[104th Congress Public Law 299]
[From the U.S. Government Printing Office]


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[DOCID: f:publ299.104]


[[Page 3625]]

                HEALTH CENTERS CONSOLIDATION ACT OF 1996

[[Page 110 STAT. 3626]]

Public Law 104-299
104th Congress

                                 An Act


 
 To amend title III of the Public Health Service Act to consolidate and 
    reauthorize provisions relating to health centers, and for other 
             purposes. <<NOTE: Oct. 11, 1996 -  [S. 1044]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress <<NOTE: Health Centers 
Consolidation Act of 1996.>> assembled,

SECTION 1. <<NOTE: 42 USC 201 note.>> SHORT TITLE.

    This Act may be cited as the ``Health Centers Consolidation Act of 
1996''.

SEC. 2. CONSOLIDATION AND REAUTHORIZATION OF PROVISIONS.

    Subpart I of part D of title III of the Public Health Service Act 
(42 U.S.C. 254b et seq.) is amended to read as follows:

                       ``Subpart I--Health Centers

``SEC. 330. <<NOTE: 42 USC 254b.>> 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--

[[Page 110 STAT. 3627]]

                                    ``(I) health services related to 
                                family medicine, internal medicine, 
                                pediatrics, obstetrics, or gynecology 
                                that are furnished by physicians and 
                                where appropriate, physician assistants, 
                                nurse practitioners, and nurse midwives;
                                    ``(II) diagnostic laboratory and 
                                radiologic services;
                                    ``(III) preventive health services, 
                                including--
                                            ``(aa) prenatal and 
                                        perinatal services;
                                            ``(bb) screening for breast 
                                        and cervical cancer;
                                            ``(cc) well-child services;
                                            ``(dd) immunizations against 
                                        vaccine-preventable diseases;
                                            ``(ee) screenings for 
                                        elevated blood lead levels, 
                                        communicable diseases, and 
                                        cholesterol;
                                            ``(ff) pediatric eye, ear, 
                                        and dental screenings to 
                                        determine the need for vision 
                                        and hearing correction and 
                                        dental care;
                                            ``(gg) voluntary family 
                                        planning services; and
                                            ``(hh) preventive dental 
                                        services;
                                    ``(IV) emergency medical services; 
                                and
                                    ``(V) pharmaceutical services as may 
                                be appropriate for particular centers;
                          ``(ii) referrals to providers of medical 
                      services and other health-related services 
                      (including substance abuse and mental health 
                      services);
                          ``(iii) patient case management services 
                      (including counseling, referral, and follow-up 
                      services) and other services designed to assist 
                      health center patients in establishing eligibility 
                      for and gaining access to Federal, State, and 
                      local programs that provide or financially support 
                      the provision of medical, social, educational, or 
                      other related services;
                          ``(iv) services that enable individuals to use 
                      the services of the health center (including 
                      outreach and transportation services and, if a 
                      substantial number of the individuals in the 
                      population served by a center are of limited 
                      English-speaking ability, the services of 
                      appropriate personnel fluent in the language 
                      spoken by a predominant number of such 
                      individuals); and
                          ``(v) education of patients and the general 
                      population served by the health center regarding 
                      the availability and proper use of health 
                      services.
                    ``(B) Exception.--With respect to a health center 
                that receives a grant only under subsection (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

[[Page 110 STAT. 3628]]

        meet the health needs of the population served by the health 
        center involved. Such term may include--
                    ``(A) environmental health services, including--
                          ``(i) the detection and alleviation of 
                      unhealthful conditions associated with water 
                      supply;
                          ``(ii) sewage treatment;
                          ``(iii) solid waste disposal;
                          ``(iv) rodent and parasitic infestation;
                          ``(v) field sanitation;
                          ``(vi) housing; and
                          ``(vii) other environmental factors related to 
                      health; and
                    ``(B) in the case of health centers receiving grants 
                under subsection (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

[[Page 110 STAT. 3629]]

                unusual local conditions which are a barrier to access 
                to or the availability of personal health services.

    ``(c) Planning Grants.--
            ``(1) In general.--
                    ``(A) Centers.--The Secretary may make grants to 
                public and nonprofit private entities for projects to 
                plan and develop health centers which will serve 
                medically underserved populations. A project for which a 
                grant may be made under this subsection may include the 
                cost of the acquisition and lease of buildings and 
                equipment (including the costs of amortizing the 
                principal of, and paying the interest on, loans) and 
                shall include--
                          ``(i) an assessment of the need that the 
                      population proposed to be served by the health 
                      center for which the project is undertaken has for 
                      required primary health services and additional 
                      health services;
                          ``(ii) the design of a health center program 
                      for such population based on such assessment;
                          ``(iii) efforts to secure, within the proposed 
                      catchment area of such center, financial and 
                      professional assistance and support for the 
                      project;
                          ``(iv) initiation and encouragement of 
                      continuing community involvement in the 
                      development and operation of the project; and
                          ``(v) proposed linkages between the center and 
                      other appropriate provider entities, such as 
                      health departments, local hospitals, and rural 
                      health clinics, to provide better coordinated, 
                      higher quality, and more cost-effective health 
                      care services.
                    ``(B) Comprehensive service delivery networks and 
                plans.--The Secretary may make grants to health centers 
                that receive assistance under this section to enable the 
                centers to plan and develop a network or plan for the 
                provision of health services, which may include the 
                provision of health services on a prepaid basis or 
                through another managed care arrangement, to some or to 
                all of the individuals which the centers serve. Such a 
                grant may only be made for such a center if--
                          ``(i) the center has received grants under 
                      subsection (e)(1)(A) for at least 2 consecutive 
                      years preceding the year of the grant under this 
                      subparagraph or has otherwise demonstrated, as 
                      required by the Secretary, that such center has 
                      been providing primary care services for at least 
                      the 2 consecutive years immediately preceding such 
                      year; and
                          ``(ii) the center provides assurances 
                      satisfactory to the Secretary that the provision 
                      of such services on a prepaid basis, or under 
                      another managed care arrangement, will not result 
                      in the diminution of the level or quality of 
                      health services provided to the medically 
                      underserved population served prior to the grant 
                      under this subparagraph.
                Any such grant may include the acquisition and lease of 
                buildings and equipment which may include data and 
                information systems (including the costs of amortizing 
                the principal of, and paying the interest on, loans), 
                and providing training and technical assistance related 
                to the provi

[[Page 110 STAT. 3630]]

                sion of health services on a prepaid basis or under 
                another managed care arrangement, and for other purposes 
                that promote the development of managed care networks 
                and plans.
            ``(2) Limitation.--Not more than two grants may be made 
        under this subsection for the same project, except that upon a 
        showing of good cause, the Secretary may make additional grant 
        awards.

    ``(d) Managed Care Loan Guarantee Program.--
            ``(1) Establishment.--
                    ``(A) In general.--The Secretary shall establish a 
                program under which the Secretary may, in accordance 
                with this subsection and to the extent that 
                appropriations are provided in advance for such program, 
                guarantee the principal and interest on loans made by 
                non-Federal lenders to health centers funded under this 
                section for the costs of developing and operating 
                managed care networks or plans.
                    ``(B) Use of funds.--Loan funds guaranteed under 
                this subsection may be used--
                          ``(i) to establish reserves for the furnishing 
                      of services on a pre-paid basis; or
                          ``(ii) for costs incurred by the center or 
                      centers, otherwise permitted under this section, 
                      as the Secretary determines are necessary to 
                      enable a center or centers to develop, operate, 
                      and own the network or plan.
                    ``(C) Publication of guidance.--Prior to considering 
                an application submitted under this subsection, the 
                Secretary shall publish guidelines to provide guidance 
                on the implementation of this section. The Secretary 
                shall make such guidelines available to the universe of 
                parties affected under this subsection, distribute such 
                guidelines to such parties upon the request of such 
                parties, and provide a copy of such guidelines to the 
                appropriate committees of Congress.
            ``(2) Protection of financial interests.--
                    ``(A) In general.--The Secretary may not approve a 
                loan guarantee for a project under this subsection 
                unless the Secretary determines that--
                          ``(i) the terms, conditions, security (if 
                      any), and schedule and amount of repayments with 
                      respect to the loan are sufficient to protect the 
                      financial interests of the United States and are 
                      otherwise reasonable, including a determination 
                      that the rate of interest does not exceed such 
                      percent per annum on the principal obligation 
                      outstanding as the Secretary determines to be 
                      reasonable, taking into account the range of 
                      interest rates prevailing in the private market 
                      for similar loans and the risks assumed by the 
                      United States, except that the Secretary may not 
                      require as security any center asset that is, or 
                      may be, needed by the center or centers involved 
                      to provide health services;
                          ``(ii) the loan would not be available on 
                      reasonable terms and conditions without the 
                      guarantee under this subsection; and

[[Page 110 STAT. 3631]]

                          ``(iii) amounts appropriated for the program 
                      under this subsection are sufficient to provide 
                      loan guarantees under this subsection.
                    ``(B) Recovery of payments.--
                          ``(i) In general.--The United States shall be 
                      entitled to recover from the applicant for a loan 
                      guarantee under this subsection the amount of any 
                      payment made pursuant to such guarantee, unless 
                      the Secretary for good cause waives such right of 
                      recovery (subject to appropriations remaining 
                      available to permit such a waiver) and, upon 
                      making any such payment, the United States shall 
                      be subrogated to all of the rights of the 
                      recipient of the payments with respect to which 
                      the guarantee was made. Amounts recovered under 
                      this clause shall be credited as reimbursements to 
                      the financing account of the program.
                          ``(ii) Modification of terms and conditions.--
                      To the extent permitted by clause (iii) and 
                      subject to the requirements of section 504(e) of 
                      the Credit Reform Act of 1990 (2 U.S.C. 661c(e)), 
                      any terms and conditions applicable to a loan 
                      guarantee under this subsection (including terms 
                      and conditions imposed under clause (iv)) may be 
                      modified or waived by the Secretary to the extent 
                      the Secretary determines it to be consistent with 
                      the financial interest of the United States.
                          ``(iii) Incontestability.--Any loan guarantee 
                      made by the Secretary under this subsection shall 
                      be incontestable--
                                    ``(I) in the hands of an applicant 
                                on whose behalf such guarantee is made 
                                unless the applicant engaged in fraud or 
                                misrepresentation in securing such 
                                guarantee; and
                                    ``(II) as to any person (or 
                                successor in interest) who makes or 
                                contracts to make a loan to such 
                                applicant in reliance thereon unless 
                                such person (or successor in interest) 
                                engaged in fraud or misrepresentation in 
                                making or contracting to make such loan.
                          ``(iv) Further terms and conditions.--
                      Guarantees of loans under this subsection shall be 
                      subject to such further terms and conditions as 
                      the Secretary determines to be necessary to assure 
                      that the purposes of this section will be 
                      achieved.
            ``(3) Loan origination fees.--
                    ``(A) In general.--The Secretary shall collect a 
                loan origination fee with respect to loans to be 
                guaranteed under this subsection, except as provided in 
                subparagraph (C).
                    ``(B) Amount.--The amount of a loan origination fee 
                collected by the Secretary under subparagraph (A) shall 
                be equal to the estimated long term cost of the loan 
                guarantees involved to the Federal Government (excluding 
                administrative costs), calculated on a net present value 
                basis, after taking into account any appropriations that 
                may be made for the purpose of offsetting such costs, 
                and in accordance with the criteria used to award loan 
                guarantees under this subsection.

[[Page 110 STAT. 3632]]

                    ``(C) Waiver.--The Secretary may waive the loan 
                origination fee for a health center applicant who 
                demonstrates to the Secretary that the applicant will be 
                unable to meet the conditions of the loan if the 
                applicant incurs the additional cost of the fee.
            ``(4) Defaults.--
                    ``(A) In general.--Subject to the requirements of 
                the Credit Reform Act of 1990 (2 U.S.C. 661 et seq.), 
                the Secretary may take such action as may be necessary 
                to prevent a default on a loan guaranteed under this 
                subsection, including the waiver of regulatory 
                conditions, deferral of loan payments, renegotiation of 
                loans, and the expenditure of funds for technical and 
                consultative assistance, for the temporary payment of 
                the interest and principal on such a loan, and for other 
                purposes. Any such expenditure made under the preceding 
                sentence on behalf of a health center or centers shall 
                be made under such terms and conditions as the Secretary 
                shall prescribe, including the implementation of such 
                organizational, operational, and financial reforms as 
                the Secretary determines are appropriate and the 
                disclosure of such financial or other information as the 
                Secretary may require to determine the extent of the 
                implementation of such reforms.
                    ``(B) Foreclosure.--The Secretary may take such 
                action, consistent with State law respecting foreclosure 
                procedures and, with respect to reserves required for 
                furnishing services on a prepaid basis, subject to the 
                consent of the affected States, as the Secretary 
                determines appropriate to protect the interest of the 
                United States in the event of a default on a loan 
                guaranteed under this subsection, except that the 
                Secretary may only foreclose on assets offered as 
                security (if any) in accordance with paragraph 
                (2)(A)(i).
            ``(5) Limitation.--Not more than one loan guarantee may be 
        made under this subsection for the same network or plan, except 
        that upon a showing of good cause the Secretary may make 
        additional loan guarantees.
            ``(6) Annual report.--Not later than April 1, 1998, and each 
        April 1 thereafter, the Secretary shall prepare and submit to 
        the appropriate committees of Congress a report concerning loan 
        guarantees provided under this subsection. Such report shall 
        include--
                    ``(A) a description of the number, amount, and use 
                of funds received under each loan guarantee provided 
                under this subsection;
                    ``(B) a description of any defaults with respect to 
                such loans and an analysis of the reasons for such 
                defaults, if any; and
                    ``(C) a description of the steps that may have been 
                taken by the Secretary to assist an entity in avoiding 
                such a default.
            ``(7) Program <<NOTE: Reports.>> evaluation.--Not later than 
        June 30, 1999, the Secretary shall prepare and submit to the 
        appropriate committees of Congress a report containing an 
        evaluation of the program authorized under this subsection. Such 
        evaluation shall include a recommendation with respect to 
        whether or not the loan guarantee program under this subsection 
        should

[[Page 110 STAT. 3633]]

        be continued and, if so, any modifications that should be made 
        to such program.
            ``(8) Authorization of appropriations.--There are authorized 
        to be appropriated to carry out this subsection such sums as may 
        be necessary.

    ``(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 2 years, for the costs of the 
                operation of public and nonprofit private entities which 
                provide health services to medically underserved 
                populations but with respect to which the Secretary is 
                unable to make each of the determinations required by 
                subsection (j)(3).
            ``(2) Use of funds.--The costs for which a grant may be made 
        under subparagraph (A) or (B) of paragraph (1) may include the 
        costs of acquiring 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 paragraph (1) to a health center 
                shall be determined by the Secretary, but may not exceed 
                the amount by which the costs of operation of the center 
                in such fiscal year exceed the total of--
                          ``(i) State, local, and other operational 
                      funding provided to the center; and
                          ``(ii) the fees, premiums, and third-party 
                      reimbursements, which the center may reasonably be 
                      expected to receive for its operations in such 
                      fiscal year.
                    ``(B) Payments.--Payments under grants under 
                subparagraph (A) or (B) of paragraph (1) shall be made 
                in advance or by way of reimbursement and in such 
                installments as the Secretary finds necessary and 
                adjustments may be made for overpayments or 
                underpayments.
                    ``(C) Use of nongrant funds.--Nongrant funds 
                described in clauses (i) and (ii) of subparagraph (A), 
                including any such funds in excess of those originally 
                expected, shall be used as permitted under this section, 
                and may be used for such other purposes as are not 
                specifically

[[Page 110 STAT. 3634]]

                prohibited under this section if such use furthers the 
                objectives of the project.

    ``(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 migra

[[Page 110 STAT. 3635]]

                tory agricultural worker labor camps, and applicable 
                Federal and State pesticide control standards; and
                    ``(B) conduct projects and studies to assist the 
                several States and entities which have received grants 
                or contracts under this section in the assessment of 
                problems related to camp and field sanitation, exposure 
                to unsafe levels of agricultural chemicals including 
                pesticides, and other environmental health hazards to 
                which migratory agricultural workers and members of 
                their families are exposed.
            ``(3) Definitions.--For purposes of this subsection:
                    ``(A) Migratory agricultural worker.--The term 
                `migratory agricultural worker' means an individual 
                whose principal employment is in agriculture on a 
                seasonal basis, who has been so employed within the last 
                24 months, and who establishes for the purposes of such 
                employment a temporary abode.
                    ``(B) Seasonal agricultural worker.--The term 
                `seasonal agricultural worker' means an individual whose 
                principal employment is in agriculture on a seasonal 
                basis and who is not a migratory agricultural worker.
                    ``(C) Agriculture.--The term `agriculture' means 
                farming in all its branches, including--
                          ``(i) cultivation and tillage of the soil;
                          ``(ii) the production, cultivation, growing, 
                      and harvesting of any commodity grown on, in, or 
                      as an adjunct to or part of a commodity grown in 
                      or on, the land; and
                          ``(iii) any practice (including preparation 
                      and processing for market and delivery to storage 
                      or to market or to carriers for transportation to 
                      market) performed by a farmer or on a farm 
                      incident to or in conjunction with an activity 
                      described in clause (ii).

    ``(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 children at risk of homelessness.
            ``(2) Required services.--In addition to required primary 
        health services (as defined in subsection (b)(1)), an entity 
        that receives a grant under this subsection shall be required to 
        provide substance abuse services as a condition of such grant.
            ``(3) Supplement not supplant requirement.--A grant awarded 
        under this subsection shall be expended to supplement, and not 
        supplant, the expenditures of the health center and the value of 
        in kind contributions for the delivery of services to the 
        population described in paragraph (1).
            ``(4) Definitions.--For purposes of this section:
                    ``(A) Homeless individual.--The term `homeless 
                individual' means an individual who lacks housing 
                (without regard to whether the individual is a member of 
                a family), including an individual whose primary 
                residence during the night is a supervised public or 
                private facility that

[[Page 110 STAT. 3636]]

                provides temporary living accommodations and an 
                individual who is a resident in transitional housing.
                    ``(B) Substance abuse.--The term `substance abuse' 
                has the same meaning given such term in section 534(4).
                    ``(C) Substance abuse services.--The term `substance 
                abuse services' includes detoxification and residential 
                treatment for substance abuse provided in settings other 
                than hospitals.

    ``(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) Applications.--
            ``(1) Submission.--No grant may be made under this section 
        unless an application therefore is submitted to, and approved 
        by, the Secretary. Such an application shall be submitted in 
        such form and manner and shall contain such information as the 
        Secretary shall prescribe.
            ``(2) Description of need.--An application for a grant under 
        subparagraph (A) or (B) of subsection (e)(1) for a health center 
        shall include--
                    ``(A) a description of the need for health services 
                in the catchment area of the center;
                    ``(B) a demonstration by the applicant that the area 
                or the population group to be served by the applicant 
                has a shortage of personal health services; and
                    ``(C) a demonstration that the center will be 
                located so that it will provide services to the greatest 
                number of individuals residing in the catchment area or 
                included in such population group.
        Such a demonstration shall be made on the basis of the criteria 
        prescribed by the Secretary under subsection (b)(3) or on any 
        other criteria which the Secretary may prescribe to determine if 
        the area or population group to be served by the applicant has a 
        shortage of personal health services. In considering an 
        application for a grant under subparagraph (A) or (B) of 
        subsection (e)(1), the Secretary may require as a condition to 
        the approval of such application an assurance that the applicant

[[Page 110 STAT. 3637]]

        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), 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 in the catchment area of the center;
                    ``(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) has or will have a contractual or other 
                      arrangement with the agency of the State, in which 
                      it provides services, which administers or 
                      supervises the administration of a State plan 
                      approved under title XIX of the Social Security 
                      Act for the payment of all or a part of the 
                      center's costs in providing health services to 
                      persons who are eligible for medical assistance 
                      under such a State plan; or
                          ``(ii) has made or will make every reasonable 
                      effort to enter into such an arrangement;
                    ``(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--

[[Page 110 STAT. 3638]]

                                    ``(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; and
                          ``(iii) 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, 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

[[Page 110 STAT. 3639]]

                      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; and
                    ``(L) the center, has developed an ongoing referral 
                relationship with one or more hospitals.
        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.
            ``(4) Approval of new or expanded service applications.--The 
        Secretary shall approve applications for grants under 
        subparagraph (A) or (B) of subsection (e)(1) for health centers 
        which--
                    ``(A) have not received a previous grant under such 
                subsection; or
                    ``(B) have applied for such a grant to expand their 
                services;
        in such a manner that the ratio of the medically underserved 
        populations in rural areas which may be expected to use the 
        services provided by such centers to the medically underserved 
        populations in urban areas which may be expected to use the 
        services provided by such centers is not less than two to three 
        or greater than three to two.

    ``(k) Technical and Other Assistance.--The Secretary may provide 
(either through the Department of Health and Human Services or by grant 
or contract) all necessary technical and other nonfinancial assistance 
(including fiscal and program management assistance and training in such 
management) to any public or private nonprofit entity to assist entities 
in developing plans for, or operating as, health centers, and in meeting 
the requirements of subsection (j)(2).
    ``(l) Authorization of Appropriations.--
            ``(1) In general.--For the purpose of carrying out this 
        section, in addition to the amounts authorized to be 
        appropriated under subsection (d), there are authorized to be 
        appropriated $802,124,000 for fiscal year 1997, and such sums as 
        may be necessary for each of the fiscal years 1998 through 2001.
            ``(2) Special provisions.--

[[Page 110 STAT. 3640]]

                    ``(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 (j)(3)) the governing boards of which (as 
                described in subsection (j)(3)(G)(ii)) do not establish 
                general policies for such centers, an amount which 
                exceeds 5 percent of the amounts appropriated under this 
                section for that fiscal year. For purposes of applying 
                the preceding sentence, the term `public centers' shall 
                not include health centers that receive grants pursuant 
                to subsection (h) or (i).
                    ``(B) Distribution of grants.--
                          ``(i) Fiscal year 1997.--For fiscal year 1997, 
                      the Secretary, in awarding grants under this 
                      section shall ensure that the amounts made 
                      available under each of subsections (g), (h), and 
                      (i) in such fiscal year bears the same 
                      relationship to the total amount appropriated for 
                      such fiscal year under paragraph (1) as the 
                      amounts appropriated for fiscal year 1996 under 
                      each of sections 329, 340, and 340A (as such 
                      sections existed one day prior to the date of 
                      enactment of this section) bears to the total 
                      amount appropriated under sections 329, 330, 340, 
                      and 340A (as such sections existed one day prior 
                      to the date of enactment of this section) for such 
                      fiscal year.
                          ``(ii) Fiscal years 1998 and 1999.--For each 
                      of the fiscal years 1998 and 1999, the Secretary, 
                      in awarding grants under this section shall ensure 
                      that the proportion of the amounts made available 
                      under each of subsections (g), (h), and (i) is 
                      equal to the proportion of amounts made available 
                      under each such subsection for the previous fiscal 
                      year, as such amounts relate to the total amounts 
                      appropriated for the previous fiscal year 
                      involved, increased or decreased by not more than 
                      10 percent.
            ``(3) Funding report.--The Secretary shall annually prepare 
        and submit to the appropriate committees of Congress a report 
        concerning the distribution of funds under this section that are 
        provided to meet the health care needs of medically underserved 
        populations, including the homeless, residents of public 
        housing, and migratory and seasonal agricultural workers, and 
        the appropriateness of the delivery systems involved in 
        responding to the needs of the particular populations. Such 
        report shall include an assessment of the relative health care 
        access needs of the targeted populations and the rationale for 
        any substantial changes in the distribution of funds.

    ``(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;

[[Page 110 STAT. 3641]]

            ``(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 (j)(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.

[[Page 110 STAT. 3642]]

            ``(2) Records.--Each <<NOTE: Regulations.>> 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.''.
SEC. 3. RURAL HEALTH OUTREACH, NETWORK DEVELOPMENT, AND 
                    TELEMEDICINE GRANT PROGRAM.

    (a) In General.--Subpart I of part D of title III of the Public 
Health Service Act (42 U.S.C. 254b et seq.) (as amended by section 2) is 
further amended by adding at the end thereof the following new section:
``SEC. 330A. RURAL <<NOTE: 42 USC 254c.>> HEALTH OUTREACH, NETWORK 
                            DEVELOPMENT, AND TELEMEDICINE GRANT 
                            PROGRAM.

    ``(a) Administration.--The rural health services outreach 
demonstration grant program established under section 301 shall be 
administered by the Office of Rural Health Policy (of the Health 
Resources and Services Administration), in consultation with State rural 
health offices or other appropriate State governmental entities.
    ``(b) Grants.--Under the program referred to in subsection (a), the 
Secretary, acting through the Director of the Office of Rural Health 
Policy, may award grants to expand access to, coordinate, restrain the 
cost of, and improve the quality of essential health care services, 
including preventive and emergency services, through the development of 
integrated health care delivery systems or networks in rural areas and 
regions.
    ``(c) Eligible Networks.--
            ``(1) Outreach networks.--To be eligible to receive a grant 
        under this section, an entity shall--
                    ``(A) be a rural public or nonprofit private entity 
                that is or represents a network or potential network 
                that includes three or more health care providers or 
                other entities that provide or support the delivery of 
                health care services; and
                    ``(B) in consultation with the State office of rural 
                health or other appropriate State entity, prepare and 
                submit to the Secretary an application, at such time, in 
                such manner, and containing such information as the 
                Secretary may require, including--

[[Page 110 STAT. 3643]]

                          ``(i) a description of the activities which 
                      the applicant intends to carry out using amounts 
                      provided under the grant;
                          ``(ii) a plan for continuing the project after 
                      Federal support is ended;
                          ``(iii) a description of the manner in which 
                      the activities funded under the grant will meet 
                      health care needs of underserved rural populations 
                      within the State; and
                          ``(iv) a description of how the local 
                      community or region to be served by the network or 
                      proposed network will be involved in the 
                      development and ongoing operations of the network.
            ``(2) For-profit entities.--An eligible network may include 
        for-profit entities so long as the network grantee is a 
        nonprofit entity.
            ``(3) Telemedicine networks.--
                    ``(A) In general.--An entity that is a health care 
                provider and a member of an existing or proposed 
                telemedicine network, or an entity that is a consortium 
                of health care providers that are members of an existing 
                or proposed telemedicine network shall be eligible for a 
                grant under this section.
                    ``(B) Requirement.--A telemedicine network referred 
                to in subparagraph (A) shall, at a minimum, be composed 
                of--
                          ``(i) a multispecialty entity that is located 
                      in an urban or rural area, which can provide 24-
                      hour a day access to a range of specialty care; 
                      and
                          ``(ii) at least two rural health care 
                      facilities, which may include rural hospitals, 
                      rural physician offices, rural health clinics, 
                      rural community health clinics, and rural nursing 
                      homes.

    ``(d) Preference.--In awarding grants under this section, the 
Secretary shall give preference to applicant networks that include--
            ``(1) a majority of the health care providers serving in the 
        area or region to be served by the network;
            ``(2) any federally qualified health centers, rural health 
        clinics, and local public health departments serving in the area 
        or region;
            ``(3) outpatient mental health providers serving in the area 
        or region; or
            ``(4) appropriate social service providers, such as agencies 
        on aging, school systems, and providers under the women, 
        infants, and children program, to improve access to and 
        coordination of health care services.

    ``(e) Use of Funds.--
            ``(1) In general.--Amounts provided under grants awarded 
        under this section shall be used--
                    ``(A) for the planning and development of integrated 
                self-sustaining health care networks; and
                    ``(B) for the initial provision of services.
            ``(2) Expenditures in rural areas.--
                    ``(A) In general.--In awarding a grant under this 
                section, the Secretary shall ensure that not less than 
                50 percent of the grant award is expended in a rural 
                area or to provide services to residents of rural areas.

[[Page 110 STAT. 3644]]

                    ``(B) Telemedicine networks.--An entity described in 
                subsection (c)(3) may not use in excess of--
                          ``(i) 40 percent of the amounts provided under 
                      a grant under this section to carry out activities 
                      under paragraph (3)(A)(iii); and
                          ``(ii) 20 percent of the amounts provided 
                      under a grant under this section to pay for the 
                      indirect costs associated with carrying out the 
                      purposes of such grant.
            ``(3) Telemedicine networks.--
                    ``(A) In general.--An entity described in subsection 
                (c)(3), may use amounts provided under a grant under 
                this section to--
                          ``(i) demonstrate the use of telemedicine in 
                      facilitating the development of rural health care 
                      networks and for improving access to health care 
                      services for rural citizens;
                          ``(ii) provide a baseline of information for a 
                      systematic evaluation of telemedicine systems 
                      serving rural areas;
                          ``(iii) purchase or lease and install 
                      equipment; and
                          ``(iv) operate the telemedicine system and 
                      evaluate the telemedicine system.
                    ``(B) Limitations.--An entity described in 
                subsection (c)(3), may not use amounts provided under a 
                grant under this section--
                          ``(i) to build or acquire real property;
                          ``(ii) purchase or install transmission 
                      equipment (such as laying cable or telephone 
                      lines, microwave towers, satellite dishes, 
                      amplifiers, and digital switching equipment); or
                          ``(iii) for construction, except that such 
                      funds may be expended for minor renovations 
                      relating to the installation of equipment;

    ``(f) Term of Grants.--Funding may not be provided to a network 
under this section for in excess of a 3-year period.
    ``(g) Authorization of Appropriations.--For the purpose of carrying 
out this section there are authorized to be appropriated $36,000,000 for 
fiscal year 1997, and such sums as may be necessary for each of the 
fiscal years 1998 through 2001.''.
    (b) Transition.--The <<NOTE: 42 USC 254b note.>> Secretary of Health 
and Human Services shall ensure the continued funding of grants made, or 
contracts or cooperative agreements entered into, under subpart I of 
part D of title III of the Public Health Service Act (42 U.S.C. 254b et 
seq.) (as such subpart existed on the day prior to the date of enactment 
of this Act), until the expiration of the grant period or the term of 
the contract or cooperative agreement. Such funding shall be continued 
under the same terms and conditions as were in effect on the date on 
which the grant, contract or cooperative agreement was awarded, subject 
to the availability of appropriations.

SEC. 4. TECHNICAL AND CONFORMING AMENDMENTS.

    (a) In General.--The Public Health Service Act is amended--
            (1) in section 224(g)(4) (42 U.S.C. 233(g)(4)), by striking 
        ``under'' and all that follows through the end thereof and 
        inserting ``under section 330.'';

[[Page 110 STAT. 3645]]

            (2) in section 340C(a)(2) (42 U.S.C. 256c) by striking 
        ``under'' and all that follows through the end thereof and 
        inserting ``with assistance provided under section 330.''; and
            (3) by repealing subparts V and VI of part D of title III 
        (42 U.S.C. 256 et seq.).

    (b) Social Security Act.--The Social Security Act is amended--
            (1) in clauses (i) and (ii)(I) of section 1861(aa)(4)(A) (42 
        U.S.C. 1395x(aa)(4)(A) (i) and (ii)(I)) by striking ``section 
        329, 330, or 340'' and inserting ``section 330 (other than 
        subsection (h))''; and
            (2) in clauses (i) and (ii)(II) of section 1905(l)(2)(B) (42 
        U.S.C. 1396d(l)(2)(B) (i) and (ii)(II)) by striking ``section 
        329, 330, 340, or 340A'' and inserting ``section 330''.

    (c) References.--Whenever <<NOTE: 42 USC 254b note.>> any reference 
is made in any provision of law, regulation, rule, record, or document 
to a community health center, migrant health center, public housing 
health center, or homeless health center, such reference shall be 
considered a reference to a health center.

    (d) FTCA Clarification.--For purposes of section 224(k)(3) of the 
Public Health Service Act (42 U.S.C. 233(k)(3)), transfers from the fund 
described in such section for fiscal year 1996 shall be deemed to have 
occurred prior to December 31, 1995.
    (e) Additional <<NOTE: 42 USC 254b note.>> Amendments.--After 
consultation with the appropriate committees of the Congress, the 
Secretary of Health and Human Services shall prepare and submit to the 
Congress a legislative proposal in the form of an implementing bill 
containing technical and conforming amendments to reflect the changes 
made by this Act.

SEC. 5. <<NOTE: 42 USC 233 note.>> EFFECTIVE DATE.

    This Act and the amendments made by this Act shall become effective 
on October 1, 1997.

    Approved October 11, 1996.

LEGISLATIVE HISTORY--S. 1044:
---------------------------------------------------------------------------

SENATE REPORTS: No. 104-186 (Comm. on Labor and Human Resources).
CONGRESSIONAL RECORD, Vol. 142 (1996):
            Sept. 20, considered and passed Senate.
            Sept. 27, considered and passed House.

                                  <all>