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[House Report 109-509]
[From the U.S. Government Publishing Office]

109th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     109-509

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                   HEALTH CENTERS RENEWAL ACT OF 2006

                                _______
                                

 June 20, 2006.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Barton of Texas, from the Committee on Energy and Commerce, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 5573]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 5573) to amend the Public Health Service Act to 
provide additional authorizations of appropriations for the 
health centers program under section 330 of such Act, having 
considered the same, report favorably thereon without amendment 
and recommend that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     1
Background and Need for Legislation..............................     2
Hearings.........................................................     3
Committee Consideration..........................................     3
Committee Votes..................................................     3
Committee Oversight Findings.....................................     3
Statement of General Performance Goals and Objectives............     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Committee Cost Estimate..........................................     4
Congressional Budget Office Cost Estimate........................     4
Federal Mandates Statement.......................................     5
Advisory Committee Statement.....................................     5
Constitutional Authority Statement...............................     5
Applicability to Legislative Branch..............................     5
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     6

                          Purpose and Summary

    The purpose of H.R. 5573, the Health Centers Renewal Act of 
2006, is to reauthorize the existing Community Health Center 
Program for fiscal years 2007 through 2011. The Health Centers 
Renewal Act will ensure that community health centers can 
continue to offer health care services to millions of medically 
underserved and uninsured people.

                  Background and Need for Legislation

    Community Health Centers (CHCs) have been in existence 
since the 1960s to provide health services in underserved 
communities. In 1996, the Health Centers Consolidation Act 
combined the various federally qualified health centers 
(FQHCs)--community, migrant, homeless, and health centers for 
residents of public housing--under Section 330 of the Public 
Health Service Act (PHSA) and created the Consolidated Health 
Centers Program. The program was later reauthorized through 
FY2006 as part of the Health Care Safety Net Amendments of 
2002. The CHC program is administered by the Health Resources 
and Services Administration's (HRSA) Bureau of Primary Health 
Care.
    CHCs have in common several specific features, as provided 
by subsection 330(k)(3) of the PHSA. CHCs (1) serve either a 
federally designated, medically underserved area or a 
population; (2) have nonprofit, public, or tax exempt status; 
(3) provide comprehensive primary health care services, 
referrals, and other services needed to facilitate access to 
care, such as care management, translation, and transportation; 
(4) have a governing board in which the majority of members are 
patients of the health center; and (5) provide services to all 
in the service area, regardless of ability to pay, and offer a 
sliding fee schedule that adjusts according to family income.
    Once designated, an FQHC is eligible for cost-based 
reimbursement from Medicaid, access to physicians through the 
National Health Service Corps and J-1 Visa Waiver Program, and 
medical malpractice coverage under the Federal Tort Claims Act.
    Presently, there are over 900 CHCs operating 3,600 urban 
and rural sites in every State and territory. Primary health 
services delivered at CHCs also include pre-natal care, mental 
health services, blood pressure and cholesterol checks, and 
care of chronic diseases such as diabetes. According to the 
Health Resources and Services Administration's (HRSA) Bureau of 
Primary Health Care, CHCs in 2003 treated over 12 million 
people in medically underserved areas, including 4.8 million 
uninsured patients. In 2003, CHCs delivered mammograms to over 
200,000 women, gave check-ups and other health services to 1.6 
million children, and administered over 2.2 million 
immunizations. By the end of 2007, 15.8 million patients will 
be receiving affordable primary and preventative health care at 
4,015 sites across the country. Notably, nearly 90 percent of 
the CHC patient population lives under 200 percent of the 
Federal poverty level.
    The Secretary may make grants, for a period of not to 
exceed two years, for the costs of the operation of public and 
nonprofit private entities which provide health services to 
medically underserved populations but with respect to which the 
Secretary is unable to make each of the determinations required 
by subsection (k)(3).
    In the May 4, 2006, hearing, witnesses differed in their 
interpretation of HRSAs current authority to provide waivers of 
the community governance board requirement. The Committee 
intends that the waiver authority of subsection (e)(1)(B) apply 
to all requirements set forth in subsection (k), including the 
ability to waive the majority patient board requirement.
    The Committee notes that look-alike centers, as outlined in 
the Social Security Act, must meet the same standards as FQHCs 
receiving grants under Section 330 of the PHSA. It is the 
intent of the Committee to clarify that the authority of the 
Secretary under existing law to provide waivers to entities 
receiving grants under Section 330 of the PHSA for particular 
requirements under subsection 330(k) also be available to the 
Secretary when making the determination that an entity applying 
for look-alike status meets the requirements set forth under 
Section 330. This bill does not expand the scope of the 
Secretary's waiver authority under existing law but rather 
clarifies the current waiver authority of the Secretary.

                                Hearings

    On May 4, 2006, the Subcommittee on Health held a hearing 
entitled ``The Critical Role of Community Health Centers in 
Ensuring Access to Care.'' The Subcommittee received testimony 
from: Elisabeth Handley, Division Director for Policy and 
Development, Bureau of Primary Health Care, Health Resources 
and Services Administration, U.S. Department of Health and 
Human Services; Roy C. Brooks, Commissioner of Tarrant County, 
Texas; Kathy Grant-Davis, Executive Director, New Jersey 
Primary Care Association; and Dan Hawkins, Vice President for 
Federal, State and Public Affairs, National Association of 
Community Health Centers, Inc.

