Health Care Safety Net Act of 2008
PL 110-355 (H.R.1343), enacted 10/08/2008

122 STAT. 3988 
PUBLIC LAW 110–355—OCT. 8, 2008 
Public Law 110–355 
110th Congress 
An Act 
To amend the Public Health Service Act to provide additional authorizations of 
appropriations for the health centers program under section 330 of such Act, 
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 ‘‘Health Care Safety Net Act 
of 2008’’. 
SEC. 2. COMMUNITY HEALTH CENTERS PROGRAM OF THE PUBLIC 
HEALTH SERVICE ACT. 
(a) ADDITIONAL AUTHORIZATIONS OF APPROPRIATIONS FOR THE 
HEALTH CENTERS PROGRAM OF PUBLIC HEALTH SERVICE ACT.— 
Section 330(r) of the Public Health Service Act (42 U.S.C. 254b(r)) 
is amended by amending paragraph (1) to read as follows: 
‘‘(1) IN GENERAL.—For the purpose of carrying out this 
section, in addition to the amounts authorized to be appro-
priated under subsection (d), there are authorized to be appro-
priated— 
‘‘(A) $2,065,000,000 for fiscal year 2008; 
‘‘(B) $2,313,000,000 for fiscal year 2009; 
‘‘(C) $2,602,000,000 for fiscal year 2010; 
‘‘(D) $2,940,000,000 for fiscal year 2011; and 
‘‘(E) $3,337,000,000 for fiscal year 2012.’’. 
(b) STUDIES RELATING TO COMMUNITY HEALTH CENTERS.— 
(1) DEFINITIONS.—For purposes of this subsection— 
(A) the term ‘‘community health center’’ means a health 
center receiving assistance under section 330 of the Public 
Health Service Act (42 U.S.C. 254b); and 
(B) the term ‘‘medically underserved population’’ has 
the meaning given that term in such section 330. 
(2) SCHOOL-BASED HEALTH CENTER STUDY.— 
(A) IN
GENERAL.—Not later than 2 years after the 
date of enactment of this Act, the Comptroller General 
of the United States shall issue a study of the economic 
costs and benefits of school-based health centers and the 
impact on the health of students of these centers. 
(B) CONTENT.—In conducting the study under subpara-
graph (A), the Comptroller General of the United States 
shall analyze— 
(i) the impact that Federal funding could have 
on the operation of school-based health centers; 
Deadline. 
42 USC 254b 
note. 
42 USC 201 note. 
Health Care 
Safety Net 
Act of 2008. 
Oct. 8, 2008 
[H.R. 1343] 
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122 STAT. 3989 
PUBLIC LAW 110–355—OCT. 8, 2008 
(ii) any cost savings to other Federal programs 
derived from providing health services in school-based 
health centers; 
(iii) the effect on the Federal Budget and the health 
of students of providing Federal funds to school-based 
health centers and clinics, including the result of pro-
viding disease prevention and nutrition information; 
(iv) the impact of access to health care from school- 
based health centers in rural or underserved areas; 
and 
(v) other sources of Federal funding for school- 
based health centers. 
(3) HEALTH CARE QUALITY STUDY.— 
(A) IN GENERAL.—Not later than 1 year after the date 
of enactment of this Act, the Secretary of Health and 
Human Services (referred to in this Act as the ‘‘Secretary’’), 
acting through the Administrator of the Health Resources 
and Services Administration, and in collaboration with the 
Agency for Healthcare Research and Quality, 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 
that describes agency efforts to expand and accelerate 
quality improvement activities in community health cen-
ters. 
