[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 1533 Enrolled Bill (ENR)]
S.1533
One Hundred Seventh Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Wednesday,
the twenty-third day of January, two thousand and two
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 Healthy Communities Access Program, which will help
coordinate services for 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,

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(a) Short Title.--This Act may be cited as the ``Health Care Safety
Net Amendments of 2002''.
(b) Table of Contents.--The table of contents for this Act is as
follows:

e06ecdbde5a38d68642cb2baf07907155765c56b6df9c232f89947c011e5cdb1

States.
Subtitle A--Rural Health Care Services Outreach, Rural Health Network
Development, and Small Health Care Provider Quality Improvement Grant
Programs

f30d9d9adfd93e204c5510ff5e007483ba11ac7ab9e3f1304378f97b77470f54

TITLE I

-CONSOLIDATED HEALTH CENTER PROGRAM AMENDMENTS

Subtitle B--Telehealth Grant Consolidation

376ed615cf41c242cdc43450036fb595f0c534856874a61c929911ad55f8e02c

TITLE II

-RURAL HEALTH

Subtitle C--Mental Health Services Telehealth Program and Rural
Emergency Medical Service Training and Equipment Assistance Program

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0a6ff1bb188b05e95a26ae2c03e65914c4e861a77eeb2aa1dedecbb35dfc8739

TITLE III

-NATIONAL HEALTH SERVICE CORPS PROGRAM

b461639cc67f55653a13f39c70b4a5fe546fa9f601877b4f1b4704d54a5ab5ce

TITLE IV

-HEALTHY COMMUNITIES ACCESS PROGRAM

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)(III)(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
redesignated 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 Secretary may make
grants to health centers that receive assistance under this
section to enable the centers to plan 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 networks 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 principal
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 subsection (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 demonstrate
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.
``(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 Secretary 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 operation 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 equipment).'';
(B) in paragraph (5)--
(i) in subparagraph (A), by inserting ``subparagraphs
(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
following:
``(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 determined 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 paragraphs
(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 agricultural
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 ``homeless
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:
``(4) Temporary continued provision of services to certain
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 subparagraph
(B)), by striking ``and residential treatment'' and inserting
``, risk reduction, outpatient treatment, residential
treatment, and rehabilitation'';
(7) in subsection (j)(3)--
(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
following:
``(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 violate the
requirements of subparagraph (G)(iii)(I).'';
(8)(A) by redesignating subsection (l) as subsection (s) and
moving that subsection (s) to the end of the section;
(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 translation,
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
linguistic 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 translation and interpretation
services; and
``(B) compensate bilingual or multilingual staff for
language 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 appropriations.--There are authorized to
be appropriated to carry out this subsection, in addition to any
funds authorized to be appropriated or appropriated for health
centers under any other subsection of this section, such sums as
may be necessary for each of fiscal years 2002 through 2006.'';
(9) by striking subsection (m) (as redesignated by paragraph
(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 (l)(3). Services provided through the
program may include necessary technical and nonfinancial 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 ``(l)(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
``(l)(3))''; and
(II) by striking ``(j)(3)(G)(ii)'' and inserting
``(l)(3)(H)''; 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.''.

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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 Appropriations.--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.
Subtitle A--Rural Health Care Services Outreach, Rural Health Network
Development, and Small Health Care Provider Quality Improvement Grant
Programs

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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 PROVIDER QUALITY IMPROVEMENT GRANT
PROGRAMS.
``(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 meanings 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 program.
``(d) Administration.--
``(1) Programs.--The rural health care services outreach, rural
health network development, and small health care provider 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.
``(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 implementation
of integrated health care networks in rural areas under
subsection (f); and
``(iii) to provide for the planning and implementation
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 determines 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 combined the
functions of the entities participating in the networks in
order to--
``(i) achieve efficiencies;
``(ii) expand access to, coordinate, and improve the
quality 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 implementation 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 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) an explanation of the reasons why Federal assistance
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 activities 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 network;
``(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 determines 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 provider 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 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) an explanation of the reasons why Federal assistance
is required to 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 determines 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 subsection 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 described in
this section, to the extent practicable, with Federal and State
agencies and nonprofit organizations that are operating 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.
``(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 to 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.''.
Subtitle B--Telehealth Grant Consolidation

727e33edb9ac763952e60c188fa87f83e14aae4cb369cd054d62cc0135b96db8

This subtitle may be cited as the ``Telehealth Grant Consolidation
Act of 2002''.

