Health Care Safety Net Amendments of 2002
PL 107-251 (S.1533), enacted 10/26/2002

PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1621 
Public Law 107-251 
107th Congress 
An Act 
To amend the Public Health Service Act to reauthorize and strengthen the health 
centers program and the National Health Service Corps, and to establish the 
Oct. 26, 2002 
Healthy Communities Access Program, which will help coordinate services for 
[S 1533] 
the uninsured and underinsured, and for other purposes. 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
Health Care 
Safety Net 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
Amendments of 
(a) SHORT TITLE.—This Act may be cited as the "Health Care l^^r^r om t 
Safety Net Amendments of 2002". 
^"^ ^^^ ^^^ °°*^-
(b) TABLE OF CONTENTS.—The table of contents for this Act 
is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—CONSOLIDATED HEALTH CENTER PROGRAM AMENDMENTS 
Sec. 101. Health centers. 
Sec. 102. Telemedicine; incentive grants regarding coordination among States. 
TITLE II—RURAL HEALTH 
Subtitle A—Rural Health Care Services Outreach, Rural Health Network Develop-
ment, and Small Health Care Provider Quality Improvement Grant Programs 
Sec. 201. Grant programs. 
Subtitle B—Telehealth Grant Consolidation 
Sec. 211. Short title. 
Sec. 212. Consolidation and reauthorization of provisions. 
Subtitle C—Mental Health Services Telehealth Program and Rural Emergency 
Medical Service Training and Equipment Assistance Program 
Sec. 221. Programs. 
TITLE III—NATIONAL HEALTH SERVICE CORPS PROGRAM 
Sec. 301. National Health Service Corps. 
Sec. 302. Designation of health professional shortage areas. 
Sec. 303. Assignment of Corps personnel. 
Sec. 304. Priorities in assignment of Corps personnel. 
Sec. 305. Cost-sharing. 
Sec. 306. Eligibility for Federal funds. 
Sec. 307. Facilitation of effective provision of Corps services. 
Sec. 308. Authorization of appropriations. 
Sec. 309. National Health Service Corps Scholarship Program. 
Sec. 310. National Health Service Corps Loan Repayment Program. 
Sec. 311. Obligated service. 
Sec. 312. Private practice. 
Sec. 313. Breach of scholarship contract or loan repayment contract. 
Sec. 314. Authorization of appropriations. 
Sec. 315. Grants to States for loan repayment programs. 
Sec. 316. Demonstration grants to States for community scholarship programs. 
Sec. 317. Demonstration project. 
116 STAT. 1622 
PUBLIC LAW 107-251—OCT. 26, 2002 
TITLE IV—HEALTHY COMMUNITIES ACCESS PROGRAM 
Sec. 401. Purpose. 
Sec. 402. Creation of Healthy Communities Access Program. 
Sec. 403. Expanding availability of dental services. 
Sec. 404. Study regarding barriers to participation of farmworkers in health pro-
grams. 
TITLE V—STUDY AND MISCELLANEOUS PROVISIONS 
Sec. 501. Guarantee study. 
Sec. 502. Graduate medical education. 
TITLE VI—CONFORMING AMENDMENTS 
Sec. 601. Conforming amendments. 
TITLE I—CONSOLIDATED HEALTH 
CENTER PROGRAM AMENDMENTS 
SEC. 101. HEALTH CENTERS. 
Section 330 of the Public Health Service Act (42 U.S.C. 254b) 
is amended— 
(1) in subsection (b)(1)(A)— 
' 
(A) in clause (i)(ni)(bb), by striking "screening for 
breast and cervical cancer" and inserting "appropriate 
cancer screening"; 
(B) in clause (ii), by inserting "(including specialty 
referral when medically indicated)" after "medical services"; 
and 
(C) in clause (iii), by inserting "housing," after "social,"; 
(2) in subsection (b)(2)— 
(A) in subparagraph (A)(i), by striking "associated with 
water supply;" and inserting the following: "associated 
with— 
"(I) water supply; 
"(II) chemical and pesticide exposures; 
"(III) air quality; or 
"(IV) exposure to lead;"; 
(B) by redesignating subparagraphs (A) and (B) as 
subparagraphs (C) and (D), respectively; and 
(C) by inserting before subparagraph (C) (as so redesig-
nated by subparagraph (B)) the following: 
"(A) behavioral and mental health and substance abuse 
services; 
"(B) recuperative care services;"; 
(3) in subsection (c)(1)— 
(A) in subparagraph (B)— 
(i) in the heading, by striking "COMPREHENSIVE 
SERVICE DELIVERY" and inserting "MANAGED CARE"; 
(ii) in the matter preceding clause (i), by striking 
"network or plan" and all that follows to the period 
and inserting "managed care network or plan."; and 
(iii) in the matter following clause (ii), by striking 
"Any such grant may include" and all that follows 
through the period; and 
(B) by adding at the end the following: 
"(C) PRACTICE 
MANAGEMENT NETWORKS.—The Sec-
retary may make grants to health centers that receive 
assistance under this section to enable the centers to plan 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1623 
and develop practice management networks that will 
enable the centers to— 
"(i) reduce costs associated with the provision of 
health care services; 
"(ii) improve access to, and availability of, health 
care services provided to individuals served by the 
centers; 
"(iii) enhance the quality and coordination of 
health care services; or 
"(iv) improve the health status of communities. 
"(D) USE OF FUNDS.—The activities for which a grant 
may be made under subparagraph (B) or (C) may include 
the purchase or lease of equipment, which may include 
data and information systems (including paying for the 
costs of amortizing the principal of, and paying the interest 
on, loans for equipment), the provision of training and 
technical assistance related to the provision of health care 
services on a prepaid basis or under another managed 
care arrangement, and other activities that promote the 
development of practice management or managed care net-
works and plans."; 
(4) in subsection (d)— 
(A) by striking the subsection heading and inserting 
"LOAN GUARANTEE PROGRAM.—"; 
(B) in paragraph (1)— 
(i) in subparagraph (A), by striking "the principal 
and interest on loans" and all that follows through 
the period and inserting "up to 90 percent of the prin-
cipal and interest on loans made by non-Federal 
lenders to health centers, funded under this section, 
for the costs of developing and operating managed 
care networks or plans described in subsection (c)(1)(B), 
or practice management networks described in sub-
section (c)(1)(C)."; 
(ii) in subparagraph (B)— 
(I) in clause (i), by striking "or"; 
(II) in clause (ii), by striking the period and 
inserting "; or"; and 
(III) by adding at the end the following: 
"(iii) to refinance an existing loan (as of the date 
of refinancing) to the center or centers, if the Secretary 
determines— 
"(I) that such refinancing will be beneficial 
to the health center and the Federal Government; 
"(II) that the center (or centers) can dem-
onstrate an ability to repay the refinanced loan 
equal to or greater than the ability of the center 
(or centers) to repay the original loan on the date 
the original loan was made."; and 
(iii) by adding at the end the following: 
"(D) PROVISION DIRECTLY TO NETWORKS OR PLANS.— 
At the request of health centers receiving assistance under 
this section, loan guarantees provided under this paragraph 
may be made directly to networks or plans that are at 
least majority controlled and, as applicable, at least 
majority owned by those health centers. 
116 STAT. 1624 
PUBLIC LAW 107-251—OCT. 26, 2002 
"(E) FEDERAL CREDIT REFORM.—The requirements of 
the Federal Credit Reform Act of 1990 (2 U.S.C. 661 et 
seq.) shall apply with respect to loans refinanced under 
subparagraph (B)(iii)."; and 
(C)(i) by striking paragraphs (6) and (7); and 
(ii) by redesignating paragraph (8) as paragraph (6); 
(4) in subsection (e)— 
(A) in paragraph (1)— 
(i) in subparagraph (B), by striking "subsection 
(j)(3)" and inserting "subsection (k)(3)"; and 
(ii) by adding at the end the following: 
"(C) OPERATION OF NETWORKS AND PLANS.—The Sec-
retary may make grants to health centers that receive 
assistance under this section, or at the request of the 
health centers, directly to a network or plan (as described 
in subparagraphs (B) and (C) of subsection (c)(1)) that 
is at least majority controlled and, as applicable, at least 
majority owned by such health centers receiving assistance 
under this section, for the costs associated with the oper-
ation of such network or plan, including the purchase or 
lease of equipment (including the costs of amortizing the 
principal of, and paying the interest on, loans for equip-
ment)."; 
(B) in paragraph (5)— 
(i) in subparagraph (A), by inserting "subpara-
graphs (A) and (B) of after "any fiscal year under"; 
(ii) by redesignating subparagraphs (B) and (C) 
as subparagraphs (C) and (D), respectively; and 
(iii) by inserting after subparagraph (A) the fol-
lowing: 
"(B) NETWORKS AND PLANS.—The total amount of grant 
funds made available for any fiscal year under paragraph 
(1)(C) and subparagraphs (B) and (C) of subsection (c)(1) 
to a health center or to a network or plan shall be deter-
mined by the Secretary, but may not exceed 2 percent 
of the total amount appropriated under this section for 
such fiscal year."; and 
(C) by redesignating paragraphs (4) and (5) as para-
graphs (3) and (4), respectively; 
(5) in subsection (g)— 
(A) in paragraph (2)— 
(i) in subparagraph (A), by inserting "and seasonal 
agricultural worker" after "agricultural worker"; and 
(ii) in subparagraph (B), by striking "and members 
of their families" and inserting "and seasonal agricul-
tural workers, and members of their families,"; and 
(B) in paragraph (3)(A), by striking "on a seasonal 
basis"; 
(6) in subsection (h)— 
(A) in paragraph (1), by striking "homeless children 
and children at risk of homelessness" and inserting "home-
less children and youth and children and youth at risk 
of homelessness"; 
(B)(i) by redesignating paragraph (4) as paragraph (5); 
and 
(ii) by inserting after paragraph (3) the following: 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1625 
"(4) TEMPORARY CONTINUED PROVISION OF SERVICES TO CER-
TAIN FORMER HOMELESS INDIVIDUALS.—If any grantee under 
this subsection has provided services described in this section 
under the grant to a homeless individual, such grantee may, 
notwithstanding that the individual is no longer homeless as 
a result of becoming a resident in permanent housing, expend 
the grant to continue to provide such services to the individual 
for not more than 12 months."; and 
(C) in paragraph (5)(C) (as redesignated by subpara-
graph (B)), by striking "and residential treatment" and 
inserting ", risk reduction, outpatient treatment, residential 
treatment, and rehabilitation"; 
(7) in subsection (jX3)— 
(A) in subparagraph (E)— 
(i) in clause (i)— 
(I) by striking "(i)" and inserting "(i)(I)"; 
(II) by striking "plan; or" and inserting "plan; 
and"; and 
(III) by adding at the end the following: 
"(II) has or will have a contractual or other 
arrangement with the State agency administering 
the program under title XXI of such Act (42 U.S.C. 
1397aa et seq.) with respect to individuals who 
are State children's health insurance program 
beneficiaries; or"; and 
(ii) by striking clause (ii) and inserting the fol-
lowing: 
"(ii) has made or will make every reasonable effort 
to enter into arrangements described in subclauses 
(I) and (II) of clause (i);"; 
(B) in subparagraph (G)-— 
(i) in clause (ii)(II), by striking "; and" and 
inserting ";"; 
(ii) by redesignating clause (iii) as clause (iv); and 
(iii) by inserting after clause (ii) the following: 
"(iii)(I) will assure that no patient will be denied 
health care services due to an individual's inability 
to pay for such services; and 
"(II) will assure that any fees or payments required 
by the center for such services will be reduced or 
waived to enable the center to fulfill the assurance 
described in subclause (I); and"; 
(C) in subparagraph (H), in the matter following clause 
(iii), by striking "or (p)" and inserting "or (q)"; 
(D) in subparagraph (K)(ii), by striking "and" at the 
end; 
(E) in subparagraph (L), by striking the period and 
inserting "; and"; and 
(F) by inserting after subparagraph (L), the following: 
"(M) the center encourages persons receiving or seeking 
health services from the center to participate in any public 
or private (including employer-offered) health programs or 
plans for which the persons are eligible, so long as the 
center, in complying with this subparagraph, does not vio-
late the requirements of subparagraph (G)(iii)(I)."; 
(8)(A) by redesignating subsection (1) as subsection (s) and 
moving that subsection (s) to the end of the section; 
99-194 O - 03 - 2 : QL 3 Part 3 
116 STAT. 1626 
PUBLIC LAW 107-251—OCT. 26, 2002 
(B) by redesignating subsections (j), (k), and (m) through 
(q) as subsections (n), (o), and (p) through (s), respectively; 
and 
(C) by inserting after subsection (i) the following: 
"(j) ACCESS GRANTS.— 
"(1) IN GENERAL.—^The Secretary may award grants to 
eligible health centers with a substantial number of clients 
with limited English speaking proficiency to provide trans-
lation, interpretation, and other such services for such clients 
with limited English speaking proficiency. 
"(2) ELIGIBLE HEALTH CENTER.—In this subsection, the term 
'eligible health center' means an entity that— 
"(A) is a health center as defined under subsection 
(a); 
"(B) provides health care services for clients for whom 
English is a second language; and 
"(C) has exceptional needs with respect to linguistic 
access or faces exceptional challenges with respect to lin-
guistic access. 
"(3) GRANT AMOUNT.—The amount of a grant awarded to 
a center under this subsection shall be determined by the 
Administrator. Such determination of such amount shall be 
based on the number of clients for whom English is a second 
language that is served by such center, and larger grant 
amounts shall be awarded to centers serving larger numbers 
of such clients. 
"(4) USE OF FUNDS.—^An eligible health center that receives 
a grant under this subsection may use funds received through 
such grant to— 
"(A) provide translation, interpretation, and other such 
services for clients for whom English is a second language, 
including hiring professional tramslation and interpretation 
services; and 
"(B) compensate bilingual or multilingual staff for lan-
guage assistance services provided by the staff for such 
clients. 
