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 bene-
ficiaries to make payments for assistance provided to
such beneficiaries by school-based health centers, and
for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. REQUIRING MEDICAID HEALTH MAINTENANCE
ORGANIZATIONS TO MAKE PAYMENTS FOR
SERVICES 
PROVIDED 
BY 
SCHOOL-BASED
HEALTH CENTERS.
(a) IN GENERAL.—Section 1903(m)(2)(A) of the
Social Security Act (42 U.S.C. 1396b(m)(2)(A)) is
amended—
(1) by striking ‘‘and’’ at the end of clause (x);
(2) by striking the period at the end of clause
(xi) and inserting ‘‘; and’’; and
(3) by adding at the end the following new
clause:
‘‘(xii) such contract provides that—
‘‘(I) the entity’s network of participating
providers of such services shall include at least
one school-based health center (as defined in
section 1905(t)), or
‘‘(II) the entity shall enter into a contract
for the provision of such services to such indi-
viduals with each school-based health center (as
so defined) located in the entity’s service area,
under terms and conditions (including terms
and conditions relating to patient referrals and
the sharing of patient records) similar to those
applicable to a contract between the entity and
a similar provider of such services in the area
(in accordance with standards established by
the Secretary).’’.
(b) 
SCHOOL-BASED
HEALTH
CENTERS
DE-
SCRIBED.—Section 1905 of such Act (42 U.S.C. 1396d)
is amended by adding at the end the following new sub-
section:
‘‘(t) The term ‘school-based health center’ means a
clinic which is located at an elementary or secondary
school and which—
‘‘(1) provides physical examinations, injury
treatment, primary health services, mental health
services, and other services (to the extent permitted
under the laws or regulations of the State in which
it is located) on an on-site basis to students enrolled
at the school (without regard to whether or not the
students are enrolled in the State plan under this
title);
‘‘(2) refers students to other providers of health
care services for services which the center does not
provide on-site;
‘‘(3) has entered into arrangements with other
providers of health care services providing services
on a 24-hour, emergency basis;
‘‘(4) has on its staff at least one physician
(whether employed on a part-time or full-time basis);
at least one physician assistant, nurse practitioner,
or clinical nurse specialist; and at least one mental
health professional; and
‘‘(5) is approved or certified as such a clinic by
the State in which it is located.’’.
(c) PROHIBITION AGAINST WAIVER
OF REQUIRE-
MENT.—The Secretary of Health and Human Services
may not waive (pursuant to section 1115 or section 1915
of the Social Security Act or otherwise) the application
of section 1903(m)(2)(A)(xii) of the Social Security Act
(as added by subsection (a)) with respect to any State.
(d) EFFECTIVE DATE.—The amendments made by
subsections (a) and (b) shall apply to quarters beginning
on or after January 1, 1996.
SEC. 2. ESTABLISHMENT OF CLEARINGHOUSE FOR INFOR-
MATION AND TECHNICAL ASSISTANCE ON
SCHOOL-BASED HEALTH CENTERS.
Not later than March 1, 1996, the Secretary of
Health and Human Services shall establish a clearing-
house through which interested parties may receive infor-
mation and technical assistance on the establishment and
operation of school-based health centers.
SEC. 3. GRANTS FOR SCHOOL-BASED HEALTH CENTERS.
(a) IN GENERAL.—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 section:
‘‘SCHOOL-BASED HEALTH CENTERS
‘‘SEC. 340E. (a) IN GENERAL.—
‘‘(1) IN GENERAL.—The Secretary may make
grants to public and nonprofit private entities for
the purpose of making available to school children
the health services specified in subsection (d) at sites
that are on or in close proximity to the premises of
a school (or at such other sites as the Secretary de-
termines to be appropriate to provide school children
with access to the services).
‘‘(2) SCHOOL CHILDREN.—For purposes of this
section, the term ‘school children’ means individuals
between the ages of 3 and 18 (inclusive).
‘‘(b) MINIMUM QUALIFICATIONS FOR GRANTEES.—
‘‘(1) STATUS AS MEDICAID PROVIDER.—
‘‘(A) Except as provided in subparagraph
(B), the Secretary may make a grant under
subsection (a) only if the applicant for the
grant is a provider of services under the State
plan approved for the State involved under title
XIX of the Social Security Act.
