In this task, you are given text for US Congressional and California state bills, your task is to generate a summary for this bill.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Rural Emergency Acute Care Hospital 
Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) According to the University of North Carolina's Center 
        for Health Services Research, 55 rural hospitals have closed in 
        the Unites States since January 2010.
            (2) In 2014, iVantage conducted a study for the National 
        Rural Health Association and found 283 hospitals at risk of 
        closure based upon performance indicators that matched those 
        facilities already forced to close in this decade.
            (3) Researchers at the University of North Carolina 
        identified inpatient volume as a substantial contributing 
        factor to the financial performance of rural hospitals, with 
        many of the at-risk hospitals having an average daily bed 
        census of less than 2.
            (4) Adverse impacts to the local economy and the loss of 
        timely access to emergency medical care are 2 major effects of 
        rural hospital closures.
            (5) According to the National Center for Rural Health 
        Works, the typical rural hospital creates over 140 jobs and 
        generates $6,800,000 in compensation while serving an average 
        population of 14,600.
            (6) The 2014 iVantage study estimates that the 283 at-risk 
        hospitals could result in the loss of 36,000 health care jobs, 
        50,000 community jobs, and $10,600,000,000 in gross domestic 
        product.
            (7) Time is the most critical factor for achieving 
        successful outcomes in emergency medicine, and emergency 
        medical clinicians refer to the time-sensitive period during 
        which successful outcomes may be best achieved as the ``golden 
        hour''.
            (8) The National Conference of State Legislatures states 
        that 60 percent of trauma deaths in the United States occur in 
        rural areas, where only 15 percent of the population is 
        represented.
            (9) The disproportionate percentage of trauma deaths in 
        rural areas is likely attributable in large part to a 
        combination of response time to the scene and distance to the 
        nearest emergency room to stabilize trauma victims.
            (10) The percentage of trauma deaths occurring in rural 
        areas could continue to increase as more rural hospitals close, 
        further limiting access to emergency services and requiring 
        patients to travel longer distances to receive emergency 
        medical care.
            (11) The creation of a rural emergency hospital designation 
        under the Medicare program will allow facilities in rural areas 
        to provide emergency medical services without having to 
        maintain inpatient beds.
            (12) In addition to providing emergency care, rural 
        emergency hospitals could convert the space previously used for 
        inpatient services to provide other medical services including, 
        but not limited to, observation care, skilled nursing facility 
        care, infusion services, hemodialysis, home health, hospice, 
        nursing home care, population health, and telemedicine 
        services.

SEC. 3. RURAL EMERGENCY HOSPITAL PROGRAM.

    (a) In General.--
            (1) Rural emergency hospital and services defined.--Section 
        1861 of the Social Security Act (42 U.S.C. 1395x) is amended--
                    (A) in subsection (e), in the last sentence of the 
                matter following paragraph (9), by inserting ``or a 
                rural emergency hospital (as defined in section 
                1861(iii)(1))'' before the period at the end; and
                    (B) by adding at the end the following subsection:

    ``Rural Emergency Hospital; Rural Emergency Hospital Outpatient 
                                Services

