Rural Health Innovation Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 4898 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 HOUSE OF REPRESENTATIVES OCTOBER 29, 2019 Mr. KUSTOFF of Tennessee (for himself, Mr. DAVID P. ROE of Tennessee, and Ms. KUSTER of New Hampshire) introduced the following bill; which was referred to the Committee on Energy and Commerce 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 2019’’. 5 VerDate Sep 11 2014 15:50 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4898.IH H4898 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 4898 IH 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. 330N. RURAL HEALTH CENTER INNOVATION AWARDS 6 PROGRAM. 7 ‘‘(a) DEFINITIONS.—In this section: 8 ‘‘(1) COVERED RURAL AREA.—The term ‘cov- 9 ered rural area’ means a rural area— 10 ‘‘(A) that is located not less than 30 min- 11 utes by automobile from the nearest emergency 12 department, using the speed limit of the most 13 direct route to such emergency department; or 14 ‘‘(B) from which an individual cannot ac- 15 cess an emergency department by road. 16 ‘‘(2) ELIGIBLE ENTITY.—The term ‘eligible en- 17 tity’ means an entity that— 18 ‘‘(A) is a Federally qualified health center; 19 ‘‘(B) is a rural health clinic; or 20 ‘‘(C) agrees (as a condition of receiving a 21 grant under this section) to establish such a 22 center or clinic, including a hospital that agrees 23 (as such a condition) to convert to a Federally 24 qualified health center. 25 VerDate Sep 11 2014 15:50 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4898.IH H4898 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 4898 IH ‘‘(3) FEDERALLY QUALIFIED HEALTH CEN- 1 TER.—The term ‘Federally qualified health center’ 2 has the meaning given such term in section 3 1861(aa) of the Social Security Act. 4 ‘‘(4) RURAL AREA.—The term ‘rural area’ has 5 the meaning given such term in section 330J(e). 6 ‘‘(5) RURAL HEALTH CLINIC.—The term ‘rural 7 health clinic’ has the meaning given such term in 8 section 1861(aa) of the Social Security Act. 9 ‘‘(b) ESTABLISHMENT.— 10 ‘‘(1) IN GENERAL.—The Secretary, acting 11 through the Administrator of the Health Resources 12 and Services Administration, shall establish a grant 13 program to be known as the ‘Rural Health Center 14 Innovation Awards program’ to award grants to eli- 15 gible entities that submit an application in accord- 16 ance with subsection (c) to enable such entities to 17 establish or maintain a Federally qualified health 18 center or rural health clinic that— 19 ‘‘(A) serves individuals in a covered rural 20 area as a walk-in urgent care center and as a 21 triage center or staging facility for necessary 22 air or ambulance transport to an emergency de- 23 partment; and 24 ‘‘(B) includes— 25 VerDate Sep 11 2014 15:50 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4898.IH H4898 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 4898 IH ‘‘(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 VerDate Sep 11 2014 23:20 Nov 04, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4898.IH H4898 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 4898 IH ‘‘(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) EXPEDITED REVIEW.—The Secretary shall 9 establish a process for expediting the review of any 10 application submitted under paragraph (1) for a 11 grant under this section from an eligible entity that 12 plans to use the funds of the grant to serve individ- 13 uals in a covered rural area in which a hospital has 14 closed in the 7 years preceding the date on which 15 the entity submitted the application. 16 ‘‘(d) GRANT PERIOD AND AMOUNTS.— 17 ‘‘(1) PERIOD.—Each grant awarded under this 18 section shall be for a period of 5 years. 19 ‘‘(2) AMOUNT.— 20 ‘‘(A) IN GENERAL.—A grant awarded 21 under this section to an eligible entity shall not 22 exceed— 23 ‘‘(i) for the first year of the grant— 24 VerDate Sep 11 2014 15:50 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4898.IH H4898 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 4898 IH ‘‘(I) $500,000 if the entity is a 1 Federally qualified health center, or a 2 rural health clinic, on the date on 3 which the award is made; and 4 ‘‘(II) $750,000 if the entity is 5 using the grant to establish a Feder- 6 ally qualified health center or a rural 7 health clinic; and 8 ‘‘(ii) for each of the third through 9 fifth years of the grant, $500,000. 10 ‘‘(B) CONSIDERATIONS.—In determining 11 the amount of a grant under this section for an 12 eligible entity for each year after the first year 13 in which the grant is awarded, the Secretary 14 shall, subject to subparagraph (A)(ii), consider 15 the number of patients treated, and the type of 16 treatment provided, by the entity in the prior 17 year. 18 ‘‘(e) REPORTING.— 19 ‘‘(1) IN GENERAL.—Not later than 3 years 20 after the date of enactment of this section, the Sec- 21 retary shall report to the committees described in 22 paragraph (2) on the grant program under this sec- 23 tion, including— 24 VerDate Sep 11 2014 15:50 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4898.IH H4898 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 4898 IH ‘‘(A) an assessment of the success of the 1 program, challenges with respect to the pro- 2 gram, and any action for regulatory flexibility 3 or legislative authority needed to improve the 4 program; 5 ‘‘(B) any savings to Federal health care 6 programs; 7 ‘‘(C) any increase in access to care; and 8 ‘‘(D) any increase in utilization of health 9 services in covered rural areas. 10 ‘‘(2) COMMITTEES.—The committees described 11 in this paragraph are— 12 ‘‘(A) the Committee on Health, Education, 13 Labor, and Pensions, and the Committee on Fi- 14 nance, of the Senate; and 15 ‘‘(B) the Committee on Energy and Com- 16 merce, and the Committee on Ways and Means, 17 of the House of Representatives. 