227 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after October 1, 2014. 
SEC. 
424. 
MEDICARE 
REMOTE 
MONITORING 
PILOT 
PROJECTS. 
(a) PILOT PROJECTS.— 
(1) IN
GENERAL.—Not later than 9 months 
after the date of enactment of this Act, the Sec-
retary of Health and Human Services (in this sec-
tion referred to as the ‘‘Secretary’’) shall conduct 
pilot projects under title XVIII of the Social Secu-
rity Act for the purpose of providing incentives to 
home health agencies to utilize home monitoring and 
communications technologies that— 
(A) enhance health outcomes for Medicare 
beneficiaries; and 
(B) reduce expenditures under such title. 
(2) SITE REQUIREMENTS.— 
(A) URBAN AND RURAL.—The Secretary 
shall conduct the pilot projects under this sec-
tion in both urban and rural areas. 
(B) SITE IN A SMALL STATE.—The Sec-
retary shall conduct at least 3 of the pilot 
projects in a State with a population of less 
than 1,000,000. 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00227
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
228 
(3) DEFINITION OF HOME HEALTH AGENCY.— 
In this section, the term ‘‘home health agency’’ has 
the meaning given that term in section 1861(o) of 
the Social Security Act (42 U.S.C. 1395x(o)). 
(b) MEDICARE BENEFICIARIES WITHIN THE SCOPE 
OF PROJECTS.—The Secretary shall specify the criteria 
for identifying those Medicare beneficiaries who shall be 
considered within the scope of the pilot projects under this 
section for purposes of the application of subsection (c) 
and for the assessment of the effectiveness of the home 
health agency in achieving the objectives of this section. 
Such criteria may provide for the inclusion in the projects 
of Medicare beneficiaries who begin receiving home health 
services under title XVIII of the Social Security Act after 
the date of the implementation of the projects. 
(c) INCENTIVES.— 
(1) PERFORMANCE
TARGETS.—The Secretary 
shall establish for each home health agency partici-
pating in a pilot project under this section a per-
formance target using one of the following meth-
odologies, as determined appropriate by the Sec-
retary: 
(A) ADJUSTED HISTORICAL PERFORMANCE 
TARGET.—The Secretary shall establish for the 
agency— 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00228
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
229 
(i) a base expenditure amount equal 
to the average total payments made to the 
agency under parts A and B of title XVIII 
of the Social Security Act for Medicare 
beneficiaries determined to be within the 
scope of the pilot project in a base period 
determined by the Secretary; and 
(ii) an annual per capita expenditure 
target for such beneficiaries, reflecting the 
base expenditure amount adjusted for risk 
and adjusted growth rates. 
(B) COMPARATIVE
PERFORMANCE
TAR-
GET.—The Secretary shall establish for the 
agency a comparative performance target equal 
to the average total payments under such parts 
A and B during the pilot project for comparable 
individuals in the same geographic area that 
are not determined to be within the scope of the 
pilot project. 
(2) INCENTIVE.—Subject to paragraph (3), the 
Secretary shall pay to each participating home care 
agency an incentive payment for each year under the 
pilot project equal to a portion of the Medicare sav-
ings realized for such year relative to the perform-
ance target under paragraph (1). 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00229
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
230 
(3) LIMITATION ON EXPENDITURES.—The Sec-
retary shall limit incentive payments under this sec-
tion in order to ensure that the aggregate expendi-
tures under title XVIII of the Social Security Act 
(including incentive payments under this subsection) 
do not exceed the amount that the Secretary esti-
mates would have been expended if the pilot projects 
under this section had not been implemented. 
(d) WAIVER AUTHORITY.—The Secretary may waive 
such provisions of titles XI and XVIII of the Social Secu-
rity Act as the Secretary determines to be appropriate for 
the conduct of the pilot projects under this section. 
(e) REPORT TO CONGRESS.—Not later than 5 years 
after the date that the first pilot project under this section 
is implemented, the Secretary shall submit to Congress a 
report on the pilot projects. Such report shall contain a 
detailed description of issues related to the expansion of 
the projects under subsection (f) and recommendations for 
such legislation and administrative actions as the Sec-
retary considers appropriate. 
(f) EXPANSION.—If the Secretary determines that 
any of the pilot projects under this section enhance health 
outcomes for Medicare beneficiaries and reduce expendi-
tures under title XVIII of the Social Security Act, the Sec-
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00230
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
231 
retary may initiate comparable projects in additional 
areas. 
(g) INCENTIVE PAYMENTS HAVE NO EFFECT ON 
OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen-
tive payment under this section— 
(1) shall be in addition to the payments that a 
home health agency would otherwise receive under 
title XVIII of the Social Security Act for the provi-
sion of home health services; and 
(2) shall have no effect on the amount of such 
payments. 
SEC. 425. RURAL HEALTH QUALITY ADVISORY COMMISSION 
AND DEMONSTRATION PROJECTS. 
(a) RURAL HEALTH QUALITY ADVISORY COMMIS-
SION.— 
(1) 
ESTABLISHMENT.—Not 
later 
than 
months after the date of the enactment of this sec-
tion, the Secretary of Health and Human Services 
(in this section referred to as the ‘‘Secretary’’) shall 
establish a commission to be known as the Rural 
Health Quality Advisory Commission (in this section 
referred to as the ‘‘Commission’’). 
(2) DUTIES OF COMMISSION.— 
(A) NATIONAL
PLAN.—The Commission 
shall develop, coordinate, and facilitate imple-
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00231
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
232 
mentation of a national plan for rural health 
quality improvement. The national plan shall— 
(i) identify objectives for rural health 
quality improvement; 
(ii) identify strategies to eliminate 
known gaps in rural health system capacity 
and improve rural health quality; and 
(iii) provide for Federal programs to 
identify opportunities for strengthening 
and aligning policies and programs to im-
prove rural health quality. 
