I

104TH CONGRESS

1ST SESSION H. R. 2420

To amend title XIX of the Social Security Act to require health maintenance

organizations and other managed care plans providing medical assistance

to medicaid beneficiaries to make payments for assistance provided to

such beneficiaries by school-based health centers, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 28, 1995

Ms. VELA ́ZQUEZ introduced the following bill; which was referred to the

Committee on Commerce

A BILL

To amend title XIX of the Social Security Act to require

health maintenance organizations and other managed

care plans providing medical assistance to medicaid beneficiaries to make payments for assistance provided to

such beneficiaries by school-based health centers, and

for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. REQUIRING MEDICAID HEALTH MAINTENANCE

2 ORGANIZATIONS TO MAKE PAYMENTS FOR

3 SERVICES PROVIDED BY SCHOOL-BASED

4 HEALTH CENTERS.

5 (a) IN GENERAL.—Section 1903(m)(2)(A) of the

6 Social Security Act (42 U.S.C. 1396b(m)(2)(A)) is

7 amended—

8 (1) by striking ‘‘and’’ at the end of clause (x);

9 (2) by striking the period at the end of clause

10 (xi) and inserting ‘‘; and’’; and

11 (3) by adding at the end the following new

12 clause:

13 ‘‘(xii) such contract provides that—

14 ‘‘(I) the entity’s network of participating

15 providers of such services shall include at least

16 one school-based health center (as defined in

17 section 1905(t)), or

18 ‘‘(II) the entity shall enter into a contract

19 for the provision of such services to such indi20 viduals with each school-based health center (as

21 so defined) located in the entity’s service area,

22 under terms and conditions (including terms

23 and conditions relating to patient referrals and

24 the sharing of patient records) similar to those

25 applicable to a contract between the entity and

26 a similar provider of such services in the area
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1 (in accordance with standards established by

2 the Secretary).’’.

3 (b) SCHOOL-BASED HEALTH CENTERS DE4 SCRIBED.—Section 1905 of such Act (42 U.S.C. 1396d)

5 is amended by adding at the end the following new sub6 section:

7 ‘‘(t) The term ‘school-based health center’ means a

8 clinic which is located at an elementary or secondary

9 school and which—

10 ‘‘(1) provides physical examinations, injury

11 treatment, primary health services, mental health

12 services, and other services (to the extent permitted

13 under the laws or regulations of the State in which

14 it is located) on an on-site basis to students enrolled

15 at the school (without regard to whether or not the

16 students are enrolled in the State plan under this

17 title);

18 ‘‘(2) refers students to other providers of health

19 care services for services which the center does not

20 provide on-site;

21 ‘‘(3) has entered into arrangements with other

22 providers of health care services providing services

23 on a 24-hour, emergency basis;

24 ‘‘(4) has on its staff at least one physician

25 (whether employed on a part-time or full-time basis);
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1 at least one physician assistant, nurse practitioner,

2 or clinical nurse specialist; and at least one mental

3 health professional; and

4 ‘‘(5) is approved or certified as such a clinic by

5 the State in which it is located.’’.

6 (c) PROHIBITION AGAINST WAIVER OF REQUIRE7 MENT.—The Secretary of Health and Human Services

8 may not waive (pursuant to section 1115 or section 1915

9 of the Social Security Act or otherwise) the application

10 of section 1903(m)(2)(A)(xii) of the Social Security Act

11 (as added by subsection (a)) with respect to any State.

12 (d) EFFECTIVE DATE.—The amendments made by

13 subsections (a) and (b) shall apply to quarters beginning

14 on or after January 1, 1996.

15 SEC. 2. ESTABLISHMENT OF CLEARINGHOUSE FOR INFOR16 MATION AND TECHNICAL ASSISTANCE ON

17 SCHOOL-BASED HEALTH CENTERS.

18 Not later than March 1, 1996, the Secretary of

19 Health and Human Services shall establish a clearing20 house through which interested parties may receive infor21 mation and technical assistance on the establishment and

22 operation of school-based health centers.
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1 SEC. 3. GRANTS FOR SCHOOL-BASED HEALTH CENTERS.