‘‘(B) The requirements established in sub-
paragraph (A) do not apply to an applicant that
provides health services without charge and
does not receive reimbursement for the services
from any third-party payors.
‘‘(2) REQUIRED
CONSULTATIONS
REGARDING
PARENTS
AND
TEACHERS.—The Secretary may
make a grant under subsection (a) only if the appli-
cant involved, in preparing the application under
subsection (j), has consulted with parents in the
community in which services under the grant are to
be provided, with teachers at schools in the commu-
nity, and with the local educational agency with ju-
risdiction over such schools.
‘‘(c) PREFERENCES IN MAKING GRANTS.—In making
grants under subsection (a), the Secretary shall give pref-
erence to qualified applicants that are experienced in deliv-
ering health care services to medically underserved popu-
lations or in areas in which a significant number of chil-
dren are at risk for health problems.
‘‘(d) AUTHORIZED SERVICES.—
‘‘(1) IN GENERAL.—The Secretary may make a
grant under subsection (a) only if the applicant in-
volved agrees as follows:
‘‘(A) Each of the following services will be
made available under the grant (as medically
appropriate for the child involved):
‘‘(i) Comprehensive health examina-
tions.
‘‘(ii) Health education and prevention
services, including prenatal care.
‘‘(iii) Follow-up care and referrals re-
garding routine health problems.
‘‘(B) Services under subparagraph (A) will
include screenings, follow-up care, and referrals
(including referrals for specialty care) regarding
dental, vision, and hearing services, and regard-
ing sexually-transmitted diseases and other
communicable diseases.
‘‘(2) OPTION
REGARDING
FAMILY
PLANNING
SERVICES.—A grantee under subsection (a) may, at
the option of the grantee, expend the grant under
such subsection to provide voluntary family planning
services. The Secretary may not require as a condi-
tion of the receipt of a grant under subsection (a)
that an applicant for the grant agree to provide such
services.
‘‘(3) OTHER SERVICES.—In addition to services
specified in any of paragraphs (1) and (2), the Sec-
retary may authorize a grantee under subsection (a)
to expend the grant for such additional health or
health-related services for school children as the Sec-
retary determines to be appropriate.
‘‘(4) AVAILABILITY THROUGHOUT YEAR.—The
Secretary may make a grant under subsection (a)
only if the applicant involved agrees that services
under the grant will be available throughout the year
(including any portion of the year during which the
school does not hold classes).
‘‘(e) CULTURAL CONTEXT OF SERVICES.—The Sec-
retary may make a grant under subsection (a) only if the
applicant involved agrees that services under the grant will
be provided in the language and cultural context most ap-
propriate for the individuals to whom the services are pro-
vided.
‘‘(f) LIMITATION
ON IMPOSITION
OF FEES
FOR
SERVICES.—The Secretary may make a grant under sub-
section (a) only if the applicant involved agrees that, if
a fee is imposed for the provision of services under the
grant, such fee—
‘‘(1) will be made according to a schedule of
fees that is made available to the public;
‘‘(2) will be adjusted to reflect the income and
resources of the school-children involved; and
‘‘(3) will not be imposed on any school child
with an income of less than 150 percent of the appli-
cable official poverty line (established by the Direc-
tor of the Office of Management and Budget and re-
vised by the Secretary in accordance with section
673(2) of the Omnibus Budget Reconciliation Act of
1981).
‘‘(g) MATCHING FUNDS.—
‘‘(1) IN GENERAL.—With respect to the costs of
the program to be carried out under subsection (a)
by an applicant, the Secretary, subject to paragraph
(3), 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—
‘‘(A) for the first fiscal year for which the
applicant receives such a grant, 10 percent of
such costs;
‘‘(B) for any second such fiscal year, 25
percent of such costs; and
‘‘(C) for any subsequent such fiscal year,
50 percent of such costs.
‘‘(2) DETERMINATION
OF
AMOUNT
CONTRIB-
UTED.—Non-Federal contributions required in para-