through 2000’’ and in-
serting ‘‘2002 through 2006’’; and
(3) by striking paragraph (2).
SEC. 309. NATIONAL HEALTH SERVICE CORPS SCHOLAR-
SHIP PROGRAM.
Section 338A of the Public Health Service Act (42
U.S.C. 254l) is amended—
(1) in subsection (a)(1), by inserting ‘‘behav-
ioral and mental health professionals,’’ after ‘‘den-
tists,’’;
(2) in subsection (b)(1)(B), by inserting ‘‘, or
an appropriate degree from a graduate program of
behavioral and mental health’’ after ‘‘other health
profession’’;
(3) in subsection (c)(1)—
(A) in subparagraph (A), by striking
‘‘338D’’ and inserting ‘‘338E’’; and
(B) in subparagraph (B), by striking
‘‘338C’’ and inserting ‘‘338D’’;
(4) in subsection (d)(1)—
(A) in subparagraph (A), by striking
‘‘and’’ at the end;
(B) by redesignating subparagraph (B) as
subparagraph (C); and
(C) by inserting after subparagraph (A)
the following:
‘‘(B) the Secretary, in considering applica-
tions from individuals accepted for enrollment
or enrolled in dental school, shall consider ap-
plications from all individuals accepted for en-
rollment or enrolled in any accredited dental
school in a State; and’’;
(5) in subsection (f)—
(A) in paragraph (1)(B)—
(i) in clause (iii), by striking ‘‘and’’
after the semicolon;
(ii) by redesignating clause (iv) as
clause (v); and
(iii) by inserting after clause (iii) the
following new clause:
‘‘(iv) if pursuing a degree from a
school of medicine or osteopathic medicine,
to complete a residency in a specialty that
the Secretary determines is consistent with
the needs of the Corps; and’’; and
(B) in paragraph (3), by striking ‘‘338D’’
and inserting ‘‘338E’’; and
(6) by striking subsection (i).
SEC. 310. NATIONAL HEALTH SERVICE CORPS LOAN REPAY-
MENT PROGRAM.
Section 338B of the Public Health Service Act (42
U.S.C. 254l–1) is amended—
(1) in subsection (a)—
(A) in paragraph (1), by inserting ‘‘behav-
ioral and mental health professionals,’’ after
‘‘dentists,’’; and
(B) in paragraph (2), by striking ‘‘(includ-
ing mental health professionals)’’;
(2) in subsection (b)(1), by striking subpara-
graph (A) and inserting the following:
‘‘(A) have a degree in medicine, osteopathic
medicine, dentistry, or another health profession, or
an appropriate degree from a graduate program of
behavioral and mental health, or be certified as a
nurse midwife, nurse practitioner, or physician as-
sistant;’’;
(3) in subsection (e), by striking ‘‘(1) IN GEN-
ERAL.—’’; and
(4) by striking subsection (i).
SEC. 311. OBLIGATED SERVICE.
Section 338C of the Public Health Service Act (42
U.S.C. 254m) is amended—
(1) in subsection (b)—
(A) in paragraph (1), in the matter pre-
ceding subparagraph (A), by striking ‘‘section
338A(f)(1)(B)(iv)’’ 
and 
inserting 
‘‘section
338A(f)(1)(B)(v)’’; and
(B) in paragraph (5)—
(i) by striking all that precedes sub-
paragraph (C) and inserting the following:
‘‘(5)(A) In the case of the Scholarship Program, the
date referred to in paragraphs (1) through (4) shall be
the date on which the individual completes the training
required for the degree for which the individual receives
the scholarship, except that—
‘‘(i) for an individual receiving such a degree
after September 30, 2000, from a school of medicine
or osteopathic medicine, such date shall be the date
the individual completes a residency in a specialty
that the Secretary determines is consistent with the
needs of the Corps; and
‘‘(ii) at the request of an individual, the Sec-
retary may, consistent with the needs of the Corps,
defer such date until the end of a period of time re-
quired for the individual to complete advanced train-
ing (including an internship or residency).’’;
(ii) by striking subparagraph (D);
(iii) by redesignating subparagraphs
(C) and (E) as subparagraphs (B) and
(C), respectively; and
(iv) in clause (i) of subparagraph (C)
(as redesignated by clause (iii)) by striking
‘‘subparagraph (A), (B), or (D)’’ and in-
serting ‘‘subparagraph (A)’’; and
(2) by striking subsection (e).
