I

104TH CONGRESS

2D SESSION H. R. 3081

To amend title III of the Public Health Service Act to consolidate and

reauthorize provisions relating to health centers, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

MARCH 13, 1996

Mr. RICHARDSON introduced the following bill; which was referred to the

Committee on Commerce

A BILL

To amend title III of the Public Health Service Act to

consolidate and reauthorize provisions relating to health

centers, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Health Centers Con5 solidation Act of 1996’’.

6 SEC. 2. CONSOLIDATION AND REAUTHORIZATION OF PRO7 VISIONS.

8 Subpart I of part D of title III of the Public Health

9 Service Act (42 U.S.C. 254b et seq.) is amended to read

10 as follows:
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1 ‘‘Subpart I—Health Centers

2 ‘‘SEC. 330. HEALTH CENTERS.

3 ‘‘(a) DEFINITION OF HEALTH CENTER.—

4 ‘‘(1) IN GENERAL.—For purposes of this sec5 tion, the term ‘health center’ means an entity that

6 serves a population that is medically underserved, or

7 a special medically underserved population com8 prised of migratory and seasonal agricultural work9 ers, the homeless, and residents of public housing,

10 by providing, either through the staff and supporting

11 resources of the center or through contracts or coop12 erative arrangements—

13 ‘‘(A) required primary health services (as

14 defined in subsection (b)(1)); and

15 ‘‘(B) as may be appropriate for particular

16 centers, additional health services (as defined in

17 subsection (b)(2)) necessary for the adequate

18 support of the primary health services required

19 under subparagraph (A);

20 for all residents of the area served by the center

21 (hereafter referred to in this section as the

22 ‘catchment area’).

23 ‘‘(2) LIMITATION.—The requirement in para24 graph (1) to provide services for all residents within

25 a catchment area shall not apply in the case of a
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1 health center receiving a grant only under subsection

2 (f), (g), or (h).

3 ‘‘(b) DEFINITIONS.—For purposes of this section:

4 ‘‘(1) REQUIRED PRIMARY HEALTH SERVICES.—

5 ‘‘(A) IN GENERAL.—The term ‘required

6 primary health services’ means—

7 ‘‘(i) basic health services which, for

8 purposes of this section, shall consist of—

9 ‘‘(I) health services related to

10 family medicine, internal medicine, pe11 diatrics, obstetrics, or gynecology that

12 are furnished by physicians and where

13 appropriate, physician assistants,

14 nurse practitioners, and nurse mid15 wives;

16 ‘‘(II) diagnostic laboratory and

17 radiologic services;

18 ‘‘(III) preventive health services,

19 including—

20 ‘‘(aa) prenatal and perinatal

21 services;

22 ‘‘(bb) screening for breast

23 and cervical cancer;

24 ‘‘(cc) well-child services;
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1 ‘‘(dd) immunizations against

2 vaccine-preventable diseases;

3 ‘‘(ee) screenings for elevated

4 blood lead levels, communicable

5 diseases, and cholesterol;

6 ‘‘(ff) pediatric eye, ear, and

7 dental screenings to determine

8 the need for vision and hearing

9 correction and dental care;

10 ‘‘(gg) voluntary family plan11 ning services; and

12 ‘‘(hh) preventive dental serv13 ices;

14 ‘‘(IV) emergency medical serv15 ices; and

16 ‘‘(V) pharmaceutical services as

17 may be appropriate for particular cen18 ters;

19 ‘‘(ii) referrals to providers of medical

20 services and other health-related services

21 (including substance abuse and mental

22 health services);

23 ‘‘(iii) patient case management serv24 ices (including counseling, referral, and fol25 low-up services) and other services de-
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1 signed to assist health center patients in

2 establishing eligibility for and gaining ac3 cess to Federal, State, and local programs

4 that provide or financially support the pro5 vision of medical, social, educational, or

6 other related services;

7 ‘‘(iv) services that enable individuals

8 to use the services of the health center (in9 cluding outreach and transportation serv10 ices and, if a substantial number of the in11 dividuals in the population served by a cen12 ter are of limited English-speaking ability,

13 the services of appropriate personnel fluent

14 in the language spoken by a predominant

15 number of such individuals); and

16 ‘‘(v) education of patients and the

17 general population served by the health

18 center regarding the availability and prop19 er use of health services.

20 ‘‘(B) EXCEPTION.—With respect to a

21 health center that receives a grant only under

22 subsection (f), the Secretary, upon a showing of

23 good cause, shall—
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1 ‘‘(i) waive the requirement that the

2 center provide all required primary health

3 services under this paragraph; and

4 ‘‘(ii) approve, as appropriate, the pro5 vision of certain required primary health

6 services only during certain periods of the

7 year.

8 ‘‘(2) ADDITIONAL HEALTH SERVICES.—The

9 term ‘additional health services’ means services that

10 are not included as required primary health services

11 and that are appropriate to meet the health needs

12 of the population served by the health center in13 volved. Such term may include—

14 ‘‘(A) environmental health services, includ15 ing—

16 ‘‘(i) the detection and alleviation of

17 unhealthful conditions associated with

18 water supply;

19 ‘‘(ii) sewage treatment;

20 ‘‘(iii) solid waste disposal;

21 ‘‘(iv) rodent and parasitic infestation;

22 ‘‘(v) field sanitation;

23 ‘‘(vi) housing; and

24 ‘‘(vii) other environmental factors re25 lated to health; and
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1 ‘‘(B) in the case of health centers receiving

2 grants under subsection (f), special occupation3 related health services for migratory and sea4 sonal agricultural workers, including—

5 ‘‘(i) screening for and control of infec6 tious diseases, including parasitic diseases;

7 and

8 ‘‘(ii) injury prevention programs, in9 cluding prevention of exposure to unsafe

10 levels of agricultural chemicals including

11 pesticides.