(B) 
DEMONSTRATION
PROJECTS.—The 
Commission shall design demonstration projects 
to test alternative models for rural health qual-
ity improvement, including with respect to both 
personal and population health. 
(C) MONITORING.—The Commission shall 
monitor progress toward the objectives identi-
fied pursuant to paragraph (1)(A). 
(3) MEMBERSHIP.— 
(A) NUMBER.—The Commission shall be 
composed of 11 members appointed by the Sec-
retary. 
(B) SELECTION.—The Secretary shall se-
lect the members of the Commission from 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00232
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
233 
among individuals with significant rural health 
care and health care quality expertise, including 
expertise in clinical health care, health care 
quality research, population or public health, or 
purchaser organizations. 
(4) CONTRACTING AUTHORITY.—Subject to the 
availability of funds, the Commission may enter into 
contracts and make other arrangements, as may be 
necessary to carry out the duties described in para-
graph (2). 
(5) STAFF.—Upon the request of the Commis-
sion, the Secretary may detail, on a reimbursable 
basis, any of the personnel of the Office of Rural 
Health Policy of the Health Resources and Services 
Administration, the Agency for Healthcare Quality 
and Research, or the Centers for Medicare & Med-
icaid Services to the Commission to assist in car-
rying out this subsection. 
(6) REPORTS TO CONGRESS.—Not later than 1 
year after the establishment of the Commission, and 
annually thereafter, the Commission shall submit a 
report to the Congress on rural health quality. Each 
such report shall include the following: 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00233
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
234 
(A) An inventory of relevant programs and 
recommendations for improved coordination and 
integration of policy and programs. 
(B) An assessment of achievement of the 
objectives identified in the national plan devel-
oped under paragraph (2) and recommenda-
tions for realizing such objectives. 
(C) Recommendations on Federal legisla-
tion, regulations, or administrative policies to 
enhance rural health quality and outcomes. 
(b) RURAL
HEALTH
QUALITY
DEMONSTRATION 
PROJECTS.— 
(1) IN
GENERAL.—Not later than 270 days 
after the date of the enactment of this section, the 
Secretary, in consultation with the Rural Health 
Quality Advisory Commission, the Office of Rural 
Health Policy of the Health Resources and Services 
Administration, the Agency for Healthcare Research 
and Quality, and the Centers for Medicare & Med-
icaid Services, shall make grants to eligible entities 
for 5 demonstration projects to implement and 
evaluate methods for improving the quality of health 
care in rural communities. Each such demonstration 
project shall include— 
(A) alternative community models that— 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00234
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
235 
(i) will achieve greater integration of 
personal and population health services; 
and 
(ii) 
address 
safety, 
effectiveness, 
patient- or community-centeredness, timeli-
ness, efficiency, and equity (the 6 aims 
identified by the Institute of Medicine of 
the National Academies in its report enti-
tled ‘‘Crossing the Quality Chasm: A New 
Health System for the 21st Century’’ re-
leased on March 1, 2001); 
(B) innovative approaches to the financing 
and delivery of health services to achieve rural 
health quality goals; and 
(C) development of quality improvement 
support structures to assist rural health sys-
tems and professionals (such as workforce sup-
port structures, quality monitoring and report-
ing, clinical care protocols, and information 
technology applications). 
(2) ELIGIBLE
ENTITIES.—In this subsection, 
the term ‘‘eligible entity’’ means a consortium 
that— 
(A) shall include— 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00235
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
236 
(i) at least one health care provider or 
health care delivery system located in a 
rural area; and 
(ii) at least one organization rep-
resenting multiple community stakeholders; 
and 
(B) may include other partners such as 
rural research centers. 
(3) CONSULTATION.—In developing the pro-
gram for awarding grants under this subsection, the 
Secretary shall consult with the Administrator of the 
Agency for Healthcare Research and Quality, rural 
health care providers, rural health care researchers, 
and private and nonprofit groups (including national 
associations) which are undertaking similar efforts. 
(4) EXPEDITED WAIVERS.—The Secretary shall 
expedite the processing of any waiver that— 
(A) is authorized under title XVIII or XIX 
of the Social Security Act (42 U.S.C. 1395 et 
seq.); and 
(B) is necessary to carry out a demonstra-
tion project under this subsection. 
(5) DEMONSTRATION
PROJECT
SITES.—The 
Secretary shall ensure that the 5 demonstration 
projects funded under this subsection are conducted 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00236
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
237 
at a variety of sites representing the diversity of 
rural communities in the Nation. 
(6) DURATION.—Each demonstration project 
under this subsection shall be for a period of 4 
years. 
(7) INDEPENDENT
EVALUATION.—The Sec-
retary shall enter into an arrangement with an enti-
ty that has experience working directly with rural 
health systems for the conduct of an independent 
evaluation of the program carried out under this 
subsection. 
(8) REPORT.—Not later than 1 year after the 
conclusion of all of the demonstration projects fund-
ed under this subsection, the Secretary shall submit 
a report to the Congress on the results of such 
projects. The report shall include— 
(A) an evaluation of patient access to care, 
patient outcomes, and an analysis of the cost 
effectiveness of each such project; and 
(B) recommendations on Federal legisla-
tion, regulations, or administrative policies to 
enhance rural health quality and outcomes. 
(c) APPROPRIATION.— 
(1) IN GENERAL.—Out of funds in the Treas-
ury not otherwise appropriated, there are appro-
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00237
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
238 
priated to the Secretary to carry out this section 
$30,000,000 for the period of fiscal years 2015 
through 2019. 
(2) AVAILABILITY.— 
(A) IN
GENERAL.—Funds appropriated 
under paragraph (1) shall remain available for 
expenditure through fiscal year 2019. 
