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SECTION 1. SHORT TITLE.

This Act may be cited as the ''Rural Health Innovation
Demonstration Act of 1993''.

SEC. 2. RURAL HEALTH EXTENSION NETWORKS.

Title XVII of the Public Health Service Act (42 U.S.C. 300u et
seq.) is amended by adding at the end thereof the following new
section:

''SEC. 1709. RURAL HEALTH EXTENSION NETWORKS.

''(a) Grants.--The Secretary, acting through the Health Resources
and Services Administration, may award competitive grants to eligible
entities to enable such entities to facilitate the development of
networks among rural and urban health care providers to preserve and
share health care resources and enhance the quality and availability of
health care in rural areas. Such networks may be statewide or
regionalized in focus.
''(b) Eligible Entities.--To be eligible to receive a grant under
subsection (a) an entity shall--
''(1)(A) be a rural health extension network that meets the
requirements of subsection (c); or
''(B) be an Area Health Education Center Program;
''(2) prepare and submit to the Secretary an application at
such time, in such form and containing such information as the
Secretary may require; and
''(3) meets such other requirements as the Secretary
determines appropriate.
''(c) Networks.--For purposes of subsection (b)(1), a rural health
extension network shall be an association or consortium of three or
more rural health care providers, and may include one or more urban
health care provider, for the purposes of applying for a grant under
this section and using amounts received under such grant to provide the
services described in subsection (d).
''(d) Services.--
''(1) In general.--An entity that receives a grant under
subsection (a) shall use amounts received under such grant to--
''(A) provide education and community
decisionmaking support for health care providers in the
rural areas served by the network;
''(B) utilize existing health care provider
education programs, including but not limited to, the
program for area health education centers under section
781, to provide educational services to health care
providers and trainees including, but not limited to,
physicians, nurses and nursing students in the areas
served by the network;
''(C) make appropriately trained facilitators
available to health care providers located in the areas
served by the network to assist such providers in
developing cooperative approaches to health care in
such area;
''(D) facilitate linkage building through the
organization of discussion and planning groups and the
dissemination of information concerning the health care
resources where available, within the area served by
the network;
''(E) support telecommunications and consultative
projects to link rural hospitals and other health care
providers, and urban or tertiary hospitals in the areas
served by the network; or
''(F) carry out any other activity determined
appropriate by the Secretary.
''(2) Education.--In carrying out activities under
paragraph (1)(B), an entity shall support the development of an
information and resource sharing system, including elements
targeted towards high risk populations and focusing on health
promotion, to facilitate the ability of rural health care
providers to have access to needed health care information.
Such activities may include the provision of training to enable
individuals to serve as coordinators of health education
programs in rural areas.
''(3) Collection and dissemination of data.--The chief
executive officer of a State shall designate a State agency
that shall be responsible for collecting and regularly
disseminating information concerning the activities of the
rural health extension networks in that State.
''(e) Matching Requirement.--An entity that receives a grant under
subsection (a) shall make available (directly or through donations from
public or private entities), non-Federal contributions towards the
costs of the operations of the network in an amount equal to the amount
of the grant.
''(f) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $10,000,000 for each of the
fiscal years 1994 through 1997.
''(g) Definition.--As used in this section and section 1710, the
term 'rural health care providers' means health care professionals and
hospitals located in rural areas. The Secretary shall ensure that for
purposes of this definition, rural areas shall include any area that
meets any applicable Federal or State definition of rural area.
''(h) Relation to Other Laws.--
''(1) In general.--Notwithstanding any provision of the
antitrust laws, it shall not be considered a violation of the
antitrust laws for entities to develop and operate networks in
accordance with this section.
''(2) Definition.--For purposes of this subsection, the
term 'antitrust laws' means--
''(A) the Act entitled 'An Act to protect trade and
commerce against unlawful restraints and monopolies',
approved July 2, 1890, commonly known as the 'Sherman
Act' (26 Stat. 209; chapter 647; 15 U.S.C. 1 et seq.);
''(B) the Federal Trade Commission Act, approved
September 26, 1914 (38 Stat. 717; chapter 311; 15
U.S.C. 41 et seq.);
''(C) the Act entitled 'An Act to supplement
existing laws against unlawful restraints and
monopolies, and for other purposes', approved October
15, 1914, commonly known as the 'Clayton Act' (38 Stat.
730; chapter 323; 15 U.S.C. 12 et seq.; 18 U.S.C. 402,
660, 3285, 3691; 29 U.S.C. 52, 53);
''(D) the Act of June 19, 1936, commonly known as
the Robinson-Patman Antidiscrimination Act (15 U.S.C.
13 et seq.); and
''(E) any State antitrust laws that would prohibit
the activities described in paragraph (1).''.

SEC. 3. RURAL MANAGED CARE COOPERATIVES.