12 ‘‘(3) MEDICALLY UNDERSERVED POPU13 LATIONS.—

14 ‘‘(A) IN GENERAL.—The term ‘medically

15 underserved population’ means the population

16 of an urban or rural area designated by the

17 Secretary as an area with a shortage of per18 sonal health services or a population group des19 ignated by the Secretary as having a shortage

20 of such services.

21 ‘‘(B) CRITERIA.—In carrying out subpara22 graph (A), the Secretary shall prescribe criteria

23 for determining the specific shortages of per24 sonal health services of an area or population

25 group. Such criteria shall—
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1 ‘‘(i) take into account comments re2 ceived by the Secretary from the chief ex3 ecutive officer of a State and local officials

4 in a State; and

5 ‘‘(ii) include factors indicative of the

6 health status of a population group or resi7 dents of an area, the ability of the resi8 dents of an area or of a population group

9 to pay for health services and their acces10 sibility to them, and the availability of

11 health professionals to residents of an area

12 or to a population group.

13 ‘‘(C) LIMITATION.—The Secretary may not

14 designate a medically underserved population in

15 a State or terminate the designation of such a

16 population unless, prior to such designation or

17 termination, the Secretary provides reasonable

18 notice and opportunity for comment and

19 consults with—

20 ‘‘(i) the chief executive officer of such

21 State;

22 ‘‘(ii) local officials in such State; and

23 ‘‘(iii) the organization, if any, which

24 represents a majority of health centers in

25 such State.
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1 ‘‘(D) PERMISSIBLE DESIGNATION.—The

2 Secretary may designate a medically under3 served population that does not meet the cri4 teria established under subparagraph (B) if the

5 chief executive officer of the State in which

6 such population is located and local officials of

7 such State recommend the designation of such

8 population based on unusual local conditions

9 which are a barrier to access to or the availabil10 ity of personal health services.

11 ‘‘(c) PLANNING GRANTS.—

12 ‘‘(1) IN GENERAL.—

13 ‘‘(A) CENTERS.—The Secretary may make

14 grants to public and nonprofit private entities

15 for projects to plan and develop health centers

16 which will serve medically underserved popu17 lations. A project for which a grant may be

18 made under this subsection may include the

19 cost of the acquisition, expansion, and mod20 ernization of existing buildings and construction

21 of new buildings (including the costs of amortiz22 ing the principal of, and paying the interest on,

23 loans) and shall include—

24 ‘‘(i) an assessment of the need that

25 the population proposed to be served by
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1 the health center for which the project is

2 undertaken has for required primary

3 health services and additional health serv4 ices;

5 ‘‘(ii) the design of a health center pro6 gram for such population based on such

7 assessment;

8 ‘‘(iii) efforts to secure, within the pro9 posed catchment area of such center, fi10 nancial and professional assistance and

11 support for the project;

12 ‘‘(iv) initiation and encouragement of

13 continuing community involvement in the

14 development and operation of the project;

15 and

16 ‘‘(v) proposed linkages between the

17 center and other appropriate provider enti18 ties, such as health departments, local hos19 pitals, and rural health clinics, to provide

20 better coordinated, higher quality, and

21 more cost-effective health care services.

22 ‘‘(B) COMPREHENSIVE SERVICE DELIVERY

23 NETWORKS AND PLANS.—The Secretary may

24 make grants to health centers that receive as25 sistance under this section to enable the centers
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1 to plan and develop a network or plan for the

2 provision of health services, which may include

3 the provision of health services on a prepaid

4 basis or through another managed care ar5 rangement, to some or to all of the individuals

6 which the centers serve. Such a grant may only

7 be made for such a center if—

8 ‘‘(i) the center has received grants

9 under subsection (d)(1)(A) for at least 2

10 consecutive years preceding the year of the

11 grant under this subparagraph or has oth12 erwise demonstrated, as required by the

13 Secretary, that such center has been pro14 viding primary care services for at least

15 the 2 consecutive years immediately pre16 ceding such year; and

17 ‘‘(ii) the center provides assurances

18 satisfactory to the Secretary that the pro19 vision of such services on a prepaid basis,

20 or under another managed care arrange21 ment, will not result in the diminution of

22 the level or quality of health services pro23 vided to the medically underserved popu24 lation served prior to the grant under this

25 subparagraph.
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1 Any such grant may include the acquisition and

2 lease, expansion, and modernization of existing

3 buildings, construction of new buildings, acqui4 sition or lease of equipment which may include

5 data and information systems, and providing

6 training and technical assistance related to the

7 provision of health services on a prepaid basis

8 or under another managed care arrangement,

9 and for other purposes that promote the devel10 opment of managed care networks and plans.

11 ‘‘(2) LIMITATION.—Not more than two grants

12 may be made under this subsection for the same

13 project, except that upon a showing of good cause,

14 the Secretary may make additional grant awards.

15 ‘‘(d) OPERATING GRANTS.—

16 ‘‘(1) AUTHORITY.—

17 ‘‘(A) IN GENERAL.—The Secretary may

18 make grants for the costs of the operation of

19 public and nonprofit private health centers that

20 provide health services to medically underserved

21 populations.

