‘‘SEC. 2748. PREFERENCES.
‘‘(a) IN GENERAL.—In making grants under sections
2749 and 2750, the Secretary shall give preference to ap-
plicants whose communities to be served show the most
substantial level of need for such services among individ-
uals who are between the ages of 10 and 19 (inclusive),
as measured by indicators of community health including
the following:
‘‘(1) High levels of poverty.
‘‘(2) The presence of a medically underserved
area or population (as defined under section 330(a)).
‘‘(3) A health professional shortage area, as
designated under section 332.
‘‘(4) High rates of indicators of health risk
among children and youth, including a high propor-
tion of children receiving services through the Indi-
viduals with Disabilities Education Act; adolescent
pregnancy, sexually transmitted disease (including
infection with the human immunodeficiency virus),
preventable disease, communicable disease, inten-
tional and unintentional injuries among children and
youth (including motor vehicle injuries); inter-
personal, community, and gang violence; rape; youth
unemployment; juvenile justice involvement; and
high rates of drug and alcohol exposure.
‘‘(b) LINKAGE TO QUALIFIED COMMUNITY HEALTH
GROUPS.—In making grants under sections 2749 and
2750, the Secretary shall give preference to applicants
that demonstrate a linkage to qualified community health
groups (as defined in section 2763(a)).
‘‘SEC. 2749. GRANTS FOR DEVELOPMENT OF PROJECTS.
‘‘(a) IN GENERAL.—The Secretary may make grants
to State health agencies or to local community partner-
ships to develop school health service sites. The locations
at which such sites may be developed include any public
or nonprofit private school.
‘‘(b) USE OF FUNDS.—A project for which a grant
may be made under subsection (a) may include but not
be limited to the cost of the following:
‘‘(1) Planning for the provision of school health
services.
‘‘(2) Recruitment, compensation, and training
of health and administrative staff.
‘‘(3) The development of agreements with re-
gional and corporate alliance health plans and the
acquisition and development of equipment and infor-
mation services necessary to support information ex-
change between school health service sites and
health plans, health providers, and other entities au-
thorized to collect information under this Act.
‘‘(4) In the case of communities described in
subsection (d)(2)(B), funds to aid in the establish-
ment of local community partnerships.
‘‘(5) Other activities necessary to assume oper-
ational status.
‘‘(c) APPLICATION FOR GRANT.—
‘‘(1) IN GENERAL.—Applicants shall submit ap-
plications in a form and manner prescribed by the
Secretary.
‘‘(2) APPLICATIONS BY STATE HEALTH AGEN-
CIES.—
‘‘(A) In the case of applicants that are
State health agencies, the application shall con-
tain assurances that the State health agency is
applying for funds—
‘‘(i) on behalf of at least one local
community partnership; and
‘‘(ii) on behalf of at least one other
community identified by the State as in
need of the services funded under this sub-
part but without a local community part-
nership.
‘‘(B) In the case of communities identified
in applications submitted by State health agen-
cies that do not yet have local community part-
nerships, the State shall describe the steps that
will be taken to aid the community in develop-
ing a local community partnership.
‘‘(C) A State applying on behalf of local
community partnerships and other communities
may retain not more than 10 percent of grants
awarded under this subpart for administrative
costs.
‘‘(d) CONTENTS OF APPLICATION.—In order to re-
ceive a grant under this section, an applicant must include
in the application the following information:
‘‘(1) An assessment of the need for school
health services in the communities to be served,
using the latest available health data and health
goals and objectives established by the Secretary.
‘‘(2) A description of how the applicant will de-
sign the proposed school health services to reach the
maximum number of school-aged children and youth
at risk for poor health outcome.
‘‘(3) An explanation of how the applicant will
integrate its services with those of other health and
social service programs within the community.
‘‘(4) An explanation of how the applicant will
link its activities to health plans serving the commu-
nities in which the applicant’s program is to be
located.
‘‘(5) A description of outcome measures to be
used to evaluate the effectiveness of the program.
‘‘(6) A description of a quality assurance pro-
gram which complies with standards that the Sec-
retary may prescribe.
‘‘(e) NUMBER OF GRANTS.—Not more than one plan-
ning grant may be made to a single applicant. A planning
grant may not exceed two years in duration.
‘‘SEC. 2750. GRANTS FOR OPERATION OF PROJECTS.
‘‘(a) IN GENERAL.—The Secretary may make grants
to State health agencies or to local community partner-
ships for the cost of operating school health service sites.
The locations at which such sites may be operated include
any public or nonprofit private school.
‘‘(b) USE OF GRANT.—The costs for which a grant
may be made under this section include but are not limited
to the following:
‘‘(1) The cost of furnishing health services that
are not covered under title I of this Act or by any
other public or private insurer.