    ``(iii)(1) The term `rural emergency hospital' means a facility 
that--
            ``(A)(i) as of December 31, 2014--
                            ``(I) was a critical access hospital; or
                            ``(II) was a hospital with not more than 50 
                        beds located in a county (or equivalent unit of 
                        local government) in a rural area (as defined 
                        in section 1886(d)(2)(D)), or was a hospital 
                        with not more than 50 beds that was treated as 
                        being located in a rural area pursuant to 
                        section 1886(d)(8)(E); or
                    ``(ii) was a critical access hospital described in 
                clause (i)(I) or a hospital described in clause (i)(II) 
                that ceased operations during the period beginning on 
                the date that is 5 years prior to the date of the 
                enactment of this subsection and ending on December 30, 
                2014;
            ``(B) provides 24-hour emergency medical care and 
        observation care that does not exceed an annual per patient 
        average of 24 hours or more than 1 midnight;
            ``(C) does not provide any acute care inpatient beds and 
        has protocols in place for the timely transfer of patients who 
        require acute care inpatient services or other inpatient 
        services;
            ``(D) has elected to be designated as a rural emergency 
        hospital;
            ``(E) has received approval to operate as a rural emergency 
        hospital from the State under section 1834(r)(3)(A); and
            ``(F) is certified by the Secretary under section 
        1834(r)(3)(B).
    ``(2) The term `rural emergency hospital outpatient services' means 
medical and other health services furnished by a rural emergency 
hospital on an outpatient basis.
    ``(3) Nothing in this subsection or section 1834(r)(3) shall be 
construed to prohibit a rural emergency hospital from providing 
extended care services.''.
            (2) Payment for rural emergency hospital services.--
                    (A) In general.--Section 1833(a) of the Social 
                Security Act (42 U.S.C. 1395l(a)) is amended--
                            (i) in paragraph (8), by striking ``and'' 
                        at the end;
                            (ii) in paragraph (9), by striking the 
                        period at the end and inserting ``; and''; and
                            (iii) by inserting after paragraph (9) the 
                        following new paragraph:
            ``(10) in the case of rural emergency hospital emergency 
        services and services provided by a rural emergency hospital or 
        other provider of ambulance services to transport patients who 
        require acute care inpatient services or other inpatient 
        services from such rural emergency hospital to a hospital or 
        critical access hospital, the amounts described in section 
        1834(r).''.
                    (B) Payment amount.--Section 1834 of the Social 
                Security Act (42 U.S.C. 1395m) is amended by adding at 
                the end the following subsection:
    ``(r) Payment Rules Relating to Rural Emergency Hospitals.--
            ``(1) Payment for rural emergency hospital outpatient 
        services.--
                    ``(A) In general.--The amount of payment for rural 
                emergency hospital outpatient services of a rural 
                emergency hospital is equal to 110 percent of the 
                reasonable costs of providing such services.
                    ``(B) Telehealth services.--For purposes of this 
                paragraph, in determining the reasonable costs of 
                providing rural emergency hospital outpatient services, 
                costs associated with having a backup physician 
                available via a telecommunications system shall be 
                considered reasonable costs.
            ``(2) Payment for transportation services.--The amount of 
        payment for services provided by a rural emergency hospital or 
        other provider of ambulance services to transport patients who 
        require acute care inpatient services or other inpatient 
        services from such rural emergency hospital to a hospital or 
        critical access hospital is equal to 110 percent of the 
        reasonable costs of providing such services.
            ``(3) Requirements for rural emergency hospitals.--
                    ``(A) State approval to operate as a rural 
                emergency hospital.--No payment shall be made under 
                this subsection to a facility, or to a provider of 
                ambulance services providing transportation services 
                from such facility, unless the State in which the 
                facility is located has approved the facility's 
                designation as a rural emergency hospital.
                    ``(B) Certification of rural emergency hospital.--
                            ``(i) In general.--No payment shall be made 
                        under this subsection to a facility, or to a 
                        provider of ambulance services providing 
                        transportation services from such facility, 
                        unless the facility has been certified by the 
                        Secretary as a rural emergency hospital.
                            ``(ii) Certification requirements.--The 
                        Secretary shall certify a facility as a rural 
                        emergency hospital if the facility--
                                    ``(I) meets the criteria for rural 
                                emergency hospitals described in 
                                subparagraphs (A) through (E) of 
                                section 1861(iii)(1);
                                    ``(II) either--
                                            ``(aa) is verified by the 
                                        American College of Surgeons as 
                                        having the resources required 
                                        of a level IV trauma center or 
                                        higher; or
                                            ``(bb) employs healthcare 
                                        professionals that successfully 
                                        completed the Advanced Trauma 
                                        Life Support Course offered by 
                                        the American College of 
                                        Surgeons within the preceding 4 
                                        years;
                                    ``(III) has in effect a transfer 
                                agreement with a level I or level II 
                                trauma center; and
                                    ``(IV) meets such staff training 
                                and certification requirements as the 
                                Secretary may require.
            ``(4) Coinsurance.--
                    ``(A) In general.--The amount of payment for rural 
                emergency hospital services or transportation services 
                made to a rural emergency hospital or other provider of 
                ambulance services under this subsection shall be 
                reduced by the coinsurance amount described in 
                subparagraph (B).
                    ``(B) Coinsurance amount.--The coinsurance amount 
                described in this subparagraph, with respect to an item 
                or service provided by a rural emergency hospital or 
                provider of ambulance services, shall be calculated in 
                the same manner as the coinsurance amount for an 
                outpatient critical access hospital service is 
                calculated under section 1866(a)(2).''.
    (b) Waiver of Distance Requirement for Replacement CAHs; Subsequent 
Redesignation of Rural Emergency Hospitals as CAHs.--Section 1820(c)(2) 
of the Social Security Act (42 U.S.C. 1395i-4(c)(2)) is amended--
            (1) in subparagraph (B)(i)(I), by inserting ``subject to 
        subparagraph (F),'' before ``is located''; and
            (2) by adding at the end the following new subparagraphs:
                    ``(F) Option to waive distance requirement.--
                Beginning on the date of the enactment of this 
                subparagraph, for every critical access hospital 
                located in a State that is certified as a rural 
                emergency hospital under section 1834(r)(3)(B), the 
                State shall have the option of waiving the distance 
                requirement described in subparagraph (B)(i)(I) with 
                respect to another facility located in the State that 
                is seeking designation as a critical access hospital 
                under this paragraph.
                    ``(G) Redesignation of a rural emergency hospital 
                as a critical access hospital.--A rural emergency 
                hospital that was previously designated as a critical 
                access hospital under this paragraph may elect to be 
                redesignated as a critical access hospital (in the same 
                manner that the hospital was originally designated as a 
                critical access hospital) at any time, subject to such 
                conditions as the Secretary may establish.''.
    (c) Studies and Reports.--
            (1) Studies.--The Secretary of Health & Human Services 
        shall conduct 3 studies to evaluate the impact of rural 
        emergency hospitals on the availability of health care and 
        health outcomes in rural areas (as defined in section 
        1886(d)(2)(D) of the Social Security Act (42 U.S.C. 1395ww)). 
        The Secretary shall conduct a study--
                    (A) 2 years after the date of the enactment of this 
                Act;
                    (B) 5 years after the date of the enactment of this 
                Act; and
                    (C) 10 years after the date of the enactment of 
                this Act.
            (2) Reports.--Not later than 6 months after each date that 
        the Secretary of Health & Human Services is required to conduct 
        a study under paragraph (1), the Secretary shall submit a 
        report to Congress containing the results of each such study.
    (d) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after the date that is 1 
year after the date of the enactment of this Act.

SEC. 4. INCLUSION OF EMERGENCY MEDICINE AS HEALTH SERVICES UNDER THE 
              NATIONAL HEALTH SERVICE CORPS.

