Subtitle A_Workforce Priorities Under Federal Payments
Part 1_Institutional Costs of Graduate Medical Education; Workforce Priorities
SUBPART A_NATIONAL COUNCIL REGARDING WORKFORCE PRIORITIES
Sec._3001._National Council on Graduate Medical Education.
SUBPART B_AUTHORIZED POSITIONS IN SPECIALTY TRAINING
Sec._3011._Cooperation of approved physician training programs.
Sec._3012._Annual authorization of number of specialty positions; requirements regarding primary health care.
Sec._3013._Allocations among specialities and programs.
SUBPART C_INSTITUTIONAL COSTS OF GRADUATE MEDICAL EDUCATION
Sec._3031._Federal formula payments to approved physician training programs.
Sec._3032._Application for payments.
Sec._3033._Availability of funds for payments; annual amount of payments.
Sec._3034._Additional funding provisions.
SUBPART D_GENERAL PROVISIONS
Sec._3041._Definitions.
SUBPART E_TRANSITIONAL PROVISIONS
Sec._3051._Transitional payments to institutions.
Part 2_Related Programs
Sec._3061._Additional funding for certain workforce programs.
Sec._3062._Programs of the Secretary of Health and Human Services.
Sec._3063._Programs of the Secretary of Labor.
Sec._3064._National Institute for Health Care Workforce Development.
Subtitle B_Academic Health Centers
Part 1_Formula Payments
Sec._3101._Federal formula payments to academic health centers.
Sec._3102._Request for payments.
Sec._3103._Availability of funds for payments; annual amount of payments.
Sec._3104._Additional funding provisions.
Part 2_Access of Patients to Academic Health Centers
Sec._3131._Contracts for ensuring access to centers.
Sec._3132._Discretionary grants regarding access to centers.
Subtitle C_Health Research Initiatives
Part 1_Programs for Certain Agencies
Sec._3201._Biomedical and behavioral research on health promotion and disease prevention.
Sec._3202._Health services research.
Part 2_Funding for Programs
Sec._3211._Authorizations regarding Public Health Service Initiatives Fund.
Subtitle D_Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health
Part 1_Funding
Sec._3301._Authorizations regarding Public Health Service Initiatives Fund.
Part 2_Core Functions of Public Health Programs
Sec._3311._Purposes.
Sec._3312._Grants to States for core health functions.
Sec._3313._Submission of information.
Sec._3314._Reports.
Sec._3315._Application for grant.
Sec._3316._General provisions.
Sec._3317._Allocations for certain activities.
Sec._3318._Definitions.
Part 3_National Initiatives Regarding Health Promotion and Disease Prevention
Sec._3331._Grants for national prevention initiatives.
Sec._3332._Priorities.
Sec._3333._Submission of information.
Sec._3334._Application for grant.
Subtitle E_Health Services for Medically Underserved Populations
Part 1_Community and Migrant Health Centers
Sec._3401._Authorizations regarding Public Health Service Initiatives Fund.
Sec._3402._Use of funds.
Part 2_Initiatives for Access to Health Care
SUBPART A_PURPOSES; FUNDING
Sec._3411._Purposes.
Sec._3412._Authorizations regarding Public Health Service Initiatives Fund.
SUBPART B_DEVELOPMENT OF QUALIFIED COMMUNITY HEALTH PLANS AND PRACTICE NETWORKS
Sec._3421._Grants and contracts for development of plans and networks.
Sec._3422._Preferences in making awards of assistance.
Sec._3423._Certain uses of awards.
Sec._3424._Accessibility of services.
Sec._3425._Additional agreements.
Sec._3426._Submission of certain information.
Sec._3427._Reports; audits.
Sec._3428._Application for assistance.
Sec._3429._General provisions.
SUBPART C_CAPITAL COST OF DEVELOPMENT OF QUALIFIED COMMUNITY HEALTH PLANS AND PRACTICE NETWORKS
Sec._3441._Loans and loan guarantees regarding plans and networks.
Sec._3442._Certain requirements.
Sec._3443._Defaults; right of recovery.
Sec._3444._Provisions regarding construction or expansion of facilities.
Sec._3445._Application for assistance.
Sec._3446._Administration of programs.
SUBPART D_ENABLING SERVICES
Sec._3461._Grants and contracts for enabling services.
Sec._3462._Authorizations regarding Public Health Service Initiatives Fund.
Part 3_National Health Service Corps
Sec._3471._Authorizations regarding Public Health Service Initiatives Fund.
Sec._3472._Allocation for participation of nurses in scholarship and loan repayment programs.
Part 4_Payments to Hospitals Serving Vulnerable Populations
Sec._3481._Payments to hospitals.
Sec._3482._Identification of eligible hospitals.
Sec._3483._Amount of payments.
Sec._3484._Base year.
Subtitle F_Mental Health; Substance Abuse
Part 1_Financial Assistance
Sec._3501._Authorizations regarding Public Health Service Initiatives Fund.
Sec._3502._Supplemental formula grants for States regarding activities under part B of title XIX of Public Health Service Act.
Sec._3503._Capital costs of development of certain centers and clinics.
Part 2_Authorities Regarding Participating States
SUBPART A_Reports
Sec._3511._Report on integration of mental health systems.
SUBPART B_Pilot Program
Sec._3521._Pilot program.
Subtitle G_Comprehensive School Health Education; School-Related Health Services
Part 1_General Provisions
Sec._3601._Purposes.
Sec._3602._Definitions.
Part 2_School Health Education; General Provisions
Sec._3611._Authorizations regarding Public Health Service Initiatives Fund.
Sec._3612._Waivers of statutory and regulatory requirements.
Part 3_School Health Education; Grants to States
SUBPART A_PLANNING GRANTS FOR STATES
Sec._3621._Application for grant.
Sec._3622._Approval of Secretary.
Sec._3623._Amount of grant.
Sec._3624._Authorized activities.
SUBPART B_IMPLEMENTATION GRANTS FOR STATES
Sec._3631._Application for grant.
Sec._3632._Selection of grantees.
Sec._3633._Amount of grant.
Sec._3634._Authorized activities; limitation on administrative costs.
Sec._3635._Subgrants to local educational agencies.
SUBPART C_STATE AND LOCAL REPORTS
Sec._3641._State and local reports.
Part 4_School Health Education; Grants to Certain Local Educational Agencies
SUBPART A_ELIGIBILITY
Sec._3651._Substantial need of area served by agency.
SUBPART B_PLANNING GRANTS FOR LOCAL EDUCATION AGENCIES
Sec._3661._Application for grant.