(B) CONTENT.—The report under subparagraph (A) 
shall focus on— 
(i) Federal efforts, as of the date of enactment 
of this Act, regarding health care quality in community 
health centers, including quality data collection, anal-
ysis, and reporting requirements; 
(ii) identification of effective models for quality 
improvement in community health centers, which may 
include models that— 
(I) incorporate care coordination, disease 
management, and other services demonstrated to 
improve care; 
(II) are designed to address multiple, co-occur-
ring diseases and conditions; 
(III) improve access to providers through non- 
traditional means, such as the use of remote moni-
toring equipment; 
(IV) target various medically underserved 
populations, including uninsured patient popu-
lations; 
(V) increase access to specialty care, including 
referrals and diagnostic testing; and 
(VI) enhance the use of electronic health 
records to improve quality; 
(iii) efforts to determine how effective quality 
improvement models may be adapted for implementa-
tion by community health centers that vary by size, 
budget, staffing, services offered, populations served, 
and other characteristics determined appropriate by 
the Secretary; 
Deadline. 
Reports. 
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122 STAT. 3990 
PUBLIC LAW 110–355—OCT. 8, 2008 
(iv) types of technical assistance and resources 
provided to community health centers that may facili-
tate the implementation of quality improvement inter-
ventions; 
(v) proposed or adopted methodologies for commu-
nity health center evaluations of quality improvement 
interventions, including any development of new meas-
ures that are tailored to safety-net, community-based 
providers; 
(vi) successful strategies for sustaining quality 
improvement interventions in the long-term; and 
(vii) partnerships with other Federal agencies and 
private organizations or networks as appropriate, to 
enhance health care quality in community health cen-
ters. 
(C) DISSEMINATION.—The Administrator of the Health 
Resources and Services Administration shall establish a 
formal mechanism or mechanisms for the ongoing dissemi-
nation of agency initiatives, best practices, and other 
information that may assist health care quality improve-
ment efforts in community health centers. 
(4) GAO STUDY ON INTEGRATED HEALTH SYSTEMS MODEL 
FOR THE DELIVERY OF HEALTH CARE SERVICES TO MEDICALLY 
UNDERSERVED AND UNINSURED POPULATIONS.— 
(A) STUDY.—The Comptroller General of the United 
States shall conduct a study on integrated health system 
models of at least 15 sites for the delivery of health care 
services to medically underserved and uninsured popu-
lations. The study shall include an examination of— 
(i) health care delivery models sponsored by public 
or private non-profit entities that— 
(I) integrate primary, specialty, and acute 
care; and 
(II) serve medically underserved and unin-
sured populations; and 
(ii) such models in rural and urban areas. 
(B) REPORT.—Not later than 1 year after the date 
of the enactment of this Act, the Comptroller General of 
the United States shall submit to Congress a report on 
the study conducted under subparagraph (A). The report 
shall include— 
(i) an evaluation of the models, as described in 
subparagraph (A), in— 
(I) expanding access to primary, preventive, 
and specialty services for medically underserved 
and uninsured populations; and 
(II) improving care coordination and health 
outcomes; 
(III) increasing efficiency in the delivery of 
quality health care; and 
(IV) conducting some combination of the fol-
lowing services— 
(aa) outreach activities; 
(bb) case management and patient naviga-
tion services; 
(cc) chronic care management; 
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122 STAT. 3991 
PUBLIC LAW 110–355—OCT. 8, 2008 
(dd) transportation to health care facili-
ties; 
(ee) development of provider networks and 
other innovative models to engage local physi-
cians and other providers to serve the medi-
cally underserved within a community; 
(ff) recruitment, training, and compensa-
tion of necessary personnel; 
(gg) acquisition of technology for the pur-
pose of coordinating care; 
(hh) improvements to provider commu-
nication, including implementation of shared 
information systems or shared clinical sys-
tems; 
(ii) determination of eligibility for Federal, 
State, and local programs that provide, or 
financially support the provision of, medical, 
social, housing, educational, or other related 
services; 
(jj) development of prevention and disease 
management tools and processes; 
(kk) translation services; 
(ll) development and implementation of 
evaluation measures and processes to assess 
patient outcomes; 
(mm) integration of primary care and 
mental health services; and 
(nn) carrying out other activities that may 
be appropriate to a community and that would 
increase access by the uninsured to health 
care, such as access initiatives for which pri-
vate entities provide non-Federal contributions 
to supplement the Federal funds provided 
through the grants for the initiatives; and 
(ii) an assessment of— 
(I) challenges, including barriers to Federal 
programs, encountered by such entities in pro-
viding care to medically underserved and unin-
sured populations; and 
(II) advantages and disadvantages of such 
models compared to other models of care delivery 
for medically underserved and uninsured popu-
lations, including— 
(aa) quality measurement and quality out-
comes; 
(bb) administrative efficiencies; and 
(cc) geographic distribution of federally- 
supported clinics compared to geographic dis-
tribution of integrated health systems. 