    Section 331(a)(3)(D) of the Public Health Service Act (42 U.S.C. 
254d(a)(3)(D)) is amended by inserting ``, and includes emergency 
medicine provided by physicians in a rural emergency hospital (as 
defined in section 1861(iii) of the Social Security Act)'' before the 
period.

SEC. 5. PERMITTING HOSPITALS WITH APPROVED RESIDENCY PROGRAMS IN 
              EMERGENCY MEDICINE TO INCLUDE TIME SPENT BY INTERNS AND 
              RESIDENTS IN THE EMERGENCY DEPARTMENT OF A RURAL HOSPITAL 
              IN FULL-TIME EQUIVALENT COUNT.

    (a) Indirect Medical Education.--Section 1886(d)(5)(B)(iv) of the 
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(iv)) is amended by 
adding at the end the following new subclause:
            ``(III) Effective for discharges occurring on or after 
        October 1, 2015, all of the time spent in patient care 
        activities in the emergency department of a rural hospital by 
        interns and residents in emergency medicine from a hospital 
        with an approved medical residency training program (as defined 
        in subsection (h)(5)(A)) in such specialty shall be included in 
        determining the number of full-time equivalent interns and 
        residents in such program if the hospital with such program 
        incurs the costs of the stipends and fringe benefits of the 
        interns or residents during the time the interns or residents 
        spend in that rural hospital in accordance with subclause (II). 
        In this subclause, the term `rural hospital' means a hospital 
        that is located in a rural area (as defined for purposes of 
        paragraph (2)(D)).''.
    (b) Direct Medical Education.--Section 1886(h)(4)(E) of the Social 
Security Act (42 U.S.C. 1395(h)(4)) is amended--
            (1) in clause (ii), by striking the period at the end and 
        inserting ``; and'';
            (2) by inserting after clause (ii) the following new 
        clause:
                            ``(iii) effective for cost reporting 
                        periods beginning on or after July 1, 2015, all 
                        of the time so spent in the emergency 
                        department of a rural hospital by residents in 
                        emergency medicine from a hospital with an 
                        approved medical residency training program in 
                        such specialty shall be counted towards the 
                        determination of full-time equivalency in such 
                        program if the hospital with such program bears 
                        all, or substantially all, of the costs of 
                        training such residents in the rural hospital. 
                        In this subparagraph, the term `rural hospital' 
                        means a hospital that is located in a rural 
                        area (as defined for purposes of subsection 
                        (d)(2)(D)).''; and
            (3) by adding at the end the following new sentence: ``For 
        purposes of this subparagraph, the emergency department of a 
        rural hospital described in clause (iii) is a nonprovider 
        setting.''.
Rural Emergency Acute Care Hospital Act  This bill amends title XVIII (Medicare) of the Social Security Act to designate as a rural emergency hospital any facility that as of December 31, 2014, was:   a critical access hospital (CAH) or a hospital with at most 50 beds located in a county in a rural area or treated as located in a rural area, or one of such hospitals that ceased operations during the period beginning five years before enactment of this Act and ending on December 30, 2014.  A rural emergency hospital:  must provide 24-hour emergency medical care and observation care not exceeding an annual per patient average of 24 hours or more than 1 midnight, does not provide any acute care inpatient beds and has protocols in place for the timely transfer of patients who require acute care inpatient services or other inpatient services, has elected to be designated as a rural emergency hospital, has received approval to operate as one from the state, and is certified by the Department of Health and Human Services (HHS).  Medicare part B (Supplementary Medical Insurance Benefits) shall cover rural emergency hospital emergency services as well as ambulance services provided by a rural emergency hospital or other provider to transport patients who require acute care inpatient services or other inpatient services from the rural emergency hospital to a hospital or a CAH. Payment for rural emergency hospital outpatient services of a rural emergency hospital, including telehealth and ambulance services, shall be 110% percent of their reasonable costs. Rural emergency hospitals must be approved by the state and certified by HHS. States shall have the option of waiving a specified distance requirement between a CAH certified as a rural emergency hospital and another facility located in the state that is seeking designation as a CAH. Primary health services which the National Health Service Corps may provide under the Public Health Service Act shall include emergency medicine provided by physicians in a rural emergency hospital. Hospitals with approved residency programs in emergency medicine shall include time spent by interns and residents in the emergency department of a rural hospital in the full-time equivalent count with respect to reimbursement for the indirect (stipend, fringe benefit) and direct (all or substantially all training) costs of medical education in subsection (d) hospitals. (Generally, a subsection [d] hospital is an acute care hospital, particularly one that receives payments under Medicare's inpatient prospective payment system [IPPS] when providing covered inpatient services to eligible beneficiaries.)

SECTION 1. DENIAL OF CASH BENEFITS TO DRUG ADDICTS AND ALCOHOLICS.

