Rural Health Clinics Act of 1983
PL 98-194 (S.2129), enacted 12/01/1983

PUBLIC LAW 98-194—DEC. 1, 1983 
97 STAT. 1345 
Public Law 98-194 
98th Congress 
An Act 
To provide revised reimbursement criteria for small rural health clinics utilizing 
National Health Service Corps personnel. 
Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, That this Act may 
be cited as the "Rural Health Clinics Act of 1983". 
FINDINGS 
Dec. 1,1983 
[S. 2129] 
Rural Health 
Clinics 
Act of 1983. 
42 u s e 201 note. 
42 u s e 254g 
note. 
SEC. 2. Congress finds and declares that— 
(1) rural health clinics are an important part of America's 
health care delivery system; 
(2) National Health Service Corps personnel assigned to rural 
health clinics located in health manpower shortage areas have 
provided valuable and needed staffing help for such clinics; 
(3) rural health clinics receiving assistance from National 
Health Service Corps personnel should be expected to reimburse 
the Federal Government for a reasonable share of the costs of 
such personnel; and 
(4) the criteria which should be applied to reimbursement by Reimbursement, 
such clinics for use of such personnel should be a fair and 
equitable one which reflects the needs of such clinics and the 
populations served by such clinics, as well as the value of the 
services rendered by such personnel. 
ALTERNATIVE REIMBURSEMENT PROVISIONS 
SEC. 3. (a)(1) Subsection (a) of section 334 of the Public Health 
Service Act (42 U.S.C. 254g) is amended— 
(A) in the matter preceding subparagraph (A) of paragraph 
(3), by inserting ", if not a small health center," after "the 
entity"; 
(B) by striking out "and" at the end of subparagraph (C) of 
such paragraph; 
(C) by redesignating paragraph (4) as (5); and 
(D) by inserting after paragraph (3) the following new para-
graph: 
"(4) the entity, if a small health center, shall pay to the 
United States, in each calendar quarter (or other period as may 
be specified in the agreement) during which any Corps member 
is assigned to such entity, an amount determined by the Secre-
tary in accordance with subsection (f); and", 
(b) Subsection (b) of such section is amended— 
(l)*by inserting ", on a prospective or retrospective basis," 
after "m whole or in part" in paragraph (1); 
(2) by inserting "which is not a small health center" after "for 
an entity" in such paragraph; 
(3) by inserting ", on a prospective or retrospective basis," 
after "in whole or in part" in paragraph (2); 
11-194 0 - 8 5 
— 44 : Q
L 3 
97 STAT. 1346 
PUBLIC LAW 98-194—DEC. 1, 1983 
Waiver. 
Payment to U.S. 
Proposed budget, 
submittal to 
Secretary. 
(4) by inserting "is not a small health center and which" after 
"for any entity which" in such paragraph; 
(5) by inserting "and does not, pursuant to paragraph (5), 
require payment by the entity in the amount described in 
subsection (fXD/' after "paragraph (1) or (2)," in paragraph (3); 
and 
(6) by adding at the end thereof the following new paragraph: 
"(5XA) If the Secretary determines that an entity which is not a 
small health center is eligible for a waiver under paragraph (1) or 
(2), the Secretary may waive the application of subsection (aX3) for 
such entity and require such entity to make pa3mient in an amount 
equal to the amount described in subsection (fKD that would be 
payable by such entity if such entity were a small health center. 
"(B) The Secretary may waive in whole or in part, on a prospective 
or retrospective basis, the application of the requirement of subpara-
graph (A) for any entity if the Secretary determines that the entity 
is financially unable to meet such requirement or that compliance 
with such requirement would unreasonably limit the ability of the 
entity to provide for the adequate support of the provision of health 
services by Corps members. Funds which would be paid to the 
United States but for a waiver under this subparagraph shall be 
used by an entity to— 
"(i) expand or improve its provision of health services; 
"(ii) increase the number of individuals served; 
"(iii) renovate or modernize facilities for its provision of 
health services; 
"(iv) improve the administration of its health service pro-
grams; or 
"(v) to establish a financial reserve to assure its ability to 
continue providing health services.". 
