[House Report 116-532]
[From the U.S. Government Publishing Office]


116th Congress }                                          { Report
                        HOUSE OF REPRESENTATIVES
  2d Session   }                                          { 116-532

======================================================================
 
        SCHOOL-BASED HEALTH CENTERS REAUTHORIZATION ACT OF 2019

                                _______
                                

 September 24, 2020.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

 Mr. Pallone, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 2075]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 2075) to amend the Public Health Service Act to 
reauthorize school-based health centers, and for other 
purposes, having considered the same, reports favorably thereon 
without amendment and recommends that the bill do pass.

                                CONTENTS

                                                                   Page
   I. Purpose and Summary.............................................1
  II. Background and Need for the Legislation.........................2
 III. Committee Hearings..............................................2
  IV. Committee Consideration.........................................3
   V. Committee Votes.................................................3
  VI. Oversight Findings..............................................3
 VII. New Budget Authority, Entitlement Authority, and Tax Expenditure3
VIII. Federal Mandates Statement......................................4
  IX. Statement of General Performance Goals and Objectives...........4
   X. Duplication of Federal Programs.................................4
  XI. Committee Cost Estimate.........................................4
 XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits.....4
XIII. Advisory Committee Statement....................................4
 XIV. Applicability to Legislative Branch.............................4
  XV. Section-by-Section Analysis of the Legislation..................4
 XVI. Changes in Existing Law Made by the Bill, as Reported...........5

                         I. Purpose and Summary

    H.R. 2075, the ``School-Based Health Centers 
Reauthorization Act of 2019'', introduced on April 3, 2020, by 
Representatives John Sarbanes (D-MD), Paul Tonko (D-NY), Elise 
Stefanik (R-NY), and Fred Upton (R-MI), would reauthorize 
funding for the school-based health centers program through 
Fiscal Year (FY) 2024, and make technical changes to the 
program, including allowing more health centers serving 
medically underserved children and adolescents to qualify for 
funding.
    School-based health centers offer primary care services to 
students in schools and receive Federal funding through the 
Health Resources and Services Administration (HRSA). The 
authorization for this program expired in 2014.

                II. Background and Need for Legislation

    School-based health centers (SBHCs) serve as critical 
access points that provide comprehensive care to children and 
adolescents in their school, a location that is safe, 
convenient, and accessible.\1\ SBHCs provide this care through 
partnerships with community health providers, such as Federally 
Qualified Health Centers, public health departments, hospitals, 
schools, and other community institutions.\2\ They serve a 
primarily low-income and medically underserved population of 
children and adolescents.\3\ School-based health centers are a 
powerful tool for achieving health equity among children and 
adolescents who experience disparities in health outcomes 
because of ethnicity, race, and/or family income.\4\
---------------------------------------------------------------------------
    \1\https://www.sbh4all.org/school-health-care/aboutsbhcs/.
    \2\https://www.hrsa.gov/our-stories/school-health-centers/
index.html.
    \3\Id.
    \4\Id.
---------------------------------------------------------------------------
    Nearly 2,000 SBHCs currently operate nationwide,\5\ and are 
funded by a combination of patient revenue from billed 
services, government grants (State, local, and Federal), 
partner contributions, and private sector grants.\6\ The 
program's statutory authorization expired in 2014.\7\ While 
SBHCs are eligible to apply for Community Health Center funding 
and other HRSA grants, they have not received any specific 
discretionary appropriations since the Affordable Care Act in 
2010. H.R. 2075 will reauthorize the School-Based Health 
Centers Program through FY 2024.
---------------------------------------------------------------------------
    \5\Health Resources and Services Administration, School-Based 
Health Centers (www.hrsa.gov/our-stories/school-health-centers/
index.html) (accessed September 18, 2020).
    \6\School-Based Health Alliance: Redefining Health for Kids and 
Teens, Who Pays for SBHCs? (www.sbh4all.org/school-health-care/school-
based-health-care-financing/) (accessed September 21, 2020).
    \7\Id.
---------------------------------------------------------------------------

                        III. Committee Hearings

    For the purposes of section 103(i) of H. Res. 6 of the 
116th Congress, the following hearing was used to develop or 
consider H.R. 2075:
    The Subcommittee on Health held a legislative hearing on 
July 29, 2020, entitled ``Improving Access to Care: Legislation 
to Reauthorize Key Public Health Programs'' to consider H.R. 
2075, the ``School-Based Health Centers Reauthorization Act of 
2019'', and other legislation. The Subcommittee received 
testimony from the following witnesses:
           Robert Boyd, M.C.R.P., M.Div., President, 
        School-Based Health Alliance;
           Linda Goler Blount, M.P.H., President and 
        CEO, Black Women's Health Imperative;
           Nancy Goodman, M.P.P., J.D., Founder and 
        Executive Director, Kids v. Cancer;
           Aaron Seth Kesselheim, M.D., J.D., M.P.H., 
        Professor of Medicine, Harvard Medical School;
           Brian Lindberg, Chief Legal Officer and 
        General Counsel, National Bone Marrow Donor Program;
           Travis T. Tygart, Chief Executive Officer, 
        U.S. Anti-Doping Agency.

