I
103D CONGRESS
1ST SESSION
H. R. 725
To amend title XIX of the Social Security Act to create a new part under
such title to provide access to services for medically underserved popu-
lations not currently served by federally qualified health centers, by
providing funds for a new program to allow federally qualified health
centers and other qualifying entities to expand such centers’ and entities’
capacity and to develop additional centers.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 2, 1993
Mr. MACHTLEY (for himself, Mr. MCCLOSKEY, and Mr. UPTON) introduced
the following bill; which was referred to the Committee on Energy and
Commerce
A BILL
To amend title XIX of the Social Security Act to create
a new part under such title to provide access to services
for medically underserved populations not currently
served by federally qualified health centers, by providing
funds for a new program to allow federally qualified
health centers and other qualifying entities to expand
such centers’ and entities’ capacity and to develop addi-
tional centers.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. FINDINGS.
The Congress finds that—
(1) at least 30 million Americans lack access to
even the most basic health services;
(2) access to health care is especially difficult
for those Americans who—
(A) live in medically underserved rural
communities or inner city neighborhoods;
(B) lack public or private health insurance
coverage and the ability to pay directly for care;
(C) must move for work purposes, such as
migrant farmworkers;
(D) are members of minority groups, or
who speak limited English; or
(E) are members of other vulnerable
groups, including persons who are homeless or
are high-risk pregnant women, infants and chil-
dren;
(3) the consequences of poor access to health
care is evidenced in elevated infant and childhood
mortality rates, dangerously low childhood immuni-
zation rates, overutilization of hospital emergency
rooms or other inappropriate providers of primary
care services, and hospitalization rates for prevent-
able conditions that are significantly higher than the
national average;
(4) efforts to provide access to essential health
care services for medically underserved Americans
will not only contribute to improved health status,
but will also result in less unnecessary care and re-
duced overall costs of health care; and
(5) the federally qualified health centers, in-
cluding the community and migrant health centers
which serve more than 6 million needy Americans,
provide an effective and proven model for extending
access to all medically underserved Americans.
SEC. 2. ESTABLISHMENT OF NEW PART UNDER THE MEDIC-
AID PROGRAM TO PROVIDE FUNDS FOR A
NEW FEDERALLY QUALIFIED HEALTH CEN-
TERS GRANTS PROGRAM.
(a) IN GENERAL.—Title XIX of the Social Security
Act is amended by inserting after the title heading the
following:
‘‘PART A—PAYMENT TO STATES FOR MEDICAL
ASSISTANCE’’.
(b) PURPOSE.—Section 1901 of the Social Security
Act (42 U.S.C. 1396) is amended—
(1) in the first sentence—
(A) by striking ‘‘and (2)’’ and inserting
‘‘(2)’’; and
(B) by striking ‘‘self care,’’ and inserting
‘‘self care; and (3) grants to assist entities in
providing health care services to medically un-
derserved individuals,’’; and
(2) by amending the second sentence to read as
follows: ‘‘The sums made available under this section
shall be used for making payments—
(A) under this part to States which have
submitted, and had approved by the Secretary,
State plans for medical assistance; and
(B) under part B to entities meeting the
requirements under such part.’’.
(c) EFFECTIVE DATE.—The amendments made by
subsections (a) and (b) shall become effective on October
1, 1993.
SEC. 3. ESTABLISHMENT OF NEW PROGRAM TO PROVIDE
FUNDS TO ALLOW FEDERALLY QUALIFIED
HEALTH CENTERS AND OTHER ENTITIES OR
ORGANIZATIONS 
TO 
PROVIDE 
EXPANDED
SERVICES TO MEDICALLY UNDERSERVED IN-
DIVIDUALS.
(a) IN GENERAL.—Title XIX of the Social Security
Act (42 U.S.C. 1396 et seq.) is amended by adding at
the end the following new part:
‘‘PART B—GRANTS TO QUALIFIED ENTITIES FOR
HEALTH SERVICES
‘‘HEALTH SERVICES ACCESS PROGRAM
‘‘SEC. 1941. (a) ESTABLISHMENT OF HEALTH SERV-
ICES ACCESS PROGRAM.—From amounts appropriated
under section 1901, the Secretary shall, acting through
the Bureau of Health Care Delivery Assistance, award
grants under this section to federally qualified health cen-
ters (each in this part referred to as an ‘FQHC’) and
other entities and organizations submitting applications
under this section (as described in subsection (c)) for the
purpose of providing access to services for medically un-
derserved populations (as defined in section 330(b)(3) of
the Public Health Service Act) or in high impact areas
(as defined in section 329(a)(5) of the Public Health Serv-
ice Act) not currently being served by an FQHC.
