I
103D CONGRESS
1ST SESSION
H. R. 3573
To amend title XIX of the Social Security Act to promote demonstrations
by States of alternative methods of delivering health care services through
community health authorities.
IN THE HOUSE OF REPRESENTATIVES
NOVEMBER 19, 1993
Mr. ROWLAND (for himself and Mr. BILIRAKIS) 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 promote
demonstrations by States of alternative methods of deliv-
ering health care services through community health au-
thorities.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Community Health Im-
provement Act of 1993’’.
SEC. 2. COMMUNITY HEALTH AUTHORITIES DEMONSTRA-
TION PROJECTS.
(a) IN GENERAL.—Title XIX of the Social Security
Act, as amended by section 13631(b) of the Omnibus
Budget Reconciliation Act of 1993, is amended—
(1) by redesignating section 1931 as section
1932; and
(2) by inserting after section 1930 the following
new section:
‘‘COMMUNITY HEALTH AUTHORITIES DEMONSTRATION
PROJECTS
‘‘SEC. 1931. (a) IN GENERAL.—In order to test the
effectiveness of various innovative health care delivery ap-
proaches through the operation of community health au-
thorities, the Secretary shall operate a program under
which States establish projects to demonstrate the effec-
tiveness of such approaches in providing access to cost-
effective preventive and primary care and related services
for various areas and populations, including low-income
residents of medically underserved areas or for medically
underserved populations. A State may operate more than
one such project.
‘‘(b) SELECTION OF STATE PROJECTS.—
‘‘(1) IN GENERAL.—A State is eligible to par-
ticipate in the program, and establish a demonstra-
tion project, under this section only if—
‘‘(A) the State submits to the Secretary an
application, at such time and in such form as
the Secretary may require, for participation in
the program; and
‘‘(B) the Secretary finds that—
‘‘(i) the application contains assur-
ances that the State will support the devel-
opment of a community health authority
that meets the requirements of this sec-
tion,
‘‘(ii) the community health authority
will meet the requirements for such an au-
thority under subsection (c),
‘‘(iii) the State provides sufficient as-
surances that the demonstration project of
a community health authority meets (or,
when operational, will meet) the require-
ments of subsection (d), and
‘‘(iv) the State will comply with the
requirements of subsections (g) and (h).
‘‘(2) CONTENTS OF APPLICATION.—Each appli-
cation submitted under paragraph (1) for a dem-
onstration project shall include at least the follow-
ing:
‘‘(A) A description of the proposed commu-
nity health authority and of the area or popu-
lation that the authority will serve.
‘‘(B) A demonstration that the CHA will
serve at least one geographic area or population
group that is designated as medically under-
served under section 330 of the Public Health
Service Act or as having a shortage of health
professionals under section 332 of such Act.
‘‘(C) An assessment of the area’s or popu-
lation’s need for services and an assurance that
the services of the CHA will be responsive to
those needs.
‘‘(D) A list of the items and services to be
furnished by the CHA under the project, bro-
ken down by those items and services that are
treated as medical assistance under the State
plan under this title and other items and serv-
ices that will be provided by the CHA (either
directly or through coordination with other enti-
ties).
‘‘(E) An assurance that the CHA has en-
tered into (or plans to enter into) written par-
ticipation agreements with a sufficient number
of providers to enable the CHA to furnish all of
such items and services to enrolled individuals.
‘‘(F) An assurance that the State plan
under this title will provide payment to the au-
thority in accordance with subsection (e).
‘‘(G) Evidence of support and assistance
from other State agencies with responsibility for
providing or supporting the provision of preven-
tive and primary care services to underserved
and at-risk populations.
‘‘(H) A proposed budget for the CHA.
‘‘(3) PRIORITY.—The Secretary shall give prior-
ity to those applications proposing to support a
CHA that includes as participating providers all
Federally-qualified health centers serving the area or
population or (in areas for which there are no Fed-
erally-qualified health centers) all entities that would
be Federally-qualified health centers but for the fail-
ure to meet the requirement described in section
329(f)(2)(G)(i) of the Public Health Service Act or
the requirement described in section 330(e)(3)(G)(i)
of such Act (relating to the composition of the enti-
ty’s governing board).
‘‘(4) PERIOD OF APPROVAL.—Each project ap-
proved under this section shall be approved for a pe-
riod of not less than 5 years, subject to renewal for
subsequent periods unless such approval is with-
drawn for cause by the Secretary or at the request
of the State.