(5) GAO STUDY ON VOLUNTEER ENHANCEMENT.— 
(A) IN GENERAL.—Not later than 6 months after the 
date of enactment of this Act, the Comptroller General 
of the United States shall conduct a study, and submit 
a report to Congress, concerning the implications of 
extending Federal Tort Claims Act (chapter 171 of title 
Deadline. 
Reports. 
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122 STAT. 3992 
PUBLIC LAW 110–355—OCT. 8, 2008 
28, United States Code) coverage to health care profes-
sionals who volunteer to furnish care to patients of health 
centers. 
(B) CONTENT.—In conducting the study under subpara-
graph (A), the Comptroller General of the United States 
shall analyze— 
(i) the potential financial implications for the Fed-
eral Government of such an extension, including any 
increased funding needed for current health center 
Federal Tort Claims Act coverage; 
(ii) an estimate of the increase in the number 
of health care professionals at health centers, and what 
types of such professionals would most likely volunteer 
given the extension of Federal Tort Claims Act cov-
erage; 
(iii) the increase in services provided by health 
centers as a result of such an increase in health care 
professionals, and in particular the effect of such action 
on the ability of health centers to secure specialty 
and diagnostic services needed by their uninsured and 
other patients; 
(iv) the volume of patient workload at health cen-
ters and how volunteer health care professionals may 
help address the patient volume; 
(v) the most appropriate manner of extending such 
coverage to volunteer health care professionals at 
health centers, including any potential difference from 
the mechanism currently used for health care profes-
sional volunteers at free clinics; 
(vi) State laws that have been shown to encourage 
physicians and other health care providers to provide 
charity care as an agent of the State; and 
(vii) other policies, including legislative or regu-
latory changes, that have the potential to increase 
the number of volunteer health care staff at health 
centers and the financial implications of such policies, 
including the cost savings associated with the ability 
to provide more services in health centers rather than 
more expensive sites of care. 
(c) RECOGNITION OF HIGH POVERTY.— 
(1) IN
GENERAL.—Section 330(c) of the Public Health 
Service Act (42 U.S.C. 254b(c)) is amended by adding at the 
end the following new paragraph: 
‘‘(3) RECOGNITION OF HIGH POVERTY.— 
‘‘(A) IN GENERAL.—In making grants under this sub-
section, the Secretary may recognize the unique needs of 
high poverty areas. 
‘‘(B) HIGH POVERTY AREA DEFINED.—For purposes of 
subparagraph (A), the term ‘high poverty area’ means a 
catchment area which is established in a manner that 
is consistent with the factors in subsection (k)(3)(J), and 
the poverty rate of which is greater than the national 
average poverty rate as determined by the Bureau of the 
Census.’’. 
(2) EFFECTIVE DATE.—The amendment made by paragraph 
(1) shall apply to grants made on or after January 1, 2009. 
42 USC 254b 
note. 
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122 STAT. 3993 
PUBLIC LAW 110–355—OCT. 8, 2008 
SEC. 3. NATIONAL HEALTH SERVICE CORPS. 
(a) FUNDING.— 
(1) REAUTHORIZATION OF NATIONAL HEALTH SERVICE CORPS 
PROGRAM.—Section 338(a) of the Public Health Service Act 
(42 U.S.C. 254k(a)) is amended by striking ‘‘2002 through 2006’’ 
and inserting ‘‘2008 through 2012’’. 
