Findings; purpose

(a)

Findings

The Congress finds as follows: (1)Nearly 8,700,000 children in the United States have no health insurance, including an increase of over 600,000 in the past year. (2)The American Medical Association rates adolescents aged 13 to 18 as the group of Americans with the poorest health indicators. (3)More than 70 percent of children who need psychiatric treatment do not receive services. (4)School-based health centers are located in over 1,700 schools in 43 States, the District of Columbia, and Puerto Rico. (5)School-based health centers ensure access to health care by providing care regardless of a child’s ability to pay. (6)Forty-five percent of children and adolescents treated at school-based health centers have no insurance. (7)Forty-four percent of children and adolescents treated at school-based health centers are enrolled in Medicaid, SCHIP, or other public coverage. (8)School-based health centers promote access to providers for many children and adolescents who otherwise would have difficulty seeing a provider. (9)School-based health centers effectively provide primary, preventative, and mental health services to children and adolescents. (10)School-based health centers effectively utilize resources by often leveraging State and local government funds, private contributions, and Medicaid, SCHIP, and private insurance payments. (11)For school-based health centers’ target demographic (students with public insurance or who are uninsured), data show that school-based health centers decrease school absences. (12)School-based health centers identify students at risk for health and behavioral problems, thus reducing obstacles to the learning process. (13)School-based health centers administer medication to students with chronic illness, which reduces absences as well as disciplinary action for students with behavioral health problems. (14)Empirical analyses show that school-based health centers reduce Medicaid costs by providing cost-effective and timely care. (15)School-based health centers encourage parental involvement to increase family participation in school- and education-oriented activities. (b)

Purpose

The purpose of this Act is to fund the development and operation of school-based health clinics— (1)to provide comprehensive and accessible primary health care services to medically underserved children, youth, and families; (2)to improve the physical health, emotional well-being, and academic performance of medically underserved children, youth, and families; and (3)to work in collaboration with the school to integrate health into the overall school environment.

School-based health clinics

Part Q of title III of the Public Health Service Act (42 U.S.C. 280h et seq.) is amended by adding at the end the following:

399Z–1.

School-based health clinics

(a)

Definitions; Establishment of Criteria

In this section: (1)

Community

The term community includes parents, consumers, local leaders, and organizations. (2)

Comprehensive primary health services

The term comprehensive primary health services means the core services offered by school-based health clinics, which— (A)shall include physical health services and mental health services; and (B)may include optional health services such as nutrition, oral health, health education, and case management services. (3)

Mental health services

The term mental health services means mental health assessments, crisis intervention, counseling, treatment, and referral to a continuum of services including emergency psychiatric care, community support programs, inpatient care, and outpatient programs. (4)

Physical health services

The term physical health services means comprehensive health assessments; diagnosis and treatment of minor, acute, and chronic medical conditions; and referrals to, and follow-up for, specialty care. (5)

School-based health clinic

The term school-based health clinic means a health clinic that— (A)is located on school property; (B)is organized through school, community, and health provider relationships; (C)is administered by a sponsoring facility; and (D)provides, at a minimum, comprehensive primary health services during school hours to children and adolescents by health professionals in accordance with State and local laws and regulations, established standards, and community practice. (6)

Sponsoring facility

The term sponsoring facility is a community-based organization, which may include— (A)a hospital; (B)a public health department; (C)a community health center; (D)a nonprofit health care agency; (E)a school or school system; and (F)a program administered by the Indian Health Service or the Bureau of Indian Affairs or operated by an Indian tribe or a tribal organization under the Indian Self-Determination and Education Assistance Act, a Native Hawaiian entity, or an urban Indian program under title V of the Indian Health Care Improvement Act. (b)

Authority To Award Grants

The Secretary shall award grants for the costs of the operation of school-based health clinics that meet the requirements of this section. (c)

Applications

To be eligible to receive a grant under this section, an entity shall— (1)be a school-based health clinic; and (2)submit to the Secretary an application at such time and in such manner as the Secretary may require containing— (A)evidence that the applicant meets all criteria necessary to be designated as a school-based health clinic; (B)evidence of local need for the services to be provided by the clinic; (C)an assurance that— (i)school-based health clinic services will be provided to those children and adolescents for whom parental or guardian consent has been obtained in cooperation with Federal, State, and local laws governing health care services provision to children and adolescents; (ii)the clinic has made and will continue to make every reasonable effort to establish and maintain collaborative relationships with other health care providers in the catchment area of the clinic; (iii)the clinic will provide on-site access during the academic day when school is in session and 24-hour coverage through an on-call system and through its backup health providers to ensure access to services on a year-round basis when the clinic is closed; (iv)the clinic will be integrated into the school environment and will coordinate health services with school personnel, such as administrators, teachers, nurses, counselors, and support personnel, as well as with other community providers co-located at the school; and (v)the clinic sponsoring facility assumes all responsibility for the clinic’s administration, operations, and oversight; and (D)such other information as the Secretary may require. (d)

Preferences

In reviewing applications under this section, the Secretary may give preference to applicants who demonstrate an ability to serve the following: (1)Communities with evidence of barriers to primary health care and mental health services for children and adolescents. (2)Communities that have consistently scored poorly on child and adolescent standardized health indicator reports. (3)Communities with high percentages of children and adolescents who are uninsured, underinsured, or enrolled in public health insurance programs. (4)Populations of children and adolescents that have demonstrated difficulty historically in accessing physical and mental health services. (e)

Waiver of requirements

The Secretary may, under appropriate circumstances, waive the application of all or part of the requirements of this section with respect to a school-based health clinic for a designated period of time to be determined by the Secretary. (f)

Use of Funds

(1)

Funds

Funds awarded under a grant under this section may be used for— (A)acquiring and leasing buildings and equipment (including the costs of amortizing the principle of, and paying interest on, loans for such buildings and equipment); (B)providing training related to the provision of comprehensive primary health services and additional health services; (C)managing a school-based health clinic; (D)paying the salaries of physicians and other personnel; and (E)purchasing medical supplies, medical equipment, office supplies, and office equipment. (2)

Amount

The amount of any grant made under this section in any fiscal year to a school-based health clinic shall be determined by the Secretary, taking into account— (A)the financial need of the clinic; (B)State, local, or other operation funding provided to the clinic; and (C)other factors as determined appropriate by the Secretary. (g)

Technical Assistance

The Secretary shall establish a program through which the Secretary provides (either through the Department of Health and Human Services or by grant or contract) technical and other assistance to school-based health clinics to assist such clinics to meet the requirements of subsection (c)(2)(C). Services provided through the program may include necessary technical and nonfinancial assistance, including fiscal and program management assistance, training in fiscal and program management, operational and administrative support, and the provision of information to the entities of the variety of resources available under this title and how those resources can be best used to meet the health needs of the communities served by the entities. (h)

Evaluation

The Secretary shall develop and implement a plan for evaluating school-based health clinics receiving funds under this section and monitoring the quality of their performance. (i)

Authorization of Appropriations

For purposes of carrying out this section, there are authorized to be appropriated $50,000,000 for fiscal year 2009, $55,000,000 for fiscal year 2010, $60,500,000 for fiscal year 2011, $66,550,000 for fiscal year 2012, and $73,200,000 for fiscal year 2013.