Outreach Program Legislationi

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TITLE 11-RURAL HEALTH
Subtitle A-Rural
Health Care
Services Outreach, Rural Health
Network
Development,
and
Small Health Care Provider
Quality Improvement Grant
Programs

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SEC. 201. GRANT PROGRAMS.

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Sect.ion 33011 of the Public Hea1t.h Selltrice Act. (42

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10 U.S.C. 254c) is amended t,o read as follo~~~s:
"SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH,
RURAL HEALTH NETWORK DEVELOPMENT,
AND SMALL HEALTH CARE PROVIDER QUALITY IMPROVEMENT GRANT PROGRAMS.

"(a) Pu~.Pos~.-The purpose of this sect.iori is t.o
provide grants for expanded tlelively of health care senices in niral areas, for t.he planning and in~plen~ent.ation
of integrated health care netwol-ks in rural areas, arid for
t.he plarming and implement.ation of small healt.11 care pro-

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vider quality improvehent. act.i~-ities.

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"(b) DEFINITIONS.-

"(1) L)m.~CTo~..-~rhet.elm 'L)irect.or' means
t.he Director specified in subsection (d).
"(2) FEDEW~I~Y
QUMJIFIED HEMATH CENTEK,;
K.UMI

HFAATJTH

CI~INIC.--T~~ t.elms 'klederally

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qualified hea1t.h center7 and 'lural health clinic7 have

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the meanings given the terms in sect.ion 1861(aa) of

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t,he Social Seculity Act (42 U .S.C. 1395x(aa)).

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"(3)

HEALTH

PIEOPESS~ONAIJ

SHOR'l'ACE

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~ i ~ . E ~ . - y hterm
e
'health professior~als11ol-t.agearea7

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means a health professional s11ol-tag.e area des-

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ignated under section 332.

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UNDERSERVED
"(4) RIEDICAI~J~I'

CORLR1UNITY.-

The term 'medically undersen-ed comn~unity~
has the
meaning given the term in section 79913.

"(5)

~ I E D I W ~ I ~UNDEKSERVED
Y

POPU -

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~&l-loN.--The

term 'medically undersel~ed popu-

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lat.ion7 has t.lle meaning given the t.elm in section

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330(b)(3).

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"(c) P ~ . O c ~ l . - - ~ l ' Secret,aly
he
shall establish, under

16 section 301, a small hea1t.h care provider quality improve17 ment grant. program.
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"(d) ~

~ ~ I N I s ~ '.-~ ~ ' I o N

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"(1) PR.OGE~ARIS.-T~~
rural health care sen7-

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ices outreach, rural health net-work dex-elopment,,and

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small health care provider quality improvement

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grant programs established under sect,ion 301 shall

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be a&ninist.ered by t.he Direct.or of the Office of

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Rural Health Policy of the Health Resources and

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Sel-vices Ac~nistrat.ion,in consult.at,ion 1vit.h St.at.e

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offices of rural hea1t.h or ot.ller appr0priat.e St.ate

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govelrlment entities.

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"(2) GRANTS.-

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"(A) IN GENEW~.-I~I
carrying out the

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programs described in paragraph ( I ) , t.he Di-

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rect.or may award grants under subsections (e),

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(f), and (g) t,o expand access t.0, coordinate, and

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improve t,he quality of essent,ial hea1t.h care

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services, and enhance the delivery of healt,h

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care, in rural areas.

"(B) 'I'YYESOF c w ~ s . - T h e L>irect.or

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may award t,he grant.s-

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"(i) to prom0t.e exyandeci de1ivel-y of

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hea1t.h care sel-vices in l-ul-al areas under

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subsect.ion (e);

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"(ii) t*o provide for t,he plannirrg and

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implementation of int,eg~at.edhealth care

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nebvol-ks in rural areas under subsection

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(0;and

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"(iii) to provide for the planning and

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implementat.ion of small hea1t.h care pro-

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vider quality improvement acti~4tiesunder

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subsect.ion (g).

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CARE SERVICES
OU~I'H.EACH
"(e) KUWA HEALTH

25 GRANTS.-

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"(1)Gwrrs.-The

l)irect,or may a~vai-dgrants

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t.o eligible entities to promot,e rural health care sen--

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ices outreach by e-panding the delivery of health

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care sewices to include new and enhanced sei-vices

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in l w a l areas. The Director may award the grants

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for periods of not more t,han 3 years.

