Health Services and Centers Amendments
PL 95-626 (S.2474), enacted 11/10/1978

PUBIIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3551 
Public Law 95-626 
95th Congress 
An Act 
To amend the Public Health Service Act and related health laws to revise ant 
extend the programs of financial assistance for the delivery of health services, 
the provision of preventive health services, and for other purposes. 
Be it enacted hy the Senate and House of Representatives of the 
United States of America in Congress assembled, 
SHORT T I T L E ; KEFERENCE TO ACT 
SECTION 1. (a) This Act may be cited as the "Health Services and 
Centers Amendments of 1978". 
(b) Except as otherwise specificall}^ provided, whenever in this Act 
an amendment or repeal is expressed in terms of an amendment to, or 
repeal of, a section or other provision, the reference shall be considered 
to be made to a section or other provision of the Public Health Service 
Act. 
TITLE 
I—HEALTH 
CENTERS 
AND 
PRIMARY HEALTH 
CARE 
PART A—MIGRANT HEALTH CENTERS AND COMMUNITY HEALTH 
CENTERS 
SHORT TITLE 
Nov. 10, 1978 
[S. 2474] 
Health Services 
and Centers 
Amendments of 
1978. 
42 u s e 201 note. 
42 u s e 201 note. 
Migrant and 
Community 
Health Centers 
Amendments of 
1978. 
SEC. 101. This part may be cited as the "Migrant and Community 42 USC 201 note. 
Health Centers Amendments of 1978". 
, , 
. 
REDESIGNATION OF MIGRANT HEALTH CENTERS 
PROVISION 
SEC. 102. (a) Section 319 is redesignated as section 329 and is trans- 42 USC 247d. 
ferred and inserted before section 330. 
42 USC 254b. 
(b) (1) Section 217(g) is amended by striking out "319" and insert- 42 USC 218. 
ing in lieu thereof -'329" each place it appears. 
(2) Section 6(b) of the Health Maintenance Organization Act of 
1973 (Public Law 93-222) is amended by striking out "310" and 42 USC300e-14a. 
inserting in lieu thereof "329". 
(3) Section 1903 (m) (2) (B) (i) of the Social Security Act is 42 USC 1396b. 
amended by striking out "section 319(d)(1)(A)" and inserting in 
lieu thereof "section 329 (d) (1) (A)". 
AMENDMENTS TO MIGRANT HEALTH CENTERS PROGRAM 
SEC. 103. (a) (1) (A) Paragraph (1) of subsection (a) of section 
329 (as redesignated by section 102(a) of this part) is amended by Supra. 
inserting " (as determined by the centers)" after "as may be appropri-
ate for particular centers" in subparagraphs (D) and (E). 
92 STAT. 3552 
PUBLIC LAW 95-626—NOV. 10, 1978 
(B) Subparagraph (G) of such paragraph is amended to read as 
follows: 
"(G) information on the availability and proper use of health 
services and services which promote and facilitate optimal use 
,, 
of health services, including, if a substantial number of the indi-
viduals in the population served by a center are of limited Eng-
lish-speaking ability, the services of appropriate personnel fluent 
in the language spoken by a predominant number of such 
individuals,". 
^., .,.; ,i 
(C) Such paragraph is further amended by inserting the following 
before the period at the end thereof: "and individuals who have pre-
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.
. 
viously been migratory agricultural workers but can no longer meet 
the requirements of paragraph (2) of this subsection because of age 
' • ' • 
or disability and members of their families within the area it serves". 
(2) Paragraph (6) of such subsection is amended (A) by striking 
out "and" at the end of subparagraph (E), (B) by striking out the 
period at the end and inserting in lieu thereof "; and", and (C) by 
inserting after subparagraph (F) the following new subparagraph: 
"(G) pharmaceutical services, as may be appropriate for par-
3,\.. < ^ )'"'• • 
ticular centers."• 
(3) Paragraph (7) of such subsection is amended— 
(A) by striking out "(including nutrition education and social 
services)" in subparagraph (K) and inserting in lieu thereof 
"(including, for the social and other nonmedical needs which 
: sMxa^h. 
affect health status, counseling, referral for assistance, and fol-
lowup services)"; 
(B) by inserting "(including nutrition education)" in subpara-
graph (M) after "health education services"; and 
(C) by striking out subparagraphs (I) and (N), by inserting 
' • '
* 
"and" at the end of subparagraph (L), and by redesignating sub-
paragraphs (J), (K), (L), and (M), as subparagraphs (I), (J), 
(K), and (L), respectively. 
(b) The second sentence of subsection (b) (1) of such section is 
amended to read as follows: "The highest priorities for such assistance 
shall be assigned to areas where the Secretary determines the greatest 
need exists.". 
(c) Subsections (a) (5), (c) (1) (B), and (d) (1) (C) of such section 
are each amended by striking out "six thousand" and inserting in 
lieu thereof "four thousand". 
• '- 
•' 
" 
(d) (1) Subparagraph (B) of subsection (d) (1) of such section is 
repealed and subparagraph (C) of such subsection is redesignated as 
<M\h'^ .:' 
subparagraph (B). 
(2) (A) Paragraph (2) of subsection (d) of such section is amended 
by striking out "or (1) (B)". 
(B) Paragraphs (1) and (3) of subsection (f) of such section are 
each amended by striking out "(d)(1)(C)" and inserting in lieu 
thereof "(d)(1)(B)". 
, .,..'^ 
(C) Subsection (h) (2) of such section is amended by striking out 
* '
^
*
*
^
' "(d)(1)(C)" each place it appears and inserting in lieu thereof 
"(d)(1)(B)". 
(3) (A) Subsection (d) (1) of such section is amended by inserting 
after subparagraph (B), as so redesignated, the following new 
subparagraph: 
Grants. 
"(C) The Secretary may make grants to migrant health centers to 
enable the centers to plan and develop the provision of health services 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3553 
on a prepaid basis to some or to all of the individuals which the cen-
ters serve. Such a grant may only be made for such a center if— 
"(i) the center has received grants under subparagraph (A) of 
e, 
this paragraph for at least two consecutive years preceding the 
year of the grant under this subparagraph; 
" (ii) the governing board of the center (described in subsection 
(f) (3) (G)) requests, in a manner prescribed bj^ the Secretary, 
that the center provide health services on a prepaid basis to some 
or to all of the population which the center serves; and 
i 
"(iii) ^^^ center provides assurances satisfactory to the Secre-
tary that the provision of such services on a prepaid basis will not 
result in the diminution of health services provided by the center 
to the population the center served prior to the grant under this 
subparagraph. 
Any such grant may include the acquisition and modernization of 
existing buildings and providing training related to the management 
of the provision of health services on a prepaid basis.". 
(B) The fourth sentence of subsection (h) (2) of such section is 
amended by inserting before the period the following: ", and not more 
than 5 per centum of such funds may be made available for grants 
under subsection (d)(1)(C)". 
(e) Subsection (d) of such section is amended by striking out para-
graph (3) and inserting in lieu thereof the following: 
"(3) Not more than two grants may be made under paragraph 
(IHC) for the same entity. 
(4) (A) The amount of any grant made in any fiscal year under 
subparagraph (A) of paragraph (1) to a health center shall be deter-
mined by the Secretary, but may not exceed the amount by which the 
costs of operation of the center in such fiscal year exceed the total of— 
" (i) the State, local, and other funds, and 
"(ii) the fees, premiums, and third-party reimbursements, 
which the center may reasonably be expected to receive for its opera-
tions in such fiscal year. In determining the amount of such a grant 
for a center, if the application for the grant requests funds for a 
service described in subparagraph (D) or (E) of subsection (a)(1) 
• • 
!; 
(other than to the extent the funds would be used for the improvement 
'•-- '; '• " • 
of private property) or a supplemental health service described in 
subparagraph (B), (F), (J), or (L) of subsection (a) (7), the Secre-
tary shall include, in an amount determined by the Secretary and to 
the extent funds are available under appropriation Acts, funds for 
such service unless the Secretary makes a written finding that such 
service is not needed and provides the applicant with a copy of such 
finding. 
"(B) Payments under grants under subparagraph (A) of para-
graph (1) shall be made in advance or by way of reimbursement and 
in such installments as the Secretary finds necessary and adjustments 
may be made for overpayments or underpayments, except that if in any 
fiscal year the sum of— 
'• • 
'• 
"(i) the total of the amounts described in clauses (i) and 
(ii) of subparagraph (A) of this paragraph received by a center 
f 
in such fiscal year, and 
• 
"(ii) the amount of the grant to the center in such fiscal year, 
exceeded the costs of the center's operation in such fiscal year because 
the amount received by the center from fees, premiums, and third-
party reimbursements was greater than expected, an adjustment in 
the amount of the grant to the center in the succeeding fiscal year 
shall be made in such a manner that the center may retain such an 
92 STAT. 3554 
PUBLIC LAW 95-626—NOV. 10, 1978 
amount (equal to not less than one-half of the amount by which such 
sum exceeded such costs) as the center can demonstrate to the satisfac-
tion of the Secretary will be used to enable the center (I) to expand 
and improve its services, (II) to increase the number of persons 
(eligible under subsection (a) to receive services from such a center) 
it is able to serve, (III) to construct and modernize its facilities, (IV) 
to improve the administration of its service programs, and (V) to 
establish the financial reserve required for the furnishing of services 
on a prepaid basis. Without the approval of the Secretary, not more 
than one-half of such retained sum may be used for construction and 
modernization of its facilities.". 
(f) Subsection (f) of such section is amended— 
(1) by redesignating paragraphs (2), (3), and (4), as para-
graphs (3), (4), and (6), respectively; 
Grant 
(2) by inserting after paragraph (1) the following new 
applications. 
paragraph: 
"(2) An application for a grant under subparagraph (A) of sub-
section (d) (1) for a migrant health center shall include— 
"(A) a description of the need in the center's catchment area 
for each of the health services described in subparagraphs (D) 
and (E) of subsection (a)(1) and in subparagraphs (B), (F), 
1 
(J), and (L) of subsection (a)(7), 
"(B) if the applicant determines that any such service is not 
f
j 
needed, the basis for such determination, and 
"(C) if the applicant does not request funds for any such 
service which the applicant determines is needed, the reason for 
not making such a request. 
In considering an application for a grant under subparagraph (A) of 
subsection (d)(1), the Secretary may require as a condition to the 
approval of such application assurance that the applicant will provide 
any specified health service described in subsection (a) which the 
Secretary finds is needed to meet specific health needs of the area 
to be served by the applicant. Such a finding shall be made in writing 
and a copy shall be provided the applicant."; and 
Improvements of 
(3) by inserting after paragraph (4), as so redesignated, the 
private property. 
following new paragraph: 
"(5) The Secretary, in making a grant under this section to a 
migrant health center for the provision of environmental health serv-
ices described in subsection (a)(1)(D), may designate a portion of 
the grant to be expended for improvements to private property for 
which the written consent of the owner has been obtained and which 
are necessary to alleviate a hazard to the health of those residing on, 
or otherwise using, the property and of other persons in the center's 
catchment area. A center may make such an expenditure for an 
improvement under a grant only after the Secretary has specifi-
cally approved such expenditure and has determined that funds 
for the improvement are not available from any other source. 
Notification of 
The Secretary shall annually notify the appropriate committees of 
congressional 
Congress of the amounts so expended and the improvements for which 
committees. 
they were spent.". 
(g)(1)(A) Clause (ii) of subparagraph (G) of paragraph (3) (as 
so redesignated) of subsection (f) of such section is amended to read 
as follows: "(ii) selects the services to be provided by the center, 
schedules the hours during which such services will be provided, 
approves the center's annual budget, approves the selection of a 
director for the center, and, except in the case of a public center (as 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3555 
defined in the second sentence of this paragraph), establishes general 
policies for the center; and if the application is for a second or sub-
sequent grant for a public center, the governing body of the center has 
approved the application or if the governing body has not approved 
the application, the failure of the governing body to approve the 
application was unreasonable;". 
(B) Such paragraph is amended by adding at the end after and 
below subparagraph (J) the following sentence: "For purposes of 
subparagraph (G) and subsection (h)(4), the term 'public center' 
means a migrant health center funded (or to be funded) through a 
grant under this section to a public agency.". 
(C) The change in the governing board requirements for migrant 
health centers made by the amendment by subparagraph (A) to sec-
tion 329(f) (3) (G)(ii) of the Public Health Service Act shall not 
apply with respect to any public migrant health center which met the 
governing board requirements in effect under section 319(f)(2)(G) 
(ii) of such Act before October 1,1978. 
(2) Subparagraph (H) of subsection (f) (3) of such section is 
amended (A) by striking out "and (IV)" and inserting in lieu thereof 
"(IV)", and (B) by inserting before the semicolon at the end the 
following: ", and (V) expenditures made from any amount the center 
was permitted to retain under subsection (d) (4) (B)". 
(h) Subsection (g) of such section is amended— 
(1) by inserting "(1)" after "(g)", and 
(2) by adding at the end the following new paragraph: 
"(2) The Secretary shall make available to each grant recipient 
under this section a list of available Federal and non-Federal resources 
to improve the environmental and nutritional status of individuals in 
the recipient's catchment area.". 
(i)(l)(A) The first sentence of subsection (h) (1) of such section 
is amended by striking out "and" after "1977," and by inserting before 
the period a comma and the following: "$2,200,000 for the fiscal year 
ending September 30, 1979, $2,500,000 for the fiscal year ending Sep-
tember 30, 1980, and $2,900,000 for the fiscal year ending September 
30,1981". 
(B) The second sentence of such subsection is amended by striking 
out "two fiscal years" and inserting in lieu thereof "five fiscal years'. 
(2) (A) The first sentence of subsection (h) (2) of such section is 
amended by striking out "and" after "1977," and by inserting before 
the period a comma and the following: "$40,800,000 for the fiscal year 
ending September 30,1979, $46,000,000 for the fiscal year ending Sep-
tember 30, 1980, and $52,100,000 for the fiscal year ending September 
30,1981". 
(B) The third sentence of such subsection is amended by striking 
out "fiscal years ending September 30, 1977, and September 30, 1978" 
and inserting in lieu thereof "any fiscal year". 
(3) Subsection (h)(3) of such section is amended to read as follows: 
"(3) In any fiscal year, the Secretary shall obligate for payments 
under grants and contracts in such fiscal year under subsection (d) (1) 
for the provision of inpatient and outpatient hospital services not less 
than 10 per centum of the amount appropriated in such fiscal year 
under paragraph (2).". 
(4) Subsection (h) of such section is amended by adding at the end 
thereof the following new paragraph: 
"(4) The Secretary may not expend in any fiscal year, for grants 
under this section to public centers (as defined in the second sentence 
of subsection (f) (3)) the governing boards of which (as described in 
"Public center.' 
42 use 254b 
note. 
List of resources. 
92 STAT. 3556 
PUBLIC LAW 95-626—NOV. 10, 1978 
subsection (f) (3) (G) (ii)) do not establish general policies for such 
centers, an amount which exceeds 5 per centum of the funds appro-
priated under this section for that fiscal year.". 
42 use 254b 
(j) The amendments made by this section shall apply with respect 
note. 
to grants and contracts made under section 329 of the Public Health 
Service Act from appropriations for the fiscal years ending after 
• a
f
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-
» .»;yr 
September 30,1978. 
42 use 254c. 
Grants. 
COMMUNITY HEALTH CENTERS 
SEC. 104. (a) Paragraph (4) of subsection (a) of section 330 is 
amended to read as follows: 
"(4) environmental health services, including, as may be appro-
priate for particular centers (as determined by the centers), the 
detection and alleviation of unhealthf ul conditions associated with 
water supply, sewage treatment, solid waste disposal, rodent and 
parasitic infestation, field sanitation, housing, and other environ-
mental factors related to health, and". 
(b) (1) Paragraph (1) of subsection (b) of such section is amended 
(A) by striking out "and" at the end of subparagraph (E), (B) by 
striking out the period at the end and inserting in lieu thereof "; and", 
and (C) by inserting after subparagraph (F) the following new 
subparagraph: 
"(G) pharmaceutical services, as may be appropriate for par-
ticular centers.". 
(2) Paragraph (2) of such subsection is amended— 
(A) by striking out "(including nutrition education and social 
services)" in subparagraph (K) and inserting in lieu thereof 
"(including, for the social and other nonmedical needs which 
affect health status, counseling, referral for assistance, and 
followup services)"; 
(B) by inserting "(including nutrition education)" in sub-
paragraph (M) after "health education services"; 
(C) by striking out "outreach workers" in subparagraph (N) 
and inserting in lieu thereof "appropriate personnel"; and 
(D) by striking out subparagraph (1) and by redesignating 
subparagraphs (J) through (N) as subparagraphs (I) through 
' 
(M), respectively. 
(c) (1) (A) Paragraph (1) of subsection (d) of such section is 
amended by adding at the end the following new subparagraph: 
"(C) The Secretary may make grants to community health centers 
to enable the centers to plan and develop the provision of health serv-
ices on a prepaid basis to some or to all of the individuals which the 
centers serve. Such a grant may only be made for such a center if— 
"(i) the center has received grants under subparagraph (A) 
of this paragraph for at least two consecutive years preceding the 
year of the grant under this subparagraph; 
"(ii) the governing board of the center (described in subsec-
tion (e)(3)(G)) requests, in a manner prescribed by the Sec-
retary, that the center provide health services on a prepaid basis 
to some or to all of the population which the center serves; and 
"(iii) the center provides assurances satisfactory to the Sec-
retary that the provision of such services on a prepaid basis will 
not result in the diminution of health services provided by the 
center to the population the center served prior to the grant under 
this subparagraph. 
;j-: 10 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3557 
Any such grant may include the acquisition and modernization of 
existing buildings and providing training related to management of 
the provision of health services on a prepaid basis.". 
(B) Paragraph (2) of such subsection is amended by striking out 
i
< • > 
"paragraph (1)" and inserting in lieu thereof "paragraph (1) (A) or 
» f -MJH^* 
(1)(B)". 
(C) Paragraph (3) of such subsection is amended by inserting "or 
(1)(C)" after "(1)(B)". 
