[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2420 Introduced in House (IH)]


104th CONGRESS
  1st Session
                                H. R. 2420

    To amend title XIX of the Social Security Act to require health 
   maintenance organizations and other managed care plans providing 
   medical assistance to medicaid beneficiaries to make payments for 
   assistance provided to such beneficiaries by school-based health 
                    centers, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 28, 1995

Ms. Velazquez introduced the following bill; which was referred to the 
                         Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
    To amend title XIX of the Social Security Act to require health 
   maintenance organizations and other managed care plans providing 
   medical assistance to medicaid beneficiaries to make payments for 
   assistance provided to such beneficiaries by school-based health 
                    centers, 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. REQUIRING MEDICAID HEALTH MAINTENANCE ORGANIZATIONS TO MAKE 
              PAYMENTS FOR SERVICES PROVIDED BY SCHOOL-BASED HEALTH 
              CENTERS.

    (a) In General.--Section 1903(m)(2)(A) of the Social Security Act 
(42 U.S.C. 1396b(m)(2)(A)) is amended--
            (1) by striking ``and'' at the end of clause (x);
            (2) by striking the period at the end of clause (xi) and 
        inserting ``; and''; and
            (3) by adding at the end the following new clause:
            ``(xii) such contract provides that--
                    ``(I) the entity's network of participating 
                providers of such services shall include at least one 
                school-based health center (as defined in section 
                1905(t)), or
                    ``(II) the entity shall enter into a contract for 
                the provision of such services to such individuals with 
                each school-based health center (as so defined) located 
                in the entity's service area, under terms and 
                conditions (including terms and conditions relating to 
                patient referrals and the sharing of patient records) 
                similar to those applicable to a contract between the 
                entity and a similar provider of such services in the 
                area (in accordance with standards established by the 
                Secretary).''.
    (b) School-Based Health Centers Described.--Section 1905 of such 
Act (42 U.S.C. 1396d) is amended by adding at the end the following new 
subsection:
    ``(t) The term `school-based health center' means a clinic which is 
located at an elementary or secondary school and which--
            ``(1) provides physical examinations, injury treatment, 
        primary health services, mental health services, and other 
        services (to the extent permitted under the laws or regulations 
        of the State in which it is located) on an on-site basis to 
        students enrolled at the school (without regard to whether or 
        not the students are enrolled in the State plan under this 
        title);
            ``(2) refers students to other providers of health care 
        services for services which the center does not provide on-
        site;
            ``(3) has entered into arrangements with other providers of 
        health care services providing services on a 24-hour, emergency 
        basis;
            ``(4) has on its staff at least one physician (whether 
        employed on a part-time or full-time basis); at least one 
        physician assistant, nurse practitioner, or clinical nurse 
        specialist; and at least one mental health professional; and
            ``(5) is approved or certified as such a clinic by the 
        State in which it is located.''.
    (c) Prohibition Against Waiver of Requirement.--The Secretary of 
Health and Human Services may not waive (pursuant to section 1115 or 
section 1915 of the Social Security Act or otherwise) the application 
of section 1903(m)(2)(A)(xii) of the Social Security Act (as added by 
subsection (a)) with respect to any State.
    (d) Effective Date.--The amendments made by subsections (a) and (b) 
shall apply to quarters beginning on or after January 1, 1996.

SEC. 2. ESTABLISHMENT OF CLEARINGHOUSE FOR INFORMATION AND TECHNICAL 
              ASSISTANCE ON SCHOOL-BASED HEALTH CENTERS.

    Not later than March 1, 1996, the Secretary of Health and Human 
Services shall establish a clearinghouse through which interested 
parties may receive information and technical assistance on the 
establishment and operation of school-based health centers.

SEC. 3. GRANTS FOR SCHOOL-BASED HEALTH CENTERS.

