What This Bill Does
This bill creates two grant programs to help rural health care centers and rural public health departments provide emergency care services. The programs aim to establish and support urgent care centers, emergency triage services, and health department emergency capabilities in rural areas.
Who It Affects
Federally qualified health centers (health care facilities that serve low-income patients) and rural health clinics in rural areas. Rural public health departments in rural areas. Hospitals that agree to convert to federally qualified health centers or rural health clinics. Patients living in rural areas seeking emergency care and urgent care services.
Key Provisions
* The Secretary of Health and Human Services, working through the Office of Rural Health Policy, establishes a Rural Health Center Innovation Awards program that gives grants to health centers and clinics that serve as walk-in urgent care centers and emergency triage facilities in rural areas. These centers must have clinical staff like doctors, nurse practitioners, and physician assistants, plus equipment like laboratories and x-ray machines. (Sec. 330Q(b))
* Grants for rural health centers last 5 years, with a maximum of $750,000 in the first year for new centers or $500,000 in the first year for existing centers, and $500,000 per year for years two through five. (Sec. 330Q(d))
* The Secretary establishes a Rural Health Department Enhancement Program that gives grants to local public health departments in rural areas to provide emergency services, triage, transport to emergency departments, and primary care services. (Sec. 330R(b))
* Rural health departments receive annual grants for 5 years, with a maximum of $500,000 per year. The first year's amount is based on equipment and staffing costs; years two through five are based on the number and type of patients treated. (Sec. 330R(d))
* Grant funds for rural health centers and departments can be used to expand operating hours, pay for construction and renovation, hire additional health care providers, obtain medical equipment, and conduct community outreach. (Sec. 330Q(b) and Sec. 330R(e))
What Changes
Federal law is amended to create two new grant programs. Rural health centers and clinics become eligible for up to $750,000 in their first year and $500,000 in subsequent years (up to 5 years total) to establish or maintain urgent care and emergency triage services. Rural public health departments become eligible for up to $500,000 per year for 5 years to enhance emergency and primary care services. The federal government authorizes $25,000,000 per year for each program from 2024 through 2028.
Important Definitions
* Federally qualified health center: A health care facility meeting requirements under the Social Security Act that provides services to low-income and uninsured patients (definition references Social Security Act, not fully stated here).
* Rural health clinic: A health care clinic meeting requirements under the Social Security Act located in a rural area (definition references Social Security Act, not fully stated here).
* Rural area: Any area designated as rural by the Office of Rural Health Policy of the Health Resources and Services Administration (federal agency determining eligibility for grants), including any area rural as of fiscal year 2023 or any area rural under future fiscal year designations.
* Rural health department: A local public health department located in a rural area.
II
118TH CONGRESS
1ST SESSION
S. 953
To amend the Public Health Service Act to establish a rural health center
innovation awards program and a rural health department enhancement
program, and for other purposes.
IN THE SENATE OF THE UNITED STATES
MARCH 23, 2023
Mrs. BLACKBURN (for herself and Mr. HICKENLOOPER) introduced the fol-
lowing bill; which was read twice and referred to the Committee on
Health, Education, Labor, and Pensions
A BILL
To amend the Public Health Service Act to establish a rural
health center innovation awards program and a rural
health department enhancement program, and for other
purposes.
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 ‘‘Rural Health Innova-
4
tion Act of 2023’’.
5
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•S 953 IS
SEC. 2. RURAL HEALTH CENTER INNOVATION AWARDS
1
PROGRAM.
2
Subpart I of part D of title III of the Public Health
3
Service Act (42 U.S.C. 254b et seq.) is amended by adding
4
at the end the following:
5
‘‘SEC. 330Q. RURAL HEALTH CENTER INNOVATION AWARDS
6
PROGRAM.
7
‘‘(a) DEFINITIONS.—In this section:
8
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en-
9
tity’ means an entity that—
10
‘‘(A) is a Federally qualified health center;
11
‘‘(B) is a rural health clinic; or
12
‘‘(C) agrees (as a condition of receiving a
13
grant under this section) to establish such a
14
center or clinic, including a hospital that agrees
15
(as such a condition) to convert to a Federally
16
qualified health center or rural health clinic.
17
‘‘(2) FEDERALLY
QUALIFIED
HEALTH
CEN-
18
TER.—The term ‘Federally qualified health center’
19
has the meaning given such term in section
20
1861(aa) of the Social Security Act.
21
‘‘(3) RURAL
AREA.—The term ‘rural area’
22
means any area that is rural, within the meaning of
23
such term as used by the Office of Rural Health
24
Policy of the Health Resources and Services Admin-
25
istration for purposes of determining eligibility for
26
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•S 953 IS
grants or services, including any area that is rural
1
within such meaning as used by such Office for fis-
2
cal year 2023 or any area that is rural within such
3
meaning as amended for a subsequent fiscal year.
4
‘‘(4) RURAL HEALTH CLINIC.—The term ‘rural
5
health clinic’ has the meaning given such term in
6
section 1861(aa) of the Social Security Act.
