An act to amend the Public Health Service Act to provide grants to improve health care in rural areas
PL 115-408 (S.2278), enacted 12/31/2018

132 STAT. 5384 
PUBLIC LAW 115–408—DEC. 31, 2018 
Public Law 115–408 
115th Congress 
An Act 
To amend the Public Health Service Act to provide grants to improve health care 
in rural areas. 
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 ‘‘State Offices of Rural Health 
Reauthorization Act of 2018’’. 
SEC. 2. STATE OFFICES OF RURAL HEALTH. 
Section 338J of the Public Health Service Act (42 U.S.C. 254r) 
is amended to read as follows: 
‘‘SEC. 338J. GRANTS TO STATE OFFICES OF RURAL HEALTH. 
‘‘(a) IN GENERAL.—The Secretary, acting through the Director 
of the Federal Office of Rural Health Policy (established under 
section 711 of the Social Security Act), shall make grants to each 
State Office of Rural Health for the purpose of improving health 
care in rural areas. 
‘‘(b) REQUIREMENT OF MATCHING FUNDS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), the Secretary 
may not make a grant under subsection (a) unless the State 
office of rural health involved agrees, with respect to the costs 
to be incurred in carrying out the purpose described in such 
subsection, to provide non-Federal contributions toward such 
costs in an amount equal to $3 for each $1 of Federal funds 
provided in the grant. 
‘‘(2) WAIVER OR REDUCTION.—The Secretary may waive or 
reduce the non-Federal contribution if the Secretary determines 
that requiring matching funds would limit the State office 
of rural health’s ability to carry out the purpose described 
in subsection (a). 
‘‘(3) DETERMINATION
OF
AMOUNT
OF
NON-FEDERAL
CON-
TRIBUTION.—Non-Federal contributions required in paragraph 
(1) may be in cash or in kind, fairly evaluated, including plant, 
equipment, or services. Amounts provided by the Federal 
Government, or services assisted or subsidized to any signifi-
cant extent by the Federal Government, may not be included 
in determining the amount of such non-Federal contributions. 
‘‘(c) CERTAIN REQUIRED ACTIVITIES.—Recipients of a grant 
under subsection (a) shall use the grant funds for purposes of— 
‘‘(1) maintaining within the State office of rural health 
a clearinghouse for collecting and disseminating information 
on— 
Determination. 
State Offices of 
Rural Health 
Reauthorization 
Act of 2018. 
42 USC 201 note. 
Dec. 31, 2018 
[S. 2278] 
VerDate Sep 11 2014 
14:16 Jan 18, 2024
Jkt 079194
PO 00000
Frm 00956
Fmt 6580
Sfmt 6581
G:\STATUTES\2018\GOVINFO FILES FOR ERIC\PART 4\79194PT4.001
79194PT4
whamilton on LAP1Z6H6L3PROD with STATUTES
132 STAT. 5385 
PUBLIC LAW 115–408—DEC. 31, 2018 
‘‘(A) rural health care issues; 
‘‘(B) research findings relating to rural health care; 
and 
‘‘(C) innovative approaches to the delivery of health 
care in rural areas; 
‘‘(2) coordinating the activities carried out in the State 
that relate to rural health care, including providing coordination 
for the purpose of avoiding redundancy in such activities; and 
‘‘(3) identifying Federal and State programs regarding rural 
health, and providing technical assistance to public and non-
profit private entities regarding participation in such programs. 
‘‘(d) REQUIREMENT REGARDING ANNUAL BUDGET FOR OFFICE.— 
The Secretary may not make a grant under subsection (a) unless 
the State involved agrees that, for any fiscal year for which the 
State office of rural health receives such a grant, the office operated 
pursuant to subsection (a) of this section will be provided with 
an annual budget of not less than $150,000. 
‘‘(e) CERTAIN USES OF FUNDS.— 
‘‘(1) RESTRICTIONS.—The Secretary may not make a grant 
under subsection (a) unless the State office of rural health 
involved agrees that the grant will not be expended— 
‘‘(A) to provide health care (including providing cash 
payments regarding such care); 
‘‘(B) to conduct activities for which Federal funds are 
expended— 
‘‘(i) within the State to provide technical and other 
nonfinancial assistance under section 330A(f); 
‘‘(ii) under a memorandum of agreement entered 
into with the State office of rural health under section 
330A(h); or 
‘‘(iii) under a grant under section 338I; 
‘‘(C) to purchase medical equipment, to purchase ambu-
lances, aircraft, or other vehicles, or to purchase major 
communications equipment; 
‘‘(D) to purchase or improve real property; or 
‘‘(E) to carry out any activity regarding a certificate 
of need. 
‘‘(2) AUTHORITIES.—Activities for which a State office of 
rural health may expend a grant under subsection (a) include— 
‘‘(A) paying the costs of maintaining an office of rural 
health for purposes of subsection (a); 
‘‘(B) subject to paragraph (1)(B)(iii), paying the costs 
of any activity carried out with respect to recruiting and 
retaining health professionals to serve in rural areas of 
the State; and 
‘‘(C) providing grants and contracts to public and non-
profit private entities to carry out activities authorized 
in this section. 
‘‘(3) LIMIT ON INDIRECT COSTS.—The Secretary may impose 
a limit of no more than 15 percent on indirect costs claimed 
by the recipient of the grant. 
‘‘(f) REPORTS.—The Secretary may not make a grant under 
subsection (a) unless the State office of rural health involved 
agrees— 
‘‘(1) to submit to the Secretary reports or performance 
data containing such information as the Secretary may require 
regarding activities carried out under this section; and 
VerDate Sep 11 2014 
14:16 Jan 18, 2024
Jkt 079194
PO 00000
Frm 00957
Fmt 6580
Sfmt 6581
G:\STATUTES\2018\GOVINFO FILES FOR ERIC\PART 4\79194PT4.001
79194PT4
whamilton on LAP1Z6H6L3PROD with STATUTES
132 STAT. 5386 
PUBLIC LAW 115–408—DEC. 31, 2018 
LEGISLATIVE HISTORY—S. 2278: 
CONGRESSIONAL RECORD, Vol. 164 (2018): 
July 24, considered and passed Senate. 
Dec. 19, considered and passed House. 
‘‘(2) to submit such a report or performance data not later 
than September 30 of each fiscal year immediately following 
any fiscal year for which the State office of rural health has 
received such a grant. 
‘‘(g) REQUIREMENT OF APPLICATION.—The Secretary may not 
make a grant under subsection (a) unless 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 such subsection. 
‘‘(h) NONCOMPLIANCE.—The Secretary may not make payments 
under subsection (a) to a State office of rural health for any fiscal 
year subsequent to the first fiscal year of such payments unless 
the Secretary determines that, for the immediately preceding fiscal 
year, the State office of rural health has complied with each of 
the agreements made by the State office of rural health under 
this section. 
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) IN GENERAL.—For the purpose of making grants under 
subsection (a), there are authorized to be appropriated 
$12,500,000 for each of fiscal years 2018 through 2022. 
‘‘(2) AVAILABILITY.—Amounts appropriated under para-
graph (1) shall remain available until expended.’’. 
Approved December 31, 2018. 
Determination. 
VerDate Sep 11 2014 
14:16 Jan 18, 2024
Jkt 079194
PO 00000
Frm 00958
Fmt 6580
Sfmt 6580
G:\STATUTES\2018\GOVINFO FILES FOR ERIC\PART 4\79194PT4.001
79194PT4
whamilton on LAP1Z6H6L3PROD with STATUTES