f\f}o[It I 103rJ Co^cfesr / U-f- Se£ffoto n 103d CONGRESS 1160 1st Session S. To amend the Public Health Service Act to provide grants to entities in rural areas that design and implement innovative approaches to improve the availability and quality of health care in such rural areas, and for other purposes. IN THE SENATE OF THE UNITED STATES June 24 (legislative day, June 22), 1993 Mr. Hatfield introduced the following bill; which was read twice and referred to the Committee on Labor and Human Resources A BILL To amend the Public Health Service Act to provide grants to entities in rural areas that design and implement innovative approaches to improve the availability and quality of health care in such rural areas, and for other purposes. 1 Be it enacted by the Senate and House ofRepresenta- 2 tives ofthe United States ofAmerica in Congress assembled, 3 SECTION 1. SHORT TITLE. 4 This Act may be cited as the "Rural Health Innova- 5 tion Demonstration Act of 1993". — 2 1 SEC. 2. RURAL HEALTH EXTENSION NETWORKS. 2 Title XVII of the Public Health Service Act (42 3 U.S.C. 300u et seq.) is amended by adding at the end 4 thereofthe following new section: 5 "SEC. 1709. RURAL HEALTH EXTENSION NETWORKS. — 6 "(a) Grants. The Secretary, acting through the 7 Health Resources and Services Administration, may 8 award competitive grants to eligible entities to enable such 9 entities to facilitate the development of networks among 10 rural and urban health care providers to preserve and 11 share health care resources and enhance the quality and 12 availability of health care in rural areas. Such networks 13 may be statewide or regionalized in focus. — 14 "(b) Eligible Entities. To be eligible to receive 15 a grant under subsection (a) an entity shall 16 "(1)(A) be a rural health extension network 17 that meets the requirements of subsection (c); or 18 "(B) be an Area Health Education Center Pro- 19 gram; 20 "(2) prepare and submit to the Secretary an 21 application at such time, in such form and contain- 22 ing such information as the Secretary may require; 23 and 24 "(3) meets such other requirements as the Sec- 25 retary determines appropriate. S 1160 is — 3 — 1 "(c) Networks. For purposes of subsection (b)(1), 2 a rural health extension network shall be an association 3 or consortium of three or more rural health care providers, 4 and may include one or more urban health care provider, 5 for the purposes of applying for a grant under this section 6 and using amounts received under such grant to provide 7 the services described in subsection (d). — 8 "(d) Services. — 9 "(1) In general. An entity that receives a 10 grant under subsection (a) shall use amounts re- 11 ceived under such grant to 12 "(A) provide education and community de- 13 cisionmaking support for health care providers 14 in the rural areas served by the network; 15 "(B) utilize existing health care provider 16 education programs, including but not limited 17 to, the program for area health education cen- 18 ters under section 781, to provide educational 19 services to health care providers and trainees 20 including, but not limited to, physicians, nurses 21 and nursing students in the areas served by the 22 network; 23 "(C) make appropriately trained 24 facilitators available to health care providers lo- 25 cated in the areas served by the network to as- •S 1160 is 4 1 sist such providers in developing cooperative ap- 2 proaches to health care in such area; 3 "(D) facilitate linkage building through the 4 organization of discussion and planning groups 5 and the dissemination of information concern- 6 ing the health care resources where available, 7 within the area served by the network; 8 "(E) support telecommunications and con- 9 sultative projects to link rural hospitals and 10 other health care providers, and urban or ter- 11 tiary hospitals in the areas served by the net- 12 work; or 13 "(F) carry out any other activity deter- 14 mined appropriate by the Secretary. — 15 "(2) Education. In carrying out activities 16 under paragraph (1)(B), an entity shall support the 17 development of an information and resource sharing 18 system, including elements targeted towards high 19 risk populations and focusing on health promotion, 20 to facilitate the ability of rural health care providers 21 to have access to needed health care information. 22 Such activities may include the provision of training 23 to enable individuals to serve as coordinators of 24 health education programs in rural areas. •S 1160 is 5 1 "(3) Collection and dissemination of — 2 data. The chief executive officer of a State shall 3 designate a State agency that shall be responsible 4 for collecting and regularly disseminating informa- 5 tion concerning the activities of the rural health ex- 6 tension networks in that State. — 7 "(e) Matching Requirement. An entity that re- 8 ceives a grant under subsection (a) shall make available 9 (directly or through donations from public or private enti- 10 ties), non-Federal contributions towards the costs of the 11 operations of the network in an amount equal to the 12 amount of the grant. — 13 "(f) Authorization of Appropriations. There 14 are authorized to be appropriated to carry out this section, 15 $10,000,000 for each of the fiscal years 1994 through 16 1997. — 17 "(g) Definition. As used in this section and sec- 18 tion 1710, the term 'rural health care providers' means 19 health care professionals and hospitals located in rural 20 areas. The Secretary shall ensure that for purposes of this 21 definition, rural areas shall include any area that meets 22 any applicable Federal or State definition of rural area. — 23 "(h) Relation to Other Laws. 24 "(1) In general.