‘‘(b) ELIGIBILITY FOR GRANTS.—(1) The Secretary
shall award grants under this section to entities or organi-
zations described in this paragraph and paragraph (2)
which have submitted a proposal to the Secretary to ex-
pand such entities or organizations operations (including
expansions to new sites (as determined necessary by the
Secretary)) to serve medically underserved populations or
high impact areas not currently served by an FQHC and
which—
‘‘(A) have as of January 1, 1993, been certified
by the Secretary as an FQHC under section
1905(l)(2)(B); or
‘‘(B) have submitted applications to the Sec-
retary 
to 
qualify 
as 
FQHC’s 
under 
section
1905(l)(2)(B); or
‘‘(C) have submitted a plan to the Secretary
which provides that the entity will meet the require-
ments to qualify as an FQHC when operational.
‘‘(2)(A) The Secretary shall also make grants under
this section to public or private nonprofit agencies, health
care entities or organizations which meet the requirements
necessary to qualify as an FQHC except, the requirement
that such entity have a consumer majority governing
board and which have submitted a proposal to the Sec-
retary to provide those services provided by an FQHC as
defined in section 1905(l)(2)(B) and which are designed
to promote access to primary care services or to reduce
reliance on hospital emergency rooms or other high cost
providers of primary health care services, provided such
proposal is developed by the entity or organizations (or
such entities or organizations acting in a consortium in
a community) with the review and approval of the Gov-
ernor of the State in which such entity or organization
is located.
‘‘(B) The Secretary shall provide in making grants
to entities or organizations described in this paragraph
that no more than 10 percent of the funds provided for
grants under this section shall be made available for
grants to such entities or organizations.
‘‘(c) APPLICATION REQUIREMENTS.—(1) In order to
be eligible to receive a grant under this section, an FQHC
or other entity or organization must submit an application
in such form and at such time as the Secretary shall pre-
scribe and which meets the requirements of this sub-
section.
‘‘(2) An application submitted under this section
must provide—
‘‘(A)(i) for a schedule of fees or payments for
the provision of the services provided by the entity
designed to cover its reasonable costs of operations;
and
‘‘(ii) for a corresponding schedule of discounts
to be applied to such fees or payments, based upon
the patient’s ability to pay (determined by using a
sliding scale formula based on the income of the pa-
tient);
‘‘(B) assurances that the entity or organization
provides services to persons who are eligible for ben-
efits under title XVIII, for medical assistance under
a State plan approved under part A or for assistance
for medical expenses under any other public assist-
ance program or private health insurance program;
and
‘‘(C) assurances that the entity or organization
has made and will continue to make every reason-
able effort to collect reimbursement for services—
‘‘(i) from persons eligible for assistance
under any of the programs described in sub-
paragraph (B); and
‘‘(ii) from patients not entitled to benefits
under any such programs.
‘‘(d) LIMITATIONS ON USE OF FUNDS.—(1) From
the amounts awarded to an entity or organization under
this section, funds may be used for purposes of planning
but may only be expended for the costs of—
‘‘(A) assessing the needs of the populations or
proposed areas to be served;
‘‘(B) preparing a description of how the needs
identified will be met;
‘‘(C) development of an implementation plan
that addresses—
‘‘(i) recruitment and training of personnel;
and
‘‘(ii) activities necessary to achieve oper-
ational status in order to meet FQHC require-
ments under 1905(l)(2)(B).
‘‘(2) From the amounts awarded to an entity or orga-
nization under this section, funds may be used for the pur-
poses of paying for the costs of recruiting, training and
compensating staff (clinical and associated administrative
personnel (to the extent such costs are not already reim-
bursed under part A or any other State or Federal pro-
gram)) to the extent necessary to allow the entity to oper-
ate at new or expanded existing sites.
‘‘(3) From the amounts awarded to an entity or orga-
nization under this section, funds may be expended for
the purposes of acquiring facilities and equipment but only
for the costs of—
‘‘(A) construction of new buildings (to the ex-
tent that new construction is found to be the most
cost-efficient approach by the Secretary);
‘‘(B) acquiring, expanding, or modernizing of
existing facilities;
‘‘(C) purchasing essential (as determined by the
Secretary) equipment; and
‘‘(D) amortization of principal and payment of
interest on loans obtained for purposes of site con-
struction, acquisition, modernization, or expansion,
as well as necessary equipment.
