Version	Word Count	Changes From Previous Version	Percent Change
Introduced in House	743	n/a	n/a
Reported in House	3,989	35	97%
Engrossed in House	3,154	11	30%
Referred in Senate	3,129	144	24%
Engrossed Amendment Senate	3,075	136	96%
Enrolled Bill	2,995	11 Show Changes Hide Changes	4%

Display Version Introduced in House Reported in House Engrossed in House Referred in Senate Engrossed Amendment Senate Enrolled Bill

HR 1343 EAS

In the Senate of the United States,September 24 (legislative day, September 17), 2008.Resolved, That the bill from the House of Representatives (H.R.1343CommentsClose CommentsPermalink

) entitled ‘An Act t One Hundred Tenth Congress CommentsClose CommentsPermalink

CommentsClose CommentsPermalink

To amend the Public Health Service Act to provide additional authorizations of appropriations for the health centers program under section 330 of such Act, and for other purposes.CommentsClose CommentsPermalink

’, do pass with the followingAMENDMENT:Strike all after the enacting clause and insert the following: Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE.CommentsClose CommentsPermalink

This Act may be cited as the ‘Health Care Safety Net Act of 2008’.CommentsClose CommentsPermalink

SEC. 2. COMMUNITY HEALTH CENTERS PROGRAM OF THE PUBLIC HEALTH SERVICE ACT.CommentsClose CommentsPermalink

(a) Additional Authorizations of Appropriations for the Health Centers Program of Public Health Service Act- Section 330(r) of the Public Health Service Act (42 U.S.C. 254b(r)) is amended by amending paragraph (1) to read as follows:CommentsClose CommentsPermalink





‘(1) IN GENERAL- For the purpose of carrying out this section, in addition to the amounts authorized to be appropriated under subsection (d), there are authorized to be appropriated--CommentsClose CommentsPermalink





‘(A) $2,065,000,000 for fiscal year 2008;CommentsClose CommentsPermalink





‘(B) $2,313,000,000 for fiscal year 2009;CommentsClose CommentsPermalink





‘(C) $2,602,000,000 for fiscal year 2010;CommentsClose CommentsPermalink





‘(D) $2,940,000,000 for fiscal year 2011; andCommentsClose CommentsPermalink





‘(E) $3,337,000,000 for fiscal year 2012.’.CommentsClose CommentsPermalink





(b) Studies Relating to Community Health Centers-CommentsClose CommentsPermalink





(1) DEFINITIONS- For purposes of this subsection--CommentsClose CommentsPermalink





(A) the term ‘community health center’ means a health center receiving assistance under section 330 of the Public Health Service Act (42 U.S.C. 254b); andCommentsClose CommentsPermalink





(B) the term ‘medically underserved population’ has the meaning given that term in such section 330.CommentsClose CommentsPermalink





(2) SCHOOL-BASED HEALTH CENTER STUDY-CommentsClose CommentsPermalink





(A) IN GENERAL- Not later than 2 years after the date of enactment of this Act, the Comptroller General of the United States shall issue a study of the economic costs and benefits of school-based health centers and the impact on the health of students of these centers.CommentsClose CommentsPermalink





(B) CONTENT- In conducting the study under subparagraph (A), the Comptroller General of the United States shall analyze--CommentsClose CommentsPermalink





(i) the impact that Federal funding could have on the operation of school-based health centers;CommentsClose CommentsPermalink





(ii) any cost savings to other Federal programs derived from providing health services in school-based health centers;CommentsClose CommentsPermalink





(iii) the effect on the Federal Budget and the health of students of providing Federal funds to school-based health centers and clinics, including the result of providing disease prevention and nutrition information;CommentsClose CommentsPermalink





(iv) the impact of access to health care from school-based health centers in rural or underserved areas; andCommentsClose CommentsPermalink





(v) other sources of Federal funding for school-based health centers.CommentsClose CommentsPermalink





(3) HEALTH CARE QUALITY STUDY-CommentsClose CommentsPermalink





(A) IN GENERAL- Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this Act as the ‘Secretary’), acting through the Administrator of the Health Resources and Services Administration, and in collaboration with the Agency for Healthcare Research and Quality, shall prepare and submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report that describes agency efforts to expand and accelerate quality improvement activities in community health centers.CommentsClose CommentsPermalink





