[House Report 117-513]
[From the U.S. Government Publishing Office]


117th Congress    }                                    {       Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                    {      117-513

======================================================================

 
MAXIMIZING OUTCOMES THROUGH BETTER INVESTMENTS IN LIFESAVING EQUIPMENT 
                      FOR (MOBILE) HEALTH CARE ACT

                                _______
                                

 September 28, 2022.--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. 5141]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 5141) to amend the Public Health Service Act to 
expand the allowable use criteria for new access points grants 
for community health centers, having considered the same, 
reports favorably thereon with an amendment and recommends that 
the bill as amended do pass.

                                CONTENTS

                                                                   Page
   I. Purpose and Summary.............................................2
  II. Background and Need for the Legislation.........................2
 III. Committee Hearings..............................................3
  IV. Committee Consideration.........................................3
   V. Committee Votes.................................................4
  VI. Oversight Findings..............................................7
 VII. New Budget Authority, Entitlement Authority, and Tax Expenditure7
VIII. Federal Mandates Statement......................................7
  IX. Statement of General Performance Goals and Objectives...........7
   X. Duplication of Federal Programs.................................7
  XI. Committee Cost Estimate.........................................7
 XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits.....7
XIII. Advisory Committee Statement....................................8
 XIV. Applicability to Legislative Branch.............................8
  XV. Section-by-Section Analysis of the Legislation..................8
 XVI. Changes in Existing Law Made by the Bill, as Reported...........8

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Maximizing Outcomes through Better 
Investments in Lifesaving Equipment for (MOBILE) Health Care Act''.

SEC. 2. NEW ACCESS POINTS GRANTS.

  (a) In General.--Section 330(e)(6)(A) of the Public Health Service 
Act (42 U.S.C. 254b(e)(6)(A)) is amended by adding at the end the 
following:
                          ``(v) Mobile units.--An existing health 
                        center may be awarded funds under clause (i) to 
                        establish a new delivery site that is a mobile 
                        unit, regardless of whether the applicant 
                        additionally proposes to establish a permanent, 
                        full-time site. In the case of a health center 
                        that is not currently receiving funds under 
                        this section, such health center may be awarded 
                        funds under clause (i) to establish a new 
                        delivery site that is a mobile unit only if 
                        such health center uses a portion of such funds 
                        to also establish a permanent, full-time 
                        site.''.
  (b) Effective Date.--The amendment made by subsection (a) shall take 
effect on January 1, 2024.

                         I. Purpose and Summary

    H.R. 5141, the ``Maximizing Outcomes through Better 
Investments in Lifesaving Equipment for (MOBILE) Health Care 
Act,'' expands access to community health center services, 
particularly in rural and underserved areas. Specifically, it 
allows existing community health centers to use New Access 
Point grants to establish mobile health units without also 
establishing new brick-and-mortar sites, as well as allowing 
new applicants to use such grants to establish mobile health 
units if they also use a portion of the grant to establish a 
permanent, full-time site. This would begin January 1, 2024.

