Title II — Expanding and improving access to community health care

“(c) Additional enhanced funding; capital projects—There are hereby appropriated, out of any monies in the Treasury not otherwise appropriated, to the CHC Fund, to be transferred to the Secretary of Health and Human Services for capital projects of the community health center program under section 330 of the Public Health Service Act, $2,000,000,000, to remain available until expended.”

“(3) Priority—In awarding grants under this subsection, the Secretary shall give priority to applicants whose projects will include, by design, cybersecurity against cyber threats.

“(4) American iron and steel products

“(A) In general—As a condition on receipt of a grant under this section for a project, an entity shall ensure that all of the iron and steel products used in the project are produced in the United States.

“(B) Application—Subparagraph (A) shall be waived in any case or category of cases in which the Secretary finds that—

“(i) applying subparagraph (A) would be inconsistent with the public interest;

“(ii) iron and steel products are not produced in the United States in sufficient and reasonably available quantities and of a satisfactory quality; or

“(iii) inclusion of iron and steel products produced in the United States will increase the cost of the overall project by more than 25 percent.

“(C) Waiver—If the Secretary receives a request for a waiver under this paragraph, the Secretary shall make available to the public, on an informal basis, a copy of the request and information available to the Secretary concerning the request, and shall allow for informal public input on the request for at least 15 days prior to making a finding based on the request. The Secretary shall make the request and accompanying information available by electronic means, including on the official public internet site of the Department of Health and Human Services.

“(D) International agreements—This paragraph shall be applied in a manner consistent with United States obligations under international agreements.

“(E) Management and oversight—The Secretary may retain up to 0.25 percent of the funds appropriated for this section for management and oversight of the requirements of this paragraph.

“(F) Effective date—This paragraph does not apply with respect to a project if a State agency approves the engineering plans and specifications for the project, in that agency’s capacity to approve such plans and specifications prior to a project requesting bids, prior to the date of enactment of this paragraph.

“(5) Funding—To carry out this subsection, there are hereby appropriated, out of amounts in the Treasury not otherwise appropriated, $750,000,000, to remain available until expended.”

“301A. Additional funding for planning, design, construction, modernization, and renovation of hospitals and outpatient health care facilities

“(a) Additional funding—For the purpose described in subsection (b), in addition to any other funds available for such purpose, there are hereby appropriated to the Secretary, out of amounts in the Treasury not otherwise appropriated, $200,000,000, to remain available until expended.

“(b) Purpose—The purpose described in this subsection is the planning, design, construction, modernization, and renovation of hospitals and outpatient health care facilities that are funded, in whole or part, by the Service through, or provided for in, a contract or compact with the Service under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5301 et seq.).”

“749C. Grants for schools of medicine and schools of osteopathic medicine in underserved areas

“(a) In general—The Secretary, acting through the Administrator of the Health Resources and Services Administration, may award grants to institutions of higher education (including consortiums of such institutions) for the establishment, improvement, or expansion of a school of medicine or osteopathic medicine, or a branch campus of a school of medicine or osteopathic medicine.

“(b) Priority—In selecting grant recipients under this section, the Secretary shall give priority to any institution of higher education (or consortium of such institutions) that—

“(1) proposes to use the grant for the establishment of a school of medicine or osteopathic medicine, or a branch campus of a school of medicine or osteopathic medicine, in an area—

“(A) in which no other such school is based; and

“(B) that is a medically underserved community or a health professional shortage area; or

“(2) is a minority-serving institution described in section 371(a) of the Higher Education Act of 1965.

“(c) Considerations—In awarding grants under this section, the Secretary, to the extent practicable, may ensure equitable distribution of awards among the geographical regions of the United States.

“(d) Use of funds—An institution of higher education (or a consortium of such institutions)—

“(1) shall use grant amounts received under this section to—

“(A) recruit, enroll, and retain students, including individuals who are from disadvantaged backgrounds (including racial and ethnic groups underrepresented among medical students and health professions), individuals from rural and underserved areas, low-income individuals, and first generation college students, at a school of medicine or osteopathic medicine or branch campus of a school of medicine or osteopathic medicine; and

“(B) develop, implement, and expand curriculum that emphasizes care for rural and underserved populations, including accessible and culturally and linguistically appropriate care and services, at such school or branch campus; and

“(2) may use grant amounts received under this section to—

“(A) plan and construct—

“(i) a school of medicine or osteopathic medicine in an area in which no other such school is based; or

“(ii) a branch campus of a school of medicine or osteopathic medicine in an area in which no other such school is based;

“(B) plan, develop, and meet criteria for accreditation for a school of medicine or osteopathic medicine or branch campus of a school of medicine or osteopathic medicine;

“(C) hire faculty, including faculty from racial and ethnic groups who are underrepresented among the medical and other health professions, and other staff to serve at such a school or branch campus;

“(D) support educational programs at such a school or branch campus;

“(E) modernize and expand infrastructure at such a school or branch campus; and

“(F) support other activities that the Secretary determines further the establishment, improvement, or expansion of a school of medicine or osteopathic medicine or branch campus of a school of medicine or osteopathic medicine.

