42 U.S.C. § 254c (THE PUBLIC HEALTH AND WELFARE)
§ 254c. Rural health care services outreach, rural health network development, and small health care provider quality improvement grant programs
(a) Purpose
The purpose of this section is to provide grants for expanded delivery of health care services 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 provider 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 1395x(aa) of this title.
(3) Health professional shortage area
The term “health professional shortage area” means a health professional shortage area designated under section 254e of this title.
(4) Medically underserved community
The term “medically underserved community” has the meaning given the term in section 295p(6) of this title.
(5) Medically underserved population
The term “medically underserved population” has the meaning given the term in section 254b(b)(3) of this title.
(c) Program
The Secretary shall establish, under section 241 of this title, a small health care provider quality improvement grant program.
(d) Administration
(1) Programs
The rural health care services outreach, rural health network development, and small health care provider quality improvement grant programs established under section 241 of this title 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 Director may award grants under subsections (e), (f), and (g) to expand access to, coordinate, and improve the quality of basic health care services, and enhance the delivery of health care, in rural areas.
(B) Types of grants
The Director may award the grants to—
(i) promote expanded delivery of health care services in rural areas under subsection (e);
(ii) provide for the planning and implementation of integrated health care networks in rural areas under subsection (f); and
(iii) provide for the planning and implementation of small health care provider 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 services outreach by improving and expanding the delivery of health care services to include new and enhanced services in rural areas, through community engagement and evidence-based or innovative, evidence-informed models. The Director may award the grants for periods of not more than 5 years.
(2) Eligibility
To be eligible to receive a grant under this subsection for a project, an entity shall—
(A) be an entity with demonstrated experience serving, or the capacity to serve, rural underserved populations;
(B) represent a consortium composed of members that—
(i) include 3 or more health care providers; and
(ii) may be nonprofit or for-profit entities; and
(C) 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 application, 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 populations in the local community or region to be served;
(C) a description of how the rural underserved populations in the local community 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;
(E) a description of how the project will be evaluated; and
(F) other such information as the Secretary determines to be appropriate.
(f) Rural health network development grants
(1) Grants
(A) In general
The Director may award rural health network development grants to eligible entities to plan, develop, and implement integrated health care networks that collaborate in order to—
(i) achieve efficiencies;
(ii) expand access to, coordinate, and improve the quality of basic health care services and associated health outcomes; and
(iii) strengthen the rural health care system as a whole.
(B) Grant periods
The Director may award grants under this subsection for periods of not more than 5 years.
(2) Eligibility
To be eligible to receive a grant under this subsection, an entity shall—
(A) be an entity with demonstrated experience serving, or the capacity to serve, rural underserved populations;
(B) represent a network composed of participants that—
(i) include 3 or more health care providers; and
(ii) may be nonprofit or for-profit entities; and
(C) not previously have received a grant under this subsection (other than a 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 Secretary an application, 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 activities carried out by the participants in the network;
(ii) the degree to which the participants are ready to integrate their functions; and
(iii) how the rural underserved populations in the local community or region to be served will benefit from and be involved in the development and ongoing operations of the network;
(D) a description of how the rural underserved populations in the local community or region to be served will experience increased access to quality health care services across the continuum of care as a result of the integration activities carried out by the network;
(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; and
(G) other such information as the Secretary determines to be appropriate.
(g) Small health care provider quality improvement grants
(1) Grants
The Director may award grants to provide for the planning and implementation of small health care provider quality improvement activities, including activities related to increasing care coordination, enhancing chronic disease management, and improving patient health outcomes. The Director may award the grants for periods of 1 to 5 years.
(2) Eligibility
To be eligible for a grant under this subsection, an entity shall—
(A)
(i) be a rural public or rural nonprofit private health care provider or provider of health care services, such as a critical access hospital or a rural health clinic; or
(ii) be another rural provider or network of small rural providers identified by the Secretary as a key source of local or regional care; and
(B) 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 or another appropriate State entity shall prepare and submit to the Secretary an application, 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 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 rural underserved populations in the local community or region to be served will experience increased 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;
(F) a description of how the project will be evaluated; and
(G) other such information as the Secretary determines to be appropriate.
(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 residents 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.
(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 agencies 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, as appropriate, shall give preference to entities that—
(A) are located in health professional shortage areas or medically underserved communities, or serve medically underserved populations; or
(B) propose to develop projects with a focus on primary care, and wellness and prevention strategies.
