I

103D CONGRESS

2D SESSION H. R. 4841

To establish a fund for various programs to strengthen and expand the

capacity of State and local governments and other entities to improve

the public health.

IN THE HOUSE OF REPRESENTATIVES

JULY 27, 1994

Mr. MORAN (for himself, Mr. STOKES, Mr. DELLUMS, Mr. HILLIARD, Mr.

FARR of California, Mr. NEAL of North Carolina, Mr. STUDDS, Ms.

PELOSI, Mr. SERRANO, Mr. FILNER, Mr. FOGLIETTA, Mr. SANDERS,

Mrs. MALONEY, and Mr. PAYNE of New Jersey) introduced the following

bill; which was referred jointly to the Committees on Energy and Commerce, Education and Labor, and Ways and Means

A BILL

To establish a fund for various programs to strengthen and

expand the capacity of State and local governments and

other entities to improve the public health.

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; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Public Health Improvement Act of 1994’’.

6 (b) TABLE OF CONTENTS.—The table of titles and

7 subtitles for this Act is as follows:
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TITLE I—PROGRAMS UNDER PUBLIC HEALTH

IMPROVEMENT TRUST FUND

Subtitle A—Programs of Public Health Service Act

Subtitle B—Comprehensive School Health Education

TITLE II—AMENDMENTS TO INTERNAL REVENUE CODE

OF 1986

1 TITLE I—PROGRAMS UNDER

2 PUBLIC HEALTH IMPROVE3 MENT TRUST FUND

4 Subtitle A—Programs of Public

5 Health Service Act

6 SEC. 101. TABLE OF CONTENTS REGARDING NEW TITLE

7 XXVII OF PUBLIC HEALTH SERVICE ACT.

8 A table describing the contents of title XXVII of the

9 Public Health Service Act, as added by section 102 of this

10 Act, is as follows:

TITLE XXVII—PROGRAMS UNDER PUBLIC HEALTH

IMPROVEMENT TRUST FUND

Subtitle A—Establishment of Fund; Advisory Commission

Sec. 2701. Public Health Improvement Trust Fund.

Sec. 2702. Public Health Advisory Commission.

Subtitle B—Core Functions of Public Health Programs

PART 1—FORMULA GRANTS TO STATES

Sec. 2711. Authorizations of appropriations from Fund.

Sec. 2712. Formula grants to States for core health functions.

Sec. 2713. Number of functions; planning.

Sec. 2714. Submission of information; reports.

Sec. 2715. Application for grant.

Sec. 2716. Determination of amount of allotment.

Sec. 2717. Allocations for certain activities.

PART 2—COMPREHENSIVE EVALUATION OF DISEASE PREVENTION AND

HEALTH PROMOTION PROGRAMS

Sec. 2718. Authorizations of appropriations from Fund.

Sec. 2719. Evaluation of programs.
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Subtitle C—Opportunities for Education and Training in

Public Health

PART 1—SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS REGARDING

SERVICE IN PUBLIC HEALTH POSITIONS

Sec. 2721. Authorizations of appropriations from Fund.

Sec. 2722. Scholarship program.

Sec. 2723. Loan repayment program.

Sec. 2724. Approved public health positions.

Sec. 2725. Allocation of funds; special considerations.

PART 2—EDUCATIONAL INSTITUTIONS REGARDING PUBLIC HEALTH

Sec. 2731. Authorizations of appropriations from Fund.

Sec. 2732. Grants for expanding capacity of institutions.

Sec. 2733. Coordination of grant activities with national priorities.

Sec. 2734. Certain requirements for grants.

PART 3—EXPANSION OF COMPETENCY IN PUBLIC HEALTH

Sec. 2736. Authorizations of appropriations from Fund.

Sec. 2737. Grants to States.

PART 4—GENERAL PROVISIONS REGARDING EDUCATION AND TRAINING

Sec. 2740. Underrepresented minorities regarding fields of public health.

Sec. 2740A. Coordination of programs.

Subtitle D—Regional Poison Control Centers

Sec. 2741. Authorizations of appropriations from Fund.

Sec. 2742. Grants for regional centers.

Sec. 2743. Requirements regarding certification.

Sec. 2744. General provisions.

Subtitle E—School-Related Health Services

PART 1—PROJECTS FOR PROVISION OF SERVICES

SUBPART A—DEVELOPMENT AND OPERATION OF PROJECTS

Sec. 2746. Authorizations of appropriations from Fund.

Sec. 2747. Eligibility for development and operation grants.

Sec. 2748. Preferences.

Sec. 2749. Grants for development of projects.

Sec. 2750. Grants for operation of projects.

Sec. 2751. Federal administrative costs.

SUBPART B—CAPITAL COSTS OF DEVELOPING PROJECTS

Sec. 2753. Loans and loan guarantees regarding projects.

Sec. 2754. Funding.

PART 2—SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS REGARDING

SCHOOL NURSES

Sec. 2755. Authorizations of appropriations from Fund.

Sec. 2755A. Scholarship program regarding upgrade in skills.

Sec. 2755B. Loan repayment program.
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Sec. 2755C. School-nurse positions.

Subtitle F—Expansion of Access to Health Services

PART 1—COMMUNITY AND MIGRANT HEALTH CENTERS

Sec. 2756. Authorizations of appropriations from Fund.

Sec. 2757. Grants to community and migrant health centers.

PART 2—QUALIFIED COMMUNITY HEALTH PLANS AND PRACTICE NETWORKS

SUBPART A—FUNDING; PURPOSES

Sec. 2761. Authorizations of appropriations from Fund.

Sec. 2762. Purposes.

SUBPART B—DEVELOPMENT OF QUALIFIED COMMUNITY HEALTH PLANS AND

PRACTICE NETWORKS

Sec. 2763. Grants and contracts for development of plans and networks.

Sec. 2764. Preferences in making awards of assistance.

Sec. 2765. Certain uses of awards.

Sec. 2766. Accessibility of services.

Sec. 2767. Additional agreements.

Sec. 2768. Submission of certain information.

Sec. 2769. Reports; audits.

Sec. 2770. Application for assistance.

Sec. 2771. General provisions.

SUBPART C—CAPITAL COST OF DEVELOPMENT OF QUALIFIED COMMUNITY

HEALTH PLANS AND PRACTICE NETWORKS

Sec. 2773. Loans and loan guarantees regarding plans and networks.

Sec. 2774. Certain requirements.

Sec. 2775. Defaults; right of recovery.

Sec. 2776. Provisions regarding construction or expansion of facilities.

Sec. 2777. Application for assistance.

Sec. 2778. Administration of programs.

PART 3—ENABLING SERVICES

Sec. 2779. Authorizations of appropriations from Fund.

Sec. 2780. Grants and contracts for enabling services.

PART 4—NATIONAL HEALTH SERVICE CORPS

Sec. 2781. Authorizations of appropriations from Fund.

PART 5—SATELLITE CLINICS REGARDING PRIMARY HEALTH CARE

Sec. 2783. Authorizations of appropriations from Fund.

Sec. 2783A. Grants to States for development and operation of satellite clinics.

PART 6—COMMUNITY HEALTH ADVISORS

Sec. 2784. Authorizations of appropriations from Fund.

Sec. 2785. Formula grants regarding community health advisor programs.

Sec. 2786. Requirements regarding community health advisor programs.

Sec. 2787. Additional agreements.

Sec. 2788. Application for assistance; State plan.
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Sec. 2789. Determination of amount of allotment.

Sec. 2790. Quality assurance; cost-effectiveness.

Sec. 2791. Evaluations; technical assistance.

Sec. 2792. Rule of construction regarding programs of Indian Health Service.

Sec. 2793. Definitions.

Sec. 2794. Effect of insufficient appropriations for minimum allotments.

PART 7—MENTAL HEALTH; SUBSTANCE ABUSE

Sec. 2795. Authorizations of appropriations from Fund.

Sec. 2796. Supplemental formula grants for States regarding activities under

part B of title XIX.

Sec. 2797. Capital costs of development of certain centers and clinics.

Subtitle E—General Provisions

Sec. 2798. Requirement regarding accreditation of schools, departments, and

programs.

Sec. 2799. Definitions.

1 SEC. 102. ESTABLISHMENT OF NEW TITLE XXVII REGARD2 ING PUBLIC HEALTH PROGRAMS.

3 The Public Health Service Act (42 U.S.C. 201 et

4 seq.) is amended by adding at the end the following title:

5 ‘‘TITLE XXVII—PROGRAMS

6 UNDER PUBLIC HEALTH IM7 PROVEMENT TRUST FUND

8 ‘‘Subtitle A—Establishment of

9 Fund; Advisory Commission

10 ‘‘SEC. 2701. PUBLIC HEALTH IMPROVEMENT TRUST FUND.

11 ‘‘(a) ESTABLISHMENT OF FUND.—There is estab12 lished in the Treasury of the United States a fund to be

13 known as the Public Health Improvement Trust Fund (in

14 this title referred to as the ‘Fund’), consisting of the

15 amounts appropriated in subsection (b) and subsection

16 (d)(3). Amounts in the Fund are available until expended.
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1 ‘‘(b) TRANSFERS TO FUND.—There are hereby ap2 propriated to the Fund amounts equivalent to the increase

3 in the revenues received in the Treasury by reason of the

4 amendments made by section 201 of the Public Health

5 Improvement Act of 1994.

6 ‘‘(c) EXPENDITURES FROM FUND.—Amounts in the

7 Fund are available for carrying out this title, and for car8 rying out subtitle B of title I of the Public Health Im9 provement Act of 1994 (relating to comprehensive school

10 health education), subject to the extent of amounts made

11 available in advance in appropriations Act pursuant to the

12 authorizations of appropriations established in the other

13 subtitles of this title and in section 2702. This section does

14 not establish any authorization of appropriations.

15 ‘‘(d) INVESTMENT.—

16 ‘‘(1) IN GENERAL.—The Secretary of the

17 Treasury shall invest such amounts of the Fund as

18 such Secretary determines are not required to meet

19 current withdrawals from the Fund. Such invest20 ments may be made only in interest-bearing obliga21 tions of the United States. For such purpose, such

22 obligations may be acquired on original issue at the

23 issue price, or by purchase of outstanding obliga24 tions at the market price.
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1 ‘‘(2) SALE OF OBLIGATIONS.—Any obligation

2 acquired by the Fund may be sold by the Secretary

3 of the Treasury at the market price.

4 ‘‘(3) AVAILABILITY OF INCOME.—Any interest

5 derived from obligations acquired by the Fund, and

6 proceeds from any sale or redemption of such obliga7 tions, are hereby appropriated to the Fund.

8 ‘‘SEC. 2702. PUBLIC HEALTH ADVISORY COMMISSION.

9 ‘‘(a) IN GENERAL.—The Secretary shall establish

10 within the Office of the Assistant Secretary for Health an

11 advisory commission to be known as the National Public

12 Health Advisory Commission (in this title referred to as

13 the ‘Commission’). The first meeting of the Commission

14 shall be held not later than 90 days after the date of the

15 enactment of the Public Health Improvement Act of 1994.

16 ‘‘(b) DUTIES.—

17 ‘‘(1) IN GENERAL.—The Commission shall pro18 vide to the Secretary advice on carrying out this title

19 (including advice on the amount of funds that

20 should be made available for each of the programs

21 of this title and including advice on improving such

22 programs) and advice on other Federal policies re23 garding the public health (including the rec24 ommendations of the Commission for changes in

25 such policies). In carrying out the preceding sen-
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1 tence, the Commission shall monitor the develop2 ment and operation of the programs of this title.

3 ‘‘(2) CERTAIN ACTIVITIES.—The activities car4 ried out under paragraph (1) by the Commission

5 shall include the following:

6 ‘‘(A) Assessing the effectiveness and cost7 effectiveness of public health programs on im8 proving health status of communities.

9 ‘‘(B) Assessing the effectiveness and cost10 effectiveness of public health interventions at

11 the community level.

12 ‘‘(C) Assessing the impact of health care

13 reform on access to clinical preventive services,

14 early detection services, and health promotion

15 services.

16 ‘‘(c) COMPOSITION.—

17 ‘‘(1) EX OFFICIO MEMBERS.—The heads of

18 each of the agencies of the Public Health Service (or

19 the designees of such heads) shall serve as nonvoting

20 members of the Commission. The Secretary may

21 designate additional Federal officials to so serve.

22 ‘‘(2) APPOINTED MEMBERS.—The Secretary

23 shall appoint to the Commission 9 individuals who

24 are not officers or employees of the Federal Govern25 ment, which individuals shall serve as voting mem-
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1 bers of the Commission. Individuals appointed under

2 the preceding sentence shall include—

3 ‘‘(A) individuals who are experienced or

4 specially trained in a field of public health;

5 ‘‘(B) members of professional organiza6 tions regarding the public health;

7 ‘‘(C) members of the general public; and

8 ‘‘(D) members of organizations represent9 ing the general public.

10 ‘‘(3) REQUIREMENT REGARDING MINORITY

11 GROUPS.—The Secretary shall ensure that the mem12 bership of the Commission includes individuals who

13 are members of racial and ethnic minority groups.

14 ‘‘(d) CHAIR.—From among the members of the Com15 mission appointed under subsection (c)(2), the President

16 shall designate an individual to serve as the chair of the

17 Commission.

18 ‘‘(e) TERMS.—

19 ‘‘(1) IN GENERAL.—The term of a member of

20 the Commission appointed under subsection (c)(2) is

21 3 years, except that, of such members first ap22 pointed to the Commission, the Secretary shall speci23 fy varying terms of membership to achieve the result

that not more than 1 24 ⁄3 of the terms of members so

25 appointed expire in any 1 year.
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1 ‘‘(2) SERVICE AFTER EXPIRATION OF TERM.—

2 A member of the Commission may continue to serve

3 after the expiration of the term of the member until

4 a successor is appointed.

5 ‘‘(f) VACANCIES.—

6 ‘‘(1) AUTHORITY OF COMMISSION.—A vacancy

7 in the membership of the Commission does not af8 fect the power of the remaining members to carry

9 out the duties under subsection (b).

10 ‘‘(2) APPOINTMENT OF SUCCESSORS.—A va11 cancy in the membership of the Commission shall be

12 filled in the manner in which the original appoint13 ment was made.

14 ‘‘(3) INCOMPLETE TERM.—If a member of the

15 Commission does not serve the full term applicable

16 to the member, the individual appointed to fill the

17 resulting vacancy shall be appointed for the remain18 der of the term of the predecessor of the individual.

19 ‘‘(g) MEETINGS.—The Commission shall meet at the

20 call of the Chair or a majority of the members, except

21 that the Commission shall meet not fewer than 3 times

22 each fiscal year.

23 ‘‘(h) COMPENSATION; REIMBURSEMENT OF EX24 PENSES.—
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1 ‘‘(1) APPOINTED MEMBERS.—Members of the

2 Commission appointed under subsection (c)(2) shall

3 receive compensation for each day (including travel4 time) engaged in carrying out the duties of the Com5 mittee. Such compensation may not be in an amount

6 in excess of the maximum rate of basic pay payable

7 under the General Schedule for positions above GS–

8 15.

9 ‘‘(2) EX OFFICIO MEMBERS.—Members of the

10 Commission who serve under subsection (c)(1) may

11 not receive compensation for service on the Commis12 sion in addition to the compensation otherwise re13 ceived for duties carried out as Federal officers or

14 employees.

15 ‘‘(3) REIMBURSEMENT.—Members of the Com16 mission may, in accordance with chapter 57 of title

17 5, United States Code, be reimbursed for travel,

18 subsistence, and other necessary expenses incurred

19 in carrying out the duties of the Commission.

20 ‘‘(i) STAFF.—

21 ‘‘(1) IN GENERAL.—The Commission may ap22 point and determine the compensation of such staff

23 as may be necessary to carry out the duties of the

24 Commission, including appointing an executive direc25 tor for the Commission. Such appointments and
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1 compensation may be made without regard to the

2 provisions of title 5, United States Code, that govern

3 appointments in the competitive services, and the

4 provisions of chapter 51 and subchapter III of chap5 ter 53 of such title that relate to classifications and

6 the General Schedule pay rates.

7 ‘‘(2) LIMITATION.—Staff appointed under para8 graph (1) may not be compensated in excess of the

9 maximum rate of basic pay payable for GS–15

10 under the General Schedule, except that the execu11 tive director may be compensated in an amount not

12 exceeding the maximum rate of basic pay payable

13 under such Schedule for positions above GS–15.

14 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS FROM

15 FUND.—For the purpose of carrying out this section,

16 there are authorized to be appropriated from the Fund

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

18 1995 through 2002.

19 ‘‘Subtitle B—Core Functions of

20 Public Health Programs

21 ‘‘PART 1—Formula Grants to States

22 ‘‘SEC. 2711. AUTHORIZATIONS OF APPROPRIATIONS FROM

23 FUND.

24 For the purpose of carrying out this subtitle, there

25 are authorized to be appropriated from the Fund
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1 $150,000,000 for fiscal year 1995, $400,000,000 for fis2 cal year 1996, $550,000,000 for fiscal year 1997,

3 $650,000,000 for fiscal year 1998, $750,000,000 for fis4 cal year 1999, $850,000,000 for fiscal year 2000,

5 $900,000,000 for fiscal year 2001, and $900,000,000 for

6 fiscal year 2002.

7 ‘‘SEC. 2712. FORMULA GRANTS TO STATES FOR CORE

8 HEALTH FUNCTIONS.

9 ‘‘(a) IN GENERAL.—In the case of each State that

10 submits to the Secretary an application in accordance with

11 section 2715 for a fiscal year, the Secretary of Health and

12 Human Services, acting through the Director of the Cen13 ters for Disease Control and Prevention, shall make a

14 grant to the State for carrying out the activities described

15 in subsection (c). The award shall consist of the allotment

16 determined under section 2716 for the State.

17 ‘‘(b) GENERAL PURPOSE.—The purpose of this sub18 title is to provide for improvements in the health status

19 of the public through carrying out the activities described

20 in subsection (b) toward attaining the Healthy People

21 2000 Objectives (as defined in section 2799). A funding

22 agreement for a grant under subsection (a) is that—

23 ‘‘(1) the grant will be expended for such activi24 ties; and
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1 ‘‘(2) the activities will be carried out by the

2 State in collaboration with local public health de3 partments, health education and training centers,

4 neighborhood health centers, and other community

5 health providers.

6 ‘‘(c) CORE FUNCTIONS OF PUBLIC HEALTH PRO7 GRAMS.—Subject to the purpose described in subsection

8 (b), the activities referred to in subsection (a) are the

9 following:

10 ‘‘(1) Data collection, and analytical activities,

11 related to population-based status and outcomes

12 monitoring, including the following:

13 ‘‘(A) The regular collection and analysis of

14 public health data (including the 10 leading

15 causes of death and their costs to society).

16 ‘‘(B) Vital statistics.

17 ‘‘(C) Personal health services data.

18 ‘‘(D) The supply and distribution of health

19 professionals.

20 ‘‘(2) Activities to reduce environmental risk and

21 to assure the safety of housing, schools, workplaces,

22 day-care centers, food and water, including the fol23 lowing activities:

24 ‘‘(A) Monitoring the overall public health

25 status and safety of communities.
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1 ‘‘(B) Assessing exposure to high lead levels

2 and other environmental contaminants; and ac3 tivities for abatement of toxicant hazards, in4 cluding lead-related hazards.

5 ‘‘(C) Monitoring the quality of community

6 water supplies used for consumption or for rec7 reational purposes.

8 ‘‘(D) Monitoring sewage and solid waste

9 disposal, radiation exposure, radon exposure,

10 and noise levels.

11 ‘‘(E) Monitoring indoor and ambient air

12 quality and related risks to vulnerable popu13 lations.

14 ‘‘(F) Assuring recreation, worker, and

15 school safety.

16 ‘‘(G) Enforcing public health safety and

17 sanitary codes.

18 ‘‘(H) Monitoring community access to ap19 propriate health services.

20 ‘‘(I) Other activities relating to promoting

21 and protecting the public health of commu22 nities.

23 ‘‘(3) Investigation, control, and public-aware24 ness activities regarding adverse health conditions

25 (such as emergency treatment preparedness, commu-
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1 nity efforts to reduce violence, outbreaks of commu2 nicable diseases within communities, chronic disease

3 and dysfunction exposure-related conditions, toxic

4 environmental pollutants, occupational and rec5 reational hazards, motor vehicle accidents, and other

6 threats to the health status of individuals).

7 ‘‘(4) Public information and education pro8 grams to reduce risks to health (such as use of to9 bacco, alcohol and other drugs; unintentional injury

10 from accidents, including motor vehicle accidents;

11 sexual activities that increase the risk to HIV trans12 mission and sexually transmitted diseases; poor diet;

13 physical inactivity; stress-related illness; mental

14 health problems; genetic disorders; and low child15 hood immunization levels).

16 ‘‘(5) Provision of public health laboratory serv17 ices to complement private clinical laboratory serv18 ices and that screen for diseases and conditions

19 (such as metabolic diseases in newborns, provide as20 sessments of blood lead levels and other environ21 mental toxicants, diagnose and contact tracing of

22 sexually transmitted diseases, tuberculosis and other

23 diseases requiring partner notification, test for infec24 tious and food-borne diseases, and monitor the safe25 ty of water and food supplies).
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1 (6) Training and education of new and existing

2 health professionals in the field of public health,

3 with special emphasis on epidemiology, biostatistics,

4 health education, public health administration, pub5 lic health nursing and dentistry, environmental and

6 occupational health sciences, public health nutrition,

7 social and behavioral health sciences, operations re8 search, and laboratory technology.

