,i  #aaeth ,,congress  #ast ,session    
,h4 ,r4 #cibf  ,,in ,,the ,,house ,,of  
,,representatives  ,october #c1         
#bjag,mr4 ,bilirakis 7for himself and   
,ms4 ,stefanik7 introduced the following
 bill2 which was referred to the        
,committee on ,energy and ,commerce  ,a 
,,bill  ,to provide for an extension for
 community health centers1 and for other
 purposes4  #a4 ,short title ,this ,act 
may be cited as the ,community          
,coordination ,and ,resource            
,empowerment ,act or the ,community     
,,care ,act4  #b4 ,extension for        
community health centers  7a7 ,community
 health centers funding ,section        
#ajejc7;b77#a77;,e7 of the ,patient     
,protection and ,affordable ,care ,act  
7#db ,u4,s4,c4 #bed;b-#b7;b77#a77;,e77  
is amended by striking #bjag and        
inserting #bjai4  7b7 ,other community  
health centers provisions ,section #ccj 
of the ,public ,health ,service ,act    
7#db ,u4,s4,c4 #bed;b7 is amended-- 7#a7
 in subsection 7b77#a77;,a77ii71 by     

striking abuse and inserting use        
disorder2  7#b7 in subsection           
7b77#b77;,a71 by striking abuse and     
inserting use disorder2  7#c7 in        
subsection 7c7--  7,a7 by striking      
subparagraphs 7,b7 through 7,d72  7,b7  
by striking 7#a7 ,in general and all    
that follows through ,the ,secretary and
 inserting the following3  7#a7 ,centers
 ,the ,secretary  2 and  7,c7 in such   
paragraph 7#a71 as amended1 by          
redesignating clauses 7i7 through 7v7 as
 subparagraphs 7,a7 through 7,e7 and    
moving the margin of each of such       
redesignated subparagraph #b ems to the 
left2  7#d7 by striking subsection 7d7  
and inserting the following3  7d7       
,improving quality of care  7#a7        
,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 services1 which may include
 models related to--  7,a7 improving the

 delivery of care for individuals with  
multiple chronic conditions2  7,b7      
workforce configuration2  7,c7 reducing 
the cost of care2  7,d7 enhancing care  
coordination2  7,e7 expanding the use of
 telehealth and technology enabled      
collaborative learning and capacity     
building models2  7,f7 care integration1
 including integration of behavioral    
health1 mental health1 or substance use 
disorder services2 and  7,g7 addressing 
emerging public health or substance use 
disorder issues to meet the health needs
 of the population served by the health 
center4  7#b7 ,sustainability ,in making
 supplemental awards under this         
subsection1 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 expended4 
7#c7 ,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       
average4  2  7#e7 in subsection         
7e77#a7-- 7,a7 in subparagraph 7,b7--   
7i7 by striking #b years and inserting  
#a year2 and  7ii7 by adding at the end 
the following3 ,the ,secretary shall not
 make a grant under this paragraph      
unless the applicant provides assurances
 to the ,secretary that within #abj days
 of receiving grant funding for the     
operation of the health center1 the     
applicant will submit1 for approval by  
the ,secretary1 an implementation plan  
to meet the requirements of subsection  
7l77#c74 ,the ,secretary may extend such
 #abj-;day period for achieving         
compliance upon a demonstration of good 
cause by the health center42 and  7,b7  
in subparagraph 7,c7-- 7i7 in the       
subparagraph heading1 by striking and   
plans2  7ii7 by striking or plan 7as    

described in subparagraphs 7,b7 and 7,c7
 of subsection 7c77#a772  7iii7 by      
striking or plan1 including the purchase
 and inserting the following3           
8including--  7i7 the purchase  2  7iv7 
by inserting 1 which may include data   
and information systems after of        
equipment2  7v7 by striking the period  
at the end and inserting a semicolon2   
and  7vi7 by adding at the end the      
following3  7ii7 the provision of       
training and technical assistance2 and  
7iii7 other activities that--  7,i7     
reduce costs associated with the        
provision of health services2  7,,ii7   
improve access to1 and availability of1 
health services provided to individuals 
served by the centers2  7,,iii7 enhance 
the quality and coordination of health  
services2 or  7,,iv7 improve the health 
status of communities4  2  7#f7 in      
subsection 7e77#e77;,b71 by striking and
 subparagraphs 7,b7 and 7,c7 of         
subsection 7c77#a7 to a health center or
 to a network or plan and inserting to a

