EXPANSION AND EXTENSION OF THE MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM.

SEC. 121. EXPANSION AND EXTENSION OF THE MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM.(a) In General.—Section 1820(g) of the Social Security Act (42 U.S.C. 1395i–4(g)) is amended by adding at the end the following new paragraph:“(6) Providing mental health services and other health services to veterans and other residents of rural areas.—“(A) Grants to states.—The Secretary may award grants to States that have submitted applications in accordance with subparagraph (B) for increasing the delivery of mental health services or other health care services deemed necessary to meet the needs of veterans of Operation Iraqi Freedom and Operation Enduring Freedom living in rural areas (as defined for purposes of section 1886(d) and including areas that are rural census tracks, as defined by the Administrator of the Health Resources and Services Administration), including for the provision of crisis intervention services and the detection of post-traumatic stress disorder, traumatic brain injury, and other signature injuries of veterans of Operation Iraqi Freedom and Operation Enduring Freedom, and for referral of such veterans to medical facilities operated by the Department of Veterans Affairs, and for the delivery of such services to other residents of such rural areas.“(B) Application.—“(i) In general.—An application is in accordance with this subparagraph if the State submits to the Secretary at such time and in such form as the Secretary may require an application containing the assurances described in subparagraphs (A)(ii) and (A)(iii) of subsection (b)(1).“(ii) Consideration of regional approaches, networks, or technology.—The Secretary may, as appropriate in awarding grants to States under subparagraph (A), consider whether the application submitted by a State under this subparagraph includes 1 or more proposals that utilize regional approaches, networks, health information technology, telehealth, or telemedicine to deliver services described in subparagraph (A) to individuals described in that 122 STAT. 2512 subparagraph. For purposes of this clause, a network may, as the Secretary determines appropriate, include Federally qualified health centers (as defined in section 1861(aa)(4)), rural health clinics (as defined in section 1861(aa)(2)), home health agencies (as defined in section 1861(o)), community mental health centers (as defined in section 1861(ff)(3)(B)) and other providers of mental health services, pharmacists, local government, and other providers deemed necessary to meet the needs of veterans.“(iii) Coordination at local level.—The Secretary shall require, as appropriate, a State to demonstrate consultation with the hospital association of such State, rural hospitals located in such State, providers of mental health services, or other appropriate stakeholders for the provision of services under a grant awarded under this paragraph.“(iv) Special consideration of certain applications.—In awarding grants to States under subparagraph (A), the Secretary shall give special consideration to applications submitted by States in which veterans make up a high percentage (as determined by the Secretary) of the total population of the State. Such consideration shall be given without regard to the number of veterans of Operation Iraqi Freedom and Operation Enduring Freedom living in the areas in which mental health services and other health care services would be delivered under the application.“(C) Coordination with va.—The Secretary shall, as appropriate, consult with the Director of the Office of Rural Health of the Department of Veterans Affairs in awarding and administering grants to States under subparagraph (A).“(D) Use of funds.—A State awarded a grant under this paragraph may, as appropriate, use the funds to reimburse providers of services described in subparagraph (A) to individuals described in that subparagraph.“(E) Limitation on use of grant funds for administrative expenses.—A State awarded a grant under this paragraph may not expend more than 15 percent of the amount of the grant for administrative expenses.“(F) Independent evaluation and final report.—The Secretary shall provide for an independent evaluation of the grants awarded under subparagraph (A). Not later than 1 year after the date on which the last grant is awarded to a State under such subparagraph, the Secretary shall submit a report to Congress on such evaluation. Such report shall include an assessment of the impact of such grants on increasing the delivery of mental health services and other health services to veterans of the United States Armed Forces living in rural areas (as so defined and including such areas that are rural census tracks), with particular emphasis on the impact of such grants on the delivery of such services to veterans of Operation Enduring Freedom and Operation Iraqi Freedom, and to other individuals living in such rural areas.”.122 STAT. 2513(b) Use of Funds for Federal Administrative Expenses.—Section 1820(g)(5) of the Social Security Act (42 U.S.C. 1395i–4(g)(5)) is amended—(1) by striking “beginning with fiscal year 2005” and inserting “for each of fiscal years 2005 through 2008”; and(2) by inserting “and, of the total amount appropriated for grants under paragraphs (1), (2), and (6) for a fiscal year (beginning with fiscal year 2009)” after “2005)”.(c) Extension of Authorization for FLEX Grants.—Section 1820(j) of the Social Security Act (42 U.S.C. 1395i–4(j)) is amended—(1) by striking “and for” and inserting “for”; and(2) by inserting “, for making grants to all States under paragraphs (1) and (2) of subsection (g), $55,000,000 in each of fiscal years 2009 and 2010, and for making grants to all States under paragraph (6) of subsection (g), $50,000,000 in each of fiscal years 2009 and 2010, to remain available until expended” before the period at the end.(d) Medicare Rural Hospital Flexibility Program.—Section 1820(g)(1) of the Social Security Act (42 U.S.C. 1395i–4(g)(1)) is amended—(1) in subparagraph (B), by striking “and” at the end;(2) in subparagraph (C), by striking the period at the end and inserting “; and”; and(3) by adding at the end the following new subparagraph:“(D) providing support for critical access hospitals for quality improvement, quality reporting, performance improvements, and benchmarking.”.(e) Assistance to Small Critical Access Hospitals Transitioning to Skilled Nursing Facilities and Assisted Living Facilities.—Section 1820(g) of the Social Security Act (42 U.S.C. 1395i–4(g)), as amended by subsection (a), is amended by adding at the end the following new paragraph:“(7) Critical access hospitals transitioning to skilled nursing facilities and assisted living facilities.—“(A) Grants.—The Secretary may award grants to eligible critical access hospitals that have submitted applications in accordance with subparagraph (B) for assisting such hospitals in the transition to skilled nursing facilities and assisted living facilities.“(B) Application.—An applicable critical access hospital seeking a grant under this paragraph shall submit an application to the Secretary on or before such date and in such form and manner as the Secretary specifies.“(C) Additional requirements.—The Secretary may not award a grant under this paragraph to an eligible critical access hospital unless—“(i) local organizations or the State in which the hospital is located provides matching funds; and“(ii) the hospital provides assurances that it will surrender critical access hospital status under this title within 180 days of receiving the grant.“(D) Amount of grant.—A grant to an eligible critical access hospital under this paragraph may not exceed $1,000,000.“(E) Funding.—There are appropriated from the Federal Hospital Insurance Trust Fund under section 1817 122 STAT. 2514 for making grants under this paragraph, $5,000,000 for fiscal year 2008.“(F) Eligible critical access hospital defined.—For purposes of this paragraph, the term ‘eligible critical access hospital’ means a critical access hospital that has an average daily acute census of less than 0.5 and an average daily swing bed census of greater than 10.0.”.