830304e65eae3d003f8d5fa21996d49a3e3c28180ff93bca45c6b07d2718f31f

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:
``SEC. 330I. TELEHEALTH NETWORK AND TELEHEALTH RESOURCE CENTERS GRANT
PROGRAMS.
``(a) Definitions.--In this section:
``(1) Director; office.--The terms `Director' and `Office' 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 meanings 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 `telehealth services'
means services provided through telehealth technologies.
``(7) Telehealth technologies.--The term `telehealth
technologies' means technologies relating to the use of electronic
information, and telecommunications technologies, to support 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 programs.
``(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 primary 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 information
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 technologies can be used in
the areas and communities, and for the populations, described in
paragraph (1), to establish telehealth 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 telehealth
network.
``(ii) Nature of entities.--Each entity participating
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):
``(I) Community or migrant health centers or other
Federally qualified health centers.
``(II) Health care providers, including
pharmacists, in private practice.
``(III) 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
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--
``(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
description 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 redundancy, 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 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 of the
Health Resources and Services Administration, notice of 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
Federal 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
educational 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;
``(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
services that enhance access to community-based health care
services in rural areas, frontier communities, or medically
underserved areas, or for medically underserved populations;
``(B) developing and acquiring, through lease or purchase,
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 providers,
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 programming;
``(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 telehealth
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;
``(G) collecting and analyzing usage statistics and data to
document the cost-effectiveness of the telehealth services; 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
support, 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
utilization of telehealth technologies to meet health care
needs;
``(E) promoting the integration of the technologies used in
clinical information systems with other telehealth
technologies;
``(F) fostering the use of telehealth technologies to
provide 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.
``(l) 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 equipment);
``(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.
``(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 underserved
populations in each State about the grant programs described in
subsection (b).
``(p) Telehealth.--It is the sense of Congress 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.
``(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
specifying, for purposes of this section, a definition of the term
`frontier area'. The definition shall be based on factors that include
population 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 appropriate. 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 Telehealth Program and Rural
Emergency Medical Service Training and Equipment Assistance Program

261088c9f5ff3962d98f08cd287c9e9995bca2165c87667da4ffd73edc7fa81c

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:
``SEC. 330J. RURAL EMERGENCY MEDICAL SERVICE TRAINING AND 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--
``(1) be--
``(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, originally 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 emergency
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
certification 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
resuscitation, 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
``(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
situation; 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 paragraph (1) for
a fiscal year for the administrative expenses of carrying out this
section.
``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 treatment 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 underserved
rural areas or in mental health underserved urban areas.
``(B) Elderly individuals located in long-term care
facilities in mental health underserved rural or urban areas.
``(4) Telehealth.--The term `telehealth' means the use of
electronic information and telecommunications technologies to
support long distance clinical health care, patient and
professional 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
telehealth 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, in
such manner, and containing such information as the Secretary
determines to be reasonable.
``(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.''.