‘‘(2) The cost of furnishing enabling services, as
defined in section 2780(g).
‘‘(3) Training, recruitment and compensation of
health professionals and other staff.
‘‘(4) Outreach services to at-risk youth and to
parents.
‘‘(5) Linkage of individuals to health plans,
community health services and social services.
‘‘(6) Other activities deemed necessary by the
Secretary.
‘‘(c) APPLICATION
FOR GRANT.—Applicants shall
submit applications in a form and manner prescribed by
the Secretary. In order to receive a grant under this sec-
tion, an applicant must include in the application the fol-
lowing information:
‘‘(1) A description of the services to be fur-
nished by the applicant.
‘‘(2) The amounts and sources of funding that
the applicant will expend, including estimates of the
amount of payments the applicant will receive from
alliance health plans and from other sources.
‘‘(3) Such other information as the Secretary
determines to be appropriate.
‘‘(d) ADDITIONAL CONTENTS OF APPLICATION.—In
order to receive a grant under this section, an applicant
must meet the following conditions:
‘‘(1) The applicant furnishes the following serv-
ices:
‘‘(A) Diagnosis and treatment of acute ill-
nesses and minor injuries.
‘‘(B) Clinical preventive health services, in-
cluding health screenings and early detection
services.
‘‘(C) Enabling services, as defined in sec-
tion 2780(g).
‘‘(D) Referrals and followups in situations
involving illness or injury.
‘‘(E) Health and social services, counseling
services, and necessary referrals, including re-
ferrals regarding mental health, substance
abuse, and interpersonal violence, including
rape.
‘‘(F) Such other services as the Secretary
determines to be appropriate.
‘‘(2) The applicant maintains agreements with
health plans offering services in the applicant’s serv-
ice area.
‘‘(3) The applicant is a participating provider in
the State’s program for medical assistance under
title XIX of the Social Security Act.
‘‘(4) The applicant does not impose charges on
students or their families for services (including col-
lection of any cost-sharing for services under the
comprehensive benefit package that otherwise would
be required).
‘‘(5) The applicant has reviewed and will peri-
odically review the needs of the population served by
the applicant in order to ensure that its services are
accessible to the maximum number of school age
children and youth in the area, and that, to the
maximum extent possible, barriers to access to serv-
ices of the applicant are removed (including barriers
resulting from the area’s physical characteristics, its
economic, social and cultural grouping, the health
care utilization patterns of children and youth, and
available transportation).
‘‘(6) In the case of an applicant which serves a
population that includes a substantial proportion of
individuals of limited English speaking ability, the
applicant has developed a plan to meet the needs of
such population to the extent practicable in the lan-
guage and cultural context most appropriate to such
individuals.
‘‘(7) The applicant will provide non-Federal
contributions toward the cost of the project in an
amount determined by the Secretary.
‘‘(8) The applicant will operate a quality assur-
ance program consistent with section 2754(e)(6).
‘‘(e) DURATION OF GRANT.—A grant under this sec-
tion shall be for a period determined by the Secretary.
‘‘(f) REPORTS.—A recipient of funding under this
section shall provide such reports and information as are
required in regulations of the Secretary.
‘‘SEC. 2751. FEDERAL ADMINISTRATIVE COSTS.
Of the amounts made available under section 2751,
the Secretary may reserve not more than 5 percent for
administrative expenses regarding this subpart.
‘‘Subpart B—Capital Costs of Developing Projects
‘‘SEC. 2753. LOANS AND LOAN GUARANTEES REGARDING
PROJECTS.
‘‘(a) IN GENERAL.—The Secretary may make loans
to, and guarantee the payment of principal and interest
to Federal and non-Federal lenders on behalf of, State
health agencies and local community partnerships for the
capital costs of developing projects in accordance with sub-
part A.
‘‘(b) APPLICABILITY OF CERTAIN PROVISIONS.—The
provisions of subpart A apply to loans and loan guarantees
under subsection (a) to the same extent and in the same
manner as such provisions apply to grants under subpart
A. Except for any provision inconsistent with the purpose
described in subsection (a), the provisions of subpart C
of part 2 of subtitle F apply to loans and loan guarantees
under subsection (a) to the same extent and in the same
manner as such provisions apply to loans and loan guaran-
tees under section 2773.
‘‘SEC. 2754. FUNDING.
Amounts available to the Secretary under section
2761 for the purpose of carrying out part 2 of subtitle
F are, in addition to such purpose, available to the Sec-
retary for the purpose of carrying out this subpart.
‘‘PART 2—SCHOLARSHIP AND LOAN REPAYMENT
PROGRAMS REGARDING SCHOOL NURSES
‘‘SEC. 2755. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
‘‘For the purpose of carrying out this part, there is
authorized to be appropriated from the Fund $10,000,000
for each of the fiscal years 1995 through 2002.