(B) CONTENT- The report under subparagraph (A) shall focus on--CommentsClose CommentsPermalink





(i) Federal efforts, as of the date of enactment of this Act, regarding health care quality in community health centers, including quality data collection, analysis, and reporting requirements;CommentsClose CommentsPermalink





(ii) identification of effective models for quality improvement in community health centers, which may include models that--CommentsClose CommentsPermalink





(I) incorporate care coordination, disease management, and other services demonstrated to improve care;CommentsClose CommentsPermalink





(II) are designed to address multiple, co-occurring diseases and conditions;CommentsClose CommentsPermalink





(III) improve access to providers through non-traditional means, such as the use of remote monitoring equipment;CommentsClose CommentsPermalink





(IV) target various medically underserved populations, including uninsured patient populations;CommentsClose CommentsPermalink





(V) increase access to specialty care, including referrals and diagnostic testing; andCommentsClose CommentsPermalink





(VI) enhance the use of electronic health records to improve quality;CommentsClose CommentsPermalink





(iii) efforts to determine how effective quality improvement models may be adapted for implementation by community health centers that vary by size, budget, staffing, services offered, populations served, and other characteristics determined appropriate by the Secretary;CommentsClose CommentsPermalink





(iv) types of technical assistance and resources provided to community health centers that may facilitate the implementation of quality improvement interventions;CommentsClose CommentsPermalink





(v) proposed or adopted methodologies for community health center evaluations of quality improvement interventions, including any development of new measures that are tailored to safety-net, community-based providers;CommentsClose CommentsPermalink





(vi) successful strategies for sustaining quality improvement interventions in the long-term; andCommentsClose CommentsPermalink





(vii) partnerships with other Federal agencies and private organizations or networks as appropriate, to enhance health care quality in community health centers.CommentsClose CommentsPermalink





(C) DISSEMINATION- The Administrator of the Health Resources and Services Administration shall establish a formal mechanism or mechanisms for the ongoing dissemination of agency initiatives, best practices, and other information that may assist health care quality improvement efforts in community health centers.CommentsClose CommentsPermalink





(4) GAO STUDY ON INTEGRATED HEALTH SYSTEMS MODEL FOR THE DELIVERY OF HEALTH CARE SERVICES TO MEDICALLY UNDERSERVED AND UNINSURED POPULATIONS-CommentsClose CommentsPermalink





(A) STUDY- The Comptroller General of the United States shall conduct a study on integrated health system models of at least 15 sites for the delivery of health care services to medically underserved and uninsured populations. The study shall include an examination of--CommentsClose CommentsPermalink





(i) health care delivery models sponsored by public or private non-profit entities that--CommentsClose CommentsPermalink





(I) integrate primary, specialty, and acute care; andCommentsClose CommentsPermalink





(II) serve medically underserved and uninsured populations; andCommentsClose CommentsPermalink





(ii) such models in rural and urban areas.CommentsClose CommentsPermalink





(B) REPORT- Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the study conducted under subparagraph (A). The report shall include--CommentsClose CommentsPermalink





(i) an evaluation of the models, as described in subparagraph (A), in--CommentsClose CommentsPermalink





(I) expanding access to primary, preventive, and specialty services for medically underserved and uninsured populations; andCommentsClose CommentsPermalink





(II) improving care coordination and health outcomes;CommentsClose CommentsPermalink





(III) increasing efficiency in the delivery of quality health care; andCommentsClose CommentsPermalink





(IV) conducting some combination of the following services--CommentsClose CommentsPermalink

(aa) outreach activities;CommentsClose CommentsPermalink

(bb) case management and patient navigation services;CommentsClose CommentsPermalink

(cc) chronic care management;CommentsClose CommentsPermalink

(dd) transportation to health care facilities;CommentsClose CommentsPermalink

(ee) development of provider networks and other innovative models to engage local physicians and other providers to serve the medically underserved within a community;CommentsClose CommentsPermalink

(ff) recruitment, training, and compensation of necessary personnel;CommentsClose CommentsPermalink