22 ‘‘(B) ENTITIES THAT FAIL TO MEET CER23 TAIN REQUIREMENTS.—The Secretary may

24 make grants, for a period of not to exceed 2-

25 years, for the costs of the operation of public
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1 and nonprofit private entities which provide

2 health services to medically underserved popu3 lations but with respect to which the Secretary

4 is unable to make each of the determinations

5 required by subsection (i)(3).

6 ‘‘(2) USE OF FUNDS.—The costs for which a

7 grant may be made under subparagraph (A) or (B)

8 of paragraph (1) may include the costs of acquiring,

9 expanding, and modernizing existing buildings and

10 constructing new buildings (including the costs of

11 amortizing the principal of, and paying interest on,

12 loans), the costs of repaying loans for buildings, and

13 the costs of providing training related to the provi14 sion of required primary health services and addi15 tional health services and to the management of

16 health center programs.

17 ‘‘(3) LIMITATION.—Not more than two grants

18 may be made under subparagraph (B) of paragraph

19 (1) for the same entity.

20 ‘‘(4) AMOUNT.—

21 ‘‘(A) IN GENERAL.—The amount of any

22 grant made in any fiscal year under paragraph

23 (1) to a health center shall be determined by

24 the Secretary, but may not exceed the amount
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1 by which the costs of operation of the center in

2 such fiscal year exceed the total of—

3 ‘‘(i) State, local, and other operational

4 funding provided to the center; and

5 ‘‘(ii) the fees, premiums, and third6 party reimbursements, which the center

7 may reasonably be expected to receive for

8 its operations in such fiscal year.

9 ‘‘(B) PAYMENTS.—Payments under grants

10 under subparagraph (A) or (B) of paragraph

11 (1) shall be made in advance or by way of reim12 bursement and in such installments as the Sec13 retary finds necessary and adjustments may be

14 made for overpayments or underpayments.

15 ‘‘(C) USE OF NONGRANT FUNDS.—

16 Nongrant funds described in clauses (i) and (ii)

17 of subparagraph (A), including any such funds

18 in excess of those originally expected, shall be

19 used as permitted under this section, and may

20 be used for such other purposes as are not spe21 cifically prohibited under this section if such

22 use furthers the objectives of the project.

23 ‘‘(e) INFANT MORTALITY GRANTS.—
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1 ‘‘(1) IN GENERAL.—The Secretary may make

2 grants to health centers for the purpose of assisting

3 such centers in—

4 ‘‘(A) providing comprehensive health care

5 and support services for the reduction of—

6 ‘‘(i) the incidence of infant mortality;

7 and

8 ‘‘(ii) morbidity among children who

9 are less than 3 years of age; and

10 ‘‘(B) developing and coordinating service

11 and referral arrangements between health cen12 ters and other entities for the health manage13 ment of pregnant women and children described

14 in subparagraph (A).

15 ‘‘(2) PRIORITY.—In making grants under this

16 subsection the Secretary shall give priority to health

17 centers providing services to any medically under18 served population among which there is a substantial

19 incidence of infant mortality or among which there

20 is a significant increase in the incidence of infant

21 mortality.

22 ‘‘(3) REQUIREMENTS.—The Secretary may

23 make a grant under this subsection only if the

24 health center involved agrees that—
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1 ‘‘(A) the center will coordinate the provi2 sion of services under the grant to each of the

3 recipients of the services;

4 ‘‘(B) such services will be continuous for

5 each such recipient;

6 ‘‘(C) the center will provide follow-up serv7 ices for individuals who are referred by the cen8 ter for services described in paragraph (1);

9 ‘‘(D) the grant will be expended to supple10 ment, and not supplant, the expenditures of the

11 center for primary health services (including

12 prenatal care) with respect to the purpose de13 scribed in this subsection; and

14 ‘‘(E) the center will coordinate the provi15 sion of services with other maternal and child

16 health providers operating in the catchment

17 area.

18 ‘‘(f) MIGRATORY AND SEASONAL AGRICULTURAL

19 WORKERS.—

20 ‘‘(1) IN GENERAL.—The Secretary may award

21 grants for the purposes described in subsections (c),

22 (d), and (e) for the planning and delivery of services

23 to a special medically underserved population com24 prised of—
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1 ‘‘(A) migratory agricultural workers, sea2 sonal agricultural workers, and members of the

3 families of such migratory and seasonal agricul4 tural workers who are within a designated

5 catchment area; and

6 ‘‘(B) individuals who have previously been

7 migratory agricultural workers but who no

8 longer meet the requirements of subparagraph

9 (A) of paragraph (4) because of age or disabil10 ity and members of the families of such individ11 uals who are within such catchment area.

12 ‘‘(2) ENVIRONMENTAL CONCERNS.—The Sec13 retary may enter into grants or contracts under this

14 subsection with public and private entities to—

15 ‘‘(A) assist the States in the implementa16 tion and enforcement of acceptable environ17 mental health standards, including enforcement

18 of standards for sanitation in migratory agricul19 tural worker labor camps, and applicable Fed20 eral and State pesticide control standards; and

21 ‘‘(B) conduct projects and studies to assist

22 the several States and entities which have re23 ceived grants or contracts under this section in

24 the assessment of problems related to camp and

25 field sanitation, exposure to unsafe levels of ag-
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1 ricultural chemicals including pesticides, and

2 other environmental health hazards to which

3 migratory agricultural workers and members of

4 their families are exposed.

5 ‘‘(3) DEFINITIONS.—For purposes of this sub6 section:

7 ‘‘(A) MIGRATORY AGRICULTURAL WORK8 ER.—The term ‘migratory agricultural worker’

9 means an individual whose principal employ10 ment is in agriculture on a seasonal basis, who

11 has been so employed within the last 24

12 months, and who establishes for the purposes of

13 such employment a temporary abode.