 health center2  7#g7 by striking       
subsection 7s72  7#h7 by redesignating  
subsections 7g7 through 7r7 as          
subsections 7h7 through 7s71            
respectively2  7#i7 by inserting after  
subsection 7f71 the following3  7g7 ,new
 access points and expanded services    
7#a7 ,approval of new access points     
7,a7 ,in general ,the ,secretary may    
approve applications for grants under   
subparagraph 7,a7 or 7,b7 of subsection 
7e77#a71 subsection 7h71 subsection 7i71
 and subsection 7j7 to establish new    
delivery sites4  7,b7 ,special          
consideration ,in carrying out          
subparagraph 7,a71 the ,secretary may   
give special consideration to applicants
 that have demonstrated the new delivery
 site will be located within a sparsely 
populated area1 or an area which has a  
level of unmet need that is higher      
relative to other applicants4  7,c7     
,consideration of applications ,in      
carrying subparagraph 7,a71 the         
,secretary shall approve applications   

for grants under subparagraphs 7,a7 and 
7,b7 of subsection 7e77#a7 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 two4     
7,d7 ,service area overlap ,if in       
carrying out subparagraph 7,a7 the      
applicant proposes to serve an area that
 is currently served by another health  
center funded under this section1 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 area4     
7#b7 ,approval of expanded service      
applications  7,a7 ,in general ,the     
,secretary may approve applications for 
grants under subparagraph 7,a7 or 7,b7  

of subsection 7e77#a7 to expand the     
capacity of the applicant to provide    
required primary health services        
described in subsection 7b77#a7 or      
additional health services described in 
subsection 7b77#b74  7,b7 ,priority     
expansion projects ,in carrying out     
subparagraph 7,a71 the ,secretary may   
give special consideration to expanded  
service applications that seek to       
address emerging public health or       
behavioral health1 mental health1 or    
substance abuse issues through          
increasing the availability of          
additional health services described in 
subsection 7b77#b7 in an area in which  
there are significant barriers to       
accessing care4  7,c7 ,consideration of 
applications ,in carrying out           
subparagraph 7,a71 the ,secretary shall 
approve applications for applicants 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 two4  2 
7#aj7 in subsection 7i7 7as so          
redesignated7-- 7,a7 in paragraph 7#a71 
by striking and children and youth at   
risk of homelessness and inserting 1    
children and youth at risk of           
homelessness1 homeless veterans1 and    
veterans at risk of homelessness2 and   
7,b7 in paragraph 7#e7-- 7i7 by striking
 subparagraph 7,b72  7ii7 by            
redesignating subparagraph 7,c7 as      
subparagraph 7,b72 and  7iii7 in        
subparagraph 7,b7 7as so redesignated7--
  7,i7 in the subparagraph heading1 by  
striking abuse and inserting use        
disorder2 and  7,,ii7 by striking abuse 
and inserting use disorder2  7#aa7 in   
subsection 7l7 7as so redesignated7--   
7,a7 in paragraph 7#b7--  7i7 in the    
paragraph heading1 by inserting unmet   
before need2  7ii7 in the matter        

preceding subparagraph 7,a71 by         
inserting and an application for a grant
 under subsection 7g7 after subsection  
7e77#a72  7iii7 in subparagraph 7,a71 by
 inserting unmet before need for health 
services2  7iv7 in subparagraph 7,b71 by
 striking and at the end2  7v7 in       
subparagraph 7,c71 by striking the      
period at the end and inserting 2 and2  
and  7vi7 by adding after subparagraph  
7,c7 the following3  7,d7 in the case of
 an application for a grant pursuant to 
subsection 7g77#a71 a demonstration that
 the applicant has consulted with       
appropriate ,state and local government 
agencies1 and health care providers     
regarding the need for the heath        
services to be provided at the proposed 
delivery site4  2  7,b7 in paragraph    
7#c7-- 7i7 in the matter preceding      
subparagraph 7,a71 by inserting or      
subsection 7g7 after subsection         
7e77#a77;,b72  7ii7 in subparagraph     
7,b71 by striking in the catchment area 
of the center and inserting 1 including 