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"(2) EI~IGIBII~ITY.-TObe eligible t.o receive a

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grant under t,ILis snbsection for a project, an

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ent.it-y-

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"(A) shall be s i-ural public or iliral nonprofit private entity;

"(B) shall represent s consort.ium composed of members"(i) that include 3 or more health
care providers; and
"(ii) t.hat may be nonprofit or for-

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profit ent.it.ies;and

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"(C) shall not previously have received a

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p a n t under this subsect.ion for t.he same or a

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similar prqject, unless the entity is proposing t.o

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expand t.he scope of the project or t.he area that

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will be served t.hrough t.he project.

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"(3) h r r ~ , ~ ~ + i ' r ~ o ~ s . be
- T eligible
o
t.o receive a

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p a n t under t,l-lis subsect,ion, an eligible entity, in

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consult,at.ion 11-it.h t,he approp1-iat.e St.at.e office of

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shall prepare and submit to t.he Secretaiy an appli-

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cation, a t such time, in such manner, and containing

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such infol-mation as t.he S e c r e t . q may require,

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inchiiling-

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"(A) a descript.ion of the project. that the

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eligible entity 1111 cai7-y out using t.he funds

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provided under the p-ar~t;

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"(B) a desciipt.ion of t.he manner in \vlLich

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the project furided under the grant 1111 meet

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t.he healt,h care needs of 1-ul-a1undersel-ved pop-

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~ilatiorlsin the local conununity

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served;

"(C) a descript.ion of how t.he local cornmu-

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nity or region t,o be served 1111 be involved in

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t,he del-elopment and ongoing operat.ions of the

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pl-oject.;
"(I)) a

plan for sustaining the project after

"(E) a desclipt,ion of how the project wiU

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Federal suppol-t for t.he project has ended;

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be el-aluated: arid

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"(I?) other such infoimat.ion a s the Sec-

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ret.al-y det.elmines t.o be approp1iat.e.
(

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KUwJ HEALTH XE~~VOIIK
DEVEI~OPAIEN~~

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"(A) IN GENEU,.-T~~ l)hect.or may

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award rural health network developmerlt grar1t.s

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t,o eligible entities to promote, through plarrrling

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and implementation, t.he development of inte-

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grated healt.11 care networks t.hat have combined

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the funct.ioris of the entities pal-ticipat.irig in the

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networks in order t.c~-

"(i) achieve efficiencies;

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"(ii) excard access t.0, coordinat.e, and

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improve t.he qua1it.y of essential health care

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sei-tices; and

"(iii) st.rerig-theri the ixral hea1t.h care

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system as a whole.

"(B) GMNT YERIODS.-T~~l)irect.or may
award such a i-uzal health network development
grant for implementat.ion act.ivities for a period
of 3 years. The l)irect.or may also award such
a i-ural healt.11 network developmerlt grant for
planning activit.ies for a period of 1 year, to assist. in the development of an integrated health
care network, if t.he proposed participants in
t.he network do not have a hist.oly of collaborat.ive efforts and a 3-year grant would be inappropriate.

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"(2) EI,ICIBI~,I~~Y.-TO
be eligible to 1-eceive a
pant. under tllis subsection, an entity"(A) shall be a rural public or l-ural nonprofit privat.e entity;

"(B) shall represent. a network composed
of pal.t.icipant,s-

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"(i) t.hat. include 3 or more health
care providers; and

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"(ii) that. may be nonprofit or for-

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profit. erit.it.ies;arid

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"(C) shall not previously have received a

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p a n t under t.1lis subsect,ion (ot.lier t.han a -grant.
for planning activit,ies) for the same or a sirnilar project.
"(3) & r r , ~ c ~ r r o ~ s . - - ~ lbe
' o eligible to receive a
grant ur~dert.his subsect.ion, an eligible entity, in
consult.at.ion with t.lie approp1iat.e St.at,e office of
i-ural health or another appl-0priat.e State entity,
sliall prepare and submit to t.he Secl-et,al.;y an application, a t such time, in such manner, and corit.airiing
such information as tlie Secretaiy may require,
including"(A) a description of t.he project that the
eligible ent.ity will car137 out. using t.he funds
provided under t.lie pant.;

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"(B) an explanation of the reasons \vhy

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Federal assistance is required t.o can7 out the

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project;

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"(C) a description of-

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"(i) the history of collaborat.ive acti1.i-

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t,ies carlied out by the part.icipants in the
netwol-k;
"(ii) t.he degree to which the pal-ticipants are reacly t.o ir1t.epat.e their funct.ions; and
"(iii) how the local commuriit.y or region to be served \%illbenefit. from and be
involved in t,he act.ivit.iescal-lied out by the

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rr ebvork;

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"(1)) a descliption of how t:he local com-

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munity or region t,o be sei-vecl will exceiience in-

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creased access t.o quality hea1t.h care services

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across the continuum of care as a result of the

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integration act.ivit.ies caiy-ied out by the net-

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work;

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"(E) a plan for sustaining the project after
t'ederal suppol-t for t.he project has ended;

"(1') a descl-iption of ho\v the project \\ill
be e~aluat.ed;and

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"(G) ot.her such irlformation as the Sec-

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ret.aly det.eimines to be appropi-iat,e.

