I

104TH CONGRESS

1ST SESSION H. R. 2206

To provide for the consolidation and simplification of health center programs,

and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

AUGUST 4, 1995

Mr. DINGELL (for himself and Mr. WAXMAN) introduced the following bill;

which was referred to the Committee on Commerce

A BILL

To provide for the consolidation and simplification of health

center programs, and for other purposes.

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

3 SECTION 1. SHORT TITLE AND REFERENCES IN ACT.

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

5 ‘‘Health Centers Consolidation Act of 1995’’.

6 (b) REFERENCES IN ACT.—The amendments in this

7 Act apply to the Public Health Service Act unless other8 wise specifically stated.
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1 SEC. 2. CONSOLIDATION OF AUTHORITY FOR COMMUNITY

2 HEALTH CENTERS, MIGRANT HEALTH CEN3 TERS, HEALTH SERVICES FOR THE HOME4 LESS, AND HEALTH SERVICES FOR RESI5 DENTS OF PUBLIC HOUSING.

6 (a) NEW AND REVISED TERMS.—

7 (1) HEALTH CENTER.—

8 (A) DEFINITION.—Section 330(a) is

9 amended to read as follows:

10 ‘‘(a) For purposes of this section, the term ‘health

11 center’ means an entity that serves a population that is

12 medically underserved, or that serves a special medically

13 underserved population comprised of migratory agricul14 tural workers, seasonal agricultural workers, the homeless,

15 or residents of public housing by providing, either through

16 its staff and supporting resources or through contracts or

17 cooperative arrangements—

18 ‘‘(1) required primary health services (as de19 fined in subsection (b)(1)); and

20 ‘‘(2) as may be appropriate for particular cen21 ters, additional health services (as defined in sub22 section (b)(2)) necessary for the adequate support of

23 the required primary health services;

24 for all residents of the area it serves (referred to in this

25 section as a ‘catchment area’).’’.
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1 (B) CONFORMING AMENDMENTS.—Section

2 330 is amended—

3 (i) by striking the term ‘‘community

4 health center’’ each place such term ap5 pears and inserting ‘‘health center’’; and

6 (ii) by striking the term ‘‘community

7 health centers’’ each place such term ap8 pears and inserting ‘‘health centers’’.

9 (2) REQUIRED PRIMARY HEALTH SERVICES.—

10 Section 330(b)(1) is amended to read as follows:

11 ‘‘(1) The term ‘required primary health serv12 ices’ means—

13 ‘‘(A) basic health services which, for pur14 poses of this section, consist of—

15 ‘‘(i) health services related to family

16 medicine, internal medicine, pediatrics, ob17 stetrics, gynecology, or dentistry that are

18 furnished by physicians, dentists, and,

19 where appropriate, physician assistants,

20 nurse practitioners, and nurse midwives;

21 ‘‘(ii) diagnostic laboratory and

22 radiologic services;

23 ‘‘(iii) preventive health services, in24 cluding—
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1 ‘‘(I) prenatal and perinatal serv2 ices;

3 ‘‘(II) screening for breast and

4 cervical cancer;

5 ‘‘(III) well-child services;

6 ‘‘(IV) immunizations against vac7 cine-preventable diseases;

8 ‘‘(V) screenings for elevated

9 blood lead levels, communicable dis10 eases, and cholesterol;

11 ‘‘(VI) pediatric eye and ear ex12 aminations to determine the need for

13 vision and hearing correction;

14 ‘‘(VII) voluntary family planning

15 services; and

16 ‘‘(VIII) preventive dental serv17 ices;

18 ‘‘(iv) emergency medical services;

19 ‘‘(v) pharmaceutical services as may

20 be appropriate for particular centers;

21 ‘‘(B) referrals to providers of medical serv22 ices and other health-related services (including

23 substance abuse and mental health services);

24 ‘‘(C) patient case management services (in25 cluding counseling, referral, and follow-up serv-
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1 ices) designed to assist health center patients in

2 establishing eligibility for, and gaining access

3 to, Federal, State, and local programs that pro4 vide or financially support the provision of med5 ical, social, educational, or other related serv6 ices;

7 ‘‘(D) services that enable individuals to use

8 the services of the center (including outreach

9 and transportation services and, if a substantial

10 number of the individuals in the population

11 served by a center are of limited English-speak12 ing ability, the services of appropriate personnel

13 fluent in the language spoken by a predominant

14 number of such individuals); and

15 ‘‘(E) education of patients and the general

16 population served by the health center regard17 ing the availability and proper use of health

18 services.’’.

