I 
113TH CONGRESS 
2D SESSION 
H. R. 4765 
To address childhood obesity, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 29, 2014 
Ms. FUDGE (for herself, Mr. ELLISON, Ms. LEE of California, Mr. RICHMOND, 
and Mr. PAYNE) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees 
on Agriculture, Education and the Workforce, the Judiciary, Financial 
Services, and Natural Resources, for a period to be subsequently deter-
mined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To address childhood obesity, 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. SHORT TITLE. 
This Act may be cited as the ‘‘Fit for Life Act of 
2014’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents of this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents. 
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TITLE I—IMPROVING THE NUTRITIONAL QUALITY OF AND 
ACCESS TO FOODS IN UNDERSERVED AMERICAN COMMUNITIES 
Subtitle A—Access to Nutritious and Quality Foods in Underserved American 
Communities 
Sec. 101. Nutritious Food Access through mobility and Innovation Program. 
Sec. 102. Expansion of the Fresh Fruit and Vegetable Program. 
Sec. 103. Expanding Access to the Summer Food Service Program for Chil-
dren. 
Sec. 104. Study and report on physical activity and nutritional quality of meals 
and snacks served, in juvenile justice facilities. 
Sec. 105. Local food insecurity assessments: evaluating the unique nutritional 
needs of local communities. 
Sec. 106. Weekends and holidays without hunger. 
Subtitle B—Ensuring a Healthy Start for Children in Underserved American 
Communities 
Sec. 111. Improving Healthy Eating and Physical Activity Among our Young-
est Children. 
Sec. 112. Health and fitness school programs: training America’s youth to live 
healthy lifestyles. 
TITLE II—ADVANCING PREVENTATIVE MEASURES AND TREAT-
MENT OF OBESITY IN ADULTS AND CHILDREN IN UNDER-
SERVED COMMUNITIES 
Sec. 201. Community health and wellness navigators pilot program: connecting 
America’s health professionals with our schools. 
Sec. 202. Coverage of evidence-based preventive services under Medicaid and 
SCHIP. 
Sec. 203. Coverage of medical nutrition therapy under Medicaid and CHIP. 
Sec. 204. Clarification of EPSDT inclusion of prevention, screening, and treat-
ment services for obesity and overweight; CHIP coverage. 
Sec. 205. National commission on child obesity. 
Sec. 206. GAO report. 
TITLE III—ENCOURAGING PHYSICAL ACTIVITY IN UNDERSERVED 
AMERICAN COMMUNITIES 
Sec. 301. Renovation of foreclosed and abandoned properties to create spaces 
that encourage physical activity in American neighborhoods. 
Sec. 302. National youth sports program revitalization. 
Sec. 303. Expansion of the Zuni Youth Enrichment Project Summer Camp. 
Sec. 304. Making routes to schools in underserved communities safe and acces-
sible with public participation through the Community Oriented 
Policing Services program. 
Sec. 305. School infrastructure healthier upgrades competitive grant. 
Sec. 306. Shared use agreement expansion pilot grant program. 
Sec. 307. Land and Water Conservation Fund Program Grants in Low-Income 
Communities and Expand Tribal Participation. 
Sec. 308. Changing Hearts, Attitudes, and Minds by Participating in Sports 
(CHAMPS) Program. 
Sec. 309. Coordinated School Health Initiatives. 
Sec. 310. Rewarding elementary and secondary schools for outstanding student 
performance in physical fitness programs. 
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TITLE I—IMPROVING THE NU-
TRITIONAL QUALITY OF AND 
ACCESS TO FOODS IN UNDER-
SERVED AMERICAN COMMU-
NITIES 
Subtitle A—Access to Nutritious 
and Quality Foods in Under-
served American Communities 
SEC. 101. NUTRITIOUS FOOD ACCESS THROUGH MOBILITY 
AND INNOVATION PROGRAM. 
(a) ADMINISTRATION.—The Secretary of Agriculture 
shall carry out a pilot program to make 3-year grants in 
accordance with this section to nonprofit organizations, 
local government agencies, and accredited colleges and 
universities. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under this section, a nonprofit organization, local govern-
ment agency, for-profit business, or accredited college or 
university shall submit to the Secretary an application in 
such form, and containing such information, as the Sec-
retary may require by rule. Such application shall include 
an assurance that such applicant will create or expand an 
innovative food distribution project that— 
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(1) serves an area in which residents have low 
income, or an area that is a food desert or food 
swamp; 
(2) is not a supermarket-based project; 
(3) provides for the free or low-cost delivery of 
fresh fruits and vegetables to food recipients who 
participate in such project; 
(4) provides for the acquisition of produce 
trucks to distribute food to such recipients without 
a delivery charge and without any other service 
charge; or 
(5) provides for the establishment of a commu-
nity food market (including a food market in a 
school) at which fresh fruits and vegetables are sold 
to such recipients at a low cost. 