    (a) In General.--Part D of title III of the Public Health Service 
Act (42 U.S.C. 254b et seq.) is amended by adding at the end the 
following section:

                     ``school-based health centers

    ``Sec. 340E. (a) In General.--
            ``(1) In general.--The Secretary may make grants to public 
        and nonprofit private entities for the purpose of making 
        available to school children the health services specified in 
        subsection (d) at sites that are on or in close proximity to 
        the premises of a school (or at such other sites as the 
        Secretary determines to be appropriate to provide school 
        children with access to the services).
            ``(2) School children.--For purposes of this section, the 
        term `school children' means individuals between the ages of 3 
        and 18 (inclusive).
    ``(b) Minimum Qualifications for Grantees.--
            ``(1) Status as medicaid provider.--
                    ``(A) Except as provided in subparagraph (B), the 
                Secretary may make a grant under subsection (a) only if 
                the applicant for the grant is a provider of services 
                under the State plan approved for the State involved 
                under title XIX of the Social Security Act.
                    ``(B) The requirements established in subparagraph 
                (A) do not apply to an applicant that provides health 
                services without charge and does not receive 
                reimbursement for the services from any third-party 
                payors.
            ``(2) Required consultations regarding parents and 
        teachers.--The Secretary may make a grant under subsection (a) 
        only if the applicant involved, in preparing the application 
        under subsection (j), has consulted with parents in the 
        community in which services under the grant are to be provided, 
        with teachers at schools in the community, and with the local 
        educational agency with jurisdiction over such schools.
    ``(c) Preferences in Making Grants.--In making grants under 
subsection (a), the Secretary shall give preference to qualified 
applicants that are experienced in delivering health care services to 
medically underserved populations or in areas in which a significant 
number of children are at risk for health problems.
    ``(d) Authorized Services.--
            ``(1) In general.--The Secretary may make a grant under 
        subsection (a) only if the applicant involved agrees as 
        follows:
                    ``(A) Each of the following services will be made 
                available under the grant (as medically appropriate for 
                the child involved):
                            ``(i) Comprehensive health examinations.
                            ``(ii) Health education and prevention 
                        services, including prenatal care.
                            ``(iii) Follow-up care and referrals 
                        regarding routine health problems.
                    ``(B) Services under subparagraph (A) will include 
                screenings, follow-up care, and referrals (including 
                referrals for specialty care) regarding dental, vision, 
                and hearing services, and regarding sexually-
                transmitted diseases and other communicable diseases.
            ``(2) Option regarding family planning services.--A grantee 
        under subsection (a) may, at the option of the grantee, expend 
        the grant under such subsection to provide voluntary family 
        planning services. The Secretary may not require as a condition 
        of the receipt of a grant under subsection (a) that an 
        applicant for the grant agree to provide such services.
            ``(3) Other services.--In addition to services specified in 
        any of paragraphs (1) and (2), the Secretary may authorize a 
        grantee under subsection (a) to expend the grant for such 
        additional health or health-related services for school 
        children as the Secretary determines to be appropriate.
            ``(4) Availability throughout year.--The Secretary may make 
        a grant under subsection (a) only if the applicant involved 
        agrees that services under the grant will be available 
        throughout the year (including any portion of the year during 
        which the school does not hold classes).
    ``(e) Cultural Context of Services.--The Secretary may make a grant 
under subsection (a) only if the applicant involved agrees that 
services under the grant will be provided in the language and cultural 
context most appropriate for the individuals to whom the services are 
provided.
    ``(f) Limitation on Imposition of Fees for Services.--The Secretary 
may make a grant under subsection (a) only if the applicant involved 
agrees that, if a fee is imposed for the provision of services under 
the grant, such fee--
            ``(1) will be made according to a schedule of fees that is 
