Mobile Health Clinics Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 4537 To amend the Public Health Service Act to improve the provision of mobile medical health care services to certain underserved areas and populations, and for other purposes. IN THE HOUSE OF REPRESENTATIVES SEPTEMBER 26, 2019 Ms. VELA´ZQUEZ introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend the Public Health Service Act to improve the provision of mobile medical health care services to certain underserved areas and populations, and for other pur- poses. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Mobile Health Clinics 4 Act of 2019’’. 5 SEC. 2. FINDINGS. 6 Congress finds the following: 7 VerDate Sep 11 2014 04:34 Oct 02, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4537.IH H4537 kjohnson on DSK79L0C42 with BILLS 2 •HR 4537 IH (1) According to the Mobile Health Map report, 1 approximately 1,500 mobile health clinics (MHCs) 2 operate nationwide. 3 (2) MHCs can effectively provide care in areas 4 where health care infrastructure is limited because 5 of distance, financial capabilities, or inadequate sup- 6 porting infrastructure, including lack of public 7 transportation resources. 8 (3) MHCs can offer services such as primary 9 care, screenings, dental care, medications, behavioral 10 health care, immunizations, laboratory tests, case 11 management, triage, and assistance for public ben- 12 efit programs. 13 (4) MHCs help improve community health and 14 access to medical services in underserved commu- 15 nities across the United States, including urban, 16 rural, and suburban areas. 17 (5) Such clinics are cost-effective and help re- 18 duce the burden on hospitals, insurers, and govern- 19 ment entities managing health programs by pro- 20 viding prevention services, which also reduces unnec- 21 essary emergency department visits. 22 (6) The average cost of a visit to a provider of 23 mobile medical health care services is significantly 24 lower than the average cost of an emergency depart- 25 VerDate Sep 11 2014 04:34 Oct 02, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4537.IH H4537 kjohnson on DSK79L0C42 with BILLS 3 •HR 4537 IH ment visit. Visiting an MHC instead of the emer- 1 gency department can result in a cost savings of 2 more than $800 per visit. 3 (7) Several studies have shown that the return 4 on investment generated by MHCs ranges from $20 5 to $36 for every $1 spent. 6 (8) MHCs are successful when they engage with 7 other local stakeholders who can provide insight, 8 knowledge, and strategies to help meet public health 9 challenges that are immediately relevant to the com- 10 munities receiving services from MHC providers. 11 (9) Funding has been the largest barrier to the 12 development and maintenance of MHCs and their 13 resources. 14 (10) With additional Federal support, health 15 systems would be able to better invest in purchasing, 16 maintaining, and upgrading mobile units, increasing 17 the number of staff, dispensing more medication, 18 and advancing the use of efficient information tech- 19 nology for health purposes. 20 SEC. 3. IMPROVING ACCESS TO MOBILE MEDICAL HEALTH 21 CARE SERVICES. 22 (a) IN GENERAL.—Subpart I of part D of title III 23 of the Public Health Service Act (42 U.S.C. 254b et seq.) 24 is amended by adding at the end the following new section: 25 VerDate Sep 11 2014 04:34 Oct 02, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4537.IH H4537 kjohnson on DSK79L0C42 with BILLS 4 •HR 4537 IH ‘‘SEC. 330N. PARTNERSHIPS TO IMPROVE ACCESS TO MO- 1 BILE MEDICAL HEALTH CARE SERVICES. 2 ‘‘(a) AUTHORITY ESTABLISHED.— 3 ‘‘(1) IN GENERAL.—The Secretary may award 4 grants, contracts, or cooperative agreements to eligi- 5 ble entities to provide mobile medical health care 6 services in accordance with subsection (e). 7 ‘‘(2) LIMITATION.—A hospital or health care 8 facility may not be eligible for a grant, contract, or 9 cooperative agreement under this section with re- 10 spect to more than one partnership described in sub- 11 section (b)(1). 12 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible for a grant, 13 contract, or cooperative agreement under this section, an 14 entity shall— 15 ‘‘(1) be a partnership consisting of— 16 ‘‘(A) one or more hospitals; or 17 ‘‘(B) one or more other local health care 18 facilities, including clinics, rural health clinics, 19 federally qualified health centers, health cen- 20 ters, primary care facilities, mental health cen- 21 ters, pharmacies, or other mobile medical as- 22 sets, without regard to whether or not such a 23 local health care facility is owned (either in 24 whole or in part) by a hospital in a partnership 25 described in subparagraph (A) or another local 26 VerDate Sep 11 2014 04:34 Oct 02, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4537.IH H4537 kjohnson on DSK79L0C42 with BILLS 5 •HR 4537 IH health care facility as described in this subpara- 1 graph; and 2 ‘‘(2) provide services for any one of the fol- 3 lowing: 4 ‘‘(A) A medically underserved community 5 (as defined in section 799B(6)). 