(2) Paragraph (4) of such subsection is amended to read as follows: 
"(4) (A) The amount of any grant made in any fiscal year under 
paragraph (1) (other than subparagraph (C)) to a community health 
center shall be determined by the Secretary, but may not exceed the 
amount by which the costs of operation of the center in such fiscal year 
exceed the total of— 
" (i) the State, local, and other funds, and 
"(ii) the fees, premiums, and third-party reimbursements, 
which the center may reasonably be expected to receive for its opera-
tions in such fiscal year. In determining the amount of such a grant 
for a center, if the application for the grant requests funds for a serv-
ice described in subsection (a) (4) (other than to the extent the funds 
would be used for the improvement of private property) or a supple-
mental health service described in subparagraph (B), (F), (L),or 
(M) of subsection (b) (2), the Secretary shall include, in an amount 
determined by the Secretary and to the extent funds are available 
under appropriation Acts, funds for such service unless the Secretary 
makes a written finding that such service is not needed and provides 
the applicant with a copy of such finding. 
"(B) Payments under grants under subparagraph (A) or (B) of 
paragraph (1) shall be made in advance or by way of reimbursement 
and in such installments as the Secretary finds necessary and adjust-
ments may be made for overpayments or underpayments, except that 
if in any fiscal year the sum of— 
"(i) the total of the amounts described in clauses (i) and (ii) 
of subparagraph (A) received by a center in such fiscal year, and 
"(ii) the amount of the grant to the center in such fiscal year, 
exceeded the costs of the center's operation in such fiscal year because 
^ , 
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the amount received by the center from fees, premiums, and third-
party reimbursements was greater than expected, an adjustment in 
the amount of the grant to the center in the succeeding fiscal year shall 
be made in such a manner that the center may retain such an amount 
(equal to not less than one-half of the amount by which such sum 
, 
. 
exceeded such costs) as the center can demonstrate to the satisfaction 
of the Secretary will be used to enable the center (I) to expand and 
improve its services, (II) to increase the number of persons (eligible 
to receive services from such a center) it is able to serve, (III) to con-
struct and modernize its facilities, (IV) to improve the administration 
of its service programs, and (V) to establish the financial reserve 
required for the furnishing of services on a prepaid basis. Without 
the approval of the Secretary, not more than one-half of such retained 
sum may be used for construction and modernization of its facilities.". 
. 
(d) (1) Paragraph (2) of subsection (e) of such section is amended— 
(A) by striking out "and" at the end of subparagraph (I), 
(B) by striking out the period at the end of subparagraph (J) 
and inserting in lieu thereof "; and", and 
(C) by adding at the end the following new subparagraph: 
92 STAT. 3558 
PUBLIC LAW 95-626—NOV. 10, 1978 
Grant 
applications. 
'Public center.' 
42 u s e 254c 
note. 
42USC 254c. 
s . . "(K) the center, in accordance with regulations prescribed by 
the Secretary, has developed an on-going referral relationship 
with one or more hospitals.". 
(2) Such subsection is amended by redesignating paragraph (2) as 
paragraph (3) and by adding after paragraph (1) the following new 
paragraph: 
"(2) An application for a grant under subparagraph (A) or (B) of 
subsection (d)(1) for a community health center shall include— 
"(A) a description of the need in the center's catchment area 
for each of the health services described in subsection (a) (4) and 
in subparagraphs (B), (F), (L), and (M) of subsection (b) (2), 
"(B) if the applicant determines that any such service is not 
needed, the basis for such determination, and 
"(C) if the applicant does not request funds for any such 
service which the applicant determines is needed, the reason for 
not making such a request. 
Tn considering an application for a grant under subparagraph (A) or 
(B) of subsection (d) (1), the Secretary may require as a condition to 
the approval of such application assurance that the applicant will 
provide any specified health services described in subsection (a) or 
(b) which the Secretary finds is needed to meet specific health needs 
of the area to be served by the applicant. Such a finding shall be made 
in writing and a copy shall be provided the applicant.". 
(3) (A) Clause (ii) of subparagraph (G) of paragraph (3) (as so 
redesignated) of such subsection is amended to read as follows: "(ii) 
meets at least once a month, selects the services to be provided by the 
center, schedules the hours during which such services will be pro-
vided, approves the center's annual budget, approves the selection of 
a director for the center, and, except in the case of a governing board 
of a public center (as defined in the second sentence of this para-
graph), establishes general policies for the center; and if the applica-
tion is for a second or subsequent grant for a public center, the 
governing body has approved the application or if the governing body 
has not approved the application, the failure of the governing body to 
approve the application was unreasonable;". 
(B) Such paragraph is amended by adding at the end after and 
below subparagraph (K) the following sentence: "For purposes of sub-
paragraph (G) and subsection (g) (4), the term 'public center' means 
a community health center funded (or to be funded) through a grant 
under this section to a public agency.". 
(C) The change in the governing board requirements for public 
community health centers made by the amendment by subparagraph 
(A) to section 330(e) (3) (G) (ii) of the Public Health Service Act 
shall not apply with respect to any public community health center 
which met the governing board requirements in effect under section 
330(e) (2) (G) (ii) of such Act before October 1,1978. 
(4) Subparagraph (H) of such paragraph is amended (A) by 
striking out "and (IV)" and inserting in lieu thereof " (IV)", and (B) 
by inserting before the semicolon at the end the following: ", and (V) 
expenditures made from any amount the center was permitted to 
retain under subsection (d) (4) (B)". 
(5) (A) Paragraph (2) of subsection (e) of such section is amended 
by inserting "paragraph (1)(A) or (1)(B) of" before "subsection (d) 
unless". 
(B) Such subsection is further amended by adding at the end the 
following new paragraphs: 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3559 
"(4) The Secretary shall approve applications for grants under 
paragraph (1) (A) or (1) (B) of subsection (d) for community health 
centers which— 
" (A) have not received a previous grant under such paragraph, 
or 
"(B) have applied for such a grant to expand their services, 
in such a manner that the ratio of the medical underserved populations 
in rural areas which may be expected to use the services provided by 
such centers to the medical underserved populations in urban areas 
which may be expected to use the services provided by such centers 
is not less than two to three or greater than three to two. 
"(5) The Secretary, in making a grant under this section to a com-
munity health center for the provision of environmental health serv-
ices described in subsection (a)(4), may designate a portion of the 
grant to be expended for improvements to private property for which 
the written consent of the owner has been obtained and which are 
necessary to alleviate a hazard to the health of those residing on, or 
otherwise using, the property and of other persons in the center's 
catchment area. A center may make such an expenditure for an 
improvement under a grant only after the Secretary has specifically 
approved such expenditure and has determined that funds for the 
improvement are not available from any other source. The Secretary 
shall annually notify the appropriate committees of Congress of the 
amounts so expended and the improvements for which they were 
spent.". 
(e) Subsection (f) of such section is amended— 
(1) by inserting "(1)" after "(f)", and 
(2) by adding at the end the following new paragraph: 
"(2) The Secretary shall make available to each grant recipient 
under this section a list of available Federal and non-Federal resources 
to improve the environmental and nutritional status of individuals in 
the recipient's catchment area.". 
(f) (1) Paragraph (1) of subsection (g) of such section is amended 
by striking out "and" after "1977," and by inserting before the period 
a comma and the following: "$6,300,000 for the fiscal year ending 
September 30,1979, $7,500,000 for the fiscal year ending September 30, 
1980, and $9,000,000 for the fiscal year ending September 30,1981". 
(2) Paragraph (2) of such subsection is amended by striking out 
"and" after "1977," and by inserting before the period a comma and 
the following: "$341,700,000 for the fiscal year ending September 30, 
1979, $397,500,000 for the fiscal year ending September 30, 1980, and 
$463,000,000 for the fiscal year ending September 30,1981". 
(3) Such paragraph is amended by adding at the end thereof the 
following sentence: "The Secretary may not expend for grants under 
subsection (d) (1) (C) in any fiscal year an amount which exceeds 5 
per centum of the funds appropriated under this subsection for that 
fiscal year.". 
(4) Such subsection is amended by adding at the end thereof the 
following new paragraph: 
"(4) The Secretary may not expend in any fiscal year, for grants 
under this section to public centers (as defined in the second sentence 
of subsection (e) (3)) the governing boards of which (as described in 
subsection (e)(3)(G)(ii)) do not establish general policies for such 
centers, an amount which exceeds 5 per centum of the funds appro-
priated under this section for that fiscal year.". 
(g) The amendments made by this section shall apply with respect 
to grants made under section 330 of the Public Health Service Act from 
appropriations for fiscal years ending after September 30,1978. 
Improvements of 
private property. 
Notification of 
congressional 
committees. 
List of resources. 
Limitations. 
Limitations. 
42 u s e 254c 
note. 
42 u s e 254c. 
92 STAT. 3560 
PUBLIC LAW 95-626—NOV. 10, 1978 
42 use 255. 
Regulations. 
42 use 247e. 
Repeals. 
42 use 256, 
prec. 255. 
) i;Hui 
'.ft 
REDESIGNATION OF OTHER PROVISION 
-' 
' ' ^ '" 
SEC. 105. (a) Section 339 is amended— 
(1) by amending its heading to read as follows: "RECEIPT, 
APPREHENSION, DETENTION, TREATMENT, AND RELEASE OP LEPERS" ; 
(2) by inserting " ( a ) " after "SEC. 339."; 
(3) by inserting at the end thereof the following new subsection: 
"(b) The Surgeon General may provide by regulation for the appre-
hension, detention, treatment, and release of persons being treated by 
the Service for leprosy."; and 
(4) by redesignating such section as section 320 and inserting 
it in subpart I of part C of title I I I immediately before section 321. 
(b) Section 340 and the heading to part D of title I I I are repealed. 
TECHNICAL ASSISTANCE DEMONSTRATION GRANTS AND CONTRACTS 
SEC. 106. (a) Part C of title I I I is amended by adding after section 
338 the following new section: 
42 use 256a. 
Ante, p. 3551. 
42 use 254c. 
KodalimiJ 
" T E C H N I C A L ASSISTANCE DEMONSTRATION GRANTS AND CONTRACTS 
"SEC. 340A. (a) (1) The Secretary may make grants to, and enter 
into contracts with, public and private entities to assist such entities 
in meeting their costs of providing technical assistance to entities 
engaged in the planning, development, or operation (or in any com-
bination of such activities) of migrant health centers under section 
329, community health centers under section 330, or any other centers 
for the delivery of primary health care. The technical assistance with 
respect to which a grant may be made under this paragraph includes— 
"(A) assistance in the selection of sites for such centers, 
" ( B ) assistance in the selection of governing boards for such 
centers, 
"(C) assistance in the management of the service programs of 
such centers, 
"(D) assistance in the recruitment, selection, and retention of 
personnel (including members of the National Health Service 
Corps) for such centers, 
" ( E ) assistance in financial management of such centers, and 
" ( F ) assistance in the procurement of facilities, equipment, and 
supplies for such centers. 
"(2) In making grants and contracts under paragraph (1), the 
Secretary shall make such grants to, and enter into such contracts 
with— 
"(A) entities which will provide technical assistance on a state-
wide basis for the planning, development, and operation of cen-
ters to provide primary health care in urban and rural areas, 
"(B) entities which will provide technical assistance solely 
for the planning, development, and operation of centers to provide 
primary health care in large, densely populated areas, 
"(C) entities which will provide technical assistance solely for 
the planning, development, and operation of centers to provide 
primary health care in rural areas, 
" ( D ) entities which will provide technical assistance for the 
planning, development, and operation of centers to provide pri-
mary health care on a regional basis in large States, and 
" ( E ) entities which will provide technical assistance within 
several contiguous States for the planning, development, and 
operation of centers to provide primary health care. 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3561 
Grants and contracts under paragraph (1) 
(other than those 
described in subparagraph (E) of this paragraph) to private entities 
may only be made to such entities to provide technical assistance in 
the States in which they are primarily engaged in business. 
"(b)(1) No grant may be made under subsection (a) unless an 
application therefor has been submitted to and approved by the 
Secretary. Such an application shall be submitted in such form and 
manner and shall contain such information as the Secretary may 
require by regulation. 
" (2) The amount of any grant or contract under subsection (a) shall 
be determined by the Secretary, except that no grant or contract to 
any entity in any fiscal year may exceed $500,000. 
(c) The Secretary shall establish a Primary Health Care Advisory 
Committee (hereinafter in this subsection referred to as the 'Com-
mittee') to make recommendations respecting— 
"(1) the capabilities of applicants for grants and contracts 
under subsection (a) to effectively carry out the projects for 
which the grants and contracts would be made; 
" (2) the renewal of grants and contracts under such subsection; 
and 
"(3) the evaluation to be made under section 106(b) of the 
Migrant and Community Health Centers Amendments of 1978. 
The Committee shall consist of five members appointed by the Secre-
tary, in accordance with section 222, from individuals who are not 
officers or employees of the Federal Government and who because of 
their expertise in providing technical assistance to primary health care 
centers are particularly qualified to serve on the Committee. 
"(d)(1) For the purpose of carrying out this section, there are 
authorized to be appropriated $3,000,000 for the fiscal year ending 
September 30, 1979, $3,000,000 for the fiscal year ending Septem-
ber 30, 1980, and $3,000,000 for the fiscal year ending Septem-
ber 30,1981. 
"(2) The authority of the Secretary to enter into contracts under 
subsection (a) shall be effective for any fiscal year only to such extent 
or in such amounts as are provided in advance in appropriation Acts.", 
(b) Not later than March 1, 1981, the Secretary of Health, Educa-
tion, and Welfare shall submit a report to Congress— 
;, 
(1) on the effectiveness of the entities assisted under section 
340A of the Public Health Service Act— 
(A) in establishing centers which meet the requirements 
of section 329 or 330 of the Public Health Service Act or 
. , t. 
other centers for the provision of primary health care, 
,.> ,; 
(B) in improving the acceptability, in the communities 
served, of migrant health centers, community health centers, 
:, . 
and other centers engaged in the delivery of primary health 
!. r- J 
care, 
(C) in improving the ability of such centers to attract and 
retain health professions personnel, and 
, " 
(D) in assisting such centers in reducing their dependence 
on public funding; 
(2) on the extent to which the effectiveness of entities assisted 
under grants and contracts under such section 340A depends on 
(A) the type of area to be served by the centers for which plan-
ning, development, and operation assistance was provided by 
ri 
such entities, and (B) the organizational structure of such 
entities; 
Limitations. 
Primary Health 
Care Advisory 
Committee. 
Establishment. 
Ante, p. 3560. 
42 u s e 217a. 
Appropriation 
authorization. 
Report to 
Congress. 
42 u s e 256a 
note. 
Ante, p. 3560. 
Ante, p. 3551, 
42 u s e 254c. 
:i!l-liM ()—KO—pt. :i 
r,!) : Ql,:! 
92 STAT. 3562 
PUBLIC LAW 95-626—NOV. 10, 1978 
(3) comparing the effectiveness of entities assisted under such 
Ante, p. 3560. 
section 340A with the effectiveness of other entities assisted under 
42 use 241. 
other provisions of title III of the Public Health Service Act in 
providing technical assistance described in paragraph (1); and 
(4) recommending the most effective methods for providing 
technical assistance described in paragraph (1). 
(c) The Secretary of Health, Education, and Welfare shall con-
duct an assessment of the various types of continuing education pro-
grams available for health professions personnel serving medical 
underserved populations and the effect such types of programs have on 
the retention of such personnel by centers engaged in the delivery of 
Report to 
primary health care to such populations. The Secretary shall report 
Congress. 
the results of such assessment to Congress not later than Janu-
ary 1,1980. 
MISCELLANEOUS 
42 use 
SEC. 107. The first sentence of section 1313 is amended by inserting 
300e-12. 
"(except as provided in sections 329, 330, and 340)" after "Act". 
Primary Health 
P A R T B—PRIMARY HEALTH 
CARE 
Care Act of 1978. 
SHORT TITLE 
42 use 201 note. 
SEC. 111. (a) This part may be cited as the "Primary Health Care 
Act of 1978". 
FINDINGS AND DECLARATION OF PURPOSE 
42 use 254a-l 
SEC. 112. (a) Congress finds that— 
note. 
(1) although the achievement of equal access to quality health 
care at a reasonable cost is a priority of the Federal Government, 
there remains a wide disparity throughout the Nation regarding 
the cost, quality, and availability of primary health services; 
(2) despite Federal financing programs designed to eliminate 
barriers to primary health services for the poor and the elderly, 
there remains a shortage of health resources to provide such serv-
ices, especially in medically underserved urban and rural areas; 
and 
(3) residents of urban and rural medically underserved areas 
lacK the availability of basic and appropriate services for health 
promotion, disease prevention, and primary care. 
(b) It is the purpose of this part— 
(1) to alleviate the shortage of health resources for the provi-
sion of primary health services to urban and rural medical under-
served populations in the United States; and 
(2) to provide authorities for research and demonstration proj-
ects which develop innovative approaches for the organization and 
^ ' delivery of primary health services. 
DESIGNATION OF PRIMARY HEALTH CARE PART I N TITLE I I I OF PUBLIC 
HEALTH SERVICE ACT 
SEC. 113. (a) Title III is amended— 
42 use prec. 248. 
(1) by striking out the heading to subpart I of part C; 
42 use 254a. 
(2) by redesignating section 328 as section 327A; and 
Ante, p. 3551. 
(3) by inserting before section 329 (as redesignated by section 
102(a) of this Act) the following heading: 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3563 
J 
"PART D—PRIMARY HJBALTH CARE 
"Subpart I—Primary Health Centers". 
(b) Sections 751(f) and 752(d) are each amended by striking out 42 USC 294t, 
"subpart II of part C" each place it appears and inserting in lieu 294u. 
thereof "subpart II of part D". 
HOSPITAL-AFFILIATED PRIMARY CARE CENTERS 
SEC. 114. Subpart I of part D of title III (as provided for under sec- 42 USC 241. 
tion 113(a) of this Act) is amended by inserting before section 329 the Ante, p. 3551. 
following new section: 
" H O S P I T A L - A F F I L I A T E D PRIMARY CARE CENTERS 
« r 
"SEC. 328. (a) For purposes of this section: 
Definitions. 
" (1) The term 'community hospital' means a— 
42 USC 254a-l. 
"(A) public general hospital owned and operated by a 
State, county, or local unit of government or by a public 
benefit corporation, or 
"(B) private nonprofit hospital, 
which primarily serves a medical underserved population (as 
defined in section 330 (b) (3)). 