“(e) Application—To be eligible to receive a grant under subsection (a), an institution of higher education (or a consortium of such institutions), shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including a description of the institution’s or consortium's planned activities described in subsection (d).

“(f) Reporting

“(1) Reports from entities—Each institution of higher education, or consortium of such institutions, awarded a grant under this section shall submit an annual report to the Secretary on the activities conducted under such grant, and other information as the Secretary may require.

“(2) Report to Congress—Not later than 5 years after the date of enactment of this section and every 5 years thereafter, the Secretary shall 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 provides a summary of the activities and outcomes associated with grants made under this section. Such reports shall include—

“(A) a list of awardees, including their primary geographic location, and location of any school of medicine or osteopathic medicine, or a branch campus of school of medicine or osteopathic medicine that was established, improved, or expanded under this program;

“(B) the total number of students (including the number of students from racial and ethnic groups underrepresented among medical students and health professions, low-income students, and first generation college students) who—

“(i) are enrolled at or who have graduated from any school of medicine or osteopathic medicine, or a branch campus of school of medicine or osteopathic medicine, that was established, improved, or expanded under this program, deidentified and disaggregated by race, ethnicity, age, sex, geographic region, disability status, and other relevant factors, to the extent such information is available; and

“(ii) who subsequently participate in an accredited internship or medical residency program upon graduation from any school of medicine or osteopathic medicine, or a branch campus of a school of medicine or osteopathic medicine, that was established, improved, or expanded under this program, deidentified and disaggregated by race, ethnicity, age, sex, geographic region, disability status, medical specialty pursued, and other relevant factors, to the extent such information is available;

“(C) the effects of such program on the health care provider workforce, including any impact on demographic representation disaggregated by race, ethnicity, and sex, and the fields or specialties pursued by students who have graduated from any school of medicine or osteopathic medicine, or a branch campus of school of medicine or osteopathic medicine, that was established, improved, or expanded under this program;

“(D) the effects of such program on health care access in underserved areas, including medically underserved communities and health professional shortage areas; and

“(E) recommendations for improving the program described in this section, and any other considerations as the Secretary determines appropriate.

“(3) Public availability—The Secretary shall make reports submitted under paragraph (2) publicly available on the internet website of the Department of Health and Human Services.

“(g) Definitions—In this section:

“(1) Branch campus

“(A) In general—The term branch campus, with respect to a school of medicine or osteopathic medicine, means an additional location of such school that is geographically apart and independent of the main campus, at which the school offers at least 50 percent of the program leading to a degree of doctor of medicine or doctor of osteopathy that is offered at the main campus.

“(B) Independence from main campus—For purposes of subparagraph (A), the location of a school described in such subparagraph shall be considered to be independent of the main campus described in such subparagraph if the location—

“(i) is permanent in nature;

“(ii) offers courses in educational programs leading to a degree, certificate, or other recognized educational credential;

“(iii) has its own faculty and administrative or supervisory organization; and

“(iv) has its own budgetary and hiring authority.

“(2) First generation college student—The term first generation college student has the meaning given such term in section 402A(h)(3) of the Higher Education Act of 1965.

“(3) Health professional shortage area—The term health professional shortage area has the meaning given such term in section 332(a).

“(4) Institution of higher education—The term institution of higher education has the meaning given such term in section 101 of the Higher Education Act of 1965.

“(5) Medically underserved community—The term medically underserved community has the meaning given such term in section 799B(6).

“(h) Funding—To carry out this section, there are hereby appropriated, out of amounts in the Treasury not otherwise appropriated, $1,000,000,000, to remain available until expended.”

“(k) Additional funding—In addition to amounts otherwise made available for such purpose, to carry out this section, there are hereby appropriated, out of amounts in the Treasury not otherwise appropriated, $100,000,000, to remain available until expended.”

“(j) Additional funding—In addition to amounts otherwise made available to carry out this section, there are hereby appropriated, out of amounts in the Treasury not otherwise appropriated, $750,000,000, to remain available until expended.”

