I 
110TH CONGRESS 
2D SESSION 
H. R. 5544 
To amend the Public Health Service Act to authorize a demonstration project 
for integrated health systems to expand access to primary and preventive 
care for the medically underserved, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 6, 2008 
Mr. BURGESS (for himself and Mr. STUPAK) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to authorize a 
demonstration project for integrated health systems to 
expand access to primary and preventive care for the 
medically underserved, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Patients and Public 
Health Partnership Act of 2008’’. 
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SEC. 2. DEMONSTRATION PROJECT FOR INTEGRATED 
HEALTH SYSTEMS TO EXPAND ACCESS TO 
PRIMARY AND PREVENTIVE SERVICES FOR 
THE MEDICALLY UNDERSERVED. 
Part D of title III of the Public Health Service Act 
(42 U.S.C. 259b et seq.) is amended by adding at the end 
the following new subpart: 
‘‘Subpart XI—Demonstration Project for Integrated 
Health Systems to Expand Access to Primary 
and Preventive Services for the Medically Un-
derserved 
‘‘SEC. 340H. DEMONSTRATION PROJECT FOR INTEGRATED 
HEALTH SYSTEMS TO EXPAND ACCESS TO 
PRIMARY AND PREVENTIVE CARE FOR THE 
MEDICALLY UNDERSERVED. 
‘‘(a) ESTABLISHMENT OF DEMONSTRATION.— 
‘‘(1) IN GENERAL.—Not later than January 1, 
2009, the Secretary shall establish a demonstration 
project (hereafter in this section referred to as the 
‘demonstration’) under which up to 30 qualifying in-
tegrated health systems receive grants for the costs 
of their operations to expand access to primary and 
preventive services for the medically underserved. 
‘‘(2) RULE
OF
CONSTRUCTION.—Nothing in 
this section shall be construed as authorizing grants 
to be made or used for the costs of specialty care or 
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hospital care furnished by an integrated health sys-
tem. 
‘‘(b) APPLICATION.—Any integrated health system 
desiring to participate in the demonstration shall submit 
an application in such manner, at such time, and con-
taining such information as the Secretary may require. 
‘‘(c) CRITERIA FOR SELECTION.—In selecting inte-
grated health systems to participate in the demonstration 
(hereafter referred to as ‘participating integrated health 
systems’), the Secretary shall ensure representation of in-
tegrated health systems that are located in a variety of 
States (including the District of Columbia and the terri-
tories and possessions of the United States) and locations 
within States, including rural areas, inner-city areas, and 
frontier areas. 
‘‘(d) DURATION.—Subject to the availability of ap-
propriations, the demonstration shall be conducted (and 
operating grants be made to each participating integrated 
health system) for a period of 3 years. 
‘‘(e) REPORTS.— 
‘‘(1) IN GENERAL.—The Secretary shall submit 
to the appropriate committees of the Congress in-
terim and final reports with respect to the dem-
onstration, with an interim report being submitted 
not later than 3 months after the demonstration has 
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been in operation for 24 months and a final report 
being submitted not later than 3 months after the 
close of the demonstration. 
‘‘(2) CONTENT.—Such reports shall evaluate 
the effectiveness of the demonstration in providing 
greater access to primary and preventive care for 
medically underserved populations, and how the co-
ordinated approach offered by integrated health sys-
tems contributes to improved patient outcomes. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) IN GENERAL.—There is authorized to be 
appropriated $25,000,000 for each of the fiscal 
years 2009, 2010, and 2011 to carry out this sec-
tion. 
‘‘(2) CONSTRUCTION.—Nothing in this section 
shall be construed as requiring or authorizing a re-
duction in the amounts appropriated for grants to 
health centers under section 330 for the fiscal years 
referred to in paragraph (1). 
‘‘(g) DEFINITIONS.—For purposes of this section: 
‘‘(1) FRONTIER
AREA.—The term ‘frontier 
area’ has the meaning given to such term in regula-
tions promulgated pursuant to section 330I(r). 
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‘‘(2) INTEGRATED HEALTH SYSTEM.—The term 
‘integrated health system’ means a health system 
that— 
‘‘(A) has a demonstrated capacity and 
commitment to provide a full range of primary 
care, specialty care, and hospital care in both 
inpatient and outpatient settings; and 
‘‘(B) is organized to provide such care in 
a coordinated fashion. 
‘‘(3) QUALIFYING
INTEGRATED
HEALTH
SYS-
TEM.— 
‘‘(A) IN GENERAL.—The term ‘qualifying 
integrated health system’ means a public or pri-
vate nonprofit entity that is an integrated 
health system that meets the requirements of 
subparagraph (B) and serves a medically under-
served population (either through the staff and 
supporting resources of the integrated health 
system or through contracts or cooperative ar-
rangements) by providing— 
‘‘(i) required primary and preventive 
health and related services (as defined in 
paragraph (4)); and 
‘‘(ii) as may be appropriate for a pop-
ulation served by a particular integrated 
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health system, integrative health services 
(as defined in paragraph (5)) that are nec-
essary for the adequate support of the re-
quired primary and preventive health and 
related services and that improve care co-
ordination. 