Title XVII of the Public Health Service Act (42 U.S.C. 300u et
seq.) as amended by section 2 is further amended by adding at the end
thereof the following new section:

''SEC. 1710. RURAL MANAGED CARE COOPERATIVES.

''(a) Grants.--The Secretary, acting through the Health Resources
and Services Administration, may award competitive grants to eligible
entities to enable such entities to develop and administer cooperatives
in rural areas that will establish an effective case management and
reimbursement system designed to support the economic viability of
essential public or private health services, facilities, health care
systems and health care resources in such rural areas.
''(b) Eligible Entities.--To be eligible to receive a grant under
subsection (a) an entity shall--
''(1) prepare and submit to the Secretary an application at
such time, in such form and containing such information as the
Secretary may require, including a description of the
cooperative that the entity intends to develop and operate
using grant funds; and
''(2) meet such other requirements as the Secretary
determines appropriate.
''(c) Cooperatives.--
''(1) In general.--Amounts provided under a grant awarded
under subsection (a) shall be used to establish and operate a
cooperative made up of all types of health care providers,
hospitals, primary access hospitals, other alternate rural
health care facilities, physicians, rural health clinics, rural
nurse practitioners and physician assistant practitioners,
public health departments and others located in, but not
restricted to, the rural areas to be served by the cooperative.
''(2) Board of directors.--A cooperative established under
paragraph (1) shall be administered by a board of directors
elected by the members of the cooperative, a majority of whom
shall represent rural providers from the local community and
include representatives from the local community. Such members
shall serve at the pleasure of such members.
''(3) Executive director.--The members of a cooperative
established under paragraph (1) shall elect an executive
director who shall serve as the chief operating officer of the
cooperative. The executive director shall be responsible for
conducting the day the day operation of the cooperative
including--
''(A) maintaining an accounting system for the
cooperative;
''(B) maintaining the business records of the
cooperative;
''(C) negotiating contracts with provider members
of the cooperative; and
''(D) coordinating the membership and programs of
the cooperative.
''(4) Reimbursements.--
''(A) Negotiations.--A cooperative established
under paragraph (1) shall facilitate negotiations among
member health care providers and third party payors
concerning the rates at which such providers will be
reimbursed for services provided to individuals for
which such payors may be liable.
''(B) Agreements.--Agreements reached under
subparagraph (A) shall be binding on the members of the
cooperative.
''(C) Employers.--Employer entities may become
members of a cooperative established under paragraph
(a) in order to provide, through a member third party
payor, health insurance coverage for its employees.
Deductibles shall only be charged to employees covered
under such insurance if such employees receive health
care services from a provider that is not a member of
the cooperative if similar services would have been
available from a member provider.
''(D) Malpractice insurance.--A cooperative
established under subsection (a) shall be responsible
for identifying and implementing an affordable
malpractice insurance program that shall include a
requirement that such cooperative assume responsibility
for the payment of a portion of the malpractice
insurance premium of providers members.
''(5) Managed care and practice standards.--A cooperative
established under paragraph (1) shall establish joint case
management and patient care practice standards programs that
health care providers that are members of such cooperative must
meet to be eligible to participate in agreements entered into
under paragraph (4). Such standards shall be developed by such
provider members and shall be subject to the approval of a
majority of the board of directors. Such programs shall include
cost and quality of care guidelines including a requirement
that such providers make available preadmission screening,
selective case management services, joint patient care practice
standards development and compliance and joint utilization
review.
''(6) Confidentiality.--
''(A) In general.--Patients records, records of
peer review, utilization review, and quality assurance
proceedings conducted by the cooperative should be
considered confidential and protected from release
outside of the cooperative. The provider members of the
cooperative shall be indemnified by the cooperative for
the good faith participation by such members in such
the required activities.
''(B) Quality data.--Notwithstanding any other
provision of law, quality data obtained by a hospital
or other member of a cooperative in the normal course
of the operations of the hospital or member shall be
immune from discovery regardless of whether such data
is used for purposes other than peer review or is
disclosed to other members of the cooperative involved.
''(d) Linkages.--A cooperative shall create linkages among member
health care providers, employers, and payors for the joint consultation
and formulation of the types, rates, costs, and quality of health care
provided in rural areas served by the cooperative.
''(e) Matching Requirement.--An entity that receives a grant under
subsection (a) shall make available (directly or through donations from
public or private entities), non-Federal contributions towards the
costs of the operations of the network in an amount equal to the amount
of the grant.
''(f) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $15,000,000 for each of the
fiscal years 1994 through 1997.
''(g) Relation to Other Laws.--
''(1) In general.--Notwithstanding any provision of the
antitrust laws, it shall not be considered a violation of the
antitrust laws for entities to develop and operate cooperatives
in accordance with this section.
''(2) Definition.--For purposes of this subsection, the
term 'antitrust laws' means--
''(A) the Act entitled 'An Act to protect trade and
commerce against unlawful restraints and monopolies',
approved July 2, 1890, commonly known as the 'Sherman
Act' (26 Stat. 209; chapter 647; 15 U.S.C. 1 et seq.);
''(B) the Federal Trade Commission Act, approved
September 26, 1914 (38 Stat. 717; chapter 311; 15
U.S.C. 41 et seq.);
''(C) the Act entitled 'An Act to supplement
existing laws against unlawful restraints and
monopolies, and for other purposes', approved October
15, 1914, commonly known as the 'Clayton Act' (38 Stat.
730; chapter 323; 15 U.S.C. 12 et seq.; 18 U.S.C. 402,
660, 3285, 3691; 29 U.S.C. 52, 53);
''(D) the Act of June 19, 1936, commonly known as
the Robinson-Patman Antidiscrimination Act (15 U.S.C.
13 et seq.); and
''(E) any State antitrust laws that would prohibit
the activities described in paragraph (1).''.