42 USC 254c. 
" (2) The terms 'hospital-affiliated primary care center' and 'pri-
mary care center' mean a distinct administrative unit of a commu-
nity hospital which is located in or adjacent to the hospital and 
which— 
"(A) provides primary health services (except that emer-
gency medical services shall be provided to the extent 
practicable through referral to the emergency room of the 
community hospital) to a catchment area which is determined 
by the hospital and approved by the Secretary ; 
"(B) provides, as may be appropriate for particular cen-
ters, supplemental health services necessary for the adequate 
support of primary health services; 
"(C) provides referral to providers of supplemental health 
services and payment, as appropriate and feasible, for their 
provision of such services; 
" (D) provides for, when the center is closed, at least referral 
to emergency medical services and authorized access to patient 
medical records on a twenty-four-hours-a-day, seven-days-
a-week basis; and 
"(E) provides information on the availability and proper 
' 
use of health services provided by the community hospital 
and the center. 
" (3) The term 'primary care group practice' means, with respect 
to a i)rimary care center affiliated with a community hospital, any 
combination of physicians and other health care providers that 
includes at least three primary care physicians (as defined in sec-
tion 771(b) (2) (F) (ii))— 
42USC295f-l. 
"(i) which combination is organized to provide primary 
health services in a manner which is consistent with the needs 
of the population to be served by the center, and which uses, 
where practicable in the provision of such services, nonphysi-
cian providers (particularly physician assistants and nurse 
practitioners) in concert with the physicians of the group 
practice; 
92 STAT. 3564 
PUBLIC LAW 95-626—NOV. 10, 1978 
"(ii) which combination is located in or adjacent to the 
community hospital; 
" (iii) the physicians of which have admitting privileges to 
the community hospital; 
• • ' \; • -•^'? ^-'.' 
" (iv) (I) the primary care physicians of which are salaried 
H". 
.nj, .;; 
and full time in the hospital and a majority of whom practice 
full time in the primary care center, or (II) which combina-
tion is organized into a partnership, corporation, or profes-
sional association which has an agreement with the hospital 
to fulfill the obligations described in subparagraphs (A) and 
', „t 
.'//«,.'• 
(C) of subsection (b) (3); and 
"(v) the primary care physicians of which are not all per-
sonnel serving with the National Health Service Corps; 
except that in the case of such a combination serving a health man-
42 use 254e. 
power shortage area (designated under section 332), in lieu of one 
of the primary care physicians required in such a combination 
''^, 
there may be a nurse practitioner or physician assistant. 
"Primary care ' 
"(4) The term 'primary care resident' means a graduate phy-
resident." 
sician in a training program which (A) is in primary care (as 
42USC295f-2. 
defined in section 772(b) (2) (F) (ii)), (B) is approved by an 
appropriate certifying body, and (C) requires that at least one-
third of the time in the last two years of residency training (or in 
the case of the osteopathic general practice resident, the last year 
'" 
of residency training) be spent in an ambulatory care setting. 
"(5) The terms 'primary health services' and 'supplemental 
health services' have the meanings given such terms in paragraphs 
42 use 254c. 
(1) and (2) of section 330 (b), respectively. 
"(b) (1) The Secretary may make grants to community hospitals 
to support demonstration projects in the planning, development, and 
operation of hospital-affiliated primary care centers. To the extent 
feasible, the Secretary shall not make a grant for such a center to 
serve a population whose need for primary health services is being met 
by a community health center, migrant health center, or other health 
care provider. 
"(2) No grant may be made under paragraph (1) unless an applica-
tion therefor is submitted to, and approved by, the Secretary. Such an 
application shall be submitted in such form and manner and shall con-
tain such information as the Secretary shall prescribe. Insofar as 
practicable, the Secretary shall approve applications under this sub-
section in a manner which results in an equitable distribution of pri-
mary care centers among urban and rural areas. 
"(3) The Secretary may not approve an application for a grant 
under paragraph (1) with respect to a primary care center affiliated 
with a community hospital unless the Secretary has made the follow-
ing determinations: 
"(A) The primary health services of the center will be pro-
vided through a primary care group practice, and may be 
provided by a primary care resident if (i) such services are pro-
vided under the direction of a member of the practice who is a 
• primary care physician, and (ii) provision of such services by the 
.1 t2i>2 i«:U £
4
» 
resident are credited toward the resident's fulfilling the require-
^
•
^ ment of the residency training program described in subsection 
(a)(4)(C). 
"(B) Except under unusual circumstances (as established by 
the Secretary by regulation), primary health services provided 
by the community hospital will be provided only through the cen-
^
i
i
> ter, and qualified personnel trained in triage will be placed in the 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3565 
hospital's emergency room, outpatient department, and in the 
... ^
^ 
primary care center to screen and direct patients to the appro- 
,,,,/:.,, 
priate location for care. 
"(C) Each patient of the center will have an identified primary 
care physician who is a member of the primary care group prac-
tice and who is responsible for continuous management of the 
patient, including the referral of the patient for inpatient, out-
patient, or emergency services. 
"(D) To the extent practicable, existing facilities and equip-
ment which are in or owned by the community hospital, which 
are not required for the delivery of inpatient or emergency serv-
ices, and which are needed in the primary care center will be con-
verted for the use of the primary care center. 
"(E) The hospital and primary care center will avoid unneces-
sary duplication of facilities and equipment, except that the pri-
mary care center may install appropriate support equipment for 
the provision of routine primary health services. 
"(F) The primary care center will be maintained as a separate 
and distinct cost and revenue center for accounting purposes. Any 
costs which are not directly associated with the operation of the 
center (including inpatient-related costs) will not be assigned to 
the center. Costs associated with the education and training of 
residents and medical and other health science students will not 
be calculated into the costs of operating the primary care center, 
except that the salaries and other costs associated with the provi-
sion of services by residents may be calculated into the costs of 
operating the center as long as such costs are proportional to the 
; 
actual percentage of time spent by the resident in the provision of 
services in the primary care center. 
"(G) The primary care center will be operated in accordance 
with all the requirements of section 330(e) (3) (other than sub- 42 USC 254c. 
paragraph (G) thereof) applicable to community health centers. 
"(H) Unless the community hospital has a governing board 
described in subparagraph (G) of section 330(e) (3) for the pri-
mary care center, the application for the grant has been reviewed 
and approved by an advisory board which is established by the 
< 
community hospital and which— 
"(i) is composed of individuals a majority of whom are 
being served by the center and who, as a group, represent the 
individuals being served by the center, 
"(ii) participates in the development of the application 
for the grant under this section and in the development of any 
application for the renewal of such a grant, and 
"(iii) once the primary care center becomes operational, 
meets at least six times each year to review the operations of 
• ; , # ' • 
the center and to develop recommendations to the hospital's 
governing board concerning the types of services to be pro-
vided by, and the operations of, the center. 
"(I) The primary care center will provide for an information 
program for its patients under which patients are fully informed 
of the covered professional services and referral services offered 
by the center and of the methods by which patient grievances 
respecting billing for such services, or the quality of such services, 
may be resolved. 
nof*? .T;. I 
'^(J) The operating hours of the primary care center will 
include those periods when the community hospital's emergency 
room and outpatient department are most utilized. 
92 STAT. 3566 
PUBLIC LAW 95-626—NOV. 10, 1978 
Application 
priorities. 
Ante, p. 3558. 
Report to 
Congress. 
42 u s e 1395, 
1396. 
Appropriation 
authorization. 
Limitation. 
"(4) In reviewing and approving applications for grants under 
this section, the Secretary shall give priority to the application of 
any community hospital— 
"(A) which (i) is located in a State whose laws do not prohibit 
the hospital from establishing a governing board for its affiliated 
primary care center which board meets the requirements of sub-
paragraph (G) of section 330(e) (3) for the governing board of a 
private community health center, and (ii) has established such a 
governing board, or 
"(B) which is located in a State whose laws prohibit the hospi-
tal from establishing such a board. 
" (5) Grants under this subsection may be used for covering the costs 
of planning, developing, and operating hospital-affiliated primary 
care centers, including the costs of acquiring and modernizing exist-
ing buildings or space located in or adjacent to the community hospi-
tal (including the costs of amortizing the principal of, and paying 
interest on, loans). 
"(c) The Secretary may provide (either through the Department of 
Health, Education, and Welfare or by grant or contract) all neces-
sary technical and other nonfinancial assistance (including fiscal and 
program management assistance and training in such management) to 
a community hospital to assist it in developing plans for, and in oper-
ating, a primary care center. The authority of the Secretary to enter 
into contracts under this subsection shall be effective for any fiscal 
year only to such extent or in such amounts as are provided in advance 
m appropriation Acts. 
"(d) Not later than March 1, 1981, the Comptroller General shall 
submit a report to Congress evaluating the operation of hospital-
affiliated primary care centers, including, with their voluntary partici-
pation, those centers not assisted under this section. With respect to 
such centers the Comptroller General shall— 
"(1) assess the costs of such centers and their methods of allo-
cating costs between the centers and their affiliated hospitals; 
"(2) assess the methods of reimbursement used (particularly 
under titles XVIII and XIX of the Social Security Act) for 
services provided by such centers; 
"(3) compare the cost and effectiveness of providing primary 
health services through such centers with the cost and effective-
ness of providing such services through community health centers 
and other entities providing similar services, and 
"(4) assess the degree to which the hospitals provided assist-
ance under this section are complying with the requirements 
specified under subsection (b) (3). 
"(e) There are authorized to be appropriated for the purpose of 
making payments for grants under subsection (a) and for the pro-
vision of assistance under subsection (c)— 
"(1) for the planning and development of primary care cen-
ters, $5,000,000 for the fiscal year ending September 30, 1979, 
and 
" (2) for the planning, development, and operation of primary 
care centers, $25,000,000 for the fiscal year ending Septem-
ber 30, 1980, and $30,000,000 for the fiscal year ending Septem-
ber 30, 1981. 
Not more than $150,000 may be used for the planning and develop-
ment of any single primary care center.". 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3567 
RESEARCH AND DEMONSTRATION PROJECTS FOR PRIMARY CARE 
SEC. 115. Part D of title III is further amended— 
42 USC 241. 
(1) by adding after section 338 the following subpart 42 USC 254k. 
heading: 
"Subpart IV—Eesearch and Demonstration Projects in Primary 
Care"; 
and 
(2) by adding after such subpart heading the following new Grants and 
s e c t i o n : 
contracts. 
" P R I M A R Y CARE RESEARCH AND DEMONSTRATION PROJECTS 
"SEC. 340. (a) The Secretary may make grants to, and enter into 42 USC 256. 
contracts with, public and private entities which provide health 
services— 
"(1) to demonstrate new and innovative methods for the pro-
vision of primary health services and dental health services, or 
" (2) to conduct research on such methods or on existing methods 
for the provision of primary health services and dental health 
services, 
to medical underserved populations or to such other populations as 
the Secretary determines are necessary to demonstrate or conduct 
research on particular methods. 
"(b) Grants and contracts may be made under subsection (a) to 
demonstrate and conduct research on— 
"(1) methods of attracting and retaining primary care physi-
cians, dentists, physician assistants, nurse practitioners, and other 
health professionals, both individually and as teams, to train 
and practice among medical underserved populations; 
" (2) differing types of organizational models and relationships, 
including federations of health service centers, designed to meet 
unique primary health and dental health service needs; 
"(3) management and technological improvements (including 
new or improved methods for biomedical communication and 
medical and financial recordkeeping and billing systems) to 
^ « ^ 
increase the productivity, effectiveness, efficiency, and financial 
stability of primary health and dental health service providers; 
"(4) methods of providing health promotion, disease preven-
tion, and health education programs, including school health 
programs; 
"(5) methods of identifying, coordinating, and integrating 
existing primary health and dental health service programs with 
mental health and social service programs to maximize use of avail-
able resources, avoid duplication of effort, and ensure a coordi-
nated, comprehensive care system; 
"(6) specific services or mixtures of services appropriate for 
a given area, including ambulatory care, home health care, 
environmental health services (described in section 330(a) (4)), 
community outreach activities, transportation services, and other 
supplemental health services (as defined in section 330(b) (2)); 
"(7) the effect of availability of primary health and home 
health services in terms of reduction of emergency room visits, 
hospitalizations, and institutionalization in long-term care 
facilities; 
"(8) the use of mobile health screening clinics to provide pre-
ventive health care services to meet the needs of medical under-
served populations; and 
92 STAT. 3568 
PUBLIC LAW 95-626—NOV. 10, 1978 
42 use 241. 
42 use 1305. 
Report to 
Congress. 
42 use 1310. 
"Medical 
underserved 
population." 
42 use 254c. 
Appropriation 
authorization. 
"(9) such other projects as the Secretary determines to be 
necessary to further the purposes of this section. 
"(c) (1) The Secretary may not make a grant or enter into a con-
tract under this section for a project if the project can be carried out 
under the authority of any other provision (other than section 301) 
of this Act. 
"(2) The Secretary shall, to the extent feasible, coordinate 
demonstration and research projects carried out under this section with 
any demonstration and research projects carried out under the Social 
Security Act for the reimbursement of services which are the subject 
of projects under this section. 
" (d) (1) No grant may be made under this section unless an applica-
tion therefor is submitted to, and approved by, the Secretary. Such 
an application shall be submitted in such form and manner and shall 
contain such information as the Secretary shall prescribe. 
"(2) The amount of any grant or contract under this section shall 
be determined by the Secretary. 
"(3) The Secretary may make payments under this section in 
advance or by way of reimbursement, and at such intervals and on 
such conditions as the Secretary may find necessary. 
"(e) The Secretary shall submit an annual report to Congress not 
latei' tlian March 1 ot each year (beginning with 1979) describing— 
"(1) the projects conducted under this section during the fiscal 
year ending in the previous year and why they could not be 
assisted under the authority of other provisions of this Act; 
"(2) the amount of funds expended in such fiscal year for each 
project area set forth in subsection (b) and, if more than 20 per 
centum of the amount appropriated for this section was expended 
on any single such project area, the reasons for such concentra-
tion of expenditures; and 
"(3) any recommendations resulting from the conduct of such 
projects. 
In (he first such report, the Secretary shall include the number of 
demonstration projects which were funded under section 1110 of the 
Social Security Act during the fiscal year ending September 30, 1978, 
which were related to health services in rural medical underserved 
areas, and which could have been assisted under this section during 
the fiscal year ending September 30, 1979, but for subsection (c) (1) 
of this section. 
"(f) As used in this section, the term 'medical underserved popula-
tion' has the meaning given such term in section 330(b)(3). 
"(g) (1) There are authorized to be appropriated for the purposes 
of funding grants and contracts under this section in areas that are 
not urbanized areas (as defined by the Census Bureau) $18,000,000 
for the fiscal year ending September 30.1979, $20,000,000 for the fiscal 
year ending September 30, 1980, and $22,000,000 for the fiscal year 
ending September 30,1981. 
" (2) There are authorized to be appropriated for the purposes of 
funding grants and contracts under this section in urbanized areas 
(as defined by the Census Bureau) $4,000,000 for the fiscal year ending 
September 30,1979, $4,500,000 for the fiscal vear ending September 30, 
1980, and $5,000,000 for the fiscal year ending September 30, 1981. 
"(3) The authority of the Secretary to enter into contracts under 
this section shall be effective for any fiscal year only to such extent 
or in such amounts as are provided in advance in appropriation Acts. 
"(4) The Secretary may continue to support, out of funds appropri-
ated under this section, those demonstration projects which were 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3569 
funded under section 1110 of the Social Security Act during fiscal 42 USC 1310. 
year ending September 30,1978, and which are related to health serv-
ices in rural medical underserved areas, but only if such projects can 
not be carried out under the authority of any other provision (other 
than section 301) of this Act.". 
42 USC 241. 
SPECIAL REPORTS ON PRIMARY HEALTH OARE NEEDS OF IMMIGRANTS, NATIVE 
INDIANS, AND ALASKAN ESKIMOS AND ON THE FUTURE OF THE NATIONAL 
HEALTH SERVICE CORPS 
SEO. 116. (a) Not later than June 30,1979, the Secretary of Health, 
Education, and Welfare (hereinafter in this section referred to as the 
"Secretary") shall submit to Congress a special report on the primary 
health care needs of immigrants. The report shall be developed 
through consultation with the Commissioner of the Immigration and 
Naturalization Service, with leaders in the health care area, and with 
representatives of immigrants. The report shall contain (1) an assess-
ment of the access of (and barriere to) immigrants in receiving health 
care services, (2) an assessment of the health needs of such immi-
grants, and (3) specific recommendations for the development of a 
national strategy to address these needs, taking into account the fact 
that significant numbers of immigrants reside in a select number of 
specific States. 
(b) (1) Not later than June 30, 1979, the Secretary shall submit to 
Congress a special report on the primary health care needs of each of 
the specific tribes of American Indians and Alaskan Natives. Such 
report shall be developed with the consultation of the Director of the 
Indian Health Service, with leaders in the field of health care, and 
with representatives of tribes of American Indians and of Alaskan 
Natives and of national Indian organizations. Such report shall con-
tain (1) an assessment of the access of (and barriers to) American 
Indians and Alaskan Natives in receiving health care services, (2) 
an examination of the types of alternative health delivery systems 
(such as mobile health care services) existing or needing to be devel-
oped to provide appropriate access of American Indians and Alaskan 
Natives who are medical underserved populations (as defined in sec-
tion 330(b) (3) of the Public Health Service Act) to health services, 
(3) an examination of the types of alternatives to institutionalization 
existing or needing to be developed for such populations, and (4) 
specific recommendations on each such issue. 
(c) Not later than February 1, 1979, the Secretary shall submit to 
Congress a special report on the present and future direction of the 
National Health Service Corps, particularly (1) its role as a health 
manpower program and as a health services delivery program, (2) the 
use and placement of members of the Corps in different types of health 
manpower shortage areas (described in section 332 (a) (1) of the Public 
Health Service Act) in meeting urban and rural health needs, (3) the 
different types of health professionals which are needed to meet urban 
and rural health needs and which should be encouraged to participate 
in the Corps, and (4) the projected size, composition, and use of the 
manpower of the Corps through 1985. Such report shall be developed 
through consultation with the National Advisory Council on the 
National Health Service Corps (established under section 337 of the 
Public Health Service Act) and with the National Advisory Council 
on Health Professions Education (established under section 702 of the 
Public Health Service Act). 
