I 

111TH CONGRESS 

1ST SESSION H. R. 3003 

To amend the Public Health Service Act to establish the School-Based Health 

Clinic program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 23, 2009 

Mrs. CAPPS (for herself, Mr. ROGERS of Michigan, Mrs. DAVIS of California, 

Mrs. CAPITO, Mrs. NAPOLITANO, Mr. BERMAN, Mr. HARE, and Ms. 

SCHAKOWSKY) introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to establish the 

School-Based Health Clinic program, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘School-Based Health 

5 Clinic Establishment Act of 2009’’. 

6 SEC. 2. FINDINGS AND PURPOSE. 

7 (a) FINDINGS.—Congress makes the following find8 ings: 


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1 (1) More than 8,000,000 children in the United 

2 States have no form of health insurance and are 

3 therefore unable to access preventive health care 

4 which may lead to untreated conditions, unnecessary 

5 diseases, and death. 

6 (2) The American Medical Association rates 

7 adolescents aged 13–18 as the group of Americans 

8 with the poorest health indicators. 

9 (3) More than 70 percent of the children who 

10 need psychiatric treatment do not receive services. 

11 (4) Children who are in poor health or are vic12 tims of child abuse, poverty, malnutrition, alcohol, 

13 and drug abuse are at risk for academic and social 

14 failure. 

15 (5) Without health and social intervention, at16 risk children are often unable to improve academic 

17 performance. 

18 (6) School-based health clinics are effective in 

19 bringing preventive and primary care to children and 

20 adolescents. 

21 (7) School-based health clinics are effective in 

22 decreasing academic failure resulting from poor 

23 health. 


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1 (b) PURPOSE.—The purpose of this Act is to fund 

2 the development and operation of school-based health clin3 ics to— 

4 (1) provide comprehensive and accessible pri5 mary health care services to medically underserved 

6 children, youth, and families; 

7 (2) improve the physical health, emotional well8 being, and academic performance of medically un9 derserved children, youth, and families; and 

10 (3) work in collaboration with the school to in11 tegrate health into the overall school environment. 

12 SEC. 3. SCHOOL-BASED HEALTH CLINICS. 

13 Part Q of title III of the Public Health Service Act 

14 (42 U.S.C. 280h et seq.) is amended by adding at the end 

15 the following: 

16 ‘‘SEC. 399Z–1. SCHOOL-BASED HEALTH CLINICS. 

17 ‘‘(a) DEFINITIONS; ESTABLISHMENT OF CRITERIA.— 

18 In this section: 

19 ‘‘(1) COMMUNITY.—The term ‘community’ in20 cludes parents, patients, local leaders, and commu21 nity based organizations. 

22 ‘‘(2) COMPREHENSIVE PRIMARY HEALTH SERV23 ICES.—The term ‘comprehensive primary health 

24 services’ means the core services offered by schoolVerDate Nov 24 2008 21:18 Jun 24, 2009 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3003.IH H3003

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1 based health clinics, which shall include the fol2 lowing: 

3 ‘‘(A) PHYSICAL.—Comprehensive health 

4 assessments, diagnosis, and treatment of minor, 

5 acute, and chronic medical conditions and refer6 rals to, and follow-up for, specialty care. 

7 ‘‘(B) MENTAL HEALTH.—Mental health 

8 assessments, crisis intervention, counseling, 

9 treatment, and referral to a continuum of serv10 ices including emergency psychiatric care, com11 munity support programs, inpatient care, and 

12 outpatient programs. 

13 ‘‘(C) OPTIONAL SERVICES.—Additional 

14 services, which may include oral health, social, 

15 and age-appropriate health education services, 

16 including nutritional counseling. 

17 ‘‘(3) MEDICALLY UNDERSERVED CHILDREN

18 AND ADOLESCENTS.— 

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

20 underserved children and adolescents’ means a 

21 population of children and adolescents who are 

22 residents of an area designated by the Sec23 retary as an area with a shortage of personal 

24 health services and health infrastructure for 

25 such children and adolescents. 


