Title: Rural Health Innovation Act of 2019
Policy area: Health

Summary:
Rural Health Innovation Act of 2019  This bill establishes two grant programs to increase access to emergency care in remote rural areas where the nearest emergency department is at least 30 minutes away or inaccessible by road.  First, the bill requires the Health Resources and Services Administration (HRSA) to provide grants to establish or maintain federally-qualified health centers or rural health clinics located remote rural areas. Eligible health centers or clinics must (1) employ physicians and professional clinical and support staff; (2) have laboratories, x-ray machines, and cardiac monitors on site; and (3) provide walk-in urgent care, and staging for transport to an emergency department.  Further, the bill requires HRSA to provide grants to rural health departments that are located in remote rural areas to support the provision of emergency services, triage and transport to emergency departments, primary care services, or other similar services. Eligible rural health departments must (1) have a nursing staff and medical equipment, (2) agree to provide such emergency or similar services, and (3) submit an estimated cost for the first year of staffing and equipment.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4898 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 4898

  To amend the Public Health Service Act to establish a rural health 
    center innovation awards program and a rural health department 
              enhancement program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 29, 2019

 Mr. Kustoff of Tennessee (for himself, Mr. David P. Roe of Tennessee, 
 and Ms. Kuster of New Hampshire) introduced the following bill; which 
          was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
  To amend the Public Health Service Act to establish a rural health 
    center innovation awards program and a rural health department 
              enhancement program, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Rural Health Innovation Act of 
2019''.

SEC. 2. RURAL HEALTH CENTER INNOVATION AWARDS PROGRAM.

    Subpart I of part D of title III of the Public Health Service Act 
(42 U.S.C. 254b et seq.) is amended by adding at the end the following:

``SEC. 330N. RURAL HEALTH CENTER INNOVATION AWARDS PROGRAM.

    ``(a) Definitions.--In this section:
            ``(1) Covered rural area.--The term `covered rural area' 
        means a rural area--
                    ``(A) that is located not less than 30 minutes by 
                automobile from the nearest emergency department, using 
                the speed limit of the most direct route to such 
                emergency department; or
                    ``(B) from which an individual cannot access an 
                emergency department by road.
            ``(2) Eligible entity.--The term `eligible entity' means an 
        entity that--
                    ``(A) is a Federally qualified health center;
                    ``(B) is a rural health clinic; or
                    ``(C) agrees (as a condition of receiving a grant 
                under this section) to establish such a center or 
                clinic, including a hospital that agrees (as such a 
                condition) to convert to a Federally qualified health 
                center.
            ``(3) Federally qualified health center.--The term 
        `Federally qualified health center' has the meaning given such 
        term in section 1861(aa) of the Social Security Act.
            ``(4) Rural area.--The term `rural area' has the meaning 
        given such term in section 330J(e).
            ``(5) Rural health clinic.--The term `rural health clinic' 
        has the meaning given such term in section 1861(aa) of the 
        Social Security Act.
    ``(b) Establishment.--
            ``(1) In general.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, shall establish a grant program to be known as 
        the `Rural Health Center Innovation Awards program' to award 
        grants to eligible entities that submit an application in 
        accordance with subsection (c) to enable such entities to 
        establish or maintain a Federally qualified health center or 
        rural health clinic that--
                    ``(A) serves individuals in a covered rural area as 
                a walk-in urgent care center and as a triage center or 
                staging facility for necessary air or ambulance 
                transport to an emergency department; and
                    ``(B) includes--
                            ``(i) professional clinical staff, 
                        including physicians, physician interns, 
                        residents, nurse practitioners, physician 
                        assistants, nurse midwives, or other health 
                        care providers providing walk-in urgent care 
                        and emergency triage; and
                            ``(ii) resources, including laboratories, 
                        x-ray machines, and cardiac monitors.
            ``(2) Permissible uses of funds.--The funds of a grant 
        awarded under this section may be used to--
                    ``(A) expand the hours of operation of a Federally 
                qualified health center or rural health clinic;
                    ``(B) pay for the costs of construction and 
                renovation of a Federally qualified health center or 
                rural health clinic; or
                    ``(C) carry out any other activity for the purposes 
                described in paragraph (1).
    ``(c) Applications and Selection.--
            ``(1) In general.--An eligible entity seeking a grant under 
        this section shall submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may reasonably require.
            ``(2) Start up centers and clinics.--An application 
        submitted under paragraph (1) by an eligible entity that is not 
        a Federally qualified health center, or a rural health clinic, 
        on the date on which the entity submits the application under 
        paragraph (1) shall include in such application a demonstration 
        of the costs of the equipment and staffing needed to establish 
        the center or clinic.
            ``(3) Expedited review.--The Secretary shall establish a 
        process for expediting the review of any application submitted 
        under paragraph (1) for a grant under this section from an 
        eligible entity that plans to use the funds of the grant to 
        serve individuals in a covered rural area in which a hospital 
        has closed in the 7 years preceding the date on which the 
        entity submitted the application.
    ``(d) Grant Period and Amounts.--
            ``(1) Period.--Each grant awarded under this section shall 
        be for a period of 5 years.
            ``(2) Amount.--
                    ``(A) In general.--A grant awarded under this 
                section to an eligible entity shall not exceed--
                            ``(i) for the first year of the grant--
                                    ``(I) $500,000 if the entity is a 
                                Federally qualified health center, or a 
                                rural health clinic, on the date on 
                                which the award is made; and
                                    ``(II) $750,000 if the entity is 
                                using the grant to establish a 
                                Federally qualified health center or a 
                                rural health clinic; and
                            ``(ii) for each of the third through fifth 
                        years of the grant, $500,000.
                    ``(B) Considerations.--In determining the amount of 
                a grant under this section for an eligible entity for 
                each year after the first year in which the grant is 
                awarded, the Secretary shall, subject to subparagraph 
                (A)(ii), consider the number of patients treated, and 
                the type of treatment provided, by the entity in the 
                prior year.
    ``(e) Reporting.--
            ``(1) In general.--Not later than 3 years after the date of 
        enactment of this section, the Secretary shall report to the 
        committees described in paragraph (2) on the grant program 
        under this section, including--
                    ``(A) an assessment of the success of the program, 
                challenges with respect to the program, and any action 
                for regulatory flexibility or legislative authority 
                needed to improve the program;
                    ``(B) any savings to Federal health care programs;
                    ``(C) any increase in access to care; and
                    ``(D) any increase in utilization of health 
                services in covered rural areas.
            ``(2) Committees.--The committees described in this 
        paragraph are--
                    ``(A) the Committee on Health, Education, Labor, 
                and Pensions, and the Committee on Finance, of the 
                Senate; and
                    ``(B) the Committee on Energy and Commerce, and the 
                Committee on Ways and Means, of the House of 
                Representatives.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $25,000,000 for each of fiscal 
years 2020 through 2024.''.