14 ‘‘(B) SEASONAL AGRICULTURAL WORK15 ER.—The term ‘seasonal agricultural worker’

16 means an individual whose principal employ17 ment is in agriculture on a seasonal basis and

18 who is not a migratory agricultural worker.

19 ‘‘(C) AGRICULTURE.—The term ‘agri20 culture’ means farming in all its branches, in21 cluding—

22 ‘‘(i) cultivation and tillage of the soil;

23 ‘‘(ii) the production, cultivation, grow24 ing, and harvesting of any commodity

25 grown on, in, or as an adjunct to or part
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1 of a commodity grown in or on, the land;

2 and

3 ‘‘(iii) any practice (including prepara4 tion and processing for market and deliv5 ery to storage or to market or to carriers

6 for transportation to market) performed by

7 a farmer or on a farm incident to or in

8 conjunction with an activity described in

9 clause (ii).

10 ‘‘(g) HOMELESS POPULATION.—

11 ‘‘(1) IN GENERAL.—The Secretary may award

12 grants for the purposes described in subsections (c),

13 (d), and (e) for the planning and delivery of services

14 to a special medically underserved population com15 prised of homeless individuals, including grants for

16 innovative programs that provide outreach and com17 prehensive primary health services to homeless chil18 dren and children at risk of homelessness.

19 ‘‘(2) REQUIRED SERVICES.—In addition to re20 quired primary health services (as defined in sub21 section (b)(1)), an entity that receives a grant under

22 this subsection shall be required to provide sub23 stance abuse services as a condition of such grant.

24 ‘‘(3) SUPPLEMENT NOT SUPPLANT REQUIRE25 MENT.—A grant awarded under this subsection shall
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1 be expended to supplement, and not supplant, the

2 expenditures of the health center and the value of in

3 kind contributions for the delivery of services to the

4 population described in paragraph (1).

5 ‘‘(4) DEFINITIONS.—For purposes of this sec6 tion:

7 ‘‘(A) HOMELESS INDIVIDUAL.—The term

8 ‘homeless individual’ means an individual who

9 lacks housing (without regard to whether the

10 individual is a member of a family), including

11 an individual whose primary residence during

12 the night is a supervised public or private facil13 ity that provides temporary living accommoda14 tions and an individual who is a resident in

15 transitional housing.

16 ‘‘(B) SUBSTANCE ABUSE.—The term ‘sub17 stance abuse’ has the same meaning given such

18 term in section 534(4).

19 ‘‘(C) SUBSTANCE ABUSE SERVICES.—The

20 term ‘substance abuse services’ includes detoxi21 fication and residential treatment for substance

22 abuse provided in settings other than hospitals.

23 ‘‘(h) RESIDENTS OF PUBLIC HOUSING.—

24 ‘‘(1) IN GENERAL.—The Secretary may award

25 grants for the purposes described in subsections (c),
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1 (d), and (e) for the planning and delivery of services

2 to a special medically underserved population com3 prised of residents of public housing (such term, for

4 purposes of this subsection, shall have the same

5 meaning given such term in section 3(b)(1) of the

6 United States Housing Act of 1937) and individuals

7 living in areas immediately accessible to such public

8 housing.

9 ‘‘(2) SUPPLEMENT NOT SUPPLANT.—A grant

10 awarded under this subsection shall be expended to

11 supplement, and not supplant, the expenditures of

12 the health center and the value of in kind contribu13 tions for the delivery of services to the population

14 described in paragraph (1).

15 ‘‘(3) CONSULTATION WITH RESIDENTS.—The

16 Secretary may not make a grant under paragraph

17 (1) unless, with respect to the residents of the public

18 housing involved, the applicant for the grant—

19 ‘‘(A) has consulted with the residents in

20 the preparation of the application for the grant;

21 and

22 ‘‘(B) agrees to provide for ongoing con23 sultation with the residents regarding the plan24 ning and administration of the program carried

25 out with the grant.
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1 ‘‘(i) APPLICATIONS.—

2 ‘‘(1) SUBMISSION.—No grant may be made

3 under this section unless an application therefore is

4 submitted to, and approved by, the Secretary. Such

5 an application shall be submitted in such form and

6 manner and shall contain such information as the

7 Secretary shall prescribe.

8 ‘‘(2) DESCRIPTION OF NEED.—An application

9 for a grant under subparagraph (A) or (B) of sub10 section (d)(1) for a health center shall include—

11 ‘‘(A) a description of the need for health

12 services in the catchment area of the center;

13 ‘‘(B) a demonstration by the applicant that

14 the area or the population group to be served

15 by the applicant has a shortage of personal

16 health services; and

17 ‘‘(C) a demonstration that the center will

18 be located so that it will provide services to the

19 greatest number of individuals residing in the

20 catchment area or included in such population

21 group.

22 Such a demonstration shall be made on the basis of

23 the criteria prescribed by the Secretary under sub24 section (b)(3) or on any other criteria which the Sec25 retary may prescribe to determine if the area or pop-
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1 ulation group to be served by the applicant has a

2 shortage of personal health services. In considering

3 an application for a grant under subparagraph (A)

4 or (B) of subsection (d)(1), the Secretary may re5 quire as a condition to the approval of such applica6 tion an assurance that the applicant will provide any

7 health service defined under paragraphs (1) and (2)

8 of subsection (b) that the Secretary finds is needed

9 to meet specific health needs of the area to be served

10 by the applicant. Such a finding shall be made in

11 writing and a copy shall be provided to the appli12 cant.