‘‘SEC. 2755A. SCHOLARSHIP PROGRAM REGARDING UP-
GRADE IN SKILLS.
‘‘(a) IN GENERAL.—The Secretary, acting through
the Administrator of the Health Resources and Services
Administration and in consultation with the Director of
the Centers for Disease Control and Prevention, shall
carry out a program under which the Secretary awards
scholarships to individuals described in subsection (b) for
the purpose of assisting the individuals with the costs of
attending programs of education in professional nursing
(exclusive of graduate programs in nursing).
‘‘(b) ELIGIBLE
INDIVIDUALS.—An individual re-
ferred to in subsection (a) is any individual meeting the
following conditions:
‘‘(1) The individual is serving or has served as
a school nurse in public or nonprofit private elemen-
tary or secondary school, and the individual is not
a professional nurse.
‘‘(2) The individual is enrolled (or accepted for
enrollment) at a program referred to in subsection
(a) as a full-time or part-time student.
‘‘(3) The individual enters into the contract re-
quired pursuant to subsection (d) as a condition of
receiving the scholarship (relating to an agreement
to provide services as a school nurse.
‘‘(d) APPLICABILITY OF CERTAIN PROVISIONS.—Ex-
cept as inconsistent with this section or section 2755C,
the provisions of subpart III of part D of title III (relating
to the Scholarship and Loan Repayment Programs of the
National Health Service Corps) apply to an award of a
scholarship under subsection (a) to the same extent and
in the same manner as such provisions apply to an award
of a scholarship under section 338A.
‘‘SEC. 2755B. LOAN REPAYMENT PROGRAM.
‘‘(a) IN GENERAL.—The Secretary, acting through
the Administrator of the Health Resources and Services
Administration and in consultation with the Director of
the Centers for Disease Control and Prevention, shall
carry out a program under which the Federal Government
enters into agreements to repay all or part of the edu-
cational loans of individuals meeting the following condi-
tions:
‘‘(1) The individual is a professional nurse and
meets the applicable legal requirements to serve as
a school nurse.
‘‘(2) The individual enters into the contract re-
quired pursuant to subsection (b) as a condition of
the Federal Government repaying such loans (relat-
ing to an agreement to provide services as a school
nurse).
‘‘(b) APPLICABILITY OF CERTAIN PROVISIONS.—Ex-
cept as inconsistent with this section or section 2755C,
the provisions of subpart III of part D of title III (relating
to the Scholarship and Loan Repayment Programs of the
National Health Service Corps) apply to an agreement re-
garding repayment under subsection (a) to the same ex-
tent and in the same manner as such provisions apply to
an agreement regarding repayment under section 338B.
‘‘(c) AMOUNT OF REPAYMENTS.—For each year for
which an individual contracts to serve as a school nurse
pursuant to subsection (b), the Secretary may repay not
more than $20,000 of the principal and interest of the
educational loans of the individual.
‘‘SEC. 2755C. SCHOOL-NURSE POSITIONS.
‘‘(a) POSITION REGARDING STUDENTS WITH SIG-
NIFICANT NEED FOR SERVICES.—
‘‘(1) IN GENERAL.—With respect to the pro-
grams under this part, the obligated service of a
program participant pursuant to sections 2755A(d)
and 2755B(b) shall be provided through an assign-
ment to a school described in subsection (b) for a
position as a school nurse.
‘‘(2) PERIOD
OF
SERVICE.—For purposes of
sections 2755A(d) and 2755B(d), the period of obli-
gated service is the following, as applicable to the
program participant involved:
‘‘(A) In the case of scholarships under sec-
tion 2755A for full-time students, the greater
of—
‘‘(i) 1 year for each year for which
such a scholarship is provided; or
‘‘(ii) 2 years.
‘‘(B) In the case of scholarships under sec-
tion 2755A for part-time students, a period de-
termined by the Secretary on the basis of the
number of hours of education or training re-
ceived under the scholarship, considering the
percentage constituted by the ratio of such
number to the number of hours for a full-time
student in the program involved.
‘‘(C) In the case of the loan repayments
under section 2755B, such period as the Sec-
retary and the participant may agree, except
that the period may not be less than 2 years.
‘‘(b) APPROVAL OF SCHOOLS FOR ASSIGNMENT OF
PROGRAM PARTICIPANTS.—The schools referred to in
subsection (a) are public or nonprofit private elementary
or secondary schools whose students include a significant
number of students with an unmet need for health services
that are provided by school nurses.
‘‘(c) DEFINITIONS.—For purposes of this subpart:
‘‘(1) The term ‘professional nurse’ has the
meaning given such term under title VIII.
‘‘(2) The term ‘program participant’ means an
individual who enters into a contract pursuant to
section 2755A(b)(3) or 2755B(a)(2).