"(5) APPLICATION.—^An eligible health center desiring a 
grant under this subsection shall submit an application to 
the Secretary at such time, in such manner, and containing 
such information as the Secretary may reasonably require, 
including— 
"(A) an estimate of the number of clients that the 
center serves for whom English is a second language; 
"(B) the ratio of the number of clients for whom English 
is a second language to the total number of clients served 
by the center; 
"(C) a description of any language assistance services 
that the center proposes to provide to aid clients for whom 
English is a second language; and 
"(D) a description of the exceptional needs of such 
center with respect to linguistic access or a description 
of the exceptional challenges faced by such center with 
respect to linguistic access. 
"(6) 
AUTHORIZATION 
OF APPROPRL\TIONS.—There 
are 
authorized to be appropriated to carry out this subsection, 
in addition to any funds authorized to be appropriated or appro-
priated for health centers under any other subsection of this 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1627 
section, such sums as may be necessary for each of fiscal 
years 2002 through 2006."; 
(9) by striking subsection (m) (as redesignated by para-
graph (9)(B)) and inserting the following: 
"(m) TECHNICAL ASSISTANCE.—The Secretary shall establish 
a program through which the Secretary shall provide technical 
and other assistance to eligible entities to assist such entities to 
meet the requirements of subsection (1)(3). Services provided 
through the program may include necessary technical and non-
financial assistance, including fiscal and program management 
assistance, training in fiscal and program management, operational 
and administrative support, and the provision of information to 
the entities of the variety of resources available under this title 
and how those resources can be best used to meet the health 
needs of the communities served by the entities."; 
(10) in subsection (q) (as redesignated by paragraph (9)(B)), 
by striking "(j)(3)(G)" and inserting "(1)(3)(G)"; and 
(11) in subsection (s) (as redesignated by paragraph 
(9)(A))— 
(A) in paragraph (1), by striking "$802,124,000" and 
all 
that 
follows 
through 
the 
period 
and 
inserting 
"$1,340,000,000 for fiscal year 2002 and such sums as 
may be necessary for each of the fiscal years 2003 through 
2006."; 
(B) in paragraph (2)— 
(i) in subparagraph (A)— 
(I) by striking "(j)(3))" and inserting "(1)(3))"; 
and 
(II) by striking "(j)(3)(G)(ii)" and inserting 
"(l)(3)(Hr; and 
(ii) by striking subparagraph (B) and inserting 
the following: 
"(B) DISTRIBUTION OF GRANTS.—For fiscal year 2002 
and each of the following fiscal years, the Secretary, in 
awarding grants under this section, shall ensure that the 
proportion of the amount made available under each of 
subsections (g), (h), and (i), relative to the total amount 
appropriated to carry out this section for that fiscal year, 
is equal to the proportion of the amount made available 
under that subsection for fiscal year 2001, relative to the 
total amount appropriated to carry out this section for 
fiscal year 2001.". 
SEC. 102. TELEMEDICINE; INCENTIVE GRANTS REGARDING COORDI- 
42 USC 254c-17. 
NATION AMONG STATES. 
(a) IN GENERAL.—The Secretary of Health and Human Services 
may make grants to State professional licensing boards to carry 
out programs under which such licensing boards of various States 
cooperate to develop and implement State policies that will reduce 
statutory and regulatory barriers to telemedicine. 
(b) AUTHORIZATION OF APPROPRL\TIONS.—For the purpose of 
carrying out subsection (a), there are authorized to be appropriated 
such sums as may be necessary for each of the fiscal years 2002 
through 2006. 
116 STAT. 1628 
PUBLIC LAW 107-251—OCT. 26, 2002 
TITLE II—RURAL HEALTH 
Subtitle A—Rural Health Care Services 
Outreach, Rural Health Network Devel-
opment, and Small Health Care Provider 
Quality Improvement Grant Programs 
SEC. 201. GRANT PROGRAMS. 
Section 330A of the Public Health Service Act (42 U.S.C. 254c) 
is amended to read as follows: 
"SEC. 
330A, 
RURAL HEALTH CARE SERVICES OUTREACH, RURAL 
HEALTH 
NETWORK 
DEVELOPMENT, 
AND 
SMALL 
HEALTH 
CARE 
PROVTOER 
QUALITY 
IMPROVEMENT 
GRANT 
PRO-
GRAMS. 
"(a) PURPOSE.—The purpose of this section is to provide grants 
for expanded delivery of health care services in rural areas, for 
the planning and implementation of integrated health care networks 
in rural areas, and for the planning and implementation of small 
health care provider quality improvement activities. 
"(b) DEFINITIONS.— 
"(1) DIRECTOR.—The term 'Director' means the Director 
specified in subsection (d). 
"(2) FEDERALLY QUALIFIED HEALTH CENTER; RURAL HEALTH 
CLINIC.—^The terms 'Federally qualified health center' and 'rural 
health clinic' have the me£inings given the terms in section 
1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)). 
"(3) HEALTH PROFESSIONAL SHORTAGE AREA.—^The term 
'health professional shortage area' means a health professional 
shortage area designated under section 332. 
"(4) 
MEDICALLY UNDERSERVED COMMUNITY.—The term 
'medically underserved community' has the meaning given the 
term in section 799B. 
"(5) 
MEDICALLY UNDERSERVED POPULATION.—The term 
'medically underserved population' has the meaning given the 
term in section 330(b)(3). 
"(c) PROGRAM.—The Secretary shall establish, under section 
301, a small health care provider quality improvement grant pro-
gram. 
"(d) ADMINISTRATION.— 
"(1) PROGRAMS.—The rural health care services outreach, 
rural health network development, and small health care pro-
vider quality improvement grant programs established under 
section 301 shall be administered by the Director of the Office 
of Rural Health Policy of the Health Resources and Services 
Administration, in consultation with State offices of rural 
health or other appropriate State government entities. 
"(2) GRANTS.— 
"(A) IN GENERAL.—In carrying out the programs 
described in paragraph (1), the Director may award grants 
under subsections (e), (f), and (g) to expand access to, 
coordinate, and improve the quality of essential health 
care services, and enhance the delivery of health care, 
in rural areas. 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1629 
"(B) TYPES OF GRANTS.—The Director may award the 
grants— 
"(i) to promote expanded delivery of health care 
services in rural areas under subsection (e); 
"(ii) to provide for the planning and implementa-
tion of integrated health care networks in rural areas 
under subsection (f); and 
"(iii) to provide for the planning and implementa-
tion of small health care provider quality improvement 
activities under subsection (g). 
"(e) RURAL HEALTH CARE SERVICES OUTREACH GRANTS.— 
"(1) GRANTS.—The Director may award grants to eligible 
entities to promote rural health care services outreach by 
expanding the delivery of health care services to include new 
and enhanced services in rural areas. The Director may award 
the grants for periods of not more than 3 years. 
"(2) ELIGIBILITY.—To be eligible to receive a grant under 
this subsection for a project, an entity— 
"(A) shall be a rural public or rural nonprofit private 
entity; 
"(B) 
shall 
represent a consortium 
composed of 
members— 
"(i) that include 3 or more health care providers; 
and 
"(ii) that may be nonprofit or for-profit entities; 
and 
"(C) shall not previously have received a grant under 
this subsection for the same or a similar project, unless 
the entity is proposing to expand the scope of the project 
or the area that will be served through the project. 
"(3) APPLICATIONS.—To be eligible to receive a grant under 
this subsection, an eligible entity, in consultation with the 
appropriate State office of rural health or another appropriate 
State entity, shall prepare and submit to the Secretary an 
application, at such time, in such manner, and containing such 
information as the Secretary may require, including— 
"(A) a description of the project that the eligible entity 
will carry out using the funds provided under the grant; 
"(B) a description of the manner in which the project 
funded under the grant will meet the health care needs 
of rural underserved populations in the local community 
or region to be served; 
"(C) a description of how the local community or region 
to be served will be involved in the development and 
ongoing operations of the project; 
"(D) a plan for sustaining the project after Federal 
support for the project has ended; 
"(E) a description of how the project will be evaluated; 
and 
"(F) other such information as the Secretary deter-
mines to be appropriate, 
"(f) RURAL HEALTH NETWORK DEVELOPMENT GRANTS.— 
"(1) GRANTS.— 
"(A) IN GENERAL.—The Director may award rural 
health network development grants to eligible entities to 
promote, through 
planning and implementation, the 
development of integrated health care networks that have 
116 STAT. 1630 
PUBLIC LAW 107-251—OCT. 26, 2002 
combined the functions of the entities participating in the 
networks in order to— 
"(i) achieve efficiencies; 
"(ii) expand access to, coordinate, and improve the 
quahty of essential health care services; and 
"(iii) strengthen the rural health care system as 
a whole. 
"(B) GRANT PERIODS.—^The Director may award such 
a rural health network development grant for implementa-
tion activities for a period of 3 years. The Director may 
also award such a rural health network development grant 
for planning activities for a period of 1 year, to assist 
in the development of an integrated health care network, 
if the proposed participants in the network do not have 
a history of collaborative efforts and a 3-year grant would 
be inappropriate. 
"(2) ELIGIBILITY.—To be eligible to receive a grant under 
this subsection, an entity— 
"(A) shall be a rural public or rural nonprofit private 
entity; 
"(B) 
shall 
represent 
a 
network 
composed 
of 
participants— 
"(i) that include 3 or more health care providers; 
and 
"(ii) that may be nonprofit or for-profit entities; 
and 
"(C) shall not previously have received a grant under 
this subsection (other than a grant for planning activities) 
for the same or a similar project. 
"(3) APPLICATIONS.—To be eligible to receive a grant under 
this subsection, an eligible entity, in consultation with the 
appropriate State ofiice of rural health or another appropriate 
State entity, shall prepare and submit to the Secretary an 
application, at such time, in such manner, and containing such 
information as the Secretary may require, including— 
"(A) a description of the project that the eligible entity 
will carry out using the funds provided under the grant; 
"(B) an explanation of the reasons why Federal assist-
ance is required to carry out the project; 
"(C) a description of— 
"(i) the history of collaborative activities carried 
out by the participants in the network; 
"(ii) the degree to which the participants are ready 
to integrate their functions; and 
"(iii) how the local community or region to be 
served will benefit from and be involved in the activi-
ties carried out by the network; 
"(D) a description of how the local community or region 
to be served will experience increased access to quality 
health care services across the continuum of care as a 
result of the integration activities carried out by the net-
work; 
"(E) a plan for sustaining the project after Federal 
support for the project has ended; 
"(F) a description of how the project will be evaluated; 
and 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1631 
"(G) other such information as the Secretary deter-
mines to be appropriate. 
"(g) 
SMALL HEALTH CARE PROVIDER QUALITY IMPROVEMENT 
GRANTS.— 
"(1) GRANTS.—The Director may award grants to provide 
for the planning and implementation of small health care pro-
vider quality improvement activities. The Director may award 
the grants for periods of 1 to 3 years. 
"(2) ELIGIBILITY.—To be eligible for a grant under this 
subsection, an entity— 
"(A)(i) shall be a rural public or rural nonprofit private 
health care provider or provider of health care services, 
such as a critical access hospital or a rural health clinic; 
or 
"(ii) shall be another rural provider or network of small 
rural providers identified by the Secretary as a key source 
of local care; and 
"(B) shall not previously have received a grant under 
this subsection for the same or a similar project. 
"(3) APPLICATIONS.—To be eligible to receive a grant under 
this subsection, an eligible entity, in consultation with the 
appropriate State ofHce of rural health or another appropriate 
State entity shall prepare and submit to the Secretary an 
application, at such time, in such manner, and containing such 
information as the Secretary may require, including— 
"(A) a description of the project that the eligible entity 
will carry out using the funds provided under the grant; 
"(B) an explanation of the reasons why Federal assist-
ance is required ta carry out the project; 
"(C) a description of the manner in which the project 
funded under the grant will assure continuous quality 
improvement in the provision of services by the entity; 
"(D) a description of how the local community or region 
to be served will experience increased access to quality 
health care services across the continuum of care as a 
result of the activities carried out by the entity; 
"(E) a plan for sustaining the project after Federal 
support for the project has ended; 
"(F) a description of how the project will be evaluated; 
and 
"(G) other such information as the Secretary deter-
mines to be appropriate. 
"(4) 
EXPENDITURES FOR SMALL HEALTH CARE PROVIDER 
QUALITY IMPROVEMENT GRANTS.—In awarding a grant under 
this subsection, the Director shall ensure that the funds made 
available through the grant will be used to provide services 
to residents of rural areas. The Director shall award not less 
than 50 percent of the funds made available under this sub-
section to providers located in and serving rural areas. 
"(h) GENERAL REQUIREMENTS.— 
"(1) PROHIBITED USES OF FUNDS.—^An entity that receives 
a grant under this section may not use funds provided through 
the grant— 
"(A) to build or acquire real property; or 
"(B) for construction. 
"(2) COORDINATION WITH OTHER AGENCIES.—The Secretary 
shall coordinate activities carried out under grant programs 
116 STAT. 1632 
PUBLIC LAW 107-251—OCT. 26, 2002 
described in this section, to the extent practicable, with Federal 
and State agencies and nonprofit organizations that are oper-
ating similar grant programs, to maximize the effect of public 
dollars in funding meritorious proposals. 
"(3) PREFERENCE.—In awarding grants under this section, 
the Secretary shall give preference to entities that— 
"(A) are located in health professional shortage areas 
or medically underserved communities, or serve medically 
underserved populations; or 
"(B) propose to develop projects with a focus on primary 
care, and wellness and prevention strategies. 
Deadline. 
"(i) REPORT.—Not later than September 30, 2005, the Secretary 
shall prepare and submit to the appropriate committees of Congress 
a report on the progress and accomplishments of the grant programs 
described in subsections (e), (f), and (g). 
"(j) AUTHORIZATION OF APPROPRIATIONS.—^There are authorized 
to be appropriated lo carry out this section $40,000,000 for fiscal 
year 2002, and such sums as may be necessary for each of fiscal 
years 2003 through 2006.". 