13 ‘‘(3) REQUIREMENTS.—Except as provided in

14 subsection (d)(1)(B), the Secretary may not approve

15 an application for a grant under subparagraph (A)

16 or (B) of subsection (d)(1) unless the Secretary de17 termines that the entity for which the application is

18 submitted is a health center (within the meaning of

19 subsection (a)) and that—

20 ‘‘(A) the required primary health services

21 of the center will be available and accessible in

22 the catchment area of the center promptly, as

23 appropriate, and in a manner which assures

24 continuity;
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1 ‘‘(B) the center will have an ongoing qual2 ity improvement system that includes clinical

3 services and management, and that maintains

4 the confidentiality of patient records;

5 ‘‘(C) the center will demonstrate its finan6 cial responsibility by the use of such accounting

7 procedures and other requirements as may be

8 prescribed by the Secretary;

9 ‘‘(D) the center—

10 ‘‘(i) has or will have a contractual or

11 other arrangement with the agency of the

12 State, in which it provides services, which

13 administers or supervises the administra14 tion of a State plan approved under title

15 XIX of the Social Security Act for the pay16 ment of all or a part of the center’s costs

17 in providing health services to persons who

18 are eligible for medical assistance under

19 such a State plan; or

20 ‘‘(ii) has made or will make every rea21 sonable effort to enter into such an ar22 rangement;

23 ‘‘(E) the center has made or will make and

24 will continue to make every reasonable effort to

25 collect appropriate reimbursement for its costs
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1 in providing health services to persons who are

2 entitled to insurance benefits under title XVIII

3 of the Social Security Act, to medical assistance

4 under a State plan approved under title XIX of

5 such Act, or to assistance for medical expenses

6 under any other public assistance program or

7 private health insurance program;

8 ‘‘(F) the center—

9 ‘‘(i) has prepared a schedule of fees or

10 payments for the provision of its services

11 consistent with locally prevailing rates or

12 charges and designed to cover its reason13 able costs of operation and has prepared a

14 corresponding schedule of discounts to be

15 applied to the payment of such fees or pay16 ments, which discounts are adjusted on the

17 basis of the patient’s ability to pay;

18 ‘‘(ii) has made and will continue to

19 make every reasonable effort—

20 ‘‘(I) to secure from patients pay21 ment for services in accordance with

22 such schedules; and

23 ‘‘(II) to collect reimbursement for

24 health services to persons described in

25 subparagraph (E) on the basis of the
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1 full amount of fees and payments for

2 such services without application of

3 any discount; and

4 ‘‘(iii) has submitted to the Secretary

5 such reports as the Secretary may require

6 to determine compliance with this subpara7 graph;

8 ‘‘(G) the center has established a govern9 ing board which except in the case of an entity

10 operated by an Indian tribe or tribal or Indian

11 organization under the Indian Self-Determina12 tion Act—

13 ‘‘(i) is composed of individuals, a ma14 jority of whom are being served by the cen15 ter and who, as a group, represent the in16 dividuals being served by the center;

17 ‘‘(ii) meets at least once a month, se18 lects the services to be provided by the cen19 ter, schedules the hours during which such

20 services will be provided, approves the cen21 ter’s annual budget, approves the selection

22 of a director for the center, and, except in

23 the case of a governing board of a public

24 center (as defined in the second sentence
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1 of this paragraph), establishes general poli2 cies for the center; and

3 ‘‘(iii) in the case of an application for

4 a second or subsequent grant for a public

5 center, has approved the application or if

6 the governing body has not approved the

7 application, the failure of the governing

8 body to approve the application was unrea9 sonable;

10 except that, upon a showing of good cause the

11 Secretary shall waive all or part of the require12 ments of this subparagraph in the case of a

13 health center that receives a grant pursuant to

14 subsection (f), (g), (h), or (o);

15 ‘‘(H) the center has developed—

16 ‘‘(i) an overall plan and budget that

17 meets the requirements of the Secretary;

18 and

19 ‘‘(ii) an effective procedure for compil20 ing and reporting to the Secretary such

21 statistics and other information as the Sec22 retary may require relating to—

23 ‘‘(I) the costs of its operations;

24 ‘‘(II) the patterns of use of its

25 services;
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1 ‘‘(III) the availability, accessibil2 ity, and acceptability of its services;

3 and

4 ‘‘(IV) such other matters relating

5 to operations of the applicant as the

6 Secretary may require;

7 ‘‘(I) the center will review periodically its

8 catchment area to—

9 ‘‘(i) ensure that the size of such area

10 is such that the services to be provided

11 through the center (including any satellite)

12 are available and accessible to the resi13 dents of the area promptly and as appro14 priate;

15 ‘‘(ii) ensure that the boundaries of

16 such area conform, to the extent prac17 ticable, to relevant boundaries of political

18 subdivisions, school districts, and Federal

19 and State health and social service pro20 grams; and

21 ‘‘(iii) ensure that the boundaries of

22 such area eliminate, to the extent possible,

23 barriers to access to the services of the

24 center, including barriers resulting from

25 the area’s physical characteristics, its resi-
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1 dential patterns, its economic and social

2 grouping, and available transportation;

3 ‘‘(J) in the case of a center which serves

4 a population including a substantial proportion

5 of individuals of limited English-speaking abil6 ity, the center has—

7 ‘‘(i) developed a plan and made ar8 rangements responsive to the needs of such

9 population for providing services to the ex10 tent practicable in the language and cul11 tural context most appropriate to such in12 dividuals; and

13 ‘‘(ii) identified an individual on its

14 staff who is fluent in both that language

15 and in English and whose responsibilities

16 shall include providing guidance to such in17 dividuals and to appropriate staff members

18 with respect to cultural sensitivities and

19 bridging linguistic and cultural differences;

20 and

21 ‘‘(K) the center, has developed an ongoing

22 referral relationship with one or more hospitals.