(B) REPORT.—For purposes of carrying 
out subsection (b)(8), funds appropriated under 
paragraph (1) shall remain available for ex-
penditure through fiscal year 2020. 
(3) RESERVATION.—Of the amount appro-
priated under paragraph (1), the Secretary shall re-
serve— 
(A) $5,000,000 to carry out subsection (a); 
and 
(B) $25,000,000 to carry out subsection 
(b), of which— 
(i) 2 percent shall be for the provision 
of technical assistance to grant recipients; 
and 
(ii) 5 percent shall be for independent 
evaluation under subsection (b)(7). 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00238
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
240 
‘‘(1) GRANTS.—The Director of the Office of 
Rural Health Policy of the Health Resources and 
Services Administration may award grants to eligible 
entities to promote rural health care services out-
reach by expanding the delivery of health care serv-
ices to include new and enhanced services in rural 
areas. The Director may award the grants for peri-
ods of not more than 3 years. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a 
grant under this subsection for a project, an enti-
ty— 
‘‘(A) shall be a rural public or rural non-
profit private entity, a facility that qualifies as 
a rural health clinic under title XVIII of the 
Social Security Act, a public or nonprofit entity 
existing exclusively to provide services to mi-
grant and seasonal farm workers in rural areas, 
or a tribal government whose grant-funded ac-
tivities will be conducted within federally recog-
nized tribal areas; 
‘‘(B) shall represent a consortium com-
posed of members— 
‘‘(i) that include 3 or more independ-
ently owned health care entities; and 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00240
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
241 
‘‘(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 shall 
prepare and submit to the Director an application at 
such time, in such manner, and containing such in-
formation as the Director 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 populations in 
the local community or region to be served; 
‘‘(C) a plan for quantifying how health 
care needs will be met through identification of 
the target population and benchmarks of service 
delivery or health status, such as— 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00241
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
242 
‘‘(i) quantifiable measurements of 
health status improvement for projects fo-
cusing on health promotion; or 
‘‘(ii) benchmarks of increased access 
to primary care, including tracking factors 
such as the number and type of primary 
care visits, identification of a medical 
home, or other general measures of such 
access; 
‘‘(D) a description of how the local com-
munity or region to be served will be involved 
in the development and ongoing operations of 
the project; 
‘‘(E) a plan for sustaining the project after 
Federal support for the project has ended; 
‘‘(F) a description of how the project will 
be evaluated; 
‘‘(G) the administrative capacity to submit 
annual performance data electronically as speci-
fied by the Director; and 
‘‘(H) other such information as the Direc-
tor determines to be appropriate. 
‘‘(c) RURAL
HEALTH
NETWORK
DEVELOPMENT 
GRANTS.— 
‘‘(1) GRANTS.— 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00242
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
243 
‘‘(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 and economies 
of scale; 
‘‘(ii) expand access to, coordinate, and 
improve the quality of the health care de-
livery system through development of orga-
nizational efficiencies; 
‘‘(iii) implement health information 
technology to achieve efficiencies, reduce 
medical errors, and improve quality; 
‘‘(iv) coordinate care and manage 
chronic illness; and 
‘‘(v) strengthen the rural health care 
system as a whole in such a manner as to 
show a quantifiable return on investment 
to the participants in the network. 
‘‘(B) GRANT PERIODS.—The Director may 
award such a rural health network development 
grant— 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00243
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
244 
‘‘(i) for a period of 3 years for imple-
mentation activities; or 
‘‘(ii) for a period of 1 year for plan-
ning activities to assist in the initial devel-
opment of an integrated health care net-
work, if the proposed participants in the 
network do not have a history of collabo-
rative efforts and a 3-year grant would be 
inappropriate. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a 
grant under this subsection, an entity— 
‘‘(A) shall be a rural public or rural non-
profit private entity, a facility that qualifies as 
a rural health clinic under title XVIII of the 
Social Security Act, a public or nonprofit entity 
existing exclusively to provide services to mi-
grant and seasonal farm workers in rural areas, 
or a tribal government whose grant-funded ac-
tivities will be conducted within federally recog-
nized tribal areas; 
‘‘(B) shall represent a network composed 
of participants— 
‘‘(i) that include 3 or more independ-
ently owned health care entities; and 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00244
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
245 
‘‘(ii) that may be nonprofit or for- 
profit entities; and 
‘‘(C) shall not previously have received a 
grant under this subsection (other than a 1- 
year grant for planning activities) 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 or another appropriate State entity, 
shall prepare and submit to the Director an applica-
tion at such time, in such manner, and containing 
such information as the Director may require, in-
cluding— 
‘‘(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; 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00245
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
246 
‘‘(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, including a description of— 
‘‘(i) return on investment for the com-
munity and the network members; and 
‘‘(ii) other quantifiable performance 
measures that show the benefit of the net-
work activities; 
‘‘(E) a plan for sustaining the project after 
Federal support for the project has ended; 
‘‘(F) a description of how the project will 
be evaluated; 
‘‘(G) the administrative capacity to submit 
annual performance data electronically as speci-
fied by the Director; and 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00246
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
247 
‘‘(H) other such information as the Direc-
tor determines to be appropriate. 
‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS-
TEMS DEVELOPMENT GRANTS.— 
‘‘(1) GRANTS.—The Director may award grants 
to eligible entities to support reduction of health dis-
parities, improve access to health care, and enhance 
rural health system development in the Delta Re-
gion. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a 
grant under this subsection, an entity shall be a 
rural public or rural nonprofit private entity, a facil-
ity that qualifies as a rural health clinic under title 
XVIII of the Social Security Act, a public or non-
profit entity existing exclusively to provide services 
to migrant and seasonal farm workers in rural 
areas, or a tribal government whose grant-funded 
activities will be conducted within federally recog-
nized tribal areas. 