19 (3) ADDITIONAL HEALTH SERVICES.—Section

20 330(b)(2) is amended to read as follows:

21 ‘‘(2) The term ‘additional health services’

22 means services which are not included as required

23 primary health services and which are appropriate to

24 meet the health needs of the population serviced by

25 the health center involved. Such term may include—
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1 ‘‘(A) environmental health services, includ2 ing—

3 ‘‘(i) the detection and alleviation of

4 unhealthful conditions associated with

5 water supply;

6 ‘‘(ii) sewage treatment;

7 ‘‘(iii) solid waste disposal;

8 ‘‘(iv) rodent and parasitic infestation;

9 ‘‘(v) field sanitation;

10 ‘‘(vi) housing; and

11 ‘‘(vii) other environmental factors re12 lated to health; and

13 ‘‘(B) in the case of health centers receiving

14 grants pursuant to subsection (f), special occu15 pation-related health services for migratory ag16 ricultural workers and seasonal agricultural

17 workers, including—

18 ‘‘(i) screening for and control of infec19 tions and parasitic diseases; and

20 ‘‘(ii) accident prevention programs, in21 cluding prevention of excessive pesticide

22 exposure.’’.

23 (b) RELOCATION AND CONSOLIDATION WITHIN SEC24 TION 330 OF AUTHORITIES RESPECTING GRANTS FOR IN25 FANT MORTALITY AND CHILDHOOD MORBIDITY, AND
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1 GRANTS FOR HEALTH CENTERS SERVING MIGRATORY

2 AND SEASONAL WORKERS, HOMELESS, AND PUBLIC

3 HOUSING POPULATIONS.—

4 (1) REDESIGNATION OF SUBSECTIONS.—Sub5 sections (e) through (k) of section 330 are redesig6 nated as subsections (i) through (o), respectively.

7 (2) GRANTS FOR INFANT MORTALITY AND

8 CHILDHOOD MORBIDITY.—

9 (A) Paragraph (2) of section 330(k) (as so

10 redesignated) is amended by redesignating such

11 paragraph as subsection (e);

12 (B) in the material redesignated (by sub13 paragraph (A) of this paragraph) as subsection

14 (e), by striking subparagraphs (A), (D), and

15 (E);

16 (C) in the material redesignated (by sub17 paragraph (A) of this paragraph) as subsection

18 (e), by redesignating subparagraphs (B), (C),

19 and (F) as paragraphs (1) through (3), respec20 tively;

21 (D) in the material redesignated (by sub22 paragraph (A) of this paragraph) as subsection

23 (e), by redesignating each clause designated as

24 (i), (ii), (iii), or (iv), as subparagraph (A), (B),

25 (C), or (D), respectively;
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1 (E) by redesignating clauses (I) and (II) of

2 paragraph (1)(A) (as redesignated by subpara3 graphs (C) and (D) of this paragraph) as

4 clauses (i) and (ii), respectively;

5 (F) by striking ‘‘subparagraph (B)’’ each

6 place such term appears in subsection (e) (as

7 redesignated by subparagraph (A) of this para8 graph) and inserting ‘‘this subsection’’;

9 (G) in subsection (e)(1)(B) (as redesig10 nated by subparagraphs (A), (C), and (D) of

11 this paragraph, by striking ‘‘clause (i)’’ and in12 serting ‘‘subparagraph (A)’’; and

13 (H) in subsection (e)(3) (as redesignated

14 by subparagraphs (A), (C), and (D) of this

15 paragraph)—

16 (i) in the matter preceding subpara17 graph (A), by striking ‘‘subparagraph (B)’’