23 For purposes of subparagraph (G), the term ‘public

24 center’ means a health center funded (or to be fund-
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1 ed) through a grant under this section to a public

2 agency.

3 ‘‘(4) APPROVAL OF NEW OR EXPANDED SERV4 ICE APPLICATIONS.—The Secretary shall approve

5 applications for grants under subparagraph (A) or

6 (B) of subsection (d)(1) for health centers which—

7 ‘‘(A) have not received a previous grant

8 under such subsection; or

9 ‘‘(B) have applied for such a grant to ex10 pand their services;

11 in such a manner that the ratio of the medically un12 derserved populations in rural areas which may be

13 expected to use the services provided by such centers

14 to the medically underserved populations in urban

15 areas which may be expected to use the services pro16 vided by such centers is not less than two to three

17 or greater than three to two.

18 ‘‘(5) NEW CONSTRUCTION.—The Secretary may

19 make a grant under subsection (c) or (d) for the

20 construction of new buildings for a health center

21 only if the Secretary determines that appropriate fa22 cilities are not available through acquiring, mod23 ernizing, or expanding existing buildings and that

24 the entity to which the grant will be made has made

25 reasonable efforts to secure from other sources
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1 funds, in lieu of the grant, to construct such facili2 ties.

3 ‘‘(j) TECHNICAL AND OTHER ASSISTANCE.—The

4 Secretary may provide (either through the Department of

5 Health and Human Services or by grant or contract) all

6 necessary technical and other nonfinancial assistance (in7 cluding fiscal and program management assistance and

8 training in such management) to any public or private

9 nonprofit entity to assist entities in developing plans for,

10 or operating as, health centers, and in meeting the re11 quirements of subsection (i)(2).

12 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—

13 ‘‘(1) IN GENERAL.—For the purpose of carry14 ing out this section there are authorized to be appro15 priated $756,518,000 for fiscal year 1997, and such

16 sums as may be necessary for each of the fiscal

17 years 1998 through 2001.

18 ‘‘(2) SPECIAL PROVISIONS.—

19 ‘‘(A) PUBLIC CENTERS.—The Secretary

20 may not expend in any fiscal year, for grants

21 under this section to public centers (as defined

22 in the second sentence of subsection (i)(3)) the

23 governing boards of which (as described in sub24 section (i)(3)(G)(ii)) do not establish general

25 policies for such centers, an amount which ex-
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1 ceeds 5 percent of the amounts appropriated

2 under this section for that fiscal year. For pur3 poses of applying the preceding sentence, the

4 term ‘public centers’ shall not include health

5 centers that receive grants pursuant to sub6 section (g) or (h).

7 ‘‘(B) DISTRIBUTION OF GRANTS.—

8 ‘‘(i) FISCAL YEAR 1997.—For fiscal

9 year 1997, the Secretary, in awarding

10 grants under this section shall ensure that

11 the amounts made available under each of

12 subsections (f), (g), and (h) in such fiscal

13 year bears the same relationship to the

14 total amount appropriated for such fiscal

15 year under paragraph (1) as the amounts

16 appropriated for fiscal year 1996 under

17 each of sections 329, 340, and 340A (as

18 such sections existed one day prior to the

19 date of enactment of this section) bears to

20 the total amount appropriated under sec21 tions 329, 330, 340, and 340A (as such

22 sections existed one day prior to the date

23 of enactment of this section) for such fiscal

24 year.
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1 ‘‘(ii) FISCAL YEARS 1998 AND 1999.—

2 For each of the fiscal years 1998 and

3 1999, the Secretary, in awarding grants

4 under this section shall ensure that the

5 proportion of the amounts made available

6 under each of subsections (f), (g), and (h)

7 is equal to the proportion of amounts made

8 available under each such subsection for

9 the previous fiscal year, as such amounts

10 relate to the total amounts appropriated

11 for the previous fiscal year involved, in12 creased or decreased by not more than 10

13 percent.

14 ‘‘(3) FUNDING REPORT.—The Secretary shall

15 annually prepare and submit to the appropriate com16 mittees of Congress a report concerning the distribu17 tion of funds under this section that are provided to

18 meet the health care needs of medically underserved

19 populations, including the homeless, residents of

20 public housing, and migratory and seasonal agricul21 tural workers, and the appropriateness of the deliv22 ery systems involved in responding to the needs of

23 the particular populations. Such report shall include

24 an assessment of the relative health care access

25 needs of the targeted populations and the rationale
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1 for any substantial changes in the distribution of

2 funds.

3 ‘‘(l) MEMORANDUM OF AGREEMENT.—In carrying

4 out this section, the Secretary may enter into a memoran5 dum of agreement with a State. Such memorandum may

6 include, where appropriate, provisions permitting such

7 State to—

8 ‘‘(1) analyze the need for primary health serv9 ices for medically underserved populations within

10 such State;

11 ‘‘(2) assist in the planning and development of

12 new health centers;

13 ‘‘(3) review and comment upon annual program

14 plans and budgets of health centers, including com15 ments upon allocations of health care resources in

16 the State;

17 ‘‘(4) assist health centers in the development of

18 clinical practices and fiscal and administrative sys19 tems through a technical assistance plan which is re20 sponsive to the requests of health centers; and

21 ‘‘(5) share information and data relevant to the

22 operation of new and existing health centers.

