I
103D CONGRESS
2D SESSION
H. R. 4555
To provide assistance for the establishment of community rural health net-
works in chronically underserved areas, to provide incentives for providers
of health care services to furnish services in such areas, to assist provid-
ers of emergency medical services in such areas, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JUNE 9, 1994
Mr. STENHOLM (for himself, Mr. ROBERTS, Mr. SLATTERY, Mr. GUNDERSON,
Mr. CLINGER, Mr. COOPER, Mr. EMERSON, Mr. LAUGHLIN, Ms. LONG,
Mr. NUSSLE, Mr. OBERSTAR, Mr. PAYNE of Virginia, Mr. POSHARD, Mr.
ROWLAND, Mr. THOMAS of Wyoming) introduced the following bill; which
was referred jointly to the Committees on Energy and Commerce, Ways
and Means, Foreign Affairs and the Judiciary
A BILL
To provide assistance for the establishment of community
rural health networks in chronically underserved areas,
to provide incentives for providers of health care services
to furnish services in such areas, to assist providers
of emergency medical services in such areas, and for
other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Rural Health Delivery System Development Act of
1994’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—GRANTS TO ENCOURAGE ESTABLISHMENT OF
COMMUNITY RURAL HEALTH NETWORKS
Sec. 101. Assistance for implementation of access plans for chronically under-
served areas.
Sec. 102. Technical assistance grants for networks.
Sec. 103. Development grants for networks.
Sec. 104. Definitions.
TITLE II—INCENTIVES FOR HEALTH PROFESSIONALS TO
PRACTICE IN RURAL AREAS
Subtitle A—National Health Service Corps Program
Sec. 201. National health service corps loan repayments excluded from gross in-
come.
Sec. 202. Modification in criteria for designation as health professional short-
age area.
Sec. 203. Other provisions regarding national health service corps.
Subtitle B—Incentives Under Other Programs
Sec. 211. Extension of additional payment under medicare for physicians’ serv-
ices furnished in former shortage areas.
Sec. 212. Refinement of geographic adjustment factor for medicare physicians’
services.
Sec. 213. Extension of student loan deferments.
Sec. 214. Development of model State scope of practice law.
TITLE III—ASSISTANCE FOR INSTITUTIONAL PROVIDERS
Subtitle A—Community and Migrant Health Centers
Sec. 301. Community and migrant health centers.
Subtitle B—Emergency Medical Systems
Sec. 311. Emergency medical services.
Sec. 312. Grants to states regarding aircraft for transporting rural victims of
medical emergencies.
Subtitle C—Assistance to Rural Providers Under Medicare
PART 1—MEDICARE ESSENTIAL ACCESS COMMUNITY HOSPITALS
Sec. 321. Amendments to essential access community hospital (EACH) pro-
gram under medicare.
PART 2—ESTABLISHMENT OF RURAL EMERGENCY ACCESS CARE HOSPITALS
Sec. 331. Rural emergency access care hospitals described.
Sec. 332. Coverage of and payment for services.
Sec. 333. Effective date.
Subtitle D—Demonstration Projects to Encourage Primary
Care and Rural-Based Graduate Medical Education
Sec. 341. State and consortium demonstration projects.
Sec. 342. Goals for projects.
Sec. 343. Definitions.
TITLE IV—UNITED STATES-MEXICO BORDER HEALTH
COMMISSION
Sec. 401. Agreement to establish binational commission.
Sec. 402. Duties.
Sec. 403. Other authorized functions.
Sec. 404. Membership.
Sec. 405. Regional offices.
Sec. 406. Reports.
Sec. 407. Definitions.
TITLE V—HOSPITAL ANTITRUST FAIRNESS
Sec. 501. Antitrust exemption.
Sec. 502. Requirements.
Sec. 503. Definition.
TITLE VI—FINANCING
Sec. 601. Increase in medicare part B premium for individuals with high in-
come.
TITLE I—GRANTS TO ENCOUR-
AGE 
ESTABLISHMENT 
OF
COMMUNITY RURAL HEALTH
NETWORKS
SEC. 101. ASSISTANCE FOR DEVELOPMENT OF ACCESS
PLANS FOR CHRONICALLY UNDERSERVED
AREAS.
(a) AVAILABILITY OF FINANCIAL ASSISTANCE TO IM-
PLEMENT ACTION PLANS TO INCREASE ACCESS.—
(1) IN GENERAL.—The Secretary shall provide
grants (in amounts determined in accordance with
paragraph (3)) over a 3-year period to an eligible
State for the development of plans to increase access
to health care services during such period for resi-
dents of areas in the State that are designated as
chronically underserved areas in accordance with
subsection (b).
(2) ELIGIBILITY REQUIREMENTS.—A State is
eligible to receive grants under this section if the
State submits to the Secretary (at such time and in
such form as the Secretary may require) assurances
that the State has developed (or is in the process of
developing) a plan to increase the access of residents
of a chronically underserved area to health care serv-
ices that meets the requirements of subsection (c),
together with such other information and assurances
as the Secretary may require.
(3) AMOUNT OF ASSISTANCE.—
(A) IN
GENERAL.—Subject to subpara-
graph (B), the amount of assistance provided to
a State under this subsection with respect to
any plan during a 3-year period shall be equal
to—
(i) for the first year of the period, an
amount equal to 100% of the amounts ex-
pended by the State during the year to im-
plement the plan described in paragraph
(1) (as reported to the Secretary in accord-
ance with such requirements as the Sec-
retary may impose);
(ii) for the second year of the period,
an amount equal to 50% of the amounts
expended by the State during the year to
implement the plan; and
(iii) for the third year of the period,
an amount equal to 33% of the amounts
expended by the State during the year to
implement the plan.