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1 ‘‘(B) CRITERIA.—The Secretary shall pre2 scribe criteria for determining the specific 

3 shortages of personal health services for medi4 cally underserved children and adolescents 

5 under subparagraph (A) that shall— 

6 ‘‘(i) take into account any comments 

7 received by the Secretary from the chief 

8 executive officer of a State and local offi9 cials in a State; and 

10 ‘‘(ii) include factors indicative of the 

11 health status of such children and adoles12 cents of an area, including the ability of 

13 the residents of such area to pay for health 

14 services, the accessibility of such services, 

15 the availability of health professionals to 

16 such children and adolescents, and other 

17 factors as determined appropriate by the 

18 Secretary. 

19 ‘‘(4) SCHOOL-BASED HEALTH CLINIC.—The 

20 term ‘school-based health clinic’ means a health clin21 ic that— 

22 ‘‘(A) is located in, or is adjacent to, a 

23 school facility of a local educational agency; 

24 ‘‘(B) is organized through school, commu25 nity, and health provider relationships; 


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1 ‘‘(C) is administered by a sponsoring facil2 ity; and 

3 ‘‘(D) provides, at a minimum, comprehen4 sive primary health services during school hours 

5 to children and adolescents by health profes6 sionals in accordance with State and local laws 

7 and regulations, established standards, and 

8 community practice. 

9 ‘‘(5) SPONSORING FACILITY.—The term ‘spon10 soring facility’ is— 

11 ‘‘(A) a hospital; 

12 ‘‘(B) a public health department; 

13 ‘‘(C) a community health center; 

14 ‘‘(D) a nonprofit health care agency; 

15 ‘‘(E) a local educational agency; or 

16 ‘‘(F) a program administered by the In17 dian Health Service or the Bureau of Indian 

18 Affairs or operated by an Indian tribe or a trib19 al organization under the Indian Self-Deter20 mination and Education Assistance Act, a Na21 tive Hawaiian entity, or an urban Indian pro22 gram under title V of the Indian Health Care 

23 Improvement Act. 

24 ‘‘(b) AUTHORITY TO AWARD GRANTS.—The Sec25 retary shall award grants for the costs of the operation 


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1 of school-based health clinics (referred to in this section 

2 as ‘SBHCs’) that meet the requirements of this section. 

3 ‘‘(c) APPLICATIONS.—To be eligible to receive a grant 

4 under this section, an entity shall— 

5 ‘‘(1) be an SBHC (as defined in subsection 

6 (a)(4)); and 

7 ‘‘(2) submit to the Secretary an application at 

8 such time, in such manner, and containing— 

9 ‘‘(A) evidence that the applicant meets all 

10 criteria necessary to be designated an SBHC; 

11 ‘‘(B) evidence of local need for the services 

12 to be provided by the SBHC; 

13 ‘‘(C) an assurance that— 

14 ‘‘(i) SBHC services will be provided to 

15 those children and adolescents for whom 

16 parental or guardian consent has been ob17 tained in accordance with Federal, State, 

18 and local laws governing health care serv19 ice provision to children and adolescents; 

20 ‘‘(ii) the SBHC has made and will 

21 continue to make every reasonable effort to 

22 establish and maintain collaborative rela23 tionships with other health care providers 

24 in the catchment area of the SBHC; 


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1 ‘‘(iii) the SBHC will provide on-site 

2 access during the academic day when 

3 school is in session and has an established 

4 network of support and access to services 

5 with backup health providers when the 

6 school or SBHC is closed; 

7 ‘‘(iv) the SBHC will be integrated into 

8 the school environment and will coordinate 

9 health services with school personnel, such 

10 as administrators, teachers, nurses, coun11 selors, and support personnel, as well as 

12 with other community providers co-located 

13 at the school; 

14 ‘‘(v) the SBHC sponsoring facility as15 sumes all responsibility for the SBHC ad16 ministration, operations, and oversight; 

17 and 

18 ‘‘(vi) the SBHC will comply with Fed19 eral, State, and local laws concerning pa20 tient privacy and student records, includ21 ing the HIPAA and Section 444 of the 

22 General Education Provisions Act; and 

23 ‘‘(D) such other information as the Sec24 retary may require. 