‘‘(c) COMMUNITY HEALTH AUTHORITY (CHA) DE-
FINED.—In this section, the terms ‘community health au-
thority’ and ‘CHA’ mean a nonprofit entity that meets the
following requirements:
‘‘(1) The entity serves (or will serve at the time
it becomes operational under a project) a geographic
area or population group that includes those des-
ignated—
‘‘(A) under section 330 of the Public
Health Service Act as medically underserved, or
‘‘(B) under section 332 of such Act as a
health professions shortage area.
‘‘(2) The entity enrolls—
‘‘(A) individuals and families who are med-
icaid-eligible;
‘‘(B) within the limits of its available re-
sources and capacity, other individuals who
have incomes below 200 percent of the Federal
official poverty level; and
‘‘(C) within the limits of its available re-
sources and capacity, other individuals and
families who are able to pay the costs of enroll-
ment.
‘‘(3) Through its participating providers, the
entity provides or, through contracts, arranges for
the provision of (or, by the time it becomes oper-
ational, will so provide or arrange for the provision
of) at least preventive services, primary care serv-
ices, inpatient and outpatient hospital services, and
any other service provided by a participating pro-
vider for which payment may be made under the
State plan under this title to enrolled individuals.
‘‘(4) The entity must include (to the maximum
extent practicable) as participating providers any of
the following providers that furnish services provided
by (or arranged by) the entity that are located in or
serve the area or population to be covered:
‘‘(A) Federally-qualified health centers.
‘‘(B) Rural health clinics.
‘‘(C) Local public health agencies that fur-
nish such services.
‘‘(D) A hospital (or other provider of inpa-
tient or outpatient hospital services) which has
a participation agreement in effect with the
State under its plan under this title, which is
located in or serving the area or population to
be served.
‘‘(5) The entity may include as participating
providers other providers (which may include private
physicians or group practice offices, other commu-
nity clinics, limited service providers (such as pre-
natal clinics), and health professionals teaching pro-
grams (such as area health educational centers))
and take other appropriate steps, to the extent need-
ed to assure that the network is reasonable in size
and able to provide (or arrange for the provision of)
the services it proposes to furnish to its enrollees.
‘‘(6) The entity must maintain written agree-
ments with each participating provider under which
the provider agrees to participate in the CHA and
agrees to accept payment from the CHA as payment
in full for services furnished to individuals enrolled
with the CHA (subject to the requirements of sub-
section (g)(4), in the case of services furnished by a
provider that are described in subparagraph (B) or
(C) of section 1905(a)(2)).
‘‘(7) Under the written agreements described in
paragraph (6), if a majority of the board of directors
of the entity has determined that a participating
provider is failing to meet any of the requirements
of the participation agreement, the board may termi-
nate the provider’s participation agreement in ac-
cordance with the following requirements:
‘‘(A) Subject to subparagraph (B), prior to
any termination of a provider’s participation
agreement, the provider shall be entitled to 30
days prior notice, a reasonable opportunity to
correct any deficiencies, and an opportunity for
a full and fair hearing conducted by the entity
to dispute the reasons for termination. The pro-
vider shall be entitled to appeal the board of di-
rectors’ decision directly to a committee consist-
ing of representatives of all of the entity’s par-
ticipating providers.
‘‘(B) If a majority of the board of directors
of the entity determines that the continued par-
ticipation of a provider presents an immediate
threat to the health and safety of patients or a
substantial risk of improper diversion of funds,
the board may suspend the provider’s participa-
tion agreement (including the receipt of funds
under the agreement) for a period of up to 60
days. During this period, the entity shall take
steps to ensure that patients who were assigned
to or cared for by the suspended provider are
appropriately assigned or referred to alternative
participating providers. The suspended provider
shall be entitled to a hearing within the period
of the suspension to show cause why the sus-
pension should be lifted and its participation
agreement restored. If dissatisfied with the
board’s decision, the provider shall be entitled
to appeal the decision directly to a committee
consisting of representatives of all of the enti-
ty’s participating providers.
‘‘(C) For all other disputes between the en-
tity and its participating providers (including
disputes over the amounts due or interim rates
to be paid to a provider), the entity shall pro-
vide an opportunity for a full and fair hearing.
‘‘(8) The entity must be governed by a board of
directors that includes representatives of the partici-
pating providers and, as appropriate, other health
professionals, civic or business leaders, elected offi-
cials, and residents of the area or population served.
