Sec. 50901. EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL HEALTH SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT OPERATE GME PROGRAMS

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## SEC. 50901 EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL HEALTH SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT OPERATE GME PROGRAMS ###

(a)Community Health Centers Funding Section 10503(b)(1)(F) of the Patient Protection and Affordable Care Act (42 U.S.C. 254b–2(b)(1)(F)), as amended by section 3101 of Public Law 115–96, is amended to read as follows: > > ##### “(F) > > $3,800,000,000 for fiscal year 2018 and $4,000,000,000 for fiscal year 2019.” > . ###

(b)Other Community Health Centers Provisions Section 330 of the Public Health Service Act (42 U.S.C. 254b) is amended— ####

(1)in subsection (b)(1)(A)(ii), by striking “abuse” and inserting “use disorder”; ####

(2)in subsection (b)(2)(A), by striking “abuse” and inserting “use disorder”; ####

(3)in subsection (c)— #####

(A)in paragraph (1), by striking subparagraphs

(B)through (D); #####

(B)by striking “

(1)In general ” and all that follows through “ The Secretary ” and inserting the following: > > #### “(1) Centers > > The Secretary” > ; and #####

(C)in paragraph (1), as amended, by redesignating clauses

(i)through

(v)as subparagraphs

(A)through

(E)and moving the margin of each of such redesignated subparagraph 2 ems to the left; ####

(4)by striking subsection

(d)and inserting the following: > > ### “(d) Improving Quality of Care > > > #### “(1) Supplemental awards > > The Secretary may award supplemental grant funds to health centers funded under this section to implement evidence-based models for increasing access to high-quality primary care services, which may include models related to— > > > ##### “(A) > > improving the delivery of care for individuals with multiple chronic conditions; > > > ##### “(B) > > workforce configuration; > > > ##### “(C) > > reducing the cost of care; > > > ##### “(D) > > enhancing care coordination; > > > ##### “(E) > > expanding the use of telehealth and technology-enabled collaborative learning and capacity building models; > > > ##### “(F) > > care integration, including integration of behavioral health, mental health, or substance use disorder services; and > > > ##### “(G) > > addressing emerging public health or substance use disorder issues to meet the health needs of the population served by the health center. > > > #### “(2) Sustainability > > In making supplemental awards under this subsection, the Secretary may consider whether the health center involved has submitted a plan for continuing the activities funded under this subsection after supplemental funding is expended. > > > #### “(3) Special consideration > > The Secretary may give special consideration to applications for supplemental funding under this subsection that seek to address significant barriers to access to care in areas with a greater shortage of health care providers and health services relative to the national average.” > ; ####

(5)in subsection (e)(1)— #####

(A)in subparagraph (B)— ######

(i)by striking “2 years” and inserting “1 year”; and ######

(ii)by adding at the end the following: “The Secretary shall not make a grant under this paragraph unless the applicant provides assurances to the Secretary that within 120 days of receiving grant funding for the operation of the health center, the applicant will submit, for approval by the Secretary, an implementation plan to meet the requirements of subsection (k)(3). The Secretary may extend such 120-day period for achieving compliance upon a demonstration of good cause by the health center.”; and #####

(B)in subparagraph (C)— ######

(i)in the subparagraph heading, by striking “and plans”; ######

(ii)by striking “or plan (as described in subparagraphs

(B)and

(C)of subsection (c)(1))”; ######

(iii)by striking “ or plan, including the purchase ” and inserting the following: > “including— > > > ###### “(i) > > the purchase” > ; ######

(iv)by inserting “, which may include data and information systems” after “of equipment”; ######

(v)by striking the period at the end and inserting a semicolon; and ######

(vi)by adding at the end the following: > > ###### “(ii) > > the provision of training and technical assistance; and > > > ###### “(iii) > > other activities that— > > > ###### “(I) > > reduce costs associated with the provision of health services; > > > ###### “(II) > > improve access to, and availability of, health services provided to individuals served by the centers; > > > ###### “(III) > > enhance the quality and coordination of health services; or > > > ###### “(IV) > > improve the health status of communities.” > ; ####