Sec._3662._Selection of grantees.
Sec._3663._Amount of grant.
Sec._3664._Authorized activities.
SUBPART C_IMPLEMENTATION GRANTS FOR LOCAL EDUCATIONAL AGENCIES
Sec._3671._Application for grant.
Sec._3672._Selection of grantees.
Sec._3673._Amount of grant.
Sec._3674._Authorized activities.
Sec._3675._Reports.
Part 5_School-Related Health Services
SUBPART A_DEVELOPMENT AND OPERATION OF PROJECTS
Sec._3681._Authorizations regarding Public Health Service Initiatives Fund.
Sec._3682._Eligibility for development and operation grants.
Sec._3683._Preferences.
Sec._3684._Grants for development of projects.
Sec._3685._Grants for operation of projects.
Sec._3686._Federal administrative costs.
SUBPART B_CAPITAL COSTS OF DEVELOPING PROJECTS
Sec._3691._Loans and loan guarantees regarding projects.
Sec._3692._Funding.
Subtitle H_Public Health Service Initiative
Sec._3701._Public Health Service Initiative.
Subtitle I_Coordination With Cobra Continuation Coverage
Sec._3801._Public Health Service Act; coordination with COBRA continuation coverage.
Title III, Subtitle A
Subtitle A_Workforce Priorities Under Federal Payments
PART 1_INSTITUTIONAL COSTS OF GRADUATE MEDICAL EDUCATION; WORKFORCE PRIORITIES
Subpart A_National Council Regarding Workforce Priorities
SEC. 3001. NATIONAL COUNCIL ON GRADUATE MEDICAL EDUCATION.
__(a) In General._There is established within the Department of Health and Human Services a council to be known as the National Council on Graduate Medical Education.
__(b) Duties._The Secretary shall carry out subpart B acting through the National Council.
__(c) Composition._
__(1) In general._The membership of the National Council shall include individuals who are appointed to the Council from among individuals who are not officers or employees of the United States. Such individuals shall be appointed by the Secretary, and shall include individuals from each of the following categories:
__(A) Consumers of health care services.
__(B) Physicians who are faculty members of medical schools.
__(C) Physicians in private practice who are not physicians described in subparagraph (B).
__(D) Officers or employees of regional and corporate health alliances.
__(E) Officers or employees of health care plans that participate in such alliances.
__(F) Such other individuals as the Secretary determines to be appropriate.
__(2) Ex officio members; other federal officers or employees._The membership of the National Council shall include individuals designated by the Secretary to serve as members of the Council from among Federal officers or employees who are appointed by the President, or by the Secretary or other Federal officers who are appointed by the President with the advice and consent of the Senate.
__(d) Chair._The Secretary shall, from among members of the National Council appointed under subsection (a)(1), designate an individual to serve as the Chair of the Council.
__(e) Definitions._For purposes of this subtitle:
__(1) The term ``medical school'' means a school of medicine (as defined in section 799 of the Public Health Service Act) or a school of osteopathic medicine (as defined in such section).
__(2) The term ``National Council'' means the council established in subsection (a).
Subpart B_Authorized Positions in Specialty Training
SEC. 3011. COOPERATION OF APPROVED PHYSICIAN TRAINING PROGRAMS.
__(a) In General._With respect to an approved physician training program in a medical specialty, a funding agreement for payments under section 3031 for a calendar year is that the program will ensure that the number of individuals enrolled in the program in the subsequent academic year is in accordance with this subpart.
__(b) Definitions._
__(1) Approved program._
__(A) For purposes of this subtitle, the term ``approved physician training program'', with respect to the medical speciality involved, means a residency or other postgraduate program that trains physicians and meets the following conditions:
__(i) Participation in the program may be counted toward certification in the medical specialty.
__(ii) The program is accredited by the Accreditation Council on Graduate Medical Education, or approved by the Council on Postgraduate Training of the American Osteopathic Association.
__(B) For purposes of this subtitle, the term ``approved physician training program'' includes any postgraduate program described in subparagraph (A) that provides health services in an ambulatory setting, without regard to whether the program provides inpatient hospital services.
__(2) Eligible program; subpart definition._For purposes of this subpart, the term ``eligible program'', with respect to an academic year, means an approved physician training program that receives payments under subpart C for the calendar year in which the academic year begins.
__(3) Other definitions._For purposes of this subtitle:
__(A)(i) The term ``academic year'' means the 1-year period beginning on July 1. The academic year beginning July 1, 1993, is academic year 1993-94.
__(ii) With respect to the funding agreement described in subsection (a), the term ``subsequent academic year'' means the academic year beginning July 1 of the calendar year for which payments are to be made under the agreement.
__(B) The term ``funding agreement'', with respect to payments under section 3031 to an approved physician training program, means that the Secretary may make the payments only if the program makes the agreement involved.
__(C) The term ``medical specialty'' includes subspecialties.
SEC. 3012. ANNUAL AUTHORIZATION OF NUMBER OF SPECIALTY POSITIONS; REQUIREMENTS REGARDING PRIMARY HEALTH CARE.
__(a) Annual Authorization of Number of Positions._In the case of each medical specialty, the National Council shall designate for each academic year the number of individuals nationwide who under section 3011 are authorized to be enrolled in eligible programs. The preceding sentence is subject to subsection (c)(2).
__(b) Primary Health Care._
__(1) In general._Subject to paragraph (2), in carrying out subsection (a) for an academic year, the National Council shall ensure that, of the class of training participants entering eligible programs for academic year 2002-03 or any subsequent academic year, the percentage of such class that completes eligible programs in primary health care is not less than 55 percent (without regard to the academic year in which the members of the class complete the programs).
__(2) Rule of construction._The requirement of paragraph (1) regarding a percentage applies in the aggregate to training participants entering eligible programs for the academic year involved, and not individually to any eligible program.
__(c) Designations Regarding 3-Year Periods._
__(1) Designation periods._For each medical specialty, the National Council shall make the annual designations under subsection (a) for periods of 3 academic years.
__(2) Initial period._The first designation period established by the National Council after the date of the enactment of this Act shall be the academic years 1998-99 through 2000-01.
__(d) Certain Considerations in Designating Annual Numbers._
__(1) In general._Factors considered by the National Council in designating the annual number of specialty positions for an academic year for a medical specialty shall include the extent to which there is a need for additional practitioners in the speciality, as indicated by the following:
__(A) The incidence and prevalence (in the general population and in various other populations) of the diseases, disorders, or other health conditions with which the specialty is concerned.