(c) PRIORITY.—The Secretary shall give priority to— 
(1) eligible applicants that propose to create or 
to expand a project that will operate in a geo-
graphical area in which there is a high incidence of 
childhood obesity; 
(2) eligible applicants that have a proven record 
of serving low-income or minority communities; and 
(3) organizations with plans for sustainability 
plans in place for continuing successful services after 
Federal funding lapses. 
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(d) REPORTING.—Each recipient of a 3-year grant 
made under this section shall submit annually to the Sec-
retary a report that includes an assessment of— 
(1) the impact that the recipient’s project has 
had on the community involved during the year for 
which such report is submitted; and 
(2) the prospects of continuing such project 
after the 3-year period for which such grant is 
made. 
SEC. 102. EXPANSION OF THE FRESH FRUIT AND VEGE-
TABLE PROGRAM. 
Section 19 of the Richard B. Russell National School 
Lunch Act (42 U.S.C. 1769a) is amended— 
(1) in subsection (a), by inserting ‘‘, secondary 
schools, childcare centers, and family childcare 
homes’’ after ‘‘elementary schools’’; 
(2) by amending subsection (b) to read as fol-
lows: 
‘‘(b) PROGRAM.—A school, childcare center, or family 
childcare home participating in the program— 
‘‘(1) shall make free fruits and vegetables avail-
able to students throughout the school, center, or 
home day (or at such other times as are considered 
appropriate by the Secretary) in 1 or more areas 
designated by the school, center, or home; and 
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‘‘(2) may make free fruits and vegetables in any 
other form (such as fresh, frozen, dried, pureed, or 
canned) available to students throughout the school, 
center, or home day (or at such other times as are 
considered appropriate by the Secretary) in 1 or 
more areas designated by the school only if such 
fruits and vegetables meet any additional nutrition 
specifications, as established by the Secretary.’’; 
(3) in subsection (d)— 
(A) in the heading, by inserting ‘‘, CEN-
TERS, OR HOMES’’; 
(B) in paragraph (1)— 
(i) in the matter preceding subpara-
graph (A), by inserting ‘‘, centers, or 
homes’’ after ‘‘schools’’; 
(ii) in subparagraph (A), by inserting 
‘‘, center, or home’’ after ‘‘school’’; 
(iii) in subparagraph (B), by inserting 
‘‘, centers, or homes’’ after ‘‘schools’’; 
(iv) by amending subparagraph (C) to 
read as follows: 
‘‘(C) ensure that each school selected is an 
elementary school or secondary school (as such 
terms are defined in section 9101 of the Ele-
mentary and Secondary Education Act of 1965 
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(20 U.S.C. 7801)), each center selected is a 
childcare center (as such term is defined in sec-
tion 399OO of the Public Health Service Act), 
and each home selected is a family childcare 
home (as such term is defined in section 399OO 
of the Public Health Service Act).’’; and 
(v) in subparagraph (D)— 
(I) in the matter preceding clause 
(i), by inserting ‘‘, centers, or homes’’ 
after ‘‘schools’’; 
(II) in clause (i), by inserting ‘‘, 
center, or home’’ after ‘‘school’’; and 
(III) in clause (ii), by inserting ‘‘, 
center, or home’’ after ‘‘as determined 
by the school’’; 
(C) in paragraph (2), by inserting ‘‘, cen-
ters, or homes’’ after each place ‘‘schools’’ ap-
pears; and 
(D) in paragraph (3), by inserting ‘‘, cen-
ters, or homes’’ after each place ‘‘schools’’ ap-
pears; and 
(4) in subsection (e), by inserting ‘‘, center, or 
home’’ after ‘‘school’’. 
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SEC. 103. EXPANDING ACCESS TO THE SUMMER FOOD 
SERVICE PROGRAM FOR CHILDREN. 