Reports to 
Congress. 
42 USC 256 note. 
Consultation. 
lif-i< :}i' 
42 USC 254c. 
42 USC 254d 
note. 
42 USC 254e. 
Consultation. 
42 USC 254j. 
42 USC 292b. 
92 STAT. 3570 
PUBLIC LAW 95-626—NOV. 10, 1978 
Grants. 
42 use 295h-l. 
42 use 254k. 
Health Services 
Extension Act of 
1978. 
42 use 201 note. 
i <.} 
, • ,, r 
PART C—MiscEiiiANEOus PROVISIONS 
.1 
SPECIAL PROJECTS FOR GRADUATE PROGRAMS I N HEALTH 
ADMINISTRATION 
SEC. 121. Section 792 (b) is amended to read as follows: 
"(b) The Secretary may make grants to assist educational institu-
tions in meeting the costs of special projects in— 
" (1) biostatistics or epidemiology, 
"(2) health administration, health planning, or health policy 
analysis and planning, 
"(3) environmental or occupational health, or 
" (4) dietetics and nutrition.". 
INCREASE I N AUTHORIZATION FOR NATIONAL H E A L T H SERVICE CORPS 
SEC. 122. Section 338(a) is amended by striking out "$57,000,000" 
and inserting in lieu thereof "$64,000,000'\ 
TITLE II—HEALTH SERVICES EXTENSION 
SHORT TITLE 
SEC. 200. This title may be cited as the "Health Services Extension 
Act of 1978". 
HEALTH INCENTIVE GRANTS FOR COMPREHENSIVE! PUBLIC HEALTH SERVICES 
42 use 24^. 
SEC 201. (a) (1) Section 314(d) (7) (A) is amended by striking out 
"and" after "1977," and inserting before the period a comma and the 
following: "and $103,000,000 for the fiscal year ending September 30, 
1979". 
(2) Section 314(d) (7) (B) is amended by striking out "and" after 
"1977," and inserting before the period a comma and the following: 
"and $20,000,000 for the fiscal year ending September 30,1979". 
42 use 246 note. 
(b)(1) The Congress finds and declares that— 
(A) individual health status can be effectively and economically 
improved through an adequate investment in community public 
.ri 
•
' 
:: 
health programs and services; 
(B) the Federal Government and the States and their commu-
nities share in the financial responsibility for funding public 
health programs; 
I; '. • 
(C) the Federal contribution to funds for public health pro-
grams should serve as an incentive to an additional investment by 
State and local governments; 
(D) existing categorical programs of Federal financial assist-
ance to combat specific public health problems should be supple-
mented by a national program of stable generic support for such 
public health activities as the prevention and control of environ-
mental health hazards, prevention and control of diseases, preven-
tion and control of health problems of particularly vulnerable 
population groups, and development and regulation of health care 
i'-:i.4.y • .f 
facilities and health services delivery systems; and 
(E) the States and their communities, not the Federal Govern-
ment, should have primary responsibility for identifying and 
• 
measuring the impact of public health problems and the allocation 
of resources for their amelioration. 
42 use 246. 
(2) Effective October 1, 1979, section 314(d) is amended to read as 
follows: 
PUBLIC LAW 95-626~NOV. 10, 1978 
92 STAT. 3571 
; ; i;i 
i 
" C O M P R E H E N S I V E 
PUBLIC 
H E A L T H 
SERVICES 
"(d)(1) The Secretary shall make grants to State health authorities Grants, 
to assist in meeting the costs of providing comprehensive public health 
services. 
"(2) No grant may be made under paragraph (1) to the State Application, 
health authority of any State unless an application therefor has been 
submitted to and approved by the Secretary. Such an application shall 
be submitted in such form and manner and shall contain such informa-
tion as the Secretary may require, and shall contain or be supported by 
assurances satisfactory to the Secretary that— 
"(A) the comprehensive public health services which will be 
provided within the State with funds under a grant under para-
graph (1) will be provided in accordance with the State health 
plan in effect under section 1524(c); 
42 USC 300m-3. 
"(B) funds received under grants under paragraph (1) will— 
"(i) be used to supplement the level of non-Federal funds 
that would otherwise be made available for the comprehensive 
public health services for which the grant funds are provided, 
and 
"(ii) not be used to supplant such non-Federal funds, 
except that the Secretary may in exceptional circumstances waive 
] 
clause (i) or (ii) or both clauses; 
"(C) the State health authority for which the application is 
submitted will— 
"(i) provide for such fiscal control and fund accounting 
procedures as may be necessary to assure the proper disburse-
ment of and accounting for funds received under grants under 
paragraph (1); 
"(ii) from time to time, as prescribed by the Secretary, 
report to the Secretary (through a uniform national reporting 
system and by such categories as the Secretary may prescribe) 
a description of the comprehensive public health services pro-
vided in the State in the fiscal year for which the grant 
applied for is made and the amount and source of funds 
expended in that fiscal year and in the preceding fiscal year 
for the provision of each such category of services; and 
"(iii) make such other reports (in such form and con-
taining such information as the Secretary may prescribe) as 
the Secretary may reasonably require and keep such records 
and afford such access thereto as the Secretary may find neces-
sary to assure the correctness of, and to verify, such reports; 
and 
"(D) the State health authority for which the application is 
submitted will have in effect a method satisfactory to the Secretary 
which will assure equitable distribution of funds under grants 
under paragraph (1) among State and local public health entities 
within the State which have made expenditures which may be used 
under paragraph (4) to compute the amount of such grants and 
which method provides that within the limit of the amount of 
funds received by the State health authority under such grants— 
"(i) each local public health entity which makes such 
expenditures shall receive from such funds in the fiscal year 
for which grants are made an amount which is equal to the 
lesser of— 
" (I) the product of the total amount of such expendi-
tures in such fiscal year and the applicable grant 
computation percentage, or 
92 STAT. 3572 
PUBLIC LAW 95-626—NOV. 10, 1978 
"(II) the product of $1.50 and the population of the 
area served by such entity (as such population and area 
j.:-.'f 5 'i\isH'- 
• 
may be determined pui-suant to guidelines established by 
»*'' ' 
the Secretary) ; and 
"(ii) amounts which a local public health entity would 
A'i 't ,
4
K
?
<
|
A 
receive under clause (i) (I) which are in excess of the appli-
cable amount computed under clause (i) (II) shall be dis-
tributed for comprehensive public health services within 
communities which have the greatest need for such services 
v;o I
?
'
»
?
•
}
• as determined by the State health authority pursuant to 
guidelines established by the Secretary. 
"Applicable 
For purposes of subparagraph (D) (i) (I), the term 'applicable grant 
grant 
computation percentage' means the percentage applicable under para-
computation^ 
graph (4) (A) (i) (II) to the computation of the amount of a grant 
percentage. 
under paragraph (1). 
Annual review. 
"(3) (A) The Secretary shall review annually the activities under-
taken by each State health authority with an approved application 
under this subsection to determine if the authority complied with the 
assurances provided with the application. The Secretary may not 
approve an application submitted under paragraph (2) if the Secre-
tary determines— 
"(i) that the State health authority for which the application 
w^as submitted did not comply with assurances provided with a 
ar i prior application under paragraph (2), and 
"(ii) that he cannot be assured that the authority will comply 
with the assurances provided with the application under 
consideration. 
"(B) Whenever the Secretary, after reasonable notice and oppor-
tunity for a hearing to the State health authority of a State, finds that, 
with respect to funds paid to the authority under a grant under para-
graph (1), there is a failure to comply with assurances provided 
under paragraph (2) with respect to the receipt of such grant, the 
Secretary shall notify the authority that further payments will not 
be made to it under such grant (or in his discretion that further pay-
ments will not be made to it from such grant for activities in which 
there is such failure), until he is satisfied that there will no longer 
be such failure. Until he is so satisfied, the Secretary shall make no 
payment to such authority from such grant or shall limit payment 
under such grant to activities in which there is no such failure. 
"(4) (A) The total amount of grants received by a State health 
authority under paragraph (1) in any fiscal year shall be the greater 
of the amount determined under clause (i) or (ii) as follows: 
* 
"(i) The total amount of grants to a State health authority 
in a fiscal year shall be the lesser of— 
"(I) an amount determined by the Secretary which may 
not be less than the product of $1.00 and the population of 
the State served by such authority or more than the product 
of $1.50 and such population, or 
"(II) in the case of the fiscal year ending September 30, 
1980,10 percent of the amount of State and local expenditures 
for comprehensive public health services within the State in 
the State's fiscal year which ended on or before July 1, 1979, 
in the case of the fiscal year ending September 30, 1981, 15 
percent of the amount of such expenditures in the State's fis-
cal year which ended on or before July 1, 1980, and in the 
•fiu'K . case of the fiscal year ending September 30, 1982, 20 percent 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3573 
of the amount of such expenditures in the State's fiscal year 
which ended on or before July 1,1981. 
In determining the amount of a grant to a State health authority 
under subclause (I), the Secretary shall take into account the 
financial need of such State and the level of State and local 
expenditures for comprehensive public health services (as defined 
in subparagraph (C)). In determining the financial need of a 
State, the Secretary shall consider, as major factors, the propor-
tion of the State's population whose income level is below the 
poverty income level established by the Secretary and the pro-
portion of its population which is living in medical underserved 
areas. 
"(ii) The total amount of grants to a State health authority in 
a fiscal year may not be less than the greater of— 
" (I) the total amount of grants received by such authority 
under paragraph (1) for the fiscal year ending September 
30,1979, or 
"(II) the product of $1 and the population of the State 
served by such authority. 
Notwithstanding clauses (i) and (ii), if for any fiscal year the amount 
appropriated for that fiscal year under paragraph (6) is less than the 
amount needed to make grants in that fiscal year in accordance with 
such clauses to all State health authorities with approved applica-
tions, the total amount of grants in that fiscal year for a State health 
authority shall not be less than an amount which bears the same ratio 
to the amounts determined for such authority in accordance with 
the applicable clause as the amount appropriated under such para-
graph bears to the amount needed to make grants in accordance with 
such clauses in such fiscal year to all State health authorities with 
approved applications. 
"(B) The Secretary, at the request of a State health authority, 
may reduce the amount of the grants to it under paragraph (1), 
by— 
"(i) the fair market value of any supplies (including vaccines 
and other prevention agents) or equipment furnished the State 
health authority, and 
"(ii) the amount of the pay, allowances, and travel expenses of 
any officer or employee of the Government when detailed to the 
State health authority and the amount of any other costs incurred 
in connection with the detail of such officer or employee, 
when the furnishing of such supplies or equipment or the detail of 
such an officer or employee is for the convenience of the State health 
authority and for the purpose of carrying out a program with respect 
to which its grant under paragraph (1) is made. The amount by which 
any such grant is so reduced shall be available for payment by the 
Secretary of the costs incurred in furnishing the supplies or equip-
ment, or in detailing the personnel, on which the reduction of such 
grant is based, and such amount shall be deemed as part of the grant 
and shall be deemed to have been paid to the State health authority. 
"(C) For purposes of subparagraph (A) (i) (II), the term 'State 
and local expenditures for comprehensive public health services' means 
expenditures by State and local public health authorities for public 
health services designated by the Secretary, but excludes expenditures 
by such authorities— 
"(i) specifically required by Federal statutory law as a condi-
tion to the receipt of Federal financial assistance, or 
"State and local 
expenditures for 
comprehensive 
public health 
services." 
92 STAT. 3574 
PUBLIC LAW 95-626—NOV. 10, 1978 
"(ii) for operating inpatient care facilities, construction, or 
mental health programs. 
"(D) For purposes of subparagraph (A) and paragraph (2)(D), 
populations shall be determined on the basis of the latest figures avail-
able from the Department of Commerce. 
"(5) The Secretary may make payments under grants under para-
graph (1) on the basis of such estimates and in such installments as 
appropriate with adjustments for any previous overpayments or 
underpayments. 
Appropriation 
"(6) (A) For the purpose of making grants under this subsection 
authorization. 
there are authorized to be appropriated $150,000,000 for the fiscal year 
ending September 30, 1980, and $170,000,000 for the fiscal year end-
ing September 30,1981. 
"(B) Of the amount appropriated under subparagraph (A) for 
any fiscal year, the Secretary shall obligate not more than $1,000,000 
for the uniform national health program reporting system referred 
to in paragraph (2) (C) (ii). 
Regulations. 
"C^) Regulations (including substantive amendments to regula-
Consultation. 
tions) under this subsection shall be promulgated by the Secretary 
after consultation with a conference of State health authorities. The 
Secretary shall consult with such conference prior to the publication 
of proposals for such regulations or amendments.". 
PROJECT GRANTS FOR PREVENTIVE HEALTH SERVICES 
42 use 247b. 
SEC. 202. Effective October 1, 1979, section 317 is amended to read 
as follows: 
u 
PROJECT GRANTS FOR PREVENTIVE HEALTH SERVICES 
"SEC. 317. (a) The Secretary may make grants— 
"(1) to State health authorities to assist them in meeting the 
costs of establishing and maintaining preventive health service 
programs for screening for, the detection, diagnosis, prevention, 
and referral for treatment of, and follow-up on compliance with 
treatment prescribed for, hypertension; and 
"(2) to States and, in consultation with State health authori-
ties, to political subdivisions of States and to other public entities 
to assist them in meeting the costs of establishing and maintain-
ing preventive health service programs (other than programs 
described in paragraph (1)). 
Application. 
"(b) No grant may be made under section (a) unless an application 
therefor has been submitted to, and approved by, the Secretary. Such 
an application shall be in such form and be submitted in such manner 
as the Secretary shall by regulation prescribe and shall provide— 
"(1) a complete description of the type and extent of the pro-
gram for which the applicant is seeking a grant under subsection 
(a); 
"(2) with respect to each such program (A) the amount of 
Federal, State, and other funds obligated by the applicant in its 
latest annual accounting period for the provision of such program, 
(B) a description of the services provided by the applicant in 
such program in such period, (C) the amount of Federal funds 
needed by the applicant to continue providing such services in 
such program, and (D) if the applicant proposes changes in the 
provision of the services in such program, the priorities of such 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3575 
proposed changes, reasons for such changes, and the amount of 
Federal funds needed by the applicant to make such changes; 
"(3) assurances satisfactory to the Secretary that the program 
which will be provided with funds under a grant under subsection 
(a) will be provided in a manner consistent with the State health 
plan in effect under section 1524(c) and in those cases where the 42 USC 300m-3. 
applicant is a State, that such program will be provided, where 
appropriate, in a manner consistent with any plans in effect under 
an application approved under section 315; 
Post, p. 3578. 
" (4) assurances satisfactory to the Secretary that the applicant 
will provide for such fiscal control and fund accounting proce-
dures as the Secretary by regulation prescribes to assure the proper 
disbursement of and accounting for funds received under grants 
under subsection (a); 
"(5) assurances satisfactory to the Secretary that the appli- 
> ,; 
cant will provide for periodic evaluation of its program or 
programs; 
"(6) assurances satisfactory to the Secretary that the applicant 
will make such reports (in such form and containing such infor-
mation as the Secretary may by regulation prescribe) as the 
Secretary may reasonably require and keep such records and 
afford such access thereto as the Secretary may find necessary to 
assure the correctness of, and to verify, such reports; 
.. ?, 
"(7) assurances satisfactory to the Secretary that the appli-
cant will comply with any other conditions imposed by this 
section with respect to grants; and 
" (8) such other information as the Secretary may by regulation 
prescribe. 
"(c) (1) The Secretary shall not approve an application submitted 
under subsection (b) for a grant for a program for which a grant 
was previously made under subsection (a) unless the Secretary 
determines— 
"(A) the program for which the application was submitted is 
operating effectively to achieve its stated purpose, 
"(B) the applicant complied with the assurances provided the 
Secretary when applying for such previous grant, and 
"(C) the applicant will comply with the assurances provided 
with the application. 
"(2) The Secretary shall review annually the activities undertaken Annual project 
by each recipient of a grant under subsection (a) to determine if the reviews, 
program assisted by such grant is operating effectively to achieve 
its stated purposes and if the recipient is in compliance with the 
assurances provided the Secretary when applying for such grant. 
"(d) The amount of a grant under subsection (a) shall be deter-
mined by the Secretary. Payments under such grants may be made 
in advance on the basis of estimates or by the way of reimbursement, 
with necessary adjustments on account of underpayments or over-
payments, and in such installments and on such terms and conditions 
as the Secretary finds necessary to carry out the purposes of such 
grants. 
"(e) The Secretary, at the request of a recipient of a grant under 
subsection (a), may reduce the amount of such grant by— 
"(1) the fair market value of any supplies (including vaccines 
and other preventive agents) or equipment furnished the grant 
recipient, and 
92 STAT. 3576 
PUBLIC LAW 95-626—NOV. 10, 1978 
M-(^Q\} 
.p.T?.f; 
Recordkeeping. 
Audit, authority. 
42 u s e 300u-4. 
Appropriation 
authorization. 
*- * " (2) the amount of the pay, allowances, and travel expenses of 
any officer or employee of the Government when detailed to the 
grant recipient and the amount of any other costs incurred in 
connection with the detail of such officer or employee, 
when the furnishing of such supplies or equipment or the detail of 
such an officer or employee is for the convenience of and at the request 
of such grant recipient and for the purpose of carrying out a program 
with respect to which the grant under subsection (a) is made. The 
amount by which any such grant is so reduced shall be available for 
payment by the Secretary of the costs incurred in furnishing the 
supplies or equipment, or in detailing the personnel, on which the 
reduction of such grant is based, and such amount shall be deemed 
as part of the grant and shall be deemed to have been paid to the 
grant recipient. 
"(f) (1) Each recipient of a grant under subsection (a) shall keep 
such records as the Secretary shall by regulation prescribe, including 
records which fully disclose the amount and disposition by such 
recipient of the proceeds of such grant, the total cost of the under-
taking in connection with which such grant was made, and the 
amount of that portion of the cost of the undertaking supplied by 
other sources, and such other records as will facilitate an effective 
audit. 