Teieheaith Grant 
Subtltlc B—^Telchealth Grant 
Consolidation Act 
^-^ 
-i • •
• j • 
of 2002 
Consolidation 
42 use 201 note. 
SEC. 211. SHORT TITLE. 
This subtitle may be cited as the "Teieheaith Grant Consolida-
tion Act of 2002". 
SEC. 212. CONSOLroATION AND REAUTHORIZATION OF PROVISIONS. 
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: 
42 use 254C-14. 
"SEC. 3301. TELEHEALTH NETWORK AND TELEHEALTH RESOURCE 
CENTERS GRANT PROGRAMS. 
"(a) DEFINITIONS.—In this section: 
"(1) DIRECTOR; OFFICE.—The terms 'Director' and 'OfiTice' 
mean the Director and Office specified in subsection (c). 
"(2) 
FEDERALLY QUALIFIED HEALTH CENTER AND RURAL 
HEALTH CLINIC—The term 'Federally qualified health center' 
and 'rural health clinic' have the mieanings given the terms 
in section 1861(aa) of the Social Security Act (42 U.S.C. 
1395x(aa)). 
"(3) FRONTIER COMMUNITY.—The term 'frontier community* 
shall have the meaning given the term in regulations issued 
under subsection (r). 
"(4) MEDICALLY UNDERSERVED AREA.—The term 'medically 
underserved area' has the meaning given the term 'medically 
underserved community' in section 799B. 
"(5) MEDICALLY UNDERSERVED POPULATION.—The term 
'medically underserved population' has the meaning given the 
term in section 330(b)(3). 
"(6) TELEHEALTH SERVICES.—The term 'teieheaith services' 
means services provided through teieheaith technologies. 
"(7) TELEHEALTH TECHNOLOGIES.—The term 'teieheaith 
technologies' means technologies relating to the use of electronic 
information, and telecommunications technologies, to support 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1633 
and promote, at a distance, health care, patient and professional 
health-related education, health administration, and public 
health. 
"(b) PROGRAMS.—The Secretary shall establish, under section 
301, telehealth network and telehealth resource centers grant pro-
grams. 
"(c) ADMINISTRATION.— 
"(1) ESTABLISHMENT.—There is established in the Health 
and Resources and Services Administration an Office for the 
Advancement of Telehealth. The Office shall be headed by 
a Director. 
"(2) DUTIES.—The telehealth 
network and telehealth 
resource centers grant programs established under section 301 
shall be administered by the Director, in consultation with 
the State offices of rural health. State offices concerning pri-
mary care, or other appropriate State government entities. 
"(d) GRANTS.— 
"(1) TELEHEALTH NETWORK GRANTS.—The Director may, 
in carrying out the telehealth network grant program referred 
to in subsection (b), award grants to eligible entities for projects 
to demonstrate how telehealth technologies can be used through 
telehealth networks in rural areas, frontier communities, and 
medically underserved areas, and for medically underserved 
populations, to— 
"(A) expand access to, coordinate, and improve the 
quality of health care services; 
"(B) improve and expand the training of health care 
providers; and 
"(C) expand and improve the quality of health informa-
tion available to health care providers, and patients and 
their families, for decisionmaking. 
"(2) 
TELEHEALTH 
RESOURCE 
CENTERS 
GRANTS.—The 
Director may, in carrying out the telehealth resource centers 
grant program referred to in subsection (b), award grants to 
eligible entities for projects to demonstrate how telehealth tech-
nologies can be used in the areas and communities, and for 
the populations, described in paragraph (1), to establish tele-
health resource centers. 
"(e) GRANT PERIODS.—The Director may award grants under 
this section for periods of not more than 4 years. 
"(f) ELIGIBLE ENTITIES.— 
"(1) TELEHEALTH NETWORK GRANTS.— 
"(A) GRANT RECIPIENT.—To be eligible to receive a 
grant under subsection (d)(1), an entity shall be a nonprofit 
entity. 
"(B) TELEHEALTH NETWORKS.— 
"(i) IN GENERAL.—To be eligible to receive a grant 
under subsection (d)(1), an entity shall demonstrate 
that the entity will provide services through a tele-
health network. 
"(ii) NATURE OF ENTITIES.—Each entity partici-
pating in the telehealth network may be a nonprofit 
or for-profit entity. 
"(iii) COMPOSITION OF NETWORK.—The telehealth 
network shall include at least 2 of the following entities 
(at least 1 of which shall be a community-based health 
care provider): 
116 STAT. 1634 
PUBLIC LAW 107-251—OCT. 26, 2002 
"(I) Community or migrant health centers or 
other Federally qualified health centers. 
"(II) Health care providers, including phar-
macists, in private practice. 
"(Ill) Entities operating clinics, including rural 
health clinics. 
"(IV) Local health departments. 
"(V) Nonprofit hospitals, including community 
access hospitals. 
"(VI) Other publicly funded health or social 
service agencies. 
"(VII) Long-term care providers. 
"(VIII) Providers of health care services in the 
home. 
"(IX) Providers of outpatient mental health 
services and entities operating outpatient mental 
health facilities. 
"(X) Local or regional emergency health care 
providers. 
"(XI) Institutions of higher education. 
"(XII) Entities operating dental clinics. 
"(2) 
TELEHEALTH 
RESOURCE 
CENTERS GRANTS.—To 
be 
eligible to receive a grant under subsection (d)(2), an entity 
shall be a nonprofit entity. 
"(g) APPLICATIONS.—To be eligible to receive a grant under 
subsection (d), an eligible entity, in consultation with the appro-
priate State office of rural health or another appropriate State 
entity, shall prepare and submit to the Secretary an application, 
at such time, in such manner, and containing such information 
as the Secretary may require, including— 
"(1) a description of the project that the eligible entity 
will carry out using the funds provided under the grant; 
"(2) a description of the manner in which the project funded 
under the grant will meet the health care needs of rural or 
other populations to be served through the project, or improve 
the access to services of, and the quality of the services received 
by, those populations; 
"(3) evidence of local support for the project, and a descrip-
tion of how the areas, communities, or populations to be served 
will be involved in the development and ongoing operations 
of the project; 
"(4) a plan for sustaining the project after Federal support 
for the project has ended; 
"(5) information on the source and amount of non-Federal 
funds that the entity will provide for the project; 
"(6) information demonstrating the long-term viability of 
the project, and other evidence of institutional commitment 
of the entity to the project; 
"(7) in the case of an application for a project involving 
a telehealth network, information demonstrating how the 
project will promote the integration of telehealth technologies 
into the operations of health care providers, to avoid redun-
dancy, and improve access to and the quality of care; and 
"(8) other such information as the Secretary determines 
to be appropriate. 
"(h) TERMS; CONDITIONS; MAXIMUM AMOUNT OF ASSISTANCE.— 
The Secretary shall establish the terms and conditions of each 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1635 
grant program described in subsection (b) and the maximum amount 
of a grant to be awarded to an individual recipient for each fiscal 
year under this section. The Secretary shall publish, in a publication Publication, 
of the Health Resources and Services Administration, notice of Notice. 
the application requirements for each grant program described in 
subsection (b) for each fiscal year. 
"(i) PREFERENCES.— 
"(1) TELEHEALTH NETWORKS.—In awarding grants under 
subsection (d)(1) for projects involving telehealth networks, the 
Secretary shall give preference to an eligible entity that meets 
at least 1 of the following requirements: 
"(A) ORGANIZATION.—The eligible entity is a rural 
community-based organization or another community-based 
organization. 
"(B) SERVICES.—The eligible entity proposes to use Fed-
eral funds made available through such a grant to develop 
plans for, or to establish, telehealth networks that provide 
mental health, public health, long-term care, home care, 
preventive, or case management services. 
"(C) COORDINATION.—The eligible entity demonstrates 
how the project to be carried out under the grant will 
be coordinated with other relevant federally funded projects 
in the areas, communities, and populations to be served 
through the grant. 
"(D) NETWORK.—The eligible entity demonstrates that 
the project involves a telehealth network that includes 
an entity that— 
"(i) provides clinical health care services, or edu-
cational services for health care providers and for 
patients or their families; and 
"(ii) is— 
"(I) a public library; 
"(II) an institution of higher education; or 
"(III) a local government entity. 
"(E) CONNECTIVITY.—The eligible entity proposes a 
project that promotes local connectivity within areas, 
communities, or populations to be served through the 
project. 
"(F) INTEGRATION.—The eligible entity demonstrates 
that health care information has-been integrated into the 
project. 
"(2) TELEHEALTH RESOURCE CENTERS.—In awarding grants 
under subsection (d)(2) for projects involving telehealth resource 
centers, the Secretary shall give preference to an eligible entity 
that meets at least 1 of the following requirements: 
"(A) PROVISION OF SERVICES.—The eligible entity has 
a record of success in the provision of telehealth services 
to medically underserved areas or medically underserved 
populations. 
"(B) COLLABORATION AND SHARING OF EXPERTISE.—^The 
eligible entity has a demonstrated record of collaborating 
and sharing expertise with providers of telehealth services 
at the national, regional, State, and local levels. 
"(C) 
BROAD RANGE OF TELEHEALTH SERVICES.—The 
eligible entity has a record of providing a broad range 
of telehealth services, which may include— 
"(i) a variety of clinical specialty services; 
116 STAT. 1636 
PUBLIC LAW 107-251—OCT. 26, 2002 
"(ii) patient or family education; 
"(iii) health care professional education; and 
"(iv) rural residency support programs, 
"(j) DISTRIBUTION OF FUNDS.— 
"(1) IN GENERAL.—In awarding grants under this section, 
the Director shall ensure, to the greatest extent possible, that 
such grants are equitably distributed among the geographical 
regions of the United States. 
"(2) TELEHEALTH NETWORKS.—In awarding grants under 
subsection (d)(1) for a fiscal year, the Director shall ensure 
that— 
"(A) not less than 50 percent of the funds awarded 
shall be awarded for projects in rural areas; and 
"(B) the total amount of funds awarded for such 
projects for that fiscal year shall be not less than the 
total amount of funds awarded for such projects for fiscal 
year 2001 under section 330A (as in effect on the day 
before the date of enactment of the Health Care Safety 
Net Amendments of 2002). 
"(k) USE OF FUNDS.— 
"(1) TELEHEALTH NETWORK PROGRAM.—The recipient of a 
grant under subsection (d)(1) may use funds received through 
such grant for salaries, equipment, and operating or other 
costs, including the cost of— 
"(A) developing and delivering clinical telehealth serv-
ices that enhance access to community-based health care 
services in rural areas, frontier communities, or medically 
underserved areas, or for medically underserved popu-
lations; 
"(B) developing and acquiring, through lease or pur-
chase, computer hardware and software, audio and video 
equipment, 
computer 
network 
equipment, 
interactive 
equipment, data terminal equipment, and other equipment 
that furthers the objectives of the telehealth network grant 
program; 
"(C)(i) developing and providing distance education, 
in a manner that enhances access to care in rural areas, 
frontier communities, or medically underserved areas, or 
for medically underserved populations; or 
"(ii) mentoring, precepting, or supervising health care 
providers and students seeking to become health care pro-
viders, in a manner that enhances access to care in the 
areas and communities, or for the populations, described 
in clause (i); 
"(D) developing and acquiring instructional program-
ming; 
"(E)(i) providing for transmission of medical data, and 
maintenance of equipment; and 
"(ii) providing for compensation (including travel 
expenses) of specialists, and referring health care providers, 
who are providing telehealth services through the tele-
health network, if no third party payment is available 
for the telehealth services delivered through the telehealth 
network; 
"(F) developing projects to use telehealth technology 
to facilitate collaboration between health care providers; 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1637 
"(G) collecting and analyzing usage statistics and data 
to document the cost-effectiveness of the telehealth serv-
ices; and 
"(H) carrying out such other activities as are consistent 
with achieving the objectives of this section, as determined 
by the Secretary. 
"(2) TELEHEALTH RESOURCE CENTERS.—The recipient of a 
grant under subsection (d)(2) may use funds received through 
such grant for salaries, equipment, and operating or other 
costs for— 
"(A) providing technical assistance, training, and sup-
port, and providing for travel expenses, for health care 
providers and a range of health care entities that provide 
or will provide telehealth services; 
"(B) disseminating information and research findings 
related to telehealth services; 
"(C) promoting effective collaboration among telehealth 
resource centers and the Office; 
"(D) conducting evaluations to determine the best utili-
zation of telehealth technologies to meet health care needs; 
"(E) promoting the integration of the technologies used 
in clinical information systems with other telehealth tech-
nologies; 
"(F) fostering the use of telehealth technologies to pro-
vide health care information and education for health care 
providers and consumers in a more effective manner; and 
"(G) implementing special projects or studies under 
the direction of the Office. 
"(1) PROHIBITED USES OF FUNDS.—^An entity that receives a 
grant under this section may not use funds made available through 
the grant— 
"(1) to acquire real property; 
"(2) for expenditures to purchase or lease equipment, to 
the extent that the expenditures would exceed 40 percent of 
the total grant funds; 
"(3) in the case of a project involving a telehealth network, 
to purchase or install transmission equipment (such as laying 
cable or telephone lines, or purchasing or installing microwave 
towers, satellite dishes, amplifiers, or digital switching equip-
ment); 
"(4) to pay for any equipment or transmission costs not 
directly related to the purposes for which the grant is awarded; 
"(5) to purchase or install general purpose voice telephone 
systems; 
"(6) for construction; or 
"(7) for expenditures for indirect costs (as determined by 
the Secretary), to the extent that the expenditures would exceed 
15 percent of the total grant funds. 
"(m) COLLABORATION.—In providing services under this section, 
an eligible entity shall collaborate, if feasible, with entities that— 
"(1)(A) are private or public organizations, that receive 
Federal or State assistance; or 
"(B) are public or private entities that operate centers, 
or carry out programs, that receive Federal or State assistance; 
and 
"(2) provide telehealth services or related activities. 