                      IV. Committee Consideration

    H.R. 2075, the ``School-Based Health Centers 
Reauthorization Act of 2019'', was introduced on April 3, 2020, 
by Representatives Sarbanes (D-MD), Tonko (D-NY), Stefanik (R-
NY), and Upton (R-MI), and was referred to the Committee on 
Energy and Commerce. It was then referred to the Subcommittee 
on Health on April 4, 2020. A legislative hearing was held on 
the bill on July 29, 2020.
    On September 9, 2020, the Subcommittee on Health was 
discharged from further consideration of H.R. 2075, as the full 
Committee on Energy and Commerce called the bill up for 
consideration. The full Committee met in virtual open markup 
session on September 9, 2020, to consider H.R. 2075. There were 
no amendments offered to the bill and the Committee then agreed 
to a motion on final passage by Mr. Pallone, Chairman of the 
committee, to order H.R. 2075, reported favorably to the House, 
without amendment, by a voice vote, a quorum being present.

                           V. Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. The 
Committee advises that there were no record votes taken on H.R. 
2075, including the motion on final passage.

                         VI. Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1) 
of rule X of the Rules of the House of Representatives, the 
oversight findings and recommendations of the Committee are 
reflected in the descriptive portion of the report.

 VII. New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to 3(c)(2) of rule XIII of the Rules of the House 
of Representatives, the Committee adopts as its own the 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues contained in the cost estimate 
prepared by the Director of the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.
    The Committee has requested but not received from the 
Director of the Congressional Budget Office a statement as to 
whether this bill contains any new budget authority, spending 
authority, credit authority, or an increase or decrease in 
revenues or tax expenditures.

                    VIII. Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

       IX. Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to 
reauthorize through FY 2024 the School-based Health Centers 
program and remove specified limitations on the receipt of 
additional or multiple funds under the program.

                   X. Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 2075 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

                      XI. Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

    XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 2075 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                   XIII. Advisory Committee Statement

    No advisory committee within the meaning of section 5(b) of 
the Federal Advisory Committee Act was created by this 
legislation.

                XIV. Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

           XV. Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 designates that the short title may be cited as 
the ``School-Based Health Centers Reauthorization Act of 
2019''.

Sec. 2. Reauthorization of school-based health centers

    Section 2 amends section 399Z of the Public Health Service 
Act (PHSA) by allowing school-based health centers to qualify 
for both funding under section 330 of the PHSA and for funding 
under this Act during the same grant period. Section 2 also 
reauthorizes the School-Based Health Center Program until FY 
2024.

       XVI. Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, and existing law in which no 
change is proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT



           *       *       *       *       *       *       *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

           *       *       *       *       *       *       *


PART Q--PROGRAMS TO IMPROVE THE HEALTH OF CHILDREN

           *       *       *       *       *       *       *


SEC. 399Z-1. SCHOOL-BASED HEALTH CENTERS.

