[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 1044 Introduced in Senate (IS)]
104th CONGRESS
1st Session
S. 1044
To amend title III of the Public Health Service Act to consolidate and
reauthorize provisions relating to health centers, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 17 (legislative day, July 10), 1995
Mrs. Kassebaum (for herself, Mr. Kennedy, Mr. Jeffords, Mr. Pell, and
Mr. Simon) introduced the following bill; which was read twice and
referred to the Committee on Labor and Human Resources
_______________________________________________________________________
A BILL
To amend title III of the Public Health Service Act to consolidate and
reauthorize provisions relating to 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. SHORT TITLE.
This Act may be cited as the ``Health Centers Consolidation Act of
1995''.
SEC. 2. CONSOLIDATION AND REAUTHORIZATION OF PROVISIONS.
Subpart I of part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq.) is amended to read as follows:
``Subpart I--Health Centers
``SEC. 330. HEALTH CENTERS.
``(a) Definition of Health Center.--
``(1) In general.--For purposes of this section, the term
`health center' means an entity that serves a population that
is medically underserved, or a special medically underserved
population comprised of migratory and seasonal agricultural
workers, the homeless, and residents of public housing, by
providing, either through the staff and supporting resources of
the center or through contracts or cooperative arrangements--
``(A) required primary health services (as defined
in subsection (b)(1)); and
``(B) as may be appropriate for particular centers,
additional health services (as defined in subsection
(b)(2)) necessary for the adequate support of the
primary health services required under subparagraph
(A);
for all residents of the area served by the center (hereafter
referred to in this section as the `catchment area').
``(2) Limitation.--The requirement in paragraph (1) to
provide services for all residents within a catchment area
shall not apply in the case of a health center receiving a
grant only under subsection (f), (g), or (h).
``(b) Definitions.--For purposes of this section:
``(1) Required primary health services.--
``(A) In general.--The term `required primary
health services' means--
``(i) basic health services which, for
purposes of this section, shall consist of--
``(I) health services related to
family medicine, internal medicine,
pediatrics, obstetrics, or gynecology
that are furnished by physicians and
where appropriate, physician
assistants, nurse practitioners, and
nurse midwives;
``(II) diagnostic laboratory and
radiologic services;
``(III) preventive health services,
including--
``(aa) prenatal and
perinatal services;
``(bb) screening for breast
and cervical cancer;
``(cc) well-child services;
``(dd) immunizations
against vaccine-preventable
diseases;
``(ee) screenings for
elevated blood lead levels,
communicable diseases, and
cholesterol;
``(ff) pediatric eye, ear,
and dental screenings to
determine the need for vision
and hearing correction and
dental care;
``(gg) voluntary family
planning services; and
``(hh) preventive dental
services;
``(IV) emergency medical services;
and
``(V) pharmaceutical services as
may be appropriate for particular
centers;
``(ii) referrals to providers of medical
services and other health-related services
(including substance abuse and mental health
services);
``(iii) patient case management services
(including counseling, referral, and follow-up
services) and other 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;
``(iv) services that enable individuals to
use the services of the health 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
``(v) education of patients and the general
population served by the health center
regarding the availability and proper use of
health services.
``(B) Exception.--With respect to a health center
that receives a grant only under subsection (f), the
Secretary, upon a showing of good cause, shall--
``(i) waive the requirement that the center
provide all required primary health services
under this paragraph; and
``(ii) approve, as appropriate, the
provision of certain required primary health
services only during certain periods of the
year.
``(2) Additional health services.--The term `additional
health services' means services that are not included as
required primary health services and that are appropriate to
meet the health needs of the population served 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 under subsection (f), special occupation-related
health services for migratory and seasonal agricultural
workers, including--
``(i) screening for and control of
infectious diseases, including parasitic
diseases; and
``(ii) injury prevention programs,
including prevention of exposure to unsafe
levels of agricultural chemicals including
pesticides.
``(3) Medically underserved populations.--
``(A) In general.--The term `medically underserved
population' means the population of an urban or rural
area designated by the Secretary as an area with a
shortage of personal health services or a population
group designated by the Secretary as having a shortage
of such services.