SEC. 312. PRIVATE PRACTICE.
Section 338D of the Public Health Service Act (42
U.S.C. 254n) is amended by striking subsection (b) and
inserting the following:
‘‘(b)(1) The written agreement described in sub-
section (a) shall—
‘‘(A) provide that, during the period of private
practice by an individual pursuant to the agreement,
the individual shall comply with the requirements of
section 334 that apply to entities; and
‘‘(B) contain such additional provisions as the
Secretary may require to carry out the objectives of
this section.
‘‘(2) The Secretary shall take such action as may be
appropriate to ensure that the conditions of the written
agreement prescribed by this subsection are adhered to.’’.
SEC. 313. BREACH OF SCHOLARSHIP CONTRACT OR LOAN
REPAYMENT CONTRACT.
(a) IN GENERAL.—Section 338E of the Public
Health Service Act (42 U.S.C. 254o) is amended—
(1) in subsection (a)(1)—
(A) in subparagraph (A), by striking the
comma and inserting a semicolon;
(B) in subparagraph (B), by striking the
comma and inserting ‘‘; or’’;
(C) in subparagraph (C), by striking ‘‘or’’
at the end; and
(D) by striking subparagraph (D);
(2) in subsection (b)—
(A) in paragraph (1)(A)—
(i) by striking ‘‘338F(d)’’ and insert-
ing ‘‘338G(d)’’;
(ii) by striking ‘‘either’’;
(iii) by striking ‘‘338D or’’ and insert-
ing ‘‘338D,’’; and
(iv) by inserting ‘‘or to complete a re-
quired residency as specified in section
338A(f)(1)(B)(iv),’’ before ‘‘the United
States’’; and
(B) by adding at the end the following new
paragraph:
‘‘(3) The Secretary may terminate a contract with an
individual under section 338A if, not later than 30 days
before the end of the school year to which the contract
pertains, the individual—
‘‘(A) submits a written request for such termi-
nation; and
‘‘(B) repays all amounts paid to, or on behalf
of, the individual under section 338A(g).’’;
(3) in subsection (c)—
(A) in paragraph (1)—
(i) in the matter preceding subpara-
graph (A), by striking ‘‘338F(d)’’ and in-
serting ‘‘338G(d)’’; and
(ii) by striking subparagraphs (A)
through (C) and inserting the following:
‘‘(A) the total of the amounts paid by the
United States under section 338B(g) on behalf of
the individual for any period of obligated service not
served;
‘‘(B) an amount equal to the product of the
number of months of obligated service that were not
completed by the individual, multiplied by $7,500;
and
‘‘(C) the interest on the amounts described in
subparagraphs (A) and (B), at the maximum legal
prevailing rate, as determined by the Treasurer of
the United States, from the date of the breach;
except that the amount the United States is entitled to
recover under this paragraph shall not be less than
$31,000.’’;
(B) by striking paragraphs (2) and (3) and
inserting the following:
‘‘(2) The Secretary may terminate a contract with an
individual under section 338B if, not later than 45 days
before the end of the fiscal year in which the contract was
entered into, the individual—
‘‘(A) submits a written request for such termi-
nation; and
‘‘(B) repays all amounts paid on behalf of the
individual under section 338B(g).’’; and
(C) by redesignating paragraph (4) as
paragraph (3);
(4) in subsection (d)(3)(A), by striking ‘‘only if
such discharge is granted after the expiration of the
five-year period’’ and inserting ‘‘only if such dis-
charge is granted after the expiration of the 7-year
period’’; and
(5) by adding at the end the following new sub-
section:
‘‘(e) Notwithstanding any other provision of Federal
or State law, there shall be no limitation on the period
within which suit may be filed, a judgment may be en-
forced, or an action relating to an offset or garnishment,
or other action, may be initiated or taken by the Secretary,
the Attorney General, or the head of another Federal
agency, as the case may be, for the repayment of the
amount due from an individual under this section.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a)(4) shall apply to any obligation for which
a discharge in bankruptcy has not been granted before the
date that is 31 days after the date of enactment of this
Act.
SEC. 314. AUTHORIZATION OF APPROPRIATIONS.
Section 338H of the Public Health Service Act (42
U.S.C. 254q) is amended to read as follows:
‘‘SEC. 338H. AUTHORIZATION OF APPROPRIATIONS.
‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—For the
purposes of carrying out this subpart, there are authorized
to be appropriated $146,250,000 for fiscal year 2002, and
such sums as may be necessary for each of fiscal years
2003 through 2006.
‘‘(b) SCHOLARSHIPS
AND LOAN REPAYMENTS.—
With respect to certification as a nurse practitioner, nurse
midwife, or physician assistant, the Secretary shall, from
amounts appropriated under subsection (a) for a fiscal
year, obligate not less than a total of 10 percent for con-
tracts for both scholarships under the Scholarship Pro-
gram under section 338A and loan repayments under the
Loan Repayment Program under section 338B to individ-
uals who are entering the first year of a course of study
or program described in section 338A(b)(1)(B) that leads
to such a certification or individuals who are eligible for
the loan repayment program as specified in section
338B(b) for a loan related to such certification.’’.
SEC. 315. GRANTS TO STATES FOR LOAN REPAYMENT PRO-
GRAMS.
Section 338I of the Public Health Service Act (42
U.S.C. 254q–1) is amended—
(1) in subsection (a), by striking paragraph (1)
and inserting the following:
‘‘(1) AUTHORITY FOR GRANTS.—The Secretary,
acting through the Administrator of the Health Re-
sources and Services Administration, may make
grants to States for the purpose of assisting the
States in operating programs described in paragraph
(2) in order to provide for the increased availability
of primary health care services in health professional
shortage areas. The National Advisory Council es-
tablished under section 337 shall advise the Admin-
istrator regarding the program under this section.’’;
(2) in subsection (e), by striking paragraph (1)
and inserting the following:
‘‘(1) to submit to the Secretary such reports re-
garding the States loan repayment program, as are
determined to be appropriate by the Secretary; and’’;
and
(3) in subsection (i), by striking paragraph (1)
and inserting the following:
‘‘(1) IN GENERAL.—For the purpose of making
grants under subsection (a), there are authorized to
be appropriated $12,000,000 for fiscal year 2002
and such sums as may be necessary for each of fis-
cal years 2003 through 2006.’’.
SEC. 316. DEMONSTRATION GRANTS TO STATES FOR COM-
MUNITY SCHOLARSHIP PROGRAMS.
Section 338L of the Public Health Service Act (42
U.S.C. 254t) is repealed.
TITLE IV—ADDITIONAL
PROVISIONS
SEC. 401. COMMUNITY ACCESS DEMONSTRATION PRO-
GRAM.
Part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq.) is amended by inserting after
subpart IV the following new subpart:
‘‘Subpart V—Community Access Demonstration Program
‘‘SEC. 340. GRANTS TO STRENGTHEN EFFECTIVENESS, EFFI-
CIENCY, AND COORDINATION OF SERVICES
FOR THE UNINSURED AND UNDERINSURED.
‘‘(a) IN GENERAL.—
‘‘(1) GRANTS.—The Secretary may make not
more than 35 grants for the purpose of carrying out
demonstration projects to improve the effectiveness,
efficiency, and coordination of services for uninsured
and underinsured individuals.
‘‘(2) 
PROJECT
PERIOD.—A 
demonstration
project under this section may not receive funding
under this section for more than three fiscal years.
‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive
a grant under this section, an entity must—
‘‘(1) be an entity that is a public or private en-
tity such as—
‘‘(A) a Federally qualified health center
(as defined under section 1861(aa)(4) of the
Social Security Act);
‘‘(B) a hospital that meets the require-
ments of section 340B(a)(4)(L) (or, if none are
available in the area, a hospital that is a pro-
vider of a substantial volume of non-emergency
health services to uninsured individuals and
families without regard to their ability to pay)
without regard to 340B (a)(4)(L)(iii); or
‘‘(C) a public health department; or
‘‘(2) represent a consortium of providers and,
as appropriate, related agencies or entities—
‘‘(A) whose principal purpose is to provide
a broad range of coordinated health care serv-
ices in a geographic area defined in the entity’s
grant application;
‘‘(B) that includes health care providers
that serve such geographic area and that have
traditionally provided care (beyond emergency
services) to uninsured and underinsured individ-
uals without regard to the individuals’ ability to
pay; and
‘‘(C) that may include other health care
providers and related agencies and organiza-
tions;
except that preference may be given to applicants that are
health care providers identified in paragraph (1).