316058cf211722cc819b5ba99a3ebd0d06e98da56960bb677a30d8b9d9c3c4a2

(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 professionals'
means health service psychologists, licensed clinical social
workers, licensed professional counselors, marriage and family
therapists, psychiatric nurse specialists, and psychiatrists.
``(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 individual 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 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)(1) In carrying out subpart III, the Secretary may, in
accordance 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 obligated
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 assignment
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 paragraph
(1), the Secretary shall examine the effect of multidisciplinary
teams.''.

c52c7b18b364462d003e84dfd47c320a3e170e84fb899408d177c46e038dd608

(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 sentence
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 designated
as having such a shortage. Not earlier than 6 years after such
date of enactment, and every 6 years thereafter, each such
center or clinic shall demonstrate that the center or clinic
meets the applicable requirements of the Federal regulations,
issued after the date of enactment 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
agricultural workers (as defined in section 330(g)(3)) and
migratory 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)(1))) may be
population groups'';
(2) in subsection (b)(2), by striking ``with special
consideration to the indicators of'' and all that follows through
``services.'' and inserting a period; and
(3) in subsection (c)(2)(B), by striking ``XVIII or XIX'' and
inserting ``XVIII, XIX, or XXI''.
(b) Regulations.--
(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 section
332 of the Public Health Service Act (42 U.S.C. 254e); or
(ii) a regulation that revises the standards concerning
priority of such an area under section 333A of that Act (42
U.S.C. 254f-1).
(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, Education, Labor,
and Pensions of the Senate a report that describes the
regulation.
(2) Effective date.--Each regulation described in paragraph
(1)(A) 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.
(c) Scholarship and Loan Repayment Programs.--The Secretary of
Health and Human Services, in consultation with organizations
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 Scholarship
Program under section 338A of the Public Health Service Act (42 U.S.C.
254l) and the Loan Repayment Program under section 338B of such Act (42
U.S.C. 254l-1).
(d) Site Designation Process.--
(1) Improvement of designation process.--The Administrator 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 health professional
shortage areas are based so that such criteria provide a more
accurate reflection of oral health care need, particularly in rural
areas.
(2) Public health service act.--Section 332 of the Public
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 information 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 information;
``(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 Comptroller
General of the United States shall submit to the Congress 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.

57589e1e98637214d7635ade8d1036506fcd79276fd8ca9c905f1276196db4b1

Section 333 of the Public 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 section 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 preference 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
``nonprofit'' 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
(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
Secretary 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 entities concerned
with site development and community needs assessment.''.

3908c3ead0bb469d3f53ef3df0c1227bc790da0402ed8741ae78c0b202b27e0a

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:
``(1) Proposed list.--The Secretary shall prepare and publish 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 inclusion 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
``paragraph (3)'';
(ii) by striking ``prepare a list of health
professional shortage areas'' and inserting ``prepare and,
as appropriate, 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.--
``(A) Entities.--Not later than 30 days after the Secretary
has added to a list under paragraph (2) an entity specified as
described in subparagraph (A) of such paragraph, 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.
``(B) Individuals.--In the case of an individual obligated
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 individual'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 revision
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 determination involved which
shall be reasonably considered by the Secretary 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 Assignment
Choices in Scholarship Program.--
``(1) Determination of available corps members.--By 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 determined
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 paragraph
(1).'';
(6) by striking subsection (f); and
(7) by redesignating subsections (c), (d), and (e) as
subsections (b), (c), and (d) respectively.

5210b7fd00638dc1de74d866a07a86967325b1042981cc82600612fdb42410de

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 MEMBERS.
``(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--
``(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 provided 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 preparing
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 federally
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 individual who is
a beneficiary under the medicaid program; and
``(ii) the State agency administering the program under
title XXI of such Act with respect to an individual 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 payments 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.''.

50b10cafdf1c02fb1e57a444bacbcd964f80c7935e628177d1e0acc85beb508e

Section 335(e)(1)(B) of the Public Health Service Act (42 U.S.C.
254h(e)(1)(B)) is amended by striking ``XVIII or XIX'' and inserting
``XVIII, XIX, or XXI''.

fab6bffba86962e56aaa22e3c2485b4031cd111ef7f54e9d32946cfe4a97c841

(a) Health Professional Shortage Areas.--Section 336 of the Public
Health Service Act (42 U.S.C. 254h-1) 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''.

a6338b3908e12d2997af04873c4866309553e1a646713d8ed96e3fc769921c2a

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).

b75a51039a30e581a2dc3b7a1bbae9d0336ebd0c68b20797b2db946a2b776213

Section 338A of the Public Health Service Act (42 U.S.C. 254l) 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 subparagraph (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
semicolon;
(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
(6) by striking subsection (i).