``(B) Criteria.--In carrying out subparagraph (A),
the Secretary shall prescribe criteria for determining
the specific shortages of personal health services of
an area or population group. Such criteria shall--
``(i) take into account comments received
by the Secretary from the chief executive
officer of a State and local officials in a
State; and
``(ii) include factors indicative of the
health status of a population group or
residents of an area, the ability of the
residents of an area or of a population group
to pay for health services and their
accessibility to them, and the availability of
health professionals to residents of an area or
to a population group.
``(C) Limitation.--The Secretary may not designate
a medically underserved population in a State or
terminate the designation of such a population unless,
prior to such designation or termination, the Secretary
provides reasonable notice and opportunity for comment
and consults with--
``(i) the chief executive officer of such
State;
``(ii) local officials in such State; and
``(iii) the organization, if any, which
represents a majority of health centers in such
State.
``(D) Permissible designation.--The Secretary may
designate a medically underserved population that does
not meet the criteria established under subparagraph
(B) if the chief executive officer of the State in
which such population is located and local officials of
such State recommend the designation of such population
based on unusual local conditions which are a barrier
to access to or the availability of personal health
services.
``(c) Planning Grants.--
``(1) In general.--
``(A) Centers.--The Secretary may make grants to
public and nonprofit private entities for projects to
plan and develop health centers which will serve
medically underserved populations. A project for which
a grant may be made under this subsection may include
the cost of the acquisition, expansion, and
modernization of existing buildings and construction of
new buildings (including the costs of amortizing the
principal of, and paying the interest on, loans) and
shall include--
``(i) an assessment of the need that the
population proposed to be served by the health
center for which the project is undertaken has
for required primary health services and
additional health services;
``(ii) the design of a health center
program for such population based on such
assessment;
``(iii) efforts to secure, within the
proposed catchment area of such center,
financial and professional assistance and
support for the project;
``(iv) initiation and encouragement of
continuing community involvement in the
development and operation of the project; and
``(v) proposed linkages between the center
and other appropriate provider entities, such
as health departments, local hospitals, and
rural health clinics, to provide better
coordinated, higher quality, and more cost-
effective health care services.
``(B) Comprehensive service delivery networks and
plans.--The Secretary may make grants to health centers
that receive assistance under this section to enable
the centers to plan and develop a network or plan for
the provision of health services, which may include the
provision of health services on a prepaid basis or
through another managed care arrangement, 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
subsection (d)(1)(A) for at least 2 consecutive
years preceding the year of the grant under
this subparagraph or has otherwise
demonstrated, as required by the Secretary,
that such center has been providing primary
care services for at least the 2 consecutive
years immediately preceding such year; and
``(ii) the center provides assurances
satisfactory to the Secretary that the
provision of such services on a prepaid basis,
or under another managed care arrangement, will
not result in the diminution of the level or
quality of health services provided to the
medically underserved population served prior
to the grant under this subparagraph.
Any such grant may include the acquisition and lease,
expansion, and modernization of existing buildings,
construction of new buildings, acquisition or lease of
equipment which may include data and information
systems, and providing training and technical
assistance related to the provision of health services
on a prepaid basis or under another managed care
arrangement, and for other purposes that promote the
development of managed care networks and plans.
``(2) Limitation.--Not more than two grants may be made
under this subsection for the same project, except that upon a
showing of good cause, the Secretary may make additional grant
awards.
``(d) Operating Grants.--
``(1) Authority.--
``(A) In general.--The Secretary may make grants
for the costs of the operation of public and nonprofit
private health centers that provide health services to
medically underserved populations.
``(B) Entities that fail to meet certain
requirements.--The Secretary may make grants, for a
period of not to exceed 2-years, for the costs of the
operation of public
and nonprofit private entities which provide health
services to medically underserved populations but with respect to which
the Secretary is unable to make each of the determinations required by
subsection (j)(3).
``(2) Use of funds.--The costs for which a grant may be
made under subparagraph (A) or (B) of paragraph (1) may include
the costs of acquiring, expanding, and modernizing existing
buildings and constructing new buildings (including the costs
of amortizing the principal of, and paying interest on, loans),
the costs of repaying loans for buildings, and the costs of
providing training related to the provision of required primary
health services and additional health services and to the
management of health center programs.
``(3) Limitation.--Not more than two grants may be made
under subparagraph (B) of paragraph (1) for the same entity.