‘‘(c) APPLICATIONS.—To be eligible to receive a grant
under this section, an eligible entity shall submit to the
Secretary an application, in such form and manner as the
Secretary shall prescribe, that shall—
‘‘(1) define a geographic area of uninsured and
underinsured individuals;
‘‘(2) identify the providers who will participate
in the consortium’s program under the grant, and
specify each one’s contribution to the care of unin-
sured and underinsured individuals in such geo-
graphic area, including the volume of care it pro-
vides to medicare and medicaid beneficiaries, to indi-
viduals served by the program under title XXI of the
Social Security Act (relating to SCHIP), and to pri-
vately paid patients;
‘‘(3) describe the activities that the applicant
and the consortium propose to perform under the
grant to further the purposes of this section;
‘‘(4) demonstrate the consortium’s ability to
build on the current system for serving uninsured
and underinsured individuals by involving providers
who have traditionally provided a significant volume
of care for that community;
‘‘(5) demonstrate the consortium’s ability to de-
velop coordinated systems of care that either directly
provide or ensure the prompt provision of a broad
range of high-quality, accessible services, including,
as appropriate, primary, secondary, and tertiary
services, as well as substance abuse treatment and
mental health services in a manner which assures
continuity of care in the community;
‘‘(6) provide evidence of community involvement
in the development, implementation, and direction of
the program that it proposes to operate;
‘‘(7) demonstrate the consortium’s ability to en-
sure that individuals participating in the program
are enrolled in public insurance programs for which
they are eligible (or know of private insurance op-
tions available to them, if any);
‘‘(8) present a plan for leveraging other sources
of revenue, which may include State and local
sources and private grant funds, and integrating
current and proposed new funding sources in a way
to assure long-term sustainability;
‘‘(9) describe a plan for evaluation of the activi-
ties carried out under the grant, including measure-
ment of progress toward the goals and objectives of
the program;
‘‘(10) demonstrate fiscal responsibility through
the use of appropriate accounting procedures and
appropriate management systems;
‘‘(11) include such other information as the
Secretary may prescribe; and
‘‘(12) demonstrate the commitment to serve in-
dividuals in the geographic area without regard to
the ability of the individual or family to pay by ar-
ranging for or providing free or reduced charge care
for the poor.
‘‘(d) PRIORITIES.—In awarding grants under this
section, the Secretary may accord priority to applicants—
‘‘(1) whose consortium includes public hospitals,
Federally qualified health centers (as defined in sec-
tion 1905(l)(2)(B) of the Social Security Act), and
other providers that are covered entities as defined
by section 340B(a)(4) of this Act (or that would be
covered entities as so defined but for subparagraph
(L)(iii) of such section);
‘‘(2) that identify a geographic area has a high
or increasing percentage of individuals who are unin-
sured;
‘‘(3) whose consortium includes other health
care providers that have a tradition of serving unin-
sured individuals and underinsured individuals in
the community;
‘‘(4) who show evidence that the program would
expand utilization of preventive and primary care
services for uninsured and underinsured individuals
and families in the community, including mental
health services or substance abuse services;
‘‘(5) whose proposed program would improve
coordination between health care providers and ap-
propriate social service providers, including local and
regional human services agencies, school systems,
and agencies on aging;
‘‘(6) that demonstrate collaboration with State
and local governments;
‘‘(7) that make use of non-Federal contribu-
tions to the greatest extent possible; or
‘‘(8) that demonstrate a significant likelihood
that the proposed program will continue after sup-
port under this section ceases.
‘‘(e) USE OF FUNDS.—
‘‘(1) USE BY GRANTEES.—
‘‘(A) IN GENERAL.—Except as provided in
paragraphs (2) and (3), a grantee may use
amounts provided under this section only for—
‘‘(i) direct expenses associated with
operating the greater integration of a
health care delivery system so that it either
directly provides or ensures the provision
of a broad range of services, as appro-
priate, including primary, secondary, and
tertiary services, as well as substance
abuse treatment and mental health serv-
ices; and
‘‘(ii) direct patient care and service
expansions to fill identified or documented
gaps within an integrated delivery system.
‘‘(B) SPECIFIC USES.—The following are
examples of purposes for which a grantee may
use grant funds, when such use meets the con-
ditions stated in subparagraph (A):
‘‘(i) Increase in outreach activities.