—Notwithstanding any provi- 25 sion of the antitrust laws, it shall not be considered •S 1160 IS — 6 1 a violation of the antitrust laws for entities to de- 2 velop and operate networks in accordance with this 3 section. — 4 "(2) Definition. For purposes of this sub- 5 section, the term 'antitrust laws' means 6 "(A) the Act entitled 'An Act to protect 7 trade and commerce against unlawful restraints 8 and monopolies', approved July 1890, com- 2, 9 monly known as the 'Sherman Act' (26 Stat. 10 209; chapter 647; 15 U.S.C. 1 et seq.); 11 "(B) the Federal Trade Commission Act, 12 approved September 26, 1914 (38 Stat. 717; 13 chapter 311; 15 U.S.C. 41 et seq.); 14 "(C) the Act entitled 'An Act to supple- 15 ment existing laws against unlawful restraints 16 and monopolies, and for other purposes', ap- 17 proved October 15, 1914, commonly known as 18 the 'Clayton Act' (38 Stat. ISO; chapter 323; 19 15 U.S.C. 12 et seq.; 18 U.S.C. 402, 660, 20 3285, 3691; 29 U.S.C. 52, 53); 21 "(D) the Act of June 19, 1936, commonly 22 known as the Robinson-Patman Antidiscrimina- 23 tion Act (15 U.S.C. 13 et seq.); and -S 1160 IS — 7 1 "(E) any State antitrust laws that would 2 prohibit the activities described in paragraph 3 (1).". 4 SEC. 3. RURAL MANAGED CARE COOPERATIVES. 5 Title XVII of the Public Health Service Act (42 6 U.S.C. 300u et seq.) as amended by section 2 is further 7 amended by adding at the end thereof the following new 8 section: 9 "SEC. 1710. RURAL MANAGED CARE COOPERATIVES. — 10 "(a) Grants. The Secretary, acting through the 11 Health Resources and Services Administration, may 12 award competitive grants to eligible entities to enable such 13 entities to develop and administer cooperatives in rural 14 areas that will establish an effective case management and 15 reimbursement system designed to support the economic 16 viability of essential public or private health services, fa- 17 cilities, health care systems and health care resources in 18 such rural areas. — 19 "(b) Eligible Entities. To be eligible to receive 20 a grant under subsection (a) an entity shall 21 "(1) prepare and submit to the Secretary an 22 application at such time, in such form and contain- 23 ing such information as the Secretary may require, 24 including a description of the cooperative that the •S 1160 is 8 1 entity intends to develop and operate using grant 2 funds; and 3 "(2) meet such other requirements as the Sec- 4 retary determines appropriate. — 5 "(c) Cooperatives. — 6 "(1) In general. Amounts provided under a 7 grant awarded under subsection (a) shall be used to 8 establish and operate a cooperative made up of all 9 types of health care providers, hospitals, primary ac- 10 cess hospitals, other alternate rural health care fa- ll cilities, physicians, rural health clinics, rural nurse 12 practitioners and physician assistant practitioners, 13 public health departments and others located in, but 14 not restricted to, the rural areas to be served by the 15 cooperative. — 16 "(2) Board of directors. A cooperative es- 17 tablished under paragraph (1) shall be administered 18 by a board of directors elected by the members of whom 19 the cooperative, a majority of shall represent 20 rural providers from the local community and in- 21 elude representatives from the local community. 22 Such members shall serve at the pleasure of such 23 members. — 24 "(3) Executive director. The members of 25 a cooperative established under paragraph (1) shall >S 1160 IS — 9 1 elect an executive director who shall serve as the 2 chief operating officer of the cooperative. The execu- 3 tive director shall be responsible for conducting the 4 day to day operation of the cooperative including 5 "(A) maintaining an accounting system for 6 the cooperative; 7 "(B) maintaining the business records of 8 the cooperative; 9 "(C) negotiating contracts with provider 10 members of the cooperative; and 11 "(D) coordinating the membership and 12 programs of the cooperative. — 13 "(4) Reimbursements. — A 14 "(A) Negotiations. cooperative es- 15 tablished under paragraph (1) shall facilitate 16 negotiations among member health care provid- 17 ers and third party payors concerning the rates 18 at which such providers will be reimbursed for 19 services provided to individuals for which such 20 payors may be liable. — 21 "(B) Agreements. Agreements reached 22 under subparagraph (A) shall be binding on the 23 members of the cooperative. 24 "(C) Employers.—Employer entities may 25 become members of a cooperative established >S 1160 IS 10 1 under paragraph (a) in order to provide, 2 through a member third party payor, health in- 3 surance coverage for its employees. Deductibles 4 shall only be charged to employees covered 5 under such insurance if such employees receive 6 health care services from a provider that is not 7 a member of the cooperative if similar services 8 would have been available from a member pro- 9 vider. — A 10 "(D) Malpractice insurance. coop- 1 1 erative established under subsection (a) shall be 12 responsible for identifying and implementing an 13 affordable malpractice insurance program that 14 shall include a requirement that such coopera- 15 tive assume responsibility for the payment of a 16 portion of the malpractice insurance premium 17 of providers members. 18 "(5) Managed care and practice stand- — A 19 ARDS. cooperative established under paragraph 20 (1) shall establish joint case management and pa- 21 tient care practice standards programs that health 22 care providers that are members of such cooperative 23 must meet to be eligible to participate in agreements 24 entered into under paragraph (4). Such standards 25 shall be developed by such provider members and •S 1160 is