151
Title I, Subtitle D
(2) INSURANCE PURCHASED MUST MEET CER-
TAIN STANDARDS.—Paragraph (2) of section 162(l)
of such Code is amended by adding at the end there-
of the following new subparagraph:
‘‘(C) TREATMENT
OF
GROUP
HEALTH
PLANS.—For purposes of this subsection, an
amount paid into a multiple employer health
plan (as defined in section 701(10) of the Em-
ployee Retirement Income Security Act of
1974) shall be deemed to be an amount paid for
insurance which constitutes medical care.’’.
(3) EFFECTIVE DATE.—The amendments made
by this subsection shall apply to taxable years begin-
ning after December 31, 1994.
SEC. 1302. DEDUCTION OF HEALTH INSURANCE PREMIUMS
FOR CERTAIN PREVIOUSLY UNINSURED INDI-
VIDUALS.
(a) IN GENERAL.—Section 213 of the Internal Reve-
nue Code of 1986 (relating to medical, dental, etc., ex-
penses) is amended by adding at the end thereof the fol-
lowing new subsection:
‘‘(f) DEDUCTION FOR CERTAIN HEALTH INSURANCE
COSTS DETERMINED WITHOUT REGARD TO ADJUSTED
GROSS INCOME THRESHOLD.—
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Title I, Subtitle D
‘‘(1) IN GENERAL.—Subsection (a) shall be ap-
plied without regard to the limitation based on ad-
justed gross income in the case of the applicable per-
centage of the amounts paid for insurance referred
to in section 162(l)(2)(C) (and including payments
referred to in section 162(l)(2)(D)).
‘‘(2) APPLICABLE PERCENTAGE.—For purposes
of paragraph (1), the term ‘applicable percentage’
means—
‘‘(A) 25 percent for taxable years begin-
ning in 1994 or 1995,
‘‘(B) 50 percent for taxable years begin-
ning in 1996 or 1997, and
‘‘(C) 100 percent for taxable years begin-
ning after 1997.
‘‘(3) DEDUCTION NOT ALLOWED TO INDIVID-
UALS
ELIGIBLE
FOR
EMPLOYER-SUBSIDIZED
COV-
ERAGE.—
‘‘(A) IN
GENERAL.—Paragraph (1) shall
not apply to any individual—
‘‘(i) who is eligible to participate in
any subsidized health plan maintained by
an employer of such individual or the
spouse of such individual, or
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Title I, Subtitle D
‘‘(ii) who is (or whose spouse is) a
member of a subsidized class of employees
of an employer of such individual or
spouse.
‘‘(B) SUBSIDIZED CLASS.—For purposes of
subparagraph (A), an individual is a member of
a subsidized class of employees of an employer
if, at any time during the 3 calendar years end-
ing with or within the taxable year, any mem-
ber of such class was eligible to participate in
any subsidized health plan maintained by such
employer.
‘‘(C) SPECIAL RULES.—
‘‘(i) CONTROLLED GROUPS.—All per-
sons treated as a single employer under
subsection (a) or (b) of section 52 or sub-
section (m) or (o) of section 414 shall be
treated as a single employer for purposes
of subparagraph (B).
‘‘(ii) CLASSES.—Classes of employees
shall be determined under regulations pre-
scribed by the Secretary based on such fac-
tors as the Secretary determines appro-
priate to carry out the purposes of this
subsection.
154
Title I, Subtitle D
‘‘(4) COORDINATION
WITH
DEDUCTION
FOR
OTHER AMOUNTS.—Amounts allowable as a deduc-
tion under subsection (a) by reason of this sub-
section shall not be taken into account in determin-
ing the deduction under subsection (a) for other
amounts.
‘‘(5) SUBSECTION NOT TO APPLY TO INDIVID-
UALS
ELIGIBLE
FOR
MEDICARE.—This subsection
shall not apply to amount paid for insurance cover-
ing an individual who is eligible for benefits under
title XVIII of the Social Security Act.’’.
(b) DEDUCTION ALLOWED WHETHER OR NOT INDI-
VIDUAL ITEMIZES OTHER DEDUCTIONS.—Subsection (a)
of section 62 of such Code is amended by inserting after
paragraph (15) the following new paragraph:
‘‘(16) COSTS
OF
CERTAIN
HEALTH
INSUR-
ANCE.—The deduction allowed by section 213 to the
extent allowable by reason of section 213(f).’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to taxable years beginning after
December 31, 1994.