18 and inserting ‘‘paragraph (1)’’;

19 (ii) by adding ‘‘and’’ at the end of

20 subparagraph (B);

21 (iii) by striking subparagraph (C);

22 and

23 (iv) by redesignating subparagraph

24 (D) as subparagraph (C).
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1 (3) GRANTS FOR HEALTH CENTERS SERVING

2 MIGRATORY AND AGRICULTURAL WORKERS.—

3 (A) Section 330 is amended by inserting

4 after subsection (e) a new subsection as follows:

5 ‘‘(f) MIGRATORY AND SEASONAL AGRICULTURAL

6 WORKER POPULATIONS.—(1) The Secretary is authorized

7 to award grants for the purposes described in subsections

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

9 to a special medically underserved population comprised

10 of migratory agricultural workers, seasonal agricultural

11 workers, and members of the families of such migratory

12 and seasonal workers who are within a designated

13 catchment area, and individuals who have previously been

14 migratory agricultural workers but can no longer meet the

15 requirements of subparagraph (A) of paragraph (4) be16 cause of age or disability and members of their families

17 who are within such catchment area.

18 ‘‘(2) The Secretary may make grants to or enter into

19 contracts with public and nonprofit private entities for

20 projects to plan and develop, and to operate, programs in

21 areas in which no health center serving the special medi22 cally underserved population described in paragraph (1)

23 exists and in which not more than 4000 migratory agricul24 tural workers and their families reside for more than two

25 months—
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1 ‘‘(A) for the provision of emergency care to mi2 gratory agricultural workers, seasonal agricultural

3 workers, and the members of families of such migra4 tory and seasonal workers; and

5 ‘‘(B) for the provision of required primary

6 health services and additional health services for

7 such workers and the members of their families.

8 Any such program may include the acquisition, expansion,

9 and modernization of existing buildings, construction of

10 new buildings, and the provision of training related to the

11 management of programs assisted under this paragraph.’’.

12 (B) Section 329(e) is amended—

13 (i) by redesignating paragraphs (1)

14 and (2) as subparagraphs (A) and (B), re15 spectively; and

16 (ii) by redesignating subsection (e) as

17 paragraph (3) of subsection 330(f).

18 (C) Section 329(a) is amended—

19 (i) in paragraph (4)—

20 (I) in subparagraph (C), by strik21 ing ‘‘subparagraphs (B)’’ and insert22 ing ‘‘clause (ii)’’; and

23 (II) by redesignating subpara24 graphs (A) through (C) as clauses (i)

25 through (iii), respectively;
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1 (ii) by redesignating paragraphs (2),

2 (3), and (4) as subparagraphs (A), (B),

3 and (C), respectively, of new paragraph (4)

4 of section 330(f), and by adjusting their

5 margins so as to align with paragraphs (1)

6 through (3) of such section 330(f).

7 (4) GRANTS FOR HEALTH CENTERS SERVING

8 HOMELESS POPULATIONS.—

9 (A) Section 330 is amended by inserting

10 after subsection (f) a new subsection as follows:

11 ‘‘(g) HOMELESS POPULATIONS.—

12 ‘‘(1) IN GENERAL.—The Secretary is authorized

13 to award grants for the purposes described in sub14 sections (c), (d), and (e) for the planning and deliv15 ery of services to a special medically underserved

16 population comprised of homeless individuals, includ17 ing homeless children and children at risk of home18 lessness.

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

22 under this subsection shall be required to provide

23 substance abuse services as a condition of such

24 grant.
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1 ‘‘(3) SUPPLEMENT NOT SUPPLANT REQUIRE2 MENT.—Any grant awarded under this subsection

3 must be expended to supplement, and not supplant,

4 the health center’s expenditures for the delivery of

5 services to the population described in paragraph

6 (1).’’.

7 (B) Paragraphs (2), (7), and (8) of section

8 340(r) are redesignated as subparagraphs (A),

9 (B), and (C) of paragraph (4), respectively, of

10 section 330(g).