9 ‘‘(7) Leadership, policy development and admin10 istration activities, including assessing needs and the

11 supply and distribution of health professionals; the

12 setting of public health standards; the development

13 of community public health policies; and the develop14 ment of community public health coalitions.

15 ‘‘(d) RESTRICTIONS ON USE OF GRANT.—

16 ‘‘(1) IN GENERAL.—A funding agreement for a

17 grant under subsection (a) for a State is that the

18 grant will not be expended—

19 ‘‘(A) to provide inpatient services;

20 ‘‘(B) to make cash payments to intended

21 recipients of health services;

22 ‘‘(C) to purchase or improve land, pur23 chase, construct, or permanently improve (other

24 than minor remodeling) any building or other

25 facility, or purchase major medical equipment;
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1 ‘‘(D) to satisfy any requirement for the ex2 penditure of non-Federal funds as a condition

3 for the receipt of Federal funds; or

4 ‘‘(E) to provide financial assistance to any

5 entity other than a public or nonprofit private

6 entity.

7 ‘‘(2) LIMITATION ON ADMINISTRATIVE EX8 PENSES.—A funding agreement for a grant under

9 subsection (a) is that the State involved will not ex10 pend more than 20 percent of the grant for adminis11 trative expenses with respect to the grant.

12 ‘‘(e) MAINTENANCE OF EFFORT.—A funding agree13 ment for a grant under subsection (a) is that the State

14 involved will maintain expenditures of non-Federal

15 amounts for core health functions at a level that is not

16 less than the level of such expenditures maintained by the

17 State for the fiscal year preceding the first fiscal year for

18 which the State receives such a grant.

19 ‘‘SEC. 2713. NUMBER OF FUNCTIONS; PLANNING.

20 ‘‘(a) NUMBER OF FUNCTIONS.—Subject to sub21 section (b), a funding agreement for a grant under section

22 2712 is that the State involved will carry out each of the

23 activities described in subsection (c) of such section.

24 ‘‘(b) PLANNING.—In making grants under section

25 2712, the Secretary shall for each State designate a period
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1 during which the State is to engage in planning to meet

2 the responsibilities of the State under subsection (a). The

3 period so designated may not exceed 18 months. With re4 spect to such period for a State, a funding agreement for

5 a grant under section 2712 for any fiscal year containing

6 any portion of the period is that, during the period, the

7 State will expend the grant only for such planning.

8 ‘‘SEC. 2714. SUBMISSION OF INFORMATION; REPORTS.

9 (a) SUBMISSION OF INFORMATION.—The Secretary

10 may make a grant under section 2712 only if the State

11 involved submits to the Secretary the following informa12 tion:

13 ‘‘(1) A description of the relationship between

14 community health providers, public and private

15 health plans, and the public health system of the

16 State.

17 ‘‘(2) A description of existing deficiencies in the

18 public health system at the State level and the local

19 level, using standards under the Healthy People

20 2000 Objectives.

21 ‘‘(3) A description of public health priorities

22 identified at the State level and local levels, includ23 ing the 10 leading causes of death and their respec24 tive direct and indirect costs to the State and the

25 Federal Government.
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1 ‘‘(4) Measurable outcomes and process objec2 tives (using criteria under the Healthy People 2000

3 Objectives) which indicate improvements in health

4 status as a result of the activities carried out under

5 section 2712(c).

6 ‘‘(5) Information regarding each such activity,

7 which—

8 ‘‘(A) identifies the amount of State and

9 local funding expended on each such activity for

10 the fiscal year preceding the fiscal year for

11 which the grant is sought; and

12 ‘‘(B) provides a detailed description of how

13 additional Federal funding will improve each

14 such activity by both the State and local public

15 health agencies.

16 ‘‘(6) A description of activities under section

17 2712(c) to be carried out at the local level, and a

18 specification for each such activity of—

19 ‘‘(A) the communities in which the activity

20 will be carried out and any collaborating agen21 cies;

22 ‘‘(B) the amount of the grant to be ex23 pended for the activity in each community so

24 specified; and
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1 ‘‘(C) the integration of community health

2 advisors (as defined in 2786(d)) with such ac3 tivities under section 2712(c).

4 ‘‘(7) A description of how such activities have

5 been coordinated with activities supported under

6 title V of the Social Security Act (relating to mater7 nal and child health).

8 ‘‘(b) REPORTS.—A funding agreement for a grant

9 under section 2712 is that the States involved will, not

10 later than the date specified by the Secretary, submit to

11 the Secretary a report describing—

12 ‘‘(1) the purposes for which the grant was

13 expended;

14 ‘‘(2) the health status of the population of the

15 State, as measured by criteria under the Healthy

16 People 2000 Objectives; and

17 ‘‘(3) the progress achieved and obstacles en18 countered in using uniform data sets under such

19 Objectives.

20 ‘‘SEC. 2715. APPLICATION FOR GRANT.

21 ‘‘The Secretary may make a grant under section

22 2712 only if an application for the grant is submitted to

23 the Secretary, the application contains each agreement de24 scribed in this part, the application contains the informa25 tion required in section 205, and the application is in such
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1 form, is made in such manner, and contains such agree2 ments, assurances, and information as the Secretary de3 termines to be necessary to carry out this part.

4 ‘‘SEC. 2716. DETERMINATION OF AMOUNT OF ALLOTMENT.

5 ‘‘For purposes of section 2712, the allotment under

6 this section for a State for a fiscal year shall be deter7 mined through a formula established by the Secretary on

8 the basis of the population, economic indicators, and

9 health status of each State. Such allotment shall be the

10 product of—

11 ‘‘(1) a percentage determined under the for12 mula; and

13 ‘‘(2) the amount appropriated under section

14 2711 for the fiscal year, less any amounts reserved

15 under section 2717.

16 ‘‘SEC. 2717. ALLOCATIONS FOR CERTAIN ACTIVITIES.

17 ‘‘Of the amounts made available under section 2711

18 for a fiscal year for carrying out this part, the Secretary

19 may reserve not more than 15 percent for carrying out

20 the following activities:

21 ‘‘(1) Technical assistance with respect to plan22 ning, development, and operation of activities under

23 section 2712(b), including provision of biostatistical

24 and epidemiological expertise, provision of laboratory
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1 expertise, and the development of uniform data sets

2 under the Health People 2000 Objectives.

3 ‘‘(2) Development and operation of a national

4 information network among State and local health

5 agencies for utilizing such uniform data sets.

6 ‘‘(3) Program monitoring and evaluation of ac7 tivities carried out under section 2712(b).

8 ‘‘(4) Development of a unified electronic report9 ing mechanism to improve the efficiency of adminis10 trative management requirements regarding the

11 provision of Federal grants to State public health

12 agencies.

13 ‘‘PART 2—COMPREHENSIVE EVALUATION OF DIS14 EASE PREVENTION AND HEALTH PRO15 MOTION PROGRAMS

16 ‘‘SEC. 2718. AUTHORIZATIONS OF APPROPRIATIONS FROM

17 FUND.

18 ‘‘For the purpose of carrying out this part, there

19 are authorized to be appropriated from the Fund

20 $100,000,000 for fiscal year 1995, $150,000,000 for each

21 of the fiscal years 1996 through 1999, and $100,000,000

22 for fiscal year 2000.

23 ‘‘SEC. 2719. EVALUATION OF PROGRAMS.

24 ‘‘(a) GRANTS.—The Secretary may make grants to,

25 or enter into cooperative agreements or contracts with, eli-
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1 gible entities for the purpose of enabling such entities to

2 carry out evaluations of the type described in subsection

3 (c). The Secretary shall carry out this section acting

4 through the Director of the Centers for Disease Control

5 and Prevention, subject to subsection (g).

6 ‘‘(b) REQUIREMENTS.—

7 ‘‘(1) ELIGIBLE ENTITIES.—To be eligible to re8 ceive an award of a grant, cooperative agreement, or

9 contract under subsection (a), an entity must—

10 ‘‘(A) be a public, nonprofit, or private en11 tity or a university;

12 ‘‘(B) prepare and submit to the Secretary

13 an application at such time, in such form, and

14 containing such information as the Secretary

15 may require, including a plan for the conduct of

16 the evaluation under the grant;

17 ‘‘(C) provide assurances that any informa18 tion collected while conducting evaluations

19 under this section will be maintained in a con20 fidential manner with respect to the identities

21 of the individuals from which such information

22 is obtained; and

23 ‘‘(D) meet any other requirements that the

24 Secretary determines to be appropriate.
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1 ‘‘(2) TYPES OF ENTITIES.—In making awards

2 under subsection (a), the Secretary shall consider

3 applications from entities proposing to conduct eval4 uations using community programs, managed care

5 programs, State and county health departments,

6 public education campaigns, school programs, and

7 other appropriate programs. The Secretary shall en8 sure that not less than 25 percent of the amounts

9 appropriated under section 2718 for a fiscal year are

10 used for making such awards to entities that will use

11 the amounts to conduct evaluations in the work12 place.

13 ‘‘(c) USE OF FUNDS.—

14 ‘‘(1) EVALUATIONS.—An award under sub15 section (a) shall be used to—

16 ‘‘(A) conduct evaluations to determine the

17 extent to which clinical preventive services,

18 health promotion and unintentional injury pre19 vention activities, and interpersonal and com20 munity violence prevention activities, achieve

21 short-term and long-term health care cost re22 ductions and health status improvement with

23 respect to the Healthy People 2000 Objectives;

24 and
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•HR 4841 IH

1 ‘‘(B) evaluate other areas determined ap2 propriate by the Secretary.

3 ‘‘(2) INCLUSION OF CERTAIN POPULATION

4 GROUPS.—In carrying out this section, the Secretary

5 shall ensure that data concerning women, children,

6 minorities, older individuals with different income

7 levels, retirees, and individuals from diverse geo8 graphical backgrounds, are obtained.

9 ‘‘(3) MINIMUM SERVICES.—The evaluations

10 that the Secretary may provide for under this sec11 tion include (but are not limited to) evaluations of

12 programs that provide one or more of the following

13 services:

14 ‘‘(A) Blood pressure screening and control

15 (to detect and control hypertension and coro16 nary health disease).

17 ‘‘(B) Early cancer screening.

18 ‘‘(C) Blood cholesterol screening and con19 trol.

20 ‘‘(D) Smoking cessation programs.

21 ‘‘(E) Substance abuse programs.

22 ‘‘(F) Dietary and nutrition counseling, in23 cluding nutrition

24 ‘‘(G) Physical fitness counseling.

25 ‘‘(H) Stress management.
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1 ‘‘(I) Diabetes education and screening.

2 ‘‘(J) Intraocular pressure screening.

3 ‘‘(K) Monitoring of prescription drug use.

4 ‘‘(L) Violence and injury prevention pro5 grams.

6 ‘‘(N) Health education.

7 ‘‘(O) Immunization rates.

8 ‘‘(4) ENVIRONMENTAL DATA.—Evaluations con9 ducted under this section may consider the health ef10 fects and cost-effectiveness of certain environmental

11 programs, including fluoridation programs, traffic

12 safety programs, pollution control programs, acci13 dent prevention programs, and antismoking pro14 grams.

15 ‘‘(5) PUBLIC POLICIES.—Evaluations conducted

16 under this section may consider the effects of pre17 vention-oriented social and economic policies on im18 provement of health status and their long-term cost

19 effectiveness.

20 ‘‘(6) USE OF EXISTING DATA.—In conducting

21 evaluations under this section, entities shall use ex22 isting data and health promotion and screening pro23 grams where practicable.

24 ‘‘(7) COOPERATION.—In providing for an eval25 uation under this section, the Secretary shall encour-
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•HR 4841 IH

1 age the recipient of the award and public and pri2 vate entities with relevant expertise (including State

3 and local agencies) to collaborate for purposes of

4 conducting the evaluation.

5 ‘‘(d) SITES.—Recipients of awards under subsection

6 (a) shall select evaluation sites under the award that

7 present the greatest potential for new and relevant knowl8 edge. Such recipients, in selecting such sites, shall ensure

9 that—

10 ‘‘(1) the sites provide evidence of pilot testing,

11 process evaluation, formative evaluation, availability

12 assessment strategies and results;

13 ‘‘(2) the sites provide evidence of a clear defini14 tion of the program and protocols for the implemen15 tation of the evaluation; and

16 ‘‘(3) the sites provide evidence of valid, appro17 priate and feasible assessment methods and tools

18 and a willingness to use common data items and in19 struments across such sites.

20 ‘‘(e) REPORTING REQUIREMENTS.—Not later than 1

21 year after an entity first receives an award under sub22 section (a), and not less than once during each 1-year pe23 riod thereafter for which such an award is made to the

24 entity, the entity shall prepare and submit to the Sec25 retary a report containing a description of the activities
29

•HR 4841 IH

1 under this section conducted during the period for which

2 the report is prepared, and the findings derived as a result

3 of such activities.

4 ‘‘(f) TERM OF EVALUATIONS.—Evaluations con5 ducted under this section shall be for a period of not less

6 than 3 years and may continue as necessary to permit the

7 grantee to adequately measure the full benefit of the

8 evaluations.

9 ‘‘(g) DISSEMINATION AND GUIDELINES.—

10 ‘‘(1) CONSULTATION.—The Secretary shall

11 carry out this subsection acting through the Director

12 of the Centers for Disease Control and Prevention

13 and the Administrator for Health Care Policy and

14 Research.

15 ‘‘(2) GUIDELINES.—The Secretary shall, where

16 feasible and practical, develop and issue practice

17 guidelines that are based on the results of evalua18 tions conducted under this section. The practice

19 guidelines shall be developed by the Secretary utiliz20 ing expert practitioners to assist in the development

21 and implementation of these guidelines.

22 ‘‘(3) DATA.—

23 ‘‘(A) IN GENERAL.—The Secretary shall

24 collect, store, analyze, and make available data

25 related to the formulation of the guidelines that
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•HR 4841 IH

1 is provided to the Centers for Disease Control

2 and Prevention by entities conducting evalua3 tions under this section.

4 ‘‘(B) USE OF DATA.—The Secretary

5 shall—

6 ‘‘(i) identify activities that prevent

7 disease, illness, injury and disability, and

8 promote good health practices; ascertain

9 their cost-effectiveness; and identify their

10 potential to overall health status with re11 spect to Healthy People 2000 Objectives;

12 ‘‘(ii) disseminate practice guidelines to

13 State and county health departments,

14 State insurance departments, insurance

15 companies, employers, professional medical

16 organizations, and others determined ap17 propriate by the Secretary; and

18 ‘‘(iii) provide information with respect

19 to recidivism rates of participation in the

20 evaluations.

21 ‘‘(4) DISSEMINATION.—The Secretary may dis22 seminate information collected from evaluations

23 under this section.

24 ‘‘(h) LIMITATION.—Amounts appropriated for carry25 ing out this section shall not be utilized to provide services.
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1 ‘‘Subtitle C—Opportunities for

2 Education and Training in Pub3 lic Health

4 ‘‘Part 1—SCHOLARSHIP AND LOAN REPAYMENT

5 PROGRAMS REGARDING SERVICE IN PUBLIC

6 HEALTH POSITIONS

7 ‘‘SEC. 2721. AUTHORIZATIONS OF APPROPRIATIONS FROM

8 FUND.

9 ‘‘For the purpose of carrying out this part, there are

10 authorized to be appropriated from the Fund

11 $100,000,000 for fiscal year 1995, $125,000,000 for fis12 cal year 1996, $150,000,000 for fiscal year 1997,

13 $150,000,000 for fiscal year 1998, $150,000,000 for fis14 cal year 1999, and $175,000,000 for each of the fiscal

15 years 2000 through 2002.

16 ‘‘SEC. 2722. SCHOLARSHIP PROGRAM.

17 ‘‘(a) IN GENERAL.—The Secretary, acting through

18 the Administrator of the Health Resources and Services

19 Administration and in consultation with the Director of

20 the Centers for Disease Control and Prevention, shall

21 carry out a program under which the Secretary awards

22 scholarships to individuals described in subsection (b) for

23 the purpose of assisting the individuals with the costs of

24 attending public and nonprofit private schools of public

25 health (or other public or nonprofit private institutions
32

•HR 4841 IH

1 providing graduate or specialized training in public

2 health).

3 ‘‘(b) ELIGIBLE INDIVIDUALS.—An individual re4 ferred to in subsection (a) is any individual meeting the

5 following conditions:

6 ‘‘(1) The individual is enrolled (or accepted for

7 enrollment) at a school or other institution referred

8 to in subsection (a) as a full-time or part-time stu9 dent in a program providing training in a health

10 profession in a field of public health (including the

11 fields of epidemiology, biostatistics, environmental

12 health, health administration and planning, behav13 ioral sciences, maternal and child health, occupa14 tional safety, public health nursing, nutrition, and

15 toxicology).

16 ‘‘(2) The individual enters into the contract re17 quired pursuant to subsection (d) as a condition of

18 receiving the scholarship (relating to an agreement

19 to provide services in approved public health posi20 tions, as defined in section 2724).

21 ‘‘(c) ELIGIBLE SCHOOLS.—For fiscal year 1997 and

22 subsequent fiscal years, the Secretary may make an award

23 of a scholarship under subsection (a) only if the Secretary

24 determines that—
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•HR 4841 IH

1 ‘‘(1) the school or other institution with respect

2 to which the award is to be provided has coordinated

3 the activities of the school or institution with rel4 evant activities of the Health Resources and Services

5 Administration and the Centers for Disease Control

6 and Prevention; and

7 ‘‘(2) not fewer than 60 percent of the graduates

8 of the school or institution are in public health posi9 tions determined by the Secretary to be consistent

10 with the needs of the United States regarding such

11 professionals.

12 ‘‘(d) APPLICABILITY OF CERTAIN PROVISIONS.—Ex13 cept as inconsistent with this section or section 2724, the

14 provisions of subpart III of part D of title III (relating

15 to the Scholarship and Loan Repayment Programs of the

16 National Health Service Corps) apply to an award of a

17 scholarship under subsection (a) to the same extent and

18 in the same manner as such provisions apply to an award

19 of a scholarship under section 338A.

20 ‘‘SEC. 2723. LOAN REPAYMENT PROGRAM.

21 ‘‘(a) IN GENERAL.—The Secretary, acting through

22 the Administrator of the Health Resources and Services

23 Administration and in consultation with the Director of

24 the Centers for Disease Control and Prevention, shall

25 carry out a program under which the Federal Government
34

•HR 4841 IH

1 enters into agreements to repay all or part of the edu2 cational loans of individuals meeting the following condi3 tions:

4 ‘‘(1) The individual involved is a graduate of a

5 school or other institution described in section

6 2722(a).

7 ‘‘(2) The individual meets the applicable legal

8 requirements to provide services as a public health

9 professional (including a professional in any of the

10 fields specified in section 2722(b)(1)).

11 ‘‘(3) The individual enters into the contract re12 quired pursuant to subsection (b) as a condition of

13 the Federal Government repaying such loans (relat14 ing to an agreement to provide services in approved

15 public health positions, as defined in section 2724).

16 ‘‘(b) APPLICABILITY OF CERTAIN PROVISIONS.—Ex17 cept as inconsistent with this section or section 2724, the

18 provisions of subpart III of part D of title III (relating

19 to the Scholarship and Loan Repayment Programs of the

20 National Health Service Corps) apply to an agreement re21 garding repayment under subsection (a) to the same ex22 tent and in the same manner as such provisions apply to

23 an agreement regarding repayment under section 338B.

24 ‘‘(c) AMOUNT OF REPAYMENTS.—For each year for

25 which an individual contracts to serve in an approved pub-
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•HR 4841 IH

1 lic health position pursuant to subsection (b), the Sec2 retary may repay not more than $20,000 of the principal

3 and interest of the educational loans of the individual.

4 ‘‘SEC. 2724. APPROVED PUBLIC HEALTH POSITIONS.

5 ‘‘(a) POSITION REGARDING POPULATIONS WITH SIG6 NIFICANT NEED FOR SERVICES.—

7 ‘‘(1) IN GENERAL.—With respect to the pro8 grams under this part, the obligated service of a

9 program participant pursuant to sections 2722(d)

10 and 2723(b) shall be provided through an assign11 ment, to an entity described in subsection (b), for a

12 position in which the participant provides services as

13 a public health professional to a population deter14 mined by the Secretary to have a significant unmet

15 need for the services of such a professional.

16 ‘‘(2) PERIOD OF SERVICE.—For purposes of

17 sections 2722(d) and 2723(d), the period of obli18 gated service is the following, as applicable to the

19 program participant involved:

20 ‘‘(A) In the case of scholarships under sec21 tion 2722 for full-time students, the greater

22 of—

23 ‘‘(i) 1 year for each year for which

24 such a scholarship is provided; or

25 ‘‘(ii) 2 years.
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•HR 4841 IH

1 ‘‘(B) In the case of scholarships under sec2 tion 2722 for part-time students, a period de3 termined by the Secretary on the basis of the

4 number of hours of education or training re5 ceived under the scholarship, considering the

6 percentage constituted by the ratio of such

7 number to the number of hours for a full-time

8 student in the program involved.

9 ‘‘(C) In the case of the loan repayments

10 under section 2723, such period as the Sec11 retary and the participant may agree, except

12 that the period may not be less than 2 years.

13 ‘‘(b) APPROVAL OF ENTITIES FOR ASSIGNMENT OF

14 PROGRAM PARTICIPANTS.—The entities referred to in

15 subsection (a) are public and nonprofit private entities ap16 proved by the Secretary as meeting such requirements for

17 the assignment of a program participant as the Secretary

18 may establish. The entities that the Secretary may so ap19 prove include State and local departments of health, public

20 hospitals, community and neighborhood health clinics, mi21 grant health clinics, community-based health-related orga22 nizations, certified regional poison control centers, pur23 chasing cooperatives regarding health insurance, and any

24 other public or nonprofit private entity.