                II. Background and Need for Legislation

    Community Health Centers (CHCs) provide comprehensive 
health care services to millions of low-income individuals 
every year, regardless of insurance status.\1\ However, for 
individuals who live in rural and other underserved areas, it 
can be difficult to access needed care. The lack of access to 
reliable transportation, distance, and challenging weather can 
create barriers to access for many individuals.\2\ Mobile 
clinics can also decrease barriers to care that result from 
stigma or mistrust by bringing care to people in locations they 
do trust such as a Veterans of Foreign War post or a trusted 
community partner's office.\3\
---------------------------------------------------------------------------
    \1\GW Public Health, GW Researchers Publish Findings on the Health 
and Economic Contributions of Community Health Centers (Aug. 23, 2022) 
(https://publichealth.gwu.edu/content/gw-researchers-publish-findings-
health-and-economic-contributions-community-health-centers).
    \2\House Committee on Energy and Commerce, Testimony of Desiree 
Sweeney, Chief Executive Officer, NEW Health, Hearing on Investing in 
Public Health: Legislation to Support Patients, Workers, and Research, 
117th Cong. (June 29, 2022).
    \3\Id.
---------------------------------------------------------------------------
    Mobile sites can help increase access to these individuals 
by meeting them where they live, and New Access Point (NAP) 
grants can provide necessary federal funding to establish 
mobile sites.\4\ However, under current law, it can be 
difficult for CHCs to use NAP grants to establish a mobile 
site. Currently, NAP grants can only be used for mobile sites 
if they are associated with a brick-and-mortar site.\5\ 
Accordingly, grantees are limited in their ability to use NAP 
grants to establish mobile sites.\6\
---------------------------------------------------------------------------
    \4\Letter from the National Association of Community Health Centers 
to Representatives Lee, Hudson, Ruiz, and Herrera Beutler (Sept. 13, 
2022).
    \5\See note 3.
    \6\See note 3.
---------------------------------------------------------------------------
    H.R. 5141 will address this barrier by authorizing the 
Health Resources and Services Administration (HRSA) to award 
NAP grants to applicants with an existing brick and mortar 
location to establish mobile sites. Applicants without an 
existing brick and mortar site must use a portion of the grant 
to establish such a site, in addition to a mobile site.

                        III. Committee Hearings

    For the purposes of section 3(c) of rule XIII of the Rules 
of the House of Representatives, the following hearing was used 
to develop or consider H.R. 5141:
    The Subcommittee on Health held a hearing on June 29, 2022, 
entitled ``Investing in Public Health: Legislation to Support 
Patients, Workers, And Research.'' The Subcommittee received 
testimony from the following witnesses:
           Kirsten Bibbins-Domingo, Ph.D., M.D., 
        M.A.S., Professor of Epidemiology and Biostatistics and 
        the Lee Goldman, M.D. Professor of Medicine, University 
        of California, San Francisco;
           Kevin Croston, M.D., CEO, North Memorial 
        Health;
           Tanika Gray Valbrun, Founder and President, 
        The White Dress Project;
           Michael D. Shannon, Executive/President of 
        Government Solutions, IPTalons, Inc.
           Desiree Sweeney, CEO, NEW Health; and
           Leslie R. Walker-Harding, M.D., F.A.A.P., 
        F.S.A.H.M., Ford/Morgan Endowed Professor Chair 
        Department of Pediatrics/Associate Dean, University of 
        Washington; Chief Academic Officer/Senior Vice 
        President, Seattle Children's Hospital.

                      IV. Committee Consideration

    H.R. 5141, the ``Maximizing Outcomes through Better 
Investments in Lifesaving Equipment for (MOBILE) Health Care 
Act,'' was introduced by Representatives Lee (D-NV), Hudson (R-
NC), Ruiz (D-CA), and Herrera Beutler (R-WA) on August 31, 
2021. Subsequently, on September 1, 2021, the bill was referred 
to the Subcommittee on Health.
    On September 14, 2022, the Subcommittee on Health met in 
open markup session, pursuant to notice, to consider H.R. 5141 
and four other bills. During consideration of the bill, an 
amendment in the nature of a substitute (AINS), offered by 
Representative Hudson, was agreed to by a voice vote. Upon 
conclusion of consideration of the bill, the Subcommittee on 
Health agreed to report the bill favorably to the full 
Committee, amended, by a roll call vote of 29 yeas to 0 nays.
    On September 21, 2022, the full Committee met in open 
markup session, pursuant to notice, to consider H.R. 5141 and 
23 other bills. No amendments were offered during consideration 
of the bill. Upon conclusion of consideration of the bill, the 
full Committee agreed to a motion on final passage offered by 
Representative Pallone, Chairman of the Committee, to order 
H.R. 5141 reported favorably to the House, as amended by the 
Subcommittee on Health, by a roll call vote of 52 yeas to 0 
nays.

