[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2206 Introduced in House (IH)]

  1st Session
                                H. R. 2206

 To provide for the consolidation and simplification of health center 
                   programs, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             August 4, 1995

Mr. Dingell (for himself and Mr. Waxman) introduced the following bill; 
            which was referred to the Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
 To provide for the consolidation and simplification of health center 
                   programs, and for other purposes.
    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE AND REFERENCES IN ACT.

    (a) Short Title.--This Act may be cited as the ``Health Centers 
Consolidation Act of 1995''.
    (b) References in Act.--The amendments in this Act apply to the 
Public Health Service Act unless otherwise specifically stated.

SEC. 2. CONSOLIDATION OF AUTHORITY FOR COMMUNITY HEALTH CENTERS, 
              MIGRANT HEALTH CENTERS, HEALTH SERVICES FOR THE HOMELESS, 
              AND HEALTH SERVICES FOR RESIDENTS OF PUBLIC HOUSING.

    (a) New and Revised Terms.--
            (1) Health center.--
                    (A) Definition.--Section 330(a) is amended to read 
                as follows:
    ``(a) For purposes of this section, the term `health center' means 
an entity that serves a population that is medically underserved, or 
that serves a special medically underserved population comprised of 
migratory agricultural workers, seasonal agricultural workers, the 
homeless, or residents of public housing by providing, either through 
its staff and supporting resources or through contracts or cooperative 
arrangements--
            ``(1) required primary health services (as defined in 
        subsection (b)(1)); and
            ``(2) as may be appropriate for particular centers, 
        additional health services (as defined in subsection (b)(2)) 
        necessary for the adequate support of the required primary 
        health services;
for all residents of the area it serves (referred to in this section as 
a `catchment area').''.
                    (B) Conforming amendments.--Section 330 is 
                amended--
                            (i) by striking the term ``community health 
                        center'' each place such term appears and 
                        inserting ``health center''; and
                            (ii) by striking the term ``community 
                        health centers'' each place such term appears 
                        and inserting ``health centers''.
            (2) Required primary health services.--Section 330(b)(1) is 
        amended to read as follows:
            ``(1) The term `required primary health services' means--
                    ``(A) basic health services which, for purposes of 
                this section, consist of--
                            ``(i) health services related to family 
                        medicine, internal medicine, pediatrics, 
                        obstetrics, gynecology, or dentistry that are 
                        furnished by physicians, dentists, and, where 
                        appropriate, physician assistants, nurse 
                        practitioners, and nurse midwives;
                            ``(ii) diagnostic laboratory and radiologic 
                        services;
                            ``(iii) preventive health services, 
                        including--
                                    ``(I) prenatal and perinatal 
                                services;
                                    ``(II) screening for breast and 
                                cervical cancer;
                                    ``(III) well-child services;
                                    ``(IV) immunizations against 
                                vaccine-preventable diseases;
                                    ``(V) screenings for elevated blood 
                                lead levels, communicable diseases, and 
                                cholesterol;
                                    ``(VI) pediatric eye and ear 
                                examinations to determine the need for 
                                vision and hearing correction;
                                    ``(VII) voluntary family planning 
                                services; and
                                    ``(VIII) preventive dental 
                                services;
                            ``(iv) emergency medical services;
                            ``(v) pharmaceutical services as may be 
                        appropriate for particular centers;
                    ``(B) referrals to providers of medical services 
                and other health-related services (including substance 
                abuse and mental health services);
                    ``(C) patient case management services (including 
                counseling, referral, and follow-up services) designed 
                to assist health center patients in establishing 
                eligibility for, and gaining access to, Federal, State, 
                and local programs that provide or financially support 
                the provision of medical, social, educational, or other 
                related services;
                    ``(D) services that enable individuals to use the 