116 STAT. 1638 
PUBLIC LAW 107-251—OCT. 26, 2002 
"(n) 
COORDINATION WITH OTHER AGENCIES.—The Secretary 
shall coordinate activities carried out under grant programs 
described in subsection (b), to the extent practicable, with Federal 
and State agencies and nonprofit organizations that are operating 
similar programs, to maximize the effect of public dollars in funding 
meritorious proposals. 
"(o) OUTREACH ACTIVITIES.—^The Secretary shall establish and 
implement procedures to carry out outreach activities to advise 
potential end users of telehealth services in rural areas, frontier 
communities, medically underserved areas, and medically under-
served populations in each State about the grant programs 
described in subsection (b). 
"(p) TELEHEALTH.—It is the sense of Congtess that, for purposes 
of this section, States should develop reciprocity agreements so 
that a provider of services under this section who is a licensed 
or otherwise authorized health care provider under the law of 
1 or more States, and who, through telehealth technology, consults 
with a licensed or otherwise authorized health care provider in 
another State, is exempt, with respect to such consultation, from 
any State law of the other State that prohibits such consultation 
on the basis that the first health care provider is not a licensed 
or authorized health care provider under the law of that State. 
DeadHne. 
"(q) REPORT.—Not later than September 30, 2005, the Secretary 
shall prepare and submit to the appropriate committees of Congress 
a report on the progress and accomplishments of the grant programs 
described in subsection (b). 
"(r) REGULATIONS.—^The Secretary shall issue regulations speci-
fying, for purposes of this section, a definition of the term 'frontier 
area'. The definition shall be based on factors that include popu-
lation density, travel distance in miles to the nearest medical 
facility, travel time in minutes to the nearest medical facility, 
and such other factors as the Secretary determines to be appro-
priate. The Secretary shall develop the definition in consultation 
with the Director of the Bureau of the Census and the Administrator 
of the Economic Research Service of the Department of Agriculture. 
"(s) AUTHORIZATION OF APPROPRIATIONS.—There are authorized 
to be appropriated to carry out this section— 
"(1) for grants under subsection (d)(1), $40,000,000 for fiscal 
year 2002, and such sums as may be necessary for each of 
fiscal years 2003 through 2006; and 
"(2) for grants under subsection (d)(2), $20,000,000 for fiscal 
year 2002, and such sums as may be necessary for each of 
fiscal years 2003 through 2006.". 
Subtitle C—Mental Health Services Tele-
health Program and Rural Emergency 
Medical Service Training and Equipment 
Assistance Program 
SEC. 221. PROGRAMS. 
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 212) is further 
amended by adding at the end the following: 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1639 
"SEC. 330J. RURAL EMERGENCY MEDICAL SERVICE TRAINING AND 
42 USC 254c-15. 
EQUIPMENT ASSISTANCE PROGRAM. 
"(a) GRANTS.—The Secretary, acting through the Administrator 
of the Health Resources and Services Administration (referred to 
in this section as the 'Secretary') shall award grants to eligible 
entities to enable such entities to provide for improved emergency 
medical services in rural areas. 
"(b) ELIGIBILITY.—To be eligible to receive a grant under this 
section, an entity shall— 
"(Dbe— 
"(A) a State emergency medical services office; 
"(B) a State emergency medical services association; 
"(C) a State office of rural health; 
"(D) a local government entity; 
"(E) a State or local ambulance provider; or 
"(F) any other entity determined appropriate by the 
Secretary; and 
"(2) prepare and submit to the Secretary an application 
at such time, in such manner, and containing such information 
as the Secretary may require, that includes— 
"(A) a description of the activities to be carried out 
under the grant; and 
"(B) an assurance that the eligible entity will comply 
with the matching requirement of subsection (e). 
"(c) USE OF FUNDS.—^An entity shall use amounts received 
under a grant made under subsection (a), either directly or through 
grants to emergency medical service squads that are located in, 
or that serve residents of, a nonmetropolitan statistical area, an 
area designated as a rural area by any law or regulation of a 
State, or a rural census tract of a metropolitan statistical area 
(as determined under the most recent Goldsmith Modification, origi-
nally published in a notice of availability of funds in the Federal 
Register on February 27, 1992, 57 Fed. Reg. 6725), to— 
"(1) recruit emergency medical service personnel; 
"(2) recruit volunteer emergency medical service personnel; 
"(3) train emergency medical service personnel in emer-
gency response, injury prevention, safety awareness, and other 
topics relevant to the delivery of emergency medical services; 
"(4) fund specific training to meet Federal or State certifi-
cation requirements; 
"(5) develop new ways to educate emergency health care 
providers through the use of technology-enhanced educational 
methods (such as distance learning); 
"(6) acquire 
emergency 
medical 
services 
equipment, 
including cardiac defibrillators; 
"(7) acquire personal protective equipment for emergency 
medical services personnel as required by the Occupational 
Safety and Health Administration; and 
"(8) educate the public concerning cardiopulmonary resus-
citation, first aid, injury prevention, safety awareness, illness 
prevention, and other related emergency preparedness topics. 
"(d) PREFERENCE.—In awarding grants under this section the 
Secretary shall give preference to— 
"(1) applications that reflect a collaborative effort by 2 
or more of the entities described in subparagraphs (A) through 
(F) of subsection (b)(1); and 
116 STAT. 1640 
PUBLIC LAW 107-251—OCT. 26, 2002 
"(2) applications submitted by entities that intend to use 
amounts provided under the grant to fund activities described 
in any of paragraphs (1) through (5) of subsection (c). 
"(e) MATCHING REQUIREMENT.—The Secretary may not award 
a grant under this section to an entity unless the entity agrees 
that the entity will make available (directly or through contributions 
from other public or private entities) non-Federal contributions 
toward the activities to be carried out under the grant in an 
amount equal to 25 percent of the amount received under the 
grant. 
"(f) EMERGENCY MEDICAL SERVICES.—In this section, the term 
'emergency medical services'— 
"(1) means resources used by a qualified public or private 
nonprofit entity, or by any other entity recognized as qualified 
by the State involved, to deliver medical care outside of a 
medical facility under emergency conditions that occur— 
"(A) as a result of the condition of the patient; or 
"(B) as a result of a natural disaster or similar situa-
tion; and 
"(2) includes services delivered by an emergency medical 
services provider (either compensated or volunteer) or other 
provider recognized by the State involved that is licensed or 
certified by the State as an emergency medical technician or 
its equivalent (as determined by the State), a registered nurse, 
a physician assistant, or a physician that provides services 
similar to services provided by such an emergency medical 
services provider. 
"(g) AUTHORIZATION OF APPROPRIATIONS.— 
"(1) IN GENERAL.—^There are authorized to be appropriated 
to carry out this section such sums as may be necessary for 
each of fiscal years 2002 through 2006. 
"(2) ADMINISTRATIVE COSTS.—The Secretary may use 
not 
more than 10 percent of the amount appropriated under para-
graph (1) for a fiscal year for the administrative expenses 
of carrying out this section. 
42 use 254C-16. 
"SEC. 330K- MENTAL HEALTH SERVICES DELIVERED VIA TELEHEALTH. 
"(a) DEFINITIONS.—In this section: 
"(1) ELIGIBLE ENTITY.—The term 'eligible entity* means a 
public or nonprofit private telehealth provider network that 
offers services that include mental health services provided 
by qualified mental health providers. 
"(2) QUALIFIED MENTAL HEALTH PROFESSIONALS.—The term 
'qualified mental health professionals' refers to providers of 
mental health services reimbursed under the medicare program 
carried out under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.) who have additional training in the treat-
ment of mental illness in children and adolescents or who 
have additional training in the treatment of mental illness 
in the elderly. 
"(3) SPECIAL POPULATIONS.—The term 'special populations* 
refers to the following 2 distinct groups: 
"(A) Children and adolescents in mental health under-
served rural areas or in mental health underserved urban 
areas. 
"(B) Elderly individuals located in long-term care facili-
ties in mental health underserved rural or urban areas. 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1641 
"(4) TELEHEALTH.—The term 'telehealth' means the use 
of electronic information and telecommunications technologies 
to support long distance clinical health care, patient and profes-
sional health-related education, public health, and health 
administration. 
"(b) PROGRAM AUTHORIZED.— 
"(1) IN GENERAL.—The Secretary, acting through the 
Director of the Office for the Advancement of Telehealth of 
the Health Resources and Services Administration, shall award 
grants to eligible entities to establish demonstration projects 
for the provision of mental health services to special populations 
as delivered remotely by qualified mental health professionals 
using telehealth and for the provision of education regarding 
mental illness as delivered remotely by qualified mental health 
professionals using telehealth. 
"(2) POPULATIONS SERVED.—The Secretary shall award the 
grants under paragraph (1) in a manner that distributes the 
grants so as to serve equitably the populations described in 
subparagraphs (A) and (B) of subsection (a)(4). 
"(c) USE OF FUNDS.— 
"(1) IN GENERAL.—^An eligible entity that receives a grant 
under this section shall use the grant funds— 
"(A) for the populations described in 
subsection 
(a)(4)(A)— 
"(i) to provide mental health services, including 
diagnosis and treatment of mental illness, as delivered 
remotely by qualified mental health professionals using 
telehealth; and 
"(ii) to collaborate with local public health entities 
to provide the mental health services; and 
"(B) for the populations 
described in 
subsection 
(a)(4)(B)— 
"(i) to provide mental health services, including 
diagnosis and treatment of mental illness, in long-
term care facilities as delivered remotely by qualified 
mental health professionals using telehealth; and 
"(ii) to collaborate with local public health entities 
to provide the mental health services. 
"(2) OTHER USES.—^An eligible entity that receives a grant 
under this section may also use the grant funds to— 
"(A) pay telecommunications costs; and 
"(B) pay qualified mental health professionals on a 
reasonable cost basis as determined by the Secretary for 
services rendered. 
"(3) PROHIBITED USES.—^An eligible entity that receives a 
grant under this section shall not use the grant funds to— 
"(A) purchase or install transmission equipment (other 
than such equipment used by qualified mental health 
professionals to deliver mental health services using tele-
health under the project involved); or 
"(B) build upon or acquire real property. 
"(d) EQUITABLE DISTRIBUTION.—In awarding grants under this 
section, the Secretary shall ensure, to the greatest extent possible, 
that such grants are equitably distributed among geographical 
regions of the United States. 
"(e) APPLICATION.—^An entity that desires a grant under this 
section shall submit an application to the Secretary at such time, 
116 STAT. 1642 
PUBLIC LAW 107-251—OCT. 26, 2002 
in such manner, and containing such information as the Secretary 
determines to be reasonable. 
Deadline. 
"(f) REPORT.—Not later than 4 years after the date of enactment 
of the Health Care Safety Net Amendments of 2002, the Secretary 
shall prepare and submit to the appropriate committees of Congress 
a report that shall evaluate activities funded with grants under 
this section. 
"(g) AUTHORIZATION OF APPROPRIATIONS.—There are authorized 
to be appropriated to carry out this section, $20,000,000 for fiscal 
year 2002 and such sums as may be necessary for fiscal years 
2003 through 2006.". 
TITLE III—NATIONAL HEALTH SERVICE 
CORPS PROGRAM 
SEC. 301. NATIONAL HEALTH SERVICE CORPS. 
(a) IN GENERAL.—Section 331 of the Public Health Service 
Act (42 U.S.C. 254d) is amended— 
(1) by adding at the end of subsection (a)(3) the following: 
"(E)(i) The term 'behavioral and mental health profes-
sionals' means health service psychologists, licensed clinical 
social workers, licensed professional counselors, marriage and 
family therapists, psychiatric nurse specialists, and psychia-
trists. 
"(ii) The term 'graduate program of behavioral and mental 
health' means a program that trains behavioral and mental 
health professionals."; 
(2) in subsection (b)— 
(A) in paragraph (1), by striking "health professions" 
and inserting "health professions, including schools at 
which graduate programs of behavioral and mental health 
are offered,"; and 
(B) in paragraph (2), by inserting "behavioral and 
mental health professionals," after "dentists,"; and 
(3) by striking subsection (c) and inserting the following: 
"(c)(1) The Secretary may reimburse an applicant for a position 
in the Corps (including an individual considering entering into 
a written agreement pursuant to section 338D) for the actual and 
reasonable expenses incurred in traveling to and from 
the 
applicant's place of residence to an eligible site to which the 
applicant may be assigned under section 333 for the purpose of 
evaluating such site with regard to being assigned at such site. 
The Secretary may establish a maximum total amount that may 
be paid to an individual as reimbursement for such expenses. 
"(2) The Secretary may. also reimburse the applicant for the 
actual and reasonable expenses incurred for the travel of 1 family 
member to accompany the applicant to such site. The Secretary 
may establish a maximum total amount that may be paid to an 
individual as reimbursement for such expenses. 
"(3) In the case of an individual who has entered into a contract 
for obligated service under the Scholarship Program or under the 
Loan Repayment Program, the Secretary may reimburse such indi-
vidual for all or part of the actual and reasonable expenses incurred 
in transporting the individual, the individual's family, and the 
family's possessions to the site of the individual's assignment under 
section 333. The Secretary may establish a maximum total amount 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1643 
that may be paid to an individual as reimbursement for such 
expenses.". 
(b) DEMONSTRATION PROJECTS.—Section 331 of the Public 
Health Service Act (42 U.S.C. 254d) is amended— 
(1) by redesignating subsection (i) as subsection (j); and 
(2) by inserting after subsection (h) the following: 
"(i)(l) In carrying out subpart III, the Secretary may, in accord-
ance with this subsection, carry out demonstration projects in which 
individuals who have entered into a contract for obligated service 
under the Loan Repayment Program receive waivers under which 
the individuals are authorized to satisfy the requirement of obli-
gated service through providing clinical service that is not full-
time. 