(gg) acquisition of technology for the purpose of coordinating care;CommentsClose CommentsPermalink

(hh) improvements to provider communication, including implementation of shared information systems or shared clinical systems;CommentsClose CommentsPermalink

(ii) determination of eligibility for Federal, State, and local programs that provide, or financially support the provision of, medical, social, housing, educational, or other related services;CommentsClose CommentsPermalink

(jj) development of prevention and disease management tools and processes;CommentsClose CommentsPermalink

(kk) translation services;CommentsClose CommentsPermalink

(ll) development and implementation of evaluation measures and processes to assess patient outcomes;CommentsClose CommentsPermalink

(mm) integration of primary care and mental health services; andCommentsClose CommentsPermalink

(nn) 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; andCommentsClose CommentsPermalink

(ii) an assessment of--CommentsClose CommentsPermalink





(I) challenges, including barriers to Federal programs, encountered by such entities in providing care to medically underserved and uninsured populations; andCommentsClose CommentsPermalink





(II) advantages and disadvantages of such models compared to other models of care delivery for medically underserved and uninsured populations, including--CommentsClose CommentsPermalink

(aa) quality measurement and quality outcomes;CommentsClose CommentsPermalink

(bb) administrative efficiencies; andCommentsClose CommentsPermalink

(cc) geographic distribution of federally-supported clinics compared to geographic distribution of integrated health systems.CommentsClose CommentsPermalink

(5) GAO STUDY ON VOLUNTEER ENHANCEMENT-CommentsClose CommentsPermalink





(A) IN GENERAL- Not later than 6 months after the date of enactment of this Act, the Comptroller General of the United States shall conduct a study, and submit a report to Congress, concerning the implications of extending Federal Tort Claims Act (chapter 171 of title 28, United States Code) coverage to health care professionals who volunteer to furnish care to patients of health centers.CommentsClose CommentsPermalink





(B) CONTENT- In conducting the study under subparagraph (A), the Comptroller General of the United States shall analyze--CommentsClose CommentsPermalink





(i) the potential financial implications for the Federal Government of such an extension, including any increased funding needed for current health center Federal Tort Claims Act coverage;CommentsClose CommentsPermalink





(ii) an estimate of the increase in the number of health care professionals at health centers, and what types of such professionals would most likely volunteer given the extension of Federal Tort Claims Act coverage;CommentsClose CommentsPermalink





(iii) the increase in services provided by health centers as a result of such an increase in health care professionals, and in particular the effect of such action on the ability of health centers to secure specialty and diagnostic services needed by their uninsured and other patients;CommentsClose CommentsPermalink





(iv) the volume of patient workload at health centers and how volunteer health care professionals may help address the patient volume;CommentsClose CommentsPermalink





(v) the most appropriate manner of extending such coverage to volunteer health care professionals at health centers, including any potential difference from the mechanism currently used for health care professional volunteers at free clinics;CommentsClose CommentsPermalink





(vi) State laws that have been shown to encourage physicians and other health care providers to provide charity care as an agent of the State; andCommentsClose CommentsPermalink





(vii) other policies, including legislative or regulatory changes, that have the potential to increase the number of volunteer health care staff at health centers and the financial implications of such policies, including the cost savings associated with the ability to provide more services in health centers rather than more expensive sites of care.CommentsClose CommentsPermalink





(c) Recognition of High Poverty-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 330(c) of the Public Health Service Act (42 U.S.C. 254b(c)) is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(3) RECOGNITION OF HIGH POVERTY-CommentsClose CommentsPermalink





‘(A) IN GENERAL- In making grants under this subsection, the Secretary may recognize the unique needs of high poverty areas.CommentsClose CommentsPermalink





‘(B) HIGH POVERTY AREA DEFINED- For purposes of subparagraph (A), the term ‘high poverty area’ means a catchment area which is established in a manner that is consistent with the factors in subsection (k)(3)(J), and the poverty rate of which is greater than the national average poverty rate as determined by the Bureau of the Census.’.CommentsClose CommentsPermalink