7
‘‘(b) ESTABLISHMENT.—
8
‘‘(1) IN
GENERAL.—The Secretary, acting
9
through the Director of the Office of Rural Health
10
Policy of the Health Resources and Services Admin-
11
istration, shall establish a grant program to be
12
known as the ‘Rural Health Center Innovation
13
Awards program’ to award grants to eligible entities
14
that submit an application in accordance with sub-
15
section (c) to enable such entities to establish or
16
maintain a Federally qualified health center or rural
17
health clinic that—
18
‘‘(A) serves individuals in a rural area as
19
a walk-in urgent care center and as a triage
20
center or staging facility for necessary air or
21
ambulance transport to an emergency depart-
22
ment; and
23
‘‘(B) includes—
24
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•S 953 IS
‘‘(i) professional clinical staff, includ-
1
ing physicians, physician interns, residents,
2
nurse practitioners, physician assistants,
3
nurse midwives, or other health care pro-
4
viders providing walk-in urgent care and
5
emergency triage; and
6
‘‘(ii) resources, including laboratories,
7
x-ray machines, and cardiac monitors.
8
‘‘(2) PERMISSIBLE
USES
OF
FUNDS.—The
9
funds of a grant awarded under this section may be
10
used to—
11
‘‘(A) expand the hours of operation of a
12
Federally qualified health center or rural health
13
clinic;
14
‘‘(B) pay for the costs of construction and
15
renovation of a Federally qualified health center
16
or rural health clinic; or
17
‘‘(C) carry out any other activity for the
18
purposes described in paragraph (1).
19
‘‘(c) APPLICATIONS AND SELECTION.—
20
‘‘(1) IN GENERAL.—An eligible entity seeking a
21
grant under this section shall submit to the Sec-
22
retary an application at such time, in such manner,
23
and containing such information as the Secretary
24
may reasonably require.
25
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•S 953 IS
‘‘(2) START
UP
CENTERS
AND
CLINICS.—An
1
application submitted under paragraph (1) by an eli-
2
gible entity that is not a Federally qualified health
3
center, or a rural health clinic, on the date on which
4
the entity submits the application under paragraph
5
(1) shall include in such application a demonstration
6
of the costs of the equipment and staffing needed to
7
establish the center or clinic.
8
‘‘(3) CONSIDERATION
OF
OVERLAP.—In the
9
case an eligible entity submits an application under
10
paragraph (1) that proposes to serve an area that is
11
served by another eligible entity through a grant
12
under this section, the Secretary may consider
13
whether an award to the eligible entity serving such
14
same area can be justified based on the unmet need
15
for additional services in such area.
16
‘‘(4) PRIORITY.—In selecting recipients of
17
grants under this section, the Secretary shall give
18
priority to an eligible entity that is operating as a
19
Federally qualified health center, or a rural health
20
clinic, on the date on which the entity submits the
21
application under paragraph (1).
22
‘‘(d) GRANT PERIOD AND AMOUNTS.—
23
‘‘(1) PERIOD.—Each grant awarded under this
24
section shall be for a period of 5 years.
25
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•S 953 IS
‘‘(2) AMOUNT.—
1
‘‘(A) IN
GENERAL.—A grant awarded
2
under this section to an eligible entity shall not
3
exceed—
4
‘‘(i) for the first year of the grant—
5
‘‘(I) $500,000 if the entity is a
6
Federally qualified health center, or a
7
rural health clinic, on the date on
8
which the award is made; and
9
‘‘(II) $750,000 if the entity is
10
using the grant to establish a Feder-
11
ally qualified health center or a rural
12
health clinic; and
13
‘‘(ii) for each of the second through
14
fifth years of the grant, $500,000.
15
‘‘(B) CONSIDERATIONS.—In determining
16
the amount of a grant under this section for an
17
eligible entity for each year after the first year
18
in which the grant is awarded, the Secretary
19
shall, subject to subparagraph (A)(ii), consider
20
the number of patients treated, and the type of
21
treatment provided, by the entity in the prior
22
year.
23
‘‘(e) REPORTING.—
24
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•S 953 IS
‘‘(1) IN
GENERAL.—Not later than 3 years
1
after the date of enactment of this section, the Sec-
2
retary shall report to the committees described in
3
paragraph (2) on the grant program under this sec-
4
tion, including—
5
‘‘(A) an assessment of the success of the
6
program, challenges with respect to the pro-
7
gram, and any action for regulatory flexibility
8
or legislative authority needed to improve the
9
program;
10
‘‘(B) any savings to Federal health care
11
programs;
12
‘‘(C) any increase in access to care; and
13
‘‘(D) any increase in utilization of health
14
services in rural areas.
15
‘‘(2) COMMITTEES.—The committees described
16
in this paragraph are—
17
‘‘(A) the Committee on Health, Education,
18
Labor, and Pensions, and the Committee on Fi-
19
nance, of the Senate; and
20
‘‘(B) the Committee on Energy and Com-
21
merce, and the Committee on Ways and Means,
22
of the House of Representatives.
23
‘‘(f) RULE OF CONSTRUCTION.—No entity receiving
24
a grant under this section shall lose status as a Federally
25
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•S 953 IS
qualified health center, or a rural health clinic, on account
1
of carrying out any activities under this section.