                           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 two record votes taken on 
H.R. 5141, including a motion by Mr. Pallone ordering H.R. 5141 
favorably reported to the House, as amended by the Subcommittee 
on Health. The motion on final passage of the bill was approved 
by a record vote of 52 yeas to 0 nays. The following are the 
record votes taken during Committee consideration, including 
the names of those members voting for and against:


	[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                         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 
authorize NAP grants for existing community health centers to 
establish mobile sites, and for new grantees to establish 
mobile sites with NAP grants if part of the grant is used to 
establish a permanent, full-time site.

                   X. Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 5141 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. 5141 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 ``Maximizing Outcomes through Better Investments in 
Lifesaving Equipment for (MOBILE) Health Care Act.''

Sec. 2. New Access Points Grants

    Section 2 authorizes, effective January 1, 2024, that NAP 
grants may be used for mobile sites regardless of whether the 
applicant proposes to establish a new brick-and-mortar 
location. New applicants are also eligible to use NAP grants to 
establish mobile sites but must use a portion of the grant to 
establish a permanent, full-time site.

       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 (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 D--Primary Health Care


                       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 (g), (h), or 
        (i).
  (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) appropriate 
                                        cancer screening;
                                          (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 (including specialty 
                        referral when medically indicated) and 
                        other health-related services 
                        (including substance use disorder 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, housing, 
                        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 (g), 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) behavioral and mental health and 
                substance use disorder services;
                  (B) recuperative care services;
                  (C) environmental health services, 
                including--
                          (i) the detection and alleviation of 
                        unhealthful conditions associated 
                        with--
                                  (I) water supply;
                                  (II) chemical and pesticide 
                                exposures;
                                  (III) air quality; or
                                  (IV) exposure to lead;
                          (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
                  (D) in the case of health centers receiving 
                grants under subsection (g), 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) 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 and lease of buildings and equipment 
        (including the costs of amortizing the principal of, 
        and paying the interest on, loans) and shall include--
                  (A) 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;
                  (B) the design of a health center program for 
                such population based on such assessment;
                  (C) efforts to secure, within the proposed 
                catchment area of such center, financial and 
                professional assistance and support for the 
                project;
                  (D) initiation and encouragement of 
                continuing community involvement in the 
                development and operation of the project; and
                  (E) 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.
          (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.
          (3) Recognition of high poverty.--
                  (A) In general.--In making grants under this 
                subsection, the Secretary may recognize the 
                unique needs of high poverty areas.
                  (B) High poverty area defined.--For purposes 
                of subparagraph (A), the term ``high poverty 
                area'' means a catchment area which is 
                established in a manner that is consistent with 
                the factors in subsection (k)(3)(J), and the 
                poverty rate of which is greater than the 
                national average poverty rate as determined by 
                the Bureau of the Census.
  (d) Improving Quality of Care.--
          (1) Supplemental awards.--The Secretary may award 
        supplemental grant funds to health centers funded under 
        this section to implement evidence-based models for 
        increasing access to high-quality primary care 
        services, which may include models related to--
                  (A) improving the delivery of care for 
                individuals with multiple chronic conditions;
                  (B) workforce configuration;
                  (C) reducing the cost of care;
                  (D) enhancing care coordination;
                  (E) expanding the use of telehealth and 
                technology-enabled collaborative learning and 
                capacity building models;
                  (F) care integration, including integration 
                of behavioral health, mental health, or 
                substance use disorder services;
                  (G) addressing emerging public health or 
                substance use disorder issues to meet the 
                health needs of the population served by the 
                health center; and
                  (H) improving access to recommended 
                immunizations.
          (2) Sustainability.--In making supplemental awards 
        under this subsection, the Secretary may consider 
        whether the health center involved has submitted a plan 
        for continuing the activities funded under this 
        subsection after supplemental funding is expended.