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"(g) SMAIJJJHEAI~THCAKEPH.O\~IUER
QUAJ~ITY
IAI-

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YK.O\JERlENT

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GRANTS.-

"(1) G w ~ s . - - T h e l)irect.or may award g~a11t.s

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to provide for the planning arid implemerltation of

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small hea1t.h care provider quality improvement ac-

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t.ivities. 'l'he Direct.01- may a~val-dt.he g.1-a11t.s for peri-

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ods of 1 t.o 3 years.

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"(2) EJ~IGIEI.J,I~~Y.-T~
be eligible for a p a n t .
under t.llis subsect,ion, an entity"(A)(i) sl~allbe a ivral public or l-riral 11011-

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profit. privat,e healt.11 care pro~lderor pro~ider

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of healt,h care seiTices, such as a critical access

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hospit.al or a l-ural health clinic; or

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"(ii) shall be another ~mralprovider or net-

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work of small l-ural providers identified by the

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Seci-eta17 as a key soul-ce of local care; and

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"(B) shall not. pl-eviously 11ave received a

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p a n t under this subsect.ion for the same or a

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similar project.

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"(3) &YJ~IC~TIONS.-TObe eligible to receive a

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p a n t under this subsect.ion, an eligible entity, in

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consult.at.ion 116th the appl-op1-iat.e St,at.e office of

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I-ural health or anot,hel- appropl-iat.e Stat,e entity

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shall prepare and submit to the Secret.ary an appli-

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cation, a t such time, in such manner, and containing

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such informat.ion as the Secret.ary may require,

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including-

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"(A) a description of t.he project t.Iiat t,he

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eligible entity nil1 early out. using t.he furids

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provided under the pant.;

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"(B) an ex,q)lanat.ion of t.he reasons why

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Federal assistance is required t.o can? out t.he

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"(C) a description of tlie manner in which

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t.he prqject fiinded under the grant. nil1 assure

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cont.inuous quality impro~ementin t,lie provision

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of services by the ent.ity;

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"(D) a desclipt.ion of how t.he local com-

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murlity or region t.o be s e ~ ~ will
e d expe~iencein-

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creased access t.o quality health care sei~Tices

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across t,he cont.iinuuum of care as a result of the

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act.ivit.ies carried out by the entity;

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project;

"(E) a plan for sust,aining the project. aft.eiv
Federal suppol-t for the project. has ended;
"(1') a descliptiori of how the project will
be evaluat.ed; and

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" ( G ) other such informat~ion as t.he Secret.ay deteimines tp be approp~iate.

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awarding a grant under t.llis subsect,ion, t.he Director

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shall ensure that. t.he funds made amilable t.l~rough

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t.he grant 11411 be used t.o pro13de sel-rices t.o resi-

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dent.s of l-ural areas. 'l'he Direct.or shall award not

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less t.llan 50 percent of the funds made available

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under t.1.k subsect.ion t,o pro~iderslocat,ed in and
se17Ting rural areas.
"(h) GENEKAI,I~EQUIHERIENTS."(1) PKOHIBITED
USES O F FUNDS.-I211

ent.ity

t.llat receives a p a n t under t.llis section may not. use
funds provided t.hrough the g ~ at.-n
"(A) t.o build or acquire real property; or

"(B) for const.ruct.ion.
"(2) COORDINATION
WITH OTHER AGENCIES.'l'he Secret.aly shall coordinat,e act.i~it.iescarried out
under grant programs described in t,llis section, to
t,he extent. practicable, \lt,ll Federal and State agencies and nonprofit orgarizat.ions that. are operating

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similar grant programs, t.o maximize the effect. of

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public dollars in funcling merit.orious proposals.

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"( 3) PH.EP~EKENCE.-I~awarding p a n t s under

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this sect.ion, the Secret.aly shall give preference t.o

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entities that-

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(A) are . located in hea1t.h professional

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shortage areas or n~edicallyundersel-ved com-

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munities, or sellre medically underserc-ed popu-

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lations; or

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"(B) propose to develop projects with a

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focus on primary care, and wellr~essand preven-

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t,ion strategies.