SEC. 4. RURAL MENTAL HEALTH OUTREACH GRANTS.

Subpart 3 of part B of title V of the Public Health Service Act (42
U.S.C. 290cc-11 et seq.) is amended by adding at the end thereof the
following new section:

''SEC. 520C. RURAL MENTAL HEALTH OUTREACH GRANTS.

''(a) In General.--The Secretary may award competitive grants to
eligible entities to enable such entities to develop and implement a
plan for mental health outreach programs in rural areas.
''(b) Eligible Entities.--To be eligible to receive a grant under
subsection (a) an entity shall--
''(1) prepare and submit to the Secretary an application at
such time, in such form and containing such information as the
Secretary may require, including a description of the
activities that the entity intends to undertake using grant
funds; and
''(2) meet such other requirements as the Secretary
determines appropriate.
''(c) Priority.--In awarding grants under subsection (a), the
Secretary shall give priority to applications that place emphasis on
mental health services for the elderly or children. Priority shall also
be given to applications that involve relationships between the
applicant and rural managed care cooperatives.
''(d) Matching Requirement.--An entity that receives a grant under
subsection (a) shall make available (directly or through donations from
public or private entities), non-Federal contributions toward the costs
of the operations of the network in an amount equal to the amount of
the grant.
''(e) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $5,000,000 for each of the
fiscal years 1994 through 1997.''.

SEC. 5. AREA HEALTH EDUCATION CENTERS.

(a) Section 746(a) of the Public Health Service Act (42 U.S.C.
293j(a)) is amended by adding at the end thereof the following new
paragraph:
''(4) Stipends.--
''(A) The Secretary make award grants under this
section to rural communities to enable such communities
to provide stipends to physicians, nurses, nurse
practitioners, physician assistants, and other health
professional trainees to encourage such individuals to
provide health care services in such rural communities.
In addition, the Secretary may award grants under this
section to rural communities to enable such communities
to provide stipends to physicians, nurses, nurse
practitioners, physician assistants, and other health
professionals that are practicing in rural areas to
retain such individuals in such areas.
''(B) A community that receives a grant under
subparagraph (A) shall make available (directly or
through donations from public or private entities),
non-Federal contributions toward the costs of the
operations of the network in an amount equal to the
amount of the grant.''.
(b) Reauthorization.--Section 746(i)(1)(A) of such Act (42 U.S.C.
293j(i)(1)(A)) is amended by striking out ''$25,000,000'' and all that
follows through ''1995'' and inserting in lieu thereof ''$25,000,000
for fiscal year 1993, and $42,000,000 for each of the fiscal years 1994
through 1997''.
Rural Health Innovation Demonstration Act of 1993 - Amends the Public Health Service Act to authorize competitive grants for the development of networks among rural and urban health care providers to preserve and share health care resources and enhance the quality and availability of health care in rural areas. Allows the networks to be statewide or regional. Specifies the services for which grant amounts must be used. Authorizes appropriations.
Authorizes competitive grants to develop and administer cooperatives in rural areas that will establish an effective case management and reimbursement system designed to support the economic viability of essential public or private health services, facilities, health care systems, and health care resources. Involves the cooperative in matters such as third party reimbursement, employee health insurance, malpractice insurance, and managed care and practice standards. Authorizes appropriations.
Authorizes competitive grants to develop and implement a plan for mental health outreach programs in rural areas. Authorizes appropriations.
Authorizes grants to enable rural communities to provide stipends to physicians, nurses, physician assistants, and other health professional trainees to: (1) encourage such individuals to provide health care services in such communities; and (2) encourage such individuals who are already practicing in such communities to stay in such areas.
Authorizes appropriations to carry out provisions relating to area health education centers.