2 (a) IN GENERAL.—Part D of title III of the Public

3 Health Service Act (42 U.S.C. 254b et seq.) is amended

4 by adding at the end the following section:

5 ‘‘SCHOOL-BASED HEALTH CENTERS

6 ‘‘SEC. 340E. (a) IN GENERAL.—

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

8 grants to public and nonprofit private entities for

9 the purpose of making available to school children

10 the health services specified in subsection (d) at sites

11 that are on or in close proximity to the premises of

12 a school (or at such other sites as the Secretary de13 termines to be appropriate to provide school children

14 with access to the services).

15 ‘‘(2) SCHOOL CHILDREN.—For purposes of this

16 section, the term ‘school children’ means individuals

17 between the ages of 3 and 18 (inclusive).

18 ‘‘(b) MINIMUM QUALIFICATIONS FOR GRANTEES.—

19 ‘‘(1) STATUS AS MEDICAID PROVIDER.—

20 ‘‘(A) Except as provided in subparagraph

21 (B), the Secretary may make a grant under

22 subsection (a) only if the applicant for the

23 grant is a provider of services under the State

24 plan approved for the State involved under title

25 XIX of the Social Security Act.
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1 ‘‘(B) The requirements established in sub2 paragraph (A) do not apply to an applicant that

3 provides health services without charge and

4 does not receive reimbursement for the services

5 from any third-party payors.

6 ‘‘(2) REQUIRED CONSULTATIONS REGARDING

7 PARENTS AND TEACHERS.—The Secretary may

8 make a grant under subsection (a) only if the appli9 cant involved, in preparing the application under

10 subsection (j), has consulted with parents in the

11 community in which services under the grant are to

12 be provided, with teachers at schools in the commu13 nity, and with the local educational agency with ju14 risdiction over such schools.

15 ‘‘(c) PREFERENCES IN MAKING GRANTS.—In making

16 grants under subsection (a), the Secretary shall give pref17 erence to qualified applicants that are experienced in deliv18 ering health care services to medically underserved popu19 lations or in areas in which a significant number of chil20 dren are at risk for health problems.

21 ‘‘(d) AUTHORIZED SERVICES.—

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

23 grant under subsection (a) only if the applicant in24 volved agrees as follows:
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1 ‘‘(A) Each of the following services will be

2 made available under the grant (as medically

3 appropriate for the child involved):

4 ‘‘(i) Comprehensive health examina5 tions.

6 ‘‘(ii) Health education and prevention

7 services, including prenatal care.

8 ‘‘(iii) Follow-up care and referrals re9 garding routine health problems.

10 ‘‘(B) Services under subparagraph (A) will

11 include screenings, follow-up care, and referrals

12 (including referrals for specialty care) regarding

13 dental, vision, and hearing services, and regard14 ing sexually-transmitted diseases and other

15 communicable diseases.

16 ‘‘(2) OPTION REGARDING FAMILY PLANNING

17 SERVICES.—A grantee under subsection (a) may, at

18 the option of the grantee, expend the grant under

19 such subsection to provide voluntary family planning

20 services. The Secretary may not require as a condi21 tion of the receipt of a grant under subsection (a)

22 that an applicant for the grant agree to provide such

23 services.

24 ‘‘(3) OTHER SERVICES.—In addition to services

25 specified in any of paragraphs (1) and (2), the Sec-
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1 retary may authorize a grantee under subsection (a)

2 to expend the grant for such additional health or

3 health-related services for school children as the Sec4 retary determines to be appropriate.

5 ‘‘(4) AVAILABILITY THROUGHOUT YEAR.—The

6 Secretary may make a grant under subsection (a)

7 only if the applicant involved agrees that services

8 under the grant will be available throughout the year

9 (including any portion of the year during which the

10 school does not hold classes).

11 ‘‘(e) CULTURAL CONTEXT OF SERVICES.—The Sec12 retary may make a grant under subsection (a) only if the

13 applicant involved agrees that services under the grant will

14 be provided in the language and cultural context most ap15 propriate for the individuals to whom the services are pro16 vided.

17 ‘‘(f) LIMITATION ON IMPOSITION OF FEES FOR

18 SERVICES.—The Secretary may make a grant under sub19 section (a) only if the applicant involved agrees that, if

20 a fee is imposed for the provision of services under the

21 grant, such fee—

22 ‘‘(1) will be made according to a schedule of

23 fees that is made available to the public;

24 ‘‘(2) will be adjusted to reflect the income and

25 resources of the school-children involved; and
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1 ‘‘(3) will not be imposed on any school child

2 with an income of less than 150 percent of the appli3 cable official poverty line (established by the Direc4 tor of the Office of Management and Budget and re5 vised by the Secretary in accordance with section

6 673(2) of the Omnibus Budget Reconciliation Act of

7 1981).