    (a) Amendments Relating to Title II Disability Benefits.--
            (1) In general.--Section 225(c) of the Social Security Act 
        (42 U.S.C. 425(c)) is amended--
                    (A) by striking ``(c)(1)(A)'' and inserting 
                ``(2)(A)'';
                    (B) by striking paragraph (7) and by redesignating 
                paragraphs (2) through (6) as paragraphs (3) through 
                (7), respectively; and
                    (C) by inserting before paragraph (2) as 
                redesignated by subparagraph (A) the following new 
                paragraph:
    ``(c)(1) No cash benefits shall be payable under this title to any 
individual who is otherwise entitled to benefits under this title based 
on disability, if such individual's alcoholism or drug addiction is a 
contributing factor material to the Commissioner's determination that 
such individual is disabled.''.
            (2) Treatment Requirements.--
                    (A) Section 225(c)(2)(A) of such Act (42 U.S.C. 
                425(c)(2)(A)), as redesignated by paragraph (1), is 
                amended to read as follows:
    ``(2)(A)(i) Any individual who would be entitled to cash benefits 
under this title but for the application of paragraph (1) may elect to 
comply with the provisions of this subsection.
            ``(ii) Any individual who is entitled to cash benefits 
        under this title by reason of disability (or whose entitlement 
        to such benefits is suspended), and who was entitled to such 
        benefits by reason of disability, for which such individual's 
        alcoholism or drug addiction was a contributing factor material 
        to the Commissioner's determination that such individual was 
        disabled, for the month preceding the month in which this 
        paragraph takes effect, shall be required to comply with the 
        provisions of this subsection.
                    (B) Section 225(c)(2)(B) of such Act (42 U.S.C. 
                425(c)(2)(B)), as so redesignated, is amended--
                            (i) by striking ``who is required under 
                        subparagraph (A)'' and inserting ``described in 
                        clause (ii) of subparagraph (A) who is 
                        required''; and
                            (ii) by striking ``paragraph (3)'' and 
                        inserting ``paragraph (4)''.
                    (C) Section 225(c)(3)(A) of such Act (42 U.S.C. 
                425(c)(3)(A)), as so redesignated, is amended--
                            (i) by striking ``paragraph (1)'' and 
                        inserting ``paragraph (2)(A)''; and
                            (ii) by striking ``paragraph (5)'' and 
                        inserting ``paragraph (6)''.
                    (D) Section 225(c)(3)(B) of such Act (42 U.S.C. 
                425(c)(3)(B)), as so redesignated, is amended by 
                striking ``paragraph (1)'' and inserting ``paragraph 
                (2)(A)''.
                    (E) Section 225(c)(5) of such Act (42 U.S.C. 
                425(c)(5)), as so redesignated, is amended by striking 
                ``paragraph (2)'' and inserting ``paragraph (3)''.
                    (F) Section 225(c)(6)(A) of such Act (42 U.S.C. 
                425(c)(6)(A), as so redesignated, is amended--
                            (i) by striking ``who are receiving 
                        benefits under this title and who as a 
                        condition of payment of such benefits'' and 
                        inserting ``described in paragraph (2)(A)(i) 
                        who elect to undergo treatment; and the 
                        monitoring and testing of all individuals 
                        described in paragraph (2)(A)(ii) who'';
                            (ii) by striking ``under paragraph (1)''; 
                        and
                            (iii) by striking ``paragraph (2)(A)'' and 
                        inserting ``paragraph (3)(A)''.
                    (G) Section 225(c)(6)(C)(ii)(I) of such Act (42 
                U.S.C. 425(c)(6)(C)(ii)(I)), as so redesignated, is 
                amended--
                            (i) by striking ``residing in the State'' 
                        and all that follows through ``they are 
                        disabled'' and inserting ``described in 
                        paragraph (2)(A) residing in the State''; and
                            (ii) by striking ``paragraph (2)(A)'' and 
                        inserting ``paragraph (3)(A)''.
                    (H) Section 225(c)(6)(C)(ii)(III) of such Act (42 
                U.S.C. 425(c)(6)(C)(ii)(III)), as so redesignated, is 
                amended by striking ``paragraph (2)(A)'' and inserting 
                ``paragraph (3)(A)''.
                    (I) Section 225(c)(6)(C) of such Act (42 U.S.C. 
                425(c)(6)(C)), as so redesignated, is amended by adding 
                at the end the following:
    ``(iii) The monitoring requirements of clause (ii) shall not apply 
in the case of any individual described in paragraph (2)(A)(i) who 
fails to comply with the requirements of paragraph (2).''.
                    (J) Section 225(c)(7) of such Act (42 U.S.C. 
                425(c)(7)), as so redesignated, is amended--
                            (i) in subparagraph (A), by striking ``who 
                        is entitled'' and all that follows through ``is 
                        under a disability'' and inserting ``described 
                        in paragraph (2)(A)''; and
                            (ii) in subparagraph (D), by striking ``(4) 
                        or (7)'' and inserting ``(5)''.
                    (K) Section 225(c)(8) of such Act (42 U.S.C. 
                425(c)(8)) is amended by striking ``(1), (4) or (7)'' 
                and inserting ``(2) or (5)''.
                    (L) Section 225(c) of such Act (42 U.S.C. 425(c)) 
                is amended by adding at the end the following new 
                paragraphs:
    ``(10) The Commissioner shall provide appropriate notification to 
each individual subject to the limitation on cash benefits contained in 
paragraph (1) and the treatment provisions contained in paragraph (2).
    ``(11) The requirements of paragraph (2) shall cease to apply to 
any individual if the Commissioner determines that such individual no 
longer needs treatment.''.
            (3) Representative payee requirements.--
                    (A) Section 205(j)(1)(B) of such Act (42 U.S.C. 
                405(j)(1)(B)) is amended to read as follows:
    ``(B) In the case of an individual entitled to benefits based on 
disability, the payment of such benefits shall be made to a 
representative payee if the Commissioner of Social Security determines 
that such payment would serve the interest of the individual because 
the individual also has an alcoholism or drug addiction condition (as 
determined by the Commissioner) and the individual is incapable of 
managing such benefits.''.
                    (B) Section 205(j)(2)(C)(v) of such Act (42 U.S.C. 
                405(j)(2)(C)(v)) is amended by striking ``entitled to 
                benefits'' and all that follows through ``under a 
                disability'' and inserting ``described in paragraph 
                (1)(B)''.
                    (C) Section 205(j)(2)(D)(ii)(II) of such Act (42 
                U.S.C. 405(j)(2)(D)(ii)(II)) is amended by striking all 
                that follows ``15 years, or'' and inserting ``described 
                in paragraph (1)(B).''.
                    (D) Section 205(j)(4)(A)(i)(II) of such Act (42 
                U.S.C. 405(j)(4)(A)(ii)(II)) is amended by striking 
                ``entitled to benefits'' and all that follows through 
                ``under a disability'' and inserting ``described in 
                paragraph (1)(B)''.
    (b) Amendments Relating to SSI Benefits.--
            (1) In general.--Section 1611(e)(3) of the Social Security 
        Act (42 U.S.C. 1382(e)(3)) is amended--
                    (A) by striking ``(B)'' and inserting ``(C)'';
                    (B) by striking ``(3)(A)'' and inserting ``(B)''; 
                and
                    (C) by inserting before subparagraph (B) as 
                redesignated by paragraph (2) the following new 
                subparagraph:
    ``(3)(A) No cash benefits shall be payable under this title to any 
individual who is otherwise eligible for benefits under this title by 
reason of disability, if such individual's alcoholism or drug addiction 
is a contributing factor material to the Commissioner's determination 
that such individual is disabled.''.
            (2) Treatment requirements.--
                    (A) Section 1611(e)(3)(B)(i)(I) of such Act (42 
                U.S.C. 1382(e)(3)(B)(i)(I)), as redesignated by 
                paragraph (1), is amended to read as follows:
    ``(B)(i)(I)(aa) Any individual who would be eligible for cash 