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"(i) HEPOW.-Not

later t,han Sept.einber 30, 2005,

9 the Secret.aiy shall prepare and submit t.o t,he appropriate
10 committees of Congress a report, on the progress and ac11 complis1unent.s of t,he grant prog-ranls described in sub12 sectior~s(e), (f), and ( g ) .

14 are authorized t.o be appropriat.eci t,o c a n y out t.llis sect.ion
15 $40,000,000 for fiscal year 2002, and such sums a s may
16 be necessaly for each of fiscal years 2003 tlroug11 2006.".
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Subtitle B-Telehealth Grant
Consolidation

19 SEC. 211. SHORT TITLE.
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This subt.it.le may be cit.ed as t.he "Telehea1t.h Grant

21 Consolidatiorl Act of 2002".

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HEALTH CENTERS CONSOLIDATION ACT OF 1996
[page 110 STAT. 362611
Public Law 104-299
104th Congress
An Act to amend title llI of the Public Health Service Act to consolidate and
reauthorize provisions relating to health centers, and for other
purposes. <>
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress <> assembled,
SECTION 1. <> SHORT TITLE.
This Act may be cited as the "Health Centers Consolidation Act of
1996".
(a) In General.--Subpart I of part D of title HI of the Public Health Service Act (42
U.S.C. 254b et seq.) (as amended by section 2) is further amended by adding at the end
thereof the following new section:
"SEC. 330A. RURAL, <> HEALTH OUTREACH, NETWORK
DEVELOPMENT, AND TELEMEDICINE GRANT PROGRAM.
"(a) Administration.--The rural health services outreach
demonstration grant program established under section 301 shall be
administered by the Ofice of Rural Health Policy (of the Health
Resources and Services Administration), in consultation with State rural
health offices or other appropriate State governmental entities.
"(b) Grants.--Under the program referred to in subsection (a), the
Secretary, acting through the Director of the Office of Rural Health
Policy, may award grants to expand access to, coordinate, restrain the
cost of, and improve the quality of essential health care services,
including preventive and emergency services, through the development of
integrated health care delivery systems or networks in rural areas and
regions.
"(c) Eligible Networks."(1) Outreach networks.--To be eligible to receive a grant
under this section, an entity shall-"(A) be a rural public or nonprofit private entity
that is or represents a network or potential network

that includes three or more health care providers o r
other entities that provide or support the delivery of
health care services; and
"(B) in consultation with the State office of rural
health o r other appropriate State entity, prepare and
submit t o the Secretary an application, at such time, in
such manner, and containing such information as the
Secretary may require, including-[ p a g e 110 STAT. 364311

"(i) a description of the activities which
the applicant intends to c a q out using amounts
provided under the grant;
"(ii) a plan for continuing the project after
Federal support is ended;
"(iii) a description of the manner in which
the activities funded under the grant will meet
health care needs o f underserved rural populations
within the State; and
"(iv) a description of how the local
community or region to be served by the network or
proposed network will b e involved in the
development and ongoing operations o f the network.
"(2) For-profit entities.--An eligible network may include
for-profit entities so long as the network grantee is a
nonprofit entity.
"(3) Telemedicine networks.-"(A) In general.--An entity that is a health care
provider and a member of an existing o r proposed
telemedicine network, or an entity that is a consortium
o f health care providers that are members of an existing
o r proposed telemedicine network shall be eligible for a
grant under this section.
"(B) Requirement.-A telemedicine network referred
t o in subparagraph (A) shall, at a minimum, be composed
of-"(i) a multispecialty entity that is located
in an urban o r rural area, which can provide 24hour a day access t o a range of specialty care;
and
"(ii) at least two rural health care
facilities, which may include rural hospitals,
rural physician offices, rural health clinics,
rural community health clinics, and rural nursing
homes.