“(bb) Community-Based mobile crisis intervention services

“(1) In general—Notwithstanding section 1902(a)(1) (relating to statewideness), section 1902(a)(10)(B) (relating to comparability), section 1902(a)(23)(A) (relating to freedom of choice of providers), or section 1902(a)(27) (relating to provider agreements), a State may provide medical assistance for qualifying community-based mobile crisis intervention services under a State plan amendment or waiver approved under section 1115 or 1915(c).

“(2) Qualifying community-based mobile crisis intervention services defined—For purposes of this subsection, the term qualifying community-based mobile crisis intervention services means, with respect to a State, items and services for which medical assistance is available under the State plan under this title or a waiver of such plan, that are—

“(A) furnished to an individual who is—

“(i) outside of a hospital or other facility setting; and

“(ii) experiencing a mental health or substance use disorder crisis;

“(B) furnished by a multidisciplinary mobile crisis team—

“(i) that includes at least 1 behavioral health care professional who is capable of conducting an assessment of the individual, in accordance with the professional's permitted scope of practice under State law, and other professionals or paraprofessionals with appropriate expertise in behavioral health or mental health crisis response, including nurses, social workers, peer support specialists, and others, as designated by the State and approved by the Secretary;

“(ii) whose members are trained in trauma-informed care, de-escalation strategies, and harm reduction;

“(iii) that is able to respond in a timely manner and, where appropriate, provides—

“(I) screening and assessment;

“(II) stabilization and de-escalation;

“(III) coordination with, and referrals to, health, social, and other services and supports as needed; and

“(IV) provision or coordination of transportation to the next step in care or treatment;

“(iv) that maintains relationships with relevant community partners, including medical and behavioral health providers, community health centers, crisis respite centers, managed care organizations (if applicable), entities able to provide assistance with application and enrollment in the State plan or a waiver of the plan, entitles able to provide assistance with applying for and enrolling in benefit programs, entities that provide assistance with housing (such as public housing authorities, Continuum of Care programs, or not-for-profit entities that provide housing assistance), and entities that provide assistance with other social services;

“(v) that coordinates with crisis intervention hotlines and emergency response systems;

“(vi) that maintains the privacy and confidentiality of patient information consistent with Federal and State requirements; and

“(vii) that operates independently from (but may coordinate with) State or local law enforcement agencies;

“(C) available 24 hours per day, every day of the year; and

“(D) voluntary to receive.

“(3) Payments

“(A) In general—Notwithstanding section 1905(b), beginning January 1, 2021, during each of the first 12 fiscal quarters that a State meets the requirements described in paragraph (4), the Federal medical assistance percentage applicable to amounts expended by the State for medical assistance for qualifying community-based mobile crisis intervention services furnished during such quarter shall be equal to 95 percent.

“(B) Exclusion of enhanced payments from territorial caps—To the extent that the amount of a payment to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa for medical assistance for qualifying community-based mobile crisis intervention services that is based on the Federal medical assistance percentage specified in subparagraph (A) exceeds the amount that would have been paid to such territory for such services if the Federal medical assistance percentage for the territory had been determined without regard to such subparagraph—

“(i) the limitation on payments to territories under subsections (f) and (g) of section 1108 shall not apply to the amount of such excess; and

“(ii) the amount of such excess shall be disregarded in applying such subsections.

“(4) Requirements—The requirements described in this paragraph are the following:

“(A) The State demonstrates, to the satisfaction of the Secretary—

“(i) that it will be able to support the provision of qualifying community-based mobile crisis intervention services that meet the conditions specified in paragraph (2); and

“(ii) how it will support coordination between mobile crisis teams and community partners, including health care providers, to enable the provision of services, needed referrals, and other activities identified by the Secretary.

“(B) The State provides assurances satisfactory to the Secretary that—

“(i) any additional Federal funds received by the State for qualifying community-based mobile crisis intervention services provided under this subsection that are attributable to the increased Federal medical assistance percentage under paragraph (3)(A) will be used to supplement, and not supplant, the level of State funds expended for such services for fiscal year 2019;

“(ii) if the State made qualifying community-based mobile crisis intervention services available in a region of the State in fiscal year 2019, the State will continue to make such services available in such region under this subsection at the same level that the State made such services available in such fiscal year; and

“(iii) the State will conduct the evaluation and assessment, and submit the report, required under paragraph (5).