benefits under this title but for the application of subparagraph (A) 
may elect to comply with the provisions of this subparagraph.
            ``(bb) Any individual who is eligible for cash benefits 
        under this title by reason of disability (or whose eligibility 
        for such benefits is suspended) or is eligible for benefits 
        pursuant to section 1619(b), and who was eligible for such 
        benefits by reason of disability, for which such individual's 
        alcoholism or drug addiction was a contributing factor material 
        to the Commissioner's determination that such individual was 
        disabled, for the month preceding the month in which this 
        subparagraph takes effect, shall be required to comply with the 
        provisions of this subparagraph.''.
                    (B) Section 1611(e)(3)(B)(i)(II) of such Act (42 
                U.S.C. 1382(e)(3)(B)(i)(II)), as so redesignated, is 
                amended by striking ``who is required under subclause 
                (I)'' and inserting ``described in division (bb) of 
                subclause (I) who is required''.
                    (C) Subclauses (I) and (II) of section 
                1611(e)(3)(B)(ii) of such Act (42 U.S.C. 
                1382(e)(3)(B)(ii)), as so redesignated, are each 
                amended by striking ``clause (i)'' and inserting 
                ``clause (i)(I)''.
                    (D) Section 1611(e)(3)(B) of such Act (42 U.S.C. 
                1382(e)(3)(B)), as so redesignated, is amended by 
                striking clause (v) and by redesignating clause (vi) as 
                clause (v).
                    (E) Section 1611(e)(3)(B)(v) of such Act (42 U.S.C. 
                1382(e)(3)(B)(v)), as redesignated by subparagraph (D), 
                is amended--
                            (i) in subclause (I), by striking ``who is 
                        eligible'' and all that follows through ``is 
                        disabled'' and inserting ``described in clause 
                        (i)(I)''; and
                            (ii) in subclause (V), by striking ``or 
                        (v)''.
                    (F) Section 1611(e)(3)(C)(i) of such Act (42 U.S.C. 
                1382(e)(3)(C)(i)), as redesignated by paragraph (1), is 
                amended by striking ``who are receiving benefits under 
                this title and who as a condition of such benefits'' 
                and inserting ``described in subparagraph (B)(i)(I)(aa) 
                who elect to undergo treatment; and the monitoring and 
                testing of all individuals described in subparagraph 
                (B)(i)(I)(bb) who''.
                    (G) Section 1611(e)(3)(C)(iii)(II)(aa) of such Act 
                (42 U.S.C. 1382(e)(3)(C)(iii)(II)(aa)), as so 
                redesignated, is amended by striking ``residing in the 
                State'' and all that follows through ``they are 
                disabled'' and inserting ``described in subparagraph 
                (B)(i)(I) residing in the State''.
                    (H) Section 1611(e)(3)(C)(iii) of such Act (42 
                U.S.C. 1382(e)(3)(C)(iii)), as so redesignated, is 
                amended by adding at the end the following:
    ``(III) The monitoring requirements of subclause (II) shall not 
apply in the case of any individual described in subparagraph 
(B)(i)(I)(aa) who fails to comply with the requirements of subparagraph 
(B).''.
                    (I) Section 1611(e)(3) of such Act (42 U.S.C. 
                1382(e)(3)), as amended by paragraph (1), is amended by 
                adding at the end the following new subparagraphs:
    ``(D) The Commissioner shall provide appropriate notification to 
each individual subject to the limitation on cash benefits contained in 
subparagraph (A) and the treatment provisions contained in subparagraph 
(B).
    ``(E) The requirements of subparagraph (B) shall cease to apply to 
any individual if the Commissioner determines that such individual no 
longer needs treatment.''.
            (3) Representative payee requirements.--
                    (A) Section 1631(a)(2)(A)(ii)(II) of such Act (42 
                U.S.C. 1383(a)(2)(A)(ii)(II)) is amended to read as 
                follows:
    ``(II) In the case of an individual eligible for benefits under 
this title by reason of disability, the payment of such benefits shall 
be made to a representative payee if the Commissioner of Social 
Security determines that such payment would serve the interest of the 
individual because the individual also has an alcoholism or drug 
addiction condition (as determined by the Commissioner) and the 
individual is incapable of managing such benefits.''.
                    (B) Section 1631(a)(2)(B)(vii) of such Act (42 
                U.S.C. 1383(a)(2)(B)(vii)) is amended by striking 
                ``eligible for benefits'' and all that follows through 
                ``is disabled'' and inserting ``described in 
                subparagraph (A)(ii)(II)''.
                    (C) Section 1631(a)(2)(B)(ix)(II) of such Act (42 
                U.S.C. 1383(a)(2)(B)(ix)(II)) is amended by striking 
                all that follows ``15 years, or'' and inserting 
                ``described in subparagraph (A)(ii)(II).''.
                    (D) Section 1631(a)(2)(D)(i)(II) of such Act (42 
                U.S.C. 1383(a)(2)(D)(i)(II)) is amended by striking 
                ``eligible for benefits'' and all that follows through 
                ``is disabled'' and inserting ``described in 
                subparagraph (A)(ii)(II)''.
            (4) Preservation of medicaid eligibility.--Section 1634(e) 
        of such Act (42 U.S.C. 1382(e)) is amended--
                    (A) by striking ``clause (i) or (v) of section 
                1611(e)(3)(A)'' and inserting ``subparagraph (A) or 
                subparagraph (B)(i)(II) of section 1611(e)(3)''; and
                    (B) by adding at the end the following: ``This 
                subsection shall cease to apply to any such person if 
                the Commissioner determines that such person no longer 
                needs treatment.''.
            (5) Conforming amendment.--Section 201(c) of the Social 
        Security Independence and Program Improvements Act of 1994 (42 
        U.S.C. 425 note) is repealed.
    (c) Effective Dates.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall apply to applicants for 
        benefits under title II or title XVI of the Social Security Act 
        for months beginning on or after the date of the enactment of 
        this Act, without regard to whether regulations have been 
        issued to implement such amendments.
            (2) Application to current recipients.--Notwithstanding any 
        other provision of law, in the case of an individual who is 
        receiving benefits under title II of the Social Security Act or 
        supplemental security income benefits under title XVI of such 
        Act as of the date of the enactment of this Act and whose 
        entitlement or eligibility for such benefits would terminate by 
        reason of the amendments made by this section, such amendments 
        shall apply with respect to the benefits of such individual for 
        months beginning on or after January 1, 1997, and the 
        Commissioner of Social Security shall so notify the individual 
        not later than 90 days after the date of the enactment of this 
        Act.
            (3) Benefits under title xvi.--For purposes of this 
        subsection, the term ``benefits under title XVI of the Social 
        Security Act'' includes supplementary payments pursuant to an 
        agreement for Federal administration under section 1616(a) of 
        the Social Security Act, and payments pursuant to an agreement 
        entered into under section 212(b) of Public Law 93-66.
Denies monthly cash disability benefits under titles II (Old Age, Survivors and Disability Insurance) (OASDI) and XVI (Supplemental Security Income) (SSI), respectively, of the Social Security Act for drug addicts and alcoholics whose substance abuse is a contributing factor material to their disability.  Allows such individuals, instead, to elect to undergo treatment for their substance abuse. (Currently, such recipients are required to undergo treatment only at approved facilities or institutions.) 
Revises OASDI and SSI program representative payee requirements to require the payment of program benefits through a representative payee if it is in the interest of an otherwise disabled individual with an alcohol or drug addiction condition who is incapable of managing such benefits. 
Preserves the Medicaid eligibility of SSI recipients denied cash disability benefits because of the connection between their drug addiction or alcoholism and their disability.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Tuberculosis Prevention and Control 
Amendments of 1993''.