__(B) The number of physicians who will be practicing in the specialty in the academic year.
__(C) The number of physicians who will be practicing in the specialty at the end of the 5-year period beginning on the first day of the academic year.
__(2) Recommendations of private organizations._In designating the annual number of specialty positions for an academic year for a medical specialty, the National Council shall consider the recommendations of organizations representing physicians in the specialty and the recommendations of organizations representing consumers of the services of such physicians.
__(3) Minimum total of respective annual numbers._
__(A) Subject to subparagraph (B), for academic year 2003-04 and subsequent academic years, the National Council shall ensure that the total of the respective annual numbers designated under subsection (a) for an academic year is a total that_
__(i) bears a relationship to the number of individuals who graduated from medical schools in the United States in the preceding academic year; and
__(ii) is consistent with the purposes of this subpart.
__(B) For each of the academic years 2003-04 through 2007-08, the total determined under subparagraph (A) shall be reduced by a percentage determined by the National Council.
__(e) Definitions._For purposes of this subtitle:
__(1) The term ``annual number of specialty positions'', with respect to a medical specialty, means the number designated by the National Council under subsection (a) for eligible programs for the academic year involved.
__(2) The term ``designation period'' means a 3-year period under subsection (c)(1) for which designations under subsection (a) are made by the National Council.
__(3) The term ``primary health care'' means the following medical specialties: Family medicine, general internal medicine, general pediatrics, and obstetrics and gynecology.
__(4) The term ``specialty position'', with respect to a medical specialty, means a position (designated under subsection (a)) as one of the individuals who may be a training participant in an eligible program.
__(5) The term ``training participant'' means an individual who is enrolled in an approved physician training program.
SEC. 3013. ALLOCATIONS AMONG SPECIALITIES AND PROGRAMS.
__(a) In General._For each academic year, the National Council shall for each medical specialty make allocations among eligible programs of the annual number of specialty positions that the Council has designated for such year. The preceding sentence is subject to subsection (b)(3).
__(b) Allocations Regarding 3-Year Period._
__(1) In general._For each medical specialty, the National Council shall make the annual allocations under subsection (a) for periods of 3 academic years.
__(2) Advance notice to programs._With respect to the first academic year of an allocation period established by the National Council, the National Council shall, not later than July 1 of the preceding academic year, notify each eligible program of the allocations made for the program for each of the academic years of the period.
__(3) Initial period._The first allocation period established by the National Council after the date of the enactment of this Act shall be the academic years 1998-99 through 2000-01.
__(c) Certain Considerations._
__(1) Geographic areas; quality of residency programs._In making allocations under subsection (a) for eligible programs of the various geographic areas, the National Council shall include among the factors considered the historical distribution among the areas of approved physician training programs, and the quality of each of the programs.
__(2) Underrepresentation of minority groups._In making an allocation under subsection (a) for an eligible program, the National Council shall include among the factors considered the following:
__(A) The extent to which the population of training participants in the program includes training participants who are members of racial or ethnic minority groups.
__(B) With respect to a racial or ethnic group represented among the training participants, the extent to which the group is underrepresented in the field of medicine generally and in the various medical specialities.
__(3) Recommendations of private organizations._In making allocations under subsection (a) for eligible programs, the National Council shall consider the recommendations of organizations representing physicians in the medical specialties and the recommendations of organizations representing consumers of the services of such physicians.
__(d) Definitions._For purposes of this subtitle, the term ``allocation period'' means a 3-year period under subsection (b)(1) for which allocations under subsection (a) are made by the National Council.
Subpart C_Institutional Costs of Graduate Medical Education
SEC. 3031. FEDERAL FORMULA PAYMENTS TO APPROVED PHYSICIAN TRAINING PROGRAMS.
__(a) In General._
__(1) Formula payments._Subject to paragraph (2), in the case of any approved physician training program that submits to the Secretary an application for a calendar year in accordance with section 3032, the Secretary shall make payments for such year to the program for the purpose specified in subsection (b). The Secretary shall make the payments in an amount determined in accordance with section 3033, and may administer the payments as a contract, grant, or cooperative agreement.
__(2) Applicable years._Payments under paragraph (1) may not be made before calendar year 1998, except that the Secretary may make such payments before such year to eligible programs in any State that has become a participating State under title I.
__(b) Payments for Operation of Approved Physician Training Programs._The purpose of payments under subsection (a) is to assist an eligible program with the costs of operation. A funding agreement for such payments is that the program will expend the payments only for such purpose.
__(c) Eligible Program; Subpart Definition._For purposes of this subpart, the term ``eligible program'', with respect to the calendar year involved, means an approved physician training program that submits to the Secretary an application for such year in accordance with section 3032.
SEC. 3032. APPLICATION FOR PAYMENTS.
__(a) In General._For purposes of section 3031, an application for payments under such section is in accordance with this section if_
__(1) the approved physician training program involved submits the application not later than the date specified by the Secretary;
__(2) the condition described in subsection (b) is met with respect to the program;
__(3) the application contains each funding agreement described in this part and the application provides assurances of compliance with such agreements that are satisfactory to the Secretary; and
__(4) the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this part.
__(b) Certain Conditions._An approved physician training program meets the condition described in this subsection for receiving payments under section 3031 for a calendar year if the institution within which the program operates agrees that such payments will be made by the Secretary directly to the program (and such agreement is included in the application under subsection (a)), and the Secretary shall ensure that such institution is permitted to participate as a provider in a regional or corporate alliance health plan during such year only if each of the approved physician training programs of the institution meets the requirements for receiving payments under such section for such year.
SEC. 3033. AVAILABILITY OF FUNDS FOR PAYMENTS; ANNUAL AMOUNT OF PAYMENTS.
__(a) Determination by Secretary of Funds Available for Payments._
__(1) Annual health professions workforce account._Subject to paragraph (2) and section 3034, the Secretary shall determine for each calendar year the amount to be made available for the purpose of making payments under section 3031 (and under section 3051, as applicable) for the year. In determining such amount, the Secretary shall consider the amount necessary for making payments in the amounts determined under subsection (b) (and the amounts necessary for making payments in the amounts determined under section 3051(e) for institutions, in the case of calendar years 1998 through 2001).
__(2) Limitation._The amount determined by the Secretary for a calendar year under paragraph (1) may not exceed the following amount, as applicable to the calendar year:
__(A) In the case of calendar year 1996, $3,200,000,000.
__(B) In the case of calendar year 1997, $3,500,000,000.
__(C) In the case of calendar year 1998, $4,800,000,000.
__(D) In the case of each of the calendar years 1999 and 2000, $5,800,000,000.
__(E) In the case of each subsequent calendar year, the amount specified in subparagraph (D) increased by the product of such amount and the general health care inflation factor for such year (as defined in subsection (c)).