67a9593aadd1caca85c712c8d2cc2f4a1dcae0954d89b714bbe81e1cbf34ce35

Section 338B of the Public Health Service Act (42 U.S.C. 254l-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,
dentistry, 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 physician
assistant;'';
(3) in subsection (e), by striking ``(1) In general.--''; and
(4) by striking subsection (i).

bb0932e62b8c30ff3af0b073d7d7543f799049252ec2798811392dc42b0c74c2

Section 338C 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 subparagraph
(A), by striking ``section 338A(f)(1)(B)(iv)'' and inserting
``section 338A(f)(1)(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 September
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 residency).'';
(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 redesignated
by clause (iii)) by striking ``subparagraph (A), (B), or
(D)'' and inserting ``subparagraph (A)''; and
(2) by striking subsection (e).

41b4232246028473c0bf07396ca0589f7a060d26d78abda940369a57b380dbe7

Section 338D of the Public 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--
``(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.''.

51873ab1739f384bd9e4bed730588dd1c9b6bfd883e752373066e642eefdd20e

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(d)'' 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 residency
as specified in section 338A(f)(1)(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
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
individual 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; and
``(C) the interest on the amounts described in
subparagraphs (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.'';
(B) by striking paragraphs (2) and (3) and inserting the
following:
``(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 (d)(3)(A), by striking ``only if such
discharge is granted after the expiration of the five-year period''
and inserting ``only if such discharge is granted after the
expiration 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.''.
(b) Effective Date.--The amendment made by subsection (a)(4) shall
apply to any obligation for which a discharge in bankruptcy has not
been granted before the date that is 31 days after the date of
enactment of this Act.

3869ce70c1a9266b2987d9e23341fdfd42f3069e8becef369e7cc75b336983b3

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 necessary
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 Repayment
Program under section 338B to individuals from disadvantaged
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)(1)(B)
that leads to such a certification or individuals who are eligible for
the loan repayment program as specified in section 338B(b) for a loan
related to such certification.''.

d5613a50fa2c1fe2ca0e7ae0e9bf6269b0da0b9a5f11b3a9d01088abf56d7874

Section 338I 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 paragraph (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.''.

e8d71e98e2cec73f3e293ee55d92e765766639d25a7ae0103ea182d1722ada67

PROGRAMS.
Section 338L of the Public Health Service Act (42 U.S.C. 254t) is
repealed.

a902e8886ea562523bcef7754125945339fc88096e49149830da416b864efcdd

Subpart III of part D of title III of the Public Health Service Act
(42 U.S.C. 254l et seq.) is amended by adding at the end the following:
``SEC. 338L. DEMONSTRATION PROJECT.
``(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)(1)) 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 1861(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
``(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 section
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 construed to
require any State to participate in the project described in this
section.
``(f) Report.--
``(1) In general.--The Secretary shall evaluate the
participation of individuals in the demonstration projects under
this section and prepare and submit a report containing the
information 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 Appropriations 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 Appropriations 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 pharmacists
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.
``(2) Fiscal year 2005.--If the Secretary determines and
certifies to Congress by not later than September 30, 2004, that
the number of individuals participating in the demonstration
project established 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.''.

b5ed539db15a76c28d4102f6580fc4d801e98663b89660dcc54f8244302ff7a9

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.