          (3) Special consideration.--The Secretary may give 
        special consideration to applications for supplemental 
        funding under this subsection that seek to address 
        significant barriers to access to care in areas with a 
        greater shortage of health care providers and health 
        services relative to the national average.
  (e) 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 1 year, 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 (k)(3). The Secretary shall not make 
                a grant under this paragraph unless the 
                applicant provides assurances to the Secretary 
                that within 120 days of receiving grant funding 
                for the operation of the health center, the 
                applicant will submit, for approval by the 
                Secretary, an implementation plan to meet the 
                requirements of subsection (k)(3). The 
                Secretary may extend such 120-day period for 
                achieving compliance upon a demonstration of 
                good cause by the health center.
                  (C) Operation of networks.--The Secretary may 
                make grants to health centers that receive 
                assistance under this section, or at the 
                request of the health centers, directly to a 
                network that is at least majority controlled 
                and, as applicable, at least majority owned by 
                such health centers receiving assistance under 
                this section, for the costs associated with the 
                operation of such network including--
                          (i) the purchase or lease of 
                        equipment, which may include data and 
                        information systems (including the 
                        costs of amortizing the principal of, 
                        and paying the interest on, loans for 
                        equipment);
                          (ii) the provision of training and 
                        technical assistance; and
                          (iii) other activities that--
                                  (I) reduce costs associated 
                                with the provision of health 
                                services;
                                  (II) improve access to, and 
                                availability of, health 
                                services provided to 
                                individuals served by the 
                                centers;
                                  (III) enhance the quality and 
                                coordination of health 
                                services; or
                                  (IV) improve the health 
                                status of communities.
          (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 and leasing buildings 
        and equipment (including the costs of amortizing the 
        principal of, and paying interest on, loans), 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) Construction.--The Secretary may award grants 
        which may be used to pay the costs associated with 
        expanding and modernizing existing buildings or 
        constructing new buildings (including the costs of 
        amortizing the principal of, and paying the interest 
        on, loans) for projects approved prior to October 1, 
        1996.
          (4) Limitation.--Not more than two grants may be made 
        under subparagraph (B) of paragraph (1) for the same 
        entity.
          (5) Amount.--
                  (A) In general.--The amount of any grant made 
                in any fiscal year under subparagraphs (A) and 
                (B) of 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) Networks.--The total amount of grant 
                funds made available for any fiscal year under 
                paragraph (1)(C) to a health center or to a 
                network shall be determined by the Secretary, 
                but may not exceed 2 percent of the total 
                amount appropriated under this section for such 
                fiscal year.
                  (C) 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.
                  (D) 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.
          (6) New access points and expanded services.--
                  (A) Approval of new access points.--
                          (i) In general.--The Secretary may 
                        approve applications for grants under 
                        subparagraph (A) or (B) of paragraph 
                        (1) to establish new delivery sites.
                          (ii) Special consideration.--In 
                        carrying out clause (i), the Secretary 
                        may give special consideration to 
                        applicants that have demonstrated the 
                        new delivery site will be located 
                        within a sparsely populated area, or an 
                        area which has a level of unmet need 
                        that is higher relative to other 
                        applicants.
                          (iii) Consideration of 
                        applications.--In carrying out clause 
                        (i), the Secretary shall approve 
                        applications for grants 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 the applicants 
                        involved to the medically underserved 
                        populations in urban areas which may be 
                        expected to use the services provided 
                        by the applicants is not less than two 
                        to three or greater than three to two.
                          (iv) Service area overlap.--If in 
                        carrying out clause (i) the applicant 
                        proposes to serve an area that is 
                        currently served by another health 
                        center funded under this section, the 
                        Secretary may consider whether the 
                        award of funding to an additional 
                        health center in the area can be 
                        justified based on the unmet need for 