‘‘(3) The term ‘school nurse’ means a nurse
who provides health services on the premises of an
elementary or secondary school and meets such cri-
teria as the Secretary may establish.
‘‘Subtitle F—Expansion of Access to
Health Services
‘‘PART 1—COMMUNITY AND MIGRANT HEALTH
CENTERS
‘‘SEC. 2756. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
‘‘(a) IN GENERAL.—For the purpose of carrying out
this part, there is authorized to be appropriated from the
Fund $100,000,000 for each of the fiscal years 1995
through 2000.
‘‘(b) RELATION TO OTHER FUNDS.—The authoriza-
tions of appropriations established in subsection (a) for
the purpose described in such subsection are in addition
to any other authorizations of appropriations that are
available for such purpose.
‘‘SEC. 
2757. 
GRANTS 
TO 
COMMUNITY 
AND 
MIGRANT
HEALTH CENTERS.
‘‘(a) IN GENERAL.—The Secretary shall make grants
in accordance with this section to migrant health centers
and community health centers.
‘‘(b) USE OF FUNDS.—
‘‘(1) DEVELOPMENT, OPERATION, AND OTHER
PURPOSES REGARDING CENTERS.—Subject to para-
graph (2), grants under subsection (a) to migrant
health centers and community health centers may be
made only in accordance with the conditions upon
which grants are made under sections 329 and 330,
respectively.
‘‘(2) REQUIRED
FINANCIAL
RESERVES.—The
Secretary may authorize migrant health centers and
community health centers to expend a grant under
subsection (a) to establish and maintain financial re-
serves required for purposes of health plans.
‘‘(c) DEFINITIONS.—For purposes of this subtitle,
the terms ‘migrant health center’ and ‘community health
center’ have the meanings given such terms in sections
329(a)(1) and 330(a), respectively.
‘‘PART 2—QUALIFIED COMMUNITY HEALTH
PLANS AND PRACTICE NETWORKS
‘‘Subpart A—Funding; Purposes
‘‘SEC. 2761. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
‘‘(a) DEVELOPMENT
OF QUALIFIED COMMUNITY
HEALTH PLANS AND PRACTICE GROUPS.—For the pur-
pose of carrying out this part, there are authorized to be
appropriated from the Fund $200,000,000 for fiscal year
1995, $500,000,000 for fiscal year 1996, $600,000,000
for fiscal year 1997, $650,000,000 for fiscal year 1998,
$500,000,000 for fiscal year 1999, and $200,000,000 for
fiscal year 2000.
‘‘(b) RELATION TO OTHER FUNDS.—The authoriza-
tions of appropriations established in subsection (a) are
in addition to any other authorizations of appropriations
that are available for the purpose described in such sub-
section.
‘‘(c) RELATIONSHIP
TO
PROGRAM
REGARDING
SCHOOL-RELATED HEALTH SERVICES.—This section is
subject to section 2754.
‘‘SEC. 2762. PURPOSES.
Subject to the provisions of this part, the purposes
of this part are as follows:
‘‘(1) To improve access to health services for
urban and rural medically-underserved populations
through a program of flexible grants, contracts, and
loans.
‘‘(2) To facilitate transition to a system in
which medically-underserved populations have an
adequate choice of community-oriented providers
and health plans.
‘‘(3) To promote the development of community
practice networks and community health plans that
integrate health professionals and health care orga-
nizations supported through public funding with
other providers in medically underserved areas.
‘‘(4) To support linkages between providers of
health care for medically-underserved populations
and health plans.
‘‘(5) To expand the capacity of community
practice networks and community health plans in
underserved areas by increasing the number of prac-
tice sites and by renovating and converting sub-
standard inpatient and outpatient facilities.
‘‘(6) To link providers in underserved areas
with each other and with public and private health
care institutions and academic health centers,
through information systems and telecommuni-
cations.
‘‘(7) To support activities that enable medically
underserved populations to gain access to the health
care system and use it effectively.
‘‘Subpart B—Development of Qualified Community
Health Plans and Practice Networks
‘‘SEC. 2763. GRANTS AND CONTRACTS FOR DEVELOPMENT
OF PLANS AND NETWORKS.
‘‘(a) IN GENERAL.—The Secretary may make grants
to and enter into contracts with consortia of public or pri-
vate health care providers for the development of qualified
community health plans and qualified community practice
networks. For purposes of this subtitle, the term ‘qualified
community health group’ means such a health plan or
such a practice network.
‘‘(b) QUALIFIED COMMUNITY HEALTH PLANS.—For
purposes of this subtitle, the term ‘qualified community
health plan’ means a health plan that meets the following
conditions:
‘‘(1) The health plan is a public or nonprofit
private entity whose principal purpose is to provide
comprehensive health services, including clinical pre-
ventive services, in 1 or more medically underserved
communities (as defined in section 2799).