“(5) State evaluation and report

“(A) State evaluation—Not later than 4 fiscal quarters after a State begins providing qualifying community-based mobile crisis intervention services in accordance with this subsection, the State shall enter into a contract with an independent entity or organization to conduct an evaluation for the purposes of—

“(i) determining the effect of the provision of such services on—

“(I) emergency room visits;

“(II) use of ambulatory services;

“(III) hospitalizations;

“(IV) the involvement of law enforcement in mental health or substance use disorder crisis events;

“(V) the diversion of individuals from jails or similar settings; and

“(ii) assessing—

“(I) the types of services provided to individuals;

“(II) the types of events responded to;

“(III) cost savings or cost-effectiveness attributable to such services;

“(IV) the experiences of individuals who receive qualifying community-based mobile crisis intervention services;

“(V) the successful connection of individuals with follow-up services; and

“(VI) other relevant outcomes identified by the Secretary.

“(B) Comparison to historical measures—The contract described in subparagraph (A) shall specify that the evaluation is based on a comparison of the historical measures of State performance with respect to the outcomes specified under such subparagraph to the State's performance with respect to such outcomes during the period beginning with the first quarter in which the State begins providing qualifying community-based mobile crisis intervention services in accordance with this subsection.

“(C) Report—Not later than 2 years after a State begins to provide qualifying community-based mobile crisis intervention services in accordance with this subsection, the State shall submit a report to the Secretary on the following:

“(i) The results of the evaluation carried out under subparagraph (A).

“(ii) The number of individuals who received qualifying community-based mobile crisis intervention services.

“(iii) Demographic information regarding such individuals when available, including the race or ethnicity, age, sex, sexual orientation, gender identity, and geographic location of such individuals.

“(iv) The processes and models developed by the State to provide qualifying community-based mobile crisis intervention services under such the State plan or waiver, including the processes developed to provide referrals for, or coordination with, follow-up care and services.

“(v) Lessons learned regarding the provision of such services.

“(D) Public availability—The State shall make the report required under subparagraph (C) publicly available, including on the website of the appropriate State agency, upon submission of such report to the Secretary.

“(6) Best practices report

“(A) In general—Not later than 3 years after the first State begins to provide qualifying community-based mobile crisis intervention services in accordance with this subsection, the Secretary shall submit a report to Congress that—

“(i) identifies the States that elected to provide services in accordance with this subsection;

“(ii) summarizes the information reported by such States under paragraph (5)(C); and

“(iii) identifies best practices for the effective delivery of community-based mobile crisis intervention services.

“(B) Public availability—The report required under subparagraph (A) shall be made publicly available, including on the website of the Department of Health and Human Services, upon submission to Congress.

“(7) State planning and evaluation grants

“(A) In general—As soon as practicable after the date of enactment of this subsection, the Secretary may award planning and evaluation grants to States for purposes of developing a State plan amendment or section 1115 or 1915(c) waiver request (or an amendment to such a waiver) to provide qualifying community-based mobile crisis intervention services and conducting the evaluation required under paragraph (5)(A). A grant awarded to a State under this paragraph shall remain available until expended.

“(B) State contribution—A State awarded a grant under this subsection shall contribute for each fiscal year for which the grant is awarded an amount equal to the State percentage determined under section 1905(b) (without regard to the temporary increase in the Federal medical assistance percentage of the State under section 6008(a) of the Families First Coronavirus Response Act (Public Law 116–127) or any other temporary increase in the Federal medical assistance percentage of the State for fiscal year 2020 or any succeeding fiscal year) of the grant amount.

“(8) Funding

“(A) Implementation and administration—There is appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, such sums as are necessary for purposes of implementing and administering this section.

“(B) Planning and evaluation grants—There is appropriated, out of any funds in the Treasury not otherwise appropriated, $25,000,000 to the Secretary for fiscal year 2021 for purposes of making grants under paragraph (7), to remain available until expended.”

“330N. Expanding capacity for health outcomes

“(a) Definitions—In this section:

“(1) Eligible entity—The term eligible entity means an entity that provides, or supports the provision of, health care services in rural areas, frontier areas, health professional shortage areas, or medically underserved areas, or to medically underserved populations or Native Americans, including Indian Tribes, Tribal organizations, and urban Indian organizations, and which may include entities leading, or capable of leading, a technology-enabled collaborative learning and capacity building model or engaging in technology-enabled collaborative training of participants in such model.

“(2) Health professional shortage area—The term health professional shortage area means a health professional shortage area designated under section 332.

“(3) Indian Tribe—The terms Indian Tribe and Tribal organization have the meanings given the terms Indian tribe and tribal organization in section 4 of the Indian Self-Determination and Education Assistance Act.