                        additional services within the 
                        catchment area.
                          (v) Mobile units.--An existing health 
                        center may be awarded funds under 
                        clause (i) to establish a new delivery 
                        site that is a mobile unit, regardless 
                        of whether the applicant additionally 
                        proposes to establish a permanent, 
                        full-time site. In the case of a health 
                        center that is not currently receiving 
                        funds under this section, such health 
                        center may be awarded funds under 
                        clause (i) to establish a new delivery 
                        site that is a mobile unit only if such 
                        health center uses a portion of such 
                        funds to also establish a permanent, 
                        full-time site.
                  (B) Approval of expanded service 
                applications.--
                          (i) In general.--The Secretary may 
                        approve applications for grants under 
                        subparagraph (A) or (B) of paragraph 
                        (1) to expand the capacity of the 
                        applicant to provide required primary 
                        health services described in subsection 
                        (b)(1) or additional health services 
                        described in subsection (b)(2).
                          (ii) Priority expansion projects.--In 
                        carrying out clause (i), the Secretary 
                        may give special consideration to 
                        expanded service applications that seek 
                        to address emerging public health or 
                        behavioral health, mental health, or 
                        substance abuse issues through 
                        increasing the availability of 
                        additional health services described in 
                        subsection (b)(2) in an area in which 
                        there are significant barriers to 
                        accessing care.
                          (iii) Consideration of 
                        applications.--In carrying out clause 
                        (i), the Secretary shall approve 
                        applications for grants 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 the applicants 
                        involved to the medically underserved 
                        populations in urban areas which may be 
                        expected to use the services provided 
                        by such applicants is not less than two 
                        to three or greater than three to two.
  (f) 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.
  (g) Migratory and Seasonal Agricultural Workers.--
          (1) In general.--The Secretary may award grants for 
        the purposes described in subsections (c), (e), and (f) 
        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 (3) 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 and seasonal 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 seasonal 
                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, 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).
  (h) Homeless Population.--
          (1) In general.--The Secretary may award grants for 
        the purposes described in subsections (c), (e), and (f) 
        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 youth, children and 
        youth at risk of homelessness, homeless veterans, and 
        veterans 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) Temporary continued provision of services to 
        certain former homeless individuals.--If any grantee 
        under this subsection has provided services described 
        in this section under the grant to a homeless 
        individual, such grantee may, notwithstanding that the 
        individual is no longer homeless as a result of 
        becoming a resident in permanent housing, expend the 
        grant to continue to provide such services to the 
        individual for not more than 12 months.
          (5) 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 use disorder services.--The 
                term ``substance abuseservices'' includes 
                detoxification, risk reduction, outpatient 
                treatment, residential treatment, and 
                rehabilitation for substance abuse provided in 
                settings other than hospitals.
  (i) Residents of Public Housing.--
          (1) In general.--The Secretary may award grants for 
        the purposes described in subsections (c), (e), and (f) 
        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.
  (j) Access Grants.--
          (1) In general.--The Secretary may award grants to 
        eligible health centers with a substantial number of 
        clients with limited English speaking proficiency to 
        provide translation, interpretation, and other such 
        services for such clients with limited English speaking 
        proficiency.
          (2) Eligible health center.--In this subsection, the 
        term ``eligible health center'' means an entity that--
                  (A) is a health center as defined under 
                subsection (a);
                  (B) provides health care services for clients 
                for whom English is a second language; and
                  (C) has exceptional needs with respect to 
                linguistic access or faces exceptional 
                challenges with respect to linguistic access.
          (3) Grant amount.--The amount of a grant awarded to a 
        center under this subsection shall be determined by the 
        Administrator. Such determination of such amount shall 
        be based on the number of clients for whom English is a 
        second language that is served by such center, and 
        larger grant amounts shall be awarded to centers 
        serving larger numbers of such clients.
          (4) Use of funds.--An eligible health center that 
        receives a grant under this subsection may use funds 
        received through such grant to--
                  (A) provide translation, interpretation, and 