‘‘(B) OTHER
REQUIREMENTS.—The re-
quirements of this subparagraph are that the 
integrated health system— 
‘‘(i) will make the required primary 
and preventive health and related services 
of the integrated health system available 
and accessible in the service area of the in-
tegrated health system promptly, as appro-
priate, and in a manner which assures con-
tinuity; 
‘‘(ii) will demonstrate financial re-
sponsibility by the use of such accounting 
procedures and other requirements as may 
be prescribed by the Secretary; 
‘‘(iii) provides or will provide services 
to individuals who are eligible for medical 
assistance under title XIX of the Social 
Security Act or for assistance under title 
XXI of such Act; 
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‘‘(iv) has prepared a schedule of fees 
or payments for the provision of its serv-
ices consistent with locally prevailing rates 
or charges and designed to cover its rea-
sonable costs of operation and has pre-
pared a corresponding schedule of dis-
counts to be applied to the payment of 
such fees or payments, which discounts are 
adjusted on the basis of the patient’s abil-
ity to pay; 
‘‘(v) will assure that no patient will be 
denied health care services due to an indi-
vidual’s inability to pay for such services; 
‘‘(vi) will assure that any fees or pay-
ments required by the system for such 
services will be reduced or waived to enable 
the system to fulfill the assurance de-
scribed in clause (v); 
‘‘(vii) provides assurances that any 
grant funds will be expended to supple-
ment, and not supplant, the expenditures 
of the integrated health system for primary 
and preventive health services for the 
medically underserved; and 
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‘‘(viii) submits to the Secretary such 
reports as the Secretary may require to de-
termine compliance with this subpara-
graph. 
‘‘(C) TREATMENT
OF
CERTAIN
ENTI-
TIES.—The term ‘qualifying integrated health 
system’ may include a nurse-managed health 
clinic if such clinic meets the requirements of 
subparagraphs (A) and (B) (except those re-
quirements that have been waived under para-
graph (4)(B)). 
‘‘(4) REQUIRED
PRIMARY
AND
PREVENTIVE 
HEALTH AND RELATED SERVICES.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the term ‘required primary 
and preventive health and related services’ 
means basic health services consisting of— 
‘‘(i) health services related to family 
medicine, internal medicine, pediatrics, ob-
stetrics, or gynecology that are furnished 
by physicians where appropriate, physician 
assistants, nurse practitioners, and nurse 
midwives; 
‘‘(ii) diagnostic laboratory services 
and radiologic services; 
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‘‘(iii) preventive health services, in-
cluding prenatal and perinatal care; appro-
priate cancer screening; well-child services; 
immunizations against vaccine-preventable 
diseases; screenings for elevated blood lead 
levels, communicable diseases, and choles-
terol; pediatric eye, ear, and dental 
screenings to determine the need for vision 
and hearing correction and dental care; 
and voluntary family planning services; 
‘‘(iv) emergency medical services; and 
‘‘(v) pharmaceutical services, behav-
ioral, mental health, and substance abuse 
services, preventive dental services, and re-
cuperative care, as may be appropriate. 
‘‘(B) EXCEPTION.—In the case of an inte-
grated health system serving a targeted popu-
lation, the Secretary shall, upon a showing of 
good cause, waive the requirement that the in-
tegrated health system provide each required 
primary and preventive health and related serv-
ice under this paragraph if the Secretary deter-
mines one or more such services are inappro-
priate or unnecessary for such population. 
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‘‘(5) INTEGRATIVE
HEALTH
SERVICES.—The 
term ‘integrative health services’ means services that 
are not included as required primary and preventive 
health and related services and are associated with 
achieving the greater integration of a health care de-
livery system to improve patient care coordination so 
that the system either directly provides or ensures 
the provision of a broad range of culturally com-
petent services. Integrative health services include 
but are not limited to the following: 
‘‘(A) Outreach activities. 
‘‘(B) Case management and patient navi-
gation services. 
‘‘(C) Chronic care management. 
‘‘(D) Transportation to health care facili-
ties. 
‘‘(E) Development of provider networks 
and other innovative models to engage local 
physicians and other providers to serve the 
medically underserved within a community. 
‘‘(F) Recruitment, training, and compensa-
tion of necessary personnel. 
‘‘(G) Acquisition of technology for the pur-
pose of coordinating care. 
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‘‘(H) Improvements to provider commu-
nication, including implementation of shared in-
formation systems or shared clinical systems. 
‘‘(I) Determination of eligibility for Fed-
eral, State, and local programs that provide, or 
financially support the provision of, medical, so-
cial, housing, educational, or other related serv-
ices. 
‘‘(J) Development of prevention and dis-
ease management tools and processes. 
‘‘(K) Translation services. 
‘‘(L) Development and implementation of 
evaluation measures and processes to assess pa-
tient outcomes. 
‘‘(M) Integration of primary care and men-
tal health services. 
‘‘(N) Carrying out other activities that 
may be appropriate to a community and that 
would increase access by the uninsured to 
health care, such as access initiatives for which 
private entities provide non-Federal contribu-
tions to supplement the Federal funds provided 
through the grants for the initiatives. 
‘‘(6) SPECIALTY
CARE.—The term ‘specialty 
care’ means care that is provided through a referral 
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