``(4) Amount.--
``(A) In general.--The amount of any grant made in
any fiscal year under paragraph (1) to a 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) State, local, and other operational
funding provided to the center; and
``(ii) the fees, premiums, and third-party
reimbursements, which the center may reasonably
be expected to receive for its operations in
such fiscal year.
``(B) Payments.--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
adjustments may be made for overpayments or
underpayments.
``(C) Use of nongrant funds.--Nongrant funds
described in clauses (i) and (ii) of subparagraph (A),
including any such funds in excess of those originally
expected, shall be used as permitted under this
section, and may be used for such other purposes as are
not specifically prohibited under this section if such
use furthers the objectives of the project.
``(e) Infant Mortality Grants.--
``(1) In general.--The Secretary may make grants to health
centers for the purpose of assisting such centers in--
``(A) providing comprehensive health care and
support services for the reduction of--
``(i) the incidence of infant mortality;
and
``(ii) morbidity among children who are
less than 3 years of age; and
``(B) developing and coordinating service and
referral arrangements between health centers and other
entities for the health management of pregnant women
and children described in subparagraph (A).
``(2) Priority.--In making grants under this subsection the
Secretary shall give priority to health centers providing
services to any medically underserved population among which
there is a substantial incidence of infant mortality or among
which there is a significant increase in the incidence of
infant mortality.
``(3) Requirements.--The Secretary may make a grant under
this subsection only if the health center involved agrees
that--
``(A) the center will coordinate the provision of
services under the grant to each of the recipients of
the services;
``(B) such services will be continuous for each
such recipient;
``(C) the center will provide follow-up services
for individuals who are referred by the center for
services described in paragraph (1);
``(D) the grant will be expended to supplement, and
not supplant, the expenditures of the center for
primary health services (including prenatal care) with
respect to the purpose described in this subsection;
and
``(E) the center will coordinate the provision of
services with other maternal and child health providers
operating in the catchment area.
``(f) Migratory and Seasonal Agricultural Workers.--
``(1) In general.--The Secretary may 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--
``(A) migratory agricultural workers, seasonal
agricultural workers, and members of the families of
such migratory and seasonal agricultural workers who
are within a designated catchment area; and
``(B) individuals who have previously been
migratory agricultural workers but who no longer meet
the requirements of subparagraph (A) of paragraph (4)
because of age or disability and members of the
families of such individuals who are within such
catchment area.
``(2) Environmental concerns.--The Secretary may enter into
grants or contracts under this subsection with public and
private entities to--
``(A) assist the States in the implementation and
enforcement of acceptable environmental health
standards, including enforcement of standards for
sanitation in migratory agricultural worker labor
camps, and applicable Federal and State pesticide
control standards; and
``(B) conduct projects and studies to assist the
several States and entities which have received grants
or contracts under this section in the assessment of
problems related to camp and field sanitation, exposure
to unsafe levels of agricultural chemicals including
pesticides, and other environmental health hazards to
which migratory agricultural workers and members of
their families are exposed.
``(3) Definitions.--For purposes of this subsection:
``(A) Migratory agricultural worker.--The term
`migratory agricultural worker' means an individual
whose principal employment is in agriculture on a
seasonal basis, who has been so employed within the
last 24 months, and who establishes for the purposes of
such employment a temporary abode.
``(B) Seasonal agricultural worker.--The term
`seasonal agricultural worker' means an individual
whose principal employment is in agriculture on a
seasonal basis and who is not a migratory agricultural
worker.
``(C) Agriculture.--The term `agriculture' means
farming in all its branches, including--
``(i) cultivation and tillage of the soil;
``(ii) the production, cultivation,
growing, and harvesting of any commodity grown
on, in, or as an adjunct to or part of a
commodity grown in or on, the land; and
``(iii) any practice (including preparation
and processing for market and delivery to
storage or to market or to carriers for
transportation to market) performed by a farmer
or on a farm incident to or in conjunction with
an activity described in clause (ii).
``(g) Homeless Population.--
``(1) In general.--The Secretary may 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 grants for innovative programs that provide outreach
and comprehensive primary health services to homeless children
and children at risk of homelessness.
``(2) Required services.--In addition to required primary
health services (as defined in subsection (b)(1)), an 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.--A grant awarded
under this subsection shall be expended to supplement, and not
supplant, the expenditures of the health center and the value
of in kind contributions for the delivery of services to the
population described in paragraph (1).