(2) EFFECTIVE DATE- The amendment made by paragraph (1) shall apply to grants made on or after January 1, 2009.CommentsClose CommentsPermalink

SEC. 3. NATIONAL HEALTH SERVICE CORPS.CommentsClose CommentsPermalink

(a) Funding-CommentsClose CommentsPermalink





(1) REAUTHORIZATION OF NATIONAL HEALTH SERVICE CORPS PROGRAM- Section 338(a) of the Public Health Service Act (42 U.S.C. 254k(a)) is amended by striking ‘2002 through 2006’ and inserting ‘2008 through 2012’.CommentsClose CommentsPermalink





(2) SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS- Subsection (a) of section 338H of such Act (42 U.S.C. 254q) is amended by striking ‘appropriated $146,250,000’ and all that follows through the period and inserting the following: ‘appropriated--CommentsClose CommentsPermalink





‘(1) for fiscal year 2008, $131,500,000;CommentsClose CommentsPermalink





‘(2) for fiscal year 2009, $143,335,000;CommentsClose CommentsPermalink





‘(3) for fiscal year 2010, $156,235,150;CommentsClose CommentsPermalink





‘(4) for fiscal year 2011, $170,296,310; andCommentsClose CommentsPermalink





‘(5) for fiscal year 2012, $185,622,980.’.CommentsClose CommentsPermalink





(b) Elimination of 6-Year Demonstration Requirement- Section 332(a)(1) of the Public Health Service Act (42 U.S.C. 254e(a)(1)) is amended by striking ‘Not earlier than 6 years’ and all that follows through ‘purposes of this section.’.CommentsClose CommentsPermalink





(c) Assignment to Shortage Area- Section 333(a)(1)(D)(ii) of the Public Health Service Act (42 U.S.C. 254f(a)(1)(D)(ii)) is amended--CommentsClose CommentsPermalink





(1) in subclause (IV), by striking ‘and’;CommentsClose CommentsPermalink





(2) in subclause (V), by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink





(3) by adding at the end the following:CommentsClose CommentsPermalink





‘(VI) the entity demonstrates willingness to support or facilitate mentorship, professional development, and training opportunities for Corps members.’.CommentsClose CommentsPermalink





(d) Professional Development and Training- Subsection (d) of section 336 of the Public Health Service Act (42 U.S.C. 254h-1) is amended to read as follows:CommentsClose CommentsPermalink





‘(d) Professional Development and Training-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary shall assist Corps members in establishing and maintaining professional relationships and development opportunities, including by--CommentsClose CommentsPermalink





‘(A) establishing appropriate professional relationships between the Corps member involved and the health professions community of the geographic area with respect to which the member is assigned;CommentsClose CommentsPermalink





‘(B) establishing professional development, training, and mentorship linkages between the Corps member involved and the larger health professions community, including through distance learning, direct mentorship, and development and implementation of training modules designed to meet the educational needs of offsite Corps members;CommentsClose CommentsPermalink





‘(C) establishing professional networks among Corps members; orCommentsClose CommentsPermalink





‘(D) engaging in other professional development, mentorship, and training activities for Corps members, at the discretion of the Secretary.CommentsClose CommentsPermalink





‘(2) ASSISTANCE IN ESTABLISHING PROFESSIONAL RELATIONSHIPS- In providing such assistance under paragraph (1), the Secretary shall focus on establishing relationships with hospitals, with academic medical centers and health professions schools, with area health education centers under section 751, with health education and training centers under section 752, and with border health education and training centers under such section 752. Such assistance shall include assistance in obtaining faculty appointments at health professions schools.CommentsClose CommentsPermalink





‘(3) SUPPLEMENT NOT SUPPLANT- Such efforts under this subsection shall supplement, not supplant, non-government efforts by professional health provider societies to establish and maintain professional relationships and development opportunities.’.CommentsClose CommentsPermalink





(e) Eligibility of the District of Columbia and Territories for the State Loan Repayment Program-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 338I(h) of the Public Health Service Act (42 U.S.C. 254q-1(h)) is amended by striking ‘several States’ and inserting ‘50 States, the District of Columbia, the Commonwealth of Puerto Rico, the United States Virgin Islands, Guam, American Samoa, Palau, the Marshall Islands, and the Commonwealth of the Northern Mariana Islands’.CommentsClose CommentsPermalink