“(4) Medically underserved population—The term medically underserved population has the meaning given the term in section 330(b)(3).

“(5) Native Americans—The term Native Americans has the meaning given the term in section 736 and includes Indian Tribes and Tribal organizations.

“(6) Technology-enabled collaborative learning and capacity building model—The term technology-enabled collaborative learning and capacity building model means a distance health education model that connects health care professionals, and particularly specialists, with multiple other health care professionals through simultaneous interactive videoconferencing for the purpose of facilitating case-based learning, disseminating best practices, and evaluating outcomes.

“(7) Urban Indian organization—The term urban Indian organization has the meaning given the term in section 4 of the Indian Health Care Improvement Act.

“(b) Program established—The Secretary shall, as appropriate, award grants to evaluate, develop, and, as appropriate, expand the use of technology-enabled collaborative learning and capacity building models, to improve retention of health care providers and increase access to health care services, such as those to address chronic diseases and conditions, infectious diseases, mental health, substance use disorders, prenatal and maternal health, pediatric care, pain management, palliative care, and other specialty care in rural areas, frontier areas, health professional shortage areas, or medically underserved areas and for medically underserved populations or Native Americans.

“(c) Use of funds

“(1) In general—Grants awarded under subsection (b) shall be used for—

“(A) the development and acquisition of instructional programming, and the training of health care providers and other professionals that provide or assist in the provision of services through models described in subsection (b), such as training on best practices for data collection and leading or participating in such technology-enabled activities consistent with technology-enabled collaborative learning and capacity-building models;

“(B) information collection and evaluation activities to study the impact of such models on patient outcomes and health care providers, and to identify best practices for the expansion and use of such models; or

“(C) other activities consistent with achieving the objectives of the grants awarded under this section, as determined by the Secretary.

“(2) Other uses—In addition to any of the uses under paragraph (1), grants awarded under subsection (b) may be used for—

“(A) equipment to support the use and expansion of technology-enabled collaborative learning and capacity building models, including for hardware and software that enables distance learning, health care provider support, and the secure exchange of electronic health information; or

“(B) support for health care providers and other professionals that provide or assist in the provision of services through such models.

“(d) Length of grants—Grants awarded under subsection (b) shall be for a period of up to 5 years.

“(e) Grant requirements—The Secretary may require entities awarded a grant under this section to collect information on the effect of the use of technology-enabled collaborative learning and capacity building models, such as on health outcomes, access to health care services, quality of care, and provider retention in areas and populations described in subsection (b). The Secretary may award a grant or contract to assist in the coordination of such models, including to assess outcomes associated with the use of such models in grants awarded under subsection (b), including for the purpose described in subsection (c)(1)(B).

“(f) Application—An eligible entity that seeks to receive a grant under subsection (b) shall submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require. Such application shall include plans to assess the effect of technology-enabled collaborative learning and capacity building models on patient outcomes and health care providers.

“(g) Access to broadband—In administering grants under this section, the Secretary may coordinate with other agencies to ensure that funding opportunities are available to support access to reliable, high-speed internet for grantees.

“(h) Technical assistance—The Secretary shall provide (either directly through the Department of Health and Human Services or by contract) technical assistance to eligible entities, including recipients of grants under subsection (b), on the development, use, and evaluation of technology-enabled collaborative learning and capacity building models in order to expand access to health care services provided by such entities, including for medically underserved areas and to medically underserved populations or Native Americans.

“(i) Research and evaluation—The Secretary, in consultation with stakeholders with appropriate expertise in such models, shall develop a strategic plan to research and evaluate the evidence for such models. The Secretary shall use such plan to inform the activities carried out under this section.

“(j) Report by Secretary—Not later than 4 years after the date of enactment of this section, the Secretary 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, and post on the internet website of the Department of Health and Human Services, a report including, at minimum—

“(1) a description of any new and continuing grants awarded to entities under subsection (b) and the specific purpose and amounts of such grants;

“(2) an overview of—

“(A) the evaluations conducted under subsections (b);

“(B) technical assistance provided under subsection (h); and

“(C) activities conducted by entities awarded grants under subsection (b); and

“(3) a description of any significant findings or developments related to patient outcomes or health care providers and best practices for eligible entities expanding, using, or evaluating technology-enabled collaborative learning and capacity building models, including through the activities described in subsection (h).

“(k) Funding—To carry out this section, there are hereby appropriated, out of amounts in the Treasury not otherwise appropriated, $100,000,000 for each of fiscal years 2021 through 2025, to remain available until expended.”