[110th Congress Public Law 355]
[From the U.S. Government Printing Office]
[DOCID: f:publ355.110]
[[Page 3987]]
HEALTH CARE SAFETY NET ACT OF 2008
[[Page 122 STAT. 3988]]
Public Law 110-355
110th Congress
An Act
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. <<NOTE: Oct. 8,
2008 - [H.R. 1343]>>
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled, <<NOTE: Health
Care Safety Net Act of 2008.>>
SECTION 1. <<NOTE: 42 USC 201 note.>> SHORT TITLE.
This Act may be cited as the ``Health Care Safety Net Act of 2008''.
SEC. 2. COMMUNITY HEALTH CENTERS PROGRAM OF THE PUBLIC HEALTH
SERVICE ACT.
(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:
``(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--
``(A) $2,065,000,000 for fiscal year 2008;
``(B) $2,313,000,000 for fiscal year 2009;
``(C) $2,602,000,000 for fiscal year 2010;
``(D) $2,940,000,000 for fiscal year 2011; and
``(E) $3,337,000,000 for fiscal year 2012.''.
(b) Studies <<NOTE: 42 USC 254b note.>> Relating to Community Health
Centers.--
(1) Definitions.--For purposes of this subsection--
(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); and
(B) the term ``medically underserved population''
has the meaning given that term in such section 330.
(2) School-based health center study.--
(A) In general.--Not <<NOTE: Deadline.>> 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.
(B) Content.--In conducting the study under
subparagraph (A), the Comptroller General of the United
States shall analyze--
(i) the impact that Federal funding could have
on the operation of school-based health centers;
[[Page 122 STAT. 3989]]
(ii) any cost savings to other Federal
programs derived from providing health services in
school-based health centers;
(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;
(iv) the impact of access to health care from
school-based health centers in rural or
underserved areas; and
(v) other sources of Federal funding for
school-based health centers.
(3) Health care quality study.--
(A) In general.--
Not <<NOTE: Deadline. Reports.>> 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.
(B) Content.--The report under subparagraph (A)
shall focus on--
(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;
(ii) identification of effective models for
quality improvement in community health centers,
which may include models that--
(I) incorporate care coordination,
disease management, and other services
demonstrated to improve care;
(II) are designed to address
multiple, co-occurring diseases and
conditions;
(III) improve access to providers
through non-traditional means, such as
the use of remote monitoring equipment;
(IV) target various medically
underserved populations, including
uninsured patient populations;
(V) increase access to specialty
care, including referrals and diagnostic
testing; and
(VI) enhance the use of electronic
health records to improve quality;
(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;
[[Page 122 STAT. 3990]]
(iv) types of technical assistance and
resources provided to community health centers
that may facilitate the implementation of quality
improvement interventions;
(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;
(vi) successful strategies for sustaining
quality improvement interventions in the long-
term; and
(vii) partnerships with other Federal agencies
and private organizations or networks as
appropriate, to enhance health care quality in
community health centers.
(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.
(4) GAO study on integrated health systems model for the
delivery of health care services to medically underserved and
uninsured populations.--
(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--
(i) health care delivery models sponsored by
public or private non-profit entities that--
(I) integrate primary, specialty,
and acute care; and
(II) serve medically underserved and
uninsured populations; and
(ii) such models in rural and urban areas.
(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--
(i) an evaluation of the models, as described
in subparagraph (A), in--
(I) expanding access to primary,
preventive, and specialty services for
medically underserved and uninsured
populations; and
(II) improving care coordination and
health outcomes;
(III) increasing efficiency in the
delivery of quality health care; and
(IV) conducting some combination of
the following services--
(aa) outreach activities;
(bb) case management and
patient navigation services;
(cc) chronic care
management;
[[Page 122 STAT. 3991]]
(dd) transportation to
health care facilities;
(ee) development of provider
networks and other innovative
models to engage local
physicians and other providers
to serve the medically
underserved within a community;
(ff) recruitment, training,
and compensation of necessary
personnel;
(gg) acquisition of
technology for the purpose of
coordinating care;
(hh) improvements to
provider communication,
including implementation of
shared information systems or
shared clinical systems;
(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;
(jj) development of
prevention and disease
management tools and processes;
(kk) translation services;
(ll) development and
implementation of evaluation
measures and processes to assess
patient outcomes;
(mm) integration of primary
care and mental health services;
and
(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; and
(ii) an assessment of--
(I) challenges, including barriers
to Federal programs, encountered by such
entities in providing care to medically
underserved and uninsured populations;
and
(II) advantages and disadvantages of
such models compared to other models of
care delivery for medically underserved
and uninsured populations, including--
(aa) quality measurement and
quality outcomes;
(bb) administrative
efficiencies; and
(cc) geographic distribution
of federally-supported clinics
compared to geographic
distribution of integrated
health systems.