                other such services for clients for whom 
                English is a second language, including hiring 
                professional translation and interpretation 
                services; and
                  (B) compensate bilingual or multilingual 
                staff for language assistance services provided 
                by the staff for such clients.
          (5) Application.--An eligible health center desiring 
        a grant under this subsection shall submit an 
        application to the Secretary at such time, in such 
        manner, and containing such information as the 
        Secretary may reasonably require, including--
                  (A) an estimate of the number of clients that 
                the center serves for whom English is a second 
                language;
                  (B) the ratio of the number of clients for 
                whom English is a second language to the total 
                number of clients served by the center;
                  (C) a description of any language assistance 
                services that the center proposes to provide to 
                aid clients for whom English is a second 
                language; and
                  (D) a description of the exceptional needs of 
                such center with respect to linguistic access 
                or a description of the exceptional challenges 
                faced by such center with respect to linguistic 
                access.
          (6) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this 
        subsection, in addition to any funds authorized to be 
        appropriated or appropriated for health centers under 
        any other subsection of this section, such sums as may 
        be necessary for each of fiscal years 2002 through 
        2006.
  (k) 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 unmet need.--An application for a 
        grant under subparagraph (A) or (B) of subsection 
        (e)(1) or subsection (e)(6) for a health center shall 
        include--
                  (A) a description of the unmet 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;
                  (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; and
                  (D) in the case of an application for a grant 
                pursuant to subsection (e)(6), a demonstration 
                that the applicant has consulted with 
                appropriate State and local government 
                agencies, and health care providers regarding 
                the need for the health services to be provided 
                at the proposed delivery site.
        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 
        (e)(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 
        (e)(1)(B) or subsection (e)(6), the Secretary may not 
        approve an application for a grant under subparagraph 
        (A) or (B) of subsection (e)(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 has made and will continue to 
                make every reasonable effort to establish and 
                maintain collaborative relationships with other 
                health care providers, including other health 
                care providers that provide care within the 
                catchment area, local hospitals, and specialty 
                providers in the catchment area of the center, 
                to provide access to services not available 
                through the health center and to reduce the 
                non-urgent use of hospital emergency 
                departments;
                  (C) the center will have an ongoing quality 
                improvement system that includes clinical 
                services and management, and that maintains the 
                confidentiality of patient records;
                  (D) the center will demonstrate its financial 
                responsibility by the use of such accounting 
                procedures and other requirements as may be 
                prescribed by the Secretary;
                  (E) the center--
                          (i)(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; and
                                  (II) has or will have a 
                                contractual or other 
                                arrangement with the State 
                                agency administering the 
                                program under title XXI of such 
                                Act (42 U.S.C. 1397aa et seq.) 
                                with respect to individuals who 
                                are State children's health 
                                insurance program 
                                beneficiaries; or
                          (ii) has made or will make every 
                        reasonable effort to enter into 
                        arrangements described in subclauses 
                        (I) and (II) of clause (i);
                  (F) 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;
                  (G) 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 (F) 
                                on the basis of the full amount 
                                of fees and payments for such 
                                services without application of 
                                any discount;
                          (iii)(I) will assure that no patient 
                        will be denied health care services due 
                        to an individual's inability to pay for 
                        such services; and
                          (II) will assure that any fees or 
                        payments required by the center for 
                        such services will be reduced or waived 
                        to enable the center to fulfill the 
                        assurance described in subclause (I); 
                        and
                          (iv) has submitted to the Secretary 
                        such reports as the Secretary may 
                        require to determine compliance with 
                        this subparagraph;
                  (H) 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 or an urban Indian 
                organization under the Indian Health Care 
                Improvement Act (25 U.S.C. 1651 et seq.)--