Section 13(a) of the Richard B. Russell National 
School Lunch Act (42 U.S.C. 1761(a)) is amended— 
(1) in paragraph (1)(A), by striking ‘‘50 per-
cent’’ each place it appears and inserting ‘‘40 per-
cent’’; 
(2) by repealing paragraph (9); and 
(3) in paragraph (10)— 
(A) in subparagraph (A)— 
(i) by striking ‘‘The Secretary’’ and 
inserting ‘‘From the amounts appropriated 
to carry out this paragraph, the Sec-
retary’’; and 
(ii) by striking ‘‘not more than 5’’; 
(B) in subparagraph (C), by striking ‘‘fis-
cal year 2006’’ and inserting ‘‘fiscal year 
2015’’; 
(C) in subparagraph (D)— 
(i) by striking ‘‘January 1, 2008’’ and 
inserting ‘‘January 1, 2015’’; and 
(ii) by striking ‘‘January 1, 2009’’ 
and inserting ‘‘January 1, 2016’’; and 
(D) by striking subparagraph (E). 
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SEC. 104. STUDY AND REPORT ON PHYSICAL ACTIVITY AND 
NUTRITIONAL 
QUALITY 
OF 
MEALS 
AND 
SNACKS SERVED IN JUVENILE JUSTICE FA-
CILITIES. 
(a) STUDY.—The Administrator of the Office of Ju-
venile Justice and Delinquency Prevention, in consultation 
with the Secretary of Agriculture, shall conduct a study 
on— 
(1) physical activity by juveniles in juvenile jus-
tice facilities, including— 
(A) the amount of such physical activity; 
(B) the types of physical activities in which 
such juveniles participate; 
(C) the number of hours per day such ju-
veniles participate in such physical activity; 
(D) the degree of inclusiveness for juve-
niles with disabilities in physical activities; 
(E) the participation rates for juveniles 
with disabilities; and 
(F) the adequacy of the amounts and types 
of physical activity of such juveniles; and 
(2) the nutritional quality of meals and snacks 
served in juvenile justice facilities. 
(b) REPORT.—Not later than two years after the date 
of the enactment of this Act, the Administrator of the Of-
fice of Juvenile Justice and Delinquency Prevention, in 
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consultation with the Secretary of Agriculture, shall sub-
mit to Congress a report on the findings of the study con-
ducted under subsection (a), including an evaluation of 
whether the amounts and types of physical activity by ju-
veniles, and the nutritional quality of meals and snacks 
served, in juvenile justice facilities are adequate to ensure 
the health and wellness of such juveniles. 
SEC. 105. LOCAL FOOD INSECURITY ASSESSMENTS: EVALU-
ATING THE UNIQUE NUTRITIONAL NEEDS OF 
LOCAL COMMUNITIES. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall establish a 3-year pilot program to 
award grants to local and tribal governments, on a com-
petitive basis, to allow such local and tribal governments, 
in partnership with the local community organizations 
under subsection (e), to— 
(1) conduct a food security assessment; and 
(2) make an inventory of the system in order to 
identify the strengths and gaps in such system. 
(b) DATA POINTS FOR ASSESSMENT.—For purposes 
of conducting an assessment and making an inventory 
under a grant under subsection (a), with respect to the 
community served by a local or tribal government, such 
government shall examine the following food security and 
food system issues in the community: 
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(1) The prevalence of childhood obesity. 
(2) The availability of safe routes to school for 
children. 
(3) The quality of food served in school and 
childcare settings. 
(4) The availability of supermarkets. 
(5) The cost and availability of fresh fruits and 
vegetables. 
(6) The concentration of convenience stores and 
other food vendors that sell a disproportionate 
amount of foods that are not fresh fruits and vegeta-
bles. 
(7) The availability of products. 
(8) The concentration of fast food restaurants. 
(9) The availability of green space or recreation 
areas, and the extent to which such space or areas 
encourage physical activity by adults and children. 
(10) Any other issues determined to be relevant 
by the local or tribal government. 
(11) Any other issues determined to be relevant 
by the Secretary of Health and Human Services. 
(c) NUMBER OF SITES.—The Secretary of Health 
and Human Services, in awarding grants under subsection 
(a), shall award grants to no more than— 
(1) 20 local governments; and 
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(2) 5 tribal governments. 
(d) PRIORITY.—In awarding grants under subsection 
(a), the Secretary of Health and Human Services shall 
give priority to those local and tribal governments that 
serve communities with the highest concentrations of pov-
erty. 