11 (C) Section 330(k)(2)(B) (as redesignated

12 by paragraph (1) of this subsection) is amended

13 by adding at the end the following sentence:

14 ‘‘For purposes of applying the preceding sen15 tence, the term ‘public centers’ shall not include

16 health centers that receive grants pursuant to

17 subsection (g).’’.

18 (5) GRANTS FOR HEALTH CENTERS SERVING

19 PUBLIC HOUSING POPULATIONS.—

20 (A) Section 330 is amended by inserting

21 after subsection (g) a new subsection as follows:

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

23 ‘‘(1) IN GENERAL.—The Secretary is authorized

24 to award grants for the purposes described in sub25 sections (c), and (d), and (e) for the planning and
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1 delivery of services to a special medically under2 served population comprised of residents of public

3 housing (which, for purposes of this subsection, shall

4 have the meaning given such term in section 3(b)(1)

5 of the United States Housing Act of 1937) and per6 sons living in areas immediately accessible to such

7 public housing.

8 ‘‘(2) PREFERENCE.—In awarding grants under

9 this subsection, the Secretary shall give preference

10 to qualified applicants who are resident management

11 corporations under section 20 of the United States

12 Housing Act of 1937 or are receiving funds as a

13 health center under this section.

14 ‘‘(3) SUPPLEMENT NOT SUPPLANT.—Any grant

15 awarded under this subsection must be expended to

16 supplement, and not supplant, the health center’s

17 expenditures for the delivery of services to the popu18 lation described in paragraph (1).’’.

19 (B) Section 340A(g) is amended—

20 (i) by redesignating paragraphs (1)

21 and (2) as subparagraphs (A) and (B), re22 spectively; and

23 (ii) by redesignating subsection (g) in

24 its entirety as paragraph (4) of section

25 330(h) and by adjusting its margins so as
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1 to align with paragraphs (1) and (2) of

2 such subsection.

3 (C) Section 330(k)(2)(B) (as previously

4 amended by paragraph (3)(C) of this sub5 section) is further amended in the last sentence

6 by inserting ‘‘or (h)’’ after ‘‘(g)’’.

7 (6) EXCEPTIONS FROM CERTAIN ADMINISTRA8 TIVE REQUIREMENTS.—

9 (A) SERVICE TO ALL WITHIN CATCHMENT

10 AREA.—Section 330(a) is amended by striking

11 the period and inserting ‘‘, except that the re12 quirement to serve all residents within a

13 catchment area shall not apply to any grant re14 ceived by a health center pursuant to subsection

15 (f), (g), or (h).’’.

16 (B) HEALTH CENTER GOVERNING

17 BOARD.—Section 330(i)(3)(G) (as redesignated

18 by paragraph (1) of this subsection) is amended

19 by striking the semi-colon at the end and in20 serting ‘‘, except that, upon a showing of good

21 cause, the Secretary may waive all or part of

22 the requirements of this subparagraph in the

23 case of a health center that receives a grant

24 pursuant to subsection (f), (g), or (h).’’.

25 (c) REDUCTION IN ADMINISTRATIVE DETAILS.—
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1 (1) Section 330(b)(4)(B) is amended by strik2 ing ‘‘infant mortality in an area or population group,

3 other’’.

4 (2) Section 330(d)(4)(A)(ii) is amended by

5 striking the last sentence.

6 (3) Section 330(d)(4)(B) is amended by strik7 ing everything after ‘‘underpayments’’ and inserting

8 instead a period.

9 (4) Section 330(i)(2) (as redesignated by sub10 section (b)(1) of this section) is amended by striking

11 ‘‘include—’’ and all that follows through ‘‘Such an

12 application shall also include’’ and inserting instead

13 ‘‘include a description of the need for health services

14 in the center’s catchment area and’’; and

15 (5) Section 330(i)(3)(H) (as redesignated by

16 subsection (b)(1) of this section) is amended—

17 (A) in clause (i), by striking ‘‘section

18 1861(z) of the Social Security Act’’ and insert19 ing ‘‘the Secretary’’;

20 (B) by inserting ‘‘and’’ at the end of clause

21 (III); and

22 (C) by striking ‘‘, and (V)’’ and all that

23 follows and inserting instead a semi-colon.