(6)in subsection (e)(5)(B)— #####

(A)in the heading of subparagraph (B), by striking “and plans”; and #####

(B)by striking “and subparagraphs

(B)and

(C)of subsection (c)(1) to a health center or to a network or plan” and inserting “to a health center or to a network”; ####

(7)in subsection (e), by adding at the end the following: > > #### “(6) New access points and expanded services > > > ##### “(A) Approval of new access points > > > ###### “(i) In general > > The Secretary may approve applications for grants under subparagraph

(A)or

(B)of paragraph

(1)to establish new delivery sites. > > > ###### “(ii) Special consideration > > In carrying out clause (i), the Secretary may give special consideration to applicants that have demonstrated the new delivery site will be located within a sparsely populated area, or an area which has a level of unmet need that is higher relative to other applicants. > > > ###### “(iii) Consideration of applications > > In carrying out clause (i), the Secretary shall approve applications for grants in such a manner that the ratio of the medically underserved populations in rural areas which may be expected to use the services provided by the applicants involved to the medically underserved populations in urban areas which may be expected to use the services provided by the applicants is not less than two to three or greater than three to two. > > > ###### “(iv) Service area overlap > > If in carrying out clause

(i)the applicant proposes to serve an area that is currently served by another health center funded under this section, the Secretary may consider whether the award of funding to an additional health center in the area can be justified based on the unmet need for additional services within the catchment area. > > > ##### “(B) Approval of expanded service applications > > > ###### “(i) In general > > The Secretary may approve applications for grants under subparagraph

(A)or

(B)of paragraph

(1)to expand the capacity of the applicant to provide required primary health services described in subsection (b)(1) or additional health services described in subsection (b)(2). > > > ###### “(ii) Priority expansion projects > > In carrying out clause (i), the Secretary may give special consideration to expanded service applications that seek to address emerging public health or behavioral health, mental health, or substance abuse issues through increasing the availability of additional health services described in subsection (b)(2) in an area in which there are significant barriers to accessing care. > > > ###### “(iii) Consideration of applications > > In carrying out clause (i), the Secretary shall approve applications for grants in such a manner that the ratio of the medically underserved populations in rural areas which may be expected to use the services provided by the applicants involved to the medically underserved populations in urban areas which may be expected to use the services provided by such applicants is not less than two to three or greater than three to two.” > ; ####

(8)in subsection (h)— #####

(A)in paragraph (1), by striking “and children and youth at risk of homelessness” and inserting “, children and youth at risk of homelessness, homeless veterans, and veterans at risk of homelessness”; and #####

(B)in paragraph (5)— ######

(i)by striking subparagraph (B); ######

(ii)by redesignating subparagraph

(C)as subparagraph (B); and ######

(iii)in subparagraph

(B)(as so redesignated)— ######

(I)in the subparagraph heading, by striking “abuse” and inserting “use disorder”; and ######

(II)by striking “abuse” and inserting “use disorder”; ####

(9)in subsection (k)— #####

(A)in paragraph (2)— ######

(i)in the paragraph heading, by inserting “unmet” before “need”; ######

(ii)in the matter preceding subparagraph (A), by inserting “or subsection (e)(6)” after “subsection (e)(1)”; ######

(iii)in subparagraph (A), by inserting “unmet” before “need for health services”; ######

(iv)in subparagraph (B), by striking “and” at the end; ######

(v)in subparagraph (C), by striking the period at the end and inserting “; and”; and ######

(vi)by adding after subparagraph

(C)the following: > > ##### “(D) > > in the case of an application for a grant pursuant to subsection (e)(6), a demonstration that the applicant has consulted with appropriate State and local government agencies, and health care providers regarding the need for the health services to be provided at the proposed delivery site.” > ; #####

(B)in paragraph (3)— ######

(i)in the matter preceding subparagraph (A), by inserting “or subsection (e)(6)” after “subsection (e)(1)(B)”; ######