(2) SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS.—Sub-
section (a) of section 338H of such Act (42 U.S.C. 254q) is 
amended by striking ‘‘appropriated $146,250,000’’ and all that 
follows through the period and inserting the following: ‘‘appro-
priated— 
‘‘(1) for fiscal year 2008, $131,500,000; 
‘‘(2) for fiscal year 2009, $143,335,000; 
‘‘(3) for fiscal year 2010, $156,235,150; 
‘‘(4) for fiscal year 2011, $170,296,310; and 
‘‘(5) for fiscal year 2012, $185,622,980.’’. 
(b) ELIMINATION OF 6-YEAR DEMONSTRATION REQUIREMENT.— 
Section 332(a)(1) of the Public Health Service Act (42 U.S.C. 
254e(a)(1)) is amended by striking ‘‘Not earlier than 6 years’’ and 
all that follows through ‘‘purposes of this section.’’. 
(c) ASSIGNMENT TO SHORTAGE AREA.—Section 333(a)(1)(D)(ii) 
of the Public Health Service Act (42 U.S.C. 254f(a)(1)(D)(ii)) is 
amended— 
(1) in subclause (IV), by striking ‘‘and’’; 
(2) in subclause (V), by striking the period at the end 
and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(VI) the entity demonstrates willingness to 
support or facilitate mentorship, professional 
development, and training opportunities for Corps 
members.’’. 
(d) PROFESSIONAL DEVELOPMENT
AND TRAINING.—Subsection 
(d) of section 336 of the Public Health Service Act (42 U.S.C. 
254h–1) is amended to read as follows: 
‘‘(d) PROFESSIONAL DEVELOPMENT AND TRAINING.— 
‘‘(1) IN GENERAL.—The Secretary shall assist Corps mem-
bers in establishing and maintaining professional relationships 
and development opportunities, including by— 
‘‘(A) establishing appropriate professional relationships 
between the Corps member involved and the health profes-
sions community of the geographic area with respect to 
which the member is assigned; 
‘‘(B) establishing professional development, training, 
and mentorship linkages between the Corps member 
involved and the larger health professions community, 
including through distance learning, direct mentorship, and 
development and implementation of training modules 
designed to meet the educational needs of offsite Corps 
members; 
‘‘(C) establishing professional networks among Corps 
members; or 
‘‘(D) engaging in other professional development, 
mentorship, and training activities for Corps members, at 
the discretion of the Secretary. 
‘‘(2) ASSISTANCE IN ESTABLISHING PROFESSIONAL RELATION-
SHIPS.—In providing such assistance under paragraph (1), the 
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122 STAT. 3994 
PUBLIC LAW 110–355—OCT. 8, 2008 
Secretary shall focus on establishing relationships with hos-
pitals, with academic medical centers and health professions 
schools, with area health education centers under section 751, 
with health education and training centers under section 752, 
and with border health education and training centers under 
such section 752. Such assistance shall include assistance in 
obtaining faculty appointments at health professions schools. 
‘‘(3) SUPPLEMENT NOT SUPPLANT.—Such efforts under this 
subsection shall supplement, not supplant, non-government 
efforts by professional health provider societies to establish 
and maintain professional relationships and development 
opportunities.’’. 
(e) ELIGIBILITY OF THE DISTRICT OF COLUMBIA AND TERRITORIES 
FOR THE STATE LOAN REPAYMENT PROGRAM.— 
(1) IN
GENERAL.—Section 338I(h) of the Public Health 
Service Act (42 U.S.C. 254q–1(h)) is amended by striking ‘‘sev-
eral States’’ and inserting ‘‘50 States, the District of Columbia, 
the Commonwealth of Puerto Rico, the United States Virgin 
Islands, Guam, American Samoa, Palau, the Marshall Islands, 
and the Commonwealth of the Northern Mariana Islands’’. 
(2) AUTHORIZATION OF APPROPRIATIONS.—Section 338I(i)(1) 
of such Act (42 U.S.C. 254q–1(i)(1)) is amended by striking 
‘‘2002’’ and all that follows through the period and inserting 
‘‘2008, and such sums as may be necessary for each of fiscal 
years 2009 through 2012.’’. 
