In the nature of a substitute.

SA 5088. Mr. DURBIN (for Mr. Kennedy (for himself and Mr. Hatch))
proposed an amendment to the bill S. 901, to amend the Public Health
Service Act to reauthorize the Community Health Centers program, the
National Health Service Corps, and rural health care programs; as
follows:

       In lieu of the matter proposed to be inserted, insert the
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Health Care Safety Net Act
     of 2008''.

     SEC. 2. COMMUNITY HEALTH CENTERS PROGRAM OF THE PUBLIC HEALTH
                   SERVICE ACT.

       (a) Additional Authorizations of Appropriations for the
     Health Centers Program of Public Health Service Act.--Section
     330(r) of the Public Health Service Act (42 U.S.C. 254b(r))
     is amended by amending paragraph (1) to read as follows:
       ``(1) In general.--For the purpose of carrying out this
     section, in addition to the amounts authorized to be
     appropriated under subsection (d), there are authorized to be
     appropriated--
       ``(A) $2,065,000,000 for fiscal year 2008;
       ``(B) $2,313,000,000 for fiscal year 2009;
       ``(C) $2,602,000,000 for fiscal year 2010;
       ``(D) $2,940,000,000 for fiscal year 2011; and
       ``(E) $3,337,000,000 for fiscal year 2012.''.
       (b) Studies Relating to Community Health Centers.--
       (1) Definitions.--For purposes of this subsection--
       (A) the term ``community health center'' means a health
     center receiving assistance under section 330 of the Public
     Health Service Act (42 U.S.C. 254b); and
       (B) the term ``medically underserved population'' has the
     meaning given that term in such section 330.
       (2) School-based health center study.--
       (A) In general.--Not later than 2 years after the date of
     enactment of this Act, the Comptroller General of the United
     States shall issue a study of the economic costs and benefits
     of school-based health centers and the impact on the health
     of students of these centers.
       (B) Content.--In conducting the study under subparagraph
     (A), the Comptroller General of the United States shall
     analyze--
       (i) the impact that Federal funding could have on the
     operation of school-based health centers;
       (ii) any cost savings to other Federal programs derived
     from providing health services in school-based health
     centers;
       (iii) the effect on the Federal Budget and the health of
     students of providing Federal funds to school-based health
     centers and clinics, including the result of providing
     disease prevention and nutrition information;
       (iv) the impact of access to health care from school-based
     health centers in rural or underserved areas; and
       (v) other sources of Federal funding for school-based
     health centers.
       (3) Health care quality study.--
       (A) In general.--Not later than 1 year after the date of
     enactment of this Act, the Secretary of Health and Human
     Services (referred to in this Act as the ``Secretary''),
     acting through the Administrator of the Health Resources and
     Services Administration, and in collaboration with the Agency
     for Healthcare Research and Quality, shall prepare and submit
     to the Committee on Health, Education, Labor, and Pensions of
     the Senate and the Committee on Energy and Commerce of the
     House of Representatives a report that describes agency
     efforts to expand and accelerate quality improvement
     activities in community health centers.
       (B) Content.--The report under subparagraph (A) shall focus
     on--
       (i) Federal efforts, as of the date of enactment of this
     Act, regarding health care quality in community health
     centers, including quality data collection, analysis, and
     reporting requirements;
       (ii) identification of effective models for quality
     improvement in community health centers, which may include
     models that--

       (I) incorporate care coordination, disease management, and
     other services demonstrated to improve care;
       (II) are designed to address multiple, co-occurring
     diseases and conditions;
       (III) improve access to providers through non-traditional
     means, such as the use of remote monitoring equipment;
       (IV) target various medically underserved populations,
     including uninsured patient populations;
       (V) increase access to specialty care, including referrals
     and diagnostic testing; and
       (VI) enhance the use of electronic health records to
     improve quality;

       (iii) efforts to determine how effective quality
     improvement models may be adapted for implementation by
     community health centers that vary by size, budget, staffing,
     services offered, populations served, and other
     characteristics determined appropriate by the Secretary;
       (iv) types of technical assistance and resources provided
     to community health centers that may facilitate the
     implementation of quality improvement interventions;
       (v) proposed or adopted methodologies for community health
     center evaluations of quality improvement interventions,
     including any development of new measures that are tailored
     to safety-net, community-based providers;
       (vi) successful strategies for sustaining quality
     improvement interventions in the long-term; and
       (vii) partnerships with other Federal agencies and private
     organizations or networks as appropriate, to enhance health
     care quality in community health centers.
       (C) Dissemination.--The Administrator of the Health
     Resources and Services Administration shall establish a
     formal mechanism or mechanisms for the ongoing dissemination
     of agency initiatives, best practices, and other information
     that may assist health care quality improvement efforts in
     community health centers.
       (4) GAO study on integrated health systems model for the
     delivery of health care services to medically underserved
     populations.--
       (A) Study.--The Comptroller General of the United States
     shall conduct a study on integrated health system models at
     not more than 10 sites for the delivery of health care
     services to medically underserved populations. The study
     shall include an examination of--
       (i) health care delivery models sponsored by public or
     private non-profit entities that--