(2) AUTHORIZATION OF APPROPRIATIONS- Section 338I(i)(1) of such Act (42 U.S.C. 254q-1(i)(1)) is amended by striking ‘2002’ and all that follows through the period and inserting ‘2008, and such sums as may be necessary for each of fiscal years 2009 through 2012.’.CommentsClose CommentsPermalink

SEC. 4. REAUTHORIZATION OF RURAL HEALTH CARE PROGRAMS.CommentsClose CommentsPermalink

Section 330A(j) of the Public Health Service Act (42 U.S.C. 254c(j)) is amended by striking ‘$40,000,000’ and all that follows through the period and inserting ‘$45,000,000 for each of fiscal years 2008 through 2012.’.CommentsClose CommentsPermalink

SEC. 5. REAUTHORIZATION OF PRIMARY DENTAL HEALTH WORKFORCE PROGRAMS.CommentsClose CommentsPermalink

Section 340G(f) of the Public Health Service Act (42 U.S.C. 256g(f)) is amended--CommentsClose CommentsPermalink





(1) by striking ‘$50,000,000’ and inserting ‘$25,000,000’; andCommentsClose CommentsPermalink





(2) by striking ‘2002’ and inserting ‘2008’.CommentsClose CommentsPermalink

SEC. 6. EMERGENCY RESPONSE COORDINATION OF PRIMARY CARE PROVIDERS.CommentsClose CommentsPermalink

(a) In General- Subtitle B of title XXVIII of the Public Health Service Act (42 U.S.C. 300hh-10 et seq.) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘SEC. 2815. EMERGENCY RESPONSE COORDINATION OF PRIMARY CARE PROVIDERS.CommentsClose CommentsPermalink

‘The Secretary, acting through Administrator of the Health Resources and Services Administration, and in coordination with the Assistant Secretary for Preparedness and Response, shallCommentsClose CommentsPermalink





‘(1) provide guidance and technical assistance to health centers funded under section 330 and to State and local health departments and emergency managers to integrate health centers into State and local emergency response plans and to better meet the primary care needs of populations served by health centers during public health emergencies; andCommentsClose CommentsPermalink





‘(2) encourage employees at health centers funded under section 330 to participate in emergency medical response programs including the National Disaster Medical System authorized in section 2812, the Volunteer Medical Reserve Corps authorized in section 2813, and the Emergency System for Advance Registration of Health Professions Volunteers authorized in section 319I.’.CommentsClose CommentsPermalink





(b) Sense of the Congress- It is the Sense of Congress that the Secretary of Health and Human Services, to the extent permitted by law, utilize the existing authority provided under the Federal Tort Claims Act for health centers funded under section 330 of the Public Health Service Act (42 U.S.C. 254b) in order to establish expedited procedures under which such health centers and their health care professionals that have been deemed eligible for Federal Tort Claims Act coverage are able to respond promptly in a coordinated manner and on a temporary basis to public health emergencies outside their traditional service area and sites, and across State lines, as necessary and appropriate.CommentsClose CommentsPermalink

SEC. 7. REVISION OF THE TIMEFRAME FOR THE RECOGNITION OF CERTAIN DESIGNATIONS IN CERTIFYING RURAL HEALTH CLINICS UNDER THE MEDICARE PROGRAM.CommentsClose CommentsPermalink

(a) In General- The second sentence of section 1861(aa)(2) of the Social Security Act (42 U.S.C. 1395x(aa)(2)) is amended by striking ‘3-year period’ and inserting ‘4-year period’ in the matter in clause (i) preceding subclause (I).CommentsClose CommentsPermalink





(b) Effective Date- The amendment made by subsection (a) shall take effect on the date of the enactment of this Act.CommentsClose CommentsPermalink

Attest: Secretary.

110th CONGRESS 2d Session H.R. 1343 AMENDMENT Speaker of the House of Representatives. CommentsClose CommentsPermalink

Vice President of the United States andCommentsClose CommentsPermalink

President of the Senate.CommentsClose CommentsPermalink