SEC. 4. REAUTHORIZATION OF RURAL HEALTH CARE PROGRAMS. 
Section 330A(j) of the Public Health Service Act (42 U.S.C. 
254c(j)) is amended by striking ‘‘$40,000,000’’ and all that follows 
through the period and inserting ‘‘$45,000,000 for each of fiscal 
years 2008 through 2012.’’. 
SEC. 
5. 
REAUTHORIZATION 
OF 
PRIMARY 
DENTAL 
HEALTH 
WORKFORCE PROGRAMS. 
Section 340G(f) of the Public Health Service Act (42 U.S.C. 
256g(f)) is amended— 
(1) by striking ‘‘$50,000,000’’ and inserting ‘‘$25,000,000’’; 
and 
(2) by striking ‘‘2002’’ and inserting ‘‘2008’’. 
SEC. 6. EMERGENCY RESPONSE COORDINATION OF PRIMARY CARE 
PROVIDERS. 
(a) IN GENERAL.—Subtitle B of title XXVIII of the Public Health 
Service Act (42 U.S.C. 300hh–10 et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 2815. EMERGENCY RESPONSE COORDINATION OF PRIMARY CARE 
PROVIDERS. 
‘‘The Secretary, acting through Administrator of the Health 
Resources and Services Administration, and in coordination with 
the Assistant Secretary for Preparedness and Response, shall 
‘‘(1) provide guidance and technical assistance to health 
centers funded under section 330 and to State and local health 
departments and emergency managers to integrate health cen-
ters into State and local emergency response plans and to 
better meet the primary care needs of populations served by 
health centers during public health emergencies; and 
42 USC 
300hh–17. 
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122 STAT. 3995 
PUBLIC LAW 110–355—OCT. 8, 2008 
LEGISLATIVE HISTORY—H.R. 1343 (S. 901): 
HOUSE REPORTS: No. 110–680 (Comm. on Energy and Commerce). 
SENATE REPORTS: No. 110–274 accompanying S. 901 (Comm. on Health, Edu-
cation, Labor, and Pensions). 
CONGRESSIONAL RECORD, Vol. 154 (2008): 
June 4, considered and passed House. 
Sept. 24, considered and passed Senate, amended. 
Sept. 25, House concurred in Senate amendment. 
‘‘(2) encourage employees at health centers funded under 
section 330 to participate in emergency medical response pro-
grams including the National Disaster Medical System author-
ized in section 2812, the Volunteer Medical Reserve Corps 
authorized in section 2813, and the Emergency System for 
Advance Registration of Health Professions Volunteers author-
ized in section 319I.’’. 
(b) SENSE
OF
THE CONGRESS.—It is the Sense of Congress 
that the Secretary of Health and Human Services, to the extent 
permitted by law, utilize the existing authority provided under 
the Federal Tort Claims Act for health centers funded under section 
330 of the Public Health Service Act (42 U.S.C. 254b) in order 
to establish expedited procedures under which such health centers 
and their health care professionals that have been deemed eligible 
for Federal Tort Claims Act coverage are able to respond promptly 
in a coordinated manner and on a temporary basis to public health 
emergencies outside their traditional service area and sites, and 
across State lines, as necessary and appropriate. 
SEC. 7. REVISION OF THE TIMEFRAME FOR THE RECOGNITION OF 
CERTAIN DESIGNATIONS IN CERTIFYING RURAL HEALTH 
CLINICS UNDER THE MEDICARE PROGRAM. 
(a) IN GENERAL.—The second sentence of section 1861(aa)(2) 
of the Social Security Act (42 U.S.C. 1395x(aa)(2)) is amended 
by striking ‘‘3-year period’’ and inserting ‘‘4-year period’’ in the 
matter in clause (i) preceding subclause (I). 
(b) EFFECTIVE DATE.—The amendment made by subsection (a) 
shall take effect on the date of the enactment of this Act. 
Approved October 8, 2008. 
42 USC 1395x 
note. 
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