SEC. 3. RURAL HEALTH DEPARTMENT ENHANCEMENT PROGRAM.

    Subpart I of part D of title III of the Public Health Service Act 
(42 U.S.C. 254b et seq.), as amended by section 2, is further amended 
by adding at the end the following:

``SEC. 330O. RURAL HEALTH DEPARTMENT ENHANCEMENT PROGRAM.

    ``(a) Definitions.--In this section:
            ``(1) Covered rural area.--The term `covered rural area' 
        has the meaning given the term in section 330N(a).
            ``(2) Rural health department.--The term `rural health 
        department' means a health department that is located in a 
        covered rural area.
    ``(b) Establishment.--The Secretary, acting through the 
Administrator of the Health Resources and Services Administration, 
shall award grants, on a competitive basis, to rural health departments 
that submit an application in accordance with subsection (c) to enhance 
such departments and enable them to provide individuals in covered 
rural areas with emergency services, triage and transport to emergency 
departments, primary care services, and other services similar to 
services provided by emergency departments.
    ``(c) Applications.--A rural health department seeking a grant 
under this section shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may reasonably require, including--
            ``(1) an indication of the estimated cost of the equipment 
        and staffing needed by the department for the first year of the 
        award to set up the activities and services under this section;
            ``(2) a demonstration that the department has, on the date 
        on which the application is submitted, a facility operating 
        that is located in a covered rural area; and
            ``(3) a demonstration that, on the date on which the 
        application is submitted, the department--
                    ``(A) has a nursing staff and medical equipment; 
                and
                    ``(B) agrees to use such staff and equipment 
                towards providing the services and carrying out the 
                activities under this section.
    ``(d) Grants.--
            ``(1) Annual awards.--The funds awarded through a grant 
        under this section to a rural health department shall be 
        awarded on an annual basis for each of 5 years.
            ``(2) Maximum amounts.--The funds awarded through a grant 
        under this section to a rural health department shall be in an 
        amount that for a year does not exceed $500,000.
            ``(3) Considerations.--The Secretary shall determine the 
        amount awarded to a rural health department through a grant 
        under this section for a year in accordance with the following:
                    ``(A) For the first year of the award, the amount 
                shall be based on the amount the rural health 
                department estimates for the cost of equipment and 
                staffing needed to set up the activities and services 
                supported under this section, as specified in the 
                application under subsection (c).
                    ``(B) For the second through fifth years of the 
                award, the amount shall be based on the number of 
                patients treated, and the type of treatment provided, 
                by the department in the prior year.
    ``(e) Use of Funds.--
            ``(1) In general.--A rural health department receiving a 
        grant under this section shall use the funds awarded through 
        the grant to provide the services and carry out the activities 
        described in subsection (b) at a facility that is located in a 
        covered rural area, including by--
                    ``(A) obtaining additional medical equipment and 
                resources necessary for providing the services and 
                activities described in subsection (b), such as 
                laboratories, x-ray machines, and cardiac monitors;
                    ``(B) hiring additional providers to provide the 
                services and carry out the activities described in 
                subsection (b), such as physician interns, residents, 
                nurse practitioners, physician assistants, and nurse 
                midwives, which hiring may be through a partnership 
                described in paragraph (2)(A); and
                    ``(C) providing outreach to the community regarding 
                the services and activities of the rural health 
                department as supported under this section.
            ``(2) Limitations.--
                    ``(A) Partnerships.--Not more than 3 percent of the 
                funds awarded through a grant under this section for a 
                year may be used towards the rural health department 
                entering into a partnership with an academic medical 
                center to assist with the hiring described in paragraph 
                (1)(B).
                    ``(B) Community outreach.--For each of the first 2 
                years of a grant awarded under this section, not more 
                than 3 percent of the funds may be used by the rural 
                health department receiving the grant for the outreach 
                described in paragraph (1)(C).
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $25,000,000 for each of fiscal 
years 2020 through 2024.''.
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