Not less than 51 percent of such board shall be com-
posed of individuals who are enrolled in the CHA
and who are representatives of the community
served.
‘‘(d) DEMONSTRATION PROJECT REQUIREMENTS.—
The requirements of this subsection, with respect to a
demonstration project of a CHA under this section, are
as follows:
‘‘(1)(A) All services furnished by the CHA
under the project shall be available and accessible to
all enrolled individuals and, except as provided in
subparagraph (B), must be available without regard
to an individual’s ability to pay for such services.
‘‘(B) A CHA shall prepare a schedule of dis-
counts to be applied to the payment of premiums by
individuals who are not medicaid-eligible individuals
which shall be adjusted on the basis of the individ-
ual’s ability to pay.
‘‘(2) The CHA shall take appropriate steps to
emphasize the provision of preventive and primary
care services, and shall ensure that each enrolled in-
dividual is assigned to a primary care physician (to
the greatest extent appropriate and feasible), except
that the CHA shall establish a process through
which an enrolled individual may be assigned to an-
other primary care physician for good cause shown.
‘‘(3) The CHA must make reasonable efforts to
reduce the unnecessary or inappropriate use of hos-
pital or other high-cost services through an emphasis
on preventive and primary care services, the imple-
mentation of utilization review or other appropriate
methods.
‘‘(4) The State must regularly provide the CHA
with information on other medical, health, and relat-
ed benefits that may be available to individuals en-
rolled with the CHA under programs other than the
State plan under this title, and the CHA must pro-
vide its enrolled individuals with enrollment informa-
tion and other assistance to assist them in obtaining
such benefits.
‘‘(5) The State and the CHA must meet such
financial standards and requirements and reporting
requirements as the Secretary specifies and must
prepare and submit to the Secretary an annual inde-
pendent financial audit conducted in accordance with
requirements specified by the Secretary.
‘‘(6) In collaboration with the State, the CHA
must adopt and use community-oriented, patient-re-
sponsive quality assurance and control systems in
accordance with requirements specified by the Sec-
retary. Such systems must include at least an ongo-
ing quality assurance program that measures
consumer satisfaction with the care provided under
the network, stresses improved health outcomes, and
operates a community health status improvement
process that identifies and investigates community
health problems and implements measures designed
to remedy them.
‘‘(e) CAPITATION PAYMENTS.—
‘‘(1) IN
GENERAL.—Under a demonstration
project under this section, the State shall enter into
an annual contract with the CHA under which the
State shall make monthly payments to the CHA for
covered services furnished through the CHA to indi-
viduals entitled to medical assistance under this title
in the amount specified in paragraph (2). Payment
shall be made at the beginning of each month on the
basis of estimates of the amounts payable and
amounts subsequently paid are subject to adjust-
ment to reflect the amounts by which previous pay-
ments were greater or less than the amount of pay-
ments that should have been made.
‘‘(2) AMOUNT OF CAPITATION PAYMENT.—The
amount of a monthly payment under paragraph (1)
during a contract year, shall be not less than 1⁄12 of
the product of—
‘‘(A)(i) the average per capita amounts ex-
pended under this title under the State plan for
covered services to be furnished under the dem-
onstration project for similar medicaid-eligible
individuals for the most recent 12-month period
ending before the date of the enactment of this
section, increased by (ii) the percentage change
in the consumer price index for all urban con-
sumers (all items; U.S. city average) during the
period that begins upon the expiration of such
12-month period and ends upon the expiration
of the most recent 12-month period ending be-
fore the first month of the contract year for
which complete financial data on such index is
available, and
‘‘(B) the number of medicaid-eligible indi-
viduals enrolled under the project as of the
15th day of the month prior to the first month
of the contract year (or, in the case of the first
year for which a contract is in effect under this
subsection, the CHA’s reasonable estimate of
the number of such individuals who will be en-
rolled in the project as of the 15th day of such
month).
‘‘(f) ADDITIONAL STATE ASSISTANCE
FOR PLAN-
NING, DEVELOPMENT, AND OPERATIONS.—
‘‘(1) IN GENERAL.—Subject to paragraph (2),
in addition to the payments under subsection (e),
demonstration projects approved under this section
are eligible to have approved expenditures described
in paragraph (3) treated, for purposes of section
1903(a)(7), as expenditures found necessary by the
Secretary for the proper and efficient administration
of the State plan under this title.