‘‘(ii) Improvements to case manage-
ment.
‘‘(iii) Development of provider net-
works.
‘‘(iv) Recruitment, training, and com-
pensation of necessary personnel.
‘‘(v) Acquisition of technology for the
purpose of coordinating health care.
‘‘(vi) Identifying and closing gaps in
health care services being provided.
‘‘(vii) Improvements to provider com-
munication, including implementation of
shared information systems or shared clin-
ical systems.
‘‘(viii) Other activities that may be
appropriate to a community that would in-
crease access to the uninsured.
‘‘(2) RESERVATION OF FUNDS FOR NATIONAL
PROGRAM PURPOSES.—The Secretary may use not
more than 3 percent of funds appropriated to carry
out this section for technical assistance to grantees,
obtaining assistance of experts and consultants,
meetings, dissemination of information, evaluation,
and activities that will extend the benefits of funded
programs to communities other than the one funded.
‘‘(f) MAINTENANCE OF EFFORT.—With respect to
activities for which a grant under this section is author-
ized, the Secretary may award such a grant only if the
recipient of the grant and each of the participating pro-
viders agree that each one will maintain its expenditures
of non-Federal funds for such activities at a level that is
not less than the level of such expenditures during the year
immediately preceding the fiscal year for which the appli-
cant is applying to receive such grant.
‘‘(g) REPORTS TO THE SECRETARY.—The recipient
of a grant under this section shall report to the Secretary
annually regarding—
‘‘(1) progress in meeting the goals stated in its
grant application; and
‘‘(2) such additional information as the Sec-
retary may require.
The Secretary may not renew an annual grant under this
section unless the Secretary is satisfied that the consor-
tium has made reasonable and demonstrable progress in
meeting the goals set forth in its grant application for the
preceding year.
‘‘(h) AUDITS.—Each entity which receives a grant
under this section shall provide for an independent annual
financial audit of all records that relate to the disposition
of funds received through this grant.
‘‘(i) TECHNICAL ASSISTANCE.—The Secretary may,
either directly or by grant or contract, provide any funded
entity with technical and other non-financial assistance
necessary to meet the requirements of this section.
‘‘(j) REPORT.—Not later than September 30, 2005,
the Secretary shall submit to the Congress a report de-
scribing the extent to which demonstration projects under
this section have been successful in improving the effec-
tiveness, efficiency, and coordination of services for unin-
sured and underinsured individuals in the geographic
areas served by such projects, including providing better
quality health care for such individuals, and at lower costs,
than would have been the case in the absence of such
projects.
‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated $40,000,000 for fiscal year 2002, and
such sums as may be necessary for each of fiscal years
2003 through 2006.’’.
SEC. 402. EXPANDING AVAILABILITY OF DENTAL SERVICES.
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:
‘‘Subpart X—Primary Dental Programs
‘‘SEC. 340F. DESIGNATED DENTAL HEALTH PROFESSIONAL
SHORTAGE AREA.
‘‘In this subpart, the term ‘designated dental health
professional shortage area’ means an area, population
group, or facility that is designated by the Secretary as
a dental health professional shortage area under section
332 or designated by the applicable State as having a den-
tal health professional shortage.
‘‘SEC. 340G. GRANTS FOR INNOVATIVE PROGRAMS.
‘‘(a) GRANT
PROGRAM
AUTHORIZED.—The Sec-
retary, acting through the Administrator of the Health
Resources and Services Administration, is authorized to
award grants to States for the purpose of helping States
develop and implement innovative programs to address the
dental workforce needs of designated dental health profes-
sional shortage areas in a manner that is appropriate to
the States’ individual needs.