‘‘(2) Two or more of the categories specified in
subsection (d) are represented among the entities
providing health services through the health plan.
‘‘(c) 
QUALIFIED
COMMUNITY
PRACTICE
NET-
WORKS.—For purposes of this subtitle, the term ‘qualified
community practice network’ means a consortium of
health care providers meeting the following conditions:
‘‘(1) The consortium is a public or nonprofit
private entity whose principal purpose is the purpose
described in subsection (b)(1).
‘‘(2) The consortium has an agreement with
one or more health plans.
‘‘(3) The participation of health care providers
in the consortium is governed by a written agree-
ment to which each of the participating providers is
a party.
‘‘(4) Two or more of the categories described in
subsection (d) are represented among the entities
participating in the consortium.
‘‘(d) RELEVANT CATEGORIES
OF ENTITIES.—For
purposes of subsections (b)(3) and (c)(4), the categories
described in this subsection are the following categories
of entities:
‘‘(1) Physicians, other health professionals, or
health care institutions that provide health services
in one or more health professional shortage areas or
provide such services to a significant number of indi-
viduals who are members of a medically underserved
population, and that do not provide health services
under any of the programs specified in paragraphs
(2) through (7) or as employees of public entities.
‘‘(2) Entities providing health services under
grants under sections 329 and 330.
‘‘(3) Entities providing health services under
grants under sections 340 and 340A.
‘‘(4) Entities providing health services under
grants under section 1001 or title XXVI.
‘‘(5) Entities providing health services under
title V of the Social Security Act.
‘‘(6) Entities providing health services through
rural health clinics and other federally qualified
health centers.
‘‘(7) Entities providing health services in urban
areas through programs under title V of the Indian
Health Care Improvement Act, and entities provid-
ing outpatient health services through programs
under the Indian Self-Determination Act.
‘‘(8) Programs providing personal health serv-
ices and operating through State or local public
health agencies.
‘‘(e) RULE OF CONSTRUCTION.—The consortia to
which the Secretary may make an award of financial as-
sistance under subsection (a) for the development of quali-
fied community practice networks include any health plan
that meets applicable requirements regarding financial sol-
vency and professional credentials, without regard to
whether the health plan is a qualified health plan.
‘‘(f) SERVICE AREA.—In making an award of finan-
cial assistance under subsection (a), the Secretary shall
designate the geographic area with respect to which the
qualified community health group involved is to provide
health services. A funding agreement for such an award
is that the qualified community health group involved will
provide such services in the area so designated.
‘‘(g) DEFINITIONS.—For purposes of this subtitle:
‘‘(1) The term ‘health professional shortage
areas’ means health professional shortage areas des-
ignated under section 332.
‘‘(2) The term ‘medically underserved popu-
lation’ means a medically underserved population
designated under section 330.
‘‘(3) The term ‘rural health clinic’’ has the
meaning given such term in section 1861(aa)(2) of
the Social Security Act.
‘‘(4) The term ‘federally qualified health cen-
ters’ has the meaning given such term in section
1861(aa)(4) of the Social Security Act.
‘‘(5) The term ‘service area’, with respect to a
qualified community health group, means the geo-
graphic area designated under subsection (f).
‘‘(6) The term ‘funding agreement’, with re-
spect to an award of financial assistance under this
section, means that the Secretary may make the
award only if the applicant for the award makes the
agreement involved.
‘‘(7) The term ‘financial assistance’, with re-
spect to awards under subsection (a), means a grant
or contract.
‘‘SEC. 2764. PREFERENCES IN MAKING AWARDS OF ASSIST-
ANCE.
‘‘In making awards of financial assistance under sec-
tion 2763, the Secretary shall give preference to applicants
in accordance with the following:
‘‘(1) The Secretary shall give preference if 3 or
more of the categories described in subsection (d) of
such section will be represented in the qualified com-
munity health group involved (pursuant to sub-
section (b)(3) or (c)(4) of such section, as the case
may be).
‘‘(2) Of applicants receiving preference under
paragraph (1), the Secretary shall give a greater de-
gree of preference according to the extent to which
a greater number of categories are represented.
‘‘(3) Of applicants receiving preference under
paragraph (1), the Secretary shall give a greater de-
gree of preference if one of the categories rep-
resented is the category described in subsection
(d)(1) of such section.
‘‘SEC. 2765. CERTAIN USES OF AWARDS.
‘‘(a) IN GENERAL.—Subject to subsections (b) and
(c), the purposes for which an award of financial assist-
ance under section 2763 may be expended in developing
a qualified community health group include the following:
‘‘(1) Planning such group, including entering
into contracts between the recipient of the award
and health care providers who are to participate in
the group.