‘‘(2) SPECIAL RULES.—
‘‘(A) LIMITATION WITH RESPECT TO ANY
COMMUNITY
HEALTH
AUTHORITY.—The total
amount of expenditures with respect to any
CHA that may be treated as expenditures for
medical assistance under paragraph (1) for any
12-month period shall not exceed $250,000.
‘‘(B) 
LIMITATION
ON
NUMBER
OF
YEARS.—The number of 12-month periods for
which expenditures are treated as expenditures
for medical assistance under paragraph (1) for
a CHA shall not exceed—
‘‘(i) 2 for expenditures for planning
and development assistance, described in
paragraph (3)(A), and
‘‘(ii) 2 for expenditures for oper-
ational assistance, described in paragraph
(3)(B).
‘‘(C) 
NO
RESULTING
REDUCTION
IN
AMOUNTS PROVIDED UNDER PHSA GRANTS.—
No grant to a CHA or one of its participating
providers under the Public Health Service Act
or this Act may be reduced on the ground that
activities of the CHA that are considered ap-
proved expenditures under paragraph (3) are
activities for which the CHA or the participat-
ing providers received funds under such Act.
‘‘(3) 
APPROVED
EXPENDITURES.—The 
ap-
proved expenditures described in this paragraph are
as follows:
‘‘(A) PLANNING AND DEVELOPMENT.—Ex-
penditures for planning and development with
respect to a CHA, including—
‘‘(i) developing internal management,
legal and financial and clinical, informa-
tion, and reporting systems for the CHA,
and carrying out other operating activities
of the CHA;
‘‘(ii) recruiting, training and com-
pensating management staff of the CHA
and, as appropriate and necessary, man-
agement and clinical staff of any partici-
pating provider;
‘‘(iii) purchasing essential equipment
and acquiring, modernizing, expanding, or
(if cost-effective) constructing facilities for
the CHA and for participating providers
(including amortization costs and payment
of interest on loans); and
‘‘(iv) entering into arrangements to
obtain or participate in emerging medical
technologies, including telemedicine.
‘‘(B) OPERATIONS.—Expenditures in sup-
port of the operations of a CHA, including—
‘‘(i) the ongoing management of the
CHA, including daily program administra-
tion, recordkeeping and reporting, assur-
ance of proper financial management (in-
cluding billings and collections) and over-
sight of program quality;
‘‘(ii) developing and operating systems
to enroll eligible individuals in the CHA;
‘‘(iii) data collection, in collaboration
with the State medicaid agency and the
State health department, designed to
measure changes in patient access to care,
the quality of care furnished, and patient
health status, and health care outcomes;
‘‘(iv) ongoing community outreach
and community education to all residents
of the area or population served, to pro-
mote the enrollment of eligible individuals
and the appropriate utilization of health
services by such individuals;
‘‘(v) the establishment of necessary
reserves or purchase of stop-loss coverage;
and
‘‘(vi) activities relating to health pro-
fessions training, including residency train-
ing at participating provider sites.
‘‘(g) ADDITIONAL REQUIREMENTS.—
‘‘(1) MANDATORY ENROLLMENT OF MEDICAID-
ELIGIBLE INDIVIDUALS.—Notwithstanding any pro-
vision of section 1903(m), a State participating in a
demonstration project under this section may require
that each medicaid-eligible resident in the service
area of a CHA operating under the project is not eli-
gible to receive any medical assistance under the
State plan that may be obtained through enrollment
with the CHA unless the individual receives such as-
sistance through enrollment with the CHA.
‘‘(2) CONTINUED
ENTITLEMENT
TO
ADDI-
TIONAL BENEFITS.—In the case of a medicaid-eligi-
ble individual enrolled with a CHA under a dem-
onstration project under this section, the individual
shall remain entitled to medical assistance for serv-
ices which are not covered services under the project.
‘‘(3) HMO-RELATED REQUIREMENTS.—A CHA
under this section shall be deemed to meet the re-
quirements of section 1903(m) (subject to paragraph
(1)) in the same manner as an entity listed under
section 1903(m)(2)(G).
‘‘(4) TREATMENT
OF
FEDERALLY-QUALIFIED
HEALTH CENTERS AND RURAL HEALTH CLINICS.—
Payments under a demonstration project under this
section to a Federally qualified health center or
rural health clinic which is a participating provider
shall 
be 
made 
consistent 
with 
section
1902(a)(13)(E) for all services offered by the CHA
which are provided by such a center or clinic.