155
Title I, Subtitle E
Subtitle E—Improved Access to
Community Health Services
PART 1—INCREASED AUTHORIZATION FOR
COMMUNITY AND MIGRANT HEALTH CENTERS
SEC. 1401. GRANT PROGRAM TO PROMOTE PRIMARY
HEALTH CARE SERVICES FOR UNDERSERVED
POPULATIONS.
(a) AUTHORIZATION.—The Secretary of Health and
Human Services shall provide for a program of grants to
migrant and community health centers (receiving grants
or contracts under section 329, 330, or 340 of the Public
Health Service Act) in order to promote the provision of
primary health care services for underserved individuals.
Such grants may be used—
(1) to promote the provision of off-site services
(through means such as mobile medical clinics);
(2) to improve birth outcomes in areas with
high infant mortality and morbidity;
(3) to establish primary care clinics in areas
identified as in need of such clinics; and
(4) for recruitment and training costs of nec-
essary providers and operating costs for unreim-
bursed services.
156
Title I, Subtitle E
(b) CONDITIONS.—(1) Grants under this subsection
shall only be made upon application, approved by the Sec-
retary.
(2) The amount of grants made under this section
shall be determined by the Secretary.
(c) AUTHORIZATION
OF APPROPRIATIONS.—There
are authorized to be appropriated—
(1) in fiscal year 1995, $100,000,000,
(2) in fiscal year 1996, $200,000,000,
(3) in fiscal year 1997, $300,000,000,
(4) in fiscal year 1998, $400,000,000, and
(5) in fiscal year 1999, $500,000,000,
to carry out this section. Of the amounts appropriated
each fiscal year under this section, at least 10 percent
shall be used for grants described in subsection (a)(1) and
at least 10 percent shall be used for grants described in
subsection (a)(2). The Secretary may use not to exceed
50 percent of the amounts appropriated to carry out this
section for the purpose of making new grants or contracts
under sections 329, 330, and 340 of the Public Health
Service Act.
(d) STUDY AND REPORT.—The Secretary shall con-
duct a study of the impact of the grants made under this
section to migrant and community health centers on ac-
cess to health care, birth outcomes, and the use of emer-
157
Title I, Subtitle E
gency room services. Not later than 2 years after the date
of the enactment of this Act, the Secretary shall submit
to Congress a report on such study and on recommenda-
tions for changes in the programs under this section in
order to promote the appropriate use of cost-effective out-
patient services.
PART 2—GRANTS FOR PROJECTS FOR
COORDINATING DELIVERY OF SERVICES
SEC. 1411. PROJECTS FOR COORDINATING DELIVERY OF
OUTPATIENT PRIMARY HEALTH SERVICES.
Part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq.) is amended by adding at the end
the following new subpart:
‘‘Subpart VII—Delivery of Services
‘‘PROJECTS FOR COORDINATING DELIVERY OF SERVICES
‘‘SEC. 340E. (a) AUTHORITY FOR GRANTS.—
‘‘(1) IN GENERAL.—The Secretary may make
grants to public and nonprofit private entities to
carry out demonstration projects for the purpose of
increasing access to outpatient primary health serv-
ices in geographic areas described in subsection (b)
through coordinating the delivery of such services
under Federal, State, local, and private programs.
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Title I, Subtitle E
‘‘(2) REQUIREMENT
REGARDING
PLAN.—The
Secretary may make a grant under paragraph (1)
only if—
‘‘(A) the applicant involved has received a
grant under subsection (l) and the Secretary
has approved the plan developed with such
grant; and
‘‘(B) the applicant agrees to carry out the
project under paragraph (1) in accordance with
the plan.
‘‘(b) QUALIFIED HEALTH SERVICE AREAS.—
‘‘(1) IN
GENERAL.—A geographic area de-
scribed in this subsection is a geographic area
that—
‘‘(A) is a rational area for the delivery of
health services;
‘‘(B) has a population of not more than
500,000 individuals; and
‘‘(C)(i) has been designated by the Sec-
retary as an area with a shortage of personal
health services; or
‘‘(ii) has a significant number of individ-
uals who have low incomes or who have insuffi-
cient insurance regarding health care.