``(4) Definitions.--For purposes of this section:
``(A) Homeless individual.--The term `homeless
individual' means an individual who lacks housing
(without regard to whether the individual is a member
of a family), including an individual whose primary
residence during the night is a supervised public or
private facility that provides temporary living
accommodations and an individual who is a resident in
transitional housing.
``(B) Substance abuse.--The term `substance abuse'
has the same meaning given such term in section 534(4).
``(C) Substance abuse services.--The term
`substance abuse services' includes detoxification and
residential treatment for substance abuse provided in
settings other than hospitals.
``(h) Residents of Public Housing.--
``(1) In general.--The Secretary may 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 residents of public housing
(such term, for purposes of this subsection, shall have the
same meaning given such term in section 3(b)(1) of the United
States Housing Act of 1937) and individuals living in areas
immediately accessible to such public housing.
``(2) Supplement not supplant.--A grant awarded under this
subsection shall be expended to supplement, and not supplant,
the expenditures of the health center and the value of in kind
contributions for the delivery of services to the population
described in paragraph (1).
``(3) Consultation with residents.--The Secretary may not
make a grant under paragraph (1) unless, with respect to the
residents of the public housing involved, the applicant for the
grant--
``(A) has consulted with the residents in the
preparation of the application for the grant; and
``(B) agrees to provide for ongoing consultation
with the residents regarding the planning and
administration of the program carried out with the
grant.
``(i) Applications.--
``(1) Submission.--No grant may be made under this section
unless an application therefore 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) Description of need.--An application for a grant
under subparagraph (A) or (B) of subsection (d)(1) for a health
center shall include--
``(A) a description of the need for health services
in the catchment area of the center;
``(B) a demonstration by the applicant that the
area or the population group to be served by the
applicant has a shortage of personal health services;
and
``(C) a demonstration that the center will be
located so that it will provide services to the
greatest number of individuals residing in the
catchment area or included in such population group.
Such a demonstration shall be made on the basis of the criteria
prescribed by the Secretary under subsection (b)(3) or on any
other criteria which the Secretary may prescribe to determine
if the area or population group to be served by the applicant
has a shortage of personal health services. In 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 an assurance that the
applicant will provide any health service defined under
paragraphs (1) and (2) of subsection (b) that 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 to the applicant.
``(3) Requirements.--Except as provided in subsection
(d)(1)(B), the Secretary may not approve an application for a
grant under subparagraph (A) or (B) of subsection (d)(1) unless
the Secretary determines that the entity for which the
application is submitted is a health center (within the meaning
of subsection (a)) and that--
``(A) the required primary health services of the
center will be available and accessible in the
catchment area of the center promptly, as appropriate,
and in a manner which assures continuity;
``(B) the center will have an ongoing quality
improvement system that includes clinical services and
management, and that maintains the confidentiality of
patient records;
``(C) the center will demonstrate its financial
responsibility by the use of such accounting procedures
and other requirements as may be prescribed by the
Secretary;
``(D) the center--
``(i) has or will have a contractual 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 center's costs in providing health
services to persons who are eligible for
medical assistance under such a State plan; or
``(ii) has made or will make every
reasonable effort to enter into such an
arrangement;
``(E) the center 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
insurance benefits under title XVIII of the Social
Security Act, to medical assistance under a State plan
approved under title XIX of such Act, or to assistance
for medical expenses under any other public assistance
program or private health insurance program;
``(F) the center--
``(i) has prepared a schedule of fees or
payments for the provision of its services
consistent with locally prevailing rates or
charges and designed to cover its reasonable
costs of operation and has prepared a
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;
``(ii) 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 services to persons described in
subparagraph (E) on the basis of the
full amount of fees and payments for
such services without application of any discount; and
``(iii) has submitted to the Secretary such
reports as the Secretary may require to
determine compliance with this subparagraph;
``(G) the center has established a governing board
which except in the case of an entity operated by an
Indian tribe or tribal or Indian organization under the
Indian Self-Determination Act--
``(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) meets at least once a month, 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
governing board of a public center (as defined
in the second sentence of this paragraph),
establishes general policies for the center;
and
``(iii) in the case of an application for a
second or subsequent grant for a public 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;
except that, upon a showing of good cause the Secretary