(e) REQUIREMENT OF PARTNERSHIPS.—In order to 
qualify for a grant under subsection (a), a local or tribal 
government shall demonstrate, to the satisfaction of the 
Secretary of Health and Human Services, that the local 
or tribal government has entered into a partnership (for 
the purpose of conducting an assessment and making an 
inventory under subsection (a)) with at least one of the 
following local community organizations: 
(1) A nonprofit, community-based organization 
or entity. 
(2) A developer or urban planning institution. 
(3) An accredited college or university. 
(4) A freestanding children’s hospital or center 
with expertise in child health and policy. 
SEC. 106. WEEKENDS AND HOLIDAYS WITHOUT HUNGER. 
Section 18 of the Richard B. Russell National School 
Lunch Act (42 U.S.C. 1769) is amended by adding at the 
end the following: 
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‘‘(l) WEEKENDS
AND HOLIDAYS WITHOUT HUN-
GER.— 
‘‘(1) DEFINITIONS.—In this subsection: 
‘‘(A) AT-RISK SCHOOL CHILD.—The term 
‘at-risk school child’ has the meaning given the 
term in section 17(r)(1). 
‘‘(B) ELIGIBLE INSTITUTION.— 
‘‘(i) IN GENERAL.—The term ‘eligible 
institution’ means a public or private non-
profit institution that is determined by the 
Secretary to be able to meet safe food stor-
age, handling, and delivery standards es-
tablished by the Secretary. 
‘‘(ii) INCLUSIONS.—The term ‘eligible 
institution’ includes— 
‘‘(I) an elementary or secondary 
school or school food service authority; 
‘‘(II) a food bank or food pantry; 
‘‘(III) a homeless shelter; and 
‘‘(IV) such other type of emer-
gency feeding agency as is approved 
by the Secretary. 
‘‘(2) ESTABLISHMENT.—Subject to the avail-
ability of appropriations provided in advance in an 
appropriations Act specifically for the purpose of 
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carrying out this subsection, the Secretary shall es-
tablish a program under which the Secretary shall 
provide commodities, on a competitive basis, to eligi-
ble institutions to provide nutritious food to at-risk 
children on weekends and during extended school 
holidays during the school year. 
‘‘(3) ELIGIBILITY.— 
‘‘(A) IN GENERAL.—To be eligible to re-
ceive commodities under this subsection, an eli-
gible institution shall submit an application to 
the Secretary at such time, in such manner, 
and containing such information as the Sec-
retary may determine. 
‘‘(B) PLAN.—An application under sub-
paragraph (A) shall include the plan of the eli-
gible institution for the distribution of nutri-
tious foods to at-risk school children, includ-
ing— 
‘‘(i) methods of food service delivery 
to at-risk school children; 
‘‘(ii) assurances that children receiv-
ing foods under the project will not be pub-
licly separated or overtly identified; 
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‘‘(iii) lists of the types of food to be 
provided under the project and provisions 
to ensure food quality and safety; 
‘‘(iv) information on the number of 
at-risk school children to be served and the 
per-child cost of providing the children 
with food; and 
‘‘(v) such other information as the 
Secretary determines to be necessary to as-
sist the Secretary in evaluating projects 
that receive commodities under this sub-
section. 
‘‘(4) PRIORITY.—In selecting applications under 
this subsection, the Secretary shall give priority to 
eligible institutions that— 
‘‘(A) have on-going programs and experi-
ence serving populations with significant pro-
portions of at-risk school children; 
‘‘(B) have a good record of experience in 
food delivery and food safety systems; 
‘‘(C) maintain high quality control, ac-
countability, and recordkeeping standards; 
‘‘(D) 
provide 
children 
with 
readily 
consumable food of high nutrient content and 
quality; 
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‘‘(E) demonstrate cost efficiencies and the 
potential for obtaining supplemental funding 
from non-Federal sources to carry out projects; 
and 
‘‘(F) demonstrate the ability to continue 
projects for the full approved term of the pilot 
project period. 
‘‘(5) GUIDELINES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
issue guidelines containing the criteria for 
projects to receive commodities under this sub-
section. 
‘‘(B) INCLUSIONS.—The guidelines shall, 
to the maximum extent practicable within the 
funds available and applications submitted, take 
into account— 
‘‘(i) geographical variations in project 
locations to include qualifying projects in 
rural, urban, and suburban areas with high 
proportions of families with at-risk school 
children; 
‘‘(ii) different types of projects that 
offer nutritious foods on weekends and 
during school holidays to at-risk school 
children; and 
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‘‘(iii) institutional capacity to collect, 
maintain, and provide statistically valid in-
formation necessary for the Secretary— 
‘‘(I) to analyze and evaluate the 
results of the pilot project; and 
‘‘(II) to make recommendations 
to Congress. 