2ebd6580ba4a83d597dbeaca8335374b2179ee18168a02d70b3f12f4fe773de4

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, EFFICIENCY, 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 uninsured
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 range
of coordinated health care services for a community 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 uninsured
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 and
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 further 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, primary,
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 program 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 new funding
sources in a way to assure long-term sustainability 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
circumstances (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
`extraordinary circumstances' means an event (or events) that
is outside of the control of the eligible entity that has
prevented the eligible entity from fulfilling the objectives
described by such entity in the application submitted under
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--
``(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
uninsured and underinsured individuals and families in the
community, including behavioral and mental health services,
oral health services, or substance abuse services;
``(D) proposes a program that would improve coordination
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 program
will continue after support under this section ceases.
``(e) Use of Funds.--
``(1) Use 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 treatment 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 transportation
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.
``(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 systems or
shared clinical systems.
``(viii) Development of common processes for
determining eligibility for the programs provided through
the system, including creating common identification cards
and single sliding scale discounts.
``(ix) Development of specific prevention and disease
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-Federal
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 purposes.--The
Secretary may use not more than 3 percent of funds appropriated to
carry out this section for providing technical assistance to
grantees, obtaining assistance of experts and consultants, holding
meetings, developing of tools, disseminating 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 underinsured
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 conducted 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 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.
``(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 uninsured 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 populations; or
``(3) supporting the research-related costs of patient care,
data collection, and academic training resulting from such
affiliations.
``(k) Authorization of Appropriations.--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.
``(l) Date Certain for Termination of Program.--Funds may not be
appropriated to carry out this section after September 30, 2006.''.

1135a012727dcbd097ad62bb861b8a3bc90396a45d112d83553e8aee5ea8afe2

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:
``Subpart X--Primary Dental Programs
``SEC. 340F. DESIGNATED DENTAL HEALTH PROFESSIONAL SHORTAGE 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.
``(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 programs 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 subsection
(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 professional 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, consolidated
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;
``(6) placement and support of dental students, dental
residents, 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 demonstrated 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.''.

fcbd41ac3f3b6e925e8704454db695c6be523060ab620282050006d91c78cc68

IN HEALTH PROGRAMS.
(a) In General.--The Secretary shall conduct a study of the
problems experienced by farmworkers (including their families) under
Medicaid and SCHIP. Specifically, the Secretary shall examine the
following:
(1) Barriers to enrollment.--Barriers to their enrollment,
including a lack of outreach and outstationed eligibility workers,
complicated applications and eligibility determination procedures,
and linguistic and cultural barriers.
(2) Lack of portability.--The lack of portability of Medicaid
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 farmworkers,
because, in part, of the problems identified in paragraphs (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 eligibility
for farmworkers under the Medicaid and SCHIP and potential
financial incentives for States to enter into such compacts.
(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 development of
programs of national migrant family coverage in which States could
participate.
(5) Public-private partnerships.--The provision of incentives
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 coverage
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 entities
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 industries.
(8) Designees of labor organizations representing farmworkers.
(d) Definitions.--For purposes of this section:
(1) Farmworker.--The term ``farmworker'' means a migratory
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.
(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 recommendations for such
legislation and administrative actions as the Secretary considers
appropriate.

16bf6cfdcda13de82837a0d1750ac9e4820c1723ed8f63c72df61277d906d2d2

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.

79fac122bfbe5b462976eb4b6c2e002d6e8fb981799b190c0f0a8ee6acae3c9c

TITLE V

-STUDY AND MISCELLANEOUS PROVISIONS

Section 762(k) of the Public Health Service Act (42 U.S.C. 294o(k))
is amended by striking ``2002'' and inserting ``2003''.

8a33f079a47cde0eb2e0d94ef7852ff0d4d93508b7062c5b6989487b5cfc240e

(a) Homeless Programs.--Subsections (g)(1)(G)(ii), (k)(2), and
(n)(1)(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)''.
(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)''.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.

827256edb816ba1acee383227542d4b59b54f7e392b7d96439ef8f48adb7ef95

Health Care Safety Net Amendments of 2002 — S. 1533

Other Sections

TITLE I

TITLE II

TITLE III

TITLE IV

TITLE V

TITLE VI

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