25 ‘‘(c) DEFINITIONS.—For purposes of this part:
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•HR 4841 IH

1 ‘‘(1) The term ‘approved public health position’,

2 with respect to a program participant, means a posi3 tion to which the participant is assigned pursuant to

4 subsection (a).

5 ‘‘(2) The term ‘program participant’ means an

6 individual who enters into a contract pursuant to

7 section 2722(b)(2) or 2723(a)(3).

8 ‘‘SEC. 2725. ALLOCATION OF FUNDS; SPECIAL CONSIDER9 ATIONS.

10 ‘‘(a) ALLOCATIONS REGARDING NEW PARTICIPANTS

11 IN SCHOLARSHIP PROGRAM.—Of the amounts appro12 priated under section 2721 for a fiscal year, the Secretary

13 shall obligate not less than 30 percent for the purpose of

14 providing awards for scholarships under section 2722 to

15 individuals who have not previously received such scholar16 ships.

17 ‘‘(b) SPECIAL CONSIDERATION FOR CERTAIN INDI18 VIDUALS.—In making awards of scholarships under sec19 tion 2722 and making repayments under section 2723, the

20 Secretary shall give special consideration to individuals

21 who are in the armed forces of the United States or who

22 are veterans of the armed forces.

23 ‘‘(c) SCHOOL HEALTH EDUCATION PROGRAMS.—The

24 Secretary shall ensure that the approved public health po25 sitions to which the Secretary assigns program partici-
38

•HR 4841 IH

1 pants under this part include positions in programs that

2 provide education on the promotion of health and the pre3 vention of diseases and that are carried out on the prem4 ises of public or nonprofit private elementary and second5 ary schools, including comprehensive school health edu6 cation programs under subtitle B of title I of the Public

7 Health Improvement Act of 1994.

8 ‘‘PART 2—EDUCATIONAL INSTITUTIONS

9 REGARDING PUBLIC HEALTH

10 ‘‘SEC. 2731. AUTHORIZATIONS OF APPROPRIATIONS FROM

11 FUND.

12 ‘‘For the purpose of carrying out this part, there are

13 authorized to be appropriated from the Fund

14 $100,000,000 for fiscal year 1995, $125,000,000 for fis15 cal year 1996, $150,000,000 for each of the fiscal years

16 1997 through 2000, and $175,000,000 for each of the fis17 cal years 2001 and 2002.

18 ‘‘SEC. 2732. GRANTS FOR EXPANDING CAPACITY OF INSTI19 TUTIONS.

20 ‘‘(a) IN GENERAL.—The Secretary may make grants

21 to institutions described in subsection (b) for the purpose

22 of expanding the educational capacities of the institutions

23 through recruiting and retaining faculty, curriculum devel24 opment, and coordinating the activities of the institutions

25 regarding education, training, and field placements.
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1 ‘‘(b) RELEVANT INSTITUTIONS.—The institutions

2 referred to in subsection (a) are public and nonprofit

3 private—

4 ‘‘(1) schools of public health;

5 ‘‘(2) departments of community and preventive

6 medicine that—

7 ‘‘(A) are within schools of medicine and

8 schools of osteopathic medicine; and

9 ‘‘(B) have established formal arrangements

10 with schools of public health in order to award

11 joint degrees in public health and another

12 health profession; and

13 ‘‘(3) schools of nursing or dentistry that have

14 established formal arrangements with schools of

15 public health in order to carry out educational pro16 grams in public health at the schools of nursing or

17 dentistry, respectively.

18 ‘‘(c) REQUIREMENTS REGARDING CURRICULUM DE19 VELOPMENT.—A funding agreement for a grant under

20 subsection (a) for an institution is that, to the extent de21 termined to be appropriate by the Secretary, the curricu22 lum of institution will include the following:

23 ‘‘(1) Subject to subsection (d)(1), part-time

24 nondegree programs for public health professionals

25 who need further training in fields of public health.
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1 ‘‘(2) With respect to the program of community

2 health advisors established in part 5 of subtitle F,

3 a program to train individuals to serve as super4 visors under such part (including training and evalu5 ating the community health advisors), which pro6 gram is carried out in collaboration with local public

7 health departments and health education and train8 ing centers.

9 ‘‘(3) A program under which the institution col10 laborates with health departments and elementary

11 and secondary schools to develop a health education

12 curriculum for use in the program established under

13 subtitle B of title I of the Public Health Improve14 ment Act of 1964.

15 ‘‘(d) ADDITIONAL REQUIREMENTS.—Funding agree16 ments for a grant under subsection (a) for an institution

17 are as follows:

18 ‘‘(1) In developing the curriculum under the

19 grant, the institution will consult with the health de20 partments in the State involved, and will follow the

21 relevant priorities of such departments;

22 ‘‘(2) The institution will, as appropriate in the

23 determination of the Secretary, coordinate the activi24 ties of the institution under the grant with relevant

25 activities of the Health Resources and Services Ad-
41

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1 ministration and the Centers for Disease Control

2 and Prevention.

3 ‘‘SEC. 2733. COORDINATION OF GRANT ACTIVITIES WITH

4 NATIONAL PRIORITIES.

5 The Secretary shall—

6 ‘‘(1) determine the needs of the United States

7 regarding the education and geographic distribution

8 of public health professionals;

9 ‘‘(2) determine priorities among such needs;

10 and

11 ‘‘(3) in making grants under section 2732, en12 sure that the curricula developed under such section,

13 and the expertise of the faculty recruited and re14 tained under such section, are consistent with such

15 priorities.

16 ‘‘SEC. 2734. CERTAIN REQUIREMENTS FOR GRANTS.

17 For fiscal year 1997 and subsequent fiscal years, the

18 Secretary may make a grant under section 2732 only if

19 the institution involved is in compliance with the following:

20 ‘‘(1) The institution has coordinated the activi21 ties of the school or institution with relevant activi22 ties of the Health Resources and Services Adminis23 tration and the Centers for Disease Control and

24 Prevention.
42

•HR 4841 IH

1 ‘‘(2) A significant number of the faculty of the

2 institution has served as practitioners in public

3 health.

4 ‘‘(3) The institution has consulted with public

5 health departments and public hospital systems in

6 the State involved in order to develop a curriculum

7 that reflects the needs and priorities of the State re8 garding the public health.

9 ‘‘(4) The institution has coordinated the activi10 ties of the institution with the activities of the health

11 departments and of community groups.

12 ‘‘(5) The institution carries out a program for

13 part-time students to receive training in fields of

14 public health.

15 ‘‘(6) Not less than 60 percent of the graduates

16 of the school or institution are in public health posi17 tions determined by the Secretary to be consistent

18 with the needs of the United States regarding such

19 professionals.

20 ‘‘PART 3—EXPANSION OF COMPETENCY IN

21 PUBLIC HEALTH

22 ‘‘SEC. 2736. AUTHORIZATIONS OF APPROPRIATIONS FROM

23 FUND.

24 ‘‘For the purpose of carrying out this section, there

25 is authorized to be appropriated from the Fund
43

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1 $60,000,000 for each of the fiscal years 1995 through

2 2002.

3 ‘‘SEC. 2737. GRANTS TO STATES.

4 ‘‘(a) STATES LACKING TRAINING PROGRAMS.—

5 ‘‘(1) IN GENERAL.—The Secretary may make

6 grants to States in which there is no program of

7 training in a field of public health but in which there

8 are 1 or more schools of medicine, osteopathic medi9 cine, nursing, dentistry, social work, pharmacy, or

10 health administration. A funding agreement for such

11 a grant is that the purpose of the grant is for the

12 State involved to assist 1 or more of such schools in

13 developing and integrating public health curricula

14 for the schools.

15 ‘‘(2) SPECIAL CONSIDERATIONS IN MAKING

16 GRANTS.—In making grants under paragraph (1),

17 the Secretary shall give special consideration to

18 States that agree to consult with 1 or more schools

19 of public health in carrying out the purpose de20 scribed in such subsection.

21 ‘‘(b) STATES WITH NONACCREDITED SCHOOLS.—

22 The Secretary may make grants to States in which there

23 are 1 or more nonaccredited schools of public health. A

24 funding agreement for such a grant is that the purpose
44

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1 of the grant is for the State involved to assist 1 or more

2 of such schools in improving the schools.

3 ‘‘(d) AMOUNT OF GRANT; LIMITATION REGARDING

4 INDIVIDUAL EDUCATIONAL ENTITIES.—

5 ‘‘(1) AMOUNT.—The amount of a grant under

6 this section to a State may not exceed $600,000.

7 ‘‘(2) LIMITATION.—A funding agreement for a

8 grant under this section for a State is that, with re9 spect to the school involved, the State will not pro10 vide more than 2 years of assistance to the school

11 from grants under this section.

12 ‘‘PART 4—GENERAL PROVISIONS REGARDING

13 EDUCATION AND TRAINING PROGRAMS

14 ‘‘SEC. 2740. UNDERREPRESENTED MINORITIES REGARDING

15 FIELDS OF PUBLIC HEALTH.

16 ‘‘In providing for the education and training of indi17 viduals in a field of public health through the programs

18 of this subtitle, the Secretary shall give special consider19 ation to individuals who are members of a racial or ethnic

20 minority group that is underrepresented in the field.

21 ‘‘SEC. 2740A. COORDINATION OF PROGRAMS.

22 ‘‘The Secretary shall ensure that activities under each

23 program of this subtitle are coordinated with activities

24 under each other such program, including activities re-
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1 garding the number and variety of public health profes2 sionals educated or trained pursuant to this subtitle.

3 ‘‘Subtitle D—Regional Poison

4 Control Centers

5 ‘‘SEC. 2741. AUTHORIZATIONS OF APPROPRIATIONS FROM

6 FUND.

7 ‘‘For the purpose of carrying out this subtitle, there

8 is authorized to be appropriated from the Fund

9 $50,000,000 for each of the fiscal years 1995 through

10 1997.

11 ‘‘SEC. 2742. GRANTS FOR REGIONAL CENTERS.

12 ‘‘(a) IN GENERAL.—The Secretary may make grants

13 to public and nonprofit private entities for centers to carry

14 out activities regarding—

15 ‘‘(1) the prevention and treatment of poisoning;

16 and

17 ‘‘(2) such other activities regarding the control

18 of poisons as the Secretary determines to be appro19 priate.

20 ‘‘(b) REGIONAL CONSIDERATIONS.—In making

21 grants under subsection (a), the Secretary shall determine

22 the need in each of the principal geographic regions of

23 the United States for a center under such subsection, and

24 shall make the grants according to priorities established

25 by the Secretary on the basis of the extent of such need
46

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1 in each of the regions. In carrying out the preceding sen2 tence, the Secretary shall ensure that no two centers re3 ceive grants for the same geographic service area.

4 ‘‘(c) MATCHING FUNDS.—

5 ‘‘(1) IN GENERAL.—With respect to the costs of

6 an entity in providing for centers under subsection

7 (a), the Secretary may make a grant under such

8 subsection only if the State in which the center is to

9 operate, or other public entities in the State, agree

10 to make available (directly or through donations

11 from public or private entities) non-Federal con12 tributions toward such costs in an amount deter13 mined by the Secretary.

14 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB15 UTED.—Non-Federal contributions required under

16 paragraph (1) may be in cash or in kind, fairly eval17 uated, including plant, equipment, or services.

18 Amounts provided by the Federal Government, or

19 services assisted or subsidized to any significant ex20 tent by the Federal Government, may not be in21 cluded in determining the amount of such non-Fed22 eral contributions.

23 ‘‘SEC. 2743. REQUIREMENTS REGARDING CERTIFICATION.

24 ‘‘(a) IN GENERAL.—Subject to subsection (b), the

25 Secretary may make a grant under section 2742 only if
47

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1 the center involved has been certified by a professional or2 ganization in the field of poison control, and the Secretary

3 has approved the organization as having in effect stand4 ards for certification that reasonably provide for the pro5 tection of the public health with respect to poisoning. In

6 carrying out the preceding sentence, the Secretary shall

7 consider the standards established by the American Asso8 ciation of Poison Control Centers.

9 ‘‘(b) TEMPORARY WAIVER.—The Secretary may

10 waive the requirement of subsection (a) for a center for

11 a period not exceeding 1 year.

12 ‘‘SEC. 2744. GENERAL PROVISIONS.

13 ‘‘(a) DURATION OF GRANT.—The period during

14 which payments are made under a grant under section

15 2742 may not exceed 3 years. The provision of such pay16 ments is subject to annual approval by the Secretary of

17 the payments and subject to the availability of appropria18 tions for the fiscal year involved to make the payments.

19 The preceding sentence may not be construed as establish20 ing a limitation on the number of such grants that may

21 be made to an entity.

22 ‘‘(b) STUDY REGARDING NEED FOR CENTERS.—

23 ‘‘(1) IN GENERAL.—The Secretary shall con24 duct a study of each of the centers for which a grant

25 under section 2742 has been provided. The purpose
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1 of the study shall be to determine the effectiveness

2 of the centers in carrying out the activities described

3 in such section and the extent to which the activities

4 have been carried out in a cost-effective manner.

5 ‘‘(2) ALTERNATIVES TO CENTERS.—In carrying

6 out the study under paragraph (1), the Secretary

7 shall determine the extent to which the activities de8 scribed in section 2742 can be effectively carried out

9 through means other than centers under such sec10 tion. The alternative means considered by the Sec11 retary under the preceding sentence shall include the

12 alternative of requiring public and private health

13 plans to carry out such activities.

14 ‘‘(3) DATE CERTAIN FOR COMPLETION.—Not

15 later than November 1, 1996, the Secretary shall

16 submit to the Congress a report describing the find17 ings made in the study under paragraph (1).

18 ‘‘(4) NOTICE TO CENTERS.—Not later than

19 February 1, 1997, the Secretary shall notify each

20 grantee under section 2742 whether the Secretary

21 considers the continued operation of the center in22 volved to be necessary in meeting the needs of the

23 geographic region involved for the activities de24 scribed in such section.
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1 ‘‘Subtitle E—School-Related Health

2 Services

3 ‘‘PART 1—PROJECTS FOR PROVISION OF

4 SERVICES

5 ‘‘Subpart A—Development and Operation of Projects

6 ‘‘SEC. 2746. AUTHORIZATIONS OF APPROPRIATIONS FROM

7 FUND.

8 ‘‘For the purpose of carrying out this part, there

9 are authorized to be appropriated from the Fund

10 $100,000,000 for fiscal year 1996, $275,000,000 for fis11 cal year 1997, $350,000,000 for fiscal year 1998, and

12 $400,000,000 for fiscal year 1999, $450,000,000 for each

13 of the fiscal years 2000 through 2002.

14 ‘‘SEC. 2747. ELIGIBILITY FOR DEVELOPMENT AND OPER15 ATION GRANTS.

16 ‘‘(a) IN GENERAL.—Entities eligible to apply for

17 and receive grants under section 2749 or 2750 are the

18 following:

19 ‘‘(1) State health agencies that apply on behalf

20 of local community partnerships for communities in

21 need of health services within the State.

22 ‘‘(2) Local community partnerships in States in

23 which health agencies have not applied.

24 ‘‘(b) LOCAL COMMUNITY PARTNERSHIPS.—
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1 ‘‘(1) IN GENERAL.—A local community partner2 ship under subsection (a)(2) is an entity that, at a

3 minimum, includes—

4 ‘‘(A) a local health care provider with expe5 rience in delivering services to pre-adolescents

6 and adolescents;

7 ‘‘(B) one or more local public schools; and

8 ‘‘(C) at least one community based organi9 zation located in the community to be served

10 that has a history of providing services to at11 risk youth in the community.

12 ‘‘(2) PARTICIPATION.—A partnership described

13 in paragraph (1) shall, to the maximum extent fea14 sible, involve broad based community participation

15 from parents and youth to be served, health and so16 cial service providers (including regional alliance

17 health plans and corporate alliance health plans in

18 which families in the community are enrolled),

19 teachers and other public school and school board

20 personnel, youth development and service organiza21 tions, and interested business leaders. Such partici22 pation may be evidenced through an expanded part23 nership, or an advisory board to such partnership.
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1 ‘‘SEC. 2748. PREFERENCES.

2 ‘‘(a) IN GENERAL.—In making grants under sections

3 2749 and 2750, the Secretary shall give preference to ap4 plicants whose communities to be served show the most

5 substantial level of need for such services among individ6 uals who are between the ages of 10 and 19 (inclusive),

7 as measured by indicators of community health including

8 the following:

9 ‘‘(1) High levels of poverty.

10 ‘‘(2) The presence of a medically underserved

11 area or population (as defined under section 330(a)).

12 ‘‘(3) A health professional shortage area, as

13 designated under section 332.

14 ‘‘(4) High rates of indicators of health risk

15 among children and youth, including a high propor16 tion of children receiving services through the Indi17 viduals with Disabilities Education Act; adolescent

18 pregnancy, sexually transmitted disease (including

19 infection with the human immunodeficiency virus),

20 preventable disease, communicable disease, inten21 tional and unintentional injuries among children and

22 youth (including motor vehicle injuries); inter23 personal, community, and gang violence; rape; youth

24 unemployment; juvenile justice involvement; and

25 high rates of drug and alcohol exposure.
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1 ‘‘(b) LINKAGE TO QUALIFIED COMMUNITY HEALTH

2 GROUPS.—In making grants under sections 2749 and

3 2750, the Secretary shall give preference to applicants

4 that demonstrate a linkage to qualified community health

5 groups (as defined in section 2763(a)).

6 ‘‘SEC. 2749. GRANTS FOR DEVELOPMENT OF PROJECTS.

7 ‘‘(a) IN GENERAL.—The Secretary may make grants

8 to State health agencies or to local community partner9 ships to develop school health service sites. The locations

10 at which such sites may be developed include any public

11 or nonprofit private school.

12 ‘‘(b) USE OF FUNDS.—A project for which a grant

13 may be made under subsection (a) may include but not

14 be limited to the cost of the following:

15 ‘‘(1) Planning for the provision of school health

16 services.

17 ‘‘(2) Recruitment, compensation, and training

18 of health and administrative staff.

19 ‘‘(3) The development of agreements with re20 gional and corporate alliance health plans and the

21 acquisition and development of equipment and infor22 mation services necessary to support information ex23 change between school health service sites and

24 health plans, health providers, and other entities au25 thorized to collect information under this Act.
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1 ‘‘(4) In the case of communities described in

2 subsection (d)(2)(B), funds to aid in the establish3 ment of local community partnerships.

4 ‘‘(5) Other activities necessary to assume oper5 ational status.

6 ‘‘(c) APPLICATION FOR GRANT.—

7 ‘‘(1) IN GENERAL.—Applicants shall submit ap8 plications in a form and manner prescribed by the

9 Secretary.

10 ‘‘(2) APPLICATIONS BY STATE HEALTH AGEN11 CIES.—

12 ‘‘(A) In the case of applicants that are

13 State health agencies, the application shall con14 tain assurances that the State health agency is

15 applying for funds—

16 ‘‘(i) on behalf of at least one local

17 community partnership; and

18 ‘‘(ii) on behalf of at least one other

19 community identified by the State as in

20 need of the services funded under this sub21 part but without a local community part22 nership.

23 ‘‘(B) In the case of communities identified

24 in applications submitted by State health agen25 cies that do not yet have local community part-
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1 nerships, the State shall describe the steps that

2 will be taken to aid the community in develop3 ing a local community partnership.

4 ‘‘(C) A State applying on behalf of local

5 community partnerships and other communities

6 may retain not more than 10 percent of grants

7 awarded under this subpart for administrative

8 costs.

9 ‘‘(d) CONTENTS OF APPLICATION.—In order to re10 ceive a grant under this section, an applicant must include

11 in the application the following information:

12 ‘‘(1) An assessment of the need for school

13 health services in the communities to be served,

14 using the latest available health data and health

15 goals and objectives established by the Secretary.

16 ‘‘(2) A description of how the applicant will de17 sign the proposed school health services to reach the

18 maximum number of school-aged children and youth

19 at risk for poor health outcome.

20 ‘‘(3) An explanation of how the applicant will

21 integrate its services with those of other health and

22 social service programs within the community.

23 ‘‘(4) An explanation of how the applicant will

24 link its activities to health plans serving the commu-
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1 nities in which the applicant’s program is to be

2 located.

3 ‘‘(5) A description of outcome measures to be

4 used to evaluate the effectiveness of the program.

5 ‘‘(6) A description of a quality assurance pro6 gram which complies with standards that the Sec7 retary may prescribe.

8 ‘‘(e) NUMBER OF GRANTS.—Not more than one plan9 ning grant may be made to a single applicant. A planning

10 grant may not exceed two years in duration.

11 ‘‘SEC. 2750. GRANTS FOR OPERATION OF PROJECTS.

12 ‘‘(a) IN GENERAL.—The Secretary may make grants

13 to State health agencies or to local community partner14 ships for the cost of operating school health service sites.

15 The locations at which such sites may be operated include

16 any public or nonprofit private school.

17 ‘‘(b) USE OF GRANT.—The costs for which a grant

18 may be made under this section include but are not limited

19 to the following:

20 ‘‘(1) The cost of furnishing health services that

21 are not covered under title I of this Act or by any

22 other public or private insurer.

23 ‘‘(2) The cost of furnishing enabling services, as

24 defined in section 2780(g).
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1 ‘‘(3) Training, recruitment and compensation of

2 health professionals and other staff.

3 ‘‘(4) Outreach services to at-risk youth and to

4 parents.

5 ‘‘(5) Linkage of individuals to health plans,

6 community health services and social services.

