procedures and other requirements as may 
be prescribed by the Secretary; 
‘‘(iii) provides or will provide services 
to individuals who are eligible for medical 
assistance under title XIX of the Social Se-
curity Act or for assistance under title XXI 
of such Act; 
‘‘(iv) has prepared a schedule of fees or 
payments for the provision of its services 
consistent with locally prevailing rates or 
charges and designed to cover its reasonable 
costs of operation and has prepared a cor-
responding schedule of discounts to be ap-
plied to the payment of such fees or pay-
ments, which discounts are adjusted on the 
basis of the patient’s ability to pay; 
‘‘(v) will assure that no patient will be 
denied health care services due to an indi-
vidual’s inability to pay for such services; 
‘‘(vi) will assure that any fees or pay-
ments required by the system for such serv-
ices will be reduced or waived to enable the 
system to fulfill the assurance described in 
clause (v); 
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‘‘(vii) provides assurances that any 
grant funds will be expended to supplement, 
and not supplant, the expenditures of the 
integrated health system for primary and 
preventive health services for the medically 
underserved; and 
‘‘(viii) submits to the Secretary such 
reports as the Secretary may require to de-
termine compliance with this subparagraph. 
‘‘(C) TREATMENT OF CERTAIN ENTITIES.— 
The term ‘qualifying integrated health system’ 
may include a nurse-managed health clinic if 
such clinic meets the requirements of subpara-
graphs (A) and (B) (except those requirements 
that have been waived under paragraph (4)(B)). 
‘‘(4) REQUIRED
PRIMARY
AND
PREVENTIVE 
HEALTH AND RELATED SERVICES.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the term ‘required primary 
and preventive health and related services’ means 
basic health services consisting of— 
‘‘(i) health services related to family 
medicine, internal medicine, pediatrics, ob-
stetrics, or gynecology that are furnished by 
physicians where appropriate, physician as-
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sistants, nurse practitioners, and nurse 
midwives; 
‘‘(ii) diagnostic laboratory services and 
radiologic services; 
‘‘(iii) preventive health services, in-
cluding prenatal and perinatal care; appro-
priate cancer screening; well-child services; 
immunizations against vaccine-preventable 
diseases; screenings for elevated blood lead 
levels, communicable diseases, and choles-
terol; 
pediatric 
eye, 
ear, 
and 
dental 
screenings to determine the need for vision 
and hearing correction and dental care; and 
voluntary family planning services; 
‘‘(iv) emergency medical services; and 
‘‘(v) pharmaceutical services, behav-
ioral, mental health, and substance abuse 
services, preventive dental services, and re-
cuperative care, as may be appropriate. 
‘‘(B) EXCEPTION.—In the case of an inte-
grated health system serving a targeted popu-
lation, the Secretary shall, upon a showing of 
good cause, waive the requirement that the inte-
grated health system provide each required pri-
mary and preventive health and related service 
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under this paragraph if the Secretary determines 
one or more such services are inappropriate or 
unnecessary for such population. 
‘‘(5) INTEGRATIVE
HEALTH
SERVICES.—The 
term ‘integrative health services’ means services that 
are not included as required primary and preventive 
health and related services and are associated with 
achieving the greater integration of a health care de-
livery system to improve patient care coordination so 
that the system either directly provides or ensures the 
provision of a broad range of culturally competent 
services. Integrative health services include but are 
not limited to the following: 
‘‘(A) Outreach activities. 
‘‘(B) Case management and patient naviga-
tion services. 
‘‘(C) Chronic care management. 
‘‘(D) Transportation to health care facili-
ties. 
‘‘(E) Development of provider networks and 
other innovative models to engage local physi-
cians and other providers to serve the medically 
underserved within a community. 
‘‘(F) Recruitment, training, and compensa-
tion of necessary personnel. 
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‘‘(G) Acquisition of technology for the pur-
pose of coordinating care. 
‘‘(H) Improvements to provider communica-
tion, including implementation of shared infor-
mation systems or shared clinical systems. 
‘‘(I) Determination of eligibility for Fed-
eral, State, and local programs that provide, or 
financially support the provision of, medical, so-
cial, housing, educational, or other related serv-
ices. 
‘‘(J) Development of prevention and disease 
management tools and processes. 
‘‘(K) Translation services. 
‘‘(L) Development and implementation of 
evaluation measures and processes to assess pa-
tient outcomes. 
‘‘(M) Integration of primary care and men-
tal health services. 
‘‘(N) Carrying out other activities that may 
be appropriate to a community and that would 
increase access by the uninsured to health care, 
such as access initiatives for which private enti-
ties provide non-Federal contributions to supple-
ment the Federal funds provided through the 
grants for the initiatives. 
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‘‘(6) SPECIALTY
CARE.—The term ‘specialty 
care’ means care that is provided through a referral 
and by a physician or nonphysician practitioner, 
such as surgical consultative services, radiology serv-
ices requiring the immediate presence of a physician, 
audiology, optometric services, cardiology services, 
magnetic resonance imagery (MRI) services, comput-
erized axial tomography (CAT) scans, nuclear medi-
cine studies, and ambulatory surgical services. 
‘‘(7) NURSE-MANAGED
HEALTH
CLINIC.—The 
term ‘nurse-managed health clinic’ means a nurse- 
practice arrangement, managed by advanced practice 
nurses, that provides care for underserved and vulner-
able populations and is associated with a school, col-
lege, or department of nursing or an independent 
nonprofit health or social services agency.’’. 
Amend the title so as to read: ‘‘A bill to amend the 
Public Health Service Act to provide additional author-
izations of appropriations for the health centers program 
under section 330 of such Act, and for other purposes.’’. 
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