other health care providers that provide
 care within the catchment area1 local  
hospitals1 and specialty providers in   
the catchment area of the center1 to    
provide access to services not available
 through the health center and to reduce
 the non-urgent use of hospital         
emergency departments2  7iii7 in        
subparagraph 7,h77ii71 by inserting who 
shall be directly employed by the center
 after approves the selection of a      
director for the center2  7iv7 in       
subparagraph 7,l71 by striking and at   
the end2  7v7 in subparagraph 7,m71 by  
striking the period and inserting 2 and2
 and  7vi7 by inserting after           
subparagraph 7,m71 the following3  7,n7 
the center has written policies and     
procedures in place to ensure the       
appropriate use of ,federal funds in    
compliance with applicable ,federal     
statutes1 regulations1 and the terms and
 conditions of the ,federal award4  2   
and  7,c7 by striking paragraph 7#d72   
7#ab7 in subsection 7m7 7as so          

redesignated71 by adding at the end the 
following3 ,funds expended to carry out 
activities under this subsection and    
operational support activities under    
subsection 7n7 shall not exceed three   
percent of the amount appropriated for  
this section for the fiscal year        
involved42  7#ac7 in subsection 7q7 7as 
so redesignated71 by striking grants for
 new health centers under subsections   
7c7 and 7e7 and inserting operating     
grants under subsection 7e71            
applications for new access points and  
expanded service pursuant to subsection 
7g72  7#ad7 in subsection 7r77#d7 7as so
 redesignated71 by adding at the end the
 following3 ,a waiver provided by the   
,secretary under this paragraph may not 
remain in effect for more than #a year  
and may not be extended after such      
period4 ,an entity may not receive more 
than one waiver under this paragraph in 
consecutive years42 and  7#ae7 in       
subsection 7s77#c7 7as so               
redesignated7-- 7,a7 by striking        

appropriate committees of ,congress a   
report concerning the distribution of   
funds under this section and inserting  
the following3 8,committee on ,health1  
,education1 ,labor1 and ,pensions of the
 ,senate1 and the ,committee on ,energy 
and ,commerce of the ,house of          
,representatives1 a report including1 at
 a minimum--  7,a7 the distribution of  
funds for carrying out this section  2  
7,b7 by striking populations4 ,such     
report shall include an assessment and  
inserting the following3 8populations2  
7,b7 an assessment  2  7,c7 by striking 
and the rationale for any substantial   
changes in the distribution of funds4   
and inserting a semicolon2 and  7,d7 by 
adding at the end the following3  7,c7  
the distribution of awards and funding  
for new or expanded services in each of 
rural areas and urban areas2  7,d7 the  
distribution of awards and funding for  
establishing new access points1 and the 
number of new access points created2    
7,e7 the amount of unexpended funding   

for loan guarantees and loan guarantee  
authority under title ,,xvi2  7,f7 the  
rationale for any substantial changes in
 the distribution of funds2  7,g7 the   
rate of closures for health centers and 
access points2  7,h7 the number and     
reason for any grants awarded pursuant  
to subsection 7e77#a77;,b72 and  7,i7   
the number and reason for any waivers   
provided pursuant to subsection 7r77#d74
  4  7c7 ,application ,amounts          
appropriated pursuant to this section   
for fiscal year #bjah or #bjai are      
subject to the requirements contained in
 ,public ,law #aae-ca for funds for     
programs authorized under sections #ccj 
through #cdj of the ,public ,health     
,service ,act 7#db ,u4,s4,c4            
#bed;b-#bef74  7d7 ,conforming          
amendments ,section #cjad7;h7 of title  
#ah1 ,united ,states ,code1 is amended--
 7#a7 in paragraph 7#a71 by striking 1  
as amended by section #bba of the       
,medicare ,access and ,,chip            
,reauthorization ,act of #bjae12 and    

7#b7 in paragraph 7#d71 by inserting and
 section #aja7;d7 of the ,,care ,act    
after section #bba7;c7 of the ,medicare 
,access and ,,chip ,reauthorization ,act
 of #bjae4