6 ‘‘(B) A medically underserved population 7 (as defined in section 330(b)(3)). 8 ‘‘(c) APPLICATION.—An eligible entity seeking fund- 9 ing under this section shall submit to the Secretary an 10 application at such time, in such manner, and containing 11 such information as the Secretary may require, including, 12 at a minimum, the following: 13 ‘‘(1) A long-term strategy and detailed imple- 14 mentation plan developed in consultation with com- 15 munity groups and appropriate stakeholders. 16 ‘‘(2) A demonstration of a specific public health 17 need that is relevant to a community or population 18 described in subsection (b)(2). 19 ‘‘(3) A description of the services that the enti- 20 ty will provide directly with funds under this section, 21 and, if applicable, a description of the services that 22 the eligible entity will provide indirectly with such 23 funds through contracts or cooperative agreements. 24 VerDate Sep 11 2014 04:34 Oct 02, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4537.IH H4537 kjohnson on DSK79L0C42 with BILLS 6 •HR 4537 IH ‘‘(4) An explanation of the entity’s inability to 1 address the need in paragraph (2) without Federal 2 assistance. 3 ‘‘(5) An identification of any related govern- 4 mental or community initiative that compliments or 5 will be coordinated with the long-term strategy and 6 detailed implementation plan required under para- 7 graph (1). 8 ‘‘(6) A plan detailing the methodologies that 9 will be used to evaluate the access and quality of 10 mobile medical health care services provided by the 11 entity to a community or population described in 12 subsection (b)(2). 13 ‘‘(7) A description of community outreach 14 mechanisms that the entity will employ to ensure the 15 participation of a community or population described 16 in subsection (b)(2). 17 ‘‘(8) An identification of best practices for 18 treatment, outreach, and data collection that the en- 19 tity will employ to track program participation and 20 program effectiveness. 21 ‘‘(9) A plan for providing mobile medical health 22 care services to individuals of limited English-speak- 23 ing ability. Such plan shall— 24 VerDate Sep 11 2014 04:34 Oct 02, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4537.IH H4537 kjohnson on DSK79L0C42 with BILLS 7 •HR 4537 IH ‘‘(A) take into account data from the Bu- 1 reau of the Census and previously documented 2 qualitative or quantitative observations from 3 community service providers offering health 4 care services in the areas in which the entity 5 will provide mobile medical health care services; 6 and 7 ‘‘(B) outline which languages are most 8 prevalent and commonly requested for trans- 9 lation services in such areas. 10 ‘‘(10)(A) Subject to subparagraph (B), an as- 11 surance that, if the entity receives a grant, contract, 12 or cooperative agreement or a renewal of such grant, 13 contract, or cooperative agreement under this sec- 14 tion, the entity will develop a plan to secure other 15 public or private funding resources to ensure the 16 continued operation and maintenance of mobile med- 17 ical health care services provided under this section 18 after funds under such grant, contract, or coopera- 19 tive agreement, or renewal, are no longer available. 20 ‘‘(B) The Secretary shall waive the requirement 21 under subparagraph (A) for the entity if the entity 22 demonstrates that complying with such requirement 23 would create an undue burden and result in signifi- 24 VerDate Sep 11 2014 04:34 Oct 02, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4537.IH H4537 kjohnson on DSK79L0C42 with BILLS 8 •HR 4537 IH cant disruption of the provision of mobile medical 1 health care services. 2 ‘‘(11) Any additional information required by 3 the Secretary. 4 ‘‘(d) REQUIREMENTS.— 5 ‘‘(1) AMOUNT.—A grant contract, or coopera- 6 tive agreement awarded under this section may not 7 exceed $750,000. 8 ‘‘(2) DURATION.—A grant, contract, or cooper- 9 ative agreement awarded under this section shall be 10 for a period of 3 years. 11 ‘‘(3) RENEWALS.— 12 ‘‘(A) IN GENERAL.