‘‘(3) APPLICATIONS.—To be eligible to receive a 
grant under this subsection, an eligible entity shall 
prepare and submit to the Director an application at 
such time, in such manner, and containing such in-
formation as the Director may require, including— 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00247
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
248 
‘‘(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 meet 
the health care needs of the Delta Region; 
‘‘(D) a description of how the local com-
munity or region to be served will experience in-
creased access to quality health care services as 
a result of the activities carried out by the enti-
ty; 
‘‘(E) a description of how health dispari-
ties will be reduced or the health system will be 
improved; 
‘‘(F) a plan for sustaining the project after 
Federal support for the project has ended; 
‘‘(G) a description of how the project will 
be evaluated including process and outcome 
measures related to the quality of care provided 
or how the health care system improves its per-
formance; 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00248
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
249 
‘‘(H) a description of how the grantee will 
develop an advisory group made up of rep-
resentatives of the communities to be served to 
provide guidance to the grantee to best meet 
community need; and 
‘‘(I) other such information as the Director 
determines to be appropriate. 
‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL-
ITY IMPROVEMENT GRANTS.— 
‘‘(1) GRANTS.—The Director may award grants 
to provide for the planning and implementation of 
small rural health care provider quality improvement 
activities. The Director may award the grants for 
periods of 1 to 3 years. 
‘‘(2) ELIGIBILITY.—To be eligible for a grant 
under this subsection, an entity— 
‘‘(A) shall be— 
‘‘(i) a rural public or rural nonprofit 
private health care provider or provider of 
health care services, such as a rural health 
clinic; or 
‘‘(ii) another rural provider or net-
work of small rural providers identified by 
the Director as a key source of local care; 
and 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00249
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
250 
‘‘(B) shall not previously have received a 
grant under this subsection for the same or a 
similar project. 
‘‘(3) PREFERENCE.—In awarding grants under 
this subsection, the Director shall give preference to 
facilities that qualify as rural health clinics under 
title XVIII of the Social Security Act. 
‘‘(4) APPLICATIONS.—To be eligible to receive a 
grant under this subsection, an eligible entity shall 
prepare and submit to the Director an application at 
such time, in such manner, and containing such in-
formation as the Director 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 as 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00250
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
251 
a result of the activities carried out by the enti-
ty; 
‘‘(E) a plan for sustaining the project after 
Federal support for the project has ended; 
‘‘(F) a description of how the project will 
be evaluated including process and outcome 
measures related to the quality of care pro-
vided; and 
‘‘(G) other such information as the Direc-
tor determines to be appropriate. 
‘‘(f) 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. 
‘‘(2) COORDINATION WITH OTHER AGENCIES.— 
The Director 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. 
‘‘(g) REPORT.—Not later than September 30, 2016, 
the Secretary shall prepare and submit to the appropriate 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00251
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
252 
committees of Congress a report on the progress and ac-
complishments of the grant programs described in sub-
sections (b), (c), (d), and (e). 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) The term ‘Delta Region’ has the meaning 
given to the term ‘region’ in section 382A of the 
Consolidated Farm and Rural Development Act (7 
U.S.C. 2009aa). 
‘‘(2) The term ‘Director’ means the Director of 
the Office of Rural Health Policy of the Health Re-
sources and Services Administration. 
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$40,000,000 for fiscal year 2015, and such sums as may 
be necessary for each of fiscal years 2016 through 2019.’’. 
SEC. 427. COMMUNITY HEALTH CENTER COLLABORATIVE 
ACCESS EXPANSION. 
Section 330 of the Public Health Service Act (42 
U.S.C. 254b) is amended by adding at the end the fol-
lowing: 
‘‘(t) MISCELLANEOUS PROVISIONS.— 
‘‘(1) RULE OF CONSTRUCTION WITH RESPECT 
TO RURAL HEALTH CLINICS.—Nothing in this sec-
tion shall be construed to prevent a community 
health center from contracting with a federally cer-
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00252
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
253 
tified rural health clinic (as defined by section 
1861(aa)(2) of the Social Security Act) for the deliv-
ery of primary health care and other mental, dental, 
and physical health services that are available at the 
rural health clinic to individuals who would other-
wise be eligible for free or reduced cost care if that 
individual were able to obtain that care at the com-
munity health center. Such services may be limited 
in scope to those primary health care and other 
mental, dental, and physical health services available 
in that rural health clinic. 
‘‘(2) ENABLING SERVICES.—To the extent pos-
sible, enabling services such as transportation and 
translation assistance shall be provided by rural 
health clinics described in paragraph (1). 
‘‘(3) ASSURANCES.—In order for a rural health 
clinic to receive funds under this section through a 
contract with a community health center for the de-
livery of primary health care and other services de-
scribed in paragraph (1), such rural health clinic 
shall establish policies to ensure— 
‘‘(A) nondiscrimination based upon the 
ability of a patient to pay; 
‘‘(B) the establishment of a sliding fee 
scale for low-income patients; and 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00253
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
254 
‘‘(C) any such services should be subject to 
full reimbursement according to the Prospective 
Payment System scale.’’. 
SEC. 428. FACILITATING THE PROVISION OF TELEHEALTH 
SERVICES ACROSS STATE LINES. 
(a) IN GENERAL.—For purposes of expediting the 
provision of telehealth services, for which payment is made 
under the Medicare Program, across State lines, the Sec-
retary of Health and Human Services shall, in consulta-
tion with representatives of States, physicians, health care 
practitioners, and patient advocates, encourage and facili-
tate the adoption of provisions allowing for multistate 
practitioner practice across State lines. 
(b) DEFINITIONS.—In subsection (a): 
(1) TELEHEALTH
SERVICE.—The term ‘‘tele-
health service’’ has the meaning given that term in 
subparagraph (F) of section 1834(m)(4) of the So-
cial Security Act (42 U.S.C. 1395m(m)(4)). 