"(2) A waiver described in paragraph (1) may be provided 
by the Secretary only if— 
"(A) the entity for which the service is to be performed— 
"(i) has been approved under section 333A for assign-
ment of a Corps member; and 
"(ii) has requested in writing assignment of a health 
professional who would serve less than full time; 
"(B) the Secretary has determined that assignment of a 
health professional who would serve less than full time would 
be appropriate for the area where the entity is located; 
"(C) a Corps member who is required to perform obligated 
service has agreed in writing to be assigned for less than 
full-time service to an entity described in subparagraph (A); 
"(D) the entity and the Corps member agree in writing 
that the less than full-time service provided by the Corps 
member will not be less than 16 hours of clinical service per 
week; 
"(E) the Corps member agrees in writing that the period 
of obligated service pursuant to section 338B will be extended 
so that the aggregate amount of less than full-time service 
performed will equal the amount of service that would be 
performed through full-time service under section 338C; and 
"(F) the Corps member agrees in writing that if the Corps 
member begins providing less than full-time service but fails 
to begin or complete the period of obligated service, the method 
stated in 338E(c) for determining the damages for breach of 
the individual's written contract will be used after converting 
periods of obligated service or of service performed into their 
full-time equivalents. 
"(3) In evaluating a demonstration project described in para-
graph (1), the Secretary shall examine the effect of multidisciplinary 
teams.". 
SEC. 302. DESIGNATION OF HEALTH PROFESSIONAL SHORTAGE AREAS. 
(a) IN GENERAL.—Section 332 of the Public Health Service 
Act (42 U.S.C. 254e) is amended— 
(1) in subsection (a)— 
(A) in paragraph (1), by inserting after the first sen-
tence the following: "All Federally qualified health centers 
and rural health clinics, as defined in section 1861(aa) 
of the Social Security Act (42 U.S.C. 1395x(aa)), that meet 
the requirements of section 334 shall be automatically des-
ignated as having such a shortage. Not earlier than 6 
years after such date of enactment, and every 6 years 
116 STAT. 1644 
PUBLIC LAW 107-251—OCT. 26, 2002 
thereafter, each such center or cHnic shall demonstrate 
that the center or clinic meets the applicable requirements 
of the Federal regulations, issued after the date of enact-
ment of this Act, that revise the definition of a health 
professional shortage area for purposes of this section."; 
and 
(B) in paragraph (3), by striking "340(r)) may be a 
population group" and inserting "330(h)(4)), seasonal agri-
cultural workers (as defined in section 330(g)(3)) and migra-
tory agricultural workers (as so defined)), and residents 
of public housing (as defined in section 3(b)(1) of the United 
States Housing Act of 1937 (42 U.S.C. 1437a(b)(l))) may 
be population groups"; 
(2) in subsection (b)(2), by striking "with special consider-
ation to the indicators of and all that follows through "serv-
ices." and inserting a period; and 
(3) in subsection (c)(2)(B), by striking "XVIII or XIX" and 
inserting "XVIII, XIX, or XXI". 
42 u s e 254e 
(b) REGULATIONS.— 
note. 
(1) REPORT.— 
(A) IN GENERAL.—The Secretary shall submit the 
report described in subparagraph (B) if the Secretary, 
acting through the Administrator of the Health Resources 
and Services Administration, issues— 
(i) a regulation that revises the definition of a 
health professional shortage area for purposes of sec-
tion 332 of the Public Health Service Act (42 U.S.C. 
254e); or 
(ii) a regulation that revises the standards con-
cerning priority of such an area under section 333A 
of that Act (42 U.S.C. 254f-l). 
(B) REPORT.—On issuing a regulation described in 
subparagraph (A), the Secretary shall prepare and submit 
to the Committee on Energy and Commerce of the House 
of Representatives and the Committee on Health, Edu-
cation, Labor, and Pensions of the Senate a report that 
describes the regulation. 
(2) EFFECTIVE DATE.—Each regulation described in para-
graph dXA) shall take effect 180 days after the committees 
described in paragraph (1)(B) receive a report referred to in 
paragraph (1)(B) describing the regulation. 
42 use 254/ 
(c) SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS.—The Sec-
note, 
retary of Health and Human Services, in consultation with organiza-
tions representing individuals in the dental field and organizations 
representing publicly funded health care providers, shall develop 
and implement a plan for increasing the participation of dentists 
and dental hygienists in the National Health Service Corps Scholar-
ship Program under section 338A of the Public Health Service 
Act (42 U.S.C. 2541) and the Loan Repayment Program under 
section 338B of such Act (42 U.S.C. 2541-1). 
(d) SITE DESIGNATION PROCESS.— 
42 u s e 254e 
(1) IMPROVEMENT OF DESIGNATION PROCESS.—^The A d m i n i s -
no**- 
trator of the Health Resources and Services Administration, 
in consultation with the Association of State and Territorial 
Dental Directors, dental societies, and other interested parties, 
shall revise the criteria on which the designations of dental 
note. 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1645 
health professional shortage areas are based so that such cri-
teria provide a more accurate reflection of oral health care 
need, particularly in rural areas. 
(2) PUBLIC HEALTH SERVICE ACT.—Section 332 of the PubUc 
Health Service Act (42 U.S.C. 254e) is amended by adding 
at the end the following: 
"(i) 
DISSEMINATION.—The 
Administrator 
of the 
Health 
Resources and Services Administration shall disseminate informa-
tion concerning the designation criteria described in subsection 
(b) to— 
"(1) the Governor of each State; 
"(2) the representative of any area, population group, or 
facility selected by any such Governor to receive such informa-
tion; 
"(3) the representative of any area, population group, or 
facility that requests such information; and 
"(4) the representative of any area, population group, or 
facility determined by the Administrator to be likely to meet 
the criteria described in subsection (b).". 
(e) GAO STUDY.—Not later than February 1, 2005, the Comp- Deadline, 
troller General of the United States shall submit to the Congress 
j ^ JJSC 254e 
a report on the appropriateness of the criteria, including but not 
limited to infant mortality rates, access to health services taking 
into account the distance to primary health services, the rate of 
poverty and ability to pay for health services, and low birth rates, 
established by the Secretary of Health and Human Services for 
the designation of health professional shortage areas and whether 
the deeming of federally qualified health centers and rural health 
clinics as such areas is appropriate and necessary. 
SEC. 303. ASSIGNMENT OF CORPS PERSONNEL. 
Section 333 of the PubHc Health Service Act (42 U.S.C. 254f) 
is amended— 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) in the matter before subparagraph (A), by 
striking "(specified in the agreement described in sec-
tion 334)"; 
(ii) in subparagraph (A), by striking "nonprofit"; 
and 
(iii) by striking subparagraph (C) and inserting 
the following: 
"(C) the entity agrees to comply with the requirements 
of section 334; and"; and 
(B) in paragraph (3), by adding at the end "In 
approving such applications, the Secretary shall give pref-
erence to applications in which a nonprofit entity or public 
entity shall provide a site to which Corps members may 
be assigned."; and 
(2) in subsection (d)— 
(A) in paragraphs (1), (2), and (4), by striking "non-
profit" each place it appears; and 
(B) in paragraph (1)— 
(i) in the second sentence— 
(I) in subparagraph (C), by striking "and" at 
the end; and 
116 STAT. 1646 
PUBLIC LAW 107-251—OCT. 26, 2002 
(II) by striking the period and inserting 
", 
and 
(E) 
developing 
long-term 
plans 
for 
addressing 
health 
professional 
shortages 
and 
improving access to health care."; and 
(ii) by adding at the end the following: "The Sec-
retary shall encourage entities that receive technical 
assistance under this paragraph to communicate with 
other communities, State Offices of Rural Health, State 
Primary Care Associations and Offices, and other enti-
ties concerned with site development and community 
needs assessment.". 
SEC. 304. PRIORITIES IN ASSIGNMENT OF CORPS PERSONNEL. 
Section 333A of the Public Health Service Act (42 U.S.C. 254f-
1) is amended— 
(1) in subsection (a)(1)(A), by striking ", as determined 
in accordance with subsection (b)"; 
(2) by striking subsection (b); 
(3) in subsection (c), by striking the second sentence; 
(4) in subsection (d)— 
(A) by redesignating paragraphs (1) through (3) as 
paragraphs (2) through (4), respectively; 
(B) by inserting before paragraph (2) (as redesignated 
by subparagraph (A)) the following: 
PubKcation. 
"(1) PROPOSED LIST.—^The Secretary shall prepare and pub-
lish a proposed list of health professional shortage areas and 
entities that would receive priority under subsection (a)(1) in 
the assignment of Corps members. The list shall contain the 
information described in paragraph (2), and the relative scores 
and relative priorities of the entities submitting applications 
under section 333, in a proposed format. All such entities 
shall have 30 days after the date of publication of the list 
to provide additional data and information in support of inclu-
sion on the list or in support of a higher priority determination 
and the Secretary shall reasonably consider such data and 
information in preparing the final list under paragraph (2)."; 
(C) in paragraph (2) (as redesignated by subparagraph 
(A)), in the matter before subparagraph (A)-— 
(i) by striking "paragraph (2)" and inserting "para-
graph (3)"; 
(ii) by striking "prepare a list of health professional 
shortage areas" and inserting "prepare and, as appro-
priate, update a list of health professional shortage 
areas and entities"; and 
(iii) by striking "for the period applicable under 
subsection (f)"; 
(D) by striking paragraph (3) (as redesignated by 
subparagraph (A)) and inserting the following: 
"(3) NOTIFICATION OF AFFECTED PARTIES.— 
DeadHne. 
"(A) ENTITIES.—Not later than 30 days after the Sec-
retary has added to a list under paragraph (2) an entity 
specified as described in subparagraph (A) of such para-
graph, the Secretary shall notify such entity that the entity 
has been provided an authorization to receive assignments 
of Corps members in the event that Corps members are 
available for the assignments. 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1647 
"(B) INDIVIDUALS.—In the case of an individual obli-
gated to provide service under the Scholarship Program, 
not later than 3 months before the date described in section 
338C(b)(5), the Secretary shall provide to such individual 
the names of each of the entities specified as described 
in paragraph (2)(B)(i) that is appropriate for the individ-
ual's medical specialty and discipline."; and 
(E) by striking paragraph (4) (as redesignated by 
subparagraph (A)) and inserting the following: 
"(4) REVISIONS.—If the Secretary proposes to make a revi- Notification. 
sion in the list under paragraph (2), and the revision would 
adversely alter the status of an entity with respect to the 
list, the Secretary shall notify the entity of the revision. Any 
entity adversely affected by such a revision shall be notified 
in writing by the Secretary of the reasons for the revision 
and shall have 30 days to file a written appeal of the determina-
tion involved which shall be reasonably considered by the Sec-
retary before the revision to the list becomes final. The revision 
to the list shall be effective with respect to assignment of 
Corps members beginning on the date that the revision becomes 
final."; 
(5) by striking subsection (e) and inserting the following: 
"(e) LIMITATION ON NUMBER OF ENTITIES OFFERED AS ASSIGN-
MENT CHOICES IN SCHOLARSHIP PROGRAM.— 
"(1) 
DETERMINATION OF AVAILABLE CORPS MEMBERS.—By Deadline. 
April 1 of each calendar year, the Secretary shall determine 
the number of participants in the Scholarship Program who 
will be available for assignments under section 333 during 
the program year beginning on July 1 of that calendar year. 
"(2) DETERMINATION OF NUMBER OF ENTITIES.—At all times 
during a program year, the number of entities specified under 
subsection (c)(2)(B)(i) shall be— 
"(A) not less than the number of participants deter-
mined with respect to that program year under paragraph 
(1); and 
"(B) not greater than twice the number of participants 
determined with respect to that program year under para-
graph (1)."; 
(6) by striking subsection (f); and 
(7) by redesignating subsections (c), (d), and (e) as sub-
sections (b), (c), and (d) respectively. 
SEC, 305. COST-SHARING. 
Subpart II of part D of title III of the Public Health Service 
Act (42 U.S.C. 254d et seq.) is amended by striking section 334 
and inserting the following: 
"SEC. 334. CHARGES FOR SERVICES BY ENTITIES USING CORPS MEM-
BERS. 
"(a) AVAILABILITY OF SERVICES REGARDLESS OF ABILITY TO PAY 
OR PAYMENT SOURCE.—^An entity to which a Corps member is 
assigned shall not deny requested health care services, and shall 
not discriminate in the provision of services to an individual— 
"(1) because the individual is unable to pay for the services; 
or 
"(2) because payment for the services would be made 
under— 
42 use 254g. 
116 STAT. 1648 
PUBLIC LAW 107-251—OCT. 26, 2002 
"(A) the medicare program under title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.); 
"(B) the medicaid program under title XIX of such 
Act (42 U.S.C. 1396 et seq.); or 
"(C) the State children's health insurance program 
under title XXI of such Act (42 U.S.C. 1397aa et seq.). 
"(b) CHARGES FOR SERVICES.—The following rules shall apply 
to charges for health care services provided by an entity to which 
a Corps member is assigned: 
"(1) IN GENERAL.— 
"(A) SCHEDULE OF FEES OR PAYMENTS.—Except as pro-
vided in paragraph (2), the entity shall prepare a schedule 
of fees or payments for the entity's services, consistent 
with locally prevailing rates or charges and designed to 
cover the entity's reasonable cost of operation. 
"(B) SCHEDULE OF DISCOUNTS.—Except as provided in 
paragraph (2), the entity shall prepare a corresponding 
schedule of discounts (including, in appropriate cases, 
waivers) to be applied to such fees or payments. In pre-
paring the schedule, the entity shall adjust the discounts 
on the basis of a patient's ability to pay. 
"(C) USE OF SCHEDULES.—The entity shall make every 
reasonable effort to secure from patients fees and payments 
for services in accordance with such schedules, and fees 
or payments shall be sufficiently discounted in accordance 
with the schedule described in subparagraph (B). 
"(2) SERVICES TO BENEFICIARIES OF FEDERAL AND FEDER-
ALLY ASSISTED PROGRAMS.—In the case of health care services 
furnished to an individual who is a beneficiary of a program 
listed in subsection (a)(2), the entity— 
"(A) shall accept an assignment pursuant to section 
1842(b)(3)(B)(ii) of the Social Security Act (42 U.S.C. 