SEC. 2. PROGRAMS OF CENTERS FOR DISEASE CONTROL.

    (a) Provision of Services for Prevention, Control, and 
Elimination.--
            (1) In general.--Section 317(j)(2) of the Public Health 
        Service Act (42 U.S.C. 247b(j)(2)) is amended in the first 
        sentence--
                    (A) by striking ``and'' after ``1991,'';
                    (B) by striking ``through 1995'' and inserting 
                ``and 1992''; and
                    (C) by inserting before the period the following: 
                ``, $300,000,000 for fiscal year 1994, and such sums as 
                may be necessary for each of the fiscal years 1995 
                through 1998''.
            (2) Emergency grants.--
                    (A) Subject to subparagraph (B), in addition to the 
                authorization of appropriations established in section 
                317(j)(2) of the Public Health Service Act for grants 
                for the prevention, control, and elimination of 
                tuberculosis, there are authorized to be appropriated 
                for such grants $85,000,000 for fiscal year 1994, and 
                such sums as may be necessary for each of the fiscal 
                years 1995 through 1998.
                    (B) Grants made pursuant to subparagraph (A) shall 
                be made by the Secretary of Health and Human Services, 
                acting through the Director of the Centers for Disease 
                Control and Prevention. The Secretary may make such a 
                grant only if the geographic area in which activities 
                under the grant are to be carried out has, relative to 
                other areas, a substantial incidence of cases of 
                tuberculosis or a substantial rate of increase in such 
                cases.
            (3) Bulk purchases.--
                    (A) Subject to subparagraph (B), in addition to the 
                authorization of appropriations established in section 
                317(j)(2) of the Public Health Service Act for grants 
                for the prevention, control, and elimination of 
                tuberculosis, there are authorized to be appropriated 
                for such grants $80,000,000 for fiscal year 1994, and 
                such sums as may be necessary for each of the fiscal 
                years 1995 through 1998.
                    (B) Amounts appropriated under subparagraph (A) 
                shall be administered by the Secretary of Health and 
                Human Services, acting through the Director of the 
                Centers for Disease Control and Prevention. For 
                purposes of the program of grants referred to in such 
                subparagraph, such amounts are available for making 
                bulk purchases of medications and other supplies with 
                respect to tuberculosis.
            (4) Other purposes.--Section 317(j)(2) of the Public Health 
        Service Act (42 U.S.C. 247b(j)(2)) is amended by inserting 
        after the first sentence the following sentence: ``The purposes 
        for which such grants under subsection (a) for such programs 
        may be expended include services with respect to 
        incarceration.''.
    (b) Research, Demonstration Projects, Education, and Training.--
Section 317(k)(2) of the Public Health Service Act (42 U.S.C. 
247b(k)(2)) is amended--
            (1) by redesignating subparagraphs (A) through (D) as 
        clauses (i) through (iv), respectively;
            (2) by inserting ``(A)'' after the paragraph designation; 
        and
            (3) by adding at the end the following subparagraph:
    ``(B) For the purpose of carrying out subparagraph (A), there are 
authorized to be appropriated $80,000,000 for fiscal year 1994, and 
such sums as may be necessary for each of the fiscal years 1995 through 
1998. The authorization of appropriations established in the preceding 
sentence is in addition to the authorization of appropriations 
established in subsection (j)(2) for carrying out this paragraph.''.
    (c) Training Centers Regarding Health Professionals.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary''), acting 
        through the Director of the Centers for Disease Control and 
        Prevention, may make grants to public and nonprofit private 
        entities for the establishment and operation of not more than 5 
        centers to train health professionals with respect to the 
        prevention and control of tuberculosis, including training in 
        identifying multi-drug resistant forms of such disease.
            (2) Screenings; other health services.--The purposes for 
        which the Secretary may authorize an entity to expend a grant 
        under paragraph (1) include screening individuals for 
        tuberculosis, providing treatment for such disease, and 
        referring individuals for services.
            (3) Facilities and equipment.--The purposes for which the 
        Secretary may authorize an entity to expend a grant under 
        paragraph (1) include providing for facilities and equipment 
        for the center under such paragraph.
            (4) Quality of laboratories.--The Secretary may make a 
        grant under paragraph (1) only if the entity involved provides 
        assurances satisfactory to the Secretary that the laboratories 
        of the center under such paragraph will have the facilities and 
        equipment to provide sophisticated training to health 
        professionals with respect to tuberculosis.
            (5) Application for grant.--The Secretary may make a grant 
        under paragraph (1) only if an application for the grant is 
        submitted to the Secretary and the application is in such form, 
        is made in such manner, and contains such agreements, 
        assurances, and information as the Secretary determines to be 
        necessary to carry out this subsection.
            (6) Amount and duration of grant.--
                    (A) The Secretary may not make a grant under 
                paragraph (1) for a fiscal year in an amount exceeding 
                $5,000,000.
                    (B) The period during which payments are made to an 
                entity from a grant under paragraph (1) may not exceed 
                3 years. The provision of such payments shall be 
                subject to annual approval by the Secretary of the 
                payments and subject to the availability of 
                appropriations for the fiscal year involved to make the 
                payments.
            (7) Evaluations; dissemination of information.--The 
        Secretary shall, directly or through contracts with public or 
        private entities, provide for evaluations of centers operated 
        pursuant to paragraph (1) and for the dissemination of 
        information developed as a result of the centers.
            (8) Authorization of appropriations.--For the purpose of 
        carrying out this subsection, there is authorized to be 
        appropriated $25,000,000 for fiscal year 1994, and such sums as 
        may be necessary for each of the fiscal years 1995 through 
        1998.