‘‘(5) OUTSTATIONING ELIGIBILITY WORKERS.—
Under the project, the State may (in addition to
meeting the requirements of section 1902(a)(55))
provide for, or pay the reasonable costs of, station-
ing eligibility workers at appropriate service sites
under the project, and may permit medicaid-eligible
individuals to be enrolled under the State plan at
such a CHA or at such a site.
‘‘(6) PURCHASE
OF
STOP-LOSS
COVERAGE.—
The State shall ensure that the CHA has purchased
stop-loss coverage to protect against default on its
obligations under the project. If an entity otherwise
qualified to serve as a CHA is prohibited under
State law from purchasing such coverage, the State
shall waive the application of such law to the extent
necessary to permit the entity to purchase such cov-
erage.
‘‘(h) EVALUATION AND REPORTING.—
‘‘(1) CHA.—Each CHA in a State with a dem-
onstration project approved under this section shall
prepare and submit to the State an annual report on
its activities during the previous year.
‘‘(2) STATE.—Taking into account the reports
submitted pursuant to paragraph (1), each State
with a demonstration project approved under this
section shall prepare and submit to the Secretary an
annual evaluation of its activities and services under
this section. Such evaluation shall include an analy-
sis of the effectiveness of the project in providing
cost-effective health care to enrolled individuals.
‘‘(3) REPORT TO CONGRESS.—Not later than 3
years after the date of the enactment of this section,
the Secretary shall submit to Congress a report on
the demonstration projects conducted under this sec-
tion. Such report shall include an analysis of the ef-
fectiveness of such projects in providing cost-effec-
tive health care for the areas or populations served.
‘‘(i) COLLABORATION IN ADMINISTRATION.—In car-
rying out this section, the Secretary shall assure the high-
est possible level of collaboration between the Health Care
Financing Administration and the Public Health Service.
Such collaboration may include (if appropriate and fea-
sible) any of the following:
‘‘(1) The provision by the Public Health Service
of new or increased grant support to eligible entities
participating in a CHA, in order to expand the avail-
ability of services (particularly preventive and pri-
mary care services).
‘‘(2) The placement of health professionals at
eligible locations and collaboration with Federally-as-
sisted health professions training programs located
in or near the areas served by community health au-
thorities.
‘‘(3) The provision of technical and other non-
financial assistance.
‘‘(j) DEFINITIONS.—In this section:
‘‘(1) MEDICAID-ELIGIBLE
INDIVIDUAL.—The
term ‘medicaid-eligible individual’ means an individ-
ual described in section 1902(a)(10)(A) and entitled
to medical assistance under the State plan.
‘‘(2) PARTICIPATING
PROVIDER.—The term
‘participating provider’ means, with respect to a
CHA, a provider that has entered into an agreement
with the CHA for the provision of covered services
under a project under this section.
‘‘(3) PREVENTIVE AND PRIMARY CARE SERV-
ICES.—‘Preventive’ and ‘primary’ services include
those services described in section 1905(l)(2)(A) and
included as Federally-qualified health center serv-
ices.’’.
(b) CONTINUED MEDICAID ELIGIBILITY FOR UP TO
1 YEAR.—Section 1902(e)(2) of such Act (42 U.S.C.
1396a(e)(2)) is amended—
(1) in subparagraph (A)—
(A) by inserting ‘‘or with a community
health authority under a demonstration project
under section 1931’’ after ‘‘section 1876’’, and
(B) by striking ‘‘such organization or en-
tity’’ and inserting ‘‘such organization, entity,
or authority’’; and
(2) in subparagraph (B), by striking ‘‘effec-
tive.’’ and inserting the following: ‘‘effective (or, in
the case of an individual enrolled with a community
health authority under a demonstration project
under section 1931, of not more than 1 year begin-
ning on the date the individual’s enrollment with the
authority becomes effective).’’.
(c) EXCEPTION TO ANTI-KICKBACK LAW.—Section
1128B(b)(3) of such Act (42 U.S.C. 1320a–7b(b)(3)) is
amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (D),
(2) by striking the period at the end of sub-
paragraph (E) and inserting ‘‘; and’’, and
(3) by adding at the end the following new sub-
paragraph:
‘‘(F) any remuneration paid, or received, by a
Federally qualified health center, rural health clinic,
or other entity which is a participating provider
under a demonstration project under section 1931 as
part of an arrangement for the procurement of
goods or services or the referral of patients or the
lease or purchase of space or equipment.’’.
