42 U.S.C. § 254c
Rural health care services outreach, rural health network development, and small health care provider quality improvement grant programs
The purpose of this section is to provide grants for expanded delivery of health care services in rural areas, for the planning and implementation of integrated health care networks in rural areas, and for the planning and implementation of small health care provider quality improvement activities.
The term “Director” means the Director specified in subsection (d).
The terms “Federally qualified health center” and “rural health clinic” have the meanings given the terms in section 1395x(aa) of this title.
The term “health professional shortage area” means a health professional shortage area designated under section 254e of this title.
The term “medically underserved community” has the meaning given the term in section 295p(6) of this title.
The term “medically underserved population” has the meaning given the term in section 254b(b)(3) of this title.
The Secretary shall establish, under section 241 of this title, a small health care provider quality improvement grant program.
The rural health care services outreach, rural health network development, and small health care provider quality improvement grant programs established under section 241 of this title shall be administered by the Director of the Office of Rural Health Policy of the Health Resources and Services Administration, in consultation with State offices of rural health or other appropriate State government entities.
In carrying out the programs described in paragraph (1), the Director may award grants under subsections (e), (f), and (g) to expand access to, coordinate, and improve the quality of basic health care services, and enhance the delivery of health care, in rural areas.
The Director may award grants to eligible entities to promote rural health care services outreach by improving and expanding the delivery of health care services to include new and enhanced services in rural areas, through community engagement and evidence-based or innovative, evidence-informed models. The Director may award the grants for periods of not more than 5 years.
The Director may award grants under this subsection for periods of not more than 5 years.
The Director may award grants to provide for the planning and implementation of small health care provider quality improvement activities, including activities related to increasing care coordination, enhancing chronic disease management, and improving patient health outcomes. The Director may award the grants for periods of 1 to 5 years.
In awarding a grant under this subsection, the Director shall ensure that the funds made available through the grant will be used to provide services to residents of rural areas. The Director shall award not less than 50 percent of the funds made available under this subsection to providers located in and serving rural areas.
The Secretary shall coordinate activities carried out under grant programs described in this section, to the extent practicable, with Federal and State agencies and nonprofit organizations that are operating similar grant programs, to maximize the effect of public dollars in funding meritorious proposals.
Not later than 4 years after
There are authorized to be appropriated to carry out this section $79,500,000 for each of fiscal years 2021 through 2025.
A prior section 254c, act July 1, 1944, ch. 373, title III, § 330, as added
2020—Subsec. (d)(2)(A). Pub. L. 116–136, § 3213(1)(A), substituted “basic” for “essential”.
Subsec. (d)(2)(B). Pub. L. 116–136, § 3213(1)(B), inserted “to” after “grants” in introductory provisions and struck out “to” at beginning of cls. (i) to (iii).
Subsec. (e)(1). Pub. L. 116–136, § 3213(2)(A), inserted “improving and” after “outreach by” and “, through community engagement and evidence-based or innovative, evidence-informed models” after “rural areas” and substituted “5 years” for “3 years”.
Subsec. (e)(2). Pub. L. 116–136, § 3213(2)(B)(i), inserted “shall” after “entity” in introductory provisions.
Subsec. (e)(2)(A). Pub. L. 116–136, § 3213(2)(B)(ii), substituted “be an entity with demonstrated experience serving, or the capacity to serve, rural underserved populations” for “shall be a rural public or rural nonprofit private entity”.
Subsec. (e)(2)(B). Pub. L. 116–136, § 3213(2)(B)(iii), (iv), struck out “shall” before “represent” and inserted “that” after “members” in introductory provisions and struck out “that” at beginning of cls. (i) and (ii).
Subsec. (e)(2)(C). Pub. L. 116–136, § 3213(2)(B)(iii), struck out “shall” before “not previously”.
Subsec. (e)(3)(C). Pub. L. 116–136, § 3213(2)(C), substituted “the rural underserved populations in the local community or region” for “the local community or region”.
Subsec. (f)(1)(A). Pub. L. 116–136, § 3213(3)(A)(i)(I), substituted “plan, develop, and implement integrated health care networks that collaborate” for “promote, through planning and implementation, the development of integrated health care networks that have combined the functions of the entities participating in the networks” in introductory provisions.
Subsec. (f)(1)(A)(ii). Pub. L. 116–136, § 3213(3)(A)(i)(II), substituted “basic health care services and associated health outcomes” for “essential health care services”.
Subsec. (f)(1)(B). Pub. L. 116–136, § 3213(3)(A)(ii), amended subpar. (B) generally. Prior to amendment, text read as follows: “The Director may award such a rural health network development grant for implementation activities for a period of 3 years. The Director may also award such a rural health network development grant for planning activities for a period of 1 year, to assist in the development of an integrated health care network, if the proposed participants in the network do not have a history of collaborative efforts and a 3-year grant would be inappropriate.”
Subsec. (f)(2). Pub. L. 116–136, § 3213(3)(B)(i), inserted “shall” after “entity” in introductory provisions.
Subsec. (f)(2)(A). Pub. L. 116–136, § (3)(B)(ii), substituted “be an entity with demonstrated experience serving, or the capacity to serve, rural underserved populations” for “shall be a rural public or rural nonprofit private entity”.
Subsec. (f)(2)(B). Pub. L. 116–136, § 3213(3)(B)(iii), struck out “shall” before “represent” and inserted “that” after “participants” in introductory provisions and struck out “that” at beginning of cls. (i) and (ii).