(2) PHYSICIAN, 
PRACTITIONER.—The terms 
‘‘physician’’ and ‘‘practitioner’’ have the meaning 
given those terms in subparagraphs (D) and (E), re-
spectively, of such section. 
(3) MEDICARE PROGRAM.—The term ‘‘Medicare 
Program’’ means the program of health insurance 
administered by the Secretary of Health and Human 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00254
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
255 
Services under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.). 
SEC. 429. SCORING OF PREVENTIVE HEALTH SAVINGS. 
Section 202 of the Congressional Budget and Im-
poundment Control Act of 1974 (2 U.S.C. 602) is amend-
ed by adding at the end the following new subsection: 
‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 
‘‘(1) DETERMINATION
BY
THE
DIRECTOR.— 
Upon a request by the chairman or ranking minority 
member of the Committee on the Budget of the Sen-
ate, or by the chairman or ranking minority member 
of the Committee on the Budget of the House of 
Representatives, the Director shall determine if a 
proposed measure would result in reductions in 
budget outlays in budgetary outyears through the 
use of preventive health and preventive health serv-
ices. 
‘‘(2) PROJECTIONS.—If the Director determines 
that a measure would result in substantial reduc-
tions in budget outlays as described in paragraph 
(1), the Director— 
‘‘(A) shall include, in any projection pre-
pared by the Director, a description and esti-
mate of the reductions in budget outlays in the 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00255
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
256 
budgetary outyears and a description of the 
basis for such conclusions; and 
‘‘(B) may prepare a budget projection that 
includes some or all of the budgetary outyears, 
notwithstanding the time periods for projections 
described in subsection (e) and sections 308, 
402, and 424. 
‘‘(3) DEFINITIONS.—As used in this sub-
section— 
‘‘(A) the term ‘preventive health’ means an 
action that focuses on the health of the public, 
individuals, and defined populations in order to 
protect, promote, and maintain health, wellness, 
and functional ability, and prevent disease, dis-
ability, and premature death that is dem-
onstrated by credible and publicly available epi-
demiological projection models, incorporating 
clinical trials or observational studies in hu-
mans, to avoid future health care costs; and 
‘‘(B) the term ‘budgetary outyears’ means 
the 2 consecutive 10-year periods beginning 
with the first fiscal year that is 10 years after 
the budget year provided for in the most re-
cently agreed to concurrent resolution on the 
budget.’’. 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00256
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
257 
SEC. 430. SENSE OF CONGRESS. 
It is the sense of the Congress that— 
(1) the maintenance of effort provisions added 
to sections 1902 and 2105(d) of the Social Security 
Act by sections 2001(b) and 2101(b) of the Patient 
Protection and Affordable Care Act were written to 
maintain the eligibility standards for the Medicaid 
program under title XIX of the Social Security Act 
and Children’s Health Insurance Program under 
title XXI of such Act until the American Health 
Benefit Exchanges in the States are fully oper-
ational; 
(2) it is imperative that the maintenance of ef-
fort provisions are enforced to the strict standard in-
tended by the Congress; 
(3) waiving the maintenance of effort provisions 
should not be permitted, except in the case of a re-
quest for a waiver that meets the explicit non-
application requirements; 
(4) the maintenance of effort provisions ensure 
the continued success of the Medicaid program and 
Children’s Health Insurance Program and were writ-
ten deliberately to specifically protect vulnerable and 
disabled individuals, children, and senior citizens, 
many of whom are also members of communities of 
color; and 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00257
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
258 
(5) the maintenance of effort provisions must 
be strictly enforced and proposals to weaken the 
maintenance of effort provisions must not be consid-
ered. 
SEC. 431. REPEAL OF REQUIREMENT FOR DOCUMENTA-
TION EVIDENCING CITIZENSHIP OR NATION-
ALITY UNDER THE MEDICAID PROGRAM. 
(a) REPEAL.—Subsections (i)(22) and (x) of section 
1903 of the Social Security Act (42 U.S.C. 1396b) are 
each repealed. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1902 of the Social Security Act (42 
U.S.C. 1396a) is amended— 
(A) by amending paragraph (46) of sub-
section (a) to read as follows: 
‘‘(46) provide that information is requested and 
exchanged for purposes of income and eligibility 
verification in accordance with a State system which 
meets the requirements of section 1137 of this 
Act;’’; 
(B) in subsection (e)(13)(A)(i)— 
(i) in the matter preceding subclause 
(I), by striking ‘‘sections 1902(a)(46)(B) 
and 1137(d)’’ and inserting ‘‘section 
1137(d)’’; and 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00258
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
259 
(ii) in subclause (IV), by striking 
‘‘1902(a)(46)(B) or’’; and 
(C) by striking subsection (ee). 
(2) Section 1903 of the Social Security Act (42 
U.S.C. 1396b) is amended— 
(A) in subsection (i), by redesignating 
paragraphs (23) through (26) as paragraphs 
(22) through (25), respectively; and 
(B) by redesignating subsections (y) and 
(z) as subsections (x) and (y), respectively. 
(3) Subsection (c) of section 6036 of the Deficit 
Reduction Act of 2005 (42 U.S.C. 1396b note) is re-
pealed. 
(c) EFFECTIVE DATE.—The repeals and amend-
ments made by this section shall take effect as if included 
in the enactment of the Deficit Reduction Act of 2005. 
SEC. 432. OFFICE OF MINORITY HEALTH IN VETERANS 
HEALTH ADMINISTRATION OF DEPARTMENT 
OF VETERANS AFFAIRS. 
(a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 
I of chapter 73 of title 38, United States Code, is amended 
by adding at the end the following new section: 
‘‘§ 7310. Office of Minority Health 
‘‘(a) ESTABLISHMENT.—There is established in the 
Department within the Office of the Under Secretary for 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00259
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
260 
Health an office to be known as the ‘Office of Minority 
Health’ (in this section referred to as the ‘Office’). 