SEC. 3. RESEARCH THROUGH NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS 
              DISEASES.

    (a) Certain Duties.--
            (1) In general.--Subpart 6 of part C of title IV of the 
        Public Health Service Act (42 U.S.C. 285f) is amended by 
        inserting after section 446 the following section:

        ``research and research training regarding tuberculosis

    ``Sec. 447. In carrying out section 446, the Director of the 
Institute shall conduct or support research and research training 
regarding the cause, diagnosis, early detection, prevention, control, 
and treatment of tuberculosis.''.
            (2) Conforming amendment.--Section 446 of the Public Health 
        Service Act (42 U.S.C. 285f) is amended by inserting after 
        ``Diseases'' the following: ``(hereafter in this subpart 
        referred to as the `Institute')''.
    (b) Authorization of Appropriations.--Section 408(a) of the Public 
Health Service Act (42 U.S.C. 284c(a)) is amended by adding at the end 
the following new paragraph:
            ``(3) For the purpose of carrying out section 447 (relating 
        to research on tuberculosis through the National Institute on 
        Allergy and Infectious Diseases), there are authorized to be 
        appropriated $50,000,000 for fiscal year 1994, and such sums as 
        may be necessary for each of the fiscal years 1995 through 
        1998. The authorization of appropriations established in the 
        preceding sentence may not be construed as terminating the 
        availability for such purpose of any other authorization of 
        appropriations.''.