"(2) The Secretary and the Comptroller General of the United 
States, or any of their duly authorized representatives, shall have 
access for the purpose of audit and examination to any books, docu-
ments, papers, and records of the recipient of grants under sub-
section (a) that are pertinent to such grants. 
"(g)(1) Nothing in this section shall limit or otherwise restrict 
the use of funds which are granted to a State or to an agency or a 
political subdivision of a State under provisions of Federal law 
(other than this section) and which are available for the conduct of 
preventive health service programs from being used in connection 
with programs assisted through grants under subsection (a). 
"(2) Nothing in this section shall be construed to require any State 
or any agency or political subdivision of a State to have a preventive 
health service program which would require any person, who objects 
to any treatment provided under such a program, to be treated or to 
have any child or ward treated under such program. 
"(h) The Secretary shall include, as part of the report required 
by section 1705, a report on the extent of the problems presented by 
the diseases and conditions referred to in subsection (j) ; on the amount 
of funds obligated under grants under subsection (a) in the preceding 
fiscal year for each of the programs listed in subsection (j); and on 
the effectiveness of the activities assisted under grants under sub-
section (a) in controlling such diseases and conditions. 
" (i) The Secretary may provide technical assistance to States, State 
health authorities, and other public entities in connection with the 
operation of their preventive health service programs. 
"(j) (1) (A) SuJbject to subparagraph (B), for purposes of grants 
under subsection (a) for preventive health service programs to immu-
nize children against immunizable diseases (including measles, rubella, 
poliomyelitis, diphtheria, pertussis, tetanus, and mumps) and for pur-
poses of grants under such subsection for the fiscal year ending 
September 30, 1979, for preventative health service programs to 
immunize individuals against influenza, there are authorized to be 
appropriated $51,000,000 for the fiscal year ending September 30,1979, 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3577 
Reports to 
congressional 
committees. 
1}P-J gi. 
$39,500,000 for the fiscal year ending September 30, 1980, and 
$45,000,000 for the fiscal year ending September 30,1981. 
"(B) No funds appropriated under subparagraph (A) may be obli-
gated for grants for preventive health service programs to immunize 
individuals against influenza until the Secretary submits to the Com-
mittees on Human Resources and Appropriations of the Senate and 
the Committees on Interstate and Foreign Commerce and Appropria-
tions of the House of Representatives the following: 
"(i) Not later than June 30, 1979, a complete report on the 
results of the influenza immunization activities in 1978 and 1979 
under funds appropriated under Public Law 95-355, which ^"^«' P- 523. 
report shall include information with respect to adverse effects 
associated with influenza immunization, any known liability 
arising out of such immunization, any report received by the 
Secretary on the safety and effectiveness of the vaccine used to 
provide such immunization, the number of persons immunized, 
and other experiences with such activities. 
"(ii) A report on the current status of the immunization pro-
gram conducted under the amendment made to this Act by the 
National Swine Flu Immunization Program of 1976 (Public 
Law 94-380), including the status of any claims still pending 42 USC 201 note, 
under the program and the Secretary's plans for dealing with 
such claims. 
"(iii) As they become available, all reports and information 
from studies conducted by or under contract with the Secretary 
with respect to liability arising out of personal injuries or 
deaths in connection with immunization programs, protection 
against such liability, and methods of compensation for such 
, , „>.?. ^ 
injuries and any other reports and information respecting such 
matters which are available to the Secretary. 
"(iv) Specific interim recommendations of the Secretary with 
respect to the matters referred to in clause (iii). 
"(v) A copy of the information which will be distributed to 
individuals before they receive any influenza immunization under 
a preventive health service program for which a grant is made 
under subsection (a). 
"(2) For the purpose of grants iinder subsection (a) for preventive 
health service programs for the control of rodents there are authorized 
to be appropriated $14,500,000 for the fiscal year ending Septem-
ber 30,1979, $15,500,000 for the fiscal year ending September 30, 1980, 
and $17,000,000 for the fiscal year ending September 30, 1981. Funds 
appropriated under this paragraph may be used to make grants to 
nonprofit private entities for any program or project for rodent con-
trol for which a grant was made under section 314(e) for the fiscal 42 USC 246. 
year ending June 30, 1975. A grant to such an entity shall be made 
in the same manner as a grant under subsection (a). 
"(3) For the purpose of grants under subsection (a) for programs 
for hypertension there are authorized to be appropriated $24,500,000 
for the fiscal year ending September 30, 1980, $29,000,000 for the 
fiscal year ending September 30,1981. 
"(4) For the purpose of grants under subsection (a) for preven-
tive health service programs for which appropriations are not author-
ized by paragraph (1), (2), or (3) there are authorized to be 
appropriated $1,000,000 for the fiscal year ending September 30, 1979, 
$1,000,000 for the fiscal year ending September 30,1980, and $1,000,000 
Appropriation 
authorizations. 
:i!l-I!M O—HO—pt. ,t 
(iO : QL;j 
92 STAT. 3578 
PUBLIC LAW 95-626—NOV. 10, 1978 
for the fiscal year ending September 30, 1981. No funds appropriated 
under this paragraph may be used for grants for immunization against 
influenza.". 
FORMULA GRANTS TO STATES FOR PREVENTIVE HEALTH 
SERVICE PROGRAMS 
SEC. 203. Title III of the Public Health Service Act is amended 
by adding after section 314 the follovring new section: 
" F O R M U L A GRANTS TO STATES FOR PREVENTIVE HEALTH 
SERVICE PROGRAMS 
42 use 247. 
"SEC 315. (a) The Secretary shall make grants to States to assist 
them in planning for and developing, and in providing (directly 
and through grants or contracts, or both, the public health authorities 
of political subdivisions of the States, other public entities, and pri-
vate entities) preventive health service programs— 
"(1) which shall be designed to reduce, through primary or 
secondary prevention of risk factors and causative conditions, the 
mortality rate for one or more of the five leading causes of death 
•5*;"' 
' ' -' 
in a State, and 
"(2) which the State receiving a grant under this subsection 
may design to also reduce, through primary or secondary pre-
vention of risk factors and causative conditions, the burden of 
illness associated with one or more of the five leading causes of 
morbidity in the State. 
Grant 
"(b) No grant may be made under subsection (a) for a preventive 
applications. 
health service program unless an application therefor has been sub-
mitted to, and approved by, the Secretary. Such an application shall be 
in such form and be submitted in such manner as the Secretary shall 
by regulation prescribe and shall provide (other than in an applica-
tion for a planning and developing grant) — 
"(1) a detailed plan of the program for which the applicant is 
seeking a grant under subsection (a), which plan— 
"(A) shall require the use, to the extent practicable, of all 
relevant professional disciplines; 
"(B) may, at the option of the State, describe a program 
or programs that are targeted toward a particular age group; 
"(C) shall set forth quantitatively the current relevant rates 
of mortality or of morbidity, as the case may be, in the State 
measured and reported in accordance with regulations of the 
Secretary; 
"(D) shall set forth the quantitative goals for reduction in 
*" )^ li 5
v
|
^ 
^}^g relevant rates of mortality and reduction in the risk fac-
tors or causative conditions associated with one or more of the 
five leading causes of death in the State; 
"(E) shall, if the applicant's program also concerns mor-
bidity, set forth the quantitative goals for reduction in the 
relevant rates of morbidity and reduction in the risk factors 
or causative conditions associated with one or more of the five 
f " ' > 
leading causes of morbidity in the State; 
"(F) shall require a separate health communications com-
ponent in the program or programs which shall include a 
description of how the communications media, including the 
electronic media, will be used to effectuate the purposes of the 
programs; 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3579 
"(G) shall identify a specific institutional entity in the 
State that will be responsible for accomplishing through con-
tracts with private entities and through other means the 
requirements of subparagraph (F); and 
"(H) shall contain such other information as the Secretary 
may by regulation prescribe; 
"(2) with respect to each of the major causes of mortality arid 
morbidity included in the program (A) the amount of Federal, 
State, and other funds obligated by the applicant in its latest 
annual accounting period with respect to such cause, (B) a descrip- 
. ; ' i*..-'' 
tion of the services provided by the applicant in such program in 
-•'• '• >'-'s;''-
such period with respect to such cause, (C) the amount of Fed-
eral funds needed by the applicant to continue providing such serv-
ices in such program, and (D) if the applicant proposes changes 
in the provision of the services in such program, the priorities of 
such proposed changes, reasons for such changes, and the amount 
of Federal funds needed by the applicant to make such changes; 
"(3) for assurances satisfactory to the Secretary that the pro-
gram which will be provided with funds under a grant under 
subsection (a) will be provided in a manner consistent with the 
State health plan in effect under section 1524 (c); 
42 USC 300m-3. 
" (4) for assurances satisfactory to the Secretary that the appli-
cant will provide for such fiscal control and fund accounting 
procedures as the Secretary by regulation prescribes to assure 
the proper disbursement of and accounting for funds received 
under grants under subsection (a); 
"(5) assurances satisfactory to the Secretary that the applicant 
will provide for periodic evaluation of its program or programs ; 
"(6) assurances satisfactory to the Secretary that the applicant 
will make such reports (in such form and containing such infor-
mation as the Secretary may by regulation prescribe) as the 
Secretary may reasonably require and keep such records and 
afford such access thereto as the Secretary may find necessary 
to assure the correctness of, and to verify, such reports; 
"(7) assurances satisfactory to the Secretary that the applicant 
will comply with any other conditions imposed by this section 
with respect to grants; and 
" (8) such other information as the Secretary may by regulation 
prescribe. 
"(c) (1) The Secretary shall not approve an application submitted Application 
under subsection (b) for a grant for a program for which a grant approval, 
was previously made under subsection (a) unless the Secretary 
determines— 
"(A) the program for which the application was submitted is 
operating effectively to achieve its stated purpose, 
"(B) the applicant complied with the assurances provided the 
Secretary when applying for such previous grant, and 
"(C) the applicant will comply with the assurances provided 
with the application. 
"(2) The Secretary shall review annually the activities undertaken Annual review, 
by each recipient of a grant under subsection (a) to determine if the 
program assisted by such grant is operating effectively to achieve its 
stated purposes and if the recipient is in compliance with the assur-
ances provided the Secretary when applying for such grant. 
"(3) Whenever the Secretary finds with respect to funds paid to it 
under a grant under subsection (a) for a program, that the program 
92 STAT. 3580 
PUBLIC LAW 95-626—NOV. 10, 1978 
is not operating effectively to achieve its stated purposes or that there 
is a failure to comply substantially with assurances provided with 
respect to the receipt of such grant, the Secretary shall notify the State 
that further payments will not be made to it under such grant (or in 
his discretion that further payments will be reduced), until he is satis-
fied that the program will operate effectively or there will no longer 
be such a failure. Until he is so satisfied, the Secretary shall make no 
payment or, in his discretion, reduce payments to the State from such 
grant. 
Grant funding 
"(d) (1) The total amount of grants made under subsection (a) in 
requirements. 
the fiscal year ending September 30,1980, to any State under subsection 
(a) to assist it in planning and developing a program described in such 
subsection shall be determined by the Secretary, except that it may not 
be less than the product of $0.10 and population of the State. Notwith-
standing the preceding sentence, if for any fiscal year the amount 
appropriated for the fiscal year ending September 30,1980, under sub-
section (1) is less than the amount needed to make grants for that fiscal 
year in accordance with such sentences to all States with approved 
applications, the total amount of grants for that fiscal year for a State 
shall not be less than an amount which bears the same ratio to the 
,£.{««;{?:, '•-•' 
amounts determined for such State in accordance with the preceding 
sentence as the amount appropriated under subsection (1) bears to 
the amount needed to make grants in accordance with such sentence for 
such fiscal year to all States with approved applications. 
" (2) The total amount of grants made to any State under subsection 
(a) for any fiscal year to assist it in providing a program described 
in such subsection shall be determined by the Secretary, except that 
it— 
"(i) may not exceed the lesser of— 
"(I) the product of $0.50 and the population of the State, 
or 
"(II) in the case of the fiscal year ending September 30, 
1982, 5 per centum of the amount of State and local expendi-
tures for preventive health services within the State in the 
State's fiscal year which ended on or before July 1, 1981; in 
the case of the fiscal year ending September 30, 1983, 7^/2 per 
centum of the amount of such expenditures in the State's 
no; f fiscal year which ended on or before July 1, 1982; and, in the 
case of the fiscal year ending September 30, 1984, 10 per cen-
ni»iJB',HifqA *
• *'' 
tum of the amount of such expenditures in the State's fiscal 
,'»vi,.^(|fl 
year which ended on or before July 1,1983; and 
"(ii) may not be less than the product of $0.25 and the popu-
lation of the State, except as provided in subsection (c) (3). 
Notwithstanding the preceding sentence, if for any fiscal year the 
amount appropriated for that fiscal year under subsection (1) is less 
than the amount needed to make grants for that fiscal year in accord-
ance with such sentence to all States with approved application the 
total amount of grants for that fiscal year for a State shall not be 
less than an amount which bears the same ratio to the amounts deter-
mined for such State in accordance with such sentence as the amount 
appropriated under subsection (1) bears to the amount needed to make 
grants in accordance with this section for such fiscal year to all States 
with approved application. 
"(e) Payments under grants under subsection (a) may be made in 
advance on the basis of estimates or by the way of reimbursement, 
with necessary adjustments on account of underpayments or over-
f'%iifH 
l&UP 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3581 
payments, and in such installments and on such terms and conditions 
as the Secretary finds necessary to carry out the purposes of such 
grants. 
"(f) The Secretary, at the request of a State which is a recipient 
of a grant under subsection (a), may reduce the amount of such grant 
by— 
"(1) the fair market value of any supplies or equipment fur-
nished the State, and 
"(2) the amount of the pay, allowances, and travel expenses 
of any officer or employee of the Government when detailed to 
the State and the amount of any other costs incurred in connection 
with the detail of such officer or employee, 
when the furnishing of such supplies or equipment or the detail of such 
an officer or employee is for the convenience of and at the request of such 
^
^ 
State and for the purpose of planning or carrying out a program with 
respect to which a grant under subsection (a) is made. The amount by 
which any such grant is so reduced shall be available for payment 
by the Secretary of the costs incurred in furnishing the supplies or 
equipment, or in detailing the personnel, on which the reduction of 
such grant is based, and such amount shall be deemed as part of the 
grant and shall be deemed to have been paid to the State. 
" (g) (1) Each State which is a recipient of a grant under subsection Recordkeeping, 
(a) shall keep such records as the Secretary shall by regulation pre-
scribe, including records which fully disclose the amount and disposi-
tion by such State of the proceeds of such grant, the total cost of the 
undertaking in connection with which such grant was made, and the 
amount of that portion of the cost of the undertaking supplied by 
other sources, and such other records as will facilitate an effective audit. 
"(2) The Secretary and the Comptroller General of the United Audit, authority. 
States, or any of their duly authorized representatives, shall have 
access for the purpose of audit and examination to any books, docu-
ments, papers, and records bf each State which is a recipient of a, 
grant under subsection (a) that are pertinent to such grant. 
"(h) (1) Nothing in this section shall limit or otherwise restrict the 
' 
use of funds which are granted to a State or to an agency or a polit- 
j^is :)g!i £i 
ical subdivision of a State under provisions of Federal law (other 
jtoii 
than this section) and which are available for the conduct of preven-
tive health service programs from being used in connection with 
programs assisted through grants under subsection (a). 
"(2) Nothing in this subsection shall be construed to require any 
State or any agency or political subdivision of a State to have a 
preventive health service program which would require any person, 
who objects to any treatment provided under such a program, to be 
treated or to have any child or ward treated under such program. 
"(i) The Secretary shall include, as part of the report required 
by section 1705, a report on the extent of the problems presented by 42 USC 300u-4. 
the causes of mortality and morbidity referred to in subsection (a); 
on the amount of funds obligated under grants under such subsection 
in the preceding fiscal year to assist the States in operating programs 
described in such subsection; and on the effectiveness of the programs 
assisted under grants under such subsection. 
"(j) (1) For purposes of subsection (a), the term 'primary preven- Definitions, 
tion of causative conditions' means the prevention of the development 
of causative conditions in healthy individuals. 
" (2) For purposes of subsection (a), the term 'secondary prevention 
of causative conditions' means the early detection, referral for diag-
92 STAT. 3582 
PUBLIC LAW 95-626—NOV. 10, 1978 
nosis and treatment, or follow-up for compliance with treatment of 
causative conditions in asymptomatic individuals. 
"(3) For purposes of subsection (d) (2), the term 'State and local 
expenditures for preventive health services' means expenditures by 
State and local public health authorities for preventive health serv-
ices but excludes expenditures by such authorities— 
"(A) specifically required by Federal statutory law as a con-
dition to the receipt of Federal financial assistance, or 
"(B) for operating inpatient care facilities or construction. 
"(4) For purposes of subsection (d), populations shall be deter-
mined on the basis of the latest figures available from the Department 
of Commerce. 
Appropriation 
"(k) (1) For the purpose of making payments under grants under 
authorization. 
subsection (a) to assist States in meeting the costs of planning and 
developing programs described in such subsection, there are author-
ized to be appropriated $20,000,000 for the fiscal year ending Sep-
tember 30,1980. 
"(2) For the purpose of making payments under grants under sub-
section (a) to assist States in meeting the costs of providing the 
programs described in such subsection, there are authorized to be 
appropriated $60,000,000 for the fiscal year ending September 30, 
•B«''r- 
1981, and $75,000,000 for the fiscal year ending September 30, 1982. 
"(3) Not less than 20 per centum of the total amount of grants 
received by a State under subsection (a) for providing a program 
described in such subsection shall be obligated by the State for 
operating the health communications component of such program. 
No funds appropriated under this paragraph shall be used (A) to 
assist States in meeting the costs of traditional law enforcement 
*^" ' 
activities (including the prevention of homicide) as defined in regu-
lations of the Secretary, or (B) for construction.". 
PROJECTS AND PROGRAMS FOR THE PREVENTION AND CONTROL OF VENEREAL 
DISEASE 
42 use 247c 
SEC. 204. (a) The Congress finds and declares that— 
* 
note. 