shall 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), (h),
or (o);
``(H) the center has developed--
``(i) an overall plan and budget that meets
the requirements of the Secretary; and
``(ii) an effective procedure for compiling
and reporting to the Secretary such statistics
and other information as the Secretary may
require relating to--
``(I) the costs of its operations;
``(II) the patterns of use of its
services;
``(III) the availability,
accessibility, and acceptability of its
services; and
``(IV) such other matters relating
to operations of the applicant as the
Secretary may require;
``(I) the center will review periodically its
catchment area to--
``(i) ensure that the size of such area is
such that the services to be provided through
the center (including any satellite) are
available and accessible to the residents of
the area promptly and as appropriate;
``(ii) ensure that the boundaries of such
area conform, to the extent practicable, to
relevant boundaries of political subdivisions,
school districts, and Federal and State health
and social service programs; and
``(iii) ensure that the boundaries of such
area eliminate, to the extent possible,
barriers to access to the services of the
center, including barriers resulting from the
area's physical characteristics, its
residential patterns, its economic and social
grouping, and available transportation;
``(J) in the case of a center which serves a
population including a substantial proportion of
individuals of limited English-speaking ability, the
center has--
``(i) developed a plan and made
arrangements responsive to the needs of such
population for providing services to the extent
practicable in the language and cultural
context most appropriate to such individuals;
and
``(ii) identified an individual on its
staff who is fluent in both that language and
in English and whose responsibilities shall
include providing guidance to such individuals
and to appropriate staff members with respect
to cultural sensitivities and bridging
linguistic and cultural differences; and
``(K) the center, has developed an ongoing referral
relationship with one or more hospitals.
For purposes of subparagraph (G), the term `public center'
means a health center funded (or to be funded) through a grant
under this section to a public agency.
``(4) Approval of new or expanded service applications.--
The Secretary shall approve applications for grants under
subparagraph (A) or (B) of subsection (d)(1) for health centers
which--
``(A) have not received a previous grant under such
subsection; or
``(B) have applied for such a grant to expand their
services;
in such a manner that the ratio of the medically underserved
populations in rural areas which may be expected to use the
services provided by such centers to the medically 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) New construction.--The Secretary may make a grant
under subsection (c) or (d) for the construction of new
buildings for a health center only if the Secretary determines
that appropriate facilities are not available through
acquiring, modernizing, or expanding existing buildings and
that the entity to which the grant will be made has made
reasonable efforts to secure from other sources
funds, in lieu of the grant, to construct such facilities.
``(j) Technical and Other Assistance.--The Secretary may provide
(either through the Department of Health and Human Services or by grant
or contract) all necessary technical and other nonfinancial assistance
(including fiscal and program management assistance and training in
such management) to any public or private nonprofit entity to assist
entities in developing plans for, or operating as, health centers, and
in meeting the requirements of subsection (i)(2).
``(k) Authorization of Appropriations.--
``(1) In general.--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) Special provisions.--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
(i)(3)) the governing boards of which (as described in
subsection (i)(3)(G)(ii)) do not establish general policies for
such centers, an amount which exceeds 5 percent of the amounts
appropriated under this section for that fiscal year. For
purposes of applying the preceding sentence, the term `public
centers' shall not include health centers that receive grants
pursuant to subsection (g) or (h).
``(3) Funding report.--The Secretary shall annually prepare
and submit to the appropriate committees of Congress a report
concerning the distribution of funds under this section that
are provided to meet the health care needs of medically
underserved populations, including the homeless, residents of
public housing, and migratory and seasonal agricultural
workers, and the appropriateness of the delivery systems
involved in responding to the needs of the particular
populations. Such report shall include an assessment of the
relative health care access needs of the targeted populations
and the rationale for any substantial changes in the
distribution of funds.
``(l) Memorandum of Agreement.--In carrying out this section, the
Secretary may enter into a memorandum of agreement with a State. Such
memorandum may include, where appropriate, provisions permitting such
State to--
``(1) analyze the need for primary health services for
medically underserved populations within such State;
``(2) assist in the planning and development of new health
centers;
``(3) review and comment upon annual program plans and
budgets of health centers, including comments upon allocations
of health care resources in the State;
``(4) assist health centers in the development of clinical
practices and fiscal and administrative systems through a
technical assistance plan which is responsive to the requests
of health centers; and
``(5) share information and data relevant to the operation
of new and existing health centers.