SEC. 4. CONSTRUCTION OR MODERNIZATION OF HEALTH FACILITIES.

    Section 1610 of the Public Health Service Act (42 U.S.C. 300r) is 
amended by adding at the end the following subsection:
    ``(c)(1) With respect to services for the prevention, control, and 
elimination of tuberculosis, the Secretary may make grants to public 
and nonprofit private entities for projects for (A) construction or 
modernization of outpatient medical facilities which are located apart 
from hospitals and which will provide such services for medically 
underserved populations, (B) conversion of existing facilities into 
outpatient medical facilities or facilities for long-term care to 
provide such services for such populations, (C) renovation of inpatient 
facilities, (D) construction or renovation of facilities to provide 
such services with respect to incarceration.
    ``(2) The amount of any grant under paragraph (1) may not exceed 80 
percent of the cost of the project for which the grant is made unless 
the project is located in an area determined by the Secretary to be an 
urban or rural poverty area, in which case the grant may cover up to 
100 percent of such costs.
    ``(3) There are authorized to be appropriated for grants under 
paragraph (1) $100,000,000 for fiscal year 1993, $250,000,000 for 
fiscal year 1994, and such sums as may be necessary for each of the 
fiscal years 1995 through 1998.''.

SEC. 5. OPTIONAL MEDICAID COVERAGE OF TB-RELATED SERVICES FOR CERTAIN 
              TB-INFECTED INDIVIDUALS.

    (a) Coverage as Optional, Categorically Needy Group.--Section 
1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(A)(ii)) is amended--
            (1) by striking ``or'' at the end of subclause (X),
            (2) by adding ``or'' at the end of subclause (XI), and
            (3) by adding at the end the following new subclause:
                                    ``(XII) who are described in 
                                subsection (z)(1) (relating to certain 
                                TB-infected individuals);''.
    (b) Group and Benefit Described.--Section 1902 of such Act is 
amended by adding at the end the following new subsection:
    ``(z)(1) Individuals described in this paragraph are individuals 
not described in subsection (a)(10)(A)(i)--
            ``(A) who have tested positively to be infected with 
        tuberculosis;
            ``(B) whose income (as determined under the State plan 
        under this title with respect to disabled individuals) does not 
        exceed the maximum amount of income a disabled individual 
        described in subsection (a)(10)(A)(i) may have and obtain 
        medical assistance under the plan; and
            ``(C) whose resources (as determined under the State plan 
        under this title with respect to disabled individuals) do not 
        exceed the maximum amount of resources a disabled individual 
        described in subsection (a)(10)(A)(i) may have and obtain 
        medical assistance under the plan.
    ``(2) For purposes of subsection (a)(10), the term `TB-related 
services' means each of the following services--
            ``(A) prescribed drugs,
            ``(B) physicians' services and services described in 
        section 1905(a)(2),
            ``(C) laboratory and X-ray services,
            ``(D) clinic services and Federally-qualified health center 
        services, and
            ``(E) case management services (as defined in section 
        1915(g)(2)),
relating to treatment of infection with tuberculosis.''.
    (c) Limitation on Benefits.--Section 1902(a)(10) of such Act is 
amended, in the matter following subparagraph (F)--
            (1) by striking ``; and (XI)'' and inserting ``, (XI)'',
            (2) by striking ``, and (XI)'' and inserting ``, (XII)'', 
        and
            (3) by inserting before the semicolon at the end the 
        following: ``, and (XIII) the medical assistance made available 
        to an individual described in subsection (z)(1) who is eligible 
        for medical assistance only because of subparagraph 
        (A)(ii)(XII) shall be limited to medical assistance for TB-
        related services (described in subsection (z)(2))''.
    (d) Conforming Expansion of Case Management Services Option.--
Section 1915(g)(1) of such Act (42 U.S.C. 1396n(g)(1)) is amended by 
inserting ``or to individuals described in section 1902(z)(1)(A)'' 
after ``or with either,''.
    (e) Conforming Amendment.--Section 1905(a) of such Act (42 U.S.C. 
1396d(a)) is amended--
            (1) by striking ``or'' at the end of clause (ix),
            (2) by adding ``or'' at the end of clause (x), and
            (3) by inserting after clause (x) the following new clause:
            ``(xi) individuals described in section 1902(z)(1),''.
    (f) Effective Date.--The amendments made by this section shall 
apply to medical assistance furnished on or after January 1, 1994, 
without regard to whether or not final regulations to carry out such 
amendments have been promulgated by such date.

Tuberculosis Prevention and Control Amendments of 1993 - Amends the Public Health Service Act to authorize appropriations for grants for the prevention, control, and elimination of tuberculosis. 
Requires the Director of the National Institute of Allergy and Infectious Diseases to conduct or support research and research training regarding tuberculosis.  Authorizes appropriations. 
Amends title XIX (Medicaid) of the Social Security Act to mandate provision to eligible persons with tuberculosis of certain drugs and services under Medicaid.