23 ‘‘(m) RECORDS.—
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1 ‘‘(1) IN GENERAL.—Each entity which receives

2 a grant under subsection (d) shall establish and

3 maintain such records as the Secretary shall require.

4 ‘‘(2) AVAILABILITY.—Each entity which is re5 quired to establish and maintain records under this

6 subsection shall make such books, documents, pa7 pers, and records available to the Secretary or the

8 Comptroller General of the United States, or any of

9 their duly authorized representatives, for examina10 tion, copying or mechanical reproduction on or off

11 the premises of such entity upon a reasonable re12 quest therefore. The Secretary and the Comptroller

13 General of the United States, or any of their duly

14 authorized representatives, shall have the authority

15 to conduct such examination, copying, and reproduc16 tion.

17 ‘‘(n) DELEGATION OF AUTHORITY.—The Secretary

18 may delegate the authority to administer the programs au19 thorized by this section to any office within the Service,

20 except that the authority to enter into, modify, or issue

21 approvals with respect to grants or contracts may be dele22 gated only within the Health Resources and Services Ad23 ministration.

24 ‘‘(o) SPECIAL CONSIDERATION.—In making grants

25 under this section, the Secretary shall give special consid-
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1 eration to the unique needs of sparsely populated rural

2 areas, including priority in the awarding of grants for new

3 health centers under subsections (c) and (d), and the

4 granting of waivers as appropriate and permitted under

5 subsections (b)(1)(B)(i) and (i)(3)(G).’’.

6 SEC. 3. RURAL HEALTH OUTREACH, NETWORK DEVELOP7 MENT, AND TELEMEDICINE GRANT PRO8 GRAM.

9 (a) IN GENERAL.—Subpart I of part D of title III

10 of the Public Health Service Act (42 U.S.C. 254b et seq.)

11 (as amended by section 2) is further amended by adding

12 at the end thereof the following new section:

13 ‘‘SEC. 330A. RURAL HEALTH OUTREACH, NETWORK DEVEL14 OPMENT, AND TELEMEDICINE GRANT PRO15 GRAM.

16 ‘‘(a) ADMINISTRATION.—The rural health services

17 outreach demonstration grant program established under

18 section 301 shall be administered by the Office of Rural

19 Health Policy (of the Health Resources and Services Ad20 ministration), in consultation with State rural health of21 fices or other appropriate State governmental entities.

22 ‘‘(b) GRANTS.—Under the program referred to in

23 subsection (a), the Secretary, acting through the Director

24 of the Office of Rural Health Policy, may award grants

25 to expand access to, coordinate, restrain the cost of, and
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1 improve the quality of essential health care services, in2 cluding preventive and emergency services, through the

3 development of integrated health care delivery systems or

4 networks in rural areas and regions.

5 ‘‘(c) ELIGIBLE NETWORKS.—

6 ‘‘(1) OUTREACH NETWORKS.—To be eligible to

7 receive a grant under this section, an entity shall—

8 ‘‘(A) be a rural public or nonprofit private

9 entity that is or represents a network or poten10 tial network that includes three or more health

11 care providers or other entities that provide or

12 support the delivery of health care services; and

13 ‘‘(B) in consultation with the State office

14 of rural health or other appropriate State en15 tity, prepare and submit to the Secretary an ap16 plication, at such time, in such manner, and

17 containing such information as the Secretary

18 may require, including—

19 ‘‘(i) a description of the activities

20 which the applicant intends to carry out

21 using amounts provided under the grant;

22 ‘‘(ii) a plan for continuing the project

23 after Federal support is ended;

24 ‘‘(iii) a description of the manner in

25 which the activities funded under the grant
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1 will meet health care needs of underserved

2 rural populations within the State; and

3 ‘‘(iv) a description of how the local

4 community or region to be served by the

5 network or proposed network will be in6 volved in the development and ongoing op7 erations of the network.

8 ‘‘(2) FOR-PROFIT ENTITIES.—An eligible net9 work may include for-profit entities so long as the

10 network grantee is a nonprofit entity.

11 ‘‘(3) TELEMEDICINE NETWORKS.—

12 ‘‘(A) IN GENERAL.—An entity that is a

13 health care provider and a member of an exist14 ing or proposed telemedicine network, or an en15 tity that is a consortium of health care provid16 ers that are members of an existing or proposed

17 telemedicine network shall be eligible for a

18 grant under this section.

19 ‘‘(B) REQUIREMENT.—A telemedicine net20 work referred to in subparagraph (A) shall, at

21 a minimum, be composed of—

22 ‘‘(i) a multispecialty entity that is lo23 cated in an urban or rural area, which can

24 provide 24-hour a day access to a range of

25 specialty care; and
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1 ‘‘(ii) at least two rural health care fa2 cilities, which may include rural hospitals,

3 rural physician offices, rural health clinics,

4 rural community health clinics, and rural

5 nursing homes.

6 ‘‘(d) PREFERENCE.—In awarding grants under this

7 section, the Secretary shall give preference to applicant

8 networks that include—

9 ‘‘(1) a majority of the health care providers

10 serving in the area or region to be served by the net11 work;

12 ‘‘(2) any federally qualified health centers, rural

13 health clinics, and local public health departments

14 serving in the area or region;

15 ‘‘(3) outpatient mental health providers serving

16 in the area or region; or

17 ‘‘(4) appropriate social service providers, such

18 as agencies on aging, school systems, and providers

19 under the women, infants, and children program, to

20 improve access to and coordination of health care

21 services.