‘‘(b) HEAD.—The Director of the Office of Minority 
Health shall be the head of the Office. The Director of 
the Office of Minority Health shall be appointed by the 
Under Secretary of Health from among individuals quali-
fied to perform the duties of the position. 
‘‘(c) FUNCTIONS.—The functions of the Office are as 
follows: 
‘‘(1) To establish short-range and long-range 
goals and objectives and coordinate all other activi-
ties within the Veterans Health Administration that 
relate to disease prevention, health promotion, health 
care services delivery, and health care research con-
cerning veterans who are members of a racial or eth-
nic minority group. 
‘‘(2) To support research, demonstrations, and 
evaluations to test new and innovative models for 
the discharge of activities described in paragraph 
(1). 
‘‘(3) To increase knowledge and understanding 
of health risk factors for veterans who are members 
of a racial or ethnic minority group. 
‘‘(4) To develop mechanisms that support bet-
ter health care information dissemination, education, 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00260
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
261 
prevention, and services delivery to veterans from 
disadvantaged backgrounds, including veterans who 
are members of a racial or ethnic minority group. 
‘‘(5) To enter into contracts or agreements with 
appropriate public and nonprofit private entities to 
develop and carry out programs to provide bilingual 
or interpretive services to assist veterans who are 
members of a racial or ethnic minority group and 
who lack proficiency in speaking the English lan-
guage in accessing and receiving health care services 
through the Veterans Health Administration. 
‘‘(6) To carry out programs to improve access 
to health care services through the Veterans Health 
Administration for veterans with limited proficiency 
in speaking the English language, including the de-
velopment and evaluation of demonstration and pilot 
projects for that purpose. 
‘‘(7) To advise the Under Secretary of Health 
on matters relating to the development, implementa-
tion, and evaluation of health professions education 
in decreasing disparities in health care outcomes be-
tween veterans who are members of a racial or eth-
nic minority group and other veterans, including cul-
tural competency as a method of eliminating such 
health disparities. 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00261
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
262 
‘‘(8) To perform such other functions and du-
ties as the Secretary or the Under Secretary for 
Health considers appropriate. 
‘‘(d) DEFINITIONS.—In this section: 
‘‘(1) The term ‘racial or ethnic minority group’ 
means the following: 
‘‘(A) American Indians (including Alaska 
Natives, Eskimos, and Aleuts). 
‘‘(B) Asian-Americans. 
‘‘(C) Native Hawaiians and other Pacific 
Islanders. 
‘‘(D) Blacks. 
‘‘(E) Hispanics. 
‘‘(2) The term ‘Hispanic’ means individuals 
whose origin is Mexican, Puerto Rican, Cuban, Cen-
tral or South American, or any other Spanish-speak-
ing country.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item relating to section 7309 the following new 
item: 
‘‘7310. Office of Minority Health.’’. 
SEC. 433. INDIAN DEFINED IN PPACA. 
(a) DEFINITION OF INDIAN.—Section 1304 of the 
Patient Protection and Affordable Care Act (42 U.S.C. 
18024) is amended by adding at the end the following: 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00262
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
263 
‘‘(f) INDIAN.— 
‘‘(1) IN GENERAL.—In this title, the term ‘In-
dian’ means any individual— 
‘‘(A) described in paragraph (13) or (28) 
of section 4 of the Indian Health Care Improve-
ment Act (25 U.S.C. 1603); 
‘‘(B) who is eligible for health services pro-
vided by the Indian Health Service under sec-
tion 809 of the Indian Health Care Improve-
ment Act (25 U.S.C. 1679); 
‘‘(C) who is of Indian descent and belongs 
to the Indian community served by the local fa-
cilities and program of the Indian Health Serv-
ice; or 
‘‘(D) who is described in paragraph (2). 
‘‘(2) INCLUDED
INDIVIDUALS.—The following 
individuals shall be considered to be an ‘Indian’: 
‘‘(A) A member of a federally recognized 
Indian tribe. 
‘‘(B) A resident of an urban center who 
meets 1 or more of the following 4 criteria: 
‘‘(i) Membership in a tribe, band, or 
other organized group of Indians, including 
those tribes, bands, or groups terminated 
since 1940 and those recognized as of the 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00263
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
264 
date of enactment of the Health Equity 
and Accountability Act of 2014 or later by 
the State in which they reside, or being a 
descendant, in the first or second degree, 
of any such member. 
‘‘(ii) Is an Eskimo or Aleut or other 
Alaska Native. 
‘‘(iii) Is considered by the Secretary of 
the Interior to be an Indian for any pur-
pose. 
‘‘(iv) Is determined to be an Indian 
under regulations promulgated by the Sec-
retary. 
‘‘(C) An individual who is considered by 
the Secretary of the Interior to be an Indian for 
any purpose. 
‘‘(D) An individual who is considered by 
the Secretary to be an Indian for purposes of 
eligibility for Indian health care services, includ-
ing as a California Indian, Eskimo, Aleut, or 
other Alaska Native.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) AFFORDABLE
CHOICES
HEALTH
BENEFIT 
PLANS.—Section 1311(c)(6)(D) of the Patient Pro-
tection and Affordable Care Act (42 U.S.C. 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00264
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
265 
18031(c)(6)(D)) is amended by striking ‘‘section 4 
of the Indian Health Care Improvement Act’’ and 
inserting ‘‘section 1304(f)’’. 
(2) REDUCED COST-SHARING FOR INDIVIDUALS 
ENROLLING IN QUALIFIED HEALTH PLANS.—Section 
1402(d) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18071(d)) is amended— 
(A) in paragraph (1), in the matter pre-
ceding subparagraph (A), by striking ‘‘section 
4(d) of the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450b(d))’’ and 
inserting ‘‘section 1304(f)’’; and 
(B) in paragraph (2), in the matter pre-
ceding subparagraph (A), by striking ‘‘(as so 
defined)’’ and inserting ‘‘(as defined in section 
1304(f))’’. 