``(m) Records.--
``(1) In general.--Each entity which receives a grant under
subsection (d) shall establish and maintain such records as the
Secretary shall require.
``(2) Availability.--Each entity which is required to
establish and maintain records under this subsection shall make
such books, documents, papers, and records available to the
Secretary or the Comptroller General of the United States, or
any of their duly authorized representatives, for examination,
copying or mechanical reproduction on or off the premises of
such entity upon a reasonable request therefore. The Secretary
and the Comptroller General of the United States, or any of
their duly authorized representatives, shall have the authority
to conduct such examination, copying, and reproduction.
``(n) Delegation of Authority.--The Secretary may delegate the
authority to administer the programs authorized by this section to any
office within the Service, except that the authority to enter into,
modify, or issue approvals with respect to grants or contracts may be
delegated only within the Health Resources and Services Administration.
``(o) Special Consideration.--In making grants under this section,
the Secretary shall give special consideration to the unique needs of
sparsely populated rural areas, including priority in the awarding of
grants for new health centers under subsections (c) and (d), and the
granting of waivers as appropriate and permitted under subsections
(b)(1)(B)(i) and (i)(3)(G).''.
SEC. 3. RURAL HEALTH OUTREACH, NETWORK DEVELOPMENT, AND TELEMEDICINE
GRANT PROGRAM.
(a) In General.--Subpart I of part D of title III of the Public
Health Service Act (42 U.S.C. 254b et seq.) (as amended by section 2)
is further amended by adding at the end thereof the following new
section:
``SEC. 330A. RURAL HEALTH OUTREACH, NETWORK DEVELOPMENT, AND
TELEMEDICINE GRANT PROGRAM.
``(a) Administration.--The rural health services outreach
demonstration grant program established under section 301 shall be
administered by the Office of Rural Health Policy (of the Health
Resources and Services Administration), in consultation with State
rural health offices or other appropriate State governmental entities.
``(b) Grants.--Under the program referred to in subsection (a), the
Secretary, acting through the Director of the Office of Rural Health
Policy, may award grants to expand access to, coordinate, restrain the
cost of, and improve the quality of essential health care services,
including preventive and emergency services, through the development of
integrated health care delivery systems or networks in rural areas and
regions.
``(c) Eligible Networks.--
``(1) Outreach networks.--To be eligible to receive a grant
under this section, an entity shall--
``(A) be a rural public or nonprofit private entity
that is or represents a network or potential network
that includes three or more health care providers or
other entities that provide or support the delivery of
health care services; and
``(B) in consultation with the State office of
rural health or other appropriate State entity, prepare
and submit to the Secretary an application, at such
time, in such manner, and containing such information
as the Secretary may require, including--
``(i) a description of the activities which
the applicant intends to carry out using
amounts provided under the grant;
``(ii) a plan for continuing the project
after Federal support is ended;
``(iii) a description of the manner in
which the activities funded under the grant
will meet health care needs of underserved
rural populations within the State; and
``(iv) a description of how the local
community or region to be served by the network
or proposed network will be involved in the
development and ongoing operations of the
network.
``(2) For-profit entities.--An eligible network may include
for-profit entities so long as the network grantee is a
nonprofit entity.
``(3) Telemedicine networks.--
``(A) In general.--An entity that is a health care
provider and a member of an existing or proposed
telemedicine network, or an entity that is a consortium
of health care providers that are members of an
existing or proposed telemedicine network shall be
eligible for a grant under this section.
``(B) Requirement.--A telemedicine network referred
to in subparagraph (A) shall, at a minimum, be composed
of--
``(i) a multispecialty entity that is
located in an urban or rural area, which can
provide 24-hour a day access to a range of
specialty care; and
``(ii) at least two rural health care
facilities, which may include rural hospitals,
rural physician offices, rural health clinics,
rural community health clinics, and rural
nursing homes.
``(d) Preference.--In awarding grants under this section, the
Secretary shall give preference to applicant networks that include--
``(1) a majority of the health care providers serving in
the area or region to be served by the network;
``(2) any federally qualified health centers, rural health
clinics, and local public health departments serving in the
area or region;
``(3) outpatient mental health providers serving in the
area or region; or
``(4) appropriate social service providers, such as
agencies on aging, school systems, and providers under the
women, infants, and children program, to improve access to and
coordination of health care services.