1395u(b)(3)(B)(ii)) with respect to an individual who is a 
beneficiary under the medicare program; and 
"(B) shall enter into an appropriate agreement with— 
"(i) the State agency administering the program 
under title XIX of such Act with respect to an indi-
vidual who is a beneficiary under the medicaid pro-
gram; and 
"(ii) the State agency administering the program 
under title XXI of such Act with respect to an indi-
vidual who is a beneficiary under the State children's 
health insurance program. 
"(3) COLLECTION OF PAYMENTS.—The entity shall take 
reasonable and appropriate steps to collect all payments due 
for health care services provided by the entity, including pay-
ments from any third party (including a Federal, State, or 
local government agency and any other third party) that is 
responsible for part or all of the charge for such services.". 
SEC. 306. ELIGIBILITY FOR FEDERAL FUNDS. 
Section 335(e)(1)(B) of the Public Health Service Act (42 U.S.C. 
254h(e)(l)(B)) is amended by striking "XVIII or XIX" and inserting 
"XVIII, XIX, or XXI". 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1649 
SEC. 307. FACILITATION OF EFFECTIVE PROVISION OF CORPS SERV-
ICES. 
(a) HEALTH PROFESSIONAL SHORTAGE AREAS.—Section 336 of 
the Public Health Service Act (42 U.S.C. 254h-l) is amended— 
(1) in subsection (c), by striking "health manpower" and 
inserting "health professional"; and 
(2) in subsection (f)(1), by striking "health manpower" and 
inserting "health professional". 
(b) TECHNICAL AMENDMENT.—Section 336A(8) of the Public 
Health Service Act (42 U.S.C. 254i(8)) is amended by striking 
"agreements under". 
SEC. 308. AUTHORIZATION OF APPROPRIATIONS. 
Section 338(a) of the Public Health Service Act (42 U.S.C. 
254k(a)) is amended— 
(1) by striking "(1) For" and inserting "For"; 
(2) by striking "1991 through 2000" and inserting "2002 
through 2006"; and 
(3) by striking paragraph (2). 
SEC. 309. NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PRO-
GRAM. 
Section 338A of the Public Health Service Act (42 U.S.C. 2541) 
is amended— 
(1) in subsection (a)(1), by inserting "behavioral and mental 
health professionals," after "dentists,"; 
(2) in subsection (b)(1)(B), by inserting ", or an appropriate 
degree from a graduate program of behavioral and mental 
health" after "other health profession"; 
(3) in subsection (c)(1)--
(A) in subparagraph (A), by striking "338D" and 
inserting "338E"; and 
(B) in subparagraph (B), by striking "338C" and 
inserting "338D"; 
(4) in subsection (d)(1)— 
(A) in subparagraph (A), by striking "and" at the end; 
(B) by redesignating subparagraph (B) as subpara-
graph (C); and 
(C) by inserting after subparagraph (A) the following: 
"(B) the Secretary, in considering applications from 
individuals accepted for enrollment or enrolled in dental 
school, shall consider applications from all individuals 
accepted for enrollment or enrolled in any accredited dental 
school in a State; and"; 
(5) in subsection (f)— 
(A) in paragraph (1)(B)— 
(i) in clause (iii), by striking "and" after the semi-
colon; 
(ii) by redesignating clause (iv) as clause (v); and 
(iii) by inserting after clause (iii) the following 
new clause: 
"(iv) if pursuing a degree from a school of medicine 
or osteopathic medicine, to complete a residency in 
a specialty that the Secretary determines is consistent 
with the needs of the Corps; and"; and 
(B) in paragraph (3), by striking "338D" and inserting 
"338E"; and 
116 STAT. 1650 
PUBLIC LAW 107-251—OCT. 26, 2002 
(6) by striking subsection (i). 
SEC. 310. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT PRO-
GRAM. 
Section 338B of the Public Health Service Act (42 U.S.C. 2541-
1) is amended— 
(1) in subsection (a)— 
(A) in paragraph (1), by inserting "behavioral and 
mental health professionals," after "dentists,"; and 
(B) in paragraph (2), by striking "(including mental 
health professionals)"; 
(2) in subsection (b)(1), by striking subparagraph (A) and 
inserting the following: 
"(A) have a degree in medicine, osteopathic medicine, den-
tistry, or another health profession, or an appropriate degree 
from a graduate program of behavioral and mental health, 
or be certified as a nurse midwife, nurse practitioner, or physi-
cian assistant;"; 
(3) in subsection (e), by striking "(1) IN GENERAL.—^"; and 
(4) by striking subsection (i). 
SEC. 311. OBLIGATED SERVICE. 
Section 3380 of the Public Health Service Act (42 U.S.C. 254m) 
is amended— 
(1) in subsection (b)— 
(A) in paragraph (1), in the matter preceding subpara-
graph (A), by striking "section 338A(f)(l)(B)(iv)" and 
inserting "section 338A(f)(l)(B)(v)"; and 
(B) in paragraph (5)— 
(i) by striking all that precedes subparagraph (C) 
and inserting the following: 
"(5)(A) In the case of the Scholarship Program, the date referred 
to in paragraphs (1) through (4) shall be the date on which the 
individual completes the training required for the degree for which 
the individual receives the scholarship, except that— 
"(i) for an individual receiving such a degree after Sep-
tember 30, 2000, from a school of medicine or osteopathic 
medicine, such date shall be the date the individual completes 
a residency in a specialty that the Secretary determines is 
consistent with the needs of the Corps; and 
"(ii) at the request of an individual, the Secretary may, 
consistent with the needs of the Corps, defer such date until 
the end of a period of time required for the individual to 
complete advanced training (including an internship or resi-
dency)."; 
(ii) by striking subparagraph (D); 
(iii) by redesignating subparagraphs (C) and (E) 
as subparagraphs (B) and (C), respectively; and 
(iv) in clause (i) of subparagraph (C) (as redesig-
nated by clause (iii)) by striking "subparagraph (A), 
(B), or (D)" and inserting "subparagraph (A)"; and 
(2) by striking subsection (e). 
SEC. 312. PRIVATE PRACTICE. 
Section 338D of the Pubhc Health Service Act (42 U.S.C. 254n) 
is amended by striking subsection (b) and inserting the following: 
"(b)(1) The written agreement described in subsection (a) 
shall— 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1651 
"(A) provide that, during the period of private practice 
by an individual pursuant to the agreement, the individual 
shall comply with the requirements of section 334 that apply 
to entities; and 
"(B) contain such additional provisions as the Secretary 
may require to carry out the objectives of this section. 
"(2) The Secretary shall take such action as may be appropriate 
to ensure that the conditions of the written agreement prescribed 
by this subsection are adhered to.". 
SEC. 
313. 
BREACH 
OF 
SCHOLARSHIP 
CONTRACT 
OR 
LOAN 
REPAYMENT 
CONTRACT. 
(a) IN GENERAL.—Section 338E of the Public Health Service 
Act (42 U.S.C. 254o) is amended— 
(1) in subsection (a)(1)— 
(A) in subparagraph (A), by striking the comma and 
inserting a semicolon; 
(B) in subparagraph (B), by striking the comma and 
inserting "; or"; 
(C) in subparagraph (C), by striking "or" at the end; 
and 
(D) by striking subparagraph (D); 
(2) in subsection (b)— 
(A) in paragraph (1)(A)— 
(i) by striking "338F(dr and inserting "338G(d)"; 
(ii) by striking "either"; 
(iii) by striking "338D or" and inserting "338D,"; 
and 
(iv) by inserting "or to complete a required resi-
dency as specified in section 338A(f)(l)(B)(iv)," before 
"the United States"; and 
(B) by adding at the end the following new paragraph: 
"(3) The Secretary may terminate a contract with an individual Deadline, 
under section 338A if, not later than 30 days before the end of 
the school year to which the contract pertains, the individual— 
"(A) submits a written request for such termination; and 
"(B) repays all amounts paid to, or on behalf of, the indi-
vidual under section 338A(g)."; 
(3) in subsection (c)— 
(A) in paragraph (1)— 
(i) in the matter preceding subparagraph (A), by 
striking "338F(d)" and inserting "338G(d)"; and 
(ii) by striking subparagraphs (A) through (C) and 
inserting the following: 
"(A) the total of the amounts paid by the United States 
under section 338B(g) on behalf of the individual for any 
period of obligated service not served; 
"(B) an amount equal to the product of the number 
of months of obligated service that were not completed 
by the individual, multiplied by $7,500; £ind 
"(C) the interest on the amounts described in subpara-
graphs (A) and (B), at the maximum legal prevailing rate, 
as determined by the Treasurer of the United States, from 
the date of the breach; 
except that the amount the United States is entitled to recover 
under this paragraph shall not be less than $31,000."; 
116 STAT. 1652 
PUBLIC LAW 107-251—OCT. 26, 2002 
(B) by striking paragraphs (2) and (3) and inserting 
the following: 
Deadline. 
"(2) The Secretary may terminate a contract with an individual 
under section 338B if, not later than 45 days before the end of 
the fiscal year in which the contract was entered into, the 
individual— 
"(A) submits a written request for such termination; and 
"(B) repays all amounts paid on behalf of the individual 
under section 338B(g)."; and 
(C) by redesignating paragraph (4) as paragraph (3); 
(4) in subsection (dX3)(A), by striking "only if such dis-
charge is granted after the expiration of the five-year period" 
and inserting "only if such discharge is granted after the expira-
tion of the 7-year period"; and 
(5) by adding at the end the following new subsection: 
"(e) Notwithstanding any other provision of Federal or State 
law, there shall be no limitation on the period within which suit 
may be filed, a judgment may be enforced, or an action relating 
to an offset or garnishment, or other action, may be initiated 
or taken by the Secretary, the Attorney General, or the head of 
another Federal agency, as the case may be, for the repayment 
of the amount due from an individual under this section.". 
42USC2540 
(b) EFFECTIVE DATE.—The amendment made by subsection 
note. 
(a)(4) shall apply to any obligation for which a discharge in bank-
ruptcy has not been granted before the date that is 31 days after 
the date of enactment of this Act. 
SEC. 314. AUTHORIZATION OF APPROPRIATIONS. 
Section 338H of the Public Health Service Act (42 U.S.C. 254q) 
is amended to read as follows: 
"SEC. 338H. AUTHORIZATION OF APPROPRIATIONS. 
"(a) AUTHORIZATION OF APPROPRIATIONS.—For the purposes of 
carrying out this subpart, there are authorized to be appropriated 
$146,250,000 for fiscal year 2002, and such sums as may be nec-
essary for each of fiscal years 2003 through 2006. 
"(b) SCHOLARSHIPS FOR NEW PARTICIPANTS.—Of the amounts 
appropriated under subsection (a) for a fiscal year, the Secretary 
shall obligate not less than 10 percent for the purpose of providing 
contracts for— 
"(1) scholarships under this subpart to individuals who 
have not previously received such scholarships; or 
"(2) scholarships or loan repayments under the Loan Repay-
ment Program under section 338B to individuals from disadvan-
taged backgrounds. 
"(c) SCHOLARSHIPS AND LOAN REPAYMENTS.—^With respect to 
certification as a nurse practitioner, nurse midwife, or physician 
assistant, the Secretary shall, from amounts appropriated under 
subsection (a) for a fiscal year, obligate not less than a total of 
10 percent for contracts for both scholarships under the Scholarship 
Program under section 338A and loan repayments under the Loan 
Repayment Program under section 338B to individuals who are 
entering the first year of a course of study or program described 
in section 338A(b)(l)(B) that leads to such a certification or individ-
uals who are eligible for the loan repa5niient program as specified 
in section 338B(b) for a loan related to such certification.". 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1653 
SEC. 315. GRANTS TO STATES FOR LOAN REPAYMENT PROGRAMS. 
Section 3381 of the Public Health Service Act (42 U.S.C. 254q-
1) is amended— 
(1) in subsection (a), by striking paragraph (1) and inserting 
the following: 
"(1) 
AUTHORITY 
FOR 
GRANTS.—The Secretary, 
acting 
through the Administrator of the Health Resources and Services 
Administration, may make grants to States for the purpose 
of assisting the States in operating programs described in para-
graph (2) in order to provide for the increased availability 
of primary health care services in health professional shortage 
areas. The National Advisory Council established under section 
337 shall advise the Administrator regarding the program 
under this section."; 
(2) in subsection (e), by striking paragraph (1) and inserting 
the following: 
"(1) to submit to the Secretary such reports regarding 
the States loan repayment program, as are determined to be 
appropriate by the Secretary; and"; and 
(3) in subsection (i), by striking paragraph (1) and inserting 
the following: 
"(1) IN GENERAL.—For the purpose of making grants under 
subsection (a), there are authorized to be 
appropriated 
$12,000,000 for fiscal year 2002 and such sums as may be 
necessary for each of fiscal years 2003 through 2006.". 
SEC. 316. DEMONSTRATION GRANTS TO STATES FOR COMMUNITY 
SCHOLARSHIP PROGRAMS. 
Section 338L of the Public Health Service Act (42 U.S.C. 254t) 
is repealed. 
SEC. 317. DEMONSTRATION PROJECT. 
Subpart III of part D of title III of the Public Health Service 
Act (42 U.S.C. 2541 et seq.) is amended by adding at the end 
the following: 
"SEC. 338L. DEMONSTRATION PROJECT. 
42 USC 254t. 
"(a) PROGRAM AUTHORIZED.—The Secretary shall establish a 
demonstration project to provide for the participation of individuals 
who are chiropractic doctors or pharmacists in the Loan Repayment 
Program described in section 338B. 
"(b) PROCEDURE.—^An individual that receives assistance under 
this section with regard to the program described in section 338B 
shall comply with all rules and requirements described in such 
section (other than subparagraphs (A) and (B) of section 338B(b)(l)) 
in order to receive assistance under this section. 
"(c) LIMITATIONS.— 
"(1) IN GENERAL.—^The demonstration project described in 
this section shall provide for the participation of individuals 
who shall provide services in rural and urban areas. 