(i) Report
Not later than 4 years after March 27, 2020, and every 5 years thereafter, the Secretary shall prepare and submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report on the activities and outcomes of the grant programs under subsections (e), (f), and (g), including the impact of projects funded under such programs on the health status of rural residents with chronic conditions.
(j) Authorization of appropriations
There are authorized to be appropriated to carry out this section $79,500,000 for each of fiscal years 2021 through 2025.
(July 1, 1944, ch. 373, title III, § 330A, as added Pub. L. 104–299, § 3(a), Oct. 11, 1996, 110 Stat. 3642; amended Pub. L. 107–251, title II, § 201, Oct. 26, 2002, 116 Stat. 1628; Pub. L. 108–163, § 2(b), Dec. 6, 2003, 117 Stat. 2021; Pub. L. 110–355, § 4, Oct. 8, 2008, 122 Stat. 3994; Pub. L. 116–136, div. A, title III, § 3213, Mar. 27, 2020, 134 Stat. 370.)
heading: Prior Provisions
text: A prior section 254c, act July 1, 1944, ch. 373, title III, § 330, as added July 29, 1975, Pub. L. 94–63, title V, § 501(a), 89 Stat. 342; amended Apr. 22, 1976, Pub. L. 94–278, title VIII, § 801(b), 90 Stat. 415; Aug. 1, 1977, Pub. L. 95–83, title III, § 304, 91 Stat. 388; Nov. 10, 1978, Pub. L. 95–626, title I, § 104(a)–(d)(3)(B), (4), (5), (e), (f), 92 Stat. 3556–3559; July 10, 1979, Pub. L. 96–32, §§ 6(b)–(d), 7(c), 93 Stat. 83, 84; Oct. 17, 1979, Pub. L. 96–88, title V, § 509(b), 93 Stat. 695; Oct. 19, 1980, Pub. L. 96–470, title I, § 106(e), 94 Stat. 2238; Aug. 13, 1981, Pub. L. 97–35, title IX, §§ 903(a), 905, 906, 95 Stat. 561, 562; Jan. 4, 1983, Pub. L. 97–414, § 8(e), 96 Stat. 2060; Apr. 24, 1986, Pub. L. 99–280, §§ 2–4, 100 Stat. 399, 400; Aug. 10, 1988, Pub. L. 100–386, §§ 3, 4, 102 Stat. 921, 923; Nov. 4, 1988, Pub. L. 100–607, title I, § 163(3), 102 Stat. 3062; Dec. 19, 1989, Pub. L. 101–239, title VI, § 6103(e)(5), 103 Stat. 2207; Nov. 6, 1990, Pub. L. 101–527, § 9(a), 104 Stat. 2332; Oct. 27, 1992, Pub. L. 102–531, title III, § 309(b), 106 Stat. 3500, related to community health centers, prior to the general amendment of this subpart by Pub. L. 104–299, § 2.
heading: Amendments
text: 2020—Subsec. (d)(2)(A). Pub. L. 116–136, § 3213(1)(A), substituted “basic” for “essential”.
Subsec. (d)(2)(B). Pub. L. 116–136, § 3213(1)(B), inserted “to” after “grants” in introductory provisions and struck out “to” at beginning of cls. (i) to (iii).
Subsec. (e)(1). Pub. L. 116–136, § 3213(2)(A), inserted “improving and” after “outreach by” and “, through community engagement and evidence-based or innovative, evidence-informed models” after “rural areas” and substituted “5 years” for “3 years”.
Subsec. (e)(2). Pub. L. 116–136, § 3213(2)(B)(i), inserted “shall” after “entity” in introductory provisions.
Subsec. (e)(2)(A). Pub. L. 116–136, § 3213(2)(B)(ii), substituted “be an entity with demonstrated experience serving, or the capacity to serve, rural underserved populations” for “shall be a rural public or rural nonprofit private entity”.
Subsec. (e)(2)(B). Pub. L. 116–136, § 3213(2)(B)(iii), (iv), struck out “shall” before “represent” and inserted “that” after “members” in introductory provisions and struck out “that” at beginning of cls. (i) and (ii).
Subsec. (e)(2)(C). Pub. L. 116–136, § 3213(2)(B)(iii), struck out “shall” before “not previously”.
Subsec. (e)(3)(C). Pub. L. 116–136, § 3213(2)(C), substituted “the rural underserved populations in the local community or region” for “the local community or region”.
Subsec. (f)(1)(A). Pub. L. 116–136, § 3213(3)(A)(i)(I), substituted “plan, develop, and implement integrated health care networks that collaborate” for “promote, through planning and implementation, the development of integrated health care networks that have combined the functions of the entities participating in the networks” in introductory provisions.