22 ‘‘(e) USE OF FUNDS.—

23 ‘‘(1) IN GENERAL.—Amounts provided under

24 grants awarded under this section shall be used—
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1 ‘‘(A) for the planning and development of

2 integrated self-sustaining health care networks;

3 and

4 ‘‘(B) for the initial provision of services.

5 ‘‘(2) EXPENDITURES IN RURAL AREAS.—

6 ‘‘(A) IN GENERAL.—In awarding a grant

7 under this section, the Secretary shall ensure

8 that not less than 50 percent of the grant

9 award is expended in a rural area or to provide

10 services to residents of rural areas.

11 ‘‘(B) TELEMEDICINE NETWORKS.—An en12 tity described in subsection (c)(3) may not use

13 in excess of—

14 ‘‘(i) 40 percent of the amounts pro15 vided under a grant under this section to

16 carry out activities under paragraph

17 (3)(A)(iii); and

18 ‘‘(ii) 20 percent of the amounts pro19 vided under a grant under this section to

20 pay for the indirect costs associated with

21 carrying out the purposes of such grant.

22 ‘‘(3) TELEMEDICINE NETWORKS.—

23 ‘‘(A) IN GENERAL.—An entity described in

24 subsection (c)(3), may use amounts provided

25 under a grant under this section to—
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1 ‘‘(i) demonstrate the use of

2 telemedicine in facilitating the development

3 of rural health care networks and for im4 proving access to health care services for

5 rural citizens;

6 ‘‘(ii) provide a baseline of information

7 for a systematic evaluation of telemedicine

8 systems serving rural areas;

9 ‘‘(iii) purchase or lease and install

10 equipment; and

11 ‘‘(iv) operate the telemedicine system

12 and evaluate the telemedicine system.

13 ‘‘(B) LIMITATIONS.—An entity described

14 in subsection (c)(3), may not use amounts pro15 vided under a grant under this section—

16 ‘‘(i) to build or acquire real property;

17 ‘‘(ii) purchase or install transmission

18 equipment (such as laying cable or tele19 phone lines, microwave towers, satellite

20 dishes, amplifiers, and digital switching

21 equipment); or

22 ‘‘(iii) for construction, except that

23 such funds may be expended for minor

24 renovations relating to the installation of

25 equipment;
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1 ‘‘(f) TERM OF GRANTS.—Funding may not be pro2 vided to a network under this section for in excess of a

3 3-year period.

4 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—For the

5 purpose of carrying out this section there are authorized

6 to be appropriated $36,000,000 for fiscal year 1997, and

7 such sums as may be necessary for each of the fiscal years

8 1998 through 2001.’’.

9 (b) TRANSITION.—The Secretary of Health and

10 Human Services shall ensure the continued funding of

11 grants made, or contracts or cooperative agreements en12 tered into, under subpart I of part D of title III of the

13 Public Health Service Act (42 U.S.C. 254b et seq.) (as

14 such subpart existed on the day prior to the date of enact15 ment of this Act), until the expiration of the grant period

16 or the term of the contract or cooperative agreement. Such

17 funding shall be continued under the same terms and con18 ditions as were in effect on the date on which the grant,

19 contract or cooperative agreement was awarded, subject

20 to the availability of appropriations.

21 SEC. 4. TECHNICAL AND CONFORMING AMENDMENTS.

22 (a) IN GENERAL.—The Public Health Service Act is

23 amended—
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1 (1) in section 224(g)(4) (42 U.S.C. 233(g)(4))

2 by striking ‘‘under’’ and all that follows through the

3 end thereof and inserting ‘‘under section 330.’’;

4 (2) in section 340C(a)(2) (42 U.S.C. 256c) by

5 striking ‘‘under’’ and all that follows through the

6 end thereof and inserting ‘‘with assistance provided

7 under section 330.’’; and

8 (3) by repealing subparts V and VI of part D

9 of title III (42 U.S.C. 256 et seq.).

10 (b) SOCIAL SECURITY ACT.—The Social Security Act

11 is amended—

12 (1) in clauses (i) and (ii)(I) of section

13 1861(aa)(4)(A) (42 U.S.C. 1395x(aa)(4)(A)(i) and

14 (ii)(I)) by striking ‘‘section 329, 330, or 340’’ and

15 inserting ‘‘section 330 (other than subsection (h))’’;

16 and

17 (2) in clauses (i) and (ii)(II) of section

18 1905(l)(2)(B) (42 U.S.C. 1396d(l)(2)(B)(i) and

19 (ii)(II)) by striking ‘‘section 329, 330, 340, or

20 340A’’ and inserting ‘‘section 330’’.

21 (c) REFERENCES.—Whenever any reference is made

22 in any provision of law, regulation, rule, record, or docu23 ment to a community health center, migrant health center,

24 public housing health center, or homeless health center,
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1 such reference shall be considered a reference to a health

2 center.

3 (d) ADDITIONAL AMENDMENTS.—After consultation

4 with the appropriate committees of the Congress, the Sec5 retary of Health and Human Services shall prepare and

6 submit to the Congress a legislative proposal in the form

7 of an implementing bill containing technical and conform8 ing amendments to reflect the changes made by this Act.

9 SEC. 5. EFFECTIVE DATE.

10 This Act and the amendments made by this Act shall

11 become effective on October 1, 1996.

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