(ii)in subparagraph (B), by striking “in the catchment area of the center” and inserting “, including other health care providers that provide care within the catchment area, local hospitals, and specialty providers in the catchment area of the center, to provide access to services not available through the health center and to reduce the non-urgent use of hospital emergency departments”; ######

(iii)in subparagraph (H)(ii), by inserting “who shall be directly employed by the center” after “approves the selection of a director for the center”; ######

(iv)in subparagraph (L), by striking “and” at the end; ######

(v)in subparagraph (M), by striking the period and inserting “; and”; and ######

(vi)by inserting after subparagraph (M), the following: > > ##### “(N) > > the center has written policies and procedures in place to ensure the appropriate use of Federal funds in compliance with applicable Federal statutes, regulations, and the terms and conditions of the Federal award.” > ; and #####

(C)by striking paragraph (4); ####

(10)in subsection (l), by adding at the end the following: “Funds expended to carry out activities under this subsection and operational support activities under subsection

(m)shall not exceed 3 percent of the amount appropriated for this section for the fiscal year involved.”; ####

(11)in subsection (q)(4), by adding at the end the following: “A waiver provided by the Secretary under this paragraph may not remain in effect for more than 1 year and may not be extended after such period. An entity may not receive more than one waiver under this paragraph in consecutive years.”; ####

(12)in subsection (r)(3)— #####

(A)by striking “ appropriate committees of Congress a report concerning the distribution of funds under this section ” and inserting the following: > “Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce of the House of Representatives, a report including, at a minimum— > > > ##### “(A) > > the distribution of funds for carrying out this section” > ; #####

(B)by striking “ populations. Such report shall include an assessment ” and inserting the following: > “populations; > > > ##### “(B) > > an assessment” > ; #####

(C)by striking “and the rationale for any substantial changes in the distribution of funds.” and inserting a semicolon; and #####

(D)by adding at the end the following: > > ##### “(C) > > the distribution of awards and funding for new or expanded services in each of rural areas and urban areas; > > > ##### “(D) > > the distribution of awards and funding for establishing new access points, and the number of new access points created; > > > ##### “(E) > > the amount of unexpended funding for loan guarantees and loan guarantee authority under title XVI; > > > ##### “(F) > > the rationale for any substantial changes in the distribution of funds; > > > ##### “(G) > > the rate of closures for health centers and access points; > > > ##### “(H) > > the number and reason for any grants awarded pursuant to subsection (e)(1)(B); and > > > ##### “(I) > > the number and reason for any waivers provided pursuant to subsection (q)(4).” > ; ####

(13)in subsection (r), by adding at the end the following new paragraph: > > #### “(5) Funding for participation of health centers in all of us research program > > In addition to any amounts made available pursuant to paragraph

(1)of this subsection, section 402A of this Act, or section 10503 of the Patient Protection and Affordable Care Act, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, to the Secretary $25,000,000 for fiscal year 2018 to support the participation of health centers in the All of Us Research Program under the Precision Medicine Initiative under section 498E of this Act.” > ; and ####

(14)by striking subsection (s). ###

(c)National Health Service Corps Section 10503(b)(2)(F) of the Patient Protection and Affordable Care Act (42 U.S.C. 254b–2(b)(2)(F)), as amended by section 3101 of Public Law 115–96, is amended to read as follows: > > ##### “(F) > > $310,000,000 for each of fiscal years 2018 and 2019.” > . ###

(d)Teaching Health Centers That Operate Graduate Medical Education Programs ####

(1)Payments Subsection

(a)of section 340H of the Public Health Service Act (42 U.S.C. 256h) is amended to read as follows: > > ### “(a) Payments > > > #### “(1) In general > > Subject to subsection (h)(2), the Secretary shall make payments under this section for direct expenses and indirect expenses to qualified teaching health centers that are listed as sponsoring institutions by the relevant accrediting body for, as appropriate— > > > ##### “(A) > > maintenance of filled positions at existing approved graduate medical residency training programs; > > > ##### “(B) > > expansion of existing approved graduate medical residency training programs; and > > > ##### “(C) > > establishment of new approved graduate medical residency training programs. > > > #### “(2) Per resident amount > > In making payments under paragraph (1), the Secretary shall consider the cost of training residents at teaching health centers and the implications of the per resident amount on approved graduate medical residency training programs at teaching health centers. > > > #### “(3) Priority > > In making payments under paragraph (1)(C), the Secretary shall give priority to qualified teaching health centers that— > > > ##### “(A) > > serve a health professional shortage area with a designation in effect under section 332 or a medically underserved community (as defined in section 799B); or > > > ##### “(B) > > are located in a rural area (as defined in section 1886(d)(2)(D) of the Social Security Act).” > . ####