159
Title I, Subtitle E
‘‘(2) AUTHORITY REGARDING MULTIPLE POLIT-
ICAL SUBDIVISIONS.—The Secretary shall make a
determination of whether a geographic area is a geo-
graphic area described in paragraph (1) without re-
gard to whether the area is a political subdivision,
without regard to whether the area is located in 2
or more political subdivisions or States, and without
regard to whether the area encompasses 2 or more
political subdivisions.
‘‘(c) PREFERENCES IN MAKING GRANTS.—In making
grants under subsection (a), the Secretary shall give pref-
erence to applicants demonstrating that, with respect to
the outpatient primary health services that will be the sub-
ject of the project conducted by the applicant under such
subsection—
‘‘(1)(A) the project will result in the reduction
of administrative expenses associated with such serv-
ices by increasing the efficiency of the administrative
processes of the providers participating in the
project, and
‘‘(B) the resulting savings will be expended for
the direct provision of such services for the des-
ignated population; or
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Title I, Subtitle E
‘‘(2) the services that will be the subject of the
project will be provided in facilities that are
underutilized.
‘‘(d) ACTIVITIES OF PROJECT MUST SERVE DES-
IGNATED POPULATION.—The Secretary may make a
grant under subsection (a) to an applicant only if the ap-
plicant demonstrates that carrying out the project under
such subsection will increase access to outpatient primary
health services for a significant segment of the designated
population.
‘‘(e) MATCHING FUNDS.—
‘‘(1) IN GENERAL.—With respect to the costs of
the project to be carried out under subsection (a) by
an applicant, the Secretary may make a grant under
such subsection only if the applicant agrees to make
available (directly or through donations from public
or private entities) non-Federal contributions toward
such costs in an amount that is not less than 50
percent of such costs.
‘‘(2) DETERMINATION
OF
AMOUNT
CONTRIB-
UTED.—Non-Federal contributions required in para-
graph (1) may be in cash or in kind, fairly evalu-
ated, including plant, equipment, or services.
Amounts provided by the Federal Government, or
services assisted or subsidized to any significant ex-
161
Title I, Subtitle E
tent by the Federal Government, may not be in-
cluded in determining the amount of such non-Fed-
eral contributions.
‘‘(f) CERTAIN LIMITATIONS REGARDING GRANTS.—
‘‘(1) PROVISION OF HEALTH SERVICES; CON-
STRUCTION
OF
FACILITIES.—The Secretary may
make a grant under subsection (a) only if the appli-
cant involved agrees that the grant will not be ex-
pended for the direct provision of any health service
or for the construction or renovation of facilities.
‘‘(2) DURATION AND AMOUNT OF GRANT.—The
period during which payments are made for a
project under subsection (a) may not exceed 4 years,
and the aggregate amount of such payments for the
period may not exceed $200,000. The provision of
such payments shall be subject to annual approval
by the Secretary of the payments and subject to the
availability of appropriations for the fiscal year in-
volved to make the payments.
‘‘(3) FINANCIAL CAPACITY FOR CONTINUATION
OF PROJECT AFTER TERMINATION OF GRANT.—The
Secretary may make a grant under subsection (a)
only if the Secretary determines that there is a rea-
sonable basis for believing that, after termination of
payments under such subsection pursuant to para-
162
Title I, Subtitle E
graph (2), the project under such subsection will
have the financial capacity to continue operating.
‘‘(g) 
AGREEMENTS
AMONG
PARTICIPANTS
IN
PROJECTS.—
‘‘(1) REQUIRED PARTICIPANTS.—The Secretary
may make a grant under subsection (a) only if the
applicant for the grant has, for purposes of carrying
out a project under such subsection, entered into
agreements with—
‘‘(A) the chief public health officers, and
the chief health officers for the elementary and
secondary schools, of each of the political sub-
divisions of the qualified health service area in
which the project under such subsection is to be
carried out (or, in the case of a political sub-
division that does not have such an official,
with another appropriate official of such sub-
division);
‘‘(B) each hospital in the qualified health
service area;
‘‘(C) representatives of entities in such
area that provide outpatient primary health
services under Federal, State, local, or private
programs;