2
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There
3
is authorized to be appropriated to carry out this section
4
$25,000,000 for each of fiscal years 2024 through 2028.’’.
5
SEC. 3. RURAL HEALTH DEPARTMENT ENHANCEMENT PRO-
6
GRAM.
7
Subpart I of part D of title III of the Public Health
8
Service Act (42 U.S.C. 254b et seq.), as amended by sec-
9
tion 2, is further amended by adding at the end the fol-
10
lowing:
11
‘‘SEC. 330R. RURAL HEALTH DEPARTMENT ENHANCEMENT
12
PROGRAM.
13
‘‘(a) DEFINITIONS.—In this section:
14
‘‘(1) RURAL AREA.—The term ‘rural area’ has
15
the meaning given the term in section 330Q(a).
16
‘‘(2) RURAL HEALTH DEPARTMENT.—The term
17
‘rural health department’ means a local public health
18
department that is located in a rural area.
19
‘‘(b)
ESTABLISHMENT.—The
Secretary,
acting
20
through the Director of the Office of Rural Health Policy
21
of the Health Resources and Services Administration,
22
shall award grants, on a competitive basis, to rural health
23
departments that submit an application in accordance
24
with subsection (c) to enhance such departments and en-
25
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9
•S 953 IS
able them to provide individuals in rural areas with emer-
1
gency services, triage and transport to emergency depart-
2
ments, primary care services, and other services similar
3
to services provided by emergency departments.
4
‘‘(c) APPLICATIONS.—A rural health department
5
seeking a grant under this section shall submit an applica-
6
tion to the Secretary at such time, in such manner, and
7
containing such information as the Secretary may reason-
8
ably require, including—
9
‘‘(1) an indication of the estimated cost of the
10
equipment and staffing needed by the department
11
for the first year of the award to set up the activities
12
and services under this section;
13
‘‘(2) a demonstration that the department has,
14
on the date on which the application is submitted,
15
a facility operating that is located in a rural area;
16
and
17
‘‘(3) a demonstration that, on the date on
18
which the application is submitted, the depart-
19
ment—
20
‘‘(A) has a nursing staff and medical
21
equipment; and
22
‘‘(B) agrees to use such staff and equip-
23
ment towards providing the services and car-
24
rying out the activities under this section.
25
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•S 953 IS
‘‘(d) GRANTS.—
1
‘‘(1) ANNUAL
AWARDS.—The funds awarded
2
through a grant under this section to a rural health
3
department shall be awarded on an annual basis for
4
each of 5 years.
5
‘‘(2) MAXIMUM AMOUNTS.—The funds awarded
6
through a grant under this section to a rural health
7
department shall be in an amount that for a year
8
does not exceed $500,000.
9
‘‘(3) CONSIDERATIONS.—The Secretary shall
10
determine the amount awarded to a rural health de-
11
partment through a grant under this section for a
12
year in accordance with the following:
13
‘‘(A) For the first year of the award, the
14
amount shall be based on the amount the rural
15
health department estimates for the cost of
16
equipment and staffing needed to set up the ac-
17
tivities and services supported under this sec-
18
tion, as specified in the application under sub-
19
section (c).
20
‘‘(B) For the second through fifth years of
21
the award, the amount shall be based on the
22
number of patients treated, and the type of
23
treatment provided, by the department in the
24
prior year.
25
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•S 953 IS
‘‘(e) USE OF FUNDS.—
1
‘‘(1) IN GENERAL.—A rural health department
2
receiving a grant under this section shall use the
3
funds awarded through the grant to provide the
4
services and carry out the activities described in sub-
5
section (b) at a facility that is located in a rural
6
area, including by—
7
‘‘(A) obtaining additional medical equip-
8
ment and resources necessary for providing the
9
services and activities described in subsection
10
(b), such as laboratories, x-ray machines, and
11
cardiac monitors;
12
‘‘(B) hiring additional providers to provide
13
the services and carry out the activities de-
14
scribed in subsection (b), such as physician in-
15
terns, residents, nurse practitioners, physician
16
assistants, and nurse midwives, which hiring
17
may be through a partnership described in
18
paragraph (2)(A); and
19
‘‘(C) providing outreach to the community
20
regarding the services and activities of the rural
21
health department as supported under this sec-
22
tion.
23
‘‘(2) LIMITATIONS.—
24
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•S 953 IS
‘‘(A) PARTNERSHIPS.—Not more than 3
1
percent of the funds awarded through a grant
2
under this section for a year may be used to-
3
wards the rural health department entering into
4
a partnership with an academic medical center
5
to assist with the hiring described in paragraph
6
(1)(B).
7
‘‘(B) COMMUNITY
OUTREACH.—For each
8
of the first 2 years of a grant awarded under
9
this section, not more than 3 percent of the
10
funds may be used by the rural health depart-
11
ment receiving the grant for the outreach de-
12
scribed in paragraph (1)(C).
13
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There
14
are authorized to be appropriated to carry out this section
15
$25,000,000 for each of fiscal years 2024 through 2028.’’.
16
Æ
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