                        Committee Consideration

    On Thursday, June 8, 2006, the Subcommittee on Health met 
in open markup session and approved H.R. 5573 for Full 
Committee consideration, without amendment, by a voice vote, a 
quorum being present. On Thursday, June 15, 2006, the Committee 
on Energy and Commerce met in open markup session and ordered 
H.R. 5573 reported to the House, without amendment, by a voice 
vote, a quorum being present.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken in connection with ordering 
H.R. 5573 reported. A motion by Mr. Deal to order H.R. 5573 
reported to the House, without amendment, was agreed to by a 
voice vote.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee held an oversight 
hearing and made findings that are reflected in this report.

         Statement of General Performance Goals and Objectives

    The goal of H.R. 5573 is to allow Community Health Centers 
to continue providing health care services to the Nation's 
medically underserved.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
5573, the Health Centers Renewal Act of 2006, would result in 
no new or increased budget authority, entitlement authority, or 
tax expenditures or revenues.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, June 19, 2006.
Hon. Joe Barton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 5573, the Health 
Centers Renewal Act of 2006.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Camile 
Williams.
            Sincerely,
                                                      Donald B. Marron,
                                                   Acting Director.
    Enclosure.

H.R. 5573--Health Centers Renewal Act of 2006

    Summary: H.R. 5573 would amend section 330 of the Public 
Health Service Act to authorize through 2011 a program that 
provides grants to community health centers (CHCs). Assuming 
appropriation of the authorized amounts, CBO estimates that 
implementing the bill would cost $1.0 billion in 2007 and $8.9 
billion over the 2007-2011 period.
    H.R. 5573 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would impose no costs on state, local, or tribal 
governments.
    Estimated Cost to the Federal Government: The estimated 
budgetary impact of H.R. 5573 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                                      By fiscal year, in millions of dollars
                                                                 -----------------------------------------------
                                                                   2006    2007    2008    2009    2010    2011
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law:
    Budget Authority\1\.........................................   1,690       0       0       0       0       0
    Estimated Outlays...........................................     896     710       0       0       0       0
Proposed Changes:
    Authorization Level.........................................       0   1,963   1,999   2,015   2,041   2,041
    Estimated Outlays...........................................       0   1,040   1,884   1,966   1,988   1,999
Spending Under H.R. 5573:
    Authorization Level\1\......................................   1,690   1,963   1,999   2,015   2,041   2,041
    Estimated Outlays...........................................     896   1,750   1,884   1,966   1,988   1,999
----------------------------------------------------------------------------------------------------------------
\1\The 2006 level is the amount appropriated for that year for grants to community health centers.

    Basis of Estimate: The Health Resources and Services 
Administration administers a program that provides grants to 
community organizations for the development and operation of 
community health centers. Those health centers provide medical 
care to poor and underserved populations. Authorization for 
that grant program expires in 2006.
    H.R. 5573 would renew funding for that program by 
authorizing appropriation of about $2 billion a year in 2007 
through 2011.
    Based on historical patterns of spending for community 
health centers, CBO estimates that implementing the bill would 
cost $1.0 billion in 2007 and $8.9 billion over the 2007-2011 
period, assuming appropriation of authorized amounts.
    Intergovernmental and Private-Sector Impact: H.R. 5573 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would impose no costs on state, local, or 
tribal governments.
    Estimate prepared by: Federal Costs: Camile Williams. 
Impact on State, Local, and Tribal Governments: Leo Lex. Impact 
on the Private Sector: Paige Shevlin.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for this legislation is provided in 
Article I, section 8, clause 3, which grants Congress the power 
to regulate commerce with foreign nations, among the several 
States, and with the Indian tribes.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation

Section 1. Short Title.

    Section 1 designates the title of the bill as the ``Health 
Centers Renewal Act of 2006.''

Section 2. Findings.

    Section 2 establishes the findings for the legislation.

Section 3. Additional Authorization of Appropriations for Health 
        Centers Program of Public Health Service Act.

    Section 3 authorizes to be appropriated to the Department 
of Health and Human Services to carry out the Act $1.963 
billion for fiscal year 2007, $1.999 billion for fiscal year 
2008, $2.015 billion for fiscal year 2009, $2.041 billion for 
fiscal year 2010, and $2.041 billion for fiscal year 2011.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

              SECTION 330 OF THE PUBLIC HEALTH SERVICE ACT

SEC. 330. HEALTH CENTERS.

  (a)  * * *

           *       *       *       *       *       *       *

  (r) Authorization of Appropriations.--
          [(1) In general.--For the purpose of carrying out 
        this section, in addition to the amounts authorized to 
        be appropriated under subsection (d), there are 
        authorized to be appropriated $1,340,000,000 for fiscal 
        year 2002 and such sums as may be necessary for each of 
        the fiscal years 2003 through 2006.]
          (1) In general.--For the purpose of carrying out this 
        section, in addition to the amounts authorized to be 
        appropriated under subsection (d), there are authorized 
        to be appropriated $1,963,000,000 for fiscal year 2007, 
        $1,999,000,000 for fiscal year 2008, $2,015,000,000 for 
        fiscal year 2009, $2,041,000,000 for fiscal year 2010, 
        and $2,041,000,000 for fiscal year 2011.

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