8 ‘‘(g) MATCHING FUNDS.—

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

10 the program to be carried out under subsection (a)

11 by an applicant, the Secretary, subject to paragraph

12 (3), may make a grant under such subsection only

13 if the applicant agrees to make available (directly or

14 through donations from public or private entities)

15 non-Federal contributions toward such costs in an

16 amount that is—

17 ‘‘(A) for the first fiscal year for which the

18 applicant receives such a grant, 10 percent of

19 such costs;

20 ‘‘(B) for any second such fiscal year, 25

21 percent of such costs; and

22 ‘‘(C) for any subsequent such fiscal year,

23 50 percent of such costs.

24 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB25 UTED.—Non-Federal contributions required in para-
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1 graph (1) may be in cash or in kind, fairly evalu2 ated, including plant, equipment, or services.

3 Amounts provided by the Federal Government, or

4 services assisted or subsidized to any significant ex5 tent by the Federal Government, may not be in6 cluded in determining the amount of such non-Fed7 eral contributions.

8 ‘‘(3) WAIVER.—The Secretary may for an ap9 plicant waive the requirement of paragraph (1) for

10 a fiscal year if the Secretary determines that the ap11 plicant will be unable to carry out a program under

12 subsection (a) otherwise. If the Secretary provides a

13 waiver under the preceding sentence for a grantee

14 under subsection (a) for a fiscal year, the Secretary

15 may make a grant to the applicant for the following

16 fiscal year only if the Secretary reviews the waiver

17 to determine whether the waiver should remain in

18 effect.

19 ‘‘(h) ADDITIONAL AGREEMENTS.—The Secretary

20 may make a grant under subsection (a) only if the appli21 cant involved agrees as follows:

22 ‘‘(1) The applicant will maintain the confiden23 tiality of patient records.
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1 ‘‘(2) The applicant will establish an ongoing

2 quality assurance program regarding services pro3 vided under the grant.

4 ‘‘(3) The applicant will not expend more than

5 10 percent of the grant for administrative expenses

6 regarding the grant.

7 ‘‘(i) REPORTS TO SECRETARY.—The Secretary may

8 make a grant under subsection (a) only if the applicant

9 agrees that, not later than February 1 of the fiscal year

10 following the fiscal year for which the grant is to be made,

11 the applicant will submit to the Secretary a report describ12 ing the program carried out by the applicant under the

13 grant, including provisions on the utilization, cost, and

14 outcome of services provided under the grant.

15 ‘‘(j) APPLICATION FOR GRANT; PLAN.—The Sec16 retary may make a grant under subsection (a) only if an

17 application for the grant is submitted to the Secretary;

18 the application contains a plan describing the proposal of

19 the applicant for a program under subsection (a); and the

20 application is in such form, is made in such manner, and

21 contains such agreements, assurances, and information as

22 the Secretary determines to be necessary to carry out this

23 section.

24 ‘‘(k) EVALUATION OF PROGRAMS.—The Secretary,

25 directly or through grants or contracts, shall provide for
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1 evaluations of programs carried out under subsection (a),

2 including the cost-effectiveness and health-effectiveness of

3 the programs.

4 ‘‘(l) REPORTS TO CONGRESS.—Not later than May

5 31 of each fiscal year, the Secretary shall submit to the

6 Congress a report on the programs carried out under sub7 section (a). The report shall include a summary of the

8 evaluations carried out under subsection (k) for the pre9 ceding fiscal year.

10 ‘‘(m) AUTHORIZATION OF APPROPRIATIONS.—For

11 the purpose of carrying out this section, there is author12 ized to be appropriated $100,000,000 for fiscal year 1996,

13 $275,000,000 for fiscal year 1997, $350,000,000 for fis14 cal year 1998, and $400,000,000 for each of the fiscal

15 years 1999 and 2000.’’.

16 (b) CONFORMING AMENDMENT.—Part D of title III

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

18 as amended by section 104 of Public Law 103–183 (107

19 Stat. 2230), is amended in the heading for subpart VIII

20 by striking ‘‘Bulk’’ and all that follows and inserting the

21 following: ‘‘Miscellaneous Provisions Regarding Primary

22 Health Care’’.

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