(B) AGGREGATE
PER
PLAN
LIMIT.—The
amount of assistance provided to a State under
332(a) of the Public Health Service
Act), or meets the criteria for des-
ignation as such an area; or
(II) was previously designated as
such an area or previously met such
criteria for an extended period prior
to the designation of the area under
this section (in accordance with cri-
teria established by the Secretary).
(ii) The availability and adequacy of
health care providers and facilities for resi-
dents of the area.
(iii) The extent to which the availabil-
ity of assistance under other Federal and
State programs has failed to alleviate the
lack of access to health care services for
residents of the area.
(iv) The percentage of residents of the
area whose income is at or below the pov-
erty level.
(v) The percentage of residents of the
area who are age 65 or older.
(vi) The existence of cultural or geo-
graphic barriers to access to health care
services in the area, including weather con-
ditions.
(3) REVIEW BY SECRETARY.—No designation
under paragraph (1) shall take effect under this sec-
tion unless the Secretary—
(A) has been notified of the proposed des-
ignation; and
(B) has not, within 60 days after the date
of receipt of the notice, disapproved the des-
ignation.
(4) PERIOD OF DESIGNATION.—A designation
under this section shall be effective during a period
specified by the Governor of not longer than 3 years.
The Governor may extend the designation for addi-
tional 3-year periods, except that a State may not
receive assistance under subsection (a)(3) for
amounts expended during any such additional peri-
ods.
(c) REQUIREMENTS FOR STATE ACCESS PLANS.—A
State plan to increase the access of residents of chronically
underserved areas to health care services meets the re-
quirements of this section if the Secretary finds that the
plan was developed with the participation of health care
providers and facilities and residents of the area that is
the subject of the plan, together with such other require-
ments as the Secretary may impose.
(d) AUTHORIZATION
OF APPROPRIATIONS.—There
are authorized to be appropriated for assistance under this
section $10,000,000 for each of the first 3 fiscal years
beginning after the date on which the Secretary develops
guidelines for the designation of areas as chronically un-
derserved areas under subsection (b)(2).
SEC. 102. TECHNICAL ASSISTANCE GRANTS FOR NET-
WORKS.
(a) IN GENERAL.—The Secretary shall make funds
available under this section to provide technical assistance
(including information regarding eligibility for other Fed-
eral programs) and advice for entities described in sub-
section (b) seeking to establish or enhance a community
rural health network in an underserved rural area.
(b) ENTITIES ELIGIBLE TO RECEIVE FUNDS.—The
following entities are eligible to receive funds for technical
assistance under this section:
(1) An entity receiving a grant under section
103.
(2) A State or unit of local government.
(3) An entity providing health care services (in-
cluding health professional education services) in the
area involved.
(c) USE OF FUNDS.—
(1) IN GENERAL.—Funds made available under
this section may be used—
(A) for planning a community health net-
work and the submission of the plan for the
network to the Secretary under section 103(c)
(subject to the limitation described in para-
graph (2));
(B) to provide assistance in conducting
community-based needs and prioritization, iden-
tifying existing regional health resources, and
developing networks, utilizing existing local pro-
viders and facilities where appropriate;
(C) to provide advice on obtaining the
proper balance of primary and secondary facili-
ties for the population served by the network;
(D) to provide assistance in coordinating
arrangements for tertiary care;
(E) to provide assistance in recruitment
and retention of health care professionals;
(F) to provide assistance in coordinating
the delivery of emergency services with the pro-
vision of other health care services in the area
served by the network;
(G) to provide assistance in coordinating
arrangements for mental health and substance
abuse treatment services; and
(H) to provide information regarding the
area or proposed network’s eligibility for Fed-
eral and State assistance for health care-related
activities, together with information on funds
available through private sources.
(2) LIMITATION ON AMOUNT AVAILABLE FOR
DEVELOPMENT OF NETWORK.—The amount of fi-
nancial assistance available for activities described in
paragraph (1) may not exceed $50,000 and may not
be available for a period of time exceeding 1 year.
(d) USE OF RURAL HEALTH OFFICES.—In carrying
out this section with respect to entities in rural areas, the
Secretary shall make funds available through—
(1) not more than 10 regional centers acting as
clearinghouses for the distribution of such funds;
(2) State Offices of Rural Health,
or any combination of such centers and Offices.
(e) AUTHORIZATION
OF APPROPRIATIONS.—There
are authorized to be appropriated $10,000,000 for each
of fiscal years 1995 through 1999 to carry out this sec-
tion. Amounts appropriated under this section shall be
available until expended.
SEC. 103. DEVELOPMENT GRANTS FOR NETWORKS.
(a) IN GENERAL.—The Secretary shall provide finan-
cial assistance to eligible entities in order to provide for
the development and implementation of community rural
health networks.
(b) ELIGIBLE ENTITIES.—
(1) IN GENERAL.—An entity is eligible to re-
ceive financial assistance under this section only if
the entity—
(A) is (i) based in a rural area or (ii) is
described in paragraph (2), (3), or (4) of sec-
tion 102(b),
(B) is undertaking to develop and imple-
ment a community rural health network in an
underserved rural area (or underserved rural
areas) with the active participation of at least
3 health care providers or facilities in the area,
and
(C) has consulted with the local govern-
ments of the area to be served by the network
and with individuals who reside in the area.
(2) COORDINATION WITH PROVIDERS OUTSIDE
OF AREA PERMITTED.—Nothing in this section shall
be construed as preventing an entity that coordi-
nates the delivery of services in an underserved rural
area with an entity outside the area from qualifying