"(2) AVAILABILITY OF OTHER HEALTH PROFESSIONALS.—^The 
Secretary may not assign an individual receiving assistance 
under this section to provide obligated service at a site unless— 
"(A) the Secretary has assigned a physician (as defined 
in section 186 l(r) of the Social Security Act) or other health 
professional licensed to prescribe drugs to provide obligated 
service at such site under section 338C or 338D; and 
116 STAT. 1654 
PUBLIC LAW 107-251—OCT. 26, 2002 
"(B) such physician or other health professional will 
provide obligated service at such site concurrently with 
the individual receiving assistance under this section. 
"(3) RULES OF CONSTRUCTION.— 
"(A) SUPERVISION OF INDIVIDUALS.—Nothing in this sec-
tion shall be construed to require or imply that a physician 
or other health professional licensed to prescribe drugs 
must supervise an individual receiving assistance under 
the demonstration project under this section, with respect 
to such project. 
"(B) LICENSURE OF HEALTH PROFESSIONALS.—Nothing 
in this section shall be construed to supersede State law 
regarding licensure of health professionals. 
"(d) DESIGNATIONS.—The demonstration project described in 
this section, and any providers who are selected to participate 
in such project, shall not be considered by the Secretary in the 
designation of a health professional shortage area under section 
332 during fiscal years 2002 through 2004. 
"(e) RULE OF CONSTRUCTION.—This section shall not be con-
strued to require any State to participate in the project described 
in this section. 
"(f) REPORT.— 
"(1) IN GENERAL.—The Secretary shall evaluate the partici-
pation of individuals in the demonstration projects under this 
section and prepare and submit a report containing the informa-
tion described in paragraph (2) to— 
"(A) the Committee on Health, Education, Labor, and 
Pensions of the Senate; 
"(B) the Subcommittee on Labor, Health and Human 
Services, and Education of the Committee on Appropria-
tions of the Senate; 
"(C) the Committee on Energy and Commerce of the 
House of Representatives; and 
"(D) the Subcommittee on Labor, Health and Human 
Services, and Education of the Committee on Appropria-
tions of the House of Representatives. 
"(2) CONTENT.—The report described in paragraph (1) shall 
detail— 
"(A) the manner in which the demonstration project 
described in this section has affected access to primary 
care services, patient satisfaction, quality of care, and 
health care services provided for traditionally underserved 
populations; 
"(B) how the participation of chiropractic doctors and 
pharmacists in the Loan Repayment Program might affect 
the designation of health professional shortage areas; and 
"(C) whether adding chiropractic doctors and phar-
macists as permanent members of the National Health 
Service Corps would be feasible and would enhance the 
effectiveness of the National Health Service Corps. 
"(g) AUTHORIZATION OF APPROPRIATIONS.— 
"(1) IN GENERAL.—There are authorized to be appropriated 
to carry out this section, such sums as may be necessary 
for fiscal years 2002 through 2004. 
Deadline. 
"(2) FISCAL YEAR 2005.—If the Secretary determines and 
certifies to Congress by not later than September 30, 2004, 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1655 
that the number of individuals participating in the demonstra-
tion project estabUshed under this section is insufficient for 
purposes of performing the evaluation described in subsection 
(f)(1), the authorization of appropriations under paragraph (1) 
shall be extended to include fiscal year 2005.". 
TITLE IV—HEALTHY COMMUNITIES 
ACCESS PROGRAM 
SEC. 401. PURPOSE. 
42 USC 256 note. 
The purpose of this title is to provide assistance to communities 
and consortia of health care providers and others, to develop or 
strengthen integrated community health care delivery systems that 
coordinate health care services for individuals who are uninsured 
or underinsured and to develop or strengthen activities related 
to providing coordinated care for individuals with chronic conditions 
who are uninsured or underinsured, through the— 
(1) coordination of services to allow individuals to receive 
efficient and higher quality care and to gain entry into and 
receive services from a comprehensive system of care; 
(2) development of the infrastructure for a health care 
delivery 
system 
characterized 
by 
effective 
collaboration, 
information sharing, and clinical and financial coordination 
among all providers of care in the community; and 
(3) provision of new Federal resources that do not supplant 
funding for existing Federal categorical programs that support 
entities providing services to low-income populations. 
SEC. 402. CREATION OF HEALTHY COMMUNITIES ACCESS PROGRAM. 
Part D of title III of the Public Health Service Act (42 U.S.C. 
254b et seq.) is amended by inserting after subpart IV the following 
new subpart: 
"Subpart V—^Healthy Communities Access 
Program 
"SEC. 340. GRANTS TO STRENGTHEN THE EFFECTIVENESS, EFFI- 
42 USC 256. 
CEENCY, AND COORDINATION OF SERVICES FOR THE 
UNINSURED AND UNDERINSURED. 
"(a) IN GENERAL.—^The Secretary may award grants to eligible 
entities to assist in the development of integrated health care 
delivery systems to serve communities of individuals who are unin-
sured and individuals who are underinsured— 
"(1) to improve the efficiency of, and coordination among, 
the providers providing services through such systems; 
"(2) to assist communities in developing programs targeted 
toward preventing and managing chronic diseases; and 
"(3) to expand and enhance the services provided through 
such systems. 
"(b) ELIGIBLE ENTITIES.—To be eligible to receive a grant under 
this section, an entity shall be an entity that— 
"(1) represents a consortium— 
"(A) whose principal purpose is to provide a broad 
rsmge of coordinated health care services for a community 
116 STAT. 1656 
PUBLIC LAW 107-251—OCT. 26, 2002 
defined in the entity's grant application as described in 
paragraph (2); and 
"(B) that includes at least one of each of the following 
providers that serve the community (unless such provider 
does not exist within the community, declines or refuses 
to participate, or places unreasonable conditions on their 
participation)— 
"(i) a Federally qualified health center (as defined 
in section 1861(aa) of the Social Security Act (42 U.S.C. 
1395x(aa))); 
"(ii) a hospital with a low-income utilization rate 
(as defined in section 1923(b)(3) of the Social Security 
Act (42 U.S.C. 1396r-4(b)(3)), that is greater than 25 
percent; 
"(iii) a public health department; and 
"(iv) an interested public or private sector health 
care provider or an organization that has traditionally 
served the medically uninsured and underserved; and 
"(2) submits to the Secretary an application, in such form 
and manner as the Secretary shall prescribe, that— 
"(A) defines a community or geographic area of unin-
sured and underinsured individuals; 
"(B) identifies the providers who will participate in 
the consortium's program under the grant, and specifies 
each provider's contribution to the care of uninsured iand 
underinsured individuals in the community, including the 
volume of care the provider provides to beneficiaries under 
the medicare, medicaid, and State child health insurance 
programs and to patients who pay privately for services; 
"(C) describes the activities that the applicant and 
the consortium propose to perform under the grant to fur-
ther the objectives of this section; 
"(D) demonstrates the consortium's ability to build on 
the current system (as of the date of submission of the 
application) for serving a community or geographic area 
of uninsured and underinsured individuals by involving 
providers who have traditionally provided a significant 
volume of care for that community; 
"(E) demonstrates the consortium's ability to develop 
coordinated systems of care that either directly provide 
or ensure the prompt provision of a broad range of high-
quality, accessible services, including, as appropriate, pri-
mary, secondary, and tertiary services, as well as substance 
abuse treatment and mental health services in a manner 
that assures continuity of care in the community or 
geographic area; 
"(F) provides evidence of community involvement in 
the development, implementation, and direction of the pro-
gram that the entity proposes to operate; 
"(G) demonstrates the consortium's ability to ensure 
that individuals participating in the program are enrolled 
in public insurance programs for which the individuals 
are eligible or know of private insurance programs where 
available; 
"(H) presents a plan for leveraging other sources of 
revenue, which may include State and local sources and 
private grant funds, and integrating current and proposed 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1657 
new funding sources in a way to assure long-term sustain-
ability of the program; 
"(I) describes a plan for evaluation of the activities 
carried out under the grant, including measurement of 
progress toward the goals and objectives of the program 
and the use of evaluation findings to improve program 
performance; 
"(J) demonstrates fiscal responsibility through the use 
of appropriate accounting procedures and appropriate 
management systems; 
"(K) demonstrates the consortium's commitment to 
serve the community without regard to the ability of an 
individual or family to pay by arranging for or providing 
free or reduced charge care for the poor; and 
"(L) includes such other information as the Secretary 
may prescribe. 
"(c) LIMITATIONS.— 
"(1) NUMBER OF AWARDS.— 
"(A) IN GENERAL.—For each of fiscal years 2003, 2004, 
2005, and 2006, the Secretary may not make more than 
35 new awards under subsection (a) (excluding renewals 
of such awards). 
"(B) RULE OF CONSTRUCTION.—This paragraph shall 
not be construed to affect awards made before fiscal year 
2003. 
"(2) IN GENERAL.—^An eligible entity may not receive a 
grant under this section (including with respect to any such 
grant made before fiscal year 2003) for more than 3 consecutive 
fiscal years, except that such entity may receive such a grant 
award for not more than 1 additional fiscal year if— 
"(A) the eligible entity submits to the Secretary a 
request for a grant for such an additional fiscal year; 
"(B) the Secretary determines that extraordinary cir-
cumstances (as defined in paragraph (3)) justify the 
granting of such request; and 
"(C) the Secretary determines that granting such 
request is necessary to further the objectives described 
in subsection (a). 
"(3) EXTRAORDINARY CIRCUMSTANCES.— 
"(A) IN GENERAL.—In paragraph (2), the term 'extraor-
dinary circumstances' means an event (or events) that is 
outside of the control of the eligible entity that has pre-
vented the eligible entity from fulfilling the objectives 
described by such entity in the application submitted imder 
subsection (b)(2). 
"(B) 
EXAMPLES.—Extraordinary 
circumstances 
include— 
"(i) natural disasters or other major disruptions 
to the security or health of the community or 
geographic area served by the eligible entity; or 
"(ii) a significant economic deterioration in the 
community or geographic area served by such eligible 
entity, that directly and adversely affects the entity 
receiving an award under subsection (a). 
"(d) PRIORITIES.—In awarding grants under this section, the 
Secretary— 
99-194 0-03-3 :QL3Part3 
116 STAT. 1658 
PUBLIC LAW 107-251—OCT. 26, 2002 
"(1) shall accord priority to applicants that demonstrate 
the extent of unmet need in the community involved for a 
more coordinated system of care; and 
"(2) may accord priority to applicants that best promote 
the objectives of this section, taking into consideration the 
extent to which the application involved— 
"(A) identifies a community whose geographical area 
has a high or increasing percentage of individuals who 
are uninsured; 
"(B) demonstrates that the applicant has included in 
its consortium providers, support systems, and programs 
that have a tradition of serving uninsured individuals and 
underinsured individuals in the community; 
"(C) shows evidence that the program would expand 
utilization of preventive and primary care services for unin-
sured and underinsured individuals and families in the 
community, including behavioral and mental health serv-
ices, oral health services, or substance abuse services; 
"(D) proposes a program that would improve coordina-
tion between health care providers and appropriate social 
service providers; 
"(E) demonstrates collaboration with State and local 
governments; 
"(F) demonstrates that the applicant makes use of 
non-Federal contributions to the greatest extent possible; 
or 
"(G) demonstrates a likelihood that the proposed pro-
gram will continue after support under this section ceases. 
"(e) USE OF FUNDS.— 
"(1) U S E BY GRANTEES.— 
"(A) IN GENERAL.—Except as provided in paragraphs 
(2) and (3), a grantee may use amounts provided under 
this section only for— 
"(i) direct expenses associated with achieving the 
greater integration of a health care delivery system 
so that the system either directly provides or ensures 
the provision of a broad range of culturally competent 
services, as appropriate, including primary, secondary, 
and tertiary services, as well as substance abuse treat-
ment and mental health services; and 
"(ii) direct patient care and service expansions to 
fill identified or documented gaps within an integrated 
delivery system. 
"(B) SPECIFIC USES.—^The following are examples of 
purposes for which a grantee may use grant funds under 
this section, when such use meets the conditions stated 
in subparagraph (A): 
"(i) Increases in outreach activities and closing 
gaps in health care service. 
"(ii) Improvements to case management. 
"(iii) Improvements to coordination of transpor-
tation to health care facilities. 
"(iv) Development of provider networks and other 
innovative models to engage physicians in voluntary 
efforts to serve the medically underserved within a 
community. 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1659 
"(v) Recruitment, training, and compensation of 
necessary personnel. 
"(vi) Acquisition of technology for the purpose of 
coordinating care. 
"(vii) Improvements to provider communication, 
including implementation of shared information sys-
tems or shared clinical systems. 
"(viii) Development of common processes for deter-
mining eligibility for the programs provided through 
the system, including creating common identification 
cards and single sliding scale discounts. 
"(ix) Development of specific prevention and dis-
ease management tools and processes. 
"(x) Translation services. 
"(xi) 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 private entities provide non-Fed-
eral contributions to supplement the Federal funds 
provided through the grants for the initiatives. 
"(2) DIRECT PATIENT CARE LIMITATION.—Not more than 15 
percent of the funds provided under a grant awarded under 
this section may be used for providing direct patient care and 
services. 
"(3) RESERVATION OF FUNDS FOR NATIONAL PROGRAM PUR-
POSES.—The Secretary may use not more than 3 percent of 
funds appropriated to carry out this section for providing tech-
nical assistance to grantees, obtaining assistance of experts 
and consultants, holding meetings, developing of tools, dissemi-
nating of information, evaluation, and carrying out activities 
that will extend the benefits of programs funded under this 
section to communities other than the community served by 
the program funded. 