(1) the number of reported cases of venereal disease persists in 
epidemic proportions in the United States; 
; 
(2) the number of persons affected by venereal disease and 
reported to public health authorities is only a fraction of those 
actually affected; 
(3) the incidence of venereal disease continues to be particu-
larly high among American youth, ages fifteen to twenty-nine, 
and among populations in metropolitan areas; 
(4) venereal disease accounts for severe permanent disabilities 
and sometimes death in newborns and causes reproductive dys-
i 1 
function in women of childbearing age; 
(5) it is conservatively estimated that the public cost of health 
care for persons suffering from complications of venereal disease 
exceeds one-half billion dollars annually; 
(6) the number of trained Federal venereal disease prevention 
and control personnel has fallen to a dangerously inadequate level; 
t;;!(!.- 
' 
(7) no vaccine for syphilis, gonorrhea, or any other venereal 
disease has yet been developed, nor does a blood test for the detec-
tion of asymptomatic gonorrhea in women exist, nor are safe and 
effective therapeutic agents available for some other venereal 
diseases; 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3583 
^ 
(8) school health education programs, public information and 
awareness campaigns, mass diagnostic screening and case followup 
have all been found to be effective venereal disease prevention and 
control methodologies; 
(9) skilled and knowledgeable health care providers, informed 
and concerned individuals and active, well-coordinated voluntary 
groups are fundamental to venereal disease prevention and 
control; 
(10) biomedical research toward improved diagnostic and ther-
apeutic tools is of singular importance to the elimination of 
venereal disease; and 
(11) an increasing number of sexually transmissible diseases 
besides syphilis and gonorrhea have become a public health hazard. 
(b) (1) Subsection (f) of section 318 is repealed and subsections (g) 
Repeal, 
and (h) of such section are redesignated as subsections (f) and (g), 42 USC 247c. 
respectively. 
(2) Subsection (g) (2) of section 317 is amended by striking out 42 USC 247b. 
"Except as provided in section 318, no funds'' and inserting in lieu 
thereof "No funds". 
(c)(1) Subsection (d)(1) of section 318 is amended by inserting Appropriation 
after " (1)" the following: "For the purpose of making grants under authorization, 
subsections (b) and (c) there are authorized to be appropriated 
$45,000,000 for the fiscal year ending September 30, 1979, $51,500,000 
for the fiscal year ending September 30, 1980, and $59,000,000 for the 
fiscal year ending September 30, 1981. For grants under subsection 
(b) in any fiscal year, the Secretary shall obligate not less than 5 
per centum of the amount appropriated for such fiscal year under 
the preceding sentence." 
(2) Subsection (b) of such section is amended (A) by striking out 42 USC 247c. 
"(1)" and paragraph (2), (B) by inserting "and public information 
and" after "demonstration," and (C) by striking out "and training". 
(d) (1) Section 318(c) is amended— 
(A) by inserting "also" after "The Secretary is" in paragraph 
( • ' • / ? 
(B) by striking out "and public" in clause (D) of paragraph 
(1) and inserting in lieu thereof "(including appropriate allied 
health personnel)", and 
(C) by inserting ", training and clinical skills improvement" 
before "activities" in clause (D) of paragraph (1). 
(2) Section 318(c) is further amended (A) by striking out para-
graph (2), (B) by striking out "(1)", and (C) by redesignating 
subparagraphs (A), (B), (C), (D), and (E) of paragraph (1) as 
paragraphs (1), (2), (3), (4),and (5),respectively. 
GENETIC DISEASES 
SEC. 205. (a) Section 402 of the National Sickle Cell Anemia, 
Cooley's Anemia, Tay-Sachs, and Genetic Diseases Act is amended 42 USC 300b 
by striking out all following "diseases," and substituting "and genetic note, 
conditions, such as Sickle Cell anemia, Cooley's Anemia, Tay-Sachs 
disease, cystic fibrosis, dysautonomia, hemophilia, retinitis pigmen-
tosa, Huntington's chorea, muscular dystrophy, and genetic condi-
tions leading to mental retardation or genetically caused mental 
disorders.". 
(b) Section 1101 (a) is amended by inserting "plan," after "projects 42 USC 300b. 
to" in paragraph (1). 
92 STAT. 3584 
PUBLIC LAW 95-626—NOV. 10, 1978 
42USC300b-3. 
(c)(1) Section 1104(a) is amended by inserting the following 
before the period at the end of the first sentence: ", including assur-
ances for an evaluation whether performed by the applicant or by 
the Secretary. Such grant or contract may be made available on 
less than a statewide or regional basis". 
(2) Section 1104 is amended by adding at the end thereof the follow-
ing new subsection: 
"(d) In making any grant or entering into any contract under 
42 use 300b. 
section 1101 the Secretary shall have developed a procedure under 
which persons from among members of the general public and from 
among leading medical or scientific authorities (acting as an advisory 
group, task force, or other entities appointed by the Secretary) knowl-
edgeable about genetic diseases or conditions will have the opportunity 
.i. > f j.-^ 
on a regular basis to make recommendations to the Secretary.". 
'T^i: 'jy:j ki' 
(d) (1) Part A of title XI is amended by adding after section 1106 
the following new section: 
.tr-^!^ li^l 
£!• 
'APPLIED TECHNOLOGY 
42 use 300b-6. 
"SEC. 1107. The Secretary, acting through an identifiable adminis-
.s,mm^u.ymm trati 
ve unit, shall— 
"(1) conduct epidemiological assessments and surveillance of 
genetic diseases to define the scope and extent of such diseases 
and the need for programs for the diagnosis, treatment, and 
control of such diseases, screening for such diseases, and the coun-
seling of persons with such diseases; 
"(2) on the basis of the assessments and surveillance described 
in paragraph (1), develop for use by the States programs which 
„, . ,^, ^ ^ 
combine in an effective manner diagnosis, treatment, and control 
"•^ 
' ' ' ''' 
' of such diseases, screening for such diseases, and counseling of 
persons with such diseases; and 
"(3) on the basis of the assessments and surveillance described 
,., 
in paragraph (1), provide technical assistance to States to imple-
ment the programs developed under paragraph (2) and train 
appropriate personnel for such programs. 
Grants or 
In carrying out this section, the Secretary may, from funds appro-
contracts, 
priated under section 1101 (b), make grants to or contracts with public 
or nonprofit private entities (including grants and contracts for 
demonstration projects).". 
(2) Section 1101(b) is amended by inserting "and section 1107" 
after "this section". 
(e)(1) Section 1101(b) is amended (A) by striking out "and" 
after "1977,", and (B) by inserting before the period a comma and 
the following: "$17,500,000 for the fiscal year ending September 30, 
1979, $21,500,000 for the fiscal year ending September 30, 1980, and 
$26,000,000 for the fiscal year ending September 30,1981". 
, ; M , 
, • ^ .. 
H E M O P H I L I A 
'•.•;• t r 
, ; • ; ; : ! • • • ; . -
42USC300C-21. 
SEC. 206. (a) Section 1131(f) is amended (1) by striking out "and" 
after "1977,", and (2) by inserting before the period a comma and 
the following: "$4,000,000 for the fiscal year ending September 30, 
1979, $5,000,000 for the fiscal year ending September 30, 1980, and 
$6,000,000 for the fiscal year ending September 30,1981". 
42 use 3000-22. 
(b) Section 1132(e) is amended (1) by striking out "and" after 
"1977,", and (2) by inserting before the period a comma and the 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3585 
following: "$2,500,000 for the fiscal year ending September 30, 1979, 
$3,000,000 for the fiscal year ending September 30,1980, and $3,500,000 
for the fiscal year ending September 30,1981". 
HOME HEALTH SERVICES 
SEC. 207. (a) Part D of title III (as amended by section 113(a) of Grants, 
this Act) is amended by inserting after subpart II the following: 
Ante, p. 3562. 
. ; ; ; , , 
: "Subpart III—Home Health Services 
"HOME HEALTH SERVICES 
"SEC. 339. (a) (1) For the purpose of demonstrating the establish- 42 USC 255. 
ment and initial operation of home health agencies (as defined in sec-
tion 1861 (o) of the Social Security Act) which will provide home 42 USC 1395x. 
health services (as defined in section 1861 (m) of the Social Security 
Act) in areas in which such services are not otherwise available, the 
Secretary may, in accordance with the provisions of this section, 
make grants to public and nonprofit private entities to meet the initial 
• • -
costs of establishing and operating such agencies and expanding the 
''''" '" -
^ 
services available through existing Oigencies, and to meet the costs of 
compensating professional and paraprofessional personnel during the 
initial operation of such agencies or the expansion of services of exist-
ing agencies. Demonstration projects and programs are to be con-
ducted, to the extent practicable, in rural and urban areas, in sparsely 
and densely populated areas, and in areas with inadequate means of 
transportation. 
"(2) In making grants under this subsection, the Secretary shall 
consider the relative needs of the several States for home health 
services and preference shall be given to areas within a State in which 
a high percentage of the population proposed to be served is composed 
of individuals who are elderly, medically indigent, or both. 
"(3) Applications for grants under this subsection shall be in such Applications, 
form and contain such information as the Secretary shall by regulation 
prescribe. 
"(4) Payments under grants under this subsection may be made in 
.^n. ;.f ' 
advance on the basis of estimates or by the way of reimbursement, 
with necessary adjustments on account of underpayments or over-
payments, and in such installments and on such terms and conditions 
as the Secretary finds necessary to carry out the purposes of such 
grants. 
"(5) There are authorized to be appropriated for grants under this 
subsection $14,000,000 for the fiscal year ending September 30, 1979, 
$16,100,000 for the fiscal year ending September 30, 1980, and 
$18,500,000 for the fiscal year ending September 30,1981. 
"(b) (1) The Secretan?^ may make grants to and enter into contracts 
with public and nonprofit private entities to assist them in demonstrat-
ing the training of professional and paraprofessional personnel to pro-
vide home health services (as defined in section 1861 (m) of the Social 
Security Act). 
"(2) Applications for grants under this subsection shall be in such Applications, 
form and contain such information as the Secretary shall by regulation 
prescribe. 
"(3) Payments under grants under this subsection may be made in 
advance on the basis of estimates or by the way of reimbursement, with 
necessary adjustments on account of underpayments or overpayments. 
• i l l 
Appropriation 
authorization. 
Grants and 
contracts. 
92 STAT. 3586 
PUBLIC LAW 95-626—NOV. 10, 1978 
Appropriation 
authorization. 
Repeal. 
42 u s e 1395x 
note. 
Ante, p. 3578. 
Grants. 
42 u s e 247a. 
Definitions. 
and in such installments and on such terms and conditions as the Sec-
retary finds necessary to carry out the purposes of such grants. The 
authority of the Secretary to enter into contracts under this subsection 
shall be effective for any fiscal year only to such extent or in such 
amounts as are provided in advance by appropriation Acts. 
"(4) There are authorized to be appropriated for grants under this 
subsection $1,500,000 for the fiscal year ending September 30, 1979, 
$2,000,000 for the fiscal year ending September 30,1980, and $2,500,000 
for the fiscal year ending September 30,1981.". 
(b) Effective October 1, 1978, section 602 of Public Law 94-63 is 
repealed. 
LEAD-BASED PAINT POISONING PREVENTION PROGRAMS 
SEC. 208. (a) Part A of title III is amended by adding after section 
315 (added by section 203 of this Act) the following new section: 
li-LEAD-BASED PAINT POISONING PREVENTION PROGRAMS 
"SEC. 316. (a) (1) (A) The Secretary may make grants to agencies 
of units of general local governments and to private nonprofit entities 
to assist them in meeting the costs of providing lead-based paint 
poisoning prevention programs. The Secretary may also make 
such grants to an agenc^y^ of State government in any case where 
State government provides direct services to citizens in local 
communities or where units of general local government within 
the State are prevented by State law from implementing or 
receiving such grants or from expending such grants in accordance 
with their intended purpose. 
"(B) Each program for which a grant is made under this subsection 
shall afford, to the maximum extent feasible, opportunities for employ-
ing the residents of communities or neighborhoods affected by lead-
based paint poisoning, and for providing appropriate training, 
education, and any information which may be necessary to inform 
such residents of opportunities for employment in lead-based paint 
elimination programs. 
"(2) For purposes of this section— 
. •. .. - * 
" (A) the term 'lead-based paint poisoning prevention program' 
means any program which provides for— 
"(i) educational programs intended to communicate to 
parents, educators, and local health officials the health danger 
and prevalence of lead-based paint poisoning among children; 
"(ii) the development and carrying out of intensive com-
munity testing programs designed to detect incidents of lead-
based paint poisoning among community residents and to 
insure 
prompt 
medical 
treatment 
for 
such 
afflicted 
individuals; 
"(iii) the development and carrying out of intensive fol-
lowup programs to insure that identified cases of lead-based 
paint poisoning are protected against further exposure to 
lead-based paints in their living environment; 
"(iv) the establishment of centralized laboratory facilities 
for analyzing biological and environmental lead specimens; 
and 
"(v) any other actions which will reduce or eliminate 
lead-based paint poisoning; and 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3587 
"(B) the term 'units of general local government' means (i) 
any city, county, township, town, borough, parish, village, or 
other general purpose political subdivisions of a State, (ii) any 
combination of units of general local government in one or more 
States, (iii) an Indian tribe, and (iv) with respect to lead-based 
paint poisoning elimination activities, in their urban areas, the 
territories and possessions of the United States, 
FoUowup programs described in subparagraph (A) (iii) shall include 
programs to eliminate lead-based paint hazards from surfaces in 
and around residential dwelling units or houses, including programs 
to provide for such purpose financial assistance to the owners of 
such units or houses who are financially unable to eliminate such 
hazards from their units or houses. In administering programs for the 
elimination of such hazards, priority shall be given to the elimination 
of such hazards in residential dwelling units or houses in which 
reside childiren with diagnosed lead-based paint poisoning. 
"(b) No grant may be made under subsection (a) unless an appli-
cation therefor has been submitted to, and approved by, the Secretary. 
Such an application shall be in such form and be submitted in such 
manner as the Secretary shall by regulation prescribe and shall 
provide— 
"(1) a complete description of the type and extent of the lead-
based paint poisoning prevention program which is to be provided 
by or through the applicant with a grant under subsection (a); 
"(2) assurances satisfactory to the Secretary that the program 
to be provided under the grant applied for will be provided in 
accordance with the State health plan in eflfect under section 
1524(c); 
"(3) assurances satisfactory to the Secretary that the appli-
cant will make such reports respecting the program as the Secre-
tary may require; and 
" (4) such other information as the Secretary may by regulation 
prescribe. 
No grant may be made under subsection (a) unless the Secretary 
determines that there is satisfactory assurance that Federal funds 
made available under such a grant for any period will be so used as 
to supplement and, to the extent practical, increase the level of State, 
local, and other non-Federal funds that would, in the absence of 
such Federal funds, be made available for the program for which 
the grant is to be made and will in no event supplant such State, local, 
and other non-Federal funds. 
"(c) The Secretary shall determine the amount of a grant made 
under subsection (a). Payments under such grants may be made in 
advance on the basis of estimates or by the way of reimbursement, 
with necessary adjustments on account of underpayments or over-
payments, and in such installments and on such terms and conditions 
as the Secretary finds necessary to carry out the purposes of such 
grants. 
"(d) (1) Each recipient of a grant under subsection (a) shall keep 
such records as the Secretary shall prescribe, including records which 
fully disclose the amount and disposition by such recipient of the 
proceeds of such grant, the total cost of the undertaking in connec-
tion with which such grant was made, and the amount of that portion 
of the cost of the undertaking supplied by other sources, and such 
other records as will facilitate an effective audit. 
"Units of general 
local 
government." 
Grant 
applications. 
42 u s e 300m-3. 
Recordkeeping. 
92 STAT. 3588 
PUBLIC LAW 95-626—NOV. 10, 1978 
Audit, authority. 
Report to 
Congress. 
Appropriation 
authorization. 
Repeals. 
42 use 4801, 
4811, 4844, 
4845. 
42 use 4846. 
Study. 
42 use 247a 
note. 
Report to 
Congress. 
"(2) The Secretary and the Comptroller General of the United 
States, or any of their duly authorized representatives, shall have 
access for the purpose of audit and examination to any books, docu-
ments, papers, and records of the recipient of grants under subsection 
(a) that are pertinent to such grants. 
"(e) The Secretary may provide technical assistance to recipients 
of grants under subsection (a) in connection with the operation of 
their lead-based paint poisoning prevention programs. 
"(f) The Secretary shall submit annually to the Congress a report 
(1) on the extent of the problems presented by lead-based paint, and 
(2) on the effectiveness of the programs assisted under grants under 
subsection (a). 
"(g) There are authorized to be appropriated for grants under 
subsection (a) $14,000,000 for the fiscal year ending September 30, 
1979, $14,000,000 for the fiscal year ending September 30, 1980, and 
$15,000,000 for the fiscal year ending September 30,1981.". 
(b) Effective October 1, 1979, titles I and II and sections 504 and 
505 of the Lead-Based Paint Poisoning Prevention Act are repealed, 
and section 506 of such Act is redesignated as section 504. 
EFFECT OF LEAD ON CHILD DEVELOPMENT 
SEC. 209. The Secretary of Health, Education, and Welfare shall 
conduct a study to determine the long-term effect on child develop-
ment of various levels of lead in blood. The Secretary shall report the 
results of such study to the Congress together with recommendations 
for such legislation as the Secretary determines is appropriate. 
42 use 300d-2. 
42 use 300d-3. 
42 use 300d-5. 
42 use 300d-l, 
300d-4. 
42 use 300d-6. 
Establishment. 
42 use 289d 
note. 
EMERGENCY MEDICAL SERVICES SYSTEMS 
« "' > 
SEC. 210. (a) Section 1203(c) is amended (1) effective June 30, 
1975, by striking out the first sentence of paragraph (2), (2) by 
striking out paragraph (3), and (3) by redesignating paragraphs (4) 
and (5) as paragraphs (3) and (4),respectively. 
(b) Effective June 30,1975, the first sentence of section 1204(b) (1) 
is repealed. 
(c) Subparagraph (B) of section 1206(b) (1) is amended to read 
as follows: 
"(B) No applicant may receive more than a total of five grants, 
contracts, or grants and contracts under this part, except that in 
determining the number of grants and contracts which an applicant 
received under this part, the Secretary shall not include any grant or 
contract received under section 1202(b) (1) or 1205.", 
(d)(1) Section 1207(a)(1) is amended by striking out "sections 
1203 and 1204" and inserting in lieu thereof "sections 1202, 1203, and 
1204". 