Subsec. (f)(1)(A)(ii). Pub. L. 116–136, § 3213(3)(A)(i)(II), substituted “basic health care services and associated health outcomes” for “essential health care services”.
Subsec. (f)(1)(B). Pub. L. 116–136, § 3213(3)(A)(ii), amended subpar. (B) generally. Prior to amendment, text read as follows: “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 assist in the development of an integrated health care network, if the proposed participants in the network do not have a history of collaborative efforts and a 3-year grant would be inappropriate.”
Subsec. (f)(2). Pub. L. 116–136, § 3213(3)(B)(i), inserted “shall” after “entity” in introductory provisions.
Subsec. (f)(2)(A). Pub. L. 116–136, § (3)(B)(ii), substituted “be an entity with demonstrated experience serving, or the capacity to serve, rural underserved populations” for “shall be a rural public or rural nonprofit private entity”.
Subsec. (f)(2)(B). Pub. L. 116–136, § 3213(3)(B)(iii), struck out “shall” before “represent” and inserted “that” after “participants” in introductory provisions and struck out “that” at beginning of cls. (i) and (ii).
Subsec. (f)(2)(C). Pub. L. 116–136, § 3213(3)(B)(iv), struck out “shall” before “not previously”.
Subsec. (f)(3)(C)(iii). Pub. L. 116–136, § 3213(3)(C)(i), amended cl. (iii) generally. Prior to amendment, cl. (iii) read as follows: “how the local community or region to be served will benefit from and be involved in the activities carried out by the network;”.
Subsec. (f)(3)(D). Pub. L. 116–136, § 3213(3)(C)(ii), substituted “the rural underserved populations in the local community or region” for “the local community or region”.
Subsec. (g)(1). Pub. L. 116–136, § 3213(4)(A), inserted “, including activities related to increasing care coordination, enhancing chronic disease management, and improving patient health outcomes” after “quality improvement activities” and substituted “5 years” for “3 years”.
Subsec. (g)(2). Pub. L. 116–136, § 3213(4)(B)(i), inserted “shall” after “entity” in introductory provisions.
Subsec. (g)(2)(A). Pub. L. 116–136, § 3213(4)(B)(ii), (iii), struck out “shall” at beginning of cls. (i) and (ii), and inserted “or regional” after “local” in cl. (ii).
Subsec. (g)(2)(B). Pub. L. 116–136, § 3213(4)(B)(ii), struck out “shall” before “not previously”.
Subsec. (g)(3)(D). Pub. L. 116–136, § 3213(4)(C), substituted “the rural underserved populations in the local community or region” for “the local community or region”.
Subsec. (h)(3). Pub. L. 116–136, § 3213(5), inserted “, as appropriate,” after “the Secretary” in introductory provisions.
Subsec. (i). Pub. L. 116–136, § 3213(6), amended subsec. (i) generally. Prior to amendment, text read as follows: “Not later than September 30, 2005, the Secretary shall prepare and submit to the appropriate committees of Congress a report on the progress and accomplishments of the grant programs described in subsections (e), (f), and (g).”
Subsec. (j). Pub. L. 116–136, § 3213(7), substituted “$79,500,000 for each of fiscal years 2021 through 2025” for “$45,000,000 for each of fiscal years 2008 through 2012”.
2008—Subsec. (j). Pub. L. 110–355 substituted “$45,000,000 for each of fiscal years 2008 through 2012.” for “$40,000,000 for fiscal year 2002, and such sums as may be necessary for each of fiscal years 2003 through 2006.”
2003—Subsec. (b)(4). Pub. L. 108–163 substituted “section 295p(6)” for “section 295p”.
2002—Pub. L. 107–251 amended section generally. Prior to amendment, section related to a rural health outreach, network development, and telemedicine grant program, and in subsec. (a), provided for administration by the Office of Rural Health Policy; in subsec. (b), set out the objectives of grants; in subsec. (c), set out eligibility requirements; in subsec. (d), described preferred characteristics of applicant networks; in subsec. (e), specified permitted uses of grant funds; in subsec. (f), limited the duration of grants; and in subsec. (g), authorized appropriations.
heading: Effective Date of 2003 Amendment
text: Amendment by Pub. L. 108–163 deemed to have taken effect immediately after the enactment of Pub. L. 107–251, see section 3 of Pub. L. 108–163, set out as a note under section 233 of this title.
heading: Effective Date
text: Section effective Oct. 1, 1996, see section 5 of Pub. L. 104–299, as amended, set out as an Effective Date of 1996 Amendment note under section 233 of this title.
heading: Rural Access to Emergency Devices
text: Pub. L. 106–505, title IV, subtitle B, Nov. 13, 2000, 114 Stat. 2340, provided that:
“SEC. 411. SHORT TITLE.
