|
U.S. Code as of:
01/19/04
Section 254b. Health centers
(a) "Health center" defined
(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) of this section); and
(B) as may be appropriate for particular centers, additional
health services (as defined in subsection (b)(2) of this
section) 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) of this section.
(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 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, 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) of this section, 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 abuse
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) of this section, special occupation-related
health services for migratory and seasonal agricultural
workers, including -
(i) screening for and control of infectious diseases,
including parasitic diseases; and
(ii) injury prevention programs, including prevention of
exposure to unsafe levels of agricultural chemicals including
pesticides.
(3) Medically underserved populations
(A) In general
The term "medically underserved population" means the
population of an urban or rural area designated by the
Secretary as an area with a shortage of personal health
services or a population group designated by the Secretary as
having a shortage of such services.
(B) Criteria
In carrying out subparagraph (A), the Secretary shall
prescribe criteria for determining the specific shortages of
personal health services of an area or population group. Such
criteria shall -
(i) take into account comments received by the Secretary
from the chief executive officer of a State and local
officials in a State; and
(ii) include factors indicative of the health status of a
population group or residents of an area, the ability of the
residents of an area or of a population group to pay for
health services and their accessibility to them, and the
availability of health professionals to residents of an area
or to a population group.
(C) Limitation
The Secretary may not designate a medically underserved
population in a State or terminate the designation of such a
population unless, prior to such designation or termination,
the Secretary provides reasonable notice and opportunity for
comment and consults with -
(i) the chief executive officer of such State;
(ii) local officials in such State; and
(iii) the organization, if any, which represents a majority
of health centers in such State.
(D) Permissible designation
The Secretary may designate a medically underserved
population that does not meet the criteria established under
subparagraph (B) if the chief executive officer of the State in
which such population is located and local officials of such
State recommend the designation of such population based on
unusual local conditions which are a barrier to access to or
the availability of personal health services.
(c) Planning grants
(1) In general
(A) Centers
The Secretary may make grants to public and nonprofit private
entities for projects to plan and develop health centers which
will serve medically underserved populations. A project for
which a grant may be made under this subsection may include the
cost of the acquisition 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) Managed care 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 managed care network or plan. Such a grant may only
be made for such a center if -
(i) the center has received grants under subsection
(e)(1)(A) of this section 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.
(C) Practice management networks
The Secretary may make grants to health centers that receive
assistance under this section to enable the centers to plan and
develop practice management networks that will enable the
centers to -
(i) reduce costs associated with the provision of health
care services;
(ii) improve access to, and availability of, health care
services provided to individuals served by the centers;
(iii) enhance the quality and coordination of health care
services; or
(iv) improve the health status of communities.
(D) Use of funds
The activities for which a grant may be made under
subparagraph (B) or (C) may include the purchase or lease of
equipment, which may include data and information systems
(including paying for the costs of amortizing the principal of,
and paying the interest on, loans for equipment), the provision
of training and technical assistance related to the provision
of health care services on a prepaid basis or under another
managed care arrangement, and other activities that promote the
development of practice management or 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) 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 up to 90 percent of 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 described in
subsection (c)(1)(B) of this section, or practice management
networks described in subsection (c)(1)(C) of this section.
(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;
(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; or
(iii) to refinance an existing loan (as of the date of
refinancing) to the center or centers, if the Secretary
determines -
(I) that such refinancing will be beneficial to the
health center and the Federal Government; or
(II) that the center (or centers) can demonstrate an
ability to repay the refinanced loan equal to or greater
than the ability of the center (or centers) to repay the
original loan on the date the original loan was made.
(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.
(D) Provision directly to networks or plans
At the request of health centers receiving assistance under
this section, loan guarantees provided under this paragraph may
be made directly to networks or plans that are at least
majority controlled and, as applicable, at least majority owned
by those health centers.
(E) Federal credit reform
The requirements of the Federal Credit Reform Act of 1990 (2
U.S.C. 661 et seq.) shall apply with respect to loans
refinanced under subparagraph (B)(iii).
(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
(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.
(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
(!1) (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) 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 (k)(3) of this section.
(C) Operation of networks and plans
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 or plan (as described in
subparagraphs (B) and (C) of subsection (c)(1) of this section)
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 or plan, including the purchase
or lease of equipment (including the costs of amortizing the
principal of, and paying the interest on, loans for equipment).
(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 and plans
The total amount of grant funds made available for any fiscal
year under paragraph (1)(C) and subparagraphs (B) and (C) of
subsection (c)(1) of this section to a health center or to a
network or plan 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.
(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) of this section 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) of this section 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 and
children and youth at risk of homelessness.
(2) Required services
In addition to required primary health services (as defined in
subsection (b)(1) of this section), 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 abuse
The term "substance abuse" has the same meaning given such
term in section 290cc-34(4) of this title.
(C) Substance abuse services
The term "substance abuse services" 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) of this section 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 1437a(b)(1) of this title) 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) of
this section;
(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 need
An application for a grant under subparagraph (A) or (B) of
subsection (e)(1) of this section 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) of this
section 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) of this section, 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) of this section 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) of this section, the
Secretary may not approve an application for a grant under
subparagraph (A) or (B) of subsection (e)(1) of this section
unless the Secretary determines that the entity for which the
application is submitted is a health center (within the meaning
of subsection (a) of this section) 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)(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 [42
U.S.C. 1396 et seq.] 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 [42 U.S.C. 1395 et seq.], to
medical assistance under a State plan approved under title XIX
of such Act [42 U.S.C. 1396 et seq.], 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
[25 U.S.C. 450f et seq.] 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) of this section;
(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; and
(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).
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) of this section 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.
(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) of this section. 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
subchapter and how those resources can be best used to meet the
health needs of the communities served by the entities.
(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) of this
section 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) of this
section, and the granting of waivers as appropriate and permitted
under subsections (b)(1)(B)(i) and (k)(3)(G) of this section.
(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 (!2) 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.
(r) 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) of
this section, there are authorized to be appropriated
$1,340,000,000 for fiscal year 2002 and such sums as may be
necessary for each of the fiscal years 2003 through 2006.
(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) of this section) the governing
boards of which (as described in subsection (k)(3)(H) of this
section) 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) of this section.
(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) of this section, 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
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.
|
|