                services of the center (including outreach and 
                transportation services and, if a substantial number of 
                the individuals in the population served by a center 
                are of limited English-speaking ability, the services 
                of appropriate personnel fluent in the language spoken 
                by a predominant number of such individuals); and
                    ``(E) education of patients and the general 
                population served by the health center regarding the 
                availability and proper use of health services.''.
            (3) Additional health services.--Section 330(b)(2) is 
        amended to read as follows:
            ``(2) The term `additional health services' means services 
        which are not included as required primary health services and 
        which are appropriate to meet the health needs of the 
        population serviced by the health center involved. Such term 
        may include--
                    ``(A) environmental health services, including--
                            ``(i) the detection and alleviation of 
                        unhealthful conditions associated with water 
                        supply;
                            ``(ii) sewage treatment;
                            ``(iii) solid waste disposal;
                            ``(iv) rodent and parasitic infestation;
                            ``(v) field sanitation;
                            ``(vi) housing; and
                            ``(vii) other environmental factors related 
                        to health; and
                    ``(B) in the case of health centers receiving 
                grants pursuant to subsection (f), special occupation-
                related health services for migratory agricultural 
                workers and seasonal agricultural workers, including--
                            ``(i) screening for and control of 
                        infections and parasitic diseases; and
                            ``(ii) accident prevention programs, 
                        including prevention of excessive pesticide 
                        exposure.''.
    (b) Relocation and Consolidation Within Section 330 of Authorities 
Respecting Grants for Infant Mortality and Childhood Morbidity, and 
Grants for Health Centers Serving Migratory and Seasonal Workers, 
Homeless, and Public Housing Populations.--
            (1) Redesignation of subsections.--Subsections (e) through 
        (k) of section 330 are redesignated as subsections (i) through 
        (o), respectively.
            (2) Grants for infant mortality and childhood morbidity.--
                    (A) Paragraph (2) of section 330(k) (as so 
                redesignated) is amended by redesignating such 
                paragraph as subsection (e);
                    (B) in the material redesignated (by subparagraph 
                (A) of this paragraph) as subsection (e), by striking 
                subparagraphs (A), (D), and (E);
                    (C) in the material redesignated (by subparagraph 
                (A) of this paragraph) as subsection (e), by 
                redesignating subparagraphs (B), (C), and (F) as 
                paragraphs (1) through (3), respectively;
                    (D) in the material redesignated (by subparagraph 
                (A) of this paragraph) as subsection (e), by 
                redesignating each clause designated as (i), (ii), 
                (iii), or (iv), as subparagraph (A), (B), (C), or (D), 
                respectively;
                    (E) by redesignating clauses (I) and (II) of 
                paragraph (1)(A) (as redesignated by subparagraphs (C) 
                and (D) of this paragraph) as clauses (i) and (ii), 
                respectively;
                    (F) by striking ``subparagraph (B)'' each place 
                such term appears in subsection (e) (as redesignated by 
                subparagraph (A) of this paragraph) and inserting 
                ``this subsection'';
                    (G) in subsection (e)(1)(B) (as redesignated by 
                subparagraphs (A), (C), and (D) of this paragraph, by 
                striking ``clause (i)'' and inserting ``subparagraph 
                (A)''; and
                    (H) in subsection (e)(3) (as redesignated by 
                subparagraphs (A), (C), and (D) of this paragraph)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``subparagraph (B)'' and 
                        inserting ``paragraph (1)'';
                            (ii) by adding ``and'' at the end of 
                        subparagraph (B);
                            (iii) by striking subparagraph (C); and
                            (iv) by redesignating subparagraph (D) as 
                        subparagraph (C).
            (3) Grants for health centers serving migratory and 
        agricultural workers.--
                    (A) Section 330 is amended by inserting after 
                subsection (e) a new subsection as follows:
    ``(f) Migratory and Seasonal Agricultural Worker Populations.--(1) 
The Secretary is authorized to award grants for the purposes described 
in subsections (c), (d), and (e) for the planning and delivery of 
services to a special medically underserved population comprised of 
migratory agricultural workers, seasonal agricultural workers, and 
members of the families of such migratory and seasonal workers who are 