(2)Funding Paragraph

(1)of section 340H(g) of the Public Health Service Act (42 U.S.C. 256h(g)), as amended by section 3101 of Public Law 115–96, is amended by striking “and $30,000,000 for the period of the first and second quarters of fiscal year 2018,” and inserting “and $126,500,000 for each of fiscal years 2018 and 2019,”. ####

(3)Annual reporting Subsection (h)(1) of section 340H of the Public Health Service Act (42 U.S.C. 256h) is amended— #####

(A)by redesignating subparagraph

(D)as subparagraph (H); and #####

(B)by inserting after subparagraph

(C)the following: > > ##### “(D) > > The number of patients treated by residents described in paragraph (4). > > > ##### “(E) > > The number of visits by patients treated by residents described in paragraph (4). > > > ##### “(F) > > Of the number of residents described in paragraph

(4)who completed their residency training at the end of such residency academic year, the number and percentage of such residents entering primary care practice (meaning any of the areas of practice listed in the definition of a primary care residency program in section 749A). > > > ##### “(G) > > Of the number of residents described in paragraph

(4)who completed their residency training at the end of such residency academic year, the number and percentage of such residents who entered practice at a health care facility— > > > ###### “(i) > > primarily serving a health professional shortage area with a designation in effect under section 332 or a medically underserved community (as defined in section 799B); or > > > ###### “(ii) > > located in a rural area (as defined in section 1886(d)(2)(D) of the Social Security Act).” > . ####

(4)Report on training costs Not later than March 31, 2019, the Secretary of Health and Human Services shall submit to the Congress a report on the direct graduate expenses of approved graduate medical residency training programs, and the indirect expenses associated with the additional costs of teaching residents, of qualified teaching health centers (as such terms are used or defined in section 340H of the Public Health Service Act (42 U.S.C. 256h)). ####

(5)Definition Subsection

(j)of section 340H of the Public Health Service Act (42 U.S.C. 256h) is amended— #####

(A)by redesignating paragraphs

(2)and

(3)as paragraphs

(3)and (4), respectively; and #####

(B)by inserting after paragraph

(1)the following: > > #### “(2) New approved graduate medical residency training program > > The term ‘new approved graduate medical residency training program’ means an approved graduate medical residency training program for which the sponsoring qualified teaching health center has not received a payment under this section for a previous fiscal year (other than pursuant to subsection (a)(1)(C)).” > . ####

(6)Technical correction Subsection

(f)of section 340H (42 U.S.C. 256h) is amended by striking “hospital” each place it appears and inserting “teaching health center”. ####

(7)Payments for previous fiscal years **[**[42 U.S.C. 256h note](/us/usc/t42/s256h)**]** The provisions of section 340H of the Public Health Service Act (42 U.S.C. 256h), as in effect on the day before the date of enactment of Public Law 115–96, shall continue to apply with respect to payments under such section for fiscal years before fiscal year 2018. ###

(e)Application Amounts appropriated pursuant to this section for fiscal year 2018 or 2019 are subject to the requirements contained in Public Law 115–31 for funds for programs authorized under sections 330 through 340 of the Public Health Service Act (42 U.S.C. 254b–256). ###

(f)Conforming Amendments Paragraph

(4)of section 3014(h) of title 18, United States Code, as amended by section 3101 of Public Law 115–96, is amended by striking “and section 3101(d) of the CHIP and Public Health Funding Extension Act” and inserting “and section 50901(e) of the Advancing Chronic Care, Extenders, and Social Services Act”.

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