(3) EXEMPTION
FROM
PENALTY
FOR
NOT 
MAINTAINING
MINIMUM
ESSENTIAL
COVERAGE.— 
Section 5000A(e) of the Internal Revenue Code of 
1986 is amended by striking paragraph (3) and in-
serting the following: 
‘‘(3) INDIANS.—Any applicable individual who 
is an Indian (as defined in section 1304(f) of the 
Patient Protection and Affordable Care Act).’’. 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00265
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
266 
SEC. 434. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 
ACCESS FOR LOW-INCOME PATIENTS. 
(a) IN GENERAL.—Not later than January 1, 2016, 
the Comptroller General of the United States shall con-
duct a study on how certain amendments made by the Pa-
tient Protection and Affordable Care Act (Public Law 
111–148) to titles XVIII and XIX of the Social Security 
Act affect the timely access to health care services for low- 
income patients. Such study shall— 
(1) evaluate and examine whether States elect-
ing to make medical assistance available under sec-
tion 1902(a)(10)(A)(i)(VIII) of the Social Security 
Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including 
States making such an election through a waiver of 
the State plan) to individuals described in such sec-
tion mitigates the need for payments to dispropor-
tionate share hospitals under section 1886(d)(5)(F) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(d)(5)(F)) and section 1923 of such Act (42 
U.S.C. 1396r–4), including the impact of such 
States electing to make medical assistance available 
to such individuals on— 
(A) the number of individuals in the 
United States who are without health insurance 
and the distribution of such individuals in rela-
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00266
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
267 
tion to areas primarily served by dispropor-
tionate share hospitals; and 
(B) the low-income utilization rate of such 
hospitals and the resulting fiscal sustainability 
of such hospitals; 
(2) evaluate the appropriate level and distribu-
tion of such payments among disproportionate hos-
pitals for purposes of— 
(A) sufficiently accounting for the level of 
uncompensated care provided by such hospitals 
to low-income patients; and 
(B) providing timely access to health serv-
ices for individuals in medically underserved 
areas; and 
(3) assess, with respect to disproportionate hos-
pitals— 
(A) the role played by such hospitals in 
providing critical access to emergency, inpa-
tient, and outpatient health services, as well as 
the location of such hospitals in relation to 
medically underserved areas; and 
(B) the extent to which such hospitals sat-
isfy the requirements established for charitable 
hospital organizations under section 501(r) of 
the Internal Revenue Code of 1986 with respect 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00267
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
268 
to community health needs assessments, finan-
cial assistance policy requirements, limitations 
on charges, and billing and collection require-
ments. 
(b) REPORTS.— 
(1) REPORT
TO
CONGRESS.—Not later than 
180 days after the date on which the study under 
subsection (a) is completed, the Comptroller General 
of the United States shall submit to the Committee 
on Energy and Commerce of the House of Rep-
resentatives and the Committee on Health, Edu-
cation, Labor, and Pensions of the Senate a report 
that contains— 
(A) the results of the study; 
(B) recommendations to Congress for any 
legislative changes to the payments to dis-
proportionate share hospitals under section 
1886(d)(5)(F) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)(F)) and section 1923 of 
such Act (42 U.S.C. 1396r–4) that are needed 
to ensure access to health services for low-in-
come patients that— 
(i) are based on the number of indi-
viduals without health insurance, the 
amount of uncompensated care provided by 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00268
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
269 
such hospitals, and the impact of reduced 
payments levels on low-income commu-
nities; and 
(ii) takes into account any reports 
submitted by the Secretary of the Treas-
ury, in consultation with the Secretary of 
Health and Human Services, to Congres-
sional committees regarding the costs in-
curred by charitable hospital organizations 
for charity care, bad debt, nonreimbursed 
expenses for services provided to individ-
uals under the Medicare Program under 
title XVIII of the Social Security Act and 
the Medicaid Program under title XIX of 
such Act, and any community benefit ac-
tivities provided by such organizations. 
(2) REPORT TO THE SECRETARY OF HEALTH 
AND HUMAN SERVICES.—Not later than 180 days 
after the date on which the study under subsection 
(a) is completed, the Comptroller General of the 
United States shall submit to the Secretary of 
Health and Human Services a report that con-
tains— 
(A) the results of the study; and 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00269
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
270 
(B) any recommendations for purposes of 
assisting in the development of the methodology 
for the adjustment of payments to dispropor-
tionate share hospitals, as required under sec-
tion 1886(r) of the Social Security Act (42 
U.S.C. 1395ww(r)) and the reduction of such 
payments section 1923(f)(7) of such Act (42 
U.S.C. 1396r–4(f)(7)), taking into account the 
reports referred to in paragraph (1)(B)(ii). 
SEC. 435. ASSISTANT SECRETARY OF THE INDIAN HEALTH 
SERVICE. 
(a) REFERENCES.—Any reference in a law, regula-
tion, document, paper, or other record of the United 
States to the Director of the Indian Health Service shall 
be deemed to be a reference to the Assistant Secretary 
of the Indian Health Service. 
(b) EXECUTIVE SCHEDULE.—Section 5315 of title 5, 
United States Code, is amended in the matter relating to 
the Assistant Secretaries of Health and Human Services 
by striking ‘‘(6)’’ and inserting ‘‘(7), 1 of whom shall be 
the Assistant Secretary of the Indian Health Service’’. 
(c) CONFORMING AMENDMENT.—Section 5316 of 
title 5, United States Code, is amended by striking ‘‘Direc-
tor, Indian Health Service, Department of Health and 
Human Services.’’. 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00270
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
271 
SEC. 436. REAUTHORIZATION OF THE NATIVE HAWAIIAN 
HEALTH CARE IMPROVEMENT ACT. 