__(b) Amount of Payments for Individual Eligible Programs._
__(1) In general._Subject to the annual health professions workforce account determined by the Secretary under subsection (a) for the calendar year involved, the amount of payments required in section 3031 to be made to an eligible program for the calendar year is an amount equal to the product of_
__(A) the number of full-time equivalent training participants in the program; and
__(B) the national average of the costs of such programs in training an individual, as determined by consideration of the following factors (and as adjusted under paragraph (2)(B)):
__(i) The national average salary of training participants.
__(ii) The national average costs of such programs in providing for faculty supervision of training participants and for related activities.
__(2) Additional provisions regarding national average cost._
__(A) The Secretary shall in accordance with paragraph (1)(B) determine, for academic year 1992-93, an amount equal to the national average described in such paragraph with respect to training an individual. The national average applicable under such paragraph for a calendar year is, subject to subparagraph (B), the amount determined under the preceding sentence increased by an amount necessary to offset the effects of health care inflation occurring since academic year 1992-93, as determined through use of the general health care inflation factors for such years (or if there is no such factor for a calendar year, the consumer price index for the year).
__(B) The national average determined under subparagraph (A) and applicable to a calendar year shall, in the case of the eligible program involved, be adjusted by a factor to reflect regional differences in the applicable wage and wage-related costs.
__(c) Definitions._For purposes of this subtitle:
__(1) The term ``annual health professions workforce account'', with respect to a calendar year, means the amount determined under subsection (a) for such year.
__(2) The term ``consumer price index'' has the meaning given such term in section 1902.
__(3) The term ``general health care inflation factor'', with respect to a year, has the meaning given such term in section 6001(a)(3) for such year.
SEC. 3034. ADDITIONAL FUNDING PROVISIONS.
__(a) Sources of Funds for Annual Health Professions Workforce Account._The annual health professions workforce account under section 3033(a) for a calendar year shall be derived from the sources specified in subsection (b).
__(b) Contributions From Medicare Trust Funds, Regional Alliances, and Corporate Alliances._For purposes of subsection (a), the sources specified in this subsection for a calendar year are the following:
__(1) Transfers made by the Secretary under section 4051.
__(2) Payments made by regional alliances under section 1353 and transferred in an amount equal to the aggregate regional alliance portion determined under subsection (c)(2)(A).
__(3) The transfer made under section (d)(1).
__(c) Contributions From Regional and Corporate Alliances._
__(1) Determination of aggregate regional and corporate alliance amount._For purposes regarding the provision of funds for the annual health professions workforce account for a calendar year, the Secretary shall determine an aggregate regional and corporate alliance amount, which amount is to be paid by such alliances pursuant to paragraphs (2) and (3) of subsection (b), respectively, and which amount shall be equal to the difference between_
__(A) the annual health professions workforce account for such year; and
__(B) the amount transferred under section 4051 for the year.
__(2) Allocation of amount among regional and corporate alliances._With respect to the aggregate regional and corporate alliance amount determined under paragraph (1) for a calendar year_
__(A) the aggregate regional alliance portion of such amount is the product of such amount and the percentage constituted by the ratio of the total plan payments of regional alliances to the combined total plan payments of regional alliances and corporate alliances; and
__(B) the aggregate corporate alliance portion of such amount is the product of such amount and the percentage constituted by the ratio of the total plan payments of corporate alliances to such combined total plan payments.
__(d) Compliance Regarding Corporate Alliances._
__(1) In general._Effective January 15 of each calendar year, there is hereby transferred to the Secretary, out of any money in the Treasury not otherwise appropriated, an amount equal to the aggregate corporate alliance portion determined under subsection (c)(2)(B) for such year.
__(2) Manner of compliance._The payment by corporate alliances of the tax imposed under section 3461 of the Internal Revenue Code of 1986 (as added by section 7121 of this Act), together with the transfer made in paragraph (1) for the calendar year involved, is deemed to be the payment required pursuant to subsection (c)(1) for corporate alliances for such year.
__(e) Definitions._For purposes of this subtitle, the term ``plan payments'' with respect to a regional or corporate alliance, means the amount paid to health plans by the alliance.
Subpart D_General Provisions
SEC. 3041. DEFINITIONS.
__For purposes of this subtitle:
__(1) The term ``academic year'' has the meaning given such term in section 3011(b).
__(2) The term ``allocation period'' has the meaning given such term in section 3013(d).
__(3) The term ``annual health professions workforce account'' has the meaning given such term in section 3033(c).
__(4) The term ``annual number of specialty positions'' has the meaning given such term in section 3012(e).
__(5) The term ``approved physician training program'' has the meaning given such term in section 3011(b).
__(6) The term ``consumer price index'' has the meaning given such term in section 3033(c).
__(7) The term ``designation period'' has the meaning given such term in section 3012(e).
__(8) The term ``eligible program'' has the meaning given such term in section 3011(b), in the case of subpart B; and has the meaning given such term in section 3031(c), in the case of subpart C.
__(9) The term ``funding agreement'' has the meaning given such term in section 3011(b).
__(10) The term ``general health care inflation factor'' has the meaning given such term in section 3033(c).
__(11) The term ``medical school'' has the meaning given such term in section 3001(e).
__(12) The term ``medical specialty'' has the meaning given such term in section 3011(b).
__(13) The term ``National Council'' has the meaning given such term in section 3001(e).
__(14) The term ``plan payments'' has the meaning given such term in section 3034(e).
__(15) The term ``primary health care'' has the meaning given such term in section 3012(e).
__(16) The term ``specialty position'' has the meaning given such term in section 3012(e).
__(17) The term ``training participant'' has the meaning given such term in section 3012(e).
Subpart E_Transitional Provisions
SEC. 3051. TRANSITIONAL PAYMENTS TO INSTITUTIONS.
__(a) Payments Regarding Effects of Subpart B Allocations._
__(1) In general._For each of the calendar years 1998 through 2001, in the case of any eligible institution that submits to the Secretary an application for the year involved in accordance with subsection (d), the Secretary shall make payments for such year to the institution for the purpose specified in subsection (c). The Secretary shall make the payments in an amount determined in accordance with subsection (e), and may administer the payments as a contract, grant, or cooperative agreement.
__(2) Applicable years._Payments under paragraph (1) may not be made before calendar year 1998, except that the Secretary may make such payments before such year to eligible institutions in any State that has become a participating State under title I.