(5) GAO study on volunteer enhancement.--
(A) In general.--
Not <<NOTE: Deadline. Reports.>> 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
[[Page 122 STAT. 3992]]
28, United States Code) coverage to health care
professionals who volunteer to furnish care to patients
of health centers.
(B) Content.--In conducting the study under
subparagraph (A), the Comptroller General of the United
States shall analyze--
(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;
(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;
(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;
(iv) the volume of patient workload at health
centers and how volunteer health care
professionals may help address the patient volume;
(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;
(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; and
(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.
(c) Recognition of High Poverty.--
(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:
``(3) Recognition of high poverty.--
``(A) In general.--In making grants under this
subsection, the Secretary may recognize the unique needs
of high poverty areas.
``(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.''.
(2) Effective <<NOTE: 42 USC 254b note.>> date.--The
amendment made by paragraph (1) shall apply to grants made on or
after January 1, 2009.
[[Page 122 STAT. 3993]]
SEC. 3. NATIONAL HEALTH SERVICE CORPS.
(a) Funding.--
(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''.
(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--
``(1) for fiscal year 2008, $131,500,000;
``(2) for fiscal year 2009, $143,335,000;
``(3) for fiscal year 2010, $156,235,150;
``(4) for fiscal year 2011, $170,296,310; and
``(5) for fiscal year 2012, $185,622,980.''.
(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.''.
(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--
(1) in subclause (IV), by striking ``and'';
(2) in subclause (V), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(VI) the entity demonstrates
willingness to support or facilitate
mentorship, professional development,
and training opportunities for Corps
members.''.
(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:
``(d) Professional Development and Training.--
``(1) In general.--The Secretary shall assist Corps members
in establishing and maintaining professional relationships and
development opportunities, including by--
``(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;
``(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;
``(C) establishing professional networks among Corps
members; or
``(D) engaging in other professional development,
mentorship, and training activities for Corps members,
at the discretion of the Secretary.
``(2) Assistance in establishing professional
relationships.--In providing such assistance under paragraph
(1), the
[[Page 122 STAT. 3994]]
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.
``(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.''.
(e) Eligibility of the District of Columbia and Territories for the
State Loan Repayment Program.--
(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''.
(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.''.
SEC. 4. REAUTHORIZATION OF RURAL HEALTH CARE PROGRAMS.
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.''.
SEC. 5. REAUTHORIZATION OF PRIMARY DENTAL HEALTH WORKFORCE
PROGRAMS.
Section 340G(f) of the Public Health Service Act (42 U.S.C. 256g(f))
is amended--
(1) by striking ``$50,000,000'' and inserting
``$25,000,000''; and
(2) by striking ``2002'' and inserting ``2008''.
SEC. 6. EMERGENCY RESPONSE COORDINATION OF PRIMARY CARE PROVIDERS.
(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:
``SEC. 2815. <<NOTE: 42 USC 300hh-17.>> EMERGENCY RESPONSE
COORDINATION OF PRIMARY CARE PROVIDERS.
``The Secretary, acting through Administrator of the Health
Resources and Services Administration, and in coordination with the
Assistant Secretary for Preparedness and Response, shall
``(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; and
[[Page 122 STAT. 3995]]
``(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.''.
(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.
SEC. 7. REVISION OF THE TIMEFRAME FOR THE RECOGNITION OF CERTAIN
DESIGNATIONS IN CERTIFYING RURAL HEALTH
CLINICS UNDER THE MEDICARE PROGRAM.
(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).
(b) Effective <<NOTE: 42 USC 1395x note.>> Date.--The amendment made
by subsection (a) shall take effect on the date of the enactment of this
Act.
Approved October 8, 2008.
LEGISLATIVE HISTORY--H.R. 1343 (S. 901):
---------------------------------------------------------------------------
HOUSE REPORTS: No. 110-680 (Comm. on Energy and Commerce).
SENATE REPORTS: No. 110-274 accompanying S. 901 (Comm. on Health,
Education, Labor, and Pensions).
CONGRESSIONAL RECORD, Vol. 154 (2008):
June 4, considered and passed House.
Sept. 24, considered and passed Senate, amended.
Sept. 25, House concurred in Senate amendment.
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