‘‘(2) Recruitment, compensation, and training
of health professionals (including public health pro-
fessionals) and administrative staff.
‘‘(3) Acquisition, expansion, modernization, and
conversion of facilities, including for purposes of
providing for sites at which health services are to be
provided through such group.
‘‘(4) Acquisition and development of informa-
tion systems (exclusive of systems that the Secretary
determines are information highways).
‘‘(5) Such other expenditures as the Secretary
determines to be appropriate.
‘‘(b) PRIORITIES AND LIMITATIONS REGARDING CAP-
ITAL COSTS.—
‘‘(1) PRIORITIES REGARDING USE OF FUNDS.—
In authorizing recipients of awards under section
2763 to use the awards for capital costs, the Sec-
retary shall give priority to authorizing expenditures
for projects for the renovation and modernization of
medical facilities necessary to prevent or eliminate
safety hazards, avoid noncompliance with licensure
or accreditation standards, or projects to replace ob-
solete facilities.
‘‘(2) LIMITATION.—The Secretary may author-
ize the use of awards under section 2763 for the
construction of new buildings only if the Secretary
determines that appropriate facilities are not avail-
able through acquiring, modernizing, expanding or
converting existing buildings, or that construction of
new buildings will cost less.
‘‘(c) TWENTY-YEAR OBLIGATION REGARDING SIG-
NIFICANT CAPITAL EXPENDITURES; RIGHT OF RECOV-
ERY.—
‘‘(1) IN GENERAL.—With respect to a facility
for which substantial capital costs are to paid from
an award of financial assistance under section 2763,
the Secretary may make the award only if the appli-
cant involved agrees that the applicant will be liable
to the United States for the amount of the award
expended for such costs, together with an amount
representing interest, if at any time during the 20-
period beginning on the date of completion of the ac-
tivities involved, the facility—
‘‘(A) ceases to be a facility utilized by a
qualified community health group, or by an-
other public or nonprofit private entity that
provides health services in one or more health
professional shortage areas or that provides
such services to a significant number of individ-
uals who are members of a medically under-
served population; or
‘‘(B) is sold or transferred to any entity
other than an entity that is—
‘‘(i) a qualified community health
group or other entity described in subpara-
graph (A); and
‘‘(ii) approved by the Secretary as a
purchaser or transferee regarding the
facility.
‘‘(2) SUBORDINATION; 
WAIVERS.—The Sec-
retary may subordinate or waive the right of recov-
ery under paragraph (1), and any other Federal in-
terest that may be derived by virtue of an award of
financial assistance under section 2763 from which
substantial capital costs are to be paid, if the Sec-
retary determines that subordination or waiver will
further the objectives of this part.
‘‘SEC. 2766. ACCESSIBILITY OF SERVICES.
‘‘(a) SERVICES
FOR
CERTAIN
INDIVIDUALS.—A
funding agreement for an award of financial assistance
under section 2763 is that the qualified community health
group involved will ensure that the services of the group
will be accessible to all individuals in the service area of
the group, directly or through formal contractual arrange-
ments with its participating providers.
‘‘(b) USE
OF THIRD-PARTY PAYORS.—A funding
agreement for an award of financial assistance under sec-
tion 2763 is that the qualified community health group
involved will ensure that the health care providers of the
group are all approved by the Secretary as providers under
title XVIII of the Social Security Act and by the appro-
priate State agency as providers under title XIX of the
Social Security Act, and the applicant has made or will
make every reasonable effort to collect appropriate reim-
bursement for its costs in providing health services to indi-
viduals who are entitled to insurance benefits under title
XVIII of the Social Security Act, to medical assistance
under a State plan approved under title XIX of the Social
Security Act, or to assistance for medical expenses under
any other public assistance program or private health in-
surance program.
‘‘(c) SCHEDULE OF FEES.—A funding agreement for
an award of financial assistance under section 2763 is that
the qualified community health group involved will—
‘‘(1) prepare a schedule of fees or payments for
the provision of health services that is consistent
with locally prevailing rates or charges and designed
to cover its reasonable costs of operation and has
prepared a corresponding schedule of discounts to be
applied to the payment of such fees or payments (or
payments of cost sharing amounts owed in the case
of covered benefits) which discounts are applied on
the basis of the patient’s ability to pay; and
‘‘(2) make every reasonable effort to secure
from patients payment in accordance with such
schedules, and to collect reimbursement for services
to persons entitled to public or private insurance
benefits or other medical assistance on the basis of
full fees without application of discounts, except that
the applicant will ensure that no person is denied
service based on the person’s inability to pay there-
for.