(2) Section 1207(a) (5) is amended by striking out "for the succeed-
ing fiscal year" and inserting in lieu thereof "for each of the two 
succeeding fiscal years". 
S E L E C T P A N E L F O R T H E 
P R O M O T I O N 
O F CHILD HEALTH 
SEC. 211. (a) The Secretary of Health, Education, and Welfare 
(hereinafter in this section referred to as the "Secretary") shall estab-
lish within the Office of the Secretary a Select Panel for the Promotion 
of Child Health (hereinafter in this section referred to as the "panel"). 
(b) (1) The panel, after reviewing all the significant medical, scien-
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3589 
> ari'jf 
.s.oitssfi'^q'ato..,; 
Report to 
Secretary and 
congressional 
committees. 
tific, behavioral, and epidemiological studies concerning the promotion 
of child health and the prevention of childhood diseases and concern-
ing the efficacy and efficiency of child health programs, shall— 
(A) formulate specific goals with respect to the promotion of 
the health status of children and expectant mothers in the United 
States; 
(B) develop a comprehensive national plan for achieving 
these goals and otherwise promoting the health of children in 
the United States; and 
(C) transmit to the Secretary, to the Committee on Interstate 
and Foreign Commerce of the House of Representatives, and to 
the Committee on Human Resources of the Senate, not later than 
eighteen months after the date of the enactment of this Act, a 
report detailing the comprehensive national plan it has developed 
and recommendations for such adminsitrative, legislative, and 
other actions as it deems appropriate to implement this plan and 
to otherwise promote the health of children in the United States. 
(2) The panel shall include in its comprehensive national plan National plan 
(developed under paragraph (1) (B)) recommendations with respect 
to— 
(A) the appropriate type and quantity of preventive health 
care and other health services needed by children in general and 
by particular types of children at risk; 
(B) the appropriate methods (and providers) for delivering 
and financing the delivery of such services; 
(C) the appropriate methods for coordinating and consolidat-
ing, within an agency and between agencies, the administration 
of child health promotion programs; 
(D) the need for research into the delivery of such services 
and the promotion of child health; 
(E) the appropriate methods for instructing children and 
parents in methods of maintaining their health; 
(F) the encouragement of innovative programs to promote 
child health; 
(G) the appropriate methods (including demonstration pro- 
.<-." '"!•• 
grams) for applying research findings to delivery of health 
" 
' 
services to children and otherwise to promoting the health of 
children; 
(H) the appropriate relationship between child health pro-
motion programs and health planning organizations ; 
(I) the appropriate support of training of health personnel 
for child health promotion programs; and 
(J) the appropriate technical assistance to States to imple-
ment child health promotion programs. 
(c)(1) The panel shall be composed of the Assistant Secretary Membership, 
for Health and the Assistant Secretary for Planning and Evaluation, 
who shall serve as ex officio members, and of fifteen other members 
who shall be appointed by the Secretary not later than sixty days 
after the date of the enactment of this Act. Among members of the 
panel appointed by the Secretary, the Secretary shall appoint not 
less than three, nor more than five, individuals employed by the 
...... . 
Department of Health, Education, and Welfare, and shall appoint 
^"^*^*---^ 
representatives from the scientific, medical, dental, allied health, 
mental health, preventive health, public health, and education profes-
sions, as well as consumers and representatives from State and local 
health agencies. 
92 STAT. 3590 
PUBLIC LAW 95-626—NOV. 10, 1978 
Term of office. 
G>inpensation. 
5 use 5332 
note. 
Appropriation 
authorization. 
42 use 
300a-29. 
42 u s e 300Z-2, 
300in-3. 
(2) The Secretary shall designate, at the time of appointment of 
members of the panel, one member to serve as chairperson and another 
to serve as vice chairperson of the panel. 
(3) Members of the panel shall serve for the life of the panel and 
the Secretary shall appoint individuals to fill vacancies on the panel as 
they may arise. 
(4) Each member of the panel (who is not a full-time officer or 
employee of the United States) shall be entitled to receive the daily 
equivalent of the annual rate of basic pay in effect for grade GS-18 of 
the General Schedule for each day (including traveltime) during 
which the member is engaged in the actual performance of duties vested 
in the panel. All the members of the panel shall be allowed, while away 
from their homes or regular places of business in the performance of 
service for the panel, travel expenses (including per diem in lieu of 
subsistence) in the same manner as persons employed intermittently in 
the Government service are allowed expenses under section 5703 
of title 5, United States Code. 
(d) (1) Upon the request of the panel, the head of any Federal 
agency is authorized to detail, on a reimbursable basis, any of the 
personnel of such agency to the panel to assist the panel in carrying 
out its functions. 
(2) The Secretary shall provide the panel with such administrative 
services and facilities as may be required to carry out its functions. 
(e) (1) The panel may, for purposes of carrying out its functions, 
hold such hearings, sit and act at such times and places, take such 
testimony, receive such evidence, and appoint such advisory commit-
tees as it may deem advisable. 
(2) The panel may secure directly from any department or agency of 
the United States information necessary to carry out its functions. 
Upon request of the chairperson of the panel, the head of each such 
department or agency shall, to the extent permitted by law, furnish the 
information and otherwise cooperate with the panel. 
(f) The panel shall cease to exist ninety days after the date of sub-
mittal of the report described in subsection (b) (1) (C). 
(g) There is authorized to be appropriated $1,000,000 for the fiscal 
year ending September 30, 1979, to carry out this section. Sums 
appropriated under this subsection shall remain available for expendi-
ture until the date the panel ceases to exist. 
TITLE III—REVIEW 
REVIEW 
SEC. 301. A grant or contract made under this Act shall be con-
sidered, for purposes of sections 1513(e) and 1524(c)(6) of the 
Public Health Service Act, to be a grant or contract made under 
that Act. 
TITLE IV—RESOURCES FOR DISEASE PREVENTION 
AND HEALTH PROMOTION 
42 use 247b-l. 
SEC. 401. (a) The Secretary of Health, Education, and Welfare 
shall undertake or support (through grants or contracts or both) 
five intensive and comprehensive community based programs in both 
rural and urban areas for the purpose of demonstrating and evaluat-
ing optimal methods for organizing and delivering comprehensive 
preventive health services to defined populations. 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3591 
(b) The Secretary shall submit to the Committee on Human 
Eesources of the Senate and the Committee on Interstate and Foreign 
Commerce of the House of Representatives on January 1, 1981, and 
on January 1 of every second year thereafter a report on the programs 
undertaken or supported under subsection (a) including, but not 
limited to, a detailed description and an evaluation of the effective-
ness of each such program. 
(c) For the purpose of undertaking or supporting demonstrations 
and evaluations pursuant to subsection (a), there are authorized to 
be appropriated $6,000,000 for the fiscal year ending September 30, 
1980, $8,000,000 for the fiscal year ending September 30, 1981, and 
$8,000,000 for the fiscal year ending September 30,1982. 
SEC. 402. (a) The Secretary of Health, Education, and Welfare, 
after consultation with appropriate public and private entities, shall 
establish a comprehensive program designed to deter smoking and 
the use of alcoholic beverages among children and adolescents. Such 
a program shall include— 
(1) the undertaking or support (through grants or contracts or 
both) of biomedical and behavioral research designed to increase 
understanding of the biological and behavioral determinants 
of smoking and the use of alcoholic beverages among children 
and adolescents, with special emphasis on children aged twelve 
or below; and 
(2) grants to States or political subdivisions of States to 
assist them in meeting the costs of demonstrations and evalua-
tions of community or school-based programs designed to deter 
smoking and the use of alcoholic beverages among children and 
adolescents. 
(b) With respect to grants under paragraph (a) (2) the Secretary 
and each grant applicant and recipient must comply with the provi-
sions of subsections (b), (c), (d), (e), (f), (g), and (h) of section 
317. 
(c) (1) For the purpose of making payments for the undertaking or 
support of research under paragraph (a)(1), there are authorized 
to be appropriated $5,000,000 for the fiscal year ending Septem-
ber 30, 1980, and $5,000,000 for the fiscal year ending September 30, 
1981. 
(2) For the purpose of making payments under paragraph (a) (2), 
there are authorized to be appropriated $10,000,000 for the fiscal 
year ending September 30, 1980, and $10,000,000 for the fiscal year 
ending September 30,1981. 
SEC. 403. (a) The Secretary of Health, Education, and Welfare 
shall conduct, or arrange for the conduct of, a study or studies of 
(1) the relative health risks associated with smoking cigarettes of 
varying levels of tar, nicotine, and carbon monoxide; and (2) the 
health risks associated with smoking cigarettes containing any sub-
stances commonly added to commercially manufactured cigarettes. 
(b) Within two years of the date of enactment of this part, the 
Secretary shall report to the Congress the results of the study or 
studies conducted pursuant to subsection (a) and any recommenda-
tions for legislative or administrative action. 
SEC. 404. (a) The Secretary, acting through the National Center for 
Health Statistics, shall submit to Congress on December 1, 1980, and 
on December 1 of every third year thereafter, a national disease 
prevention data profile in order to provide a data base for the effective 
implementation of this Act and to increase public awareness of the 
Report to 
congressional 
committees. 
Appropriation 
authorization. 
Smoking and 
alcoholic 
beverages 
program. 
42 u s e 247b-2. 
Ante, p. 3574. 
Appropriation 
authorization. 
Study. 
42 use 287b 
note. 
Report to 
(Congress. 
National disease 
prevention data 
profile, submittal 
to Congress. 
42 u s e 242p. 
92 STAT. 3592 ~- 
PUBLIC LAW 95-626—NOV. 10, 1978 
,..f t-vKiW prevalence, incidence, and any trends in the preventable causes of 
death and disability in the United States. Such profile shall include 
at a minimum— 
(1) mortality rates for preventable diseases; 
(2) morbidity rates associated with preventable diseases; 
-i^n 
(3) the physical determinants of health of the population of 
the United States and the relationship between these determi-
nants of health and the incidence and prevalence of preventable 
causes of death and disability; and 
(4) the behavioral determinants of health of the population 
of the United States including, but not limited to, smoking, nutri-
tional and dietary habits, exercise, and alcohol consumption, and 
hm. 
the relationship between these determinants of health and the 
incidence and prevalence of preventable causes of death and 
disability, 
(b) In preparing the profile required by subsection (a), the Secre-
tary, acting through the National Center for Health Statistics, shall 
42 use 244-k, 
comply with all relevant provisions of sections 306 and 308 of the 
242m. 
Public Health Service Act. 
TITLE V—OFFICE OF PHYSICAL FITNESS AND 
SPORTS MEDICINE 
ESTABLISHMENT OF OFFICE 
SEC. 501. Section 1706 of the Public Health Service Act (42 U.S.C. 
3000-3005) is amended to read as follows: 
"OFFICE OF HEALTH INFORMATION, HEALTH PROMOTION AND PHYSICAL 
FITNESS AND SPORTS MEDICINE 
42 use 300U-5. 
"SEC. 
1706. (a) The Secretary shall establish within the Office of the 
Assistant Secretary for Health an Office of Health Information, 
p..,i>x^ , i * Health Promotion and Physical Fitness and Sports Medicine which 
shall— 
Am. 
"(1) coordinate all activities within the Department which 
relate to health information and health promotion, preventive 
health services, and education in the appropriate use of health 
care; 
"(2) coordinate its activities with similar activities of organiza-
tions in the private sector; 
.•,|;i,s,-,- 
" (3) establish a national information clearinghouse to facilitate 
A\ irA :'-' : • 
the exchange of information concerning matters relating to health 
information and health promotion, preventive health services, and 
education in the appropriate use of health care, to facilitate access 
to such information, and to assist in the analysis of issues and 
problems relating to such matters; and 
Qt ttoqsH 
"(4) support projects, conduct research, and disseminate infor-
.a^-ivsao) 
mation in the areas of physical fitness and sports medicine. 
"(b) The Office shall also— 
"(1) assist, and foster research, investigations, and model proj-
„,;-. J 
.,, ;.o • 
," ects on the nature of physical fitness, the development of physical 
fitness, and the relation of physical fitness to health; 
l&y- 
"(2) assist, and foster research and investigations into the 
utilization of sports medicine, the development of sports medicine 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3593 
techniques, and the application of sports medicine throughout 
organized systems of athletic competition and in personal physical 
fitness development activities at every age and competition level; 
"(3) foster and assist research into the proper role of nutrition 
in physical fitness programs; 
"(4) promote the coordination of research and model programs 
conducted by the Office with similar programs conducted by other 
agencies of the Federal Government and other public and private 
organizations; 
"(5) communicate the results of the studies in the widest pos-
sible manner to the American people and to special groups with 
particular interests and special needs in the development of phys-
ical fitness, such as young children, the handicapped, senior 
citizens, and workers in occupations which present special risks 
of physical disability; and 
" (6) have a Director appointed by the Secretary. 
"(c) The President's Council on Physical Fitness shall serve as the 
Advisory Body of the Office on all matters related to physical fitness. 
The activities of the Office and guidelines for the physical fitness 
programs supported by the Office shall be in conformance to guidelines 
developed by the President's Council on Physical Fitness. 
SEC. 502. Title XVII of the Public Health Service Act is amended 
by adding at the end thereof the following new sections: 
"PROJECT GRANTS TO STATE COUNCILS ON PHYSICAL FITNESS 
roR PHYSICAL FITNESS IMPROVEMENT 
"SEC. 1707. (a) The Office may make grants to each State for the 42 USC 300u-6. 
establishment by the Governor of a State Council on Physical Fitness 
or appropriate similar administrative unit. 
"(b) The State Council shall consist of at least fifteen members, 
chosen by the Governor to serve terms of four years, and appointed 
from among persons who have distinguished records in the areas of 
physical fitness, sports medicine, public health, athletic competition, 
education, labor, business management, and nutrition. 
"(c) It shall be the duty of the State Council on Physical Fitness 
to— 
" (1) promote the development of physical fitness with the assist-
ance of local health and educational agencies, business, labor 
unions, health action and advocacy groups, religious, fraternal and 
social organizations, community based multiservice recreational 
agencies, and health maintenance organizations; 
"(2) assess the physical fitness and nutrition status of residents 
of the State; 
"(3) plan and administer a program of grants-in-aid to support 
physical fitness projects, research projects, and public information 
efforts to promote the development of physical fitness for the 
residents of the State; 
"(4) evaluate and improve the availability and quality of sports 
medicine and athletic trainer programs in the State. 
"(d) Each State shall be eligible for a grant under this section in 
an amount which is equal to not less than 1 per centum of the funds 
appropriated for the purposes of this section. The first $75,000 of grant 
funds to each State under this section shall not be made until an amount 
equal to the amount of the grant is made available to the State for 
the purposes of this section from non-Federal sources. 
:W-194 O—80—pt. :i 
(il : Q U 
92 STAT. 3594 
PUBLIC LAW 95-626—NOV. 10, 1978 
"(e) Funds made available for the purposes of this section shall not 
be used to supplant non-Federal funds. 
"(f) Fifty per centum of the funds appropriated under section 
42 use 221. 
503(d) of this Act shall be allocated for the purposes of this section. 
"(g) In submitting an annual application for funds under this 
section the applicant must provide a description of all projects intended 
to be funded under subsection (c)(3). 
"PROJECT GRANTS FOR PHYSICAL FITNESS IMPROVEMENT 
AND RESEARCH PROJECTS 
42 use 300u-7. 
"SEC. 1708. (a) The Director of the Office may make grants or enter 
into contracts with public or private entities to conduct research and 
establish model projects with regard to improvement of physical 
fitness. 
"(b) Projects encompassed under this section may encompass— 
" (1) entire small communities, both urban and rural, 
" (2) educational settings for a variety of age groups, 
"(3) occupational settings, 
" (4) groups of handicapped individuals, and 
" (5) groups of senior citizens. 
Appropriation 
"(d) There are authorized to be appropriated for the purposes of 
authorization. 
section 1707, Section 1706, and this section $6,000,000 for the fiscal 
year ending September 30, 1980, and $6,000,000 for the fiscal year 
ending September 30,1981. 
42 use 300U-8. 
Clearinghouse. 
Appropriation 
authorization. 
42 use 300U-9. 
"NATIONAL PROGRAM ON SPORTS MEDICINE RESEARCH 
"SEC. 1709. (a) The Office shall establish a program of project 
grants to conduct research into the problem of athletic injuries with 
specific concentration on frequency of injuries, seriousness of injuries, 
the development of training and conditioning techniques and the 
development of athletic protective equipment to enable participants 
to avoid injuries to the maximum extent feasible, recovery rates, and 
problems associated with full recovery from athletic injuries. 
" (b) The Office shall, in cooperation with the President's Council on 
Physical Fitness, establish a Clearinghouse on Sports Medicine 
Eesearch to disseminate the results of that research to practitioners in 
relevant fields of health care and physical fitness. 
"(c) There are authorized to be appropriated to carry out the pur-
poses of this section $1,500,000 for the fiscal year ending Septem-
ber 30, 1980, and $1,500,000 for the fiscal year ending September 30, 
1981. 
II 
CONFERENCE ON EDUCATION I N LIFETIME SPORTS 
"SEC. 1710. (a) The Office and the Office of Education of the Depart-
ment of Health, Education, and Welfare shall conduct a joint con-
ference during 1979 on the teaching and support of educational 
programs in lifetime sports by secondary and postsecondary educa-
tional institutions. 
"(b) The purpose of the Conference shall be to explore current 
programs on lifetime sports within these institutions and to support 
the expansion of such educational programs in other institutions of 
secondary and postsecondary education.". 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3595 
TITLE VI—GRANT PROGRAM 
FINDINGS AND PURPOSES 
SEC. 601. (a) The Congress finds that— 
Adolescent 
(1) adolescents are at a high risk of unwanted pregnancy; 
pregnancies. 
(2) in 1975, almost 1,000,000 adolescents became pregnant and 42 USC 
nearly 600,000 carried their babies to term; 
300a-21. 