       (I) integrate primary, specialty, and acute care; and
       (II) serve medically underserved populations; and

       (ii) such models in rural and urban areas.
       (B) Report.--Not later than 1 year after the date of the
     enactment of this Act, the Comptroller General of the United
     States shall submit to Congress a report on the study
     conducted under subparagraph (A). The report shall include--
       (i) an evaluation of the models, as described in
     subparagraph (A), in--

       (I) expanding access to primary and preventive services for
     medically underserved populations; and
       (II) improving care coordination and health outcomes; and

       (ii) an assessment of--

       (I) challenges encountered by such entities in providing
     care to medically underserved populations; and
       (II) advantages and disadvantages of such models compared
     to other models of care delivery for medically underserved
     populations.

     SEC. 3. NATIONAL HEALTH SERVICE CORPS.

       (a) Funding.--
       (1) National health service corps program.--Section 338(a)
     of the Public Health Service Act (42 U.S.C. 254k(a)) is
     amended by striking ``2002 through 2006'' and inserting
     ``2008 through 2012''.
       (2) Scholarship and loan repayment programs.--Section
     338H(a) of the Public Health Service Act (42 U.S.C. 254q(a))
     is amended by striking ``appropriated $146,250,000'' and all
     that follows through the period and inserting the following:
     ``appropriated--
       ``(1) for fiscal year 2008, $131,500,000;
       ``(2) for fiscal year 2009, $143,335,000;
       ``(3) for fiscal year 2010, $156,235,150;
       ``(4) for fiscal year 2011, $170,296,310; and
       ``(5) for fiscal year 2012, $185,622,980.''.
       (b) Elimination of 6-Year Demonstration Requirement.--
     Section 332(a)(1) of the Public Health Service Act (42 U.S.C.
     254e(a)(1)) is amended by striking ``Not earlier than 6
     years'' and all that follows through ``purposes of this
     section.''.
       (c) Assignment to Shortage Area.--Section 333(a)(1)(D)(ii)
     of the Public Health

[[Page S6978]]

     Service Act (42 U.S.C. 254f(a)(1)(D)(ii)) is amended--
       (1) in subclause (IV), by striking ``and'';
       (2) in subclause (V), by striking the period at the end and
     inserting ``; and''; and
       (3) by adding at the end the following:
       ``(VI) the entity demonstrates willingness to support or
     facilitate mentorship, professional development, and training
     opportunities for Corps members.''.
       (d) Professional Development and Training.--Subsection (d)
     of section 336 of the Public Health Service Act (42 U.S.C.
     254h-1) is amended to read as follows:
       ``(d) Professional Development and Training.--
       ``(1) In general.--The Secretary shall assist Corps members
     in establishing and maintaining professional relationships
     and development opportunities, including by--
       ``(A) establishing appropriate professional relationships
     between the Corps member involved and the health professions
     community of the geographic area with respect to which the
     member is assigned;
       ``(B) establishing professional development, training, and
     mentorship linkages between the Corps member involved and the
     larger health professions community, including through
     distance learning, direct mentorship, and development and
     implementation of training modules designed to meet the
     educational needs of offsite Corps members;
       ``(C) establishing professional networks among Corps
     members; or
       ``(D) engaging in other professional development,
     mentorship, and training activities for Corps members, at the
     discretion of the Secretary.
       ``(2) Assistance in establishing professional
     relationships.--In providing such assistance under paragraph
     (1), the Secretary shall focus on establishing relationships
     with hospitals, with academic medical centers and health
     professions schools, with area health education centers under
     section 751, with health education and training centers under
     section 752, and with border health education and training
     centers under such section 752. Such assistance shall include
     assistance in obtaining faculty appointments at health
     professions schools.
       ``(3) Supplement not supplant.--Such efforts under this
     subsection shall supplement, not supplant, non-government
     efforts by professional health provider societies to
     establish and maintain professional relationships and
     development opportunities.''.

     SEC. 4. REAUTHORIZATION OF RURAL HEALTH CARE PROGRAMS.

       Section 330A(j) of the Public Health Service Act (42 U.S.C.
     254c(j)) is amended by striking ``$40,000,000'' and all that
     follows and inserting ``$45,000,000 for each of fiscal years
     2008 through 2012.''.

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