‘‘(d) BARRIERS WITHIN SERVICE AREA.—A funding
agreement for an award of financial assistance under sec-
tion 2763 is that the qualified community health group
involved will ensure that the following conditions are met:
‘‘(1) In the service area of the group, the group
will ensure that—
‘‘(A) the services of the group are acces-
sible to all residents; and
‘‘(B) to the maximum extent possible, bar-
riers to access to the services of the group are
eliminated, including barriers resulting from the
area’s physical characteristics, its residential
patterns, its economic, social and cultural
groupings, and available transportation.
‘‘(2) The group will periodically conduct reviews
within the service area of the group to determine
whether the conditions described in paragraph (1)
are being met.
‘‘(e) LIMITED ABILITY TO SPEAK ENGLISH LAN-
GUAGE.—A funding agreement for an award of financial
assistance under section 2763 is that, if the service area
of the qualified community health group involved includes
a substantial number of individuals who have a limited
ability to speak the English language, the applicant will—
‘‘(1) maintain arrangements responsive to the
needs of such individuals for providing services to
the extent practicable in the language and cultural
context most appropriate to such individuals; and
‘‘(2) maintain a sufficient number of staff
members who are fluent in both English and the
languages spoken by such individuals, and will en-
sure that the responsibilities of the employees in-
clude providing guidance and assistance to such in-
dividuals and to other staff members of the group.
‘‘SEC. 2767. ADDITIONAL AGREEMENTS.
‘‘(a) REQUIRED SERVICES.—A funding agreement
for an award of financial assistance under section 2763
is that the qualified community health group involved will
provide enabling services (as defined in section 2780(g))
and all of the items and services identified by the Sec-
retary in rules regarding qualified community health plans
and practice networks.
‘‘(b) QUALITY CONTROL SYSTEM.—A funding agree-
ment for an award of financial assistance under section
2763 is that the qualified community health group in-
volved will maintain a community-oriented, patient respon-
sive, quality control system under which the group, in ac-
cordance with regulations prescribed by the Secretary—
‘‘(1) conducts an ongoing quality assurance
program for the health services delivered by partici-
pating provider entities;
‘‘(2) maintains a continuous community health
status improvement process that is based on out-
comes reporting by the State, including any such re-
ports available pursuant to the Healthy People 2000
Objectives; and
‘‘(3) maintains a system for development, com-
pilation, evaluation and reporting of information to
the public and to the State and local health depart-
ments involved regarding the costs of operation,
service utilization patterns, availability, accessibility
and acceptability of services, developments in the
health status of the populations served, uniform
health and clinical performance measures and finan-
cial performance of the network or plan.
‘‘(c) USE
OF EXISTING RESOURCES.—A funding
agreement for an award of financial assistance under sec-
tion 2763 is that the applicant will, in developing the
qualified community health group involved, utilize existing
resources to the maximum extent practicable.
‘‘SEC. 2768. SUBMISSION OF CERTAIN INFORMATION.
‘‘(a) ASSESSMENT OF NEED.—The Secretary may
make an award of financial assistance under section 2763
only if the applicant involved submits to the Secretary an
assessment of the need that the medically underserved
population or populations proposed to be served by the ap-
plicant have for health services and for enabling services
(as defined in section 2780(g)).
‘‘(b) DESCRIPTION OF INTENDED EXPENDITURES;
RELATED INFORMATION.—The Secretary may make an
award of financial assistance under section 2763 only if
the applicant involved submits to the Secretary the follow-
ing information:
‘‘(1) A description of how the applicant will de-
sign the proposed quality community health plan or
practice network (including the service sites in-
volved) for such populations based on the assess-
ment of need.
‘‘(2) A description of efforts to secure, within
the proposed service area of such health plan or
practice network (including the service sites in-
volved), financial and professional assistance and
support for the project.
‘‘(3) Evidence of significant community involve-
ment in the initiation, development and ongoing op-
eration of the project.
‘‘SEC. 2769. REPORTS; AUDITS.
‘‘A funding agreement for an award of financial as-
sistance under section 2763 is that the applicant involved
will—
‘‘(1) provide such reports and information on
activities carried out under this section in a manner
and form required by the Secretary; and
‘‘(2) provide an annual organization-wide audit
that meets applicable standards of the Secretary.
‘‘SEC. 2770. APPLICATION FOR ASSISTANCE.
‘‘The Secretary may make an award of financial as-
sistance under section 2763 only if an application for the
award is submitted to the Secretary, the application con-
tains each funding agreement described in this subpart,
the application contains the information required in sec-
tion 2768, and the application is in such form, is made
in such manner, and contains such agreements, assur-
ances, and information as the Secretary determines to be
necessary to carry out this subpart.
‘‘SEC. 2771. GENERAL PROVISIONS.
‘‘(a) LIMITATION ON NUMBER OF AWARDS.—The
Secretary may not make more than two awards of finan-
cial assistance under section 2763 for the same project.