7 ‘‘(6) Other activities deemed necessary by the

8 Secretary.

9 ‘‘(c) APPLICATION FOR GRANT.—Applicants shall

10 submit applications in a form and manner prescribed by

11 the Secretary. In order to receive a grant under this sec12 tion, an applicant must include in the application the fol13 lowing information:

14 ‘‘(1) A description of the services to be fur15 nished by the applicant.

16 ‘‘(2) The amounts and sources of funding that

17 the applicant will expend, including estimates of the

18 amount of payments the applicant will receive from

19 alliance health plans and from other sources.

20 ‘‘(3) Such other information as the Secretary

21 determines to be appropriate.

22 ‘‘(d) ADDITIONAL CONTENTS OF APPLICATION.—In

23 order to receive a grant under this section, an applicant

24 must meet the following conditions:
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•HR 4841 IH

1 ‘‘(1) The applicant furnishes the following serv2 ices:

3 ‘‘(A) Diagnosis and treatment of acute ill4 nesses and minor injuries.

5 ‘‘(B) Clinical preventive health services, in6 cluding health screenings and early detection

7 services.

8 ‘‘(C) Enabling services, as defined in sec9 tion 2780(g).

10 ‘‘(D) Referrals and followups in situations

11 involving illness or injury.

12 ‘‘(E) Health and social services, counseling

13 services, and necessary referrals, including re14 ferrals regarding mental health, substance

15 abuse, and interpersonal violence, including

16 rape.

17 ‘‘(F) Such other services as the Secretary

18 determines to be appropriate.

19 ‘‘(2) The applicant maintains agreements with

20 health plans offering services in the applicant’s serv21 ice area.

22 ‘‘(3) The applicant is a participating provider in

23 the State’s program for medical assistance under

24 title XIX of the Social Security Act.
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1 ‘‘(4) The applicant does not impose charges on

2 students or their families for services (including col3 lection of any cost-sharing for services under the

4 comprehensive benefit package that otherwise would

5 be required).

6 ‘‘(5) The applicant has reviewed and will peri7 odically review the needs of the population served by

8 the applicant in order to ensure that its services are

9 accessible to the maximum number of school age

10 children and youth in the area, and that, to the

11 maximum extent possible, barriers to access to serv12 ices of the applicant are removed (including barriers

13 resulting from the area’s physical characteristics, its

14 economic, social and cultural grouping, the health

15 care utilization patterns of children and youth, and

16 available transportation).

17 ‘‘(6) In the case of an applicant which serves a

18 population that includes a substantial proportion of

19 individuals of limited English speaking ability, the

20 applicant has developed a plan to meet the needs of

21 such population to the extent practicable in the lan22 guage and cultural context most appropriate to such

23 individuals.
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1 ‘‘(7) The applicant will provide non-Federal

2 contributions toward the cost of the project in an

3 amount determined by the Secretary.

4 ‘‘(8) The applicant will operate a quality assur5 ance program consistent with section 2754(e)(6).

6 ‘‘(e) DURATION OF GRANT.—A grant under this sec7 tion shall be for a period determined by the Secretary.

8 ‘‘(f) REPORTS.—A recipient of funding under this

9 section shall provide such reports and information as are

10 required in regulations of the Secretary.

11 ‘‘SEC. 2751. FEDERAL ADMINISTRATIVE COSTS.

12 Of the amounts made available under section 2751,

13 the Secretary may reserve not more than 5 percent for

14 administrative expenses regarding this subpart.

15 ‘‘Subpart B—Capital Costs of Developing Projects

16 ‘‘SEC. 2753. LOANS AND LOAN GUARANTEES REGARDING

17 PROJECTS.

18 ‘‘(a) IN GENERAL.—The Secretary may make loans

19 to, and guarantee the payment of principal and interest

20 to Federal and non-Federal lenders on behalf of, State

21 health agencies and local community partnerships for the

22 capital costs of developing projects in accordance with sub23 part A.

24 ‘‘(b) APPLICABILITY OF CERTAIN PROVISIONS.—The

25 provisions of subpart A apply to loans and loan guarantees
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1 under subsection (a) to the same extent and in the same

2 manner as such provisions apply to grants under subpart

3 A. Except for any provision inconsistent with the purpose

4 described in subsection (a), the provisions of subpart C

5 of part 2 of subtitle F apply to loans and loan guarantees

6 under subsection (a) to the same extent and in the same

7 manner as such provisions apply to loans and loan guaran8 tees under section 2773.

9 ‘‘SEC. 2754. FUNDING.

10 Amounts available to the Secretary under section

11 2761 for the purpose of carrying out part 2 of subtitle

12 F are, in addition to such purpose, available to the Sec13 retary for the purpose of carrying out this subpart.

14 ‘‘PART 2—SCHOLARSHIP AND LOAN REPAYMENT

15 PROGRAMS REGARDING SCHOOL NURSES

16 ‘‘SEC. 2755. AUTHORIZATIONS OF APPROPRIATIONS FROM

17 FUND.

18 ‘‘For the purpose of carrying out this part, there is

19 authorized to be appropriated from the Fund $10,000,000

20 for each of the fiscal years 1995 through 2002.

21 ‘‘SEC. 2755A. SCHOLARSHIP PROGRAM REGARDING UP22 GRADE IN SKILLS.

23 ‘‘(a) IN GENERAL.—The Secretary, acting through

24 the Administrator of the Health Resources and Services

25 Administration and in consultation with the Director of
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1 the Centers for Disease Control and Prevention, shall

2 carry out a program under which the Secretary awards

3 scholarships to individuals described in subsection (b) for

4 the purpose of assisting the individuals with the costs of

5 attending programs of education in professional nursing

6 (exclusive of graduate programs in nursing).

7 ‘‘(b) ELIGIBLE INDIVIDUALS.—An individual re8 ferred to in subsection (a) is any individual meeting the

9 following conditions:

10 ‘‘(1) The individual is serving or has served as

11 a school nurse in public or nonprofit private elemen12 tary or secondary school, and the individual is not

13 a professional nurse.

14 ‘‘(2) The individual is enrolled (or accepted for

15 enrollment) at a program referred to in subsection

16 (a) as a full-time or part-time student.

17 ‘‘(3) The individual enters into the contract re18 quired pursuant to subsection (d) as a condition of

19 receiving the scholarship (relating to an agreement

20 to provide services as a school nurse.

21 ‘‘(d) APPLICABILITY OF CERTAIN PROVISIONS.—Ex22 cept as inconsistent with this section or section 2755C,

23 the provisions of subpart III of part D of title III (relating

24 to the Scholarship and Loan Repayment Programs of the

25 National Health Service Corps) apply to an award of a
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1 scholarship under subsection (a) to the same extent and

2 in the same manner as such provisions apply to an award

3 of a scholarship under section 338A.

4 ‘‘SEC. 2755B. LOAN REPAYMENT PROGRAM.

5 ‘‘(a) IN GENERAL.—The Secretary, acting through

6 the Administrator of the Health Resources and Services

7 Administration and in consultation with the Director of

8 the Centers for Disease Control and Prevention, shall

9 carry out a program under which the Federal Government

10 enters into agreements to repay all or part of the edu11 cational loans of individuals meeting the following condi12 tions:

13 ‘‘(1) The individual is a professional nurse and

14 meets the applicable legal requirements to serve as

15 a school nurse.

16 ‘‘(2) The individual enters into the contract re17 quired pursuant to subsection (b) as a condition of

18 the Federal Government repaying such loans (relat19 ing to an agreement to provide services as a school

20 nurse).

21 ‘‘(b) APPLICABILITY OF CERTAIN PROVISIONS.—Ex22 cept as inconsistent with this section or section 2755C,

23 the provisions of subpart III of part D of title III (relating

24 to the Scholarship and Loan Repayment Programs of the

25 National Health Service Corps) apply to an agreement re-
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1 garding repayment under subsection (a) to the same ex2 tent and in the same manner as such provisions apply to

3 an agreement regarding repayment under section 338B.

4 ‘‘(c) AMOUNT OF REPAYMENTS.—For each year for

5 which an individual contracts to serve as a school nurse

6 pursuant to subsection (b), the Secretary may repay not

7 more than $20,000 of the principal and interest of the

8 educational loans of the individual.

9 ‘‘SEC. 2755C. SCHOOL-NURSE POSITIONS.

10 ‘‘(a) POSITION REGARDING STUDENTS WITH SIG11 NIFICANT NEED FOR SERVICES.—

12 ‘‘(1) IN GENERAL.—With respect to the pro13 grams under this part, the obligated service of a

14 program participant pursuant to sections 2755A(d)

15 and 2755B(b) shall be provided through an assign16 ment to a school described in subsection (b) for a

17 position as a school nurse.

18 ‘‘(2) PERIOD OF SERVICE.—For purposes of

19 sections 2755A(d) and 2755B(d), the period of obli20 gated service is the following, as applicable to the

21 program participant involved:

22 ‘‘(A) In the case of scholarships under sec23 tion 2755A for full-time students, the greater

24 of—
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1 ‘‘(i) 1 year for each year for which

2 such a scholarship is provided; or

3 ‘‘(ii) 2 years.

4 ‘‘(B) In the case of scholarships under sec5 tion 2755A for part-time students, a period de6 termined by the Secretary on the basis of the

7 number of hours of education or training re8 ceived under the scholarship, considering the

9 percentage constituted by the ratio of such

10 number to the number of hours for a full-time

11 student in the program involved.

12 ‘‘(C) In the case of the loan repayments

13 under section 2755B, such period as the Sec14 retary and the participant may agree, except

15 that the period may not be less than 2 years.

16 ‘‘(b) APPROVAL OF SCHOOLS FOR ASSIGNMENT OF

17 PROGRAM PARTICIPANTS.—The schools referred to in

18 subsection (a) are public or nonprofit private elementary

19 or secondary schools whose students include a significant

20 number of students with an unmet need for health services

21 that are provided by school nurses.

22 ‘‘(c) DEFINITIONS.—For purposes of this subpart:

23 ‘‘(1) The term ‘professional nurse’ has the

24 meaning given such term under title VIII.
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1 ‘‘(2) The term ‘program participant’ means an

2 individual who enters into a contract pursuant to

3 section 2755A(b)(3) or 2755B(a)(2).

4 ‘‘(3) The term ‘school nurse’ means a nurse

5 who provides health services on the premises of an

6 elementary or secondary school and meets such cri7 teria as the Secretary may establish.

8 ‘‘Subtitle F—Expansion of Access to

9 Health Services

10 ‘‘PART 1—COMMUNITY AND MIGRANT HEALTH

11 CENTERS

12 ‘‘SEC. 2756. AUTHORIZATIONS OF APPROPRIATIONS FROM

13 FUND.

14 ‘‘(a) IN GENERAL.—For the purpose of carrying out

15 this part, there is authorized to be appropriated from the

16 Fund $100,000,000 for each of the fiscal years 1995

17 through 2000.

18 ‘‘(b) RELATION TO OTHER FUNDS.—The authoriza19 tions of appropriations established in subsection (a) for

20 the purpose described in such subsection are in addition

21 to any other authorizations of appropriations that are

22 available for such purpose.
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1 ‘‘SEC. 2757. GRANTS TO COMMUNITY AND MIGRANT

2 HEALTH CENTERS.

3 ‘‘(a) IN GENERAL.—The Secretary shall make grants

4 in accordance with this section to migrant health centers

5 and community health centers.

6 ‘‘(b) USE OF FUNDS.—

7 ‘‘(1) DEVELOPMENT, OPERATION, AND OTHER

8 PURPOSES REGARDING CENTERS.—Subject to para9 graph (2), grants under subsection (a) to migrant

10 health centers and community health centers may be

11 made only in accordance with the conditions upon

12 which grants are made under sections 329 and 330,

13 respectively.

14 ‘‘(2) REQUIRED FINANCIAL RESERVES.—The

15 Secretary may authorize migrant health centers and

16 community health centers to expend a grant under

17 subsection (a) to establish and maintain financial re18 serves required for purposes of health plans.

19 ‘‘(c) DEFINITIONS.—For purposes of this subtitle,

20 the terms ‘migrant health center’ and ‘community health

21 center’ have the meanings given such terms in sections

22 329(a)(1) and 330(a), respectively.
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1 ‘‘PART 2—QUALIFIED COMMUNITY HEALTH

2 PLANS AND PRACTICE NETWORKS

3 ‘‘Subpart A—Funding; Purposes

4 ‘‘SEC. 2761. AUTHORIZATIONS OF APPROPRIATIONS FROM

5 FUND.

6 ‘‘(a) DEVELOPMENT OF QUALIFIED COMMUNITY

7 HEALTH PLANS AND PRACTICE GROUPS.—For the pur8 pose of carrying out this part, there are authorized to be

9 appropriated from the Fund $200,000,000 for fiscal year

10 1995, $500,000,000 for fiscal year 1996, $600,000,000

11 for fiscal year 1997, $650,000,000 for fiscal year 1998,

12 $500,000,000 for fiscal year 1999, and $200,000,000 for

13 fiscal year 2000.

14 ‘‘(b) RELATION TO OTHER FUNDS.—The authoriza15 tions of appropriations established in subsection (a) are

16 in addition to any other authorizations of appropriations

17 that are available for the purpose described in such sub18 section.

19 ‘‘(c) RELATIONSHIP TO PROGRAM REGARDING

20 SCHOOL-RELATED HEALTH SERVICES.—This section is

21 subject to section 2754.

22 ‘‘SEC. 2762. PURPOSES.

23 Subject to the provisions of this part, the purposes

24 of this part are as follows:

25 ‘‘(1) To improve access to health services for

26 urban and rural medically-underserved populations
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1 through a program of flexible grants, contracts, and

2 loans.

3 ‘‘(2) To facilitate transition to a system in

4 which medically-underserved populations have an

5 adequate choice of community-oriented providers

6 and health plans.

7 ‘‘(3) To promote the development of community

8 practice networks and community health plans that

9 integrate health professionals and health care orga10 nizations supported through public funding with

11 other providers in medically underserved areas.

12 ‘‘(4) To support linkages between providers of

13 health care for medically-underserved populations

14 and health plans.

15 ‘‘(5) To expand the capacity of community

16 practice networks and community health plans in

17 underserved areas by increasing the number of prac18 tice sites and by renovating and converting sub19 standard inpatient and outpatient facilities.

20 ‘‘(6) To link providers in underserved areas

21 with each other and with public and private health

22 care institutions and academic health centers,

23 through information systems and telecommuni24 cations.
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1 ‘‘(7) To support activities that enable medically

2 underserved populations to gain access to the health

3 care system and use it effectively.

4 ‘‘Subpart B—Development of Qualified Community

5 Health Plans and Practice Networks

6 ‘‘SEC. 2763. GRANTS AND CONTRACTS FOR DEVELOPMENT

7 OF PLANS AND NETWORKS.

8 ‘‘(a) IN GENERAL.—The Secretary may make grants

9 to and enter into contracts with consortia of public or pri10 vate health care providers for the development of qualified

11 community health plans and qualified community practice

12 networks. For purposes of this subtitle, the term ‘qualified

13 community health group’ means such a health plan or

14 such a practice network.

15 ‘‘(b) QUALIFIED COMMUNITY HEALTH PLANS.—For

16 purposes of this subtitle, the term ‘qualified community

17 health plan’ means a health plan that meets the following

18 conditions:

19 ‘‘(1) The health plan is a public or nonprofit

20 private entity whose principal purpose is to provide

21 comprehensive health services, including clinical pre22 ventive services, in 1 or more medically underserved

23 communities (as defined in section 2799).
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1 ‘‘(2) Two or more of the categories specified in

2 subsection (d) are represented among the entities

3 providing health services through the health plan.

4 ‘‘(c) QUALIFIED COMMUNITY PRACTICE NET5 WORKS.—For purposes of this subtitle, the term ‘qualified

6 community practice network’ means a consortium of

7 health care providers meeting the following conditions:

8 ‘‘(1) The consortium is a public or nonprofit

9 private entity whose principal purpose is the purpose

10 described in subsection (b)(1).

11 ‘‘(2) The consortium has an agreement with

12 one or more health plans.

13 ‘‘(3) The participation of health care providers

14 in the consortium is governed by a written agree15 ment to which each of the participating providers is

16 a party.

17 ‘‘(4) Two or more of the categories described in

18 subsection (d) are represented among the entities

19 participating in the consortium.

20 ‘‘(d) RELEVANT CATEGORIES OF ENTITIES.—For

21 purposes of subsections (b)(3) and (c)(4), the categories

22 described in this subsection are the following categories

23 of entities:

24 ‘‘(1) Physicians, other health professionals, or

25 health care institutions that provide health services
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1 in one or more health professional shortage areas or

2 provide such services to a significant number of indi3 viduals who are members of a medically underserved

4 population, and that do not provide health services

5 under any of the programs specified in paragraphs

6 (2) through (7) or as employees of public entities.

7 ‘‘(2) Entities providing health services under

8 grants under sections 329 and 330.

9 ‘‘(3) Entities providing health services under

10 grants under sections 340 and 340A.

11 ‘‘(4) Entities providing health services under

12 grants under section 1001 or title XXVI.

13 ‘‘(5) Entities providing health services under

14 title V of the Social Security Act.

15 ‘‘(6) Entities providing health services through

16 rural health clinics and other federally qualified

17 health centers.

18 ‘‘(7) Entities providing health services in urban

19 areas through programs under title V of the Indian

20 Health Care Improvement Act, and entities provid21 ing outpatient health services through programs

22 under the Indian Self-Determination Act.

23 ‘‘(8) Programs providing personal health serv24 ices and operating through State or local public

25 health agencies.
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1 ‘‘(e) RULE OF CONSTRUCTION.—The consortia to

2 which the Secretary may make an award of financial as3 sistance under subsection (a) for the development of quali4 fied community practice networks include any health plan

5 that meets applicable requirements regarding financial sol6 vency and professional credentials, without regard to

7 whether the health plan is a qualified health plan.

8 ‘‘(f) SERVICE AREA.—In making an award of finan9 cial assistance under subsection (a), the Secretary shall

10 designate the geographic area with respect to which the

11 qualified community health group involved is to provide

12 health services. A funding agreement for such an award

13 is that the qualified community health group involved will

14 provide such services in the area so designated.

15 ‘‘(g) DEFINITIONS.—For purposes of this subtitle:

16 ‘‘(1) The term ‘health professional shortage

17 areas’ means health professional shortage areas des18 ignated under section 332.

19 ‘‘(2) The term ‘medically underserved popu20 lation’ means a medically underserved population

21 designated under section 330.

22 ‘‘(3) The term ‘rural health clinic’’ has the

23 meaning given such term in section 1861(aa)(2) of

24 the Social Security Act.
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1 ‘‘(4) The term ‘federally qualified health cen2 ters’ has the meaning given such term in section

3 1861(aa)(4) of the Social Security Act.

4 ‘‘(5) The term ‘service area’, with respect to a

5 qualified community health group, means the geo6 graphic area designated under subsection (f).

7 ‘‘(6) The term ‘funding agreement’, with re8 spect to an award of financial assistance under this

9 section, means that the Secretary may make the

10 award only if the applicant for the award makes the

11 agreement involved.

12 ‘‘(7) The term ‘financial assistance’, with re13 spect to awards under subsection (a), means a grant

14 or contract.

15 ‘‘SEC. 2764. PREFERENCES IN MAKING AWARDS OF ASSIST16 ANCE.

17 ‘‘In making awards of financial assistance under sec18 tion 2763, the Secretary shall give preference to applicants

19 in accordance with the following:

20 ‘‘(1) The Secretary shall give preference if 3 or

21 more of the categories described in subsection (d) of

22 such section will be represented in the qualified com23 munity health group involved (pursuant to sub24 section (b)(3) or (c)(4) of such section, as the case

25 may be).
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1 ‘‘(2) Of applicants receiving preference under

2 paragraph (1), the Secretary shall give a greater de3 gree of preference according to the extent to which

4 a greater number of categories are represented.

5 ‘‘(3) Of applicants receiving preference under

6 paragraph (1), the Secretary shall give a greater de7 gree of preference if one of the categories rep8 resented is the category described in subsection

9 (d)(1) of such section.

10 ‘‘SEC. 2765. CERTAIN USES OF AWARDS.

11 ‘‘(a) IN GENERAL.—Subject to subsections (b) and

12 (c), the purposes for which an award of financial assist13 ance under section 2763 may be expended in developing

14 a qualified community health group include the following:

15 ‘‘(1) Planning such group, including entering

16 into contracts between the recipient of the award

17 and health care providers who are to participate in

18 the group.

19 ‘‘(2) Recruitment, compensation, and training

20 of health professionals (including public health pro21 fessionals) and administrative staff.

22 ‘‘(3) Acquisition, expansion, modernization, and

23 conversion of facilities, including for purposes of

24 providing for sites at which health services are to be

25 provided through such group.
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1 ‘‘(4) Acquisition and development of informa2 tion systems (exclusive of systems that the Secretary

3 determines are information highways).

4 ‘‘(5) Such other expenditures as the Secretary

5 determines to be appropriate.

6 ‘‘(b) PRIORITIES AND LIMITATIONS REGARDING CAP7 ITAL COSTS.—

8 ‘‘(1) PRIORITIES REGARDING USE OF FUNDS.—

9 In authorizing recipients of awards under section

10 2763 to use the awards for capital costs, the Sec11 retary shall give priority to authorizing expenditures

12 for projects for the renovation and modernization of

13 medical facilities necessary to prevent or eliminate

14 safety hazards, avoid noncompliance with licensure

15 or accreditation standards, or projects to replace ob16 solete facilities.