(d) COVERAGE
OF
PARTICIPATING
PROVIDERS
UNDER FEDERAL TORT CLAIMS ACT.—Section 224 of the
Public Health Service Act (42 U.S.C. 233), as amended
by the Federally Supported Health Centers Assistance Act
of 1992, is amended by adding at the end the following
new subsection:
‘‘(l) The provisions of subsection (g) shall apply with
respect to any provider of health services that has in effect
a participation agreement with a community health net-
work authority under section 1931 of the Social Security
Act in the same manner that such provisions apply to an
entity described in paragraph (4) and any officer, em-
ployee, or contractor of such an entity who is a physician
or other licensed or certified health care practitioner.’’.
(e) EFFECTIVE DATE.—The amendments made by
this section shall apply to calendar quarters beginning on
or after October 1, 1994.
SEC. 3. HEALTH CENTER PROGRAM AMENDMENTS.
(a) AUTHORIZATION OF GRANTS FOR NETWORK DE-
VELOPMENT.—
(1) MIGRANT HEALTH CENTERS.—Section 329
of the Public Health Service Act (42 U.S.C. 254b)
is amended by adding at the end the following:
‘‘(j)(1) The Secretary may make a grant, to an entity
receiving a grant under this section or to a group of such
entities, to support the planning and development of
health service networks (as defined in paragraph (3))
which will serve high impact areas, medically underserved
areas, or medically underserved populations within the
area they serve (or propose to serve).
‘‘(2) A grant under this subsection for the planning
and development of a health service network may be used
for the following costs:
‘‘(A) The costs of developing the network cor-
porate entity, including planning and needs assess-
ment.
‘‘(B) The costs of developing internal manage-
ment for the network, as well as costs of developing
legal, financial, clinical, information, billing, and re-
porting systems, and other costs necessary to
achieve operational status.
‘‘(C) The costs of recruitment, training, and
compensation of management staff of the network
and, as appropriate and necessary, the management
and clinical staff of any participating provider.
‘‘(D) The costs of developing additional primary
health and related service sites, including costs relat-
ed to purchase of essential equipment, acquisition,
modernization, expansion, or, if cost-effective, con-
struction of facilities.
‘‘(3) In this subsection, the term ‘health service net-
work’ means a nonprofit private entity that—
‘‘(A) through its participating providers (which
may provide services directly or through contract)
assures the provision of primary health and related
services and, as appropriate, supplemental health
services to residents of the high impact area or
medically underserved area or members of the medi-
cally underserved population covered by the network,
‘‘(B) includes, as participating providers, at
least all recipients of grants under this section or
section 330, 340, or 340A that provide primary
health and related services to the residents of the
area it serves (or proposes to serve), and that may
include, at the entity’s option, any other providers of
primary health or supplemental health services to
residents of the high impact area or medically un-
derserved area or members of the medically under-
served population covered by the network, but only
if such participating providers agree to provide serv-
ices without regard to an individual’s ability to pay,
and
‘‘(C) is governed by individuals a majority of
whom are patients, employees, or board members of
its participating providers that receive grants under
this section or section 330, 340, or 340A.’’.
(2) COMMUNITY
HEALTH
CENTERS.—Section
330 of such Act (42 U.S.C. 254c) is amended by
adding at the end the following:
‘‘(l)(1) The Secretary may make a grant, to an entity
receiving a grant under this section or to a group of such
entities, to support the planning and development of
health service networks (as defined in section 329(j)(3))
which will serve high impact areas, medically underserved
areas, or medically underserved populations within the
area they serve (or propose to serve).
‘‘(2) A grant under this subsection for the planning
and development of a health service network may be used
for the costs described in section 329(j)(2).’’.
(3) EFFECTIVE DATE.—The amendments made
by this subsection shall take effect on the date of the
enactment of this Act.
(b) EXTENSION OF AUTHORIZATION OF APPROPRIA-
TIONS.—
(1) 
MIGRANT
HEALTH
CENTERS.—Section
329(h)(1)(A) of such Act (42 U.S.C. 254b(h)(1)(A))
is amended—
(A) by inserting ‘‘and subsection (j)’’ after
‘‘through (e)’’, and
(B) by striking ‘‘1994’’ and inserting
‘‘1999’’.
(2) COMMUNITY
HEALTH
CENTERS.—Section
330(g)(1)(A) of such Act (42 U.S.C. 254c(g)(1)(A))
is amended by striking ‘‘1994’’ and inserting
‘‘1999’’.
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HR 3573 IH—2
HR 3573 IH—3