‘‘(b) AMOUNT.—The amount of any award of finan-
cial assistance under section 2763 for any project shall
be determined by the Secretary.
‘‘Subpart C—Capital Cost of Development of Quali-
fied Community Health Plans and Practice Net-
works
‘‘SEC. 2773. LOANS AND LOAN GUARANTEES REGARDING
PLANS AND NETWORKS.
‘‘(a) IN GENERAL.—The Secretary may make loans
to, and guarantee the payment of principal and interest
to Federal and non-Federal lenders on behalf of, public
and private entities for the capital costs of developing
qualified community health groups (as defined in section
2763(a)).
‘‘(b) PREFERENCES; ACCESSIBILITY OF SERVICES;
CERTAIN OTHER PROVISIONS.—The provisions of subpart
B apply to loans and loan guarantees under subsection
(a) to the same extent and in the same manner as such
provisions apply to awards of grants and contracts under
section 2763.
‘‘(c) USE OF ASSISTANCE.—
‘‘(1) IN GENERAL.—With respect to the devel-
opment of qualified community health groups, the
capital costs for which loans made pursuant to sub-
section (a) may be expended are, subject to para-
graphs (2) and (3), the following:
‘‘(A) The acquisition, modernization, ex-
pansion or construction of facilities, or the con-
version of unneeded hospital facilities to facili-
ties that will assure or enhance the provision
and accessibility of health care and enabling
services to medically underserved populations.
‘‘(B) The purchase of major equipment, in-
cluding equipment necessary for the support of
external and internal information systems.
‘‘(C) The establishment of reserves re-
quired for furnishing services on a prepaid
basis.
‘‘(D) Such other capital costs as the Sec-
retary may determine are necessary to achieve
the objectives of this section.
‘‘(2) PRIORITIES REGARDING USE OF FUNDS.—
In providing loans or loan guarantees under sub-
section (a) for an entity, the Secretary shall give pri-
ority to authorizing the use of amounts for projects
for the renovation and modernization of medical fa-
cilities necessary to prevent or eliminate safety haz-
ards, avoid noncompliance with licensure or accredi-
tation standards, or projects to replace obsolete
facilities.
‘‘(3) LIMITATION.—The Secretary may author-
ize the use of amounts under subsection (a) for the
construction of new buildings only if the Secretary
determines that appropriate facilities are not avail-
able through acquiring, modernizing, expanding or
converting existing buildings, or that construction of
new buildings will cost less.
‘‘(d) AMOUNT
OF
ASSISTANCE.—The principal
amount of loans or loan guarantees under subsection (a)
may, when added to any other assistance under this sec-
tion, cover up to 100 percent of the costs involved.
‘‘SEC. 2774. CERTAIN REQUIREMENTS.
‘‘(a) LOANS.—
‘‘(1) IN GENERAL.—The Secretary may approve
a loan under section 2773 only if—
‘‘(A) the Secretary is reasonably satisfied
that the applicant for the project for which the
loan would be made will be able to make pay-
ments of principal and interest thereon when
due; and
‘‘(B) the applicant provides the Secretary
with reasonable assurances that there will be
available to it such additional funds as may be
necessary to complete the project or undertak-
ing with respect to which such loan is re-
quested.
‘‘(2) TERMS AND CONDITIONS.—Any loan made
under section 2773 shall, subject to the Federal
Credit Reform Act of 1990, meet such terms and
conditions (including provisions for recovery in case
of default) as the Secretary, in consultation with the
Secretary of the Treasury, determines to be nec-
essary to carry out the purposes of such section
while adequately protecting the financial interests of
the United States. Terms and conditions for such
loans shall include provisions regarding the follow-
ing:
‘‘(A) Security.
‘‘(B) Maturity date.
‘‘(C) Amount and frequency of install-
ments.
‘‘(D) Rate of interest, which shall be at a
rate comparable to the rate of interest prevail-
ing on the date the loan is made.
106
‘‘(2) AUTHORIZED
PROGRAM
SERVICES.—For
purposes of paragraph (1)(D), the services specified
in this paragraph for a program are as follows:
‘‘(A) The program will collaborate with
health care providers and related entities in
order to facilitate the provision of health serv-
ices and health-related social services (including
collaborating with local health departments,
community health centers, public hospital sys-
tems, migrant health centers, rural health clin-
ics, hospitals, physicians and nurses, providers
of health education, pre-school facilities for chil-
dren, elementary and secondary schools, and
providers of social services).
‘‘(B) The program will provide public edu-
cation on health promotion and on the preven-
tion of diseases, illnesses, injuries, and disabil-
ities, and will facilitate the appropriate use of
available health services and health-related so-
cial services.
‘‘(C) The program will provide health-re-
lated counseling.
‘‘(D) The program will provide referrals
for available health services and health-related
social services.