17 ‘‘(2) LIMITATION.—The Secretary may author18 ize the use of awards under section 2763 for the

19 construction of new buildings only if the Secretary

20 determines that appropriate facilities are not avail21 able through acquiring, modernizing, expanding or

22 converting existing buildings, or that construction of

23 new buildings will cost less.
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1 ‘‘(c) TWENTY-YEAR OBLIGATION REGARDING SIG2 NIFICANT CAPITAL EXPENDITURES; RIGHT OF RECOV3 ERY.—

4 ‘‘(1) IN GENERAL.—With respect to a facility

5 for which substantial capital costs are to paid from

6 an award of financial assistance under section 2763,

7 the Secretary may make the award only if the appli8 cant involved agrees that the applicant will be liable

9 to the United States for the amount of the award

10 expended for such costs, together with an amount

11 representing interest, if at any time during the 20-

12 period beginning on the date of completion of the ac13 tivities involved, the facility—

14 ‘‘(A) ceases to be a facility utilized by a

15 qualified community health group, or by an16 other public or nonprofit private entity that

17 provides health services in one or more health

18 professional shortage areas or that provides

19 such services to a significant number of individ20 uals who are members of a medically under21 served population; or

22 ‘‘(B) is sold or transferred to any entity

23 other than an entity that is—
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1 ‘‘(i) a qualified community health

2 group or other entity described in subpara3 graph (A); and

4 ‘‘(ii) approved by the Secretary as a

5 purchaser or transferee regarding the

6 facility.

7 ‘‘(2) SUBORDINATION; WAIVERS.—The Sec8 retary may subordinate or waive the right of recov9 ery under paragraph (1), and any other Federal in10 terest that may be derived by virtue of an award of

11 financial assistance under section 2763 from which

12 substantial capital costs are to be paid, if the Sec13 retary determines that subordination or waiver will

14 further the objectives of this part.

15 ‘‘SEC. 2766. ACCESSIBILITY OF SERVICES.

16 ‘‘(a) SERVICES FOR CERTAIN INDIVIDUALS.—A

17 funding agreement for an award of financial assistance

18 under section 2763 is that the qualified community health

19 group involved will ensure that the services of the group

20 will be accessible to all individuals in the service area of

21 the group, directly or through formal contractual arrange22 ments with its participating providers.

23 ‘‘(b) USE OF THIRD-PARTY PAYORS.—A funding

24 agreement for an award of financial assistance under sec25 tion 2763 is that the qualified community health group
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1 involved will ensure that the health care providers of the

2 group are all approved by the Secretary as providers under

3 title XVIII of the Social Security Act and by the appro4 priate State agency as providers under title XIX of the

5 Social Security Act, and the applicant has made or will

6 make every reasonable effort to collect appropriate reim7 bursement for its costs in providing health services to indi8 viduals who are entitled to insurance benefits under title

9 XVIII of the Social Security Act, to medical assistance

10 under a State plan approved under title XIX of the Social

11 Security Act, or to assistance for medical expenses under

12 any other public assistance program or private health in13 surance program.

14 ‘‘(c) SCHEDULE OF FEES.—A funding agreement for

15 an award of financial assistance under section 2763 is that

16 the qualified community health group involved will—

17 ‘‘(1) prepare a schedule of fees or payments for

18 the provision of health services that is consistent

19 with locally prevailing rates or charges and designed

20 to cover its reasonable costs of operation and has

21 prepared a corresponding schedule of discounts to be

22 applied to the payment of such fees or payments (or

23 payments of cost sharing amounts owed in the case

24 of covered benefits) which discounts are applied on

25 the basis of the patient’s ability to pay; and
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1 ‘‘(2) make every reasonable effort to secure

2 from patients payment in accordance with such

3 schedules, and to collect reimbursement for services

4 to persons entitled to public or private insurance

5 benefits or other medical assistance on the basis of

6 full fees without application of discounts, except that

7 the applicant will ensure that no person is denied

8 service based on the person’s inability to pay there9 for.

10 ‘‘(d) BARRIERS WITHIN SERVICE AREA.—A funding

11 agreement for an award of financial assistance under sec12 tion 2763 is that the qualified community health group

13 involved will ensure that the following conditions are met:

14 ‘‘(1) In the service area of the group, the group

15 will ensure that—

16 ‘‘(A) the services of the group are acces17 sible to all residents; and

18 ‘‘(B) to the maximum extent possible, bar19 riers to access to the services of the group are

20 eliminated, including barriers resulting from the

21 area’s physical characteristics, its residential

22 patterns, its economic, social and cultural

23 groupings, and available transportation.

24 ‘‘(2) The group will periodically conduct reviews

25 within the service area of the group to determine
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1 whether the conditions described in paragraph (1)

2 are being met.

3 ‘‘(e) LIMITED ABILITY TO SPEAK ENGLISH LAN4 GUAGE.—A funding agreement for an award of financial

5 assistance under section 2763 is that, if the service area

6 of the qualified community health group involved includes

7 a substantial number of individuals who have a limited

8 ability to speak the English language, the applicant will—

9 ‘‘(1) maintain arrangements responsive to the

10 needs of such individuals for providing services to

11 the extent practicable in the language and cultural

12 context most appropriate to such individuals; and

13 ‘‘(2) maintain a sufficient number of staff

14 members who are fluent in both English and the

15 languages spoken by such individuals, and will en16 sure that the responsibilities of the employees in17 clude providing guidance and assistance to such in18 dividuals and to other staff members of the group.

19 ‘‘SEC. 2767. ADDITIONAL AGREEMENTS.

20 ‘‘(a) REQUIRED SERVICES.—A funding agreement

21 for an award of financial assistance under section 2763

22 is that the qualified community health group involved will

23 provide enabling services (as defined in section 2780(g))

24 and all of the items and services identified by the Sec-
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1 retary in rules regarding qualified community health plans

2 and practice networks.

3 ‘‘(b) QUALITY CONTROL SYSTEM.—A funding agree4 ment for an award of financial assistance under section

5 2763 is that the qualified community health group in6 volved will maintain a community-oriented, patient respon7 sive, quality control system under which the group, in ac8 cordance with regulations prescribed by the Secretary—

9 ‘‘(1) conducts an ongoing quality assurance

10 program for the health services delivered by partici11 pating provider entities;

12 ‘‘(2) maintains a continuous community health

13 status improvement process that is based on out14 comes reporting by the State, including any such re15 ports available pursuant to the Healthy People 2000

16 Objectives; and

17 ‘‘(3) maintains a system for development, com18 pilation, evaluation and reporting of information to

19 the public and to the State and local health depart20 ments involved regarding the costs of operation,

21 service utilization patterns, availability, accessibility

22 and acceptability of services, developments in the

23 health status of the populations served, uniform

24 health and clinical performance measures and finan25 cial performance of the network or plan.
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1 ‘‘(c) USE OF EXISTING RESOURCES.—A funding

2 agreement for an award of financial assistance under sec3 tion 2763 is that the applicant will, in developing the

4 qualified community health group involved, utilize existing

5 resources to the maximum extent practicable.

6 ‘‘SEC. 2768. SUBMISSION OF CERTAIN INFORMATION.

7 ‘‘(a) ASSESSMENT OF NEED.—The Secretary may

8 make an award of financial assistance under section 2763

9 only if the applicant involved submits to the Secretary an

10 assessment of the need that the medically underserved

11 population or populations proposed to be served by the ap12 plicant have for health services and for enabling services

13 (as defined in section 2780(g)).

14 ‘‘(b) DESCRIPTION OF INTENDED EXPENDITURES;

15 RELATED INFORMATION.—The Secretary may make an

16 award of financial assistance under section 2763 only if

17 the applicant involved submits to the Secretary the follow18 ing information:

19 ‘‘(1) A description of how the applicant will de20 sign the proposed quality community health plan or

21 practice network (including the service sites in22 volved) for such populations based on the assess23 ment of need.

24 ‘‘(2) A description of efforts to secure, within

25 the proposed service area of such health plan or
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1 practice network (including the service sites in2 volved), financial and professional assistance and

3 support for the project.

4 ‘‘(3) Evidence of significant community involve5 ment in the initiation, development and ongoing op6 eration of the project.

7 ‘‘SEC. 2769. REPORTS; AUDITS.

8 ‘‘A funding agreement for an award of financial as9 sistance under section 2763 is that the applicant involved

10 will—

11 ‘‘(1) provide such reports and information on

12 activities carried out under this section in a manner

13 and form required by the Secretary; and

14 ‘‘(2) provide an annual organization-wide audit

15 that meets applicable standards of the Secretary.

16 ‘‘SEC. 2770. APPLICATION FOR ASSISTANCE.

17 ‘‘The Secretary may make an award of financial as18 sistance under section 2763 only if an application for the

19 award is submitted to the Secretary, the application con20 tains each funding agreement described in this subpart,

21 the application contains the information required in sec22 tion 2768, and the application is in such form, is made

23 in such manner, and contains such agreements, assur24 ances, and information as the Secretary determines to be

25 necessary to carry out this subpart.
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1 ‘‘SEC. 2771. GENERAL PROVISIONS.

2 ‘‘(a) LIMITATION ON NUMBER OF AWARDS.—The

3 Secretary may not make more than two awards of finan4 cial assistance under section 2763 for the same project.

5 ‘‘(b) AMOUNT.—The amount of any award of finan6 cial assistance under section 2763 for any project shall

7 be determined by the Secretary.

8 ‘‘Subpart C—Capital Cost of Development of Quali9 fied Community Health Plans and Practice Net10 works

11 ‘‘SEC. 2773. LOANS AND LOAN GUARANTEES REGARDING

12 PLANS AND NETWORKS.

13 ‘‘(a) IN GENERAL.—The Secretary may make loans

14 to, and guarantee the payment of principal and interest

15 to Federal and non-Federal lenders on behalf of, public

16 and private entities for the capital costs of developing

17 qualified community health groups (as defined in section

18 2763(a)).

19 ‘‘(b) PREFERENCES; ACCESSIBILITY OF SERVICES;

20 CERTAIN OTHER PROVISIONS.—The provisions of subpart

21 B apply to loans and loan guarantees under subsection

22 (a) to the same extent and in the same manner as such

23 provisions apply to awards of grants and contracts under

24 section 2763.

25 ‘‘(c) USE OF ASSISTANCE.—
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1 ‘‘(1) IN GENERAL.—With respect to the devel2 opment of qualified community health groups, the

3 capital costs for which loans made pursuant to sub4 section (a) may be expended are, subject to para5 graphs (2) and (3), the following:

6 ‘‘(A) The acquisition, modernization, ex7 pansion or construction of facilities, or the con8 version of unneeded hospital facilities to facili9 ties that will assure or enhance the provision

10 and accessibility of health care and enabling

11 services to medically underserved populations.

12 ‘‘(B) The purchase of major equipment, in13 cluding equipment necessary for the support of

14 external and internal information systems.

15 ‘‘(C) The establishment of reserves re16 quired for furnishing services on a prepaid

17 basis.

18 ‘‘(D) Such other capital costs as the Sec19 retary may determine are necessary to achieve

20 the objectives of this section.

21 ‘‘(2) PRIORITIES REGARDING USE OF FUNDS.—

22 In providing loans or loan guarantees under sub23 section (a) for an entity, the Secretary shall give pri24 ority to authorizing the use of amounts for projects

25 for the renovation and modernization of medical fa-
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•HR 4841 IH

1 cilities necessary to prevent or eliminate safety haz2 ards, avoid noncompliance with licensure or accredi3 tation standards, or projects to replace obsolete

4 facilities.

5 ‘‘(3) LIMITATION.—The Secretary may author6 ize the use of amounts under subsection (a) for the

7 construction of new buildings only if the Secretary

8 determines that appropriate facilities are not avail9 able through acquiring, modernizing, expanding or

10 converting existing buildings, or that construction of

11 new buildings will cost less.

12 ‘‘(d) AMOUNT OF ASSISTANCE.—The principal

13 amount of loans or loan guarantees under subsection (a)

14 may, when added to any other assistance under this sec15 tion, cover up to 100 percent of the costs involved.

16 ‘‘SEC. 2774. CERTAIN REQUIREMENTS.

17 ‘‘(a) LOANS.—

18 ‘‘(1) IN GENERAL.—The Secretary may approve

19 a loan under section 2773 only if—

20 ‘‘(A) the Secretary is reasonably satisfied

21 that the applicant for the project for which the

22 loan would be made will be able to make pay23 ments of principal and interest thereon when

24 due; and
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•HR 4841 IH

1 ‘‘(B) the applicant provides the Secretary

2 with reasonable assurances that there will be

3 available to it such additional funds as may be

4 necessary to complete the project or undertak5 ing with respect to which such loan is re6 quested.

7 ‘‘(2) TERMS AND CONDITIONS.—Any loan made

8 under section 2773 shall, subject to the Federal

9 Credit Reform Act of 1990, meet such terms and

10 conditions (including provisions for recovery in case

11 of default) as the Secretary, in consultation with the

12 Secretary of the Treasury, determines to be nec13 essary to carry out the purposes of such section

14 while adequately protecting the financial interests of

15 the United States. Terms and conditions for such

16 loans shall include provisions regarding the follow17 ing:

18 ‘‘(A) Security.

19 ‘‘(B) Maturity date.

20 ‘‘(C) Amount and frequency of install21 ments.

22 ‘‘(D) Rate of interest, which shall be at a

23 rate comparable to the rate of interest prevail24 ing on the date the loan is made.
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1 ‘‘(b) LOAN GUARANTEES.—The Secretary may not

2 approve a loan guarantee under section 2773 unless the

3 Secretary determines that the terms, conditions, security

4 (if any), schedule and amount of repayments with respect

5 to the loan are sufficient to protect the financial interests

6 of the United States and are otherwise reasonable. Such

7 loan guarantees shall be subject to such further terms and

8 conditions as the Secretary determines, in consultation

9 with the Secretary of the Treasury, and subject to the

10 Federal Credit Reform Act of 1990, to be necessary to

11 ensure that the purposes of this section will be achieved.

12 ‘‘(c) USE OF EXISTING RESOURCES.—The Secretary

13 may provide a loan or loan guarantee under section 2773

14 only if the applicant involved agrees that, in developing

15 the qualified community health group involved, the appli16 cant will utilize existing resources to the maximum extent

17 practicable.

18 ‘‘SEC. 2775. DEFAULTS; RIGHT OF RECOVERY.

19 ‘‘(a) DEFAULTS.—

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

21 such action as may be necessary to prevent a default

22 on loans or loan guarantees under section 2773, in23 cluding the waiver of regulatory conditions, deferral

24 of loan payments, renegotiation of loans, and the ex25 penditure of funds for technical and consultative as-
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1 sistance, for the temporary payment of the interest

2 and principal on such a loan, and for other pur3 poses.

4 ‘‘(2) FORECLOSURE.—The Secretary may take

5 such action, consistent with State law respecting

6 foreclosure procedures, as the Secretary deems ap7 propriate to protect the interest of the United States

8 in the event of a default on a loan made pursuant

9 to section 2773, including selling real property

10 pledged as security for such a loan or loan guarantee

11 and for a reasonable period of time taking posses12 sion of, holding, and using real property pledged as

13 security for such a loan or loan guarantee.

14 ‘‘(3) WAIVERS.—The Secretary may, for good

15 cause, but with due regard to the financial interests

16 of the United States, waive any right of recovery

17 which the Secretary has by reasons of the failure of

18 a borrower to make payments of principal of and in19 terest on a loan made pursuant to section 2773, ex20 cept that if such loan is sold and guaranteed, any

21 such waiver shall have no effect upon the Secretary’s

22 guarantee of timely payment of principal and

23 interest.

24 ‘‘(b) TWENTY-YEAR OBLIGATION; RIGHT OF RECOV25 ERY.—
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1 ‘‘(1) IN GENERAL.—With respect to a facility

2 for which a loan is to be made pursuant to section

3 2773, the Secretary may provide the loan or loan

4 guarantee only if the applicant involved agrees that

5 the applicant will be liable to the United States for

6 the amount of the loan or loan guarantee, together

7 with an amount representing interest, if at any time

8 during the 20-period beginning on the date of com9 pletion of the activities involved, the facility—

10 ‘‘(A) ceases to be a facility utilized by a

11 qualified community health group, or by an12 other public or nonprofit private entity that

13 provides health services in one or more health

14 professional shortage areas or that provides

15 such services to a significant number of individ16 uals who are members of a medically under17 served population; or

18 ‘‘(B) is sold or transferred to any entity

19 other than an entity that is—

20 ‘‘(i) a qualified community health

21 group or other entity described in subpara22 graph (A); and

23 ‘‘(ii) approved by the Secretary as a

24 purchaser or transferee regarding the facil25 ity.
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1 ‘‘(2) SUBORDINATION; WAIVERS.—The Sec2 retary may subordinate or waive the right of recov3 ery under paragraph (1), and any other Federal in4 terest that may be derived by virtue of a loan or

5 loan guarantee under subsection (a), if the Secretary

6 determines that subordination or waiver will further

7 the objectives of this part.

8 ‘‘SEC. 2776. PROVISIONS REGARDING CONSTRUCTION OR

9 EXPANSION OF FACILITIES.

10 ‘‘(a) SUBMISSION OF INFORMATION.—In the case of

11 a project for construction, conversion, expansion or mod12 ernization of a facility, the Secretary may provide loans

13 or loan guarantees under section 2773 only if the appli14 cant submits to the Secretary the following:

15 ‘‘(1) A description of the site.

16 ‘‘(2) Plans and specifications which meet re17 quirements prescribed by the Secretary.

18 ‘‘(3) Information reasonably demonstrating that

19 title to such site is vested in one or more of the enti20 ties filing the application (unless the agreement de21 scribed in subsection (b)(1) is made).

22 ‘‘(4) A specification of the type of assistance

23 being requested under section 2773.

24 ‘‘(b) AGREEMENTS.—In the case of a project for con25 struction, conversion, expansion or modernization of a fa-
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1 cility, the Secretary may provide loans or loan guarantees

2 under section 2773 only if the applicant makes the follow3 ing agreements:

4 ‘‘(1) Title to such site will be vested in one or

5 more of the entities filing the application (unless the

6 assurance described in subsection (a)(3) has been

7 submitted under such subsection).

8 ‘‘(2) Adequate financial support will be avail9 able for completion of the project and for its mainte10 nance and operation when completed.

11 ‘‘(3) All laborers and mechanics employed by

12 contractors or subcontractors in the performance of

13 work on a project will be paid wages at rates not

14 less than those prevailing on similar construction in

15 the locality as determined by the Secretary of Labor

16 in accordance with the Act of March 3, 1931 (40

17 U.S.C. 276a et seq; commonly known as the Davis18 Bacon Act), and the Secretary of Labor shall have

19 with respect to such labor standards the authority

20 and functions set forth in Reorganization Plan

21 Numbered 14 of 1950 (15 FR 3176; 5 U.S.C. Ap22 pendix) and section 276c of title 40.

23 ‘‘(4) The facility will be made available to all

24 persons seeking service regardless of their ability to

25 pay.
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1 ‘‘SEC. 2777. APPLICATION FOR ASSISTANCE.

2 ‘‘The Secretary may provide loans or loan guarantees

3 under section 2773 only if an application for such assist4 ance is submitted to the Secretary, the application con5 tains each agreement described in this subpart, the appli6 cation contains the information required in section

7 2781(a), and the application is in such form, is made in

8 such manner, and contains such agreements, assurances,

9 and information as the Secretary determines to be nec10 essary to carry out this subpart.

11 ‘‘SEC. 2778. ADMINISTRATION OF PROGRAMS.

12 This subpart, and any other program of the Secretary

13 that provides loans or loan guarantees, shall be carried

14 out by a centralized loan unit established within the De15 partment of Health and Human Services.

16 ‘‘PART 3—ENABLING SERVICES

17 ‘‘SEC. 2779. AUTHORIZATIONS OF APPROPRIATIONS FROM

18 FUND.

19 ‘‘(a) ENABLING SERVICES.—For the purpose of car20 rying out this part, there are authorized to be appro21 priated from the Fund $200,000,000 for each of the fiscal

22 year 1996 through 1999, and $100,000,000 for fiscal year

23 2000.

24 ‘‘(b) RELATION TO OTHER FUNDS.—The authoriza25 tions of appropriations established in subsection (a) are

26 in addition to any other authorizations of appropriations
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1 that are available for the purpose described in such sub2 section.

3 ‘‘SEC. 2780. GRANTS AND CONTRACTS FOR ENABLING SERV4 ICES.

5 ‘‘(a) IN GENERAL.—

6 ‘‘(1) GRANTS AND CONTRACTS.—The Secretary

7 may make grants to and enter into contracts with

8 entities described in paragraph (2) to assist such en9 tities in providing the services described in sub10 section (b) for the purpose of increasing the extent

11 to which individuals appropriately utilize health serv12 ices that are available to the individuals, including

13 health services for which the individuals are eligible

14 under Federal and State programs.

15 ‘‘(2) RELEVANT ENTITIES.—For purposes of

16 paragraph (1), the entities described in this para17 graph are qualified community health groups (as de18 fined in section 2763(a)), and other public or non19 profit private entities, that—

20 ‘‘(A) provide health services in one or more

21 health professional shortage areas or that pro22 vide such services to a significant number of in23 dividuals who are members of a medically un24 derserved population; and
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1 ‘‘(B) are experienced in providing services

2 to increase the extent to which individuals ap3 propriately utilize health services that are avail4 able to the individuals.

5 ‘‘(b) ENABLING SERVICES.—The services referred to

6 in subsection (a)(1) are transportation, community and

7 patient outreach, patient education, translation services,

8 and such other services as the Secretary determines to be

9 appropriate in carrying out the purpose described in such

10 subsection.