(c) Subsection (c) of such section is amended— 
(1) by inserting "which is not a small health center" after "an 
entity"; 
(2) by inserting "or subsection (bX5XA)" before "shall be used 
by the entity". 
(d) Such section is amended by adding at the end thereof the 
following new subsection: 
"(f)(1) An entity which is a small health center shall pay to the 
United States, as prescribed by the Secretary in each calendar 
quarter (or other period as may be specified in the agreement) 
during which any Corps member is assigned to such entity, an 
amount equal to the amount (prorated for a calendar quarter or 
other period) by which the revenues that the center may reasonably 
expect to receive during an annual period for the provision of health 
services exceeds the costs that the center may reasonably expect to 
incur in the provision of such services, except that the amount that 
an entity shall pay to the United States under this paragraph shall 
not exceed the amount such entity would pay to the United States 
under paragraph (3) of subsection (a) if such paragraph applied to 
such entity. 
"(2XA) To determine for purposes of paragraph (1) the revenues 
and costs which an entity that is a small health center may reason-
ably be expected to receive and incur in an annual period for the 
provision of health services, the entity shall submit to the Secretary 
before the beginning of such period a proposed budget which— 
PUBLIC LAW 98-194—DEC. 1, 1983 
97 STAT. 1347 
"(i) describes the primary and supplemental health services 
(as defined in section 330) which are needed by the area the 
entity serves in such period; and 
"(ii) states the revenues and costs which the entity expects to 
receive and incur in providing such health services in such 
period. 
"(B) From the submission under subparagraph (A) and other 
information available to the Secretary, the Secretary shall de-
termine— 
"(i) the primary and supplemental health services (as defined 
in section 330) needed in the area the entity serves; 
"(ii) the fees, premiums, third party reimbursements, and 
other revenues the entity making the submission may reason-
ably expect to receive from the provision of such services; and 
"(iii) the costs which the entity may reasonably expect to 
incur in providing such services. 
The revenues and costs determined by the Secretary shall be the 
revenues and costs used in making the determination under para-
graph (1). 
"(3) The Secretary may waive in whole or in part, on a prospective 
or retrospective basis, the application of paragraph (1) for an entity 
which is a small health center if the Secretary determines that the 
entity needs all or part of the amounts otherwise payable under 
such paragraph to— 
"(A) expand or improve its provision of health services; 
"(B) increase the number of individuals served; 
"(C) renovate or modernize facilities for its provision of health 
services; 
"(D) improve the administration of its health service pro-
grams; or 
"(E) establish a financial reserve to assure its ability to 
continue providing health services. 
"(4) The excess (if any) of the amount of funds collected by an 
entity which is a small health center in accordance with subsection 
(aX2) over the amount paid to the United States in accordance with 
paragraph (1) of this subsection shall be used by the center for the 
purposes set out in subparagraphs (A) through (E) of paragraph (3) 
of this subsection or to recruit and retain health manpower to 
provide health services to the individuals in the health manpower 
shortage area for which the entity submitted an application. 
"(5) For purposes of this section, the term 'small health center' 
means an entity other than— 
"(A) a hospital (or part of a hospital); 
"(B) a public entity; or 
"(C) an entity that is receiving a grant under section 329 or 
section 330, except that such term includes an entity whose 
grant is less than the total of the amounts, calculated on an 
annual basis, specified in subparagraphs (A) and (B) of subsec-
tion (aX3).". 
42 use 254c. 
Revenues and 
costs. 
Waiver. 
Health 
manpower. 
"Small health 
center." 
42 use 254b, 
254c. 
97 STAT. 1348 
PUBLIC LAW 98-194—DEC. 1, 1983 
EFFECTIVE DATE AND APPUCABIUTY 
42USC254g 
SEC. 4. The amendments made by section 3 shall apply with 
^°^- 
respect to agreements entered into under section 334 of the Public 
Ante, p. 1345. 
Health Service Act after the date of the enactment of this Act, but, 
to the extent feasible, the Secretary of Health and Human Services 
shall revise agreements entered into under such section 334 before 
such date to reflect the amendments made by section 3. 
Approved December 1, 1983. 
LEGISLATIVE HISTORY—S. 2129: 
CONGRESSIONAL RECORD, Vol. 129 (1983): 
Nov. 18, considered and passed Senate and House.