Subsec. (f)(2)(C). Pub. L. 116–136, § 3213(3)(B)(iv), struck out “shall” before “not previously”.
Subsec. (f)(3)(C)(iii). Pub. L. 116–136, § 3213(3)(C)(i), amended cl. (iii) generally. Prior to amendment, cl. (iii) read as follows: “how the local community or region to be served will benefit from and be involved in the activities carried out by the network;”.
Subsec. (f)(3)(D). Pub. L. 116–136, § 3213(3)(C)(ii), substituted “the rural underserved populations in the local community or region” for “the local community or region”.
Subsec. (g)(1). Pub. L. 116–136, § 3213(4)(A), inserted “, including activities related to increasing care coordination, enhancing chronic disease management, and improving patient health outcomes” after “quality improvement activities” and substituted “5 years” for “3 years”.
Subsec. (g)(2). Pub. L. 116–136, § 3213(4)(B)(i), inserted “shall” after “entity” in introductory provisions.
Subsec. (g)(2)(A). Pub. L. 116–136, § 3213(4)(B)(ii), (iii), struck out “shall” at beginning of cls. (i) and (ii), and inserted “or regional” after “local” in cl. (ii).
Subsec. (g)(2)(B). Pub. L. 116–136, § 3213(4)(B)(ii), struck out “shall” before “not previously”.
Subsec. (g)(3)(D). Pub. L. 116–136, § 3213(4)(C), substituted “the rural underserved populations in the local community or region” for “the local community or region”.
Subsec. (h)(3). Pub. L. 116–136, § 3213(5), inserted “, as appropriate,” after “the Secretary” in introductory provisions.
Subsec. (i). Pub. L. 116–136, § 3213(6), amended subsec. (i) generally. Prior to amendment, text read as follows: “Not later than
Subsec. (j). Pub. L. 116–136, § 3213(7), substituted “$79,500,000 for each of fiscal years 2021 through 2025” for “$45,000,000 for each of fiscal years 2008 through 2012”.
2008—Subsec. (j). Pub. L. 110–355 substituted “$45,000,000 for each of fiscal years 2008 through 2012.” for “$40,000,000 for fiscal year 2002, and such sums as may be necessary for each of fiscal years 2003 through 2006.”
2003—Subsec. (b)(4). Pub. L. 108–163 substituted “section 295p(6)” for “section 295p”.
2002—Pub. L. 107–251 amended section generally. Prior to amendment, section related to a rural health outreach, network development, and telemedicine grant program, and in subsec. (a), provided for administration by the Office of Rural Health Policy; in subsec. (b), set out the objectives of grants; in subsec. (c), set out eligibility requirements; in subsec. (d), described preferred characteristics of applicant networks; in subsec. (e), specified permitted uses of grant funds; in subsec. (f), limited the duration of grants; and in subsec. (g), authorized appropriations.
Amendment by Pub. L. 108–163 deemed to have taken effect immediately after the enactment of Pub. L. 107–251, see section 3 of Pub. L. 108–163, set out as a note under section 233 of this title.
Section effective
Pub. L. 106–505, title IV, subtitle B, “This subtitle may be cited as the ‘Rural Access to Emergency Devices Act’ or the ‘Rural AED Act’.
Pub. L. 106–129, § 6,
Ex. Ord. No. 13941,
By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:
Since 2010, the year the [Patient Protection and] Affordable Care Act [Pub. L. 111–148] was passed, 129 rural hospitals in the United States have closed. Predictably, financial distress is the strongest driver for risk of closure, and many rural hospitals lack sufficient patient volume to be sustainable under traditional healthcare-reimbursement mechanisms. From 2015 to 2017, the average occupancy rate of a hospital that closed was only 22 percent. When hospitals close, the patient population around them carries an increased risk of mortality due to increased travel time and decreased access.
During the COVID–19 public health emergency (PHE), hospitals curtailed elective medical procedures and access to in-person clinical care was limited. To help patients better access healthcare providers, my Administration implemented new flexibility regarding what services may be provided via telehealth, who may provide them, and in what circumstances, and the use of telehealth increased dramatically across the Nation. Internal analysis by the Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services (HHS) showed a weekly jump in virtual visits for CMS beneficiaries, from approximately 14,000 pre-PHE to almost 1.7 million in the last week of April. Additionally, a recent report by HHS shows that nearly half (43.5 percent) of Medicare fee-for-service primary care visits were provided through telehealth in April, compared with far less than one percent (0.1 percent) in February before the PHE. Importantly, the report finds that telehealth visits continued to be frequent even after in-person primary care visits resumed in May, indicating that the expansion of telehealth services is likely to be a more permanent feature of the healthcare delivery system.
Rural healthcare providers, in particular, need these types of flexibilities to provide continuous care to patients in their communities. It is the purpose of this order to increase access to, improve the quality of, and improve the financial economics of rural healthcare, including by increasing access to high-quality care through telehealth.
(a) increase rural access to healthcare by eliminating regulatory burdens that limit the availability of clinical professionals;
(b) prevent disease and mortality by developing rural-specific efforts to drive improved health outcomes;
(c) reduce maternal mortality and morbidity; and
(d) improve mental health in rural communities.
(a) the additional telehealth services offered to Medicare beneficiaries; and
(b) the services, reporting, staffing, and supervision flexibilities offered to Medicare providers in rural areas.
(i) the authority granted by law to an executive department or agency, or the head thereof; or
(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.
(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.
(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.