‘‘(4) From the amounts awarded to an entity or orga-
nization under this section, funds may be expended for
the payment of services but only for the costs of—
‘‘(A) providing or arranging for the provision of
all services through the entity necessary to qualify
such 
entity 
as 
an 
FQHC 
under 
section
1905(l)(2)(B);
‘‘(B) providing or arranging for any other serv-
ice that an FQHC may provide and be reimbursed
for under this title; and
‘‘(C) providing any unreimbursed costs of pro-
viding services as described in section 330(a) of the
Public Health Service Act to patients.
‘‘(e) PRIORITIES IN THE AWARDING OF GRANTS.—
(1) The Secretary shall give priority in awarding grants
under this section to entities which have, as of January
1, 1993, been certified as an FQHC under section
1905(l)(2)(B) and which have submitted a proposal to the
Secretary to expand their operations (including expansion
to new sites) to serve medically underserved populations
for high impact areas not currently served by an FQHC.
The Secretary shall give first priority in awarding grants
under this section to those FQHCs or other entities which
propose to serve populations with the highest degree of
unmet need, and which can demonstrate the ability to ex-
pand their operations in the most efficient manner.
‘‘(2) The Secretary shall give second priority in
awarding grants to entities which have submitted applica-
tions to the Secretary which demonstrate that the entity
will qualify as an FQHC under section 1905(l)(2)(B) be-
fore it provides or arranges for the provision of services
supported by funds awarded under this section, and which
are serving or proposing to serve medically underserved
populations or high impact areas which are not currently
served (or proposed to be served) by an FQHC.
‘‘(3) The Secretary shall give third priority in award-
ing grants in subsequent years to those FQHCs or other
entities which have provided for expanded services and
project and are able to demonstrate that such entity will
incur significant unreimbursed costs in providing such ex-
panded services.
‘‘(f) RETURN OF FUNDS TO SECRETARY FOR COSTS
REIMBURSED FROM OTHER SOURCES.—To the extent
that an entity or organization receiving funds under this
part is reimbursed from another source for the provision
of services to an individual, and does not use such in-
creased reimbursement to expand services furnished, areas
served, to compensate for costs of unreimbursed services
provided to patients, or to promote recruitment, training,
or retention of personnel, such excess revenues shall be
returned to the Secretary.
‘‘(g) TERMINATION OF GRANTS.—(1)(A) With re-
spect to any entity that is receiving funds awarded under
this section and which subsequently fails to meet the re-
quirements to qualify as an FQHC under section
1905(l)(2)(B) or is an entity that is not required to meet
the requirements to qualify as an FQHC under section
1905(l)(2)(B) but fails to meet the requirements of this
section, the Secretary shall terminate the award of funds
under this section to such entity.
‘‘(B) Prior to any termination of funds under this
section to an entity, the entities shall be entitled to 60
days prior notice of termination and, as provided by the
Secretary in regulations, an opportunity to correct any de-
ficiencies in order to allow the entity to continue to receive
funds under this section.
‘‘(2) Upon any termination of funding under this sec-
tion, the Secretary may (to the extent practicable)—
‘‘(A) sell any property (including equipment)
acquired or constructed by the entity using funds
made available under this section or transfer such
property to another FQHC, in which case the Sec-
retary shall reimburse any costs which were incurred
by the entity in acquiring or constructing such prop-
erty (including equipment) which were not supported
by grants under this section; and
‘‘(B) recoup any funds provided to an entity
terminated under this section.
‘‘(h) LIMITATION ON AMOUNT OF EXPENDITURES.—
The amount of funds that may be expended under this
title to carry out the purposes of this part shall be for
fiscal year 1994, $200,000,000, for fiscal year 1995,
$400,000,000, for fiscal year 1996, $600,000,000, for fis-
cal year 1997, $800,000,000, for fiscal year 1998,
$800,000,000, and for fiscal years thereafter such sums
as provided by Congress.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall become effective with respect to serv-
ices furnished by a federally qualified health center or
other qualifying entity described in this section beginning
on or after October 1, 1993.
SEC. 4. STUDY AND REPORT ON SERVICES PROVIDED BY
COMMUNITY HEALTH CENTERS AND HOS-
PITALS.
(a) IN GENERAL.—The Secretary of Health and
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall provide for a study to examine the relation-
ship and interaction between community health centers
and hospitals in providing services to individuals residing
in medically underserved areas. The Secretary shall ensure
that the National Rural Research Centers participate in
such study.
(b) REPORT.—The Secretary shall provide to the ap-
propriate committees of Congress a report summarizing
the findings of the study within 90 days of the end of
each project year and shall include in such report rec-
ommendations on methods to improve the coordination of
and provision of services in medically underserved areas
by community health centers and hospitals.
(c) AUTHORIZATION.—There are authorized to carry
out the study provided for in this section $150,000 for
each of fiscal years 1994 and 1995.
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