                          (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 who shall be directly 
                        employed by 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, for the length of the 
                project period, all or part of the requirements 
                of this subparagraph in the case of a health 
                center that receives a grant pursuant to 
                subsection (g), (h), (i), or (p);
                  (I) 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;
                  (J) 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;
                  (K) 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;
                  (L) the center, has developed an ongoing 
                referral relationship with one or more 
                hospitals;
                  (M) the center encourages persons receiving 
                or seeking health services from the center to 
                participate in any public or private (including 
                employer-offered) health programs or plans for 
                which the persons are eligible, so long as the 
                center, in complying with this subparagraph, 
                does not violate the requirements of 
                subparagraph (G)(iii)(I); and
                  (N) the center has written policies and 
                procedures in place to ensure the appropriate 
                use of Federal funds in compliance with 
                applicable Federal statutes, regulations, and 
                the terms and conditions of the Federal award.
        For purposes of subparagraph (H), the term ``public 
        center'' means a health center funded (or to be funded) 
        through a grant under this section to a public agency.
  (l) Technical Assistance.--The Secretary shall establish a 
program through which the Secretary shall provide (either 
through the Department of Health and Human Services or by grant 
or contract) technical and other assistance to eligible 
entities to assist such entities to meet the requirements of 
subsection (k)(3). 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. Funds expended to carry 
out activities under this subsection and operational support 
activities under subsection (m) shall not exceed 3 percent of 
the amount appropriated for this section for the fiscal year 
involved.
  (m) 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.
  (n) Records.--
          (1) In general.--Each entity which receives a grant 
        under subsection (e) 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.
  (o) Delegation of Authority.--The Secretary may delegate the 
authority to administer the programs authorized by this section 
to any office, except that the authority to enter into, modify, 
or issue approvals with respect to grants or contracts may be 
delegated only within the central office of the Health 
Resources and Services Administration.
  (p) Special Consideration.--In making grants under this 
section, the Secretary shall give special consideration to the 
unique needs of sparsely populated rural areas, including 
giving priority in the awarding of grants for new health 
centers under subsections (c) and (e), and the granting of 
waivers as appropriate and permitted under subsections 
(b)(1)(B)(i) and (k)(3)(G).
  (q) Audits.--
          (1) In general.--Each entity which receives a grant 
        under this section shall provide for an independent 
        annual financial audit of any books, accounts, 
        financial records, files, and other papers and property 
        which relate to the disposition or use of the funds 
        received under such grant and such other funds received 
        by or allocated to the project for which such grant was 
        made. For purposes of assuring accurate, current, and 
        complete disclosure of the disposition or use of the 
        funds received, each such audit shall be conducted in 
        accordance with generally accepted accounting 
        principles. Each audit shall evaluate--
                  (A) the entity's implementation of the 
                guidelines established by the Secretary 
                respecting cost accounting,
                  (B) the processes used by the entity to meet 
                the financial and program reporting 
                requirements of the Secretary, and
                  (C) the billing and collection procedures of 
                the entity and the relation of the procedures 
                to its fee schedule and schedule of discounts 
                and to the availability of health insurance and 
                public programs to pay for the health services 
                it provides.
        A report of each such audit shall be filed with the 
        Secretary at such time and in such manner as the 
        Secretary may require.
          (2) Records.--Each entity which receives a grant 
        under this section shall establish and maintain such 
        records as the Secretary shall by regulation require to 
        facilitate the audit required by paragraph (1). The 
        Secretary may specify by regulation the form and manner 
        in which such records shall be established and 
        maintained.
          (3) Availability of records.--Each entity which is 
        required to establish and maintain records or to 
        provide for and audit 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.
          (4) Waiver.--The Secretary may, under appropriate 
        circumstances, waive the application of all or part of 
        the requirements of this subsection with respect to an 
        entity. A waiver provided by the Secretary under this 
        paragraph may not remain in effect for more than 1 year 
        and may not be extended after such period. An entity 
        may not receive more than one waiver under this 
        paragraph in consecutive years.
  (r) Authorization of Appropriations.--
          (1) General amounts for grants.--For the purpose of 
        carrying out this section, in addition to the amounts 
        authorized to be appropriated under subsection (d), 
        there is authorized to be appropriated the following:
                  (A) For fiscal year 2010, $2,988,821,592.
                  (B) For fiscal year 2011, $3,862,107,440.
                  (C) For fiscal year 2012, $4,990,553,440.