‘‘(b) STATE ACTIVITIES.—A State receiving a grant
under subsection (a) may use funds received under the
grant for—
‘‘(1) loan forgiveness and repayment programs
for dentists who—
‘‘(A) agree to practice in designated dental
health professional shortage areas;
‘‘(B) are dental school graduates who
agree to serve as public health dentists for the
Federal, State, or local government; and
‘‘(C) agree to—
‘‘(i) provide services to patients re-
gardless of such patients’ ability to pay;
and
‘‘(ii) use a sliding payment scale for
patients who are unable to pay the total
cost of services;
‘‘(2) dental recruitment and retention efforts;
‘‘(3) grants and low-interest or no-interest loans
to help dentists who participate in the medicaid pro-
gram under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) to establish or expand practices
in designated dental health professional shortage
areas by equipping dental offices or sharing in the
overhead costs of such practices;
‘‘(4) the establishment or expansion of dental
residency programs in coordination with accredited
dental training institutions in States without dental
schools;
‘‘(5) programs developed in consultation with
State and local dental societies to expand or estab-
lish oral health services and facilities in designated
dental health professional shortage areas, including
services and facilities for children with special needs,
such as—
‘‘(A) the expansion or establishment of a
community-based dental facility, free-standing
dental clinic, consolidated health center dental
facility, school-linked dental facility, or United
States dental school-based facility;
‘‘(B) the establishment of a mobile or port-
able dental clinic; and
‘‘(C) the establishment or expansion of pri-
vate dental services to enhance capacity through
additional equipment or additional hours of op-
eration;
‘‘(6) placement and support of dental students,
dental residents, and advanced dentistry trainees;
‘‘(7) continuing dental education, including dis-
tance-based education;
‘‘(8) practice support through teledentistry con-
ducted in accordance with State laws;
‘‘(9) community-based prevention services such
as water fluoridation and dental sealant programs;
‘‘(10) coordination with local educational agen-
cies within the State to foster programs that pro-
mote children going into oral health or science pro-
fessions;
‘‘(11) the establishment of faculty recruitment
programs at accredited dental training institutions
whose mission includes community outreach and
service and that have a demonstrated record of serv-
ing underserved States;
‘‘(12) the development of a State dental officer
position or the augmentation of a State dental office
to coordinate oral health and access issues in the
State; and
‘‘(13) any other activities determined to be ap-
propriate by the Secretary.
‘‘(c) APPLICATION.—
‘‘(1) IN
GENERAL.—Each State desiring a
grant under this section shall submit an application
to the Secretary at such time, in such manner, and
containing such information as the Secretary may
reasonably require.
‘‘(2) ASSURANCES.—The application shall in-
clude assurances that the State will meet the re-
quirements of subsection (d) and that the State pos-
sesses sufficient infrastructure to manage the activi-
ties to be funded through the grant and to evaluate
and report on the outcomes resulting from such ac-
tivities.
‘‘(d) MATCHING REQUIREMENT.—The Secretary may
not make a grant to a State under this section unless that
State agrees that, with respect to the costs to be incurred
by the State in carrying out the activities for which the
grant was awarded, the State will provide non-Federal
contributions in an amount equal to not less than 40 per-
cent of Federal funds provided under the grant. The State
may provide the contributions in cash or in kind, fairly
evaluated, including plant, equipment, and services and
may provide the contributions from State, local, or private
sources.
‘‘(e) REPORT.—Not later than 5 years after the date
of enactment of the Health Care Safety Net Improvement
Act, the Secretary shall prepare and submit to the appro-
priate committees of Congress a report containing data
relating to whether grants provided under this section
have increased access to dental services in designated den-
tal health professional shortage areas.
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There
is authorized to be appropriated to carry out this section,
$50,000,000 for the 5-fiscal year period beginning with
fiscal year 2002.’’.
SEC. 403. STUDY REGARDING BARRIERS TO PARTICIPA-
TION OF FARMWORKERS IN HEALTH PRO-
GRAMS.
(a) IN GENERAL.—The Secretary shall conduct a
study of the problems experienced by farmworkers (includ-
ing their families) under Medicaid and SCHIP. Specifi-
cally, the Secretary shall examine the following:
(1) BARRIERS TO ENROLLMENT.—Barriers to
their enrollment, including a lack of outreach and
outstationed eligibility workers, complicated applica-
tions and eligibility determination procedures, and
linguistic and cultural barriers.
(2) LACK OF PORTABILITY.—The lack of port-
ability of Medicaid and SCHIP coverage for farm-
workers who are determined eligible in one State but
who move to other States on a seasonal or other
periodic basis.
(3) POSSIBLE SOLUTIONS.—The development of
possible solutions to increase enrollment and access
to benefits for farmworkers, because, in part, of the
problems identified in paragraphs (1) and (2), and
the associated costs of each of the possible solution
described in subsection (b).