—The Secretary may 13 renew a grant, contract, or cooperative agree- 14 ment awarded under this section with respect to 15 an eligible entity if the entity— 16 ‘‘(i) submits to the Secretary an appli- 17 cation for renewal at such time, in such 18 manner, and containing such information 19 as the Secretary may require; and 20 ‘‘(ii) demonstrates in such application 21 that— 22 ‘‘(I) grant, contract, or coopera- 23 tive agreement funds made available 24 to the entity were used in a manner 25 VerDate Sep 11 2014 04:34 Oct 02, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4537.IH H4537 kjohnson on DSK79L0C42 with BILLS 9 •HR 4537 IH required under the most recently ap- 1 proved application of the entity under 2 this section; and 3 ‘‘(II) the entity has made signifi- 4 cant progress in achieving the objec- 5 tives of the initial application ap- 6 proved for the entity under this sec- 7 tion. 8 ‘‘(B) DURATION.—An initial renewal for 9 an eligible entity under subparagraph (A) shall, 10 at a minimum, be for a period of 2 years. Any 11 subsequent renewal for such an entity shall be 12 for a period of 1 year. 13 ‘‘(e) USE OF FUNDS.—A grant, contract, or coopera- 14 tive agreement awarded under this section may be ex- 15 pended for— 16 ‘‘(1) purchases of mobile medical health care 17 service vehicles; 18 ‘‘(2) maintenance or upgrade of mobile medical 19 health care service vehicles; 20 ‘‘(3) hiring of casework staff, physicians, practi- 21 tioners, pharmacists, nursing personnel, or similar 22 medical professionals; 23 ‘‘(4) hiring and professional development of ad- 24 ministrative, oversight, clerical, or other support 25 VerDate Sep 11 2014 04:34 Oct 02, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4537.IH H4537 kjohnson on DSK79L0C42 with BILLS 10 •HR 4537 IH staff managing the operations or care provided by 1 mobile medical health care service vehicles; 2 ‘‘(5) professional development, including appro- 3 priate training for medical professionals specified in 4 paragraph (3); 5 ‘‘(6) distributing or dispensing prescriptions; 6 ‘‘(7) advancing the use of information tech- 7 nology for treatment purposes, including the employ- 8 ment of appropriate staff required for maintenance 9 to ensure the secure and stable operations of com- 10 puters, servers, and other appropriate information 11 technology infrastructure; and 12 ‘‘(8) increasing access of medically underserved 13 communities (as defined in section 799B(6)) or 14 medically underserved populations (as defined in sec- 15 tion 330(b)(3)) to mobile medical health care serv- 16 ices, including required primary health services (as 17 defined in section 330(b)(1)), substance use disorder 18 services (as defined in section 330(h)(5)(C)), and 19 mental health counseling. 20 ‘‘(f) SUPPLEMENT, NOT SUPPLANT, REQUIRE- 21 MENT.—A grant, contract, or cooperative agreement 22 awarded under this section shall be expended to supple- 23 ment, and not supplant, the expenditures of the eligible 24 entity involved and the value of in-kind contributions for 25 VerDate Sep 11 2014 04:34 Oct 02, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4537.IH H4537 kjohnson on DSK79L0C42 with BILLS 11 •HR 4537 IH the delivery of services to medically underserved commu- 1 nities or medically underserved populations. 2 ‘‘(g) ANNUAL REPORT.—An eligible entity that re- 3 ceives funds under this section during a fiscal year shall 4 submit to the Secretary, on a date specified by the Sec- 5 retary, an annual report detailing the progress in address- 6 ing the public health need specified in subsection (c)(2). 7 ‘‘(h) MOBILE MEDICAL HEALTH CARE SERVICE DE- 8 FINED.—In this section, the term ‘mobile medical health 9 care service’ means any health care-related service pro- 10 vided in a moveable vehicle or a non-permanent clinic. 11 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 12 authorized to be appropriated to carry out this section 13 $15,000,000 for fiscal year 2020 and each succeeding fis- 14 cal year.’’. 15 (b) RULEMAKING.—Not later than the date that is 16 one year after the date of enactment of this Act, the Sec- 17 retary of Health and Human Services shall, through notice 18 and comment rulemaking, establish— 19 (1) a process for awarding grants, contract, and 20 cooperative agreement including renewing and termi- 21 nating grants, contract, and cooperative agreement 22 under section 330N of the Public Health Service 23 Act, as added by subsection (a); 24 VerDate Sep 11 2014 04:34 Oct 02, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H4537.IH H4537 kjohnson on DSK79L0C42 with BILLS 12 •HR 4537 IH (2) benchmarks for measuring significant 1 progress as described in subsection (d)(3)(A)(ii)(II) 2 of such section; and 3 (3) a process for providing entities described in 4 such section a fair hearing and appellate review re- 5 garding any decision by the Secretary to renew or 6 terminate a grant, contract, or cooperative agree- 7 ment under such section. 8 Æ VerDate Sep 11 2014 04:34 Oct 02, 2019 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6301 E:\BILLS\H4537.IH H4537 kjohnson on DSK79L0C42 with BILLS