‘‘(6) EVALUATION.— 
‘‘(A) INTERIM
EVALUATION.—Not later 
than November 30, 2016, the Secretary shall 
complete an interim evaluation of the pilot pro-
gram carried out under this subsection. 
‘‘(B) FINAL REPORT.—Not later than De-
cember 31, 2017, the Secretary shall submit to 
Congress a final report that contains— 
‘‘(i) an evaluation of the pilot pro-
gram carried out under this subsection; 
and 
‘‘(ii) any recommendations of the Sec-
retary for legislative action. 
‘‘(7) FUNDING.— 
‘‘(A) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—There is authorized to be appropriated 
to carry out this section such sums as are nec-
essary, to remain available until expended. 
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‘‘(B) AVAILABILITY OF FUNDS.—Not more 
than 3 percent of the funds made available 
under subparagraph (A) may be used by the 
Secretary for expenses associated with review of 
the operations and evaluation of the projects 
carried out under this subsection.’’. 
Subtitle B—Ensuring a Healthy 
Start for Children in Under-
served American Communities 
SEC. 111. IMPROVING HEALTHY EATING AND PHYSICAL AC-
TIVITY AMONG OUR YOUNGEST CHILDREN. 
Title III of the Public Health Service Act (42 U.S.C. 
241 et seq.) is amended by adding at the end the fol-
lowing: 
‘‘PART W—HEALTHY KIDS PROGRAM 
‘‘SEC. 399OO. DEFINITIONS. 
‘‘In this part: 
‘‘(1) CHILDCARE CENTER.—The term ‘childcare 
center’ means a center licensed or otherwise author-
ized to provide childcare services for fewer than 24 
hours per day per child in a nonresidential setting, 
unless care in excess of 24 hours is due to the na-
ture of the parents’ work. 
‘‘(2) EARLY
LEARNING
COUNCIL.—The term 
‘early learning council’ means an early childhood as-
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sembly that is established to advise Governors, State 
legislators, or State agency administrators on how 
best to meet the needs of young children and their 
families specifically through improvement of pro-
grams and services. 
‘‘(3) FAMILY
CHILDCARE
HOME.—The term 
‘family childcare home’ means a private family home 
where home-based childcare is provided for a portion 
of the day, unless care in excess of 24 hours is due 
to the nature of the parents’ work, and that is cer-
tified, registered, or licensed in the State in which 
it is located. 
‘‘(4) SCREEN TIME LIMITS.—The term ‘screen 
time limits’ means policies or guidelines, such as 
those developed by the American Academy of Pediat-
rics, designed to reduce the daily amount of time 
that children spend watching or looking at digital 
monitors or displays, including television sets, com-
puter monitors, or hand-held gaming devices. 
‘‘(5) SECRETARY.—The term ‘Secretary’ means 
the Secretary of Health and Human Services. 
‘‘SEC. 399OO–1. GRANTS. 
‘‘(a) IN GENERAL.—The Secretary, in consultation 
with appropriate entities within the Department of Health 
and Human Services, shall award 3-year competitive 
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grants to 5 State health departments (or other appro-
priate childcare licensing entities within such States) to 
help reduce and prevent obesity among the birth to 5-year- 
old population of the State in childcare settings outside 
a child’s place of residence. 
‘‘(b) USE
OF FUNDS.—State grantees shall use 
amounts received under a grant under this subsection to— 
‘‘(1) provide, or enter into contracts to provide, 
training (that meets the requirements of subsection 
(c)) to the staff of national, State, or community- 
based organizations with networks of childcare cen-
ters, or a consortium of childcare centers and family 
childcare homes consisting of at least 10 centers, for 
the purpose of implementing evidence-based healthy 
eating and physical activity policies and practices, 
including curricula and other interventions; and 
‘‘(2) provide grants to childcare centers and 
family childcare homes, whose staff received the 
training described in paragraph (1), to implement 
practice, curricula, and policy changes (that meet 
the requirements of subsection (d)) that promote 
healthy eating and physical activity among the birth 
to 5 years of age population. 
Preference in awarding grants shall be given to those 
States that demonstrate collaboration between relevant 
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State entities related to childcare and health and with key 
stakeholders, such as State early learning councils and 
other community-based 
organizations 
working 
with 
childcare centers or family childcare homes. 