24 (6) Section 330(j) (as redesignated by sub25 section (b)(1) of this section) is amended—
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1 (A) by striking ‘‘(1)’’; and

2 (B) by striking paragraph (2).

3 (7) Section 330(m) (as redesignated by sub4 section (b)(1) of this section) is amended—

5 (A) by striking paragraph (1) and by re6 designating paragraphs (2) through (4) as

7 paragraphs (1) through (3), respectively;

8 (B) in the first sentence of paragraph (1)

9 (as redesignated by subparagraph (A) of this

10 paragraph), by striking everything after ‘‘re11 quire’’ and inserting a period; and

12 (C) in the first sentence of paragraph (2)

13 (as redesignated by subparagraph (A) of this

14 paragraph), by striking ‘‘or to provide for and

15 audit’’.

16 (d) APPROPRIATIONS.—

17 (1) AUTHORIZATION.—Section 330(k)(1)(A) (as

18 redesignated by subsection (b)(1) of this section) is

19 amended to read as follows:

20 ‘‘(k)(1) AUTHORIZATION OF APPROPRIATIONS.—For

21 the purpose of carrying out this section, there are author22 ized to be appropriated $756,000,000 for fiscal year 1996

23 and such sums as may be necessary for each of the fiscal

24 years 1997 through 2000.’’.
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1 (2) REDESIGNATION OF SPECIAL PROVISIONS

2 AND ADDITION OF PERFORMANCE BONUS SET3 ASIDE.—

4 (A) Section 330(k) (as so redesignated and

5 amended) is further amended—

6 (i) by striking ‘‘(B)’’ and inserting

7 ‘‘(2) SPECIAL PROVISIONS.—(A)’’;

8 (ii)(A) in paragraph (3), by striking

9 ‘‘(e)(3)’’ and ‘‘(e)(3)(G)(ii)’’ and inserting

10 ‘‘(i)(3)’’ and ‘‘(i)(3)(G)(ii)’’, respectively,

11 and

12 (B) by redesignating paragraph (3) as

13 subparagraph (B) of paragraph (2); and

14 (iii) by adding at the end of section

15 330(k)(2) a new subparagraph (C) as fol16 lows:

17 ‘‘(C) From the funds appropriated pursuant to

18 paragraph (1) for any fiscal year, the Secretary may

19 reserve an amount not to exceed 10 percent for use

20 in making supplemental awards to grantees that the

21 Secretary determines have demonstrated high or im22 proved performance in carrying out the purposes of

23 this section.’’.
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1 (3) SPECIAL RULE REGARDING ALLOCATION OF

2 FUNDING.—Section 330(k)(2) is amended by adding

3 at the end a new subparagraph (D) as follows:

4 ‘‘(D) For fiscal years 1996 through 1998, the

5 Secretary shall award grants under this section in

6 such a manner that the percentages of the amount

7 appropriated pursuant to paragraph (1) that are

8 available to support grants made pursuant to sub9 sections (f), (g), and (h) shall equal the percentages

10 of the base amount that were appropriated under

11 sections 329, 340, and 340A, respectively, for fiscal

12 year 1995. For purposes of the preceding sentence,

13 the term ‘base amount’ refers to the total of the

14 amounts appropriated to carry out sections 329,

15 330, 340, and 340A for fiscal year 1995.’’.

16 (e) DELEGATION AUTHORITY.—Section 330(n) (as

17 redesignated by subsection (b)(1) of this section) is

18 amended by striking ‘‘the central office of’’.

19 (f) ELIMINATION OF VARIOUS REGULATION RE20 QUIREMENTS.—

21 (1) Section 330(b)(4) is amended—

22 (A) in the first sentence, by striking ‘‘by

23 regulation’’; and

24 (B) by striking the last sentence.
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1 (2) Section 330(i)(3)(B) (as redesignated by

2 subsection (b)(1) of this section) is amended by

3 striking ‘‘established in accordance with regulations

4 prescribed by the Secretary’’ and inserting instead

5 ‘‘as the Secretary may prescribe’’.