                  (D) For fiscal year 2013, $6,448,713,307.
                  (E) For fiscal year 2014, $7,332,924,155.
                  (F) For fiscal year 2015, $8,332,924,155.
                  (G) For fiscal year 2016, and each subsequent 
                fiscal year, the amount appropriated for the 
                preceding fiscal year adjusted by the product 
                of--
                          (i) one plus the average percentage 
                        increase in costs incurred per patient 
                        served; and
                          (ii) one plus the average percentage 
                        increase in the total number of 
                        patients served.
          (2) Special provisions.--
                  (A) Public centers.--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 (k)(3)) the 
                governing boards of which (as described in 
                subsection (k)(3)(H)) 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 (h) or (i).
                  (B) Distribution of grants.--For fiscal year 
                2002 and each of the following fiscal years, 
                the Secretary, in awarding grants under this 
                section, shall ensure that the proportion of 
                the amount made available under each of 
                subsections (g), (h), and (i), relative to the 
                total amount appropriated to carry out this 
                section for that fiscal year, is equal to the 
                proportion of the amount made available under 
                that subsection for fiscal year 2001, relative 
                to the total amount appropriated to carry out 
                this section for fiscal year 2001.
          (3) Funding report.--The Secretary shall annually 
        prepare and submit to the Committee on Health, 
        Education, Labor, and Pensions of the Senate, and the 
        Committee on Energy and Commerce of the House of 
        Representatives, a report including, at a minimum--
                  (A) the distribution of funds for carrying 
                out 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;
                  (B) an assessment of the relative health care 
                access needs of the targeted populations;
                  (C) the distribution of awards and funding 
                for new or expanded services in each of rural 
                areas and urban areas;
                  (D) the distribution of awards and funding 
                for establishing new access points, and the 
                number of new access points created;
                  (E) the amount of unexpended funding for loan 
                guarantees and loan guarantee authority under 
                title XVI;
                  (F) the rationale for any substantial changes 
                in the distribution of funds;
                  (G) the rate of closures for health centers 
                and access points;
                  (H) the number and reason for any grants 
                awarded pursuant to subsection (e)(1)(B); and
                  (I) the number and reason for any waivers 
                provided pursuant to subsection (q)(4).
          (4) Rule of construction with respect to rural health 
        clinics.--
                  (A) In general.--Nothing in this section 
                shall be construed to prevent a community 
                health center from contracting with a Federally 
                certified rural health clinic (as defined in 
                section 1861(aa)(2) of the Social Security 
                Act), a low-volume hospital (as defined for 
                purposes of section 1886 of such Act), a 
                critical access hospital, a sole community 
                hospital (as defined for purposes of section 
                1886(d)(5)(D)(iii) of such Act), or a medicare-
                dependent share hospital (as defined for 
                purposes of section 1886(d)(5)(G)(iv) of such 
                Act) for the delivery of primary health care 
                services that are available at the clinic or 
                hospital to individuals who would otherwise be 
                eligible for free or reduced cost care if that 
                individual were able to obtain that care at the 
                community health center. Such services may be 
                limited in scope to those primary health care 
                services available in that clinic or hospitals.
                  (B) Assurances.--In order for a clinic or 
                hospital to receive funds under this section 
                through a contract with a community health 
                center under subparagraph (A), such clinic or 
                hospital shall establish policies to ensure--
                          (i) nondiscrimination based on the 
                        ability of a patient to pay; and
                          (ii) the establishment of a sliding 
                        fee scale for low-income patients.
          (5) Funding for participation of health centers in 
        all of us research program.--In addition to any amounts 
        made available pursuant to paragraph (1) of this 
        subsection, section 402A of this Act, or section 10503 
        of the Patient Protection and Affordable Care Act, 
        there is authorized to be appropriated, and there is 
        appropriated, out of any monies in the Treasury not 
        otherwise appropriated, to the Secretary $25,000,000 
        for fiscal year 2018 to support the participation of 
        health centers in the All of Us Research Program under 
        the Precision Medicine Initiative under section 498E of 
        this Act.
          (6) Additional amounts for supplemental awards.--In 
        addition to any amounts made available pursuant to this 
        subsection, section 402A of this Act, or section 10503 
        of the Patient Protection and Affordable Care Act, 
        there is authorized to be appropriated, and there is 
        appropriated, out of any monies in the Treasury not 
        otherwise appropriated, $1,320,000,000 for fiscal year 
        2020 for supplemental awards under subsection (d) for 
        the detection of SARS-CoV-2 or the prevention, 
        diagnosis, and treatment of COVID-19.

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