18 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 19 is authorized to be appropriated to carry out this section 20 $25,000,000 for each of fiscal years 2020 through 2024.’’. 21 SEC. 3. RURAL HEALTH DEPARTMENT ENHANCEMENT PRO- 22 GRAM. 23 Subpart I of part D of title III of the Public Health 24 Service Act (42 U.S.C. 254b et seq.), as amended by sec- 25 VerDate Sep 11 2014 15:50 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4898.IH H4898 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 4898 IH tion 2, is further amended by adding at the end the fol- 1 lowing: 2 ‘‘SEC. 330O. RURAL HEALTH DEPARTMENT ENHANCEMENT 3 PROGRAM. 4 ‘‘(a) DEFINITIONS.—In this section: 5 ‘‘(1) COVERED RURAL AREA.—The term ‘cov- 6 ered rural area’ has the meaning given the term in 7 section 330N(a). 8 ‘‘(2) RURAL HEALTH DEPARTMENT.—The term 9 ‘rural health department’ means a health depart- 10 ment that is located in a covered rural area. 11 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 12 through the Administrator of the Health Resources and 13 Services Administration, shall award grants, on a competi- 14 tive basis, to rural health departments that submit an ap- 15 plication in accordance with subsection (c) to enhance 16 such departments and enable them to provide individuals 17 in covered rural areas with emergency services, triage and 18 transport to emergency departments, primary care serv- 19 ices, and other services similar to services provided by 20 emergency departments. 21 ‘‘(c) APPLICATIONS.—A rural health department 22 seeking a grant under this section shall submit an applica- 23 tion to the Secretary at such time, in such manner, and 24 VerDate Sep 11 2014 15:50 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4898.IH H4898 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 4898 IH containing such information as the Secretary may reason- 1 ably require, including— 2 ‘‘(1) an indication of the estimated cost of the 3 equipment and staffing needed by the department 4 for the first year of the award to set up the activities 5 and services under this section; 6 ‘‘(2) a demonstration that the department has, 7 on the date on which the application is submitted, 8 a facility operating that is located in a covered rural 9 area; and 10 ‘‘(3) a demonstration that, on the date on 11 which the application is submitted, the depart- 12 ment— 13 ‘‘(A) has a nursing staff and medical 14 equipment; and 15 ‘‘(B) agrees to use such staff and equip- 16 ment towards providing the services and car- 17 rying out the activities under this section. 18 ‘‘(d) GRANTS.— 19 ‘‘(1) ANNUAL AWARDS.—The funds awarded 20 through a grant under this section to a rural health 21 department shall be awarded on an annual basis for 22 each of 5 years. 23 ‘‘(2) MAXIMUM AMOUNTS.—The funds awarded 24 through a grant under this section to a rural health 25 VerDate Sep 11 2014 15:50 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4898.IH H4898 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 4898 IH department shall be in an amount that for a year 1 does not exceed $500,000. 2 ‘‘(3) CONSIDERATIONS.—The Secretary shall 3 determine the amount awarded to a rural health de- 4 partment through a grant under this section for a 5 year in accordance with the following: 6 ‘‘(A) For the first year of the award, the 7 amount shall be based on the amount the rural 8 health department estimates for the cost of 9 equipment and staffing needed to set up the ac- 10 tivities and services supported under this sec- 11 tion, as specified in the application under sub- 12 section (c). 13 ‘‘(B) For the second through fifth years of 14 the award, the amount shall be based on the 15 number of patients treated, and the type of 16 treatment provided, by the department in the 17 prior year. 18 ‘‘(e) USE OF FUNDS.— 19 ‘‘(1) IN GENERAL.—A rural health department 20 receiving a grant under this section shall use the 21 funds awarded through the grant to provide the 22 services and carry out the activities described in sub- 23 section (b) at a facility that is located in a covered 24 rural area, including by— 25 VerDate Sep 11 2014 15:50 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4898.IH H4898 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 4898 IH ‘‘(A) obtaining additional medical equip- 1 ment and resources necessary for providing the 2 services and activities described in subsection 3 (b), such as laboratories, x-ray machines, and 4 cardiac monitors; 5 ‘‘(B) hiring additional providers to provide 6 the services and carry out the activities de- 7 scribed in subsection (b), such as physician in- 8 terns, residents, nurse practitioners, physician 9 assistants, and nurse midwives, which hiring 10 may be through a partnership described in 11 paragraph (2)(A); and 12 ‘‘(C) providing outreach to the community 13 regarding the services and activities of the rural 14 health department as supported under this sec- 15 tion. 16 ‘‘(2) LIMITATIONS.— 17 ‘‘(A) PARTNERSHIPS.—Not more than 3 18 percent of the funds awarded through a grant 19 under this section for a year may be used to- 20 wards the rural health department entering into 21 a partnership with an academic medical center 22 to assist with the hiring described in paragraph 23 (1)(B). 24 VerDate Sep 11 2014 15:50 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H4898.IH H4898 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 4898 IH ‘‘(B) COMMUNITY OUTREACH.—For each 1 of the first 2 years of a grant awarded under 2 this section, not more than 3 percent of the 3 funds may be used by the rural health depart- 4 ment receiving the grant for the outreach de- 5 scribed in paragraph (1)(C). 6 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 7 are authorized to be appropriated to carry out this section 8 $25,000,000 for each of fiscal years 2020 through 2024.’’. 9 Æ VerDate Sep 11 2014 15:50 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6301 E:\BILLS\H4898.IH H4898 pamtmann on DSKBC07HB2PROD with BILLS