(b) POSSIBLE SOLUTIONS.—Possible solutions to be
examined shall include each of the following:
(1) INTERSTATE COMPACTS.—The use of inter-
state compacts among States that establish port-
ability and reciprocity for eligibility for farmworkers
under the Medicaid and SCHIP and potential finan-
100
cial incentives for States to enter into such com-
pacts.
(2) DEMONSTRATION PROJECTS.—The use of
multi-state demonstration waiver projects under sec-
tion 1115 of the Social Security Act (42 U.S.C.
1315) to develop comprehensive migrant coverage
demonstration projects.
(3) USE OF CURRENT LAW FLEXIBILITY.—Use
of current law Medicaid and SCHIP State plan pro-
visions relating to coverage of residents and out-of-
State coverage.
(4) NATIONAL MIGRANT FAMILY COVERAGE.—
The development of programs of national migrant
family coverage in which States could participate.
(5) PUBLIC-PRIVATE PARTNERSHIPS.—The pro-
vision of incentives for development of public-private
partnerships to develop private coverage alternatives
for farmworkers.
(6) OTHER POSSIBLE SOLUTIONS.—Such other
solutions as the Secretary deems appropriate.
(c) CONSULTATIONS.—In conducting the study, the
Secretary shall consult with the following:
(1) Farmworkers affected by the lack of port-
ability of coverage under the Medicaid program or
the State children’s health insurance program
101
(under titles XIX and XXI of the Social Security
Act).
(2) Individuals with expertise in providing
health care to farmworkers, including designees of
national and local organizations representing mi-
grant health centers and other providers.
(3) Resources with expertise in health care fi-
nancing.
(4) Representatives of foundations and other
nonprofit entities that have conducted or supported
research on farmworker health care financial issues.
(5) Representatives of Federal agencies which
are involved in the provision or financing of health
care to farmworkers, including the Health Care Fi-
nancing Administration and the Health Research
and Services Administration.
(6) Representatives of State governments.
(7) Representatives from the farm and agricul-
tural industries.
(8) Designees of labor organizations rep-
resenting farmworkers.
(d) DEFINITIONS.—For purposes of this section:
(1) FARMWORKER.—The term ‘‘farmworker’’
means a migratory agricultural worker or seasonal
agricultural worker, as such terms are defined in
102
section 330(g)(3) of the Public Health Service Act
(42 U.S.C. 254c(g)(3)), and includes a family mem-
ber of such a worker.
(2) MEDICAID.—The term ‘‘Medicaid’’ means
the program under title XIX of the Social Security
Act.
(3) SCHIP.—The term ‘‘SCHIP’’ means the
State children’s health insurance program under
title XXI of the Social Security Act.
(e) REPORT.—Not later than one year after the date
of the enactment of this Act, the Secretary shall transmit
a report to the President and the Congress on the study
conducted under this section. The report shall contain a
detailed statement of findings and conclusions of the
study, together with its recommendations for such legisla-
tion and administrative actions as the Secretary considers
appropriate.
SEC. 404. ELIGIBILITY OF CERTAIN ENTITIES FOR GRANTS.
If under a program established in this Act (other
than section 401), or if pursuant to an amendment made
by this Act, a private entity that is not a nonprofit entity
is eligible for an award of a grant, contract, or cooperative
agreement, such an award may not be made to such pri-
vate entity unless the entity is the only available provider
of quality health services in the geographic area involved.
103
SEC. 405. CONFORMING AMENDMENTS.
(a) 
HOMELESS
PROGRAMS.—Subsections
(g)(1)(G)(ii), (k)(2), and (n)(1)(C) of section 224, and
sections 317A(a)(2), 317E(c), 318A(e), 332(a)(2)(C),
340D(c)(5), 799B(6)(B), 1313, and 2652(2) of the Public
Health Service Act (42 U.S.C. 233, 247b–1(a)(2), 247b–
6(c), 247c–1(e), 254e(a)(2)(C), 256d(c)(5), 295p(6)(B),
300e–12, and 300ff–52(2)) are amended by striking
‘‘340’’ and inserting ‘‘330(h)’’.
(b) HOMELESS INDIVIDUAL.—Section 534(2) of the
Public Health Service Act (42 U.S.C. 290cc–34(2)) is
amended by striking ‘‘340(r)’’ and inserting ‘‘330(h)(5)’’.
Passed the House of Representatives October 1,
2002.
Attest:
Clerk.