6 (3) Section 330 (i)(3)(H) (as redesignated by

7 subsection (b)(1) of this section) is amended—

8 (A) by striking ’’, in accordance with regu9 lations of the Secretary,’’; and

10 (B) by striking ’’, by regulation,’’.

11 (4) Section 330(i)(3)(K) (as redesignated by

12 subsection (b)(1) of this section) is amended by

13 striking ‘‘, in accordance with regulations of the Sec14 retary,’’.

15 (5) Section 330(m)(2) (as redesignated by sub16 section (b)(1) of this section) is amended by striking

17 ‘‘by regulation’’.

18 (g) TECHNICAL AND CONFORMING AMENDMENTS.—

19 (1) Section 330(c)(1)(A) is amended by striking

20 ‘‘primary’’ and all that follows and inserting instead

21 ‘‘required primary health services and additional

22 health services;’’.

23 (2) Section 330(d)(1)(B) is amended by strik24 ing ‘‘subsection (e)(3)’’ and inserting instead ‘‘sub25 section (i)(3)’’.
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1 (3) Section 330(d)(1)(C)(ii) is amended by

2 striking ‘‘subsection (e)(3)(G)’’ and inserting ‘‘sub3 section (i)(3)(G)’’.

4 (4) Section 330(d)(2) is amended by striking

5 ‘‘primary health services, supplemental health serv6 ices and environmental health services’’ and insert7 ing ‘‘required primary health services and additional

8 health services’’.

9 (5) Section 330(i)(1) (as redesignated by sub10 section (b)(1) of this section) is amended by striking

11 ‘‘subsection (c) or (d)’’ and inserting ‘‘this section’’.

12 (6) Section 330(i)(3) (as redesignated by sub13 section (b)(1) of this section) is amended in the mat14 ter following subparagraph (K) by striking ‘‘and

15 subsection (g)(4)’’.

16 (7) Section 330(i)(5) (as redesignated by sub17 section (b)(1) of this section) is amended by striking

18 ‘‘subsection (a)(4)’’ and inserting ‘‘subsection

19 (b)(2)’’.

20 (8) Section 330(j) (as redesignated by sub21 section (b)(1) and amended by subsection (c)(6) of

22 this section) is further amended—

23 (A) by striking ‘‘Health, Education, and

24 Welfare’’ and inserting ‘‘Health and Human

25 Services’’; and
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1 (B) by striking ‘‘subsection (e)(2)’’ and in2 serting ‘‘(i)(2)’’.

3 (9) The heading of section 330 is amended to

4 read as follows:

5 ‘‘HEALTH CENTERS’’.

6 (10) The heading of subpart I of part D of title

7 III is amended to read as follows:

8 ‘‘SUBPART I—HEALTH CENTERS’’.

9 (11) Section 224(g)(4) is amended by striking

10 everything after ‘‘under’’ and inserting instead ‘‘sec11 tion 330.’’.

12 (12) Section 340C(a)(2) is amended by striking

13 everything after ‘‘diseases’’ and inserting instead

14 ‘‘with assistance provided under section 330.’’.

15 (13) Section 1861(aa)(4)(A) of the Social Secu16 rity Act is amended in clauses (i) and (ii)(I) by

17 striking ‘‘section 329, 330, or 340’’ and inserting in18 stead ‘‘section 330 (other than subsection (h) there19 of)’’.

20 (14) Section 1905(l)(2)(B) of the Social Secu21 rity Act is amended in clauses (i) and (ii)(II) by

22 striking ‘‘section 329, 330, 340, or 340A’’ and in23 serting instead ‘‘section 330’’.

24 (h) REPEALS.—Section 329 and subparts V and VI

25 of part D of title III of the Public Health Service Act

26 are repealed.
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1 (i) EFFECTIVE DATE.—This section and the amend2 ments made thereby shall be effective with respect to fiscal

3 years beginning after September 30, 1995.

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