"(f) GRANTEE REQUIREMENTS.— 
"(1) EVALUATION OF EFFECTIVENESS.—^A grantee under this 
section shall— 
"(A) report to the Secretary annually regarding— 
"(i) progress in meeting the goals and measurable 
objectives set forth in the grant application submitted 
by the grantee under subsection (b); and 
"(ii) the extent to which activities conducted by 
such grantee have— 
"(I) improved the effectiveness, efficiency, and 
coordination of services for uninsured and under-
insured 
individuals 
in 
the 
communities 
or 
geographic areas served by such grantee; 
"(II) resulted in the provision of better quality 
health care for such individuals; and 
"(III) resulted in the provision of health care 
to such individuals at lower cost than would have 
been possible in the absence of the activities con-
ducted by such grantee; and 
"(B) provide for an independent annual financial audit 
of all records that relate to the disposition of funds received 
through the grant. 
"(2) PROGRESS.—The Secretary may not renew an annual 
grant under this section for an entity for a fiscal year unless 
116 STAT. 1660 
PUBLIC LAW 107-251—OCT. 26, 2002 
the Secretary is satisfied that the consortium represented by 
the entity has made reasonable and demonstrable progress 
in meeting the goals and measurable objectives set forth in 
the entity's grant application for the preceding fiscal year. 
"(g) MAINTENANCE OF EFFORT.—^With respect to activities for 
which a grant under this section is authorized, the Secretary may 
award such a grant only if the applicant for the grant, and each 
of the participating providers, agree that the grantee and each 
such provider will maintain its expenditures of non-Federal funds 
for such activities at a level that is not less than the level of 
such expenditures during the fiscal year immediately preceding 
the fiscal year for which the applicant is applying to receive such 
grant. 
"(h) 
TECHNICAL ASSISTANCE.—The Secretary 
may, 
either 
directly or by grant or contract, provide any entity that receives 
a grant under this section with technical and other nonfinancial 
assistance necessary to meet the requirements of this section. 
Deadline. 
"(i) EVALUATION OF PROGRAM.—Not later than September 30, 
2005, the Secretary shall prepare and submit to the appropriate 
committees of Congress a report that describes the extent to which 
projects funded under this section have been successful in improving 
the effectiveness, efficiency, and coordination of services for unin-
sured and underinsured 
individuals 
in the communities 
or 
geographic areas served by such projects, including whether the 
projects resulted in the provision of better quality health care 
for such individuals, and whether such care was provided at lower 
costs, than would have been provided in the absence of such projects, 
"(j) DEMONSTRATION AUTHORITY.—The Secretary may make 
demonstration awards under this section to historically black health 
professions schools for the purposes of— 
"(1) developing patient-based research infrastructure at 
historically black health professions schools, which have an 
affiliation, or affiliations, with any of the providers identified 
in subsection (b)(1)(B); 
"(2) establishment of joint and collaborative programs of 
medical research and data collection between historically black 
health professions schools and such providers, whose goal is 
to improve the health status of medically underserved popu-
lations; or 
"(3) supporting the research-related costs of patient care, 
data collection, and academic training resulting from such affili-
ations. 
"(k) AUTHORIZATION OF APPROPRLVTIONS.—There are authorized 
to be appropriated to carry out this section such sums as may 
be necessary for each of fiscal years 2002 through 2006. 
"(1) DATE CERTAIN FOR TERMINATION OF PROGRAM.—Funds may 
not be appropriated to carry out this section after September 30, 
2006.". 
SEC. 403. EXPANDING AVAILABILITY OF DENTAL SERVICES. 
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: 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1661 
"Subpart X—Primary Dental Programs 
"SEC. 340F. DESIGNATED DENTAL HEALTH PROFESSIONAL SHORT- 
42 USC 256f. 
AGE AREA. 
"In this subpart, the term 'designated dental health professional 
shortage area' means an area, population group, or facility that 
is designated by the Secretary as a dental health professional 
shortage area under section 332 or designated by the applicable 
State as having a dental health professional shortage. 
**SEC. 340G. GRANTS FOR INNOVATIVE PROGRAMS. 
42 USC 256g. 
"(a) GRANT PROGRAM AUTHORIZED.—The Secretary, acting 
through the Administrator of the Health Resources and Services 
Administration, is authorized to award grants to States for the 
purpose of helping States develop and implement innovative pro-
grams to address the dental workforce needs of designated dental 
health professional shortage areas in a manner that is appropriate 
to the States' individual needs. 
"(b) STATE ACTIVITIES.—^A State receiving a grant under sub-
section (a) may use funds received under the grant for— 
"(1) loan forgiveness and repayment programs for dentists 
who— 
"(A) agree to practice in designated dental health 
professional shortage areas; 
"(B) are dental school graduates who agree to serve 
as public health dentists for the Federal, State, or local 
government; and 
"(C) agree to— 
"(i) provide services to patients regardless of such 
patients' ability to pay; and 
"(ii) use a sliding payment scale for patients who 
are unable to pay the total cost of services; 
"(2) dental recruitment and retention efforts; 
"(3) grants and low-interest or no-interest loans to help 
dentists who participate in the medicaid program under title 
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) to 
establish or expand practices in designated dental health profes-
sional shortage areas by equipping dental offices or sharing 
in the overhead costs of such practices; 
"(4) the establishment or expansion of dental residency 
programs in coordination with accredited dental training 
institutions in States without dental schools; 
"(5) programs developed in consultation with State and 
local dental societies to expand or establish oral health services 
and facilities in designated dental health professional shortage 
areas, including services and facilities for children with special 
needs, such as— 
"(A) the expansion or establishment of a community-
based dental facility, free-standing dental clinic, consoli-
dated health center dental facility, school-linked dental 
facility, or United States dental school-based facility; 
"(B) the establishment of a mobile or portable dental 
clinic; and 
"(C) the establishment or expansion of private dental 
services to enhance capacity through additional equipment 
or additional hours of operation; 
116 STAT. 1662 
PUBLIC LAW 107-251—OCT. 26, 2002 
Deadline. 
42 u s e 1396a 
note. 
"(6) placement and support of dental students, dental resi-
dents, and advanced dentistry trainees; 
"(7) continuing dental education, including distance-based 
education; 
"(8) practice support through teledentistry conducted in 
accordance with State laws; 
"(9) community-based prevention services such as water 
fluoridation and dental sealant programs; 
"(10) coordination with local educational agencies within 
the State to foster programs that promote children going into 
oral health or science professions; 
"(11) the establishment of faculty recruitment programs 
at accredited dental training institutions whose mission 
includes community outreach and service and that have a dem-
onstrated record of serving underserved States; 
"(12) the development of a State dental officer position 
or the augmentation of a State dental office to coordinate oral 
health and access issues in the State; and 
"(13) any other activities determined to be appropriate 
by the Secretary. 
"(c) APPLICATION.— 
"(1) IN GENERAL.—Each State desiring 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. 
"(2) ASSURANCES.—The application shall include assurances 
that the State will meet the requirements of subsection (d) 
and that the State possesses sufficient infrastructure to manage 
the activities to be funded through the grant and to evaluate 
and report on the outcomes resulting from such activities. 
"(d) MATCHING REQUIREMENT.—The Secretary may not make 
a grant to a State under this section unless that State agrees 
that, with respect to the costs to be incurred by the State in 
carrying out the activities for which the grant was awarded, the 
State will provide non-Federal contributions in an amount equal 
to not less than 40 percent of Federal funds provided under the 
grant. The State may provide the contributions in cash or in kind, 
fairly evaluated, including plant, equipment, and services and may 
provide the contributions from State, local, or private sources. 
"(e) REPORT.—Not later than 5 years after the date of enactment 
of the Health Care Safety Net Amendments of 2002, the Secretary 
shall prepare and submit to the appropriate committees of Congress 
a report containing data relating to whether grants provided under 
this section have increased access to dental services in designated 
dental health professional shortage areas. 
"(f) AUTHORIZATION OF APPROPRIATIONS.—There is authorized 
to be appropriated to carry out this section, $50,000,000 for the 
5-fiscal year period beginning with fiscal year 2002.". 
SEC. 404. STUDY REGARDING BARRIERS TO PARTICIPATION OF FARM-
WORKERS IN HEALTH PROGRAMS. 
(a) IN GENERAL.— 
problems experienced 
under Medicaid and 
examine the following: 
(1) BARRIERS 
ment, including a 
The Secretary shall conduct a study of the 
by farmworkers (including their families) 
SCHIP. Specifically, the Secretary shall 
TO ENROLLMENT.—Barriers to their enroll-
lack of outreach and outstationed eligibility 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1663 
workers, complicated applications and eligibility determination 
procedures, and linguistic and cultural barriers. 
(2) LACK OF PORTABILITY.—The lack of portability of Med-
icaid and SCHIP coverage for farmworkers who are determined 
eligible in one State but who move to other States on a seasonal 
or other periodic basis. 
(3) POSSIBLE SOLUTIONS.—The development of possible 
solutions to increase enrollment and access to benefits for farm-
workers, because, in part, of the problems identified in para-
graphs (1) and (2), and the associated costs of each of the 
possible solutions described in subsection (b). 
(b) POSSIBLE SOLUTIONS.—Possible solutions to be examined 
shall include each of the following: 
(1) INTERSTATE COMPACTS.—The use of interstate compacts 
among States that establish portability and reciprocity for eligi-
bility for farmworkers under the Medicaid and SCHIP and 
potential financial incentives for States to enter into such com-
pacts. 
(2) DEMONSTRATION PROJECTS.—The use of multi-state 
demonstration waiver projects under section 1115 of the Social 
Security Act (42 U.S.C. 1315) to develop comprehensive migrant 
coverage demonstration projects. 
(3) USE OF CURRENT LAW FLEXIBILITY.—Use of current law 
Medicaid and SCHIP State plan provisions relating to coverage 
of residents and out-of-State coverage. 
(4) NATIONAL MIGRANT FAMILY COVERAGE.—The develop-
ment of programs of national migrant family coverage in which 
States could participate. 
(5) PUBLIC-PRIVATE PARTNERSHIPS.—The provision of incen-
tives for development of public-private partnerships to develop 
private coverage alternatives for farmworkers. 
(6) OTHER POSSIBLE SOLUTIONS.—Such other solutions as 
the Secretary deems appropriate. 
(c) CONSULTATIONS.—In conducting the study, the Secretary 
shall consult with the following: 
(1) Farmworkers affected by the lack of portability of cov-
erage under the Medicaid program or the State children's health 
insurance program (under titles XIX and XXI of the Social 
Security Act). 
(2) Individuals with expertise in providing health care to 
farmworkers, 
including 
designees of national and local 
organizations representing migrant health centers and other 
providers. 
(3) Resources with expertise in health care financing. 
(4) Representatives of foundations and other nonprofit enti-
ties that have conducted or supported research on farmworker 
health care financial issues. 
(5) Representatives of Federal agencies which are involved 
in the provision or financing of health care to farmworkers, 
including the Health Care Financing Administration and the 
Health Research and Services Administration. 
(6) Representatives of State governments. 
(7) Representatives from the farm and agricultural indus-
tries. 
(8) Designees of labor organizations representing farm-
workers. 
(d) DEFINITIONS.—For purposes of this section: 
116 STAT. 1664 
PUBLIC LAW 107-251—OCT. 26, 2002 
(1) FARMWORKER.—The term "farmworker" means a migra-
tory agricultural worker or seasonal agricultural worker, as 
such terms are defined in section 330(g)(3) of the Public Health 
Service Act (42 U.S.C. 254c(g)(3)), and includes a family 
member of such a worker. 
(2) MEDICAID.—^The term "Medicaid" means the program 
under title XIX of the Social Security Act. 
(3) SCHIP.—The term "SCHIP" means the State children's 
health insurance program under title XXI of the Social Security 
Act. 
Deadline. 
(e) REPORT.—Not later than one year after the date of the 
enactment of this Act, the Secretary shall transmit a report to 
the President and the Congress on the study conducted under 
this section. The report shall contain a detailed statement of 
findings and conclusions of the study, together with its recommenda-
tions for such legislation and administrative actions as the Secretary 
considers appropriate. 
TITLE V—STUDY AND MISCELLANEOUS 
PROVISIONS 
42 use 254b 
SEC. 501. GUARANTEE STUDY. 
The Secretary of Health and Human Services shall conduct 
a study regarding the ability of the Department of Health and 
Human Services to provide for solvency for managed care networks 
involving health centers receiving funding under section 330 of 
the Public Health Service Act. The Secretary shall prepare and 
submit a report to the appropriate Committees of Congress 
regarding such ability not later than 2 years after the date of 
enactment of the Health Care Safety Net Amendments of 2002. 
SEC. 502. GRADUATE MEDICAL EDUCATION. 
Section 762(k) of the Public Health Service Act (42 U.S.C. 
294o(k)) is amended by striking "2002" and inserting "2003". 
TITLE VI—CONFORMING AMENDMENTS 
SEC. 601. CONFORMING AMENDMENTS. 
(a) HOMELESS PROGRAMS.—Subsections (g)(l)(G)(ii), (k)(2), and 
(n)(l)(C) of section 224, and sections 317A(a)(2), 317E(c), 318A(e), 
332(a)(2)(C), .340D(c)(5), 799B(6)(B), 1313, and 2652(2) of the Public 
Health Service Act (42 U.S.C. 233, 247b-1(a)(2), 247b-6(c), 247c-
1(e), 254e(a)(2)(C), 256d(c)(5), 295p(6)(B), 300e-12, and 300ff-52(2)) 
are amended by striking "340" and inserting "330(h)". 
PUBLIC LAW 107-251—OCT. 26, 2002 
116 STAT. 1665 
(b) HOMELESS INDIVIDUAL.—Section 534(2) of the Public Health 
Service Act (42 U.S.C. 290cc-34(2)) is amended by striking "340(r)" 
and inserting "330(h)(5)". 
Approved October 26, 2002. 
LEGISLATIVE HISTORY—S. 1533 (H.R. 3450): 
SENATE REPORTS: No. 107-83 (Comm. on Health, Education, Labor, and Pen-
sions). 
CONGRESSIONAL RECORD, Vol. 148 (2002): 
Apr. 16, considered and passed Senate. 
Oct. 16, considered and passed House, amended. 
Oct. 17, Senate concurred in House amendment. 
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 38 (2002): 
Oct. 26, Presidential remarks.