‘‘(c) TRAINING REQUIREMENTS.— 
‘‘(1) IN
GENERAL.—Training provided under 
subsection (b) shall— 
‘‘(A) include the provision of information 
concerning age-appropriate healthy eating and 
physical activity interventions and culturally 
competent curricula for the birth to 5 years of 
age population in the State involved, which at 
a minimum shall include— 
‘‘(i) a handbook that includes rec-
ommendations, guidelines, and best prac-
tices for childcare centers and family 
childcare homes relating to healthy eating, 
physical activity, and screen time reduc-
tion; 
‘‘(ii) information about the availability 
of and services provided by childcare 
health consultants; and 
‘‘(iii) health and wellness resources 
available through the Child Care Bureau 
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and the Maternal and Child Health Bu-
reau; 
‘‘(B) identify, improve upon, and expand 
nutrition and physical activity best practices 
targeted to the birth to 5 years of age popu-
lation in the State involved and identify strate-
gies for incorporating parental education and 
other parental involvement; and 
‘‘(C) provide instruction on how to appro-
priately model, direct, and encourage childcare 
staff behavior to apply the best practices and 
strategies identified under subparagraph (B). 
‘‘(2) TRAINING ENTITIES.—A grantee may con-
duct the training required under this section di-
rectly, or may provide such training through a con-
tract with— 
‘‘(A) an appropriate national, State, or 
community organization with relevant expertise; 
‘‘(B) a health care provider or professional 
organization with relevant expertise; 
‘‘(C) a university or research center that 
employs faculty with relevant expertise; or 
‘‘(D) any other entity determined appro-
priate by the State and approved by the Sec-
retary. 
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educational agency, bureau-funded school, or non-
profit health or education organization in low-income 
communities to ensure increased access to medical 
care through educating parents and school adminis-
trators. 
(3) The community navigators will carry out 
educational activities for elementary school and sec-
ondary school students and their parents in low-in-
come communities with the goal of— 
(A) increasing familial intake of nutritious 
meals; 
(B) increasing physical activity both in and 
out of the school setting; and 
(C) increasing access to medical care. 
(4) The community navigators will specifically 
recognize and address that there are subgroups that 
are shown to have particular barriers to physical ac-
tivities, such as persons with disabilities. 
(c) REPORT.—Not later than 2 years after the date 
of the enactment of this Act, the Secretary shall submit 
a report to the Congress on the effectiveness of the pro-
gram under this section. 
(d) DEFINITIONS.—In this section: 
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(1) The term ‘‘bureau-funded school’’ has the 
meaning given such term in section 1146 of the 
Education Amendments of 1978 (25 U.S.C. 2026). 
(2) The terms ‘‘elementary school’’, ‘‘local edu-
cational agency’’, and ‘‘secondary school’’ have the 
meanings given to such terms in section 9101 of the 
Elementary and Secondary Education Act of 1965 
(20 U.S.C. 7801). 
(3) The term ‘‘eligible entity’’ includes a Feder-
ally qualified health center (as defined in section 
1861(aa) of the Social Security Act (42 U.S.C. 
1395x(aa))), a facility operated by the Indian 
Health Service (including a facility operated by an 
Indian tribe or tribal organization through a con-
tract or compact with the Service under the Indian 
Self-Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.)), a free-standing children’s 
hospital that is described in subparagraph (L) or 
(M) of section 340B(a)(4) of the Public Health 
Service Act (42 U.S.C. 256b(a)(4)), a non-profit 
with demonstrated effectiveness in the area of health 
care and with a focus on serving low-income commu-
nities, a rural hospital, and a rural health clinic. 
(4) The term ‘‘low-income communities’’ in-
cludes— 
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(A) communities with a high percentage of 
children eligible for free and reduced priced 
lunches under the Richard B. Russell National 
School Lunch Act (42 U.S.C. 1751 et seq.); 
and 
(B) any other communities determined by 
the Secretaries to be low-income for purposes of 
this section. 
(5) The term ‘‘nonprofit health or education or-
ganization’’ shall be defined by the Secretary. 
(6) The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
(7) The term ‘‘State’’ includes the District of 
Columbia and any commonwealth, territory, or pos-
session of the United States, including the Common-
wealth of Puerto Rico, the United States Virgin Is-
lands, Guam, American Samoa, and the Common-
wealth of the Northern Mariana Islands. 
(e) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal years 2015 and 
2016. 
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