(a) NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— 
Section 6(h)(1) of the Native Hawaiian Health Care Im-
provement Act (42 U.S.C. 11705(h)(1)) is amended by 
striking ‘‘may be necessary for fiscal years 1993 through 
2019’’ and inserting ‘‘are necessary’’. 
(b) ADMINISTRATIVE
GRANT
FOR
PAPA
OLA 
LOKAHI.—Section 7(b) of the Native Hawaiian Health 
Care Improvement Act (42 U.S.C. 11706(b)) is amended 
by striking ‘‘may be necessary for fiscal years 1993 
through 2019’’ and inserting ‘‘are necessary’’. 
(c) NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.— 
Section 10(c) of the Native Hawaiian Health Care Im-
provement Act (42 U.S.C. 11709(c)) is amended by strik-
ing ‘‘may be necessary for fiscal years 1993 through 
2019’’ and inserting ‘‘are necessary’’. 
TITLE V—IMPROVING HEALTH 
OUTCOMES 
FOR 
WOMEN, 
CHILDREN, AND FAMILIES 
SEC. 501. GRANTS TO PROMOTE POSITIVE HEALTH BEHAV-
IORS IN WOMEN AND CHILDREN. 
Part Q of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended by adding at the end 
the following: 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00271
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
272 
‘‘SEC. 399Z–2. GRANTS TO PROMOTE POSITIVE HEALTH BE-
HAVIORS IN WOMEN AND CHILDREN. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col-
laboration with the Administrator of the Health Resources 
and Services Administration and other Federal officials 
determined appropriate by the Secretary, is authorized to 
award grants to eligible entities to promote positive health 
behaviors for women and children in target populations, 
especially racial and ethnic minority women and children 
in medically underserved communities. 
‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 
subsection (a) may be used to support the activities of 
community health workers, including such activities— 
‘‘(1) to educate and provide outreach regarding 
enrollment in health insurance including the State 
Children’s Health Insurance Program under title 
XXI of the Social Security Act, Medicare under title 
XVIII of such Act, and Medicaid under title XIX of 
such Act; 
‘‘(2) to educate, guide, and provide outreach in 
a community setting regarding health problems prev-
alent among women and children and especially 
among racial and ethnic minority women and chil-
dren; 
‘‘(3) to educate, guide, and provide experiential 
learning opportunities that target risk factors that 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00272
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
273 
impede achieving healthy behaviors and good health 
outcomes, including— 
‘‘(A) poor nutrition; 
‘‘(B) physical inactivity; 
‘‘(C) being overweight or obese; 
‘‘(D) tobacco use; 
‘‘(E) alcohol and substance use; 
‘‘(F) injury and violence; 
‘‘(G) risky sexual behavior; 
‘‘(H) mental health problems; 
‘‘(I) musculoskeletal health and arthritis; 
‘‘(J) dental and oral health problems; 
‘‘(K) understanding informed consent; and 
‘‘(L) stigma; 
‘‘(4) to educate and guide regarding effective 
strategies to promote positive health behaviors with-
in the family; 
‘‘(5) to promote community wellness and aware-
ness; and 
‘‘(6) to educate and refer target populations to 
appropriate health care agencies and community- 
based programs and organizations in order to in-
crease access to quality health care services, includ-
ing preventive health services. 
‘‘(c) APPLICATION.— 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00273
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
274 
‘‘(1) IN
GENERAL.—Each eligible entity that 
desires to receive a grant under subsection (a) shall 
submit an application to the Secretary, at such time, 
in such manner, and accompanied by such additional 
information as the Secretary may require. 
‘‘(2) CONTENTS.—Each application submitted 
pursuant to paragraph (1) shall— 
‘‘(A) describe the activities for which as-
sistance under this section is sought; 
‘‘(B) contain an assurance that, with re-
spect to each community health worker pro-
gram receiving funds under the grant awarded, 
such program provides in-language training and 
supervision to community health workers to en-
able such workers to provide authorized pro-
gram activities in (at least) the most commonly 
used languages within a particular geographic 
region; 
‘‘(C) contain an assurance that the appli-
cant will evaluate the effectiveness of commu-
nity health worker programs receiving funds 
under the grant; 
‘‘(D) contain an assurance that each com-
munity health worker program receiving funds 
under the grant will provide culturally com-
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00274
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS
357 
‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 
OF FDA-APPROVED CONTRACEPTION. 
‘‘(a) IN GENERAL.—Subject to subsection (c), a 
pharmacy that receives Food and Drug Administration- 
approved drugs or devices in interstate commerce shall 
maintain compliance with the following: 
‘‘(1) If a customer requests a contraceptive that 
is in stock, the pharmacy shall ensure that the con-
traceptive is provided to the customer without delay. 
‘‘(2) If a customer requests a contraceptive that 
is not in stock and the pharmacy in the normal 
course of business stocks contraception, the phar-
macy shall immediately inform the customer that the 
contraceptive is not in stock and without delay offer 
the customer the following options: 
‘‘(A) If the customer prefers to obtain the 
contraceptive through a referral or transfer, the 
pharmacy shall— 
‘‘(i) locate a pharmacy of the cus-
tomer’s choice or the closest pharmacy 
confirmed to have the contraceptive in 
stock; and 
‘‘(ii) refer the customer or transfer 
the prescription to that pharmacy. 
‘‘(B) If the customer prefers for the phar-
macy to order the contraceptive, the pharmacy 
VerDate Mar 15 2010 
23:38 Aug 05, 2014
Jkt 039200
PO 00000
Frm 00357
Fmt 6652
Sfmt 6201
E:\BILLS\H5294.IH
H5294
smartinez on DSK4TPTVN1PROD with BILLS