(3) pregnancy and childbirth among adolescents, particularly 
young adolescents, often results in severe adverse health, social, 
and economic consequences, including: a higher percentage of 
pregnancy and childbirth complications; a higher incidence of 
low-birth-weight babies; a higher frequency of developmental 
disabilities; higher infant mortality and morbidity; a decreased 
likelihood of completing schooling; a greater likelihood that 
adolescent marriage will end in divorce; and higher risks of 
unemployment and welfare dependency; 
(4) an adolescent who becomes pregnant once is likely to 
experience rapid repeat pregnancies and childbearing, with 
increased risks; 
(5) the problems of adolescent pregnancy and parenthood are 
multiple and complex and are best approached through a variety 
of integrated and essential services; 
(6) such services, including a wide array of educational and 
supportive services, often are not available to the adolescents who 
need them, or are available but fragmented and thus of limited 
effectiveness in preventing pregnancies and future 
welfare 
dependency; and 
(7) Federal policy therefor should encourage the development 
of appropriate health, educational, and social services where 
they are now lacking or. inadequate, and the better coordination 
of existing services where they are available in order to prevent 
unwanted early and repeat pregnancies and to help adolescents 
become productive, independent contributors to family and com-
munity life. 
(b) Therefore, the purposes of this Act are— 
(1) to establish better coordination, integration, and linkages 
among existing programs in order to expand and improve the 
availability of, and access to, needed comprehensive community 
services which assist in preventing unwanted initial and repeat 
pregTiancies among adolescents, enable pregnant adolescents to 
obtain proper care and assist pregnant adolescents and adolescent 
parents to become productive independent contributors to family 
and community life, with primary emphasis on services to ado-
lescents who are 17 years of age and under and are pregnant or 
who are parents; 
(2) to expand the availability of such services that are essential 
to that objective; and 
(3) to promote innovative, comprehensive, and integrated 
approaches to the delivery of such services. 
DEFINITIONS 
SEC. 602. For the purposes of this Act, the term— 
42 USC 
(1) "Secretary" means the Secretary of the Department of 300a-22. 
Health, Education, and Welfare; 
92 STAT. 3596 
PUBLIC LAW 95-626—NOV. 10, 1978 
(2) "eligible person" means— 
(A) with regard to the provision of all necessary core 
services and such necessary supplemental services as may be 
available, a pregnant adolescent or an adolescent parent; or 
(B) with regard to the provision of the services described 
in paragraphs (4) (A), (4) (B), and (4) (G) and referral to 
such other services which may be appropriate, a nonpreg-
nant adolescent; 
(3) "eligible grant recipient" means a public or nonprofit 
private organization or agency which demonstrates, to the satis-
faction of the Secretary, the capability of providing in a single 
setting all core services or the capability of creating a network 
through which all core services would be provided; 
(4) "core services" means those services which shall be provided 
by all grantees which are— 
(A) pregnancy testing, maternity counseling, and referral 
services; 
(B) family planning services, except that such services for 
nonpregnant adolescents shall be limited to counseling and 
referral unless suitable and appropriate family planning 
services are not otherwise available in the community; 
(C) primary and preventive health services including pre-
and post-natal care; 
(D) nutrition information and counseling; 
(E) referral for screening and treatment of venereal 
disease; 
(F) referral to appropriate pediatric care; 
(G) educational services in sexuality and family life 
(including sex education), and including family planning 
information; 
(H) referral to appropriate educational and vocational 
services; 
(1) adoption counseling and referral services; and 
(J) referral to other appropriate health services. 
(6) "supplemental services" means those services which may 
be provided and are— 
(A) child care sufficient to enable the adolescent parent to 
continue her education or to enter into employment; 
(B) consumer education and homemaking; 
(C) counseling for extended family members of the eligible 
person; 
(D) transportation; and 
(E) such other services consistent with the purposes of this 
Act as the Secretary may approve in accordance with regula-
tions promulgated by the Secretary; 
(6) "adolescent parent" means a parent under the age of 21. 
AUTHORITY TO MAKE GRANTS 
42 use 
SEC. 603. The Secretary may make grants to further the purposes 
300a-23. 
of this Act to eligible grant recipients which have submitted an 
application which the Secretary finds meets the requirements of section 
42 use 291f. 
606 for projects which the Secretary determines will help com-
munities provide core and supplemental services in easily accessible 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3597 
locations, assure a continuity of services and appropriate assistance, 
and coordinate, integrate, and establish linkages among such services. 
Projects shall, as appropriate, provide, supplement, or improve the 
quality of such services, and in providing services, give primary 
emphasis to adolescents who are 17 years of age or under and are 
pregnant or who are parents. 
USES OF GRANTS 
SEC. 604. (a) Funds provided under this Act may be used by 42 USC 
grantees only to— 
300a-24. 
(1) provide core services to eligible persons; 
(2) coordinate, integrate, and provide linkages among providers 
of core, supplemental, and other services for eligible persons in 
furtherance of the purposes of this Act; 
(3) provide supplemental services where such services are not 
adequate or not available to eligible persons in the community and 
which are essential to the care of pregnant adolescents and to the 
prevention of adolescent pregnancy; 
(4) plan for the administration and coordination of pre^ancy 
prevention and pregnancy-related services for adolescents (includ-
ing family life and sex education), which will further the objec-
tives of this Act; and 
(5) fulfill assurances required for grant approval by section 
606. 
(b) Grantees shall charge fees for services only pursuant to a fee 
schedule, approved by the Secretary as a part of the application 
described in section 606, which bases fees charged by the grantee on the 42 USC 291f. 
income of the eligible person or the parents or legal guardians of the 
eligible person and takes into account the difficulty adolescents face in 
obtaining resources to pay for services. In no case may a grantee dis-
criminate with regard to the provision of services to any individual 
because of that individual's inability to provide payment for such 
services. 
PRIORITIES, AMOUNTS, AND DURATION OF GRANTS 
SEC. 605. (a) In approving applications for grants under this Act, 42 USC 
the Secretary shall give priority to applicants who— 
300a-25. 
(1) serve an area where there is a high incidence of adolescent 
pregnancy; 
(2) serve an area where the incidence of low-income families is 
high and where the availability of pregnancy-related services is 
low; 
(3) show evidence of having the ability to bring together a wide 
range of needed care and, as appropriate, supplemental services in 
comprehensive single-site projects, or to establish a well-integrated 
network of such services (appropriate for the target population 
and geographic area to be served including the special needs of 
rural areas) for adolescents at risk of initial or repeat preg-
nancies ; 
(4) will utilize to the maximum extent feasible, existing avail-
able programs and facilities such as neighborhood and primary 
health care centers, family planning clinics, children and youth 
centers, maternal and infant health centers, regional rural health 
facilities, school and other educational programs, mental health 
programs, nutrition programs, recreation programs, and other 
ongoing pregnancy prevention and pregnancy-related services; 
92 STAT. 3598 
PUBLIC LAW 95-626—NOV. 10, 1978 
Limitation. 
Waiver. 
(5) make use, to the maximum extent feasible, of other Federal, 
State, and local funds, programs, contributions, and other third-
party reimbursements; 
(6) can demonstrate a community commitment to the program 
by making available to the project non-Federal funds, personnel, 
and facilities; and 
(7) have involved the community to be served, including public 
and private agencies, adolescents, and families, in the planning 
and implementation of the project. 
(b) (1) The amount of a grant under this Act shall be determined 
by the Secretary, based on factors such as the incidence of adolescent 
pregnancy in the geographic area to be served, and the adequacy of 
pregnancy prevention and pregnancy-related services in the area to be 
served. 
(2) In making grants under this Act, the Secretary shall consider 
the special needs of rural areas and, to the maximum extent practicable, 
shall distribute funds in consideration of the relative number of ado-
lescents in such areas in need of such services. 
(c) (1) A grantee may not receive funds under this Act for a period 
in excess of 5 years. 
(2) Subject to paragraph (3), a grant made under this Act may not 
exceed 70 percent of the costs of a project assisted under this Act for 
the first and second years of the project. In each year succeeding the 
second year of the project the amount of the Federal grant under this 
Act shall decrease by no less than 10 percent of the amount of the 
Federal grant under this Act in the preceding year. 
(3) The Secretary may waive the limitation specified in paragraph 
(2) in any year in accordance with criteria established by regulation. 
REQUIREMENTS FOR GRANT APPROVAL 
42 use 
SEC. 606. (a) An application for a grant under this Act shall be in 
300a-26. 
such form and contain such information as the Secretary may require, 
and shall include— 
(1) an identification of the incidence of adolescent pregnancy 
and related problems; 
(2) a description of the economic conditions and income levels 
in the geographic area to be served; 
(3) a description of existing pregnancy prevention and 
pregnancy-related services (including family life and sex educa-
tion), and including where, how, by whom and to whom they are 
provided, and the extent to which they are coordinated in the 
geographic area to be served; 
(4) a description of the major unmet needs for services for 
adolescents at risk of initial or repeat pregnancies, the number of 
adolescents currently served in the area, and the number of ado-
lescents not being served in the area; 
(5) a description of how all of the core services will be provided 
in the project using funds under this Act or otherwise provided by 
the grantee, to whom they will be provided, how they will be 
coordinated, integrated, and linked with other related programs 
and services and the source or sources of funding of such core 
services; 
(6) a description of how adolescents needing services other than 
those provided directly by the grantee will be identified and how 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3599 
access and appropriate referral to those services (such as medic-
aid; public assistance; employment services; child care services 
for adolescent parents; and other city, county, and State programs 
related to adolescent pregnancy) will be provided including a 
description of the plan to coordinate such services with activities 
funded under this Act; 
(7) a description of any fee schedule to be used for any services 
provided directly by the grantee and the method by which it was 
derived, together with assurances that the applicant will make 
every reasonable effort to collect reimbursement for its costs in 
providing services to persons who are entitled to have payment 
made on their behalf for such services under any Federal or other 
government program or private insurance program; 
(8) a description of the grantee's capacity to continue serv-
ices as Federal funds decrease and in the absence of Federal 
assistance; 
(9) a description of the results expected from the provision of 
services and activities, and the procedures to be used for evaluat-
ing those results; 
(10) a summary of the views of public agencies, providers of 
services, and the general public in the geographic area to be 
served, of the proposed use of the funds provided under a grant 
provided under this^ct arid a description of procedures used 
to obtain those views, and, in the case of applicants who propose 
to coordinate services administered by a State, the written com-
ments of the appropriate State officials responsible for such 
services; 
(11) assurances that the applicant will have an ongoing quality 
assurance program; 
(12) assurances that the applicant shall have a system for main-
taining the confidentiality of patient records in accordance with 
regulations promulgated by the Secretary; 
(13) assurances that the applicant will demonstrate its finan-
cial responsibility by the use of such accounting procedures and 
other requirements as may be prescribed by the Secretary; 
(14) assurances that the applicant (A) has or will have a con-
tractual or other arrangement with the agency of the State, in 
which it provides services, which administers or supervises the 
administration of a State plan approved under title XIX of the 
Social Security Act for the payment of all or a part of the appli- 42 USC 1396. 
cant's costs in providing health services to persons who are 
eligible for medical assistance under such a State plan, or (B) 
has made or will make every reasonable effort to enter into such 
an arrangement; 
(15) assurances that the applicant has made or will make and 
will continue to make every reasonable effort to collect appropriate 
reimbursement for its costs in providing health services to persons 
who are entitled to benefits under title V of the Social Security 42 USC 
Act, to medical assistance under a State plan approved under title 701. 
XIX of such Act, or to assistance for medical expenses under any 
other public assistance program or private health insurance 
program; 
(16) assurances that the applicant has or will make and' will 
continue to make every reasonable effort to collect appropriate 
reimbursement for its costs in providing services to persons 
entitled to services under title XX of the Social Security Act; 
42 USC 1397. 
92 STAT. 3600 
PUBLIC LAW 95-626—NOV. 10, 1978 
(17) assurances that the applicant (A) has prepared a sched-
ule of fees or payments for the provision of its services designed 
to cover its reasonable costs of operation and a corresponding 
schedule of discounts to be applied to the payment of such fees or 
payments, which discounts are adjusted on the basis of the 
patient's ability to pay, (B) has made and will continue to make 
every reasonable effort (i) to secure from patients payment for 
services in accordance with such schedules, and (ii) to collect 
reimbursement for health or other services on the basis of the full 
amount of fees and payments for such services without application 
of any discount, and (C) has ^submitted to the Secretary such 
reports as he may require to determine compliance with this 
paragraph; 
(18) assurances that the applicant will make maximum use of 
42 use 300. 
funds available under title X of the Public Health Service Act; 
(19) assurances that the acceptance by any individual of family 
planning services or family planning or population growth infor-
mation (including educational materials) provided through finan-
cial assistance under this title shall be voluntary and shall not be 
a prerequisite to eligibility for or receipt of any other sendee 
furnished by the applicant; 
(20) assurances that fees collected by the applicant for services 
rendered in accordance with this Act shall be used by the applicant 
to further the purposes of this Act; 
(21) assurances that unemancipated minors requesting services 
from the applicant will be encouraged, whenever feasible, to con-
sult with their parents with respect to such services; 
(22) assurances that all pregnant adolescents receiving services 
will be informed of the availability of counseling (either by the 
entity providing core services or through a referral agreement 
with such other entity which provides such counseling) on all 
options, regarding her pregnancy; 
(23) assurances that primary emphasis for services paid for 
with funds under this Act shall be given to pregnant adolescents 
and adolescent parents 17 and under who are not able to obtain 
needed assistance through other means; and 
(24) assurances that funds received under this Act shall not 
supplant funds received from any other Federal, State, or local 
program or any private sources of funds. 
(b) Each grantee which participates in the program established by 
this title shall make such reports concerning its use of Federal funds 
as the Secretary may require. Reports shall include the impact the 
project has had on reducing the rate of first and repeat pregnancies 
among adolescents, and the effect on factors usually associated with 
welfare dependency. 
(c) The Secretary shall provide the Governor of each State copies 
of applications received for grants under this Act from applicants 
withm such State. The Governor shall have a period of 60 days from 
receipt of such copies to review and submit comments to the Secretary. 
(d) No application submitted for a grant under this Act may be 
approved unless the Secretary is satisfied that core services shall be 
available through the grantee within a reasonable time after such 
grant is received. 
PUBLIC LAW 95-626—NOV. 10, 1978 
92 STAT. 3601 
AUTHORIZATION OF APPROPRIATIONS 
SEC. 607. For the purpose of carrying out this title, there are author- 42 USC 
ized to be appropriated $50,000,000 for the fiscal year ending Septem- 300a-27. 
ber 30, 1979, $65,000,000 for the fiscal year ending September 30,1980 
and $75,000,000 for the fiscal year ending September 30, 1981. 
FUND RESTRICTION 
SEC. 608. No funds for grants made under the provisions of this Act 42 USC 
may be used for payment for the performance of an abortion. 
300a-28. 
TITLE VII—IMPROVING COORDINATION OF FEDERAL 
AND STATE PROGRAMS 
SEC. 701. (a) The Secretary shall coordinate, consistent with pro- 42 USC 
visions of other Federal law respecting coordination of such policies 300a-41. 
and programs. Federal policies and programs providing services 
related to prevention of initial and repeat adolescent pregnancies. 
Among other things, the Secretary shall— 
(1) require that grantees under title VI report periodically on 42 USC 291. 
Federal, State, and local programs or policies that interfere with 
the delivery and coordination of pregnancy prevention and preg-
nancy-related services to adolescents; 
(2) provide technical assistance to assure that coordination by 
grantees of Federal programs at the State and local level will be 
facilitated; 
(3) recommend legislative modifications of programs of the 
Department of Health, Education, and Welfare that provide 
pregnancy-related services in order to facilitate their use as a 
base for delivery of more comprehensive pregnancy prevention 
and pregnancy-related services to adolescents; 
(4) give funding priority, where appropriate, to grantees using 
single or coordinated grant applications for multiple programs; 
and 
(5) give priority, where appropriate, to providing funding 
under existing Federal programs to projects providing compre-
hensive pregnancy prevention and pregnancy-related services. 
(b) A State using funds provided under title VI to improve the 
delivery of pregnancy prevention and pregnancy-related services 
throughout the State shall coordinate its activities with programs of 
local grantees, if any, that are funded under title VI. 
(c) The Secretary shall set aside, in each fiscal year, not less than 
1 per centum nor more than 3 per centum of the funds appropriated 
under this Act for evaluation of activities under titles VI and VII and 42 USC 292. 
shall designate a program unit to carry out such evaluations, which 
shall be a program unit other than the unit having primary adminis-
trative responsibility for carrying out the grant program authorized 
by this Act. The Secretary shall submit to the appropriate committees 
of the Congress, not later than February 1, 1981, and periodically 
thereafter copies of summaries of all such evaluations. 
(d) The program unit responsible for carrying out the activities 
under titles VI and VII shall report directly to the Assistant Secretary 
for Health in consultation and in coordination with the Deputy 
Assistant Secretary for Population Affairs. 
92 STAT. 3602 
PUBLIC LAW 95-626—NOV. 10, 1978 
Contract 
authority, 
42 u s e 300a 
note. 
-21 
Report to 
Congress. 
Appropriation 
au^orization. 
TITLE VIII—STUDY OF ADOLESCENT PREGNANCY 
SEC. 801. (a) The Secretary of Health, Education, and Welfare shall 
contract with an independent entity to perform a study of the problem 
of adolescent pregnancies. The study shall evaluate the effectiveness 
of existing programs relating to health, education, and public wel-
fare, as they relate to this problem, and shall include suggestions as to 
the most effective means for reducing or eliminating unwanted adoles-
cent pregnancies. The Secretary shall report the results of such study 
to the Congress not later than one year after the date of the enact-
ment of this Act. 
(b) There are authorized to be appropriated such sums, not to exceed 
$500,000, as may be necessary to carry out the provisions of this 
section. 
Approved November 10, 1978. 
LEGISLATIVE HISTORY: 
HOUSE REPORTS: No. 95-1191 accompanying H.R. 12370 (Coram, on Interstate and 
Foreign Commerce) and No. 95-1799 (Coram, of Conference). 
SENATE REPORT No. 95-860 (Coram, on Human Resources). 
CONGRESSIONAL RECORD, Vol. 124 (1978): 
Sept. 25, H.R. 12370 considered and failed of passage in House. 
Sept. 29, considered and passed Senate. 
Oct. 11, 13, H.R. 12370 considered and passed House; passage vacated, and 
S. 2474, araendedl, passed in lieu. 
Oct. 15, Senate and House agreed to conference report.