  (a) Definitions; Establishment of Criteria.--In this section:
          (1) Comprehensive primary health services.--The term 
        ``comprehensive primary health services'' means the 
        core services offered by school-based health centers, 
        which shall include the following:
                  (A) Physical.--Comprehensive health 
                assessments, diagnosis, and treatment of minor, 
                acute, and chronic medical conditions, and 
                referrals to, and follow-up for, specialty care 
                and oral and vision health services.
                  (B) Mental health.--Mental health and 
                substance use disorder assessments, crisis 
                intervention, counseling, treatment, and 
                referral to a continuum of services including 
                emergency psychiatric care, community support 
                programs, inpatient care, and outpatient 
                programs.
          (2) Medically underserved children and adolescents.--
                  (A) In general.--The term ``medically 
                underserved children and adolescents'' means a 
                population of children and adolescents who are 
                residents of an area designated as a medically 
                underserved area or a health professional 
                shortage area by the Secretary.
                  (B) Criteria.--The Secretary shall prescribe 
                criteria for determining the specific shortages 
                of personal health services for medically 
                underserved children and adolescents under 
                subparagraph (A) that shall--
                          (i) take into account any 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 such children and 
                        adolescents of an area, including the 
                        ability of the residents of such area 
                        to pay for health services, the 
                        accessibility of such services, the 
                        availability of health professionals to 
                        such children and adolescents, and 
                        other factors as determined appropriate 
                        by the Secretary.
          (3) School-based health center.--The term ``school-
        based health center'' means a health clinic that--
                  (A) meets the definition of a school-based 
                health center under section 2110(c)(9)(A) of 
                the Social Security Act and is administered by 
                a sponsoring facility (as defined in section 
                2110(c)(9)(B) of the Social Security Act);
                  (B) provides, at a minimum, comprehensive 
                primary health services during school hours to 
                children and adolescents by health 
                professionals in accordance with established 
                standards, community practice, reporting laws, 
                and other State laws, including parental 
                consent and notification laws that are not 
                inconsistent with Federal law; and
                  (C) does not perform abortion services.
  (b) Authority To Award Grants.--The Secretary shall award 
grants for the costs of the operation of school-based health 
centers (referred to in this section as ``SBHCs'') that meet 
the requirements of this section.
  (c) Applications.--To be eligible to receive a grant under 
this section, an entity shall--
          (1) be an SBHC (as defined in subsection (a)(3)); and
          (2) submit to the Secretary an application at such 
        time, in such manner, and containing--
                  (A) evidence that the applicant meets all 
                criteria necessary to be designated an SBHC;
                  (B) evidence of local need for the services 
                to be provided by the SBHC;
                  (C) an assurance that--
                          (i) SBHC 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 service provision to children and 
                        adolescents;
                          (ii) the SBHC 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 SBHC;
                          (iii) the SBHC 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 school or the SBHC 
                        is closed;
                          (iv) the SBHC 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;
                          (v) the SBHC sponsoring facility 
                        assumes all responsibility for the SBHC 
                        administration, operations, and 
                        oversight; and
                          (vi) the SBHC will comply with 
                        Federal, State, and local laws 
                        concerning patient privacy and student 
                        records, including regulations 
                        promulgated under the Health Insurance 
                        Portability and Accountability Act of 
                        1996 and section 444 of the General 
                        Education Provisions Act; and
                  (D) such other information as the Secretary 
                may require.
  (d) Preferences and Consideration.--In reviewing 
applications:
          (1) The Secretary may give preference to applicants 
        who demonstrate an ability to serve the following:
                  (A) Communities that have evidenced barriers 
                to primary health care and mental health and 
                substance use disorder prevention services for 
                children and adolescents.
                  (B) Communities with high per capita numbers 
                of children and adolescents who are uninsured, 
                underinsured, or enrolled in public health 
                insurance programs.
                  (C) Populations of children and adolescents 
                that have historically demonstrated difficulty 
                in accessing health and mental health and 
                substance use disorder prevention services.
          (2) The Secretary may give consideration to whether 
        an applicant has received a grant under subsection (a) 
        of section 4101 of the Patient Protection and 
        Affordable Care Act.
  (e) Waiver of Requirements.--The Secretary may--
          (1) under appropriate circumstances, waive the 
        application of all or part of the requirements of this 
        subsection with respect to an SBHC for not to exceed 2 
        years; and
          (2) upon a showing of good cause, waive the 
        requirement that the SBHC provide all required 
        comprehensive primary health services 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--
                  (A) may be used for--
                          (i) acquiring and leasing equipment 
                        (including the costs of amortizing the 
                        principle of, and paying interest on, 
                        loans for such equipment);
                          (ii) providing training related to 
                        the provision of required comprehensive 
                        primary health services and additional 
                        health services;
                          (iii) the management and operation of 
                        health center programs;
                          (iv) the payment of salaries for 
                        physicians, nurses, and other personnel 
                        of the SBHC; and
                  (B) may not be used to provide abortions.
          (2) Construction.--The Secretary may award grants 
        which may be used to pay the costs associated with 
        expanding and modernizing existing buildings for use as 
        an SBHC, including the purchase of trailers or 
        manufactured buildings to install on the school 
        property.
          (3)  [Limitations.-- 
                  [(A) In general.--Any provider of services] 
                Limitation._Any provider of services  that is 
                determined by a State to be in violation of a 
                State law described in subsection (a)(3)(B) 
                with respect to activities carried out at a 
                SBHC shall not be eligible to receive 
                additional funding under this section.
                  [(B) No overlapping grant period.--No entity 
                that has received funding under section 330 for 
                a grant period shall be eligible for a grant 
                under this section for with respect to the same 
                grant period.]
  (g) Matching Requirement.--
          (1) In general.--Each eligible entity that receives a 
        grant under this section shall provide, from non-
        Federal sources, an amount equal to 20 percent of the 
        amount of the grant (which may be provided in cash or 
        in-kind) to carry out the activities supported by the 
        grant.
          (2) Waiver.--The Secretary may waive all or part of 
        the matching requirement described in paragraph (1) for 
        any fiscal year for the SBHC if the Secretary 
        determines that applying the matching requirement to 
        the SBHC would result in serious hardship or an 
        inability to carry out the purposes of this section.
  (h) Supplement, Not Supplant.--Grant funds provided under 
this section shall be used to supplement, not supplant, other 
Federal or State funds.
  (i) Evaluation.--The Secretary shall develop and implement a 
plan for evaluating SBHCs and monitoring quality performance 
under the awards made under this section.
  (j) Age Appropriate Services.--An eligible entity receiving 
funds under this section shall only provide age appropriate 
services through a SBHC funded under this section to an 
individual.
  (k) Parental Consent.--An eligible entity receiving funds 
under this section shall not provide services through a SBHC 
funded under this section to an individual without the consent 
of the parent or guardian of such individual if such individual 
is considered a minor under applicable State law.
  (l) Authorization of Appropriations.--For purposes of 
carrying out this section, there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years [2010 through 2014] 2019 through 2024.

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