__(b) Eligible Institution._For purposes of this section, the term ``eligible institution'', with respect to a calendar year, means an institution_
__(1) in which there are one or more programs that_
__(A) are approved physician training programs; and
__(B) are receiving payments under section 3031 for such year; and
__(2) whose number of speciality positions (in the medical specialities with respect to which such payments are made) is below the number of such positions at the institution for academic year 1993-94 as a result of allocations under subpart B.
__(c) Purpose of Payments._The purpose of payments under subsection (a) is to assist an eligible institution with the costs of operation. A funding agreement for such payments is that the institution will expend the payments only for such purpose.
__(d) Application for Payments._For purposes of subsection (a), an application for payments under such subsection is in accordance with this subsection if the institution involved submits the application not later than the date specified by the Secretary; the institution has cooperated with the approved physician training programs of the institution in meeting the condition described in section 3032(b); the application contains each funding agreement described in this section and provides assurances of compliance with such agreements satisfactory to the Secretary; and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section.
__(e) Amount of Payments._
__(1) In general._Subject to the annual health professions workforce account determined by the Secretary under section 3033(a) for the calendar year involved, the amount of payments required in subsection (a) to be made to an eligible institution for the calendar year is the product of the amount determined under paragraph (2) and the applicable percentage specified in paragraph (3).
__(2) Number of specialty positions lost; national average salary._For purposes of paragraph (1), the amount determined under this paragraph for an eligible institution for the calendar year involved is the product of_
__(A) an amount equal to the number of full-time equivalent specialty positions lost; and
__(B) the national average salary of training participants.
__(3) Applicable percentage._For purposes of paragraph (1), the applicable percentage for a calendar year is the following, as applicable to such year:
__(A) For calendar year 1998, 100 percent.
__(B) For calendar year 1999, 75 percent.
__(C) For calendar year 2000, 50 percent.
__(D) For calendar year 2001, 25 percent.
__(4) Determination of specialty positions lost._
__(A) For purposes of this section, the number of specialty positions lost, with respect to a calendar year, is the difference between_
__(i) the number of specialty positions described in subparagraph (B) that are estimated for the institution involved for the academic year beginning in such calendar year; and
__(ii) the number of such specialty positions at the institution for academic year 1993-94.
__(B) For purposes of subparagraph (A), the specialty positions described in this subparagraph are specialty positions in the medical specialities with respect to which payments under section 3031 are made to programs of the institution involved.
__(5) Additional provision regarding national average salary._
__(A) The Secretary shall determine, for academic year 1992-93, an amount equal to the national average described in paragraph (2)(B). The national average applicable under such paragraph for a calendar year is, subject to subparagraph (B), the amount determined under the preceding sentence increased by an amount necessary to offset the effects of health care inflation occurring since academic year 1992-93, as determined through use of the general health care inflation factors for such years (or if there is no such factor for a year, the consumer price index for the year).
__(B) The national average determined under subparagraph (A) and applicable to a calendar year shall, in the case of the eligible institution involved, be adjusted by a factor to reflect regional differences in the applicable wage and wage-related costs.
PART 2_RELATED PROGRAMS
SEC. 3061. ADDITIONAL FUNDING FOR CERTAIN WORKFORCE PROGRAMS.
__(a) In General._For purpose of carrying out the programs described in sections 3062 and 3063, there is authorized to be appropriated $200,000,000 for fiscal year 1994 and each subsequent fiscal year (in addition to amounts that may otherwise be authorized to be appropriated for carrying out the programs).
__(b) Allocations._With respect to the amount appropriated under subsection (a) for a fiscal year, the Secretary of Health and Human Services and the Secretary of Labor shall enter into an agreement specifying the aggregate portion of such amount to be made available for the programs described in section 3062 and the aggregate portion to be made available for the programs described in section 3063.
SEC. 3062. PROGRAMS OF THE SECRETARY OF HEALTH AND HUMAN SERVICES.
__(a) In General._The programs described in this section and carried out with amounts made available under section 3061 shall be carried out by the Secretary of Health and Human Services.
__(b) Primary Care Physician and Physician Assistant Training._For purposes of section 3061, the programs described in this section include programs to support projects to train additional numbers of primary care physicians and physician assistants, including projects to enhance community-based generalist training for medical students, residents, and practicing physicians; to retrain mid-career physicians previously certified in a nonprimary care medical specialty; to expand the supply of physicians with special training to serve in rural and inner-city medically underserved areas; to support expansion of service-linked educational networks that train a range of primary care providers in community settings; to provide for training in managed care, cost-effective practice management, and continuous quality improvement; and to develop additional information on primary care workforce issues as required to meet future needs in health care.
__(b) Training of Underrepresented Minorities and Disadvantaged Persons._For purposes of section 3061, the programs described in this section include a program to support projects to increase the number of underrepresented minority and disadvantaged persons in medicine, osteopathy, dentistry, nursing, public health, and other health professions, including projects to provide continuing financial assistance for such persons entering health professions training programs; to increase support for recruitment and retention of such persons in the health professions; to maintain efforts to foster interest in health careers among such persons at the preprofessional level; and to increase the number of minority health professions faculty.
__(c) Nurse Training._For purposes of section 3061, the programs described in this section include the following:
__(1) A program to support projects to support midlevel provider training and address priority nursing workforce needs, including projects to train additional nurse practitioners and nurse midwives; to support baccalaureate-level nurse training programs providing preparation for careers in teaching, community health service, and specialized clinical care; to train additional nurse clinicians and nurse anesthetists; to support interdisciplinary school-based community nursing programs; and to promote research on nursing workforce issues.
__(2) A program to develop and encourage the adoption of model professional practice statutes for advanced practice nurses and physician assistants, and to otherwise support efforts to remove inappropriate barriers to practice by such nurses and such physician assistants.
__(d) Other Programs._For purposes of section 3061, the programs described in this section include a program to train health professionals and administrators in managed care, cost-effective practice management, continuous quality improvement practices, and provision of culturally sensitive care.
__(e) Relationship to Existing Programs._This section may be carried out through programs established in title VII or VIII of the Public Health Service Act, as appropriate and as consistent with the purposes of such programs.
SEC. 3063. PROGRAMS OF THE SECRETARY OF LABOR.
__(a) In General._The programs described in this section and carried out with amounts made available under section 3061 shall be carried out by the Secretary of Labor (in this section referred to as the ``Secretary'').
__(b) Retraining Programs; Advanced Career Positions; Job Banks._
__(1) In general._For purposes of section 3061, the programs described in this section are the following:
__(A) A program to retrain administrative and clerical workers for positions as technicians, nurses, and physician assistants.