"(d) Preference.--In awarding grants under this section, the
Secretary shall give preference to applicant networks that include-"(1) a majority of the health care providers serving in the
area or region to be served by the network;
"(2) any federally qualified health centers, rural health
clinics, and local public health departments serving in the area
or region;
"(3) outpatient mental health providers serving in the area
or region; or
"(4) appropriate social service providers, such as agencies
on aging, school systems, and providers under the women,
infants, and children program, to improve access to and
coordination of health care services.
"(e) Use of Funds.-"(1) In general.--Amounts provided under grants awarded
under this section shall be used"(A) for the planning and development of integrated
self-sustaining health care networks; and
"(B) for the initial provision of services.
" ( 2 ) Expenditures in rural areas.-"(A) In general.--In awarding a grant under this
section, the Secretary shall ensure that not less than
50 percent of the grant award is expended in a rural
area or to provide services to residents of rural areas.
" ( f ) Term of Grants.--Funding may not be provided to a network
under this section for in excess of a 3-year period.
"(g) Authorization of Appropriations.--For the purpose of carrying
out this section there are authorized to be appropriated $36,000,000 for
fiscal year 1997, and such sums as may be necessary for each of the
fiscal years 1998 through 2001.".
(b) Transition.--The <> Secretary of Health
and Human Services shall ensure the continued hnding of grants made, or
contracts or cooperative agreements entered into, under subpart I of
part D of title III of the Public Health Service Act (42 U.S.C. 254b et
seq.) (as such subpart existed on the day prior to the date of enactment
of this Act), until the expiration of the grant period or the term of
the contract or cooperative agreement. Such fiinding shall be continued
under the same terms and conditions as were in effect on the date on
which the grant, contract or cooperative agreement was awarded, subject
to the availability of appropriations.

CaIendar No. 956
l O l n CONCRES~
Hh i o n

]

SENATE

[

REPORT
101-516

DEPARTMENTS O F LABOEZ, HEALTH AND RUMAN SERVICES, AND EDUCATION AND RELATED AGENCIES APPROPRLATION BILL, 1991

Health seruices outreach grants

The & m m i b provides $20,000,000 to establish projects to demonstrate the effectiveness of outreach to populations in rural areas
that do not normally seek health or mental health services. This
activity reflects two major concerns of the Committee: (1) that the
outreach activities of community and migrant health centers and
local health departments are almost nonexistent and that m a y
people are not being reached until expensive hospital care is required; and (2) that communi@ and migrant health centers, local
health departmeilt~,and private medicine by and large do not coop
erate and coordinate to reach these forgotten populations in rural
America
The Commit& was pleased to receive the re rt of the National
Advisory Committee on Rural Health to the L e t a r y of Health
and Human Services. The National Advisory Committee recommends in its report that the Secretary develop a series of programs
to facilitate integration and coordination of services in or among
rural communities. These programs are recommended to include
new demonstrations to enhance linkages, integration, and cooperation among hospitals, medical group practices, public health departments, and other local primary care p r ~ e d e r s .The Committee
concurs with t h e National Advisory Committee. Therefore, the
Committee has provided t h e funds for this new initiative.
-- .
In order to evaluate the effectiveness of outreach programs, the
Committee directs that $20,000,000 be made available for up to 40
cooperative outreach programs under the authority of section 301
of the Public Health Service Act. The Committee recognizes the
vast difference in rural areas and their resourcrx, and expects wide
fleniility in these grants. The individual grantees must be coalitions of a t least three of the following entities, and they must share
outreach workers: community/migrant health centers, I d health
departments, community mental health centers, hospitals or private practices, other publicly h d e d h e d t h or social services agencies. The Committee expects that these projects will be distributed
in such a way as to maximize development of models applicable to
different rural areas.
'

'Social Security Act
Title Contents
OFFICE OF RURAL HEALTH POLICY

SEC. 711.[42 U.S.C. 9121There shall be established in the Department of Health and Human
Services (in this section referred to as the "Department") an Office of Rural Health Policy (in
this section referred to as the "Office"). The Office shall be headed by a Director, who shall
advise the Secretary on the effects of current policies and proposed statutory, regulatory,
administrative, and budgetary changes in the programs established under titles XVIII and XIX on
the financial viability of small rural hospitals, the ability of rural areas (and rural hospitals in
particular) to attract and retain physicians and other heaIth professionals, and access to (and the
quality of) health care in rural areas.

In addition to advising the Secretary with respect to the matters specified in subsection (a), the
Director, through the Office, shall(1) oversee compliance with the requirements of section 1102(b) of this Act and section
4403 of the Omnibus Budget Reconciliation Act of 1987 (as such section pertains to rural
health issues),
(2) establish and maintain a clearinghouse for collecting and disseminating information
on-(A) rural health care issues, including rural mental health, rural infant mortality
prevention, and rural occupational safety and preventive health promotion,
(B) research findings relating to rural health care, and
(C) innovative approaches to the delivery of health care in rural areas, including
programs providing community-based mental health services, pre-natal and infant
care services, and rural occupational safety and preventive health education and
promotion,
(3)coordinate the activities within the Department that relate to rural health care, and
(4)provide information to the Secretary and others in the Department with respect to the
activities, of other Federal departments and agencies, that relate to rural health care,
including activities relating to rural mental health, rural infant mortality, and rural
occupational safety and preventive health promotion.