“This subtitle may be cited as the ‘Rural Access to Emergency Devices Act’ or the ‘Rural AED Act’.
“SEC. 412. FINDINGS.
“Congress makes the following findings:
“(1) Heart disease is the leading cause of death in the United States.
“(2) The American Heart Association estimates that 250,000 Americans die from sudden cardiac arrest each year.
“(3) A cardiac arrest victim’s chance of survival drops 10 percent for every minute that passes before his or her heart is returned to normal rhythm.
“(4) Because most cardiac arrest victims are initially in ventricular fibrillation, and the only treatment for ventricular fibrillation is defibrillation, prompt access to defibrillation to return the heart to normal rhythm is essential.
“(5) Lifesaving technology, the automated external defibrillator, has been developed to allow trained lay rescuers to respond to cardiac arrest by using this simple device to shock the heart into normal rhythm.
“(6) Those people who are likely to be first on the scene of a cardiac arrest situation in many communities, particularly smaller and rural communities, lack sufficient numbers of automated external defibrillators to respond to cardiac arrest in a timely manner.
“(7) The American Heart Association estimates that more than 50,000 deaths could be prevented each year if defibrillators were more widely available to designated responders.
“(8) Legislation should be enacted to encourage greater public access to automated external defibrillators in communities across the United States.
“SEC. 413. GRANTS.
“(a) In General.—
The Secretary of Health and Human Services, acting through the Rural Health Outreach Office of the Health Resources and Services Administration, shall award grants to community partnerships that meet the requirements of subsection (b) to enable such partnerships to purchase equipment and provide training as provided for in subsection (c).
“(b) Community Partnerships.—
A community partnership meets the requirements of this subsection if such partnership—
“(1) is composed of local emergency response entities such as community training facilities, local emergency responders, fire and rescue departments, police, community hospitals, and local non-profit entities and for-profit entities concerned about cardiac arrest survival rates;
“(2) evaluates the local community emergency response times to assess whether they meet the standards established by national public health organizations such as the American Heart Association and the American Red Cross; and
“(3) submits to the Secretary of Health and Human Services an application at such time, in such manner, and containing such information as the Secretary may require.
“(c) Use of Funds.—
Amounts provided under a grant under this section shall be used—
“(1) to purchase automated external defibrillators that have been approved, or cleared for marketing, by the Food and Drug Administration; and
“(2) to provide defibrillator and basic life support training in automated external defibrillator usage through the American Heart Association, the American Red Cross, or other nationally recognized training courses.
“(d) Report.—
Not later than 4 years after the date of the enactment of this Act [Nov. 13, 2000], the Secretary of Health and Human Services shall prepare and submit to the appropriate committees of Congress a report containing data relating to whether the increased availability of defibrillators has affected survival rates in the communities in which grantees under this section operated. The procedures under which the Secretary obtains data and prepares the report under this subsection shall not impose an undue burden on program participants under this section.
“(e) Authorization of Appropriations.—
There is authorized to be appropriated $25,000,000 for fiscal years 2001 through 2003 to carry out this section.”
heading: Report on Telemedicine
text: Pub. L. 106–129, § 6, Dec. 6, 1999, 113 Stat. 1675, provided that:
“Not later than January 10, 2001, the Secretary of Health and Human Services shall submit to the Congress a report that—
“(1) identifies any factors that inhibit the expansion and accessibility of telemedicine services, including factors relating to telemedicine networks;
“(2) identifies any factors that, in addition to geographical isolation, should be used to determine which patients need or require access to telemedicine care;
“(3) determines the extent to which—
“(A) patients receiving telemedicine service have benefited from the services, and are satisfied with the treatment received pursuant to the services; and
“(B) the medical outcomes for such patients would have differed if telemedicine services had not been available to the patients;
“(4) determines the extent to which physicians involved with telemedicine services have been satisfied with the medical aspects of the services;
“(5) determines the extent to which primary care physicians are enhancing their medical knowledge and experience through the interaction with specialists provided by telemedicine consultations; and
“(6) identifies legal and medical issues relating to State licensing of health professionals that are presented by telemedicine services, and provides any recommendations of the Secretary for responding to such issues.”