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1 ‘‘(d) PREFERENCES.—In reviewing applications, the 

2 Secretary may give preference to applicants who dem3 onstrate an ability to serve the following: 

4 ‘‘(1) Communities that have evidenced barriers 

5 to primary health care and mental health services 

6 for children and adolescents. 

7 ‘‘(2) Communities with high percentages of chil8 dren and adolescents who are uninsured, under9 insured, or enrolled in public health insurance pro10 grams. 

11 ‘‘(3) Populations of children and adolescents 

12 that have historically demonstrated difficulty in ac13 cessing health and mental health services. 

14 ‘‘(e) WAIVER OF REQUIREMENTS.—The Secretary 

15 may— 

16 ‘‘(1) under appropriate circumstances, waive 

17 the application of all or part of the requirements of 

18 this section with respect to an SBHC for no more 

19 than 2 years; and 

20 ‘‘(2) upon a showing of good cause, waive the 

21 requirement that the SBHC provide all required 

22 comprehensive primary health services for a des23 ignated period of time to be determined by the Sec24 retary. 

25 ‘‘(f) USE OF FUNDS.— 


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1 ‘‘(1) FUNDS.—Funds awarded under a grant 

2 under this section may be used for— 

3 ‘‘(A) acquiring and leasing equipment (in4 cluding the costs of amortizing the principle of, 

5 and paying interest on, loans for such equip6 ment), 

7 ‘‘(B) providing training related to the pro8 vision of required comprehensive primary health 

9 services and additional health services, 

10 ‘‘(C) the management and operation of 

11 health center programs, and 

12 ‘‘(D) the payment of salaries for physi13 cians, nurses, and other personnel of the 

14 SBHC. 

15 ‘‘(2) CONSTRUCTION.—The Secretary may 

16 award grants which may be used to pay the costs as17 sociated with expanding and modernizing existing 

18 buildings for use as an SBHC, including the pur19 chase of trailers or manufactured building to install 

20 on the school property. 

21 ‘‘(3) AMOUNT.—The amount of any grant made 

22 in any fiscal year to an SBHC shall be determined 

23 by the Secretary, taking into account— 

24 ‘‘(A) the financial need of the SBHC; 


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1 ‘‘(B) State, local, or other operation fund2 ing provided to the SBHC; and 

3 ‘‘(C) other factors as determined appro4 priate by the Secretary. 

5 ‘‘(g) MATCHING REQUIREMENT.— 

6 ‘‘(1) REQUIREMENT.—Each recipient of a grant 

7 under this section shall provide, from non-Federal 

8 sources, an amount equal to 20 percent of the 

9 amount of the grant (which may be provided in cash 

10 or in kind) to carry out the activities supported by 

11 the grant. 

12 ‘‘(2) WAIVER.—The Secretary may waive all or 

13 part of the matching requirement described in para14 graph (1) for any fiscal year for an SBHC if the 

15 Secretary determines that applying the matching re16 quirement to the SBHC would result in serious 

17 hardship or an inability to carry out the purposes of 

18 this section. 

19 ‘‘(h) SUPPLEMENT, NOT SUPPLANT.—Grant funds 

20 provided under this section shall be used to supplement, 

21 not supplant, other Federal or State funds. 

22 ‘‘(i) TECHNICAL ASSISTANCE.—The Secretary shall 

23 establish a program through which the Secretary shall 

24 provide (either through the Department of Health and 

25 Human Services or by grant or contract) technical and 


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1 other assistance to SBHCs to assist such SBHCs to meet 

2 the requirements of subsection (c)(2)(C). Services pro3 vided through the program may include necessary tech4 nical and nonfinancial assistance, including fiscal and pro5 gram management assistance, training in fiscal and pro6 gram management, operational and administrative sup7 port, and the provision of information to the entities of 

8 the variety of resources available under this title and how 

9 those resources can be best used to meet the health needs 

10 of the communities served by the entities. 

11 ‘‘(j) EVALUATION.—The Secretary shall develop and 

12 implement a plan for evaluating SBHCs and monitoring 

13 quality performances under the awards made under this 

14 section. 

15 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—For 

16 purposes of carrying out this section, there are authorized 

17 to be appropriated $50,000,000 for fiscal year 2010 and 

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

19 2011 through 2014.’’. 

Æ 


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