within a designated catchment area, and individuals who have previously 
been migratory agricultural workers but can no longer meet the 
requirements of subparagraph (A) of paragraph (4) because of age or 
disability and members of their families who are within such catchment 
area.
    ``(2) The Secretary may make grants to or enter into contracts with 
public and nonprofit private entities for projects to plan and develop, 
and to operate, programs in areas in which no health center serving the 
special medically underserved population described in paragraph (1) 
exists and in which not more than 4000 migratory agricultural workers 
and their families reside for more than two months--
            ``(A) for the provision of emergency care to migratory 
        agricultural workers, seasonal agricultural workers, and the 
        members of families of such migratory and seasonal workers; and
            ``(B) for the provision of required primary health services 
        and additional health services for such workers and the members 
        of their families.
Any such program may include the acquisition, expansion, and 
modernization of existing buildings, construction of new buildings, and 
the provision of training related to the management of programs 
assisted under this paragraph.''.
                    (B) Section 329(e) is amended--
                            (i) by redesignating paragraphs (1) and (2) 
                        as subparagraphs (A) and (B), respectively; and
                            (ii) by redesignating subsection (e) as 
                        paragraph (3) of subsection 330(f).
                    (C) Section 329(a) is amended--
                            (i) in paragraph (4)--
                                    (I) in subparagraph (C), by 
                                striking ``subparagraphs (B)'' and 
                                inserting ``clause (ii)''; and
                                    (II) by redesignating subparagraphs 
                                (A) through (C) as clauses (i) through 
                                (iii), respectively;
                            (ii) by redesignating paragraphs (2), (3), 
                        and (4) as subparagraphs (A), (B), and (C), 
                        respectively, of new paragraph (4) of section 
                        330(f), and by adjusting their margins so as to 
                        align with paragraphs (1) through (3) of such 
                        section 330(f).
            (4) Grants for health centers serving homeless 
        populations.--
                    (A) Section 330 is amended by inserting after 
                subsection (f) a new subsection as follows:
    ``(g) Homeless Populations.--
            ``(1) In general.--The Secretary is authorized to award 
        grants for the purposes described in subsections (c), (d), and 
        (e) for the planning and delivery of services to a special 
        medically underserved population comprised of homeless 
        individuals, including homeless children and children at risk 
        of homelessness.
            ``(2) Required services.--In addition to required primary 
        health services (as defined in subsection (b)(1)), any entity 
        that receives a grant under this subsection shall be required 
        to provide substance abuse services as a condition of such 
        grant.
            ``(3) Supplement not supplant requirement.--Any grant 
        awarded under this subsection must be expended to supplement, 
        and not supplant, the health center's expenditures for the 
        delivery of services to the population described in paragraph 
        (1).''.
                    (B) Paragraphs (2), (7), and (8) of section 340(r) 
                are redesignated as subparagraphs (A), (B), and (C) of 
                paragraph (4), respectively, of section 330(g).
                    (C) Section 330(k)(2)(B) (as redesignated by 
                paragraph (1) of this subsection) is amended by adding 
                at the end the following sentence: ``For purposes of 
                applying the preceding sentence, the term `public 
                centers' shall not include health centers that receive 
                grants pursuant to subsection (g).''.
            (5) Grants for health centers serving public housing 
        populations.--
                    (A) Section 330 is amended by inserting after 
                subsection (g) a new subsection as follows:
    ``(h) Residents of Public Housing.--
            ``(1) In general.--The Secretary is authorized to award 
        grants for the purposes described in subsections (c), and (d), 
        and (e) for the planning and delivery of services to a special 
        medically underserved population comprised of residents of 
        public housing (which, for purposes of this subsection, shall 
        have the meaning given such term in section 3(b)(1) of the 
        United States Housing Act of 1937) and persons living in areas 
        immediately accessible to such public housing.
            ``(2) Preference.--In awarding grants under this 
        subsection, the Secretary shall give preference to qualified 
        applicants who are resident management corporations under 
        section 20 of the United States Housing Act of 1937 or are 
        receiving funds as a health center under this section.
            ``(3) Supplement not supplant.--Any grant awarded under 
        this subsection must be expended to supplement, and not 
        supplant, the health center's expenditures for the delivery of 
        services to the population described in paragraph (1).''.
                    (B) Section 340A(g) is amended--
                            (i) by redesignating paragraphs (1) and (2) 
                        as subparagraphs (A) and (B), respectively; and
                            (ii) by redesignating subsection (g) in its 
                        entirety as paragraph (4) of section 330(h) and 
                        by adjusting its margins so as to align with 
                        paragraphs (1) and (2) of such subsection.
                    (C) Section 330(k)(2)(B) (as previously amended by 
                paragraph (3)(C) of this subsection) is further amended 
                in the last sentence by inserting ``or (h)'' after 
                ``(g)''.
            (6) Exceptions from certain administrative requirements.--
                    (A) Service to all within catchment area.--Section 
                330(a) is amended by striking the period and inserting 
                ``, except that the requirement to serve all residents
                 within a catchment area shall not apply to any grant 
received by a health center pursuant to subsection (f), (g), or (h).''.
                    (B) Health center governing board.--Section 
                330(i)(3)(G) (as redesignated by paragraph (1) of this 
                subsection) is amended by striking the semi-colon at 
                the end and inserting ``, except that, upon a showing 
                of good cause, the Secretary may waive all or part of 
                the requirements of this subparagraph in the case of a 
                health center that receives a grant pursuant to 
                subsection (f), (g), or (h).''.
    (c) Reduction in Administrative Details.--
            (1) Section 330(b)(4)(B) is amended by striking ``infant 
        mortality in an area or population group, other''.
            (2) Section 330(d)(4)(A)(ii) is amended by striking the 
        last sentence.
            (3) Section 330(d)(4)(B) is amended by striking everything 
        after ``underpayments'' and inserting instead a period.
            (4) Section 330(i)(2) (as redesignated by subsection (b)(1) 
        of this section) is amended by striking ``include--'' and all 
        that follows through ``Such an application shall also include'' 
        and inserting instead ``include a description of the need for 
        health services in the center's catchment area and''; and
            (5) Section 330(i)(3)(H) (as redesignated by subsection 
        (b)(1) of this section) is amended--
                    (A) in clause (i), by striking ``section 1861(z) of 
                the Social Security Act'' and inserting ``the 
                Secretary'';
                    (B) by inserting ``and'' at the end of clause 
                (III); and
                    (C) by striking ``, and (V)'' and all that follows 
                and inserting instead a semi-colon.
            (6) Section 330(j) (as redesignated by subsection (b)(1) of 
        this section) is amended--
                    (A) by striking ``(1)''; and
                    (B) by striking paragraph (2).
            (7) Section 330(m) (as redesignated by subsection (b)(1) of 
        this section) is amended--
                    (A) by striking paragraph (1) and by redesignating 
                paragraphs (2) through (4) as paragraphs (1) through 
                (3), respectively;
                    (B) in the first sentence of paragraph (1) (as 
                redesignated by subparagraph (A) of this paragraph), by 
                striking everything after ``require'' and inserting a 
                period; and
                    (C) in the first sentence of paragraph (2) (as 
                redesignated by subparagraph (A) of this paragraph), by 
                striking ``or to provide for and audit''.
    (d) Appropriations.--
            (1) Authorization.--Section 330(k)(1)(A) (as redesignated 
        by subsection (b)(1) of this section) is amended to read as 
        follows:
    ``(k)(1) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be appropriated 
$756,000,000 for fiscal year 1996 and such sums as may be necessary for 
each of the fiscal years 1997 through 2000.''.
            (2) Redesignation of special provisions and addition of 
        performance bonus set-aside.--
                    (A) Section 330(k) (as so redesignated and amended) 
                is further amended--
                            (i) by striking ``(B)'' and inserting ``(2) 
                        Special provisions.--(A)'';
                            (ii)(A) in paragraph (3), by striking 
                        ``(e)(3)'' and ``(e)(3)(G)(ii)'' and inserting 
                        ``(i)(3)'' and ``(i)(3)(G)(ii)'', respectively, 
                        and
                            (B) by redesignating paragraph (3) as 
                        subparagraph (B) of paragraph (2); and
                            (iii) by adding at the end of section 
                        330(k)(2) a new subparagraph (C) as follows:
            ``(C) From the funds appropriated pursuant to paragraph (1) 
        for any fiscal year, the Secretary may reserve an amount not to 
        exceed 10 percent for use in making supplemental awards to 
        grantees that the Secretary determines have demonstrated high 
        or improved performance in carrying out the purposes of this 
        section.''.
            (3) Special rule regarding allocation of funding.--Section 
        330(k)(2) is amended by adding at the end a new subparagraph 
        (D) as follows:
            ``(D) For fiscal years 1996 through 1998, the Secretary 
        shall award grants under this section in such a manner that the 
        percentages of the amount appropriated pursuant to paragraph 
        (1) that are available to support grants made pursuant to 
        subsections (f), (g), and (h) shall equal the percentages of 
        the base amount that were appropriated under sections 329, 340, 
        and 340A, respectively, for fiscal year 1995. For purposes of 
        the preceding sentence, the term `base amount' refers to the 
        total of the amounts appropriated to carry out sections 329, 
        330, 340, and 340A for fiscal year 1995.''.
    (e) Delegation Authority.--Section 330(n) (as redesignated by 
subsection (b)(1) of this section) is amended by striking ``the central 
office of''.
    (f) Elimination of Various Regulation Requirements.--
            (1) Section 330(b)(4) is amended--
                    (A) in the first sentence, by striking ``by 
                regulation''; and
                    (B) by striking the last sentence.
            (2) Section 330(i)(3)(B) (as redesignated by subsection 
        (b)(1) of this section) is amended by striking ``established in 
        accordance with regulations prescribed by the Secretary'' and 
        inserting instead ``as the Secretary may prescribe''.
            (3) Section 330 (i)(3)(H) (as redesignated by subsection 
        (b)(1) of this section) is amended--
                    (A) by striking '', in accordance with regulations 
                of the Secretary,''; and
                    (B) by striking '', by regulation,''.
            (4) Section 330(i)(3)(K) (as redesignated by subsection 
        (b)(1) of this section) is amended by striking ``, in 
        accordance with regulations of the Secretary,''.
            (5) Section 330(m)(2) (as redesignated by subsection (b)(1) 
        of this section) is amended by striking ``by regulation''.
    (g) Technical and Conforming Amendments.--
            (1) Section 330(c)(1)(A) is amended by striking ``primary'' 
        and all that follows and inserting instead ``required primary 
        health services and additional health services;''.
            (2) Section 330(d)(1)(B) is amended by striking 
        ``subsection (e)(3)'' and inserting instead ``subsection 
        (i)(3)''.
            (3) Section 330(d)(1)(C)(ii) is amended by striking 
        ``subsection (e)(3)(G)'' and inserting ``subsection 
        (i)(3)(G)''.
            (4) Section 330(d)(2) is amended by striking ``primary 
        health services, supplemental health services and environmental 
        health services'' and inserting ``required primary health 
        services and additional health services''.
            (5) Section 330(i)(1) (as redesignated by subsection (b)(1) 
        of this section) is amended by striking ``subsection (c) or 
        (d)'' and inserting ``this section''.
            (6) Section 330(i)(3) (as redesignated by subsection (b)(1) 
        of this section) is amended in the matter following 
        subparagraph (K) by striking ``and subsection (g)(4)''.
            (7) Section 330(i)(5) (as redesignated by subsection (b)(1) 
        of this section) is amended by striking ``subsection (a)(4)'' 
        and inserting ``subsection (b)(2)''.
            (8) Section 330(j) (as redesignated by subsection (b)(1) 
        and amended by subsection (c)(6) of this section) is further 
        amended--
                    (A) by striking ``Health, Education, and Welfare'' 
                and inserting ``Health and Human Services''; and
                    (B) by striking ``subsection (e)(2)'' and inserting 
                ``(i)(2)''.
            (9) The heading of section 330 is amended to read as 
        follows:

                          ``health centers''.

            (10) The heading of subpart I of part D of title III is 
        amended to read as follows:

                     ``Subpart I--Health Centers''.

            (11) Section 224(g)(4) is amended by striking everything 
        after ``under'' and inserting instead ``section 330.''.
            (12) Section 340C(a)(2) is amended by striking everything 
        after ``diseases'' and inserting instead ``with assistance 
        provided under section 330.''.
            (13) Section 1861(aa)(4)(A) of the Social Security Act is 
        amended in clauses (i) and (ii)(I) by striking ``section 329, 
        330, or 340'' and inserting instead ``section 330 (other than 
        subsection (h) thereof)''.
            (14) Section 1905(l)(2)(B) of the Social Security Act is 
        amended in clauses (i) and (ii)(II) by striking ``section 329, 
        330, 340, or 340A'' and inserting instead ``section 330''.
    (h) Repeals.--Section 329 and subparts V and VI of part D of title 
III of the Public Health Service Act are repealed.
    (i) Effective Date.--This section and the amendments made thereby 
shall be effective with respect to fiscal years beginning after 
September 30, 1995.
                                 <all>
HR 2206 IH----2