__(B) A demonstration program to assist workers in health care institutions in obtaining advanced career positions.
__(C) A program to support development of health-worker job banks in local employment services agencies.
__(D) A program for skills upgrading, occupational retraining, and quality improvement.
__(E) A program to facilitate the comprehensive workforce adjustment initiative.
__(2) Use of funds._Amounts made available under section 3061 for carrying out this section may be expended for program support, faculty development, trainee support, workforce analysis, and dissemination of information, as necessary to produce required performance outcomes, and for establishing and operating the Institute authorized in section 3064.
__(c) Certain Requirements for Programs._In carrying out the programs described in subsection (b), the Secretary shall, with respect to the organizations and employment positions involved, provide for the following:
__(1) Explicit, clearly defined skill requirements developed for all the positions and projections of the number of openings for each position.
__(2) Opportunities for internal career movement.
__(3) Opportunities to work while training or completing and educational program.
__(4) Evaluation and dissemination.
__(5) Training opportunities in several forms, as appropriate.
__(d) Administrative Requirements._In carrying out the programs described in subsection (b), the Secretary shall, with respect to the organizations and employment positions involved, provide for the following:
__(1) Implementation and administration jointly by management and employees and their representatives.
__(2) Discussion with employees as to training needs for career advancement.
__(3) Commitment to a policy of internal hirings and promotion.
__(4) Provision of support services.
__(5) Consultations with employers and with organized labor.
SEC. 3064. NATIONAL INSTITUTE FOR HEALTH CARE WORKFORCE DEVELOPMENT.
__(a) Establishment of Institute._The Secretary of Health and Human Services and the Secretary of Labor may jointly establish an office to be known as the National Institute for Health Care Workforce Development. The subsequent provisions of this section apply to any such Institute.
__(b) Director._The Institute shall be headed by a director, who shall be appointed jointly by the Secretaries.
__(c) Duties._
__(1) In general._The Director of the Institute shall make recommendations to the Secretaries regarding_
__(A) the supply of health care workers needed for the system of regional and corporate alliance health plans established under title I; and
__(B) the impact of such system on health care workers and the needs of such workers with respect to the system, including needs regarding education, training, and other matters relating to career development.
__(2) Administration of programs regarding retraining, advanced career positions, and job banks._The Secretary of Labor may carry out section 3063 acting through the Director of the Institute.
__(d) Advisory Board._
__(1) In general._The Secretaries shall establish an advisory board to assist in the develop of recommendations under subsection (c).
__(2) Composition._The Advisory Board shall be composed of_
__(A) the Secretary of Labor;
__(B) the Secretary of Health and Human Services;
__(C) representatives of health care workers in organized labor;
__(D) representatives of health care institutions;
__(E) representatives of health care education organizations;
__(F) representatives of consumer organizations; and
__(G) such other individuals as the Secretaries determine to be appropriate.
__(e) Staff, Quarters, and Other Assistance._The Secretaries shall provide the Institute and the Advisory Board with such staff, quarters, and other administrative assistance as may be necessary for the Institute and the Advisory Board to carry out this section.
__(f) Definitions._For purposes of this section:
__(1) The term ``Advisory Board'' means the advisory board established under subsection (c).
__(2) The term ``Institute'' means an Institute established under subsection (a).
__(3) The term ``Secretaries'' means the Secretary of Health and Human Services and the Secretary of Labor.
__(g) Sunset._Effective upon the end of calendar year 2000, this section is repealed.
Title III, Subtitle B
Subtitle B_Academic Health Centers
PART 1_FORMULA PAYMENTS
SEC. 3101. FEDERAL FORMULA PAYMENTS TO ACADEMIC HEALTH CENTERS.
__(a) In General._
__(1) Formula payments._In the case of any academic health center that submits to the Secretary a written request for a calendar year in accordance with section 3102, the Secretary shall make payments for such year to the center for the purpose specified in subsection (b). The Secretary shall make the payments in an amount determined in accordance with section 3103, and shall administer the payments as a contract, grant, or cooperative agreement.
__(2) Applicable years._Payments under paragraph (1) may not be made before calendar year 1998, except that the Secretary may make such payments before such year to eligible programs in any State that has become a participating State under title I.
__(b) Payments for Costs Attributable to Academic Nature of Centers._The purpose of payments under subsection (a) is to assist academic health centers with costs that are not routinely incurred by other entities in providing health services, but are incurred by such centers in providing health services by virtue of the academic nature of such centers.
__(c) Academic Health Centers._For purposes of this subtitle, the term ``academic health center'' means an entity that operates a teaching hospital that carries out an approved physician training program (as defined in section 3011(b)).
SEC. 3102. REQUEST FOR PAYMENTS.
_(a) In General._For purposes of section 3101, a written request for payments under such section is in accordance with this section if the academic health center involved submits the request not later than the date specified by the Secretary; the request is accompanied by each funding agreement described in this part; and the request is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this part.
__(b) Continued Status as Academic Health Center._A funding agreement for payments under section 3101 is that the entity involved will maintain status as an academic health center. For purposes of this subtitle, the term ``funding agreement'', with respect to payments under section 3101 to an entity, means that the Secretary may make the payments only if the entity makes the agreement involved.
SEC. 3103. AVAILABILITY OF FUNDS FOR PAYMENTS; ANNUAL AMOUNT OF PAYMENTS.
__(a) Determination by Secretary of Funds Available for Payments._
__(1) Annual academic health center account._Subject to paragraph (2) and section 3104, the Secretary shall determine for each calendar year the amount to be made available for the purpose of making payments under section 3101 for the year to eligible centers. In determining such amount, the Secretary shall consider the need of eligible centers for assistance with the costs described in section 3101(b).
__(2) Limitation._The amount determined by the Secretary for a calendar year under paragraph (1) may not exceed the following amount, as applicable to the calendar year:
__(A) In the case of calendar year 1996, $3,100,000,000.
__(B) In the case of each of the calendar years 1997 and 1998, $3,200,000,000.
__(C) In the case of calendar year 1999, $3,700,000,000.
__(D) In the case of calendar year 2000, $3,800,000,000.
__(E) In the case of each subsequent calendar year, the amount specified in subparagraph (C) increased by the product of such amount and the general health care inflation factor (as defined in subsection (c)).
__(b) Amount of Payments for Individual Eligible Centers._The amount of payments required in section 3101 to be made to an eligible center for a calendar year is an amount equal to the product of_
__(1) the annual academic health center account determined by the Secretary under subsection (a) for the calendar year; and
__(2) the percentage constituted by the ratio of_
__(A) an amount equal to product of_
__(i) the portion of the gross receipts of the center for the preceding calendar year that was derived from providing services to patients (both inpatients and outpatients); and
__(ii) the indirect teaching adjustment factor determined under section 1886(d)(5)(B)(ii) of the Social Security Act (as in effect before January 1, 1998) and applicable to patients discharged from the center in such preceding year (or, in the case of patients discharged from the center on or after January 1, 1998, applicable to patients discharged in calendar year 1997); to
__(B) the sum of the respective amounts determined under subparagraph (A) for eligible centers.
__(c) Report Regarding Modifications in Formula._Not later than July 1, 1996, the Secretary shall submit to the Congress a report containing any recommendations of the Secretary regarding policies for allocating amounts under subsection (a) among eligible centers.
__(d) Definition._For purposes of this subtitle:
__(1) The term ``eligible center'', with respect to the calendar year involved, means an academic health center that submits to the Secretary a written request for such year in accordance with section 3102.
__(2) The term ``annual academic health center account'', with respect to a calendar year, means the amount determined under subsection (a) for such year.
__(2) The term ``general health care inflation factor'', with respect to a year, has the meaning given such term in section 6001(a)(3) for such year.
SEC. 3104. ADDITIONAL FUNDING PROVISIONS.
__(a) Sources of Funds for Annual Academic Health Center._The annual academic health center account under section 3103(a) for a calendar year shall be derived from the sources specified in subsection (b).
__(b) Contributions From Medicare Trust Funds, Regional Alliances, and Corporate Alliances._For purposes of subsection (a), the sources specified in this subsection for a calendar year are the following:
__(1) Transfers made by the Secretary under section 4052.
__(2) Payments made by regional alliances under section 1353 and transferred in an amount equal to the aggregate regional alliance portion determined under subsection (c)(2)(A).
__(3) The transfer made under section (d)(1).
__(c) Contributions From Regional and Corporate Alliances._
__(1) Determination of aggregate regional and corporate alliance amount._For purposes regarding the provision of funds for the annual academic health center account for a calendar year, the Secretary shall determine an aggregate regional and corporate alliance amount, which amount is to be paid by such alliances pursuant to paragraphs (2) and (3) of subsection (b), respectively, and which amount shall be equal to the difference between_
__(A) the annual academic health center account for such year; and
__(B) the amount transferred under section 4052 for the year.
__(2) Allocation of amount among regional and corporate alliances._With respect to the aggregate regional and corporate alliance amount determined under paragraph (1) for a calendar year_
__(A) the aggregate regional alliance portion of such amount is the product of such amount and the percentage constituted by the ratio of the total plan payments of regional alliances to the combined total plan payments of regional alliances and corporate alliances; and
__(B) the aggregate corporate alliance portion of such amount is the product of such amount and the percentage constituted by the ratio of the total plan payments of corporate alliances to such combined total plan payments.
__(d) Compliance Regarding Corporate Alliances._
__(1) In general._Effective January 15 of each calendar year, there is hereby transferred to the Secretary, out of any money in the Treasury not otherwise appropriated, an amount equal to the aggregate corporate alliance portion determined under subsection (c)(2)(B) for such year.
__(2) Manner of compliance._The payment by corporate alliances of the tax imposed under section 3461 of the Internal Revenue Code of 1986 (as added by section 7121 of this Act), together with the transfer made in paragraph (1) for the calendar year involved, is deemed to be the payment required pursuant to subsection (c)(1) for corporate alliances for such year..
__(e) Definitions._For purposes of this subtitle, the term ``plan payments'' with respect to a regional or corporate alliance, means the amount paid to health plans by the alliance.
PART 2_ACCESS OF PATIENTS TO ACADEMIC HEALTH CENTERS
SEC. 3131. CONTRACTS FOR ENSURING ACCESS TO CENTERS.
__(a) Contracts With Health Plans._Regional and corporate health alliances under this Act shall ensure that, in accordance with subsection (b), the health plans of the alliances enter into sufficient contracts with eligible centers to ensure that enrollees in regional or corporate alliance health plans, as appropriate, receive the specialized treatment expertise of such centers, subject to such exceptions as the Secretary may provide.
__(b) Utilization of Specialized Treatment Expertise of Centers._Contracts under subsection (a) between eligible centers and health plans are in accordance with this subsection if the contracts provide that, with respect to health conditions within the specialized treatment expertise of the centers, health plans will refer medical cases involving such conditions to the centers.
__(c) Specialized Treatment Expertise._For purposes of this subtitle, the term ``specialized treatment expertise'', with respect to treatment of a health condition by an academic health center, means expertise in treating rare diseases, treating unusually severe conditions, and providing other specialized health care.
SEC. 3132. DISCRETIONARY GRANTS REGARDING ACCESS TO CENTERS.
__(a) Rural Information and Referral Systems._The Secretary may make grants to eligible centers for the establishment and operation of information and referral systems to provide the services of such centers to rural regional and corporate health alliance health plans.
__(b) Other Purposes Regarding Urban and Rural Areas._The Secretary may make grants to eligible centers to carry out activities (other than activities carried out under subsection (a)) for the purpose of providing the services of eligible centers to residents of rural or urban communities who otherwise would not have adequate access to such services.
Title III, Subtitle C
Subtitle C_Health Research Initiatives
PART 1_PROGRAMS FOR CERTAIN AGENCIES
SEC. 3201. BIOMEDICAL AND BEHAVIORAL RESEARCH ON HEALTH PROMOTION AND DISEASE PREVENTION.
__Section 402(f) of the Public Health Service Act (42 U.S.C. 282(f)), as amended by section 201 of Public Law 103-43 (107 Stat. 144), is amended_
__(1) in paragraph (3), by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively;
__(2) by redesignating paragraphs (1) through (3) as subparagraphs (A) through (C);
__(3) by inserting ``(1)'' after ``(f)''; and
__(4) by adding at the end the following paragraph:
__``(2)(A) The Director of NIH, in collaboration with the Associate Director for Prevention and with the heads of the agencies of the National Institutes of Health, shall ensure that such Institutes conduct and support biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions (including Alzheimer's disease, breast cancer, heart disease, and stroke).
__``(B) In carrying out subparagraph (A), the Director of NIH shall give priority to conducting and supporting research on child and adolescent health (including birth defects), chronic and recurrent health conditions, reproductive health, mental health, elderly health, substance abuse, infectious diseases, health and wellness promotion, and environmental health, and to resource development related to such research.''.
SEC. 3202. HEALTH SERVICES RESEARCH.
__Section 902 of the Public Health Service Act (42 U.S.C. 299a), as amended by section 2(b) of Public Law 102-410 (106 Stat. 2094), is amended by adding at the end the following subsection:
__``(f) Research on Health Care Reform._
__``(1) In general._In carrying out section 901(b), the Administrator shall conduct and support research on the reform of the health care system of the United States, as directed by the National Board.
__``(2) Priorities._In carrying out paragraph (1), the Administrator shall give priority to the following:
__``(A) Conducting and supporting research on the appropriateness and effectiveness of alternative clinical strategies; the quality and outcomes of care; and administrative simplification.
__``(B) Conducting and supporting research on consumer choice and information resources; the effects of health care reform on health delivery systems; workplace injury and illness prevention; methods for risk adjustment; factors influencing access to health care for underserved populations; and primary care.
__``(C) The development of clinical practice guidelines consistent with section 913, the dissemination of such guidelines consistent with section 903, and the assessment of the effectiveness of such guidelines.''.
PART 2_FUNDING FOR PROGRAMS
SEC. 3211. AUTHORIZATIONS REGARDING PUBLIC HEALTH SERVICE INITIATIVES FUND.
__(a) Biomedical and Behavioral Research on Health Promotion and Disease Prevention._For the purpose of carrying out activities pursuant to the amendments made by section 3201, there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $400,000,000 for fiscal year 1995, and $500,000,000 for each of the fiscal years 1996 through 2000.
__(b) Health Services Research._For the purpose of carrying out activities pursuant to the amendments made by section 3202, there are authorized to be appropriated from the Public Health Service Initiatives Fund $150,000,000 for fiscal year 1995, $400,000,000 for fiscal year 1996, $500,000,000 for fiscal year 1997, and $600,000,000 for each of the fiscal years 1998 through 2000.
__(c) Relation to Other Funds._The authorizations of appropriations established in subsections (a) and (b) are in addition to any other authorizations of appropriations that are available for the purposes described in such subsections.
Title III, Subtitle D
Subtitle D_Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health
PART 1_FUNDING
SEC. 3301. AUTHORIZATIONS REGARDING PUBLIC HEALTH SERVICE INITIATIVES FUND.
__(a) Core Functions of Public Health Programs._For the purpose of carrying out part 2, there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $12,000,000 for fiscal year 1995, $325,000,000 for fiscal year 1996, $450,000,000 for fiscal year 1997, $550,000,000 for fiscal year 1998, $650,000,000 for fiscal year 1999, and $750,000,000 for fiscal year 2000.
__(b) National Initiatives Regarding Health Promotion and Disease Prevention._For the purpose of carrying out part 3, there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $175,000,000 for fiscal year 1996, and $200,000,000 for each of the fiscal years 1997 through 2000.
__(c) Relation to Other Funds._The authorizations of appropriations established in subsections (a) and (b) are in addition to any other authorizations of appropriations that are available for the purposes described in such subsections.
PART 2_CORE FUNCTIONS OF PUBLIC HEALTH PROGRAMS
SEC. 3311. PURPOSES.
__Subject to the subsequent provisions of this subtitle, the purposes of this part are to strengthen the capacity of State and local public health agencies to carry out the following functions:
__(1) To monitor and protect the health of communities against communicable diseases and exposure to toxic environmental pollutants, occupational hazards, harmful products, and poor quality health care.
__(2) To identify and control outbreaks of infectious disease and patterns of chronic disease and injury.
__(3) To inform and educate health care consumers and providers about their roles in preventing and controlling disease and the appropriate use of medical services.
__(4) To develop and test new prevention and public health control interventions.
SEC. 3312. GRANTS TO STATES FOR CORE HEALTH FUNCTIONS.
__(a) In General._The Secretary may make grants to States for the purpose of carrying out one or more of the functions described in subsection (b).
__(b) Core Functions of Public Health Programs._For purposes of subsection (a), the functions described in this subsection are, subject to subsection to subsection (c), as follows:
__(1) Data collection, activities related to population health measurement and outcomes monitoring, including the regular collection and analysis of public health data, vital statistics, and personal health services data and analysis for planning and needs assessment purposes of data collected from health plans through the information system under title V of this Act.
__(2) Activities to protect the environment and to assure the safety of housing, workplaces, food and water, including the following activities:
__(A) Monitoring the overall public health quality and safety of communities.
__(B) Assessing exposure to high lead levels and water contamination.
__(C) Monitoring sewage and solid waste disposal, radiation exposure, radon exposure, and noise levels.
__(D) Abatement of lead-related hazards.
__(E) Assuring recreation and worker safety.
__(F) Enforcing public health safety and sanitary codes.
__(G) Other activities relating to promoting the public health of communities.
__(3) Investigation and control of adverse health conditions, including improvements in emergency treatment preparedness, cooperative activities to reduce violence levels in communities, activities to control the outbreak of disease, exposure related conditions and other threats to the health status of individuals.
__(4) Public information and education programs to reduce risks to health such as use of tobacco, alcohol and other drugs, sexual activities that increase the risk to HIV transmission and sexually transmitted diseases, poor diet, physical inactivity, and low childhood immunization levels.
__(5) Accountability and quality assurance activities, including monitoring the quality of personal health services furnished by health plans and providers of medical and health services in a manner consistent with the overall quality of care monitoring activities undertaken under title V, and monitoring communities' overall access to health services.
__(6) Provision of public health laboratory services to complement private clinical laboratory services and that screen for diseases and conditions such as metabolic diseases in newborns, provide toxicology assessments of blood lead levels and other environmental toxins, diagnose sexually transmitted diseases, tuberculosis and other diseases requiring partner notification, test for infectious and food-borne diseases, and monitor the safety of water and food supplies.
__(7) Training and education to assure provision of care by all health professionals, with special emphasis placed on the training of public health professions including epidemiologists, biostatisticians, health educators, public health administrators, sanitarians and laboratory technicians.
__(8) Leadership, policy development and administration activities, including needs assessment, the setting of public health standards, the development of community public health policies, and the development of community public health coalitions.
__(c) Restrictions on Use of Grant._
__ (1) In general._A funding agreement for a grant under subsection (a) for a State is that the grant will not be expended_
__(A) to provide inpatient services;
__(B) to make cash payments to intended recipients of health services;
__(C) to purchase or improve land, purchase, construct, or permanently improve (other than minor remodeling) any building or other facility, or purchase major medical equipment;
__(D) to satisfy any requirement for the expenditure of non-Federal funds as a condition for the receipt of Federal funds; or
__(E) to provide financial assistance to any entity other than a public or nonprofