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S. 1045 (is) To amend the National Foundation on the Arts and the Humanities Act of [Introduced in Senate] ...

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                                                       Calendar No. 279


  1st Session

                                S. 1044

                          [Report No. 104-186]


                                 A BILL

To amend title III of the Public Health Service Act to consolidate and 
   reauthorize provisions relating to health centers, and for other 


                           December 15, 1995

                        Reported with amendments
                                                       Calendar No. 279
  1st Session
                                S. 1044

                          [Report No. 104-186]

To amend title III of the Public Health Service Act to consolidate and 
   reauthorize provisions relating to health centers, and for other 



                July 17 (legislative day, July 10), 1995

Mrs. Kassebaum, (for herself, Mr. Kennedy, Mr. Jeffords, Mr. Pell, and 
  Mr. Simon) introduced the following bill; which was read twice and 
         referred to the Committee on Labor and Human Resources

                           December 15, 1995

              Reported by Mrs. Kassebaum, with amendments
  [Omit the part struck through and insert the part printed in italic]


                                 A BILL

To amend title III of the Public Health Service Act to consolidate and 
   reauthorize provisions relating to health centers, and for other 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,


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


    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


    ``(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 
        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 (f), (g), or (h).
    ``(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, 
                                            ``(aa) prenatal and 
                                        perinatal services;
                                            ``(bb) screening for breast 
                                        and cervical cancer;
                                            ``(cc) well-child services;
                                            ``(dd) immunizations 
                                        against vaccine-preventable 
                                            ``(ee) screenings for 
                                        elevated blood lead levels, 
                                        communicable diseases, and 
                                            ``(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 
                                    ``(IV) emergency medical services; 
                                    ``(V) pharmaceutical services as 
                                may be appropriate for particular 
                            ``(ii) referrals to providers of medical 
                        services and other health-related services 
                        (including substance abuse and mental health 
                            ``(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 (f), 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 
            ``(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) environmental health services, including--
                            ``(i) the detection and alleviation of 
                        unhealthful conditions associated with water 
                            ``(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 (f), 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 
            ``(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 
                            ``(ii) local officials in such State; and
                            ``(iii) the organization, if any, which 
                        represents a majority of health centers in such 
                    ``(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 
    ``(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, expansion, and 
                modernization of existing buildings and construction of 
                new buildings (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 
                            ``(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 
                    ``(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 (d)(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 

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