``(e) Use of Funds.--
``(1) In general.--Amounts provided under grants awarded
under this section shall be used--
``(A) for the planning and development of
integrated self-sustaining health care networks; and
``(B) for the initial provision of services.
``(2) Expenditures in rural areas.--
``(A) In general.--In awarding a grant under this
section, the Secretary shall ensure that not less than
50 percent of the grant award is expended in a rural
area or to provide services to residents of rural
areas.
``(B) Telemedicine networks.--An entity described
in subsection (c)(3) may not use in excess of--
``(i) 40 percent of the amounts provided
under a grant under this section to carry out
activities under paragraph (3)(A)(iii); and
``(ii) 20 percent of the amounts provided
under a grant under this section to pay for the
indirect costs associated with carrying out the
purposes of such grant.
``(3) Telemedicine networks.--
``(A) In general.--An entity described in
subsection (c)(3), may use amounts provided under a
grant under this section to--
``(i) demonstrate the use of telemedicine
in facilitating the development of rural health
care networks and for improving access to
health care services for rural citizens;
``(ii) provide a baseline of information
for a systematic evaluation of telemedicine
systems serving rural areas;
``(iii) purchase or lease and install
equipment; and
``(iv) operate the telemedicine system and
evaluate the telemedicine system.
``(B) Limitations.--An entity described in
subsection (c)(3), may not use amounts provided under a
grant under this section--
``(i) to build or acquire real property;
``(ii) purchase or install transmission
equipment (such as laying cable or telephone
lines, microwave towers, satellite dishes,
amplifiers, and digital switching equipment);
or
``(iii) for construction, except that such
funds may be expended for minor renovations
relating to the installation of equipment;
``(f) Term of Grants.--Funding may not be provided to a network
under this section for in excess of a 3-year period.
``(g) Authorization of Appropriations.--For the purpose of carrying
out this section there are authorized to be appropriated $36,000,000
for fiscal year 1996, and such sums as may be necessary for each of the
fiscal years 1997 through 2000.''.
(b) Transition.--The Secretary of Health and Human Services shall
ensure the continued funding of grants made, or contracts or
cooperative agreements entered into, under subpart I of part D of title
III of the Public Health Service Act (42 U.S.C. 254b et seq.) (as such
subpart existed on the day prior to the date of enactment of this Act),
until the expiration of the grant period or the term of the contract or
cooperative agreement. Such funding shall be continued under the same
terms and conditions as where in effect on the date on which the grant,
contract or cooperative agreement was awarded, subject to the
availability of appropriations.
SEC. 4. TECHNICAL AND CONFORMING AMENDMENTS.
(a) In General.--The Public Health Service Act is amended--
(1) in section 224(g)(4) (42 U.S.C. 233(g)(4)) by striking
``under'' and all that follows through the end thereof and
inserting ``under section 330.'';
(2) in section 340C(a)(2) (42 U.S.C. 256c) by striking
``diseases'' and all that follows through the end thereof and
inserting ``with assistance provided under section 330.''; and
(3) by repealing subparts V and VI of part D of title III
(42 U.S.C. 256 et seq.).
(b) Social Security Act.--The Social Security Act is amended--
(1) in clauses (i) and (ii)(I) of section 1861(aa)(4)(A)
(42 U.S.C. 1395x(aa)(4)(A)(i) and (ii)(I)) by striking
``section 329, 330, or 340'' and inserting ``section 330 (other
than subsection (h))''; and
(2) in clauses (i) and (ii)(II) of section 1905(l)(2)(B)
(42 U.S.C. 1396d(l)(2)(B)(i) and (ii)(II)) by striking
``section 329, 330, 340, or 340A'' and inserting ``section
330''.
(c) References.--Whenever any reference is made in any provision of
law, regulation, rule, record, or document to a community health
center, migrant health center, public housing health center, or
homeless health center, such reference shall be considered a reference
to a health center.
(d) Additional Amendments.--After consultation with the appropriate
committees of the Congress, the Secretary of Health and Human Services
shall prepare and submit to the Congress a legislative proposal in the
form of an implementing bill containing technical and conforming
amendments to reflect the changes made by this Act.
SEC. 5. EFFECTIVE DATE.
This Act and the amendments made by this Act shall become effective
on October 1, 1995.
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