11 ‘‘(c) CERTAIN REQUIREMENTS REGARDING PROJECT

12 AREA.—The Secretary may make an award of a grant or

13 contract under subsection (a) only if the applicant in14 volved—

15 ‘‘(1) submits to the Secretary—

16 ‘‘(A) information demonstrating that the

17 medically underserved populations in the com18 munity to be served under the award have a

19 need for enabling services; and

20 ‘‘(B) a proposed budget for providing such

21 services; and

22 ‘‘(2) the applicant for the award agrees that the

23 residents of the community will be significantly in24 volved in the project carried out with the award.
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1 ‘‘(d) IMPOSITION OF FEES.—The Secretary may

2 make an award of a grant or contract under subsection

3 (a) only if the applicant involved agrees that, in the project

4 carried out under such subsection, enabling services will

5 be provided without charge to the recipients of the serv6 ices.

7 ‘‘(e) USE OF EXISTING RESOURCES.—The Secretary

8 may make an award of a grant or contract under sub9 section (a) only if the applicant involved agrees that, in

10 carrying out the project under such subsection, the appli11 cant will utilize existing resources to the maximum extent

12 practicable.

13 ‘‘(f) APPLICATION FOR AWARDS OF ASSISTANCE.—

14 The Secretary may make an award of a grant or contract

15 under subsection (a) only if an application for the award

16 is submitted to the Secretary, the application contains

17 each agreement described in this subpart, the application

18 contains the information required in subsection (d)(1),

19 and the application is in such form, is made in such man20 ner, and contains such agreements, assurances, and infor21 mation as the Secretary determines to be necessary to

22 carry out this subpart.

23 ‘‘(g) DEFINITION.—For purposes of this section, the

24 term ‘enabling services’ means services described in sub-
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1 section (b) that are provided for the purpose described in

2 subsection (a)(1).

3 ‘‘PART 4—NATIONAL HEALTH SERVICE CORPS

4 ‘‘SEC. 2781. AUTHORIZATIONS OF APPROPRIATIONS FROM

5 FUND.

6 ‘‘(a) ADDITIONAL FUNDING; GENERAL CORPS PRO7 GRAM; ALLOCATIONS REGARDING NURSES.—For the pur8 pose of carrying out subpart II of part D of title III, and

9 for the purpose of carrying out subsection (c), there are

10 authorized to be appropriated from the Fund $50,000,000

11 for fiscal year 1995, $100,000,000 for fiscal year 1996,

12 and $200,000,000 for each of the fiscal years 1997

13 through 2000.

14 ‘‘(b) RELATION TO OTHER FUNDS.—The authoriza15 tions of appropriations established in subsection (a) are

16 in addition to any other authorizations of appropriations

17 that are available for the purpose described in such sub18 section.

19 ‘‘(c) ALLOCATION FOR PARTICIPATION OF NURSES

20 IN SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS.—

21 Of the amounts appropriated under subsection (a), the

22 Secretary shall reserve such amounts as may be necessary

23 to ensure that, of the aggregate number of individuals who

24 are participants in the Scholarship Program under section

25 338A, or in the Loan Repayment Program under section
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1 338B, the total number who are being educated as nurses

2 or are serving as nurses, respectively, is increased to 30

3 percent.

4 ‘‘(d) AVAILABILITY OF FUNDS.—An appropriation

5 under this section for any fiscal year may be made at any

6 time before that fiscal year and may be included in an

7 Act making an appropriation under an authorization

8 under subsection (a) for another fiscal year; but no funds

9 may be made available from any appropriation under this

10 section for obligation under sections 331 through 335, sec11 tion 336A, and section 337 before the fiscal year involved.

12 ‘‘PART 5—SATELLITE CLINICS REGARDING

13 PRIMARY HEALTH CARE

14 ‘‘SEC. 2783. AUTHORIZATION OF APPROPRIATIONS FORM

15 FUND.

16 For the purpose of carrying out this part, there is

17 authorized to be appropriated from the Fund $50,000,000

18 for each of the fiscal years 1995 through 2000.

19 ‘‘SEC. 2783A. GRANTS TO STATES FOR DEVELOPMENT AND

20 OPERATION OF SATELLITE CLINICS.

21 ‘‘(a) IN GENERAL.—With respect to outpatient

22 health centers that are providers of comprehensive health

23 services, the Secretary may make grants to States for the

24 purpose of assisting such centers in developing or operat25 ing facilities that—
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1 ‘‘(1) provide clinical preventive services, treat2 ment of minor illnesses and injuries, family planning

3 services, and referrals for health services, mental

4 health services, and health-related social services;

5 and

6 ‘‘(2) are located at a distance from the center

7 sufficient to increase the extent to which individuals

8 in the geographic area involved have access to the

9 services specified in paragraph (1).

10 ‘‘(b) CERTAIN REQUIREMENTS.—The Secretary may

11 make a grant under subsection (a) only if the State agrees

12 that the health facility for which the grant is made, once

13 in operation, will meet the following conditions:

14 ‘‘(1) The clinical preventive services provided by

15 the facility will include routine preventive services,

16 including family planning services, for pregnant and

17 postpartum women and for children, including

18 health screenings and immunizations.

19 ‘‘(2) The principal providers of health services

20 at the facility, and the principal managers of the fa21 cility, will be nurse practitioners or nurse clinicians,

22 subject to applicable law.

23 ‘‘(3) The outpatient health center operating the

24 facility will serve as a referral center for physician
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1 services and will provide for the ongoing monitoring

2 of the activities of the facility.

3 ‘‘(c) MATCHING FUNDS.—The Secretary may make

4 a grant under subsection (a) only if the State involved

5 agrees to make non-Federal contributions toward the costs

6 of developing and operating the health facilities involved.

7 ‘‘(d) APPLICATION FOR GRANT.—The Secretary may

8 make a grant under subsection (a) only if an application

9 for the grant is submitted to the Secretary and the appli10 cation is in such form, is made in such manner, and con11 tains such agreements, assurances, and information as the

12 Secretary determines to be necessary to carry out this

13 part.

14 ‘‘(e) LIMITATION ON AMOUNT OF ASSISTANCE PER

15 FACILITY.—With respect to a health facility for which one

16 or more grants under subsection (a) are made, the Sec17 retary may not provide more than an aggregate $250,000

18 for the development and operation of the facility.

19 ‘‘PART 6—COMMUNITY HEALTH ADVISORS

20 ‘‘SEC. 2784. AUTHORIZATION OF APPROPRIATIONS FROM

21 FUND.

22 For the purpose of carrying out this part, there is

23 authorized to be appropriated from the Fund

24 $100,000,000 for fiscal year 1995, $125,000,000 for fis25 cal year 1996, $150,000,000 for fiscal year 1997,
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1 $175,000,000 for fiscal year 1998, $175,000,000 for fis2 cal year 1999, and $175,000,000 for fiscal year 2000.

3 ‘‘SEC. 2785. FORMULA GRANTS REGARDING COMMUNITY

4 HEALTH ADVISOR PROGRAMS.

5 ‘‘(a) FORMULA GRANTS.—

6 ‘‘(1) IN GENERAL.—In the case of each State

7 (or entity designated by a State under subsection

8 (b)) that submits to the Secretary an application in

9 accordance with section 2788 for a fiscal year, the

10 Secretary of Health and Human Services, acting

11 through the Director of the Centers for Disease

12 Control and Prevention and in coordination with the

13 heads of the agencies specified in paragraph (2),

14 shall make an award of financial assistance to the

15 State or entity for the development and operation of

16 community health advisor programs under section

17 2786(b). The award shall consist of the allotment

18 determined under section 2789 with respect to the

19 State, subject to section 2794.

20 ‘‘(2) COORDINATION WITH OTHER AGENCIES.—

21 The agencies referred to in paragraph (1) regarding

22 coordination are the Health Resources and Services

23 Administration, the National Institutes of Health,

24 and the Substance Abuse and Mental Health Serv25 ices Administration.
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1 ‘‘(b) DESIGNATED ENTITIES.—With respect to the

2 State involved, an entity other than the State may receive

3 an award under subsection (a) only if the entity—

4 ‘‘(1) is a public or nonprofit private academic

5 organization (or other public or nonprofit private en6 tity); and

7 ‘‘(2) has been designated by the State to carry

8 out the purpose described in such subsection in the

9 State and to receive amounts under such subsection

10 in lieu of the State.

11 ‘‘(c) ROLE OF STATE AGENCY FOR PUBLIC

12 HEALTH.—A funding agreement for an award under sub13 section (a) is that—

14 ‘‘(1) if the applicant is a State, the award will

15 be administered by the State agency with the prin16 cipal responsibility for carrying out public health

17 programs; and

18 ‘‘(2) if the applicant is an entity designated

19 under subsection (b), the award will be administered

20 in consultation with such State agency.

21 ‘‘(d) STATEWIDE RESPONSIBILITIES; LIMITATION ON

22 EXPENDITURES.—

23 ‘‘(1) STATEWIDE RESPONSIBILITIES.—A fund24 ing agreement for an award under subsection (a) is

25 that the applicant involved will—
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1 ‘‘(A) operate a clearinghouse to maintain

2 and disseminate information on community

3 health advisor programs (and similar programs)

4 in the State, including information on develop5 ing and operating such programs, on training

6 individuals to participate in the programs, and

7 on evaluation of the programs;

8 ‘‘(B) collaborate with schools of public

9 health to provide to community health advisor

10 programs in the State technical assistance in

11 training and supervising community health ad12 visors under section 2787(g)(1); and

13 ‘‘(C) coordinate the activities carried out in

14 the State under the award, including coordina15 tion between the various community health ad16 visor programs and coordination between such

17 programs and related activities of the State and

18 of other public or private entities.

19 ‘‘(2) LIMITATION.—A funding agreement for an

20 award under subsection (a) is that the applicant in21 volved will not expend more than 15 percent of the

22 award in the aggregate for carrying out paragraph

23 (1) and for the expenses of administering the award

24 with respect to the State involved, including the

25 process of receiving payments from the Secretary
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1 under the award, allocating the payments among the

2 entities that are to develop and operate the commu3 nity health advisor programs involved, and monitor4 ing compliance with the funding agreements made

5 under this subtitle by the applicant.

6 ‘‘SEC. 2786. REQUIREMENTS REGARDING COMMUNITY

7 HEALTH ADVISOR PROGRAMS.

8 ‘‘(a) PURPOSE OF AWARD; HEALTHY PEOPLE 2000

9 OBJECTIVES.—

10 ‘‘(1) IN GENERAL.—Subject to paragraph (2), a

11 funding agreement for an award under section 2785

12 for an applicant is that the purpose of the award is,

13 through community health advisor programs under

14 subsection (b), to assist the State involved in attain15 ing the Healthy People 2000 Objectives.

16 ‘‘(2) AUTHORITY REGARDING SELECTION OF

17 PRIORITY OBJECTIVES.—With respect to compliance

18 with the agreement made under paragraph (1), an

19 applicant receiving an award under section 2785

20 may, from among the various Healthy People 2000

21 Objectives, select one or more Objectives to be given

22 priority in the operation of a community health advi23 sor program of the applicant, subject to the appli24 cant selecting such priorities in consultation with the
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1 entity that is to carry out the program and the local

2 health department involved.

3 ‘‘(b) REQUIREMENTS FOR PROGRAMS.—

4 ‘‘(1) IN GENERAL.—A funding agreement for

5 an award under section 2785 for an applicant is

6 that, in expending the award, the purpose described

7 in subsection (a)(1) will be carried out in accordance

8 with the following:

9 ‘‘(A) For each community for which the

10 purpose is to be carried out, the applicant will

11 establish a program in accordance with this

12 subsection.

13 ‘‘(B) The program will be carried out in a

14 community only if the applicant has, under sec15 tion 2787(a), identified the community as hav16 ing a significant need for the program.

17 ‘‘(C) The program will be operated by a

18 public or nonprofit private entity with experi19 ence in providing health or health-related social

20 services to individuals who are underserved with

21 respect to such services.

22 ‘‘(D) The services of the program, as spec23 ified in paragraph (2), will be provided prin24 cipally by community health advisors (as de25 fined in subsection (d)).
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1 ‘‘(2) AUTHORIZED PROGRAM SERVICES.—For

2 purposes of paragraph (1)(D), the services specified

3 in this paragraph for a program are as follows:

4 ‘‘(A) The program will collaborate with

5 health care providers and related entities in

6 order to facilitate the provision of health serv7 ices and health-related social services (including

8 collaborating with local health departments,

9 community health centers, public hospital sys10 tems, migrant health centers, rural health clin11 ics, hospitals, physicians and nurses, providers

12 of health education, pre-school facilities for chil13 dren, elementary and secondary schools, and

14 providers of social services).

15 ‘‘(B) The program will provide public edu16 cation on health promotion and on the preven17 tion of diseases, illnesses, injuries, and disabil18 ities, and will facilitate the appropriate use of

19 available health services and health-related so20 cial services.

21 ‘‘(C) The program will provide health-re22 lated counseling.

23 ‘‘(D) The program will provide referrals

24 for available health services and health-related

25 social services.
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1 ‘‘(E) For the purpose of increasing the ca2 pacity of individuals to utilize health services

3 and health-related social services under Federal,

4 State, and local programs, the following condi5 tions will be met:

6 ‘‘(i) The program will assist individ7 uals in establishing eligibility under the

8 programs and in receiving the services or

9 other benefits of the programs.

10 ‘‘(ii) The program will provide such

11 other services as the Secretary determines

12 to be appropriate, which services may in13 clude (but are not limited to) transpor14 tation and translation services.

15 ‘‘(F) The program will provide outreach

16 services to inform the community of the avail17 ability of the services of the program.

18 ‘‘(c) PRIORITY FOR MEDICALLY UNDERSERVED COM19 MUNITIES.—A funding agreement for an award under sec20 tion 2785 is that the applicant involved will give priority

21 to developing and operating community health advisor

22 programs for medically underserved communities.

23 ‘‘(d) DEFINITION OF COMMUNITY HEALTH ADVI24 SOR.—For purposes of this part, the term ‘community

25 health advisor’ means an individual—
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1 ‘‘(1) who has demonstrated the capacity to

2 carry out one or more of the authorized program

3 services;

4 ‘‘(2) who, for not less than 1 year, has been a

5 resident of the community in which the community

6 health advisor program involved is to be operated;

7 and

8 ‘‘(3) is a member of a socioeconomic group to

9 be served by the program.

10 ‘‘SEC. 2787. ADDITIONAL AGREEMENTS.

11 ‘‘(a) IDENTIFICATION OF COMMUNITY NEEDS.—A

12 funding agreement for an award under section 2785 is

13 that the applicant involved will—

14 ‘‘(1) identify the needs of the community in15 volved for the authorized program services, including

16 the identifying of the resources of the community

17 that are available for carrying out the program;

18 ‘‘(2) in identifying such needs, consult with

19 members of the community, with individuals and

20 programs that provide health services in the commu21 nity, and with individuals and programs that provide

22 health-related social services in the community; and

23 ‘‘(3) consider such needs in carrying out a com24 munity health advisor program for the community.

25 ‘‘(b) MATCHING FUNDS.—
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1 ‘‘(1) IN GENERAL.—With respect to the cost of

2 carrying out a community health advisor program, a

3 funding agreement for an award under section 2785

4 is that the applicant involved will make available (di5 rectly or through donations from public or private

6 entities) non-Federal contributions toward such cost

7 in an amount that is not less than 25 percent of

8 such cost.

9 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB10 UTED.—

11 ‘‘(A) Non-Federal contributions required in

12 paragraph (1) may be in cash or in kind, fairly

13 evaluated, including plant, equipment, or serv14 ices. Amounts provided by the Federal Govern15 ment, or services assisted or subsidized to any

16 significant extent by the Federal Government,

17 may not be included in determining the amount

18 of such non-Federal contributions.

19 ‘‘(B) With respect to the State in which

20 the community health advisor program involved

21 is to be carried out, amounts provided by the

22 State in compliance with subsection (c) shall be

23 included in determining the amount of non-Fed24 eral contributions under paragraph (1).
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1 ‘‘(c) MAINTENANCE OF EFFORT.—With respect to

2 the purposes for which an award under section 2785 is

3 authorized in this subtitle to be expended, the Secretary

4 may make such an award only if the State involved agrees

5 to maintain expenditures of non-Federal amounts for such

6 purposes at a level that is not less than the level of such

7 expenditures maintained by the State for the fiscal year

8 preceding the first fiscal year for which such an award

9 is made with respect to the State.

10 ‘‘(d) CULTURAL CONTEXT OF SERVICES.—A funding

11 agreement for an award under section 2785 for an appli12 cant is that the services of the community health advisor

13 program involved will be provided in the language and cul14 tural context most appropriate for the individuals served

15 by the program, and that for such purpose the community

16 health advisors of the program will include an appropriate

17 number of advisors who are fluent in both English and

18 not less than one of the other relevant languages.

19 ‘‘(e) NUMBER OF PROGRAMS PER AWARD; PRO20 GRAMS FOR URBAN AND RURAL AREAS.—A funding

21 agreement for an award under section 2785 for an appli22 cant is that the number of community health advisor pro23 grams operated in the State with the award will be deter24 mined by the Secretary, except that (subject to section

25 2786(b)(1)(B)) such a program will be carried out in not
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1 less than one urban area of the State, and in not less than

2 one rural area of the State.

3 ‘‘(f) ONGOING SUPERVISION OF ADVISORS.—A fund4 ing agreement for an award under section 2785 is that

5 the applicant involved will ensure that each community

6 health advisor program operated with the award provides

7 for the ongoing supervision of the community health advi8 sors of the program, and that the individuals serving as

9 supervisors in the program will include 1 or more public

10 health nurses with field experience and managerial experi11 ence.

12 ‘‘(g) CERTAIN EXPENDITURES.—

13 ‘‘(1) TRAINING; CONTINUING EDUCATION.—

14 Funding agreements for an award under section

15 2785 include the following:

16 ‘‘(A) The applicant involved will ensure

17 that, for each community health advisor pro18 gram operated with the award, a program is

19 carried out to train community health advisors

20 to provide the authorized program services, in21 cluding practical experiences in providing serv22 ices for health promotion and disease preven23 tion.
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1 ‘‘(B) The program of training will provide

2 for the continuing education of the community

3 health advisors.

4 ‘‘(C) Not more than 15 percent of the

5 award will be expended for the program of

6 training.

7 ‘‘(2) COMPENSATION.—With respect to compli8 ance with the agreements made under this subtitle,

9 the purposes for which an award under section 2785

10 may be expended include providing compensation for

11 the services of community health advisors.

12 ‘‘(h) REPORTS TO SECRETARY; ASSESSMENT OF EF13 FECTIVENESS.—Funding agreements for an award under

14 section 2785 for an applicant include the following:

15 ‘‘(1) The applicant will ensure that, for each

16 fiscal year for which a community health advisor

17 program receives amounts from the award, the pro18 gram will prepare a report describing the activities

19 of the program for such year, including—

20 ‘‘(A) a specification of the number of indi21 viduals served by the program;

22 ‘‘(B) a specification of the entities with

23 which the program has collaborated in carrying

24 out the purpose described in section 2786(a)(1);

25 and
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1 ‘‘(C) an assessment of the extent of the ef2 fectiveness of the program in carrying out such

3 purpose.

4 ‘‘(2) Such reports will include such additional

5 information regarding the applicant and the pro6 grams as the Secretary may require.

7 ‘‘(3) The applicant will prepare the reports as

8 a single document and will submit the document to

9 the Secretary not later than February 1 of the fiscal

10 year following the fiscal year for which the reports

11 were prepared.

12 ‘‘SEC. 2788. APPLICATION FOR ASSISTANCE; STATE PLAN.

13 For purposes of section 2785, an application is in ac14 cordance with this section if—

15 ‘‘(1) the application is submitted not later than

16 the date specified by the Secretary;

17 ‘‘(2) the application contains each funding

18 agreement described in this subtitle;

19 ‘‘(3) the application contains a State plan de20 scribing the purposes for which the award is to be

21 expended in the State, including a description of the

22 manner in which the applicant will comply with each

23 such funding agreement; and

24 ‘‘(4) the application is in such form, is made in

25 such manner, and contains such agreements, assur-
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1 ances, and information as the Secretary determines

2 to be necessary to carry out this subtitle.

3 ‘‘SEC. 2789. DETERMINATION OF AMOUNT OF ALLOTMENT.

4 ‘‘(a) IN GENERAL.—For purposes of section 2785,

5 the allotment under this section with respect to a State

6 for a fiscal year is the sum of the respective amounts de7 termined for the State under subsection (b) and sub8 section (c).

9 ‘‘(b) AMOUNT RELATING TO POPULATION.—For pur10 poses of subsection (a), the amount determined under this

11 subsection is the product of—

12 ‘‘(1) an amount equal to 50 percent of the

13 amount appropriated under section 2784 for the fis14 cal year and available for awards under section

15 2785; and

16 ‘‘(2) the percentage constituted by the ratio

17 of—

18 ‘‘(A) the number of individuals residing in

19 the State involved; to

20 ‘‘(B) the sum of the respective amounts

21 determined for each State under subparagraph

22 (A).

23 ‘‘(c) AMOUNT RELATING TO POVERTY LEVEL.—For

24 purposes of subsection (a), the amount determined under

25 this subsection is the product of—
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1 ‘‘(1) the amount determined under subsection

2 (b)(1); and

3 ‘‘(2) the percentage constituted by the ratio

4 of—

5 ‘‘(A) the number of individuals residing in

6 the State whose income is at or below an

7 amount equal to 200 percent of the official pov8 erty line; to

9 ‘‘(B) the sum of the respective amounts

10 determined for each State under subparagraph

11 (A).

12 ‘‘SEC. 2790. QUALITY ASSURANCE; COST-EFFECTIVENESS.