        made available to the public;
            ``(2) will be adjusted to reflect the income and resources 
        of the school-children involved; and
            ``(3) will not be imposed on any school child with an 
        income of less than 150 percent of the applicable official 
        poverty line (established by the Director of the Office of 
        Management and Budget and revised by the Secretary in 
        accordance with section 673(2) of the Omnibus Budget 
        Reconciliation Act of 1981).
    ``(g) Matching Funds.--
            ``(1) In general.--With respect to the costs of the program 
        to be carried out under subsection (a) by an applicant, the 
        Secretary, subject to paragraph (3), may make a grant under 
        such subsection only if the applicant agrees to make available 
        (directly or through donations from public or private entities) 
        non-Federal contributions toward such costs in an amount that 
        is--
                    ``(A) for the first fiscal year for which the 
                applicant receives such a grant, 10 percent of such 
                costs;
                    ``(B) for any second such fiscal year, 25 percent 
                of such costs; and
                    ``(C) for any subsequent such fiscal year, 50 
                percent of such costs.
            ``(2) Determination of amount contributed.--Non-Federal 
        contributions required in paragraph (1) may be in cash or in 
        kind, fairly evaluated, including plant, equipment, or 
        services. Amounts provided by the Federal Government, or 
        services assisted or subsidized to any significant extent by 
        the Federal Government, may not be included in determining the 
        amount of such non-Federal contributions.
            ``(3) Waiver.--The Secretary may for an applicant waive the 
        requirement of paragraph (1) for a fiscal year if the Secretary 
        determines that the applicant will be unable to carry out a 
        program under subsection (a) otherwise. If the Secretary 
        provides a waiver under the preceding sentence for a grantee 
        under subsection (a) for a fiscal year, the Secretary may make 
        a grant to the applicant for the following fiscal year only if 
        the Secretary reviews the waiver to determine whether the 
        waiver should remain in effect.
    ``(h) Additional Agreements.--The Secretary may make a grant under 
subsection (a) only if the applicant involved agrees as follows:
            ``(1) The applicant will maintain the confidentiality of 
        patient records.
            ``(2) The applicant will establish an ongoing quality 
        assurance program regarding services provided under the grant.
            ``(3) The applicant will not expend more than 10 percent of 
        the grant for administrative expenses regarding the grant.
    ``(i) Reports to Secretary.--The Secretary may make a grant under 
subsection (a) only if the applicant agrees that, not later than 
February 1 of the fiscal year following the fiscal year for which the 
grant is to be made, the applicant will submit to the Secretary a 
report describing the program carried out by the applicant under the 
grant, including provisions on the utilization, cost, and outcome of 
services provided under the grant.
    ``(j) Application for Grant; Plan.--The Secretary may make a grant 
under subsection (a) only if an application for the grant is submitted 
to the Secretary; the application contains a plan describing the 
proposal of the applicant for a program under subsection (a); and the 
application is in such form, is made in such manner, and contains such 
agreements, assurances, and information as the Secretary determines to 
be necessary to carry out this section.
    ``(k) Evaluation of Programs.--The Secretary, directly or through 
grants or contracts, shall provide for evaluations of programs carried 
out under subsection (a), including the cost-effectiveness and health-
effectiveness of the programs.
    ``(l) Reports to Congress.--Not later than May 31 of each fiscal 
year, the Secretary shall submit to the Congress a report on the 
programs carried out under subsection (a). The report shall include a 
summary of the evaluations carried out under subsection (k) for the 
preceding fiscal year.
    ``(m) Authorization of Appropriations.--For the purpose of carrying 
out this section, there is authorized to be appropriated $100,000,000 
for fiscal year 1996, $275,000,000 for fiscal year 1997, $350,000,000 
for fiscal year 1998, and $400,000,000 for each of the fiscal years 
1999 and 2000.''.
    (b) Conforming Amendment.--Part D of title III of the Public Health 
Service Act (42 U.S.C 254b et seq.), as amended by section 104 of 
Public Law 103-183 (107 Stat. 2230), is amended in the heading for 
subpart VIII by striking ``Bulk'' and all that follows and inserting 
the following: ``Miscellaneous Provisions Regarding Primary Health 
Care''.
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