13 ‘‘The Secretary shall establish guidelines for assuring

14 the quality of community health advisor programs (includ15 ing quality in the training of community health advisors)

16 and for assuring the cost-effectiveness of the programs.

17 A funding agreement for an award under section 2785 is

18 that the applicant involved will carry out such programs

19 in accordance with the guidelines.

20 ‘‘SEC. 2791. EVALUATIONS; TECHNICAL ASSISTANCE.

21 ‘‘(a) EVALUATIONS.—The Secretary shall conduct

22 evaluations of community health advisor programs and

23 disseminate information developed as result of the evalua24 tions to the States. In conducting such evaluations, the

25 Secretary shall determine whether the programs are in
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1 compliance with the guidelines established under section

2 2790.

3 ‘‘(b) TECHNICAL ASSISTANCE.—The Secretary may

4 provide technical assistance to recipients of awards under

5 section 2785 with respect to the planning, development,

6 and operation of community health advisor programs.

7 ‘‘(c) GRANTS AND CONTRACTS.—The Secretary may

8 carry out this section directly or through grants, coopera9 tive agreements, or contracts.

10 ‘‘(d) LIMITATION ON EXPENDITURES.—Of the

11 amounts appropriated under section 2784 for a fiscal year,

12 the Secretary may reserve not more than 10 percent for

13 carrying out this section.

14 ‘‘SEC. 2792. RULE OF CONSTRUCTION REGARDING PRO15 GRAMS OF INDIAN HEALTH SERVICE.

16 This subtitle may not be construed as requiring the

17 Secretary to modify or terminate the program carried out

18 by the Director of the Indian Health Service and des19 ignated by such Director as the Community Health Rep20 resentative Program. The Secretary shall ensure that sup21 port for such Program is not supplanted by awards under

22 section 2785. In communities in which both such Program

23 and a community health advisor program are being carried

24 out, the Secretary shall ensure that the community health

25 advisor program works in cooperation with, and as a
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1 complement to, the Community Health Representative

2 Program.

3 ‘‘SEC. 2793. DEFINITIONS.

4 For purposes of this subtitle:

5 ‘‘(1) The term ‘authorized program services’,

6 with respect to a community health advisor program,

7 means the services specified in section 2786(b)(2).

8 ‘‘(2) The term ‘community health advisor’’ has

9 the meaning given such term in section 2786(d).

10 ‘‘(3) The term ‘community health advisor pro11 gram’ means a program carried out under section

12 2786(b).

13 ‘‘(4) The term ‘financial assistance’, with re14 spect to an award under section 2785, means a

15 grant, cooperative agreement, or a contract.

16 ‘‘(5) The term ‘funding agreement’ means an

17 agreement required as a condition of receiving an

18 award under section 2785.

19 ‘‘(6) The term ‘official poverty line’ means the

20 official poverty line established by the Director of

21 the Office of Management and Budget and revised

22 by the Secretary in accordance with section 673(2)

23 of the Omnibus Budget Reconciliation Act of 1981,

24 which poverty line is applicable to the size of the

25 family involved.
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1 ‘‘(7) The term ‘State involved’, with respect to

2 an applicant for an award under section 2785,

3 means the State in which the applicant is to carry

4 out a community health advisor program.

5 ‘‘SEC. 2794. EFFECT OF INSUFFICIENT APPROPRIATIONS

6 FOR MINIMUM ALLOTMENTS.

7 ‘‘(a) IN GENERAL.—If the amounts made available

8 under section 2784 for a fiscal year are insufficient for

9 providing each State (or entity designated by the State

10 pursuant to section 2785, as the case may be) with an

11 award under section 2785 in an amount equal to or great12 er than the amount specified in section 2789(a)(2), the

13 Secretary shall, from such amounts as are made available

14 under subsection (a), make such awards on a discretionary

15 basis.

16 ‘‘(b) RULE OF CONSTRUCTION.—For purposes of

17 subsection (a), awards under section 2785 are made on

18 a discretionary basis if the Secretary determines which

19 States (or entities designated by States pursuant to such

20 section, as the case may be) are to receive such awards,

21 subject to meeting the requirements of this subtitle for

22 such an award, and the Secretary determines the amount

23 of such awards.
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1 ‘‘PART 7—MENTAL HEALTH; SUBSTANCE ABUSE

2 ‘‘SEC. 2795. AUTHORIZATIONS OF APPROPRIATIONS FROM

3 FUND.

4 ‘‘(a) IN GENERAL.—For the purpose of carrying out

5 this part, there are authorized to be appropriated from

6 the Fund $100,000,000 for fiscal year 1995,

7 $150,000,000 for fiscal year 1996, $200,000,000 for fis8 cal year 1997, and $250,000,000 for each of the fiscal

9 years 1998 through 2000.

10 ‘‘(b) ALLOCATION AMONG PROGRAMS.—Of the

11 amounts made available under subsection (a) for a fiscal

12 year—

13 ‘‘(1) the Secretary may reserve for carrying out

14 section 2797 such amounts as the Secretary deter15 mines to be appropriate; and

16 ‘‘(2) the Secretary shall, of the remaining

17 amounts, reserve 50 percent for carrying out sub18 section (a) of section 2796 and 50 percent for carry19 ing out subsection (b) of such section.

20 ‘‘(c) RELATION TO OTHER FUNDS.—The authoriza21 tions of appropriations established in subsection (a) are

22 in addition to any other authorizations of appropriations

23 that are available for the purpose described in such sub24 section.
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1 ‘‘SEC. 2796. SUPPLEMENTAL FORMULA GRANTS FOR

2 STATES REGARDING ACTIVITIES UNDER

3 PART B OF TITLE XIX.

4 ‘‘(a) MENTAL HEALTH.—

5 ‘‘(1) IN GENERAL.—In the case of any State

6 that submits to the Secretary an application in ac7 cordance with subsection (e) for a fiscal year with

8 respect to mental health, the Secretary shall make a

9 grant to the State for the purposes authorized in

10 subsection (c) with respect to mental health. The

11 grant shall consist of the allotment determined

12 under paragraph (2) for the State for such year.

13 ‘‘(2) DETERMINATION OF ALLOTMENT.—For

14 purposes of paragraph (1), the allotment under this

15 paragraph for a State for a fiscal year shall be de16 termined as follows: With respect to the amount re17 served under section 2795(b)(2) for carrying out

18 this subsection, section 1918 shall be applied to such

19 amount to the same extent and in the same manner

20 as section 1918 is applied to the amount determined

21 under section 1918(a)(2).

22 ‘‘(b) SUBSTANCE ABUSE.—

23 ‘‘(1) IN GENERAL.—In the case of any State

24 that submits to the Secretary an application in ac25 cordance with subsection (e) for a fiscal year with

26 respect to substance abuse, the Secretary shall make
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1 a grant to the State for the purposes authorized in

2 subsection (c) with respect to substance abuse. The

3 grant shall consist of the allotment determined

4 under paragraph (2) for the State for such year.

5 ‘‘(2) DETERMINATION OF ALLOTMENT.—For

6 purposes of paragraph (1), the allotment under this

7 paragraph for a State for a fiscal year shall be de8 termined as follows: With respect to the amount re9 served under section 2795(b)(2) for carrying out

10 this subsection, section 1933 shall be applied to such

11 amount to the same extent and in the same manner

12 as section 1933 is applied to the amount determined

13 pursuant to sections 1933(a)(1)(B)(i).

14 ‘‘(c) USE OF GRANTS.—

15 ‘‘(1) IN GENERAL.—With respect to the expend16 iture of a grant to a State under subsection (a) or

17 (b), the Secretary, subject to paragraph (3)—

18 ‘‘(A) shall designate as authorized expendi19 tures such of the activities described in para20 graph (2) with respect to mental health and

21 substance abuse, respectively, as the Secretary

22 determines to be appropriate; and

23 ‘‘(B) may make the grant only if the State

24 agrees to expend the grant in accordance with

25 the activities so designated.
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1 ‘‘(2) DESCRIPTION OF ACTIVITIES.—The activi2 ties referred to in paragraph (1) are (as applicable

3 to the grant involved) the following:

4 ‘‘(A) For the purpose of increasing the ac5 cess of individuals to services relating to mental

6 health and substance abuse, the following serv7 ices: Transportation, community and patient

8 outreach, patient education, translation serv9 ices, and such other services as the Secretary

10 determines to be appropriate regarding such

11 purpose.

12 ‘‘(B) Improving the capacity of State and

13 local service systems to coordinate and monitor

14 mental health and substance abuse services, in15 cluding improvement of management informa16 tion systems, and establishment of linkages be17 tween public and private providers of mental

18 health and substance abuse services and pri19 mary care providers and health plans.

20 ‘‘(C) Providing incentives to integrate pub21 lic and private systems for the treatment of

22 mental health and substance abuse disorders.

23 ‘‘(D) Any activity for which a grant under

24 section 1911 or section 1921 is authorized to be

25 expended.
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1 ‘‘(3) REPORTS ON INTEGRATION OF SERVICES

2 INTO HEALTH CARE DELIVERY SYSTEM.—

3 ‘‘(A) The Secretary may make a grant

4 under subsection (a) or (b) for a fiscal year

5 only if the State involved agrees to report to the

6 Secretary for the fiscal year, in accordance with

7 criteria under subparagraph (B), information

8 on—

9 ‘‘(i) any activities carried out by the

10 State toward integrating the provision of

11 mental health and substance abuse services

12 in the State into the general health care

13 delivery system in the State;

14 ‘‘(ii) the extent to which the activities

15 have been effective;

16 ‘‘(iii) the difficulties encountered in

17 carrying out such activities; and

18 ‘‘(iv) the recommendations of the

19 State regarding such activities.

20 ‘‘(B) The Secretary shall establish criteria

21 for the uniform collecting and reporting of data

22 under subparagraph (A).

23 ‘‘(C) The Secretary shall disseminate to

24 the States the information by the Secretary

25 under subparagraph (A), as appropriate.
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1 ‘‘(D) A State may expend a grant under

2 subsection (a) or (b) for the costs of complying

3 with subparagraph (A).

4 ‘‘(d) MAINTENANCE OF EFFORT.—

5 ‘‘(1) IN GENERAL.—With respect to the activi6 ties for which a grant under subsection (a) or (b) is

7 to be made, the Secretary may make the grant only

8 if the State involved agrees to maintain expenditures

9 of non-Federal amounts for such activities at a level

10 that is not less than the level of such expenditures

11 maintained by the State for the fiscal year preceding

12 the first fiscal year for which the State receives such

13 a grant.

14 ‘‘(2) WAIVER.—The Secretary may waive all or

15 part of the requirement established for a State

16 under paragraph (1) if—

17 ‘‘(A) the State agrees that the amounts

18 that otherwise would have been subject to such

19 requirement will be expended for the purpose of

20 developing community-based systems of care to

21 promote the eventual integration of the public

22 and private systems for treatment of mental

23 health, or substance abuse, as applicable to the

24 grant;
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1 ‘‘(B) the State submits to the Secretary a

2 request for the waiver and a description of the

3 manner in which the State will carry out such

4 purpose; and

5 ‘‘(C) the Secretary approves the waiver.

6 ‘‘(e) APPLICATION FOR GRANT.—For purposes of

7 subsection (a)(1) and (b)(1), an application for a grant

8 under this section regarding mental health or substance

9 abuse, respectively, is in accordance with this subsection

10 if the State involved submits the application not later than

11 the date specified by the Secretary, the application con12 tains each applicable agreement described in this section,

13 and the application otherwise is in such form, is made in

14 such manner, and contains such agreements, assurances,

15 and information as the Secretary determines to be nec16 essary to carry out the purpose involved.

17 ‘‘SEC. 2797. CAPITAL COSTS OF DEVELOPMENT OF CERTAIN

18 CENTERS AND CLINICS.

19 ‘‘(a) IN GENERAL.—The Secretary may make loans

20 to, and guarantee the payment of principal and interest

21 to Federal and non-Federal lenders on behalf of, public

22 and private entities for the capital costs to be incurred

23 by the entities in the development of non-acute, residential

24 treatment centers and community-based ambulatory

25 clinics.
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1 ‘‘(b) PRIORITIES REGARDING USE OF FUNDS.—In

2 providing loans or loan guarantees under subsection (a),

3 the Secretary shall give priority to authorizing the use of

4 amounts for projects in health professional shortage areas

5 or in geographic area in which there resides a significant

6 number of individuals who are members of a medically un7 derserved population.

8 ‘‘(c) APPLICABILITY OF CERTAIN PROVISIONS.—The

9 Secretary may provide loans or loan guarantees under

10 subsection (a) only if the applicant involved agrees that,

11 except to the extent inconsistent with the purpose de12 scribed in subsection (a), subpart C of part 2 applies to

13 such assistance to the same extent and in the same man14 ner as such subpart applies to loans and loan guarantees

15 under section 2773.

16 ‘‘Subtitle G—General Provisions

17 ‘‘SEC. 2798. REQUIREMENT REGARDING ACCREDITATION

18 OF SCHOOLS, DEPARTMENTS, AND PRO19 GRAMS.

20 ‘‘Except as indicated otherwise in this title:

21 ‘‘(1) A reference in this title to a school of pub22 lic health, a school of nursing, or any other entity

23 providing education or training in a health profes24 sion (whether a school, department, program, or
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1 other entity) is a reference to the entity as defined

2 under section 799 or 853.

3 ‘‘(2) If an entity is not defined in either of such

4 sections, the reference in this title to the entity has

5 the meaning provided by the Secretary, except that

6 the Secretary shall require for purposes of this title

7 that the entity be accredited for the provision of the

8 education or training involved.

9 ‘‘SEC. 2799. DEFINITIONS.

10 ‘‘(a) IN GENERAL.—For purposes of this title:

11 ‘‘(1) The term ‘Healthy People 2000 Objectives’

12 means the objectives established by the Secretary to13 ward the goals of increasing the span of healthy life,

14 reducing health disparities among various popu15 lations, and providing access to preventive services,

16 which objectives apply to the health status of the

17 population of the United States for the year 2000.

18 ‘‘(2) The term ‘medically underserved commu19 nity’ means—

20 (A) a community that has a substantial

21 number of individuals who are members of a

22 medically underserved population, as defined in

23 section 330; or
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1 (B) a community a significant portion of

2 which is a health professional shortage area

3 designated under section 332.

4 Subtitle B—Comprehensive School

5 Health Education

6 PART 1—GENERAL PROVISIONS

7 SEC. 111. TABLE OF CONTENTS FOR SUBTITLE.

8 The table of contents for this subtitle is as follows:

Subtitle B—Comprehensive School Health Education

Part 1—General Provisions

Sec. 111. Table of contents for subtitle.

Sec. 112. Authorizations of appropriations from Fund.

Sec. 113. Definitions.

Part 2—Purposes

Sec. 121. Purposes.

Part 3—Grants to State Education Agencies

SUBPART A—PLANNING GRANTS FOR STATE EDUCATION AGENCIES

Sec. 131. Application for grant.

Sec. 132. Approval of Secretary.

Sec. 133. Amount of grant.

Sec. 134. Authorized activities.

SUBPART B—IMPLEMENTATION GRANTS FOR STATE EDUCATION AGENCIES

Sec. 141. Application for grant.

Sec. 142. Selection of grantees.

Sec. 143. Amount of grant.

Sec. 144. Authorized activities; limitation on administrative costs.

Sec. 145. Subgrants to local educational agencies.

SUBPART C—STATE AND LOCAL REPORTS

Sec. 151. State and local reports.

Part 4—Grants to Certain Local Educational Agencies

SUBPART A—ELIGIBILITY

Sec. 161. Substantial need of area served by agency.

SUBPART B—PLANNING GRANTS FOR LOCAL EDUCATION AGENCIES

Sec. 171. Application for grant.
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Sec. 172. Selection of grantees.

Sec. 173. Amount of grant.

Sec. 174. Authorized activities.

SUBPART C—IMPLEMENTATION GRANTS FOR LOCAL EDUCATIONAL AGENCIES

Sec. 181. Application for grant.

Sec. 182. Selection of grantees.

Sec. 183. Amount of grant.

Sec. 184. Authorized activities.

Sec. 185. Reports.

1 SEC. 112. AUTHORIZATIONS OF APPROPRIATIONS FROM

2 FUND.

3 (a) FUNDING FOR SCHOOL HEALTH EDUCATION.—

4 For the purpose of carrying out this subtitle, there are

5 authorized to be appropriated from the Fund

6 $100,000,000 for fiscal year 1995, $125,000,000 for fis7 cal year 1996, $150,000,000 for fiscal year 1997,

8 $175,000,000 for fiscal year 1998, $200,000,000 for fis9 cal year 1999, and $200,000,000 for fiscal year 2000.

10 (b) ALLOCATIONS.—Of the amounts appropriated

11 under subsection (a) for a fiscal year—

12 (1) the Secretary may reserve not more than

13 $13,000,000 for carrying out part 4;

14 (2) the Secretary may reserve not more than

15 $5,000,000 to support national leadership activities,

16 such as research and demonstration, evaluation, and

17 training and technical assistance in comprehensive

18 school health education; and
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1 (3) the Secretary may reserve not more than 5

2 percent for administrative expenses regarding parts

3 3 and 4.

4 (c) RELATION TO OTHER FUNDS.—The authoriza5 tions of appropriations established in subsection (a) are

6 in addition to any other authorizations of appropriations

7 that are available for the purpose described in such sub8 section.

9 SEC. 113. DEFINITIONS.

10 (a) COMPREHENSIVE SCHOOL HEALTH EDUCATION

11 PROGRAM.—For purposes of this subtitle, the term ‘‘com12 prehensive school health education program’’ means a pro13 gram that addresses locally relevant priorities and meets

14 the following conditions:

15 (1) The program is sequential, and age and de16 velopmentally appropriate.

17 (2) The program is provided, in the area served

18 by the program, every year for all students from kin19 dergarten through grade 12.

20 (3) The program provides comprehensive health

21 education, including the following components:

22 (A) Community health.

23 (B) Environmental health.

24 (C) Personal health.

25 (D) Family life.
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1 (E) Growth and development.

2 (F) Nutritional health.

3 (G) Prevention and control of diseases, dis4 abilities, and genetic disorders.

5 (H) Safety, prevention, and treatment of

6 injuries, including motor vehicle injuries.

7 (I) Substance abuse, including tobacco and

8 alcohol use.

9 (J) Consumer health, including education

10 to ensure that students understand the benefits

11 and appropriate use of medical services, includ12 ing immunizations and other clinical preventive

13 services.

14 (K) Mental health.

15 (4) The program promotes personal responsibil16 ity for a healthy lifestyle and provides the knowledge

17 and skills necessary to adopt a healthy lifestyle, in18 cluding teaching the legal, social, and health con19 sequences of behaviors that pose health risks.

20 (5) The program is sensitive to cultural and

21 ethnic issues in the content of instructional mate22 rials and approaches.

23 (6) The program includes activities that sup24 port instruction.
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1 (7) The program includes activities to promote

2 involvement by parents, families, community organi3 zations, and other appropriate entities.

4 (8) The program is coordinated with other Fed5 eral, State, and local health education and preven6 tion programs, including such programs under title

7 XXVII of the Public Health Service Act, and with

8 other Federal, State and local education programs,

9 including those carried out under title I of the Ele10 mentary and Secondary Education Act of 1965.

11 (9) The program focuses on the particular

12 health concerns of the students in the State, school

13 district, or school, as the case may be.

14 (b) OTHER DEFINITIONS.—For purposes of this sub15 title:

16 (1) The term ‘‘local educational agency’’ has

17 the meaning given such term in section 1471(12) of

18 the Elementary and Secondary Education Act of

19 1965.

20 (2) The term ‘‘State educational agency’’ has

21 the meaning given such term in section 1471(23) of

22 the Elementary and Secondary Education Act of

23 1965.
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1 PART 2—PURPOSES

2 SEC. 121. PURPOSES.

3 Subject to the subsequent provisions of this subtitle,

4 the purposes of this subtitle are as follows:

5 (1) To support the provision in kindergarten

6 through grade 12 of sequential, age-appropriate,

7 comprehensive health education programs that ad8 dress locally relevant priorities.

9 (2) To establish a national framework within

10 which States can create comprehensive school health

11 education programs that—

12 (A) target the health risk behaviors ac13 counting for the majority of the morbidity and

14 mortality among youth and adults, including

15 the following: Tobacco use; alcohol and other

16 drug abuse; sexual behaviors resulting in infec17 tion with the human immunodeficiency virus, in

18 other sexually transmitted diseases or in unin19 tended pregnancy; behaviors resulting in inten20 tional and unintentional injuries; dietary pat21 terns resulting in disease; and sedentary life22 styles; and

23 (B) are integrated with plans and pro24 grams in the State, if any, under title III of the

25 Goals 2000: Educate America Act and those

26 targeting health promotion and disease preven-
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1 tion goals related to the national health objec2 tives set forth in Healthy People 2000.

3 (3) To pay the initial costs of planning and es4 tablishing Statewide comprehensive school health

5 education programs that will be implemented and

6 maintained with local, State, and other Federal re7 sources.

8 (4) To support Federal activities such as re9 search and demonstrations, evaluations, and training

10 and technical assistance regarding comprehensive

11 school health education.

12 (5) To motivate youth, especially low-achieving

13 youth, to stay in school, avoid teen pregnancy, and

14 strive for success by providing intensive, high-quality

15 health education programs that include peer-teach16 ing, family, and community involvement.

17 (6) To improve the knowledge and skills of chil18 dren and youth by integrating academic and experi19 ential learning in health education with other ele20 ments of a comprehensive school health program.

21 (7) To further the National Education Goals

22 set forth in title I of the Goals 2000: Educate Amer23 ica Act and the national health objectives set forth

24 in Healthy People 2000.
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1 PART 3—GRANTS TO STATE EDUCATION

2 AGENCIES

3 Subpart A—Planning Grants for State Education

4 Agencies

5 SEC. 131. APPLICATION FOR GRANT.

6 (a) IN GENERAL.—Any State educational agency

7 that wishes to receive a planning grant under this part

8 shall submit an application to the Secretary of Health and

9 Human Services, at such time and in such manner as the

10 Secretary may require.

11 (b) APPLICATION; JOINT DEVELOPMENT; CON12 TENTS.—An application under subsection (a) shall be

13 jointly developed by the State educational agency and the

14 State health agencies of the State involved, and shall con15 tain the following:

16 (1) An assessment of the State’s need for com17 prehensive school health education, using goals es18 tablished by the Department of Health and Human

19 Services and the Department of Education and the

20 State’s school improvement plan, if any, under title

21 III of Goals 2000: Educate America Act.

22 (2) A description of how the State educational

23 agency will collaborate with the State public health

24 agency in the planning, development, and implemen25 tation of a comprehensive school health education
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1 program in the State, including coordination of ex2 isting health education programs and resources.

3 (3) A plan to build capacity at the State and

4 local levels to provide staff development and tech5 nical assistance to local educational agency and local

6 health agency personnel involved with comprehensive

7 school health education.

8 (4) A preliminary plan for evaluating com9 prehensive school health education activities.

10 (5) Information demonstrating that the State

11 has established a State-level advisory council whose

12 membership includes representatives of the State

13 agencies with principal responsibilities for programs

14 regarding health, education, and mental health.

15 (6) A timetable and proposed budget for the

16 planning process.

17 (7) Such other information and assurances as

18 the Secretary may require.

19 (c) NUMBER OF GRANTS.—States may receive one

20 planning grant annually and no more than two planning

21 grants may be awarded to any one State.

22 SEC. 132. APPROVAL OF SECRETARY.

23 The Secretary may approve the application of a State

24 under section 131 if the Secretary determines that—
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1 (1) the application meets the requirements of

2 this part; and

3 (2) there is a substantial likelihood that the

4 State will be able to develop and implement a com5 prehensive school health education plan that com6 plies with the requirements of part 2.

7 SEC. 133. AMOUNT OF GRANT.

8 For any fiscal year, the minimum grant to any State

9 under this part is an amount determined by the Secretary

10 to be necessary to enable the State to conduct the plan11 ning process and the maximum such grant is $500,000.

12 SEC. 134. AUTHORIZED ACTIVITIES.

13 A State may use funds received under this part only

14 for the following:

15 (1) To establish and carry out the State plan16 ning process.

17 (2) To conduct Statewide or sub-State regional

18 coordination and collaboration activities for local

19 educational agencies, local health agencies, schools

20 of public health, departments of preventive health or

21 community medicine, and other agencies and organi22 zations, as appropriate.

23 (3) To conduct activities to build capacity to

24 provide staff development and technical assistance

25 services to local educational agency and local health
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1 agency personnel involved with comprehensive school

2 health education.

3 (4) To develop student learning objectives and

4 assessment instruments.

5 (5) To work with State and local health agen6 cies and State and local educational agencies to re7 duce barriers to the implementation of comprehen8 sive school health education programs in schools.

9 (6) To prepare the plan required to receive an

10 implementation grant under part 2.

11 (7) To adopt, validate, and disseminate curricu12 lum models and program strategies, if the Secretary

13 determines that such activities are necessary to

14 achieving the objectives of the State’s program.

15 Subpart B—Implementation Grants for State

16 Education Agencies

17 SEC. 141. APPLICATION FOR GRANT.

18 (a) IN GENERAL.—Any State that wishes to receive

19 an implementation grant under this part shall submit an

20 application to the Secretary of Health and Human Serv21 ices, at such time, in such manner, and containing such

22 information and assurances as the Secretary may require.

23 (b) APPLICATION AND STATE PLAN; JOINT DEVEL24 OPMENT; CONTENTS.—An application under subsection

25 (a) shall be jointly developed by the State educational
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1 agency and the State health agencies of the State involved,

2 and shall include a State plan for comprehensive school

3 health education programs (as defined in section 113) that

4 describes the following:

5 (1) The State’s goals and objectives for those

6 programs.

7 (2) How the State will allocate funds to local

8 educational agencies in accordance with section 144.

9 (3) How the State will coordinate programs

10 under this part with other local, State and Federal

11 health education programs.

12 (4) How comprehensive school health education

13 programs will be coordinated with other local, State

14 and Federal education programs, such as programs

15 under title I of the Elementary and Secondary Edu16 cation Act of 1965, with the State’s school improve17 ment plan, if any, under title III of the Goals 2000:

18 Educate America Act, and with any similar pro19 grams.

20 (5) How the State has worked with State and

21 local education agencies and with State and local

22 health agencies to reduce barriers to implementing

23 comprehensive school health education programs.
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1 (6) How the State will monitor the implementa2 tion and effectiveness of such programs by local edu3 cational agencies.

4 (7) How the State will build capacity for profes5 sional development of health educators and the re6 gional deployment and employment of such edu7 cators.

8 (8) How the State will provide staff develop9 ment and technical assistance to local educational

10 agencies.

11 (9) The respective roles of the State educational

12 agency, local educational agencies, the State health

13 agency, and the local health agencies in developing

14 and implementing such school health education pro15 grams.

16 (10) How such school health education pro17 grams will be tailored to the extent practicable to be

18 culturally and linguistically sensitive and responsive

19 to the various needs of the students served, includ20 ing individuals with disabilities, and individuals from

21 disadvantaged backgrounds (including racial and

22 ethnic minorities).

23 (11) How the State will evaluate and report on

24 the State’s progress toward attaining the goals and

25 objectives described in paragraph (1).
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1 SEC. 142. SELECTION OF GRANTEES.

2 (a) SELECTION OF GRANTEES.—The Secretary shall

3 establish criteria for the competitive selection of grantees

4 under this part.

5 (b) OPPORTUNITY FOR PLANNING GRANT.—If the

6 Secretary does not approve a State’s application under

7 this part and determines that the State could benefit from

8 a planning grant under part 1, the Secretary shall inform

9 the State of any planning grant funds that may be avail10 able to it under part 1, subject to section 131(c).

11 SEC. 143. AMOUNT OF GRANT.

12 (a) IN GENERAL.—For any fiscal year, the minimum

13 grant to any State under this part is an amount deter14 mined by the Secretary to be necessary to enable the State

15 to conduct the implementation process.

16 (b) CRITERIA.—In determining the amount of any

17 such grant, the Secretary may consider such factors as

18 the number of children enrolled in schools in the State,

19 the number of school-aged children living in poverty in the

20 State, and the scope and quality of the State’s plan.

21 SEC. 144. AUTHORIZED ACTIVITIES; LIMITATION ON ADMIN22 ISTRATIVE COSTS.

23 (a) SUBGRANTS TO LOCAL EDUCATIONAL AGEN24 CIES.—Each State that receives funds under this part for

25 any fiscal year shall retain not more than 75 percent of

26 those funds in the first year, 50 percent of those funds
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1 in the second and third years, and 25 percent of those

2 funds in each succeeding year. Those funds not retained

3 by the State shall be used to make grants to local edu4 cational agencies in accordance with section 145.

5 b) STATE-LEVEL ACTIVITIES.—Each State shall use

6 retained funds for any fiscal year for the following pur7 poses:

8 (1) To conduct Statewide or sub-State regional

9 coordination and collaboration activities.

10 (2) To adapt, validate, or disseminate program

11 models or strategies for comprehensive school health

12 education.

13 (3) To build capacity to deliver staff develop14 ment and technical assistance services to local edu15 cational agencies, and State and local health agen16 cies.

17 (4) To promote program activities involving

18 families and coordinating program activities with

19 community groups and agencies.

20 (5) To evaluate and report to the Secretary on

21 the progress made toward attaining the goals and

22 objectives described in section 131(b)(1).

23 (6) To conduct such other activities to achieve

24 the objectives of this part as the Secretary may by

25 regulation authorize.
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1 (c) STATE ADMINISTRATION.—Of the amounts re2 ceived by a State for a fiscal year under this part and

3 remaining after any grants to local educational agencies

4 made from such amounts, the State may use up to 10

5 percent for the costs of administering such amounts, in6 cluding the activities of the State advisory council and

7 monitoring the performance of local educational agencies.

8 SEC. 145. SUBGRANTS TO LOCAL EDUCATIONAL AGENCIES.

9 (a) APPLICATION FOR GRANT.—Any local edu10 cational agency that wishes to receive a grant under this

11 part shall submit an application to the State, containing

12 such information and assurances as the State may require,

13 including a description of the following:

14 (1) The local educational agency’s goals and ob15 jectives for comprehensive school health education

16 programs.

17 (2) How the local educational agency will con18 centrate funds in high-need schools and provide suf19 ficient funds to targeted schools to ensure the imple20 mentation of comprehensive programs.

21 (3) How the local educational agency will mon22 itor the implementation of these programs.

23 (4) How the local educational agency will en24 sure that school health education programs are tai25 lored to the extent practicable to be culturally and
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1 linguistically sensitive and responsive to the various

2 needs of the students served, including individuals

3 with disabilities, and individuals from disadvantaged

4 backgrounds (including racial and ethnic minorities).

5 (5) How the local educational agency, in con6 sultation with the local health agency, will evaluate

7 and report on its progress toward attaining the goals

8 and objectives described in paragraph (1).

9 (b) SELECTION OF SUBGRANTEES.—Each State shall

10 give priority to applications from local educational agen11 cies serving areas with high needs, as indicated by criteria

12 developed by the State, which shall include, but need not

13 be limited to, high rates of any of the following:

14 (1) Poverty among school-aged youth.

15 (2) Births to adolescents.

16 (3) Sexually transmitted diseases among school17 aged youth.

18 (4) Drug and alcohol use among school-aged

19 youth.

20 (5) Violence among school-aged youth.

21 (6) Obesity in school-aged youth.

22 (c) AUTHORIZED ACTIVITIES.—Each local edu23 cational agency that receives a grant under this part shall

24 use the grant funds to implement comprehensive school

25 health education programs, as defined in section 113. The
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1 purposes for which the grant may be expended include

2 compensating individuals who teach such programs.

3 Subpart C—State and Local Reports

4 SEC. 151. STATE AND LOCAL REPORTS.

5 (a) STATE REPORTS.—Each State that receives a

6 grant under this part shall collect and submit to the Sec7 retary such data and other information on State and local

8 programs as the Secretary may require.

9 (b) IN GENERAL.—Each local educational agency

10 that receives a grant under part 2 shall collect and report

11 to the State such data and other information as the Sec12 retary may require.

13 PART 4—GRANTS TO CERTAIN LOCAL

14 EDUCATIONAL AGENCIES

15 Subpart A—Eligibility

16 SEC. 161. SUBSTANTIAL NEED OF AREA SERVED BY

17 AGENCY.

18 Any local educational agency is eligible for a grant

19 under this part for any fiscal year if—

20 (1) the agency enrolls at least 25,000 students;

21 and

22 (2) the geographic area served by the agency

23 has a substantial need for such a grant, relative to

24 other geographic areas in the United States.
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1 Subpart B—Planning Grants for Local Education

2 Agencies

3 SEC. 171. APPLICATION FOR GRANT.

4 (a) IN GENERAL.—Any local educational agency that

5 wishes to receive a planning grant under this part shall

6 submit an application to the Secretary of Health and

7 Human Services at such time and in such manner as the

8 Secretary may require.

9 (b) STATE EDUCATIONAL AGENCY REVIEW.—Each

10 such local educational agency, before submitting its appli11 cation to the Secretary, shall submit the application to the

12 State educational agency for comment by such agency and

13 by the State health agencies of the State.

14 (c) CONTENTS OF APPLICATIONS.—Each such appli15 cation shall contain the following:

16 (1) An assessment of the local educational

17 agency’s need for comprehensive school health edu18 cation, using goals established by the Department of

19 Health and Human Services and the Department of

20 Education, as well as local health and education

21 strategies, such as State school improvement plans,

22 if any, under title III of the Goals 2000: Educate

23 America Act.

24 (2) Information demonstrating that the local

25 educational agency has established or selected a

26 community-level advisory council, which shall include
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1 representatives of relevant community agencies such

2 as those that administer education, child nutrition,

3 health, and mental health programs.

4 (3) A description of how the local educational

5 agency will collaborate with the State educational

6 agency, the State health agency, and the local health

7 agency in the planning and development of a com8 prehensive school health education program in the

9 local educational agency, including coordination of

10 existing health education programs and resources.

11 (4) A plan to build capacity at the local edu12 cational agency to provide staff development and

13 technical assistance to local educational agency and

14 local health agency personnel involved with com15 prehensive school health education.

16 (5) A preliminary plan for evaluating com17 prehensive school health education activities.

18 (6) A timetable and proposed budget for the

19 planning process.

20 (7) Such other information and assurances as

21 the Secretary may require.

22 (d) NUMBER OF GRANTS.—Local educational agen23 cies may receive at a maximum two annual planning

24 grants.
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1 SEC. 172. SELECTION OF GRANTEES.

2 (a) SELECTION CRITERIA.—The Secretary shall es3 tablish criteria for the competitive selection of grantees

4 under this part.

5 (b) LIMITATION.—The Secretary shall not approve

6 an application from a local educational agency in a State

7 that has an approved plan under part 1 or 2 of subtitle

8 C of this title unless the Secretary determines, after con9 sultation with the State that the local application is con10 sistent with the State plan, if one exists.

11 SEC. 173. AMOUNT OF GRANT.

12 For any fiscal year, the minimum grant to any local

13 educational agency under this part is an amount deter14 mined by the Secretary to be necessary to enable the local

15 educational agency to conduct the planning process, and

16 the maximum such grant is $500,000.

17 SEC. 174. AUTHORIZED ACTIVITIES.

18 A local educational agency may use funds received

19 under this part only for the following:

20 (1) To establish and carry out the local edu21 cational agency planning process.

22 (2) To undertake joint training, staffing, ad23 ministration, and other coordination and collabora24 tion activities for local educational agencies, local

25 health agencies, and other agencies and organiza26 tions, as appropriate.
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1 (3) To conduct activities to build capacity to

2 provide staff development and technical assistance

3 services to local educational agency and local health

4 agency personnel involved with comprehensive school

5 health education.

6 (4) To develop student learning objectives and

7 assessment instruments.

8 (5) To work with State and local health agen9 cies and State educational agencies to reduce bar10 riers to the implementation of comprehensive school

11 health education programs in schools, by, for exam12 ple, ensuring that adequate time is a available dur13 ing the school day for such programs.

14 (6) To prepare the plan required to receive an

15 implementation grant under part 3.

16 Subpart C—Implementation Grants for Local

17 Educational Agencies

18 SEC. 181. APPLICATION FOR GRANT.

19 (a) IN GENERAL.—Any local educational agency that

20 wishes to receive an implementation grant under this part

21 shall submit an application to the Secretary of Health and

22 Human Services, at such time, in such manner, and con23 taining such information and assurances as the Secretary

24 may require.
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1 (b) STATE EDUCATIONAL AGENCY REVIEW.—Each

2 such local educational agency shall submit its application

3 to the State educational agency for comment before sub4 mitting it to the Secretary.

5 (c) LOCAL EDUCATIONAL AGENCY PLAN.—Each

6 such application shall include a local educational agency

7 plan for comprehensive school health education programs

8 (as defined in section 113) that describes the following:

9 (1) The local educational agency’s goals and ob10 jectives for those programs.

11 (2) How the local educational agency will co12 ordinate programs under this part with other local,

13 State and Federal health education programs.

14 (3) How comprehensive school health education

15 programs will be coordinated with other local, State

16 and Federal education programs, such as programs

17 under title I of the Elementary and Secondary Edu18 cation Act of 1965, and with State’s school improve19 ment plan, if any, under title III of the Goals 2000:

20 Educate America Act.

21 (4) How the local educational agency has

22 worked with State educational agencies and with

23 State and local health agencies to reduce barriers to

24 implementing comprehensive school health education

25 programs.
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1 (5) How local educational agencies will monitor

2 the implementation of such programs.

3 (6) How the local educational agency, in con4 sultation with the State educational agency and

5 State and local health agencies and in conjunction

6 with other local professional development activities,

7 will build capacity for professional development of

8 health educators.

9 (7) How the local educational agency, in con10 sultation with the State educational agency and

11 State and local health agencies, will provide staff de12 velopment and technical assistance.

13 (8) The respective roles of the State educational

14 agency, local educational agencies, the State health

15 agency, and the local health agencies in developing

16 and implementing such school health education pro17 grams.

18 (9) How such school health education programs

19 will be tailored to the extent practicable to be cul20 turally and linguistically sensitive and responsive to

21 the various needs of the students served, including

22 individuals with disabilities, and individuals from

23 disadvantaged backgrounds (including racial and

24 ethnic minorities).
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1 (10) How the local educational agency, in con2 sultation with the local health agency, will evaluate

3 and report on the local educational agency’s progress

4 toward attaining the goals and objectives described

5 in paragraph (1).

6 SEC. 182. SELECTION OF GRANTEES.

7 (a) SELECTION OF GRANTEES.—The Secretary shall

8 establish criteria for the competitive selection of grantees

9 under this part.

10 (b) LIMITATION.—The Secretary shall not approve

11 an application from a local educational agency in a State

12 that has an approved plan under part 1 or 2 of subtitle

13 C unless the Secretary determines, after consultation with

14 the State that the local application is consistent with such

15 State plan.

16 (c) OPPORTUNITY FOR PLANNING GRANT.—If the

17 Secretary does not approve a local educational agency’s

18 application under this part and determines that the local

19 educational agency could benefit from a planning grant

20 under part 2, the Secretary shall inform the local edu21 cational agency of any planning grant funds that may be

22 available to it under part 2, subject to section 171(d).

23 SEC. 183. AMOUNT OF GRANT.

24 (a) IN GENERAL.—For any fiscal year, the minimum

25 grant to any local educational agency under this part is
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1 an amount determined by the Secretary to be necessary

2 to enable the local educational agency to conduct the im3 plementation process.

4 (b) CRITERIA.—In determining the amount of any

5 such grant, the Secretary may consider such factors as

6 the number of children enrolled in schools in the local edu7 cational agency, the number of school-aged children living

8 in poverty in the local educational agency, and the scope

9 and quality of the local educational agency’s plan.

10 SEC. 184. AUTHORIZED ACTIVITIES.

11 Each local educational agency that receives a grant

12 under this part shall use the grant funds as follows:

13 (1) To implement comprehensive school health

14 education programs, as defined in section 113.

15 (2) To conduct local or regional coordination

16 and collaboration activities.

17 (3) To provide staff development and technical

18 assistance to schools, local health agencies, and

19 other community agencies involved in providing com20 prehensive school health education programs.

21 (4) To administer the program and monitor

22 program implementation at the local level.

23 (5) To evaluate and report to the Secretary on

24 the local educational agency’s progress toward at-
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1 taining the goals and objectives described in section

2 181(c)(1).

3 (6) To conduct such other activities as the Sec4 retary may by regulation authorize.

5 SEC. 185. REPORTS.

6 Each local educational agency that receives a grant

7 under this part shall collect and report to the Secretary

8 and the State such data and other information as the Sec9 retary may require.

10 TITLE II—AMENDMENTS TO IN11 TERNAL REVENUE CODE OF

12 1986

13 SEC. 201. DISALLOWANCE OF DEDUCTION FOR CERTAIN

14 ADVERTISING EXPENSES FOR TOBACCO

15 PRODUCTS OR ALCOHOLIC BEVERAGES.

16 (a) DEDUCTION DISALLOWED.—Part IX of sub17 chapter B of chapter 1 of the Internal Revenue Code of

18 1986 (relating to items not deductible) is amended by add19 ing at the end thereof the following new section:

20 ‘‘SEC. 280I. DISALLOWANCE OF DEDUCTION FOR CERTAIN

21 ADVERTISING EXPENSES FOR TOBACCO

22 PRODUCTS OR ALCOHOLIC BEVERAGES.

23 ‘‘(a) IN GENERAL.—No deduction otherwise allow24 able under this chapter shall be allowed for any amount
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1 paid or incurred to advertise any tobacco product or

2 alcoholic beverage—

3 ‘‘(1) on television or radio,

4 ‘‘(2) in any newspaper, magazine, or other peri5 odical,

6 ‘‘(3) on any billboard, poster, sign, decal, or

7 matchbook,

8 ‘‘(4) through promotion allowances, premiums,

9 or samples, or

10 ‘‘(5) through any means of private advertising.

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

12 ‘‘(1) TOBACCO PRODUCT.—The term ‘tobacco

13 product’ means any cigarette, cigar, smokeless to14 bacco, pipe tobacco, or similar tobacco product. For

15 purposes of the preceding sentence, the terms ‘ciga16 rette’, ‘cigar’, and ‘smokeless tobacco’ have the re17 spective meanings given to such terms by section

18 5702.

19 ‘‘(2) ALCOHOLIC BEVERAGE.—The term ‘alco20 holic beverage’ means any beverage which is subject

21 to tax under subpart A, C, or D of part I of

22 subchapter A of chapter 51 (relating to taxes on

23 distilled spirits, wines, and beer).’’.
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1 (b) CONFORMING AMENDMENT.—The table of sec2 tions for such part IX is amended by adding at the end

3 thereof the following new item:

‘‘Sec. 280I. Disallowance of deduction for certain advertising expenses for tobacco products or alcoholic beverages.’’

4 (c) EFFECTIVE DATE.—The amendments made by

5 this section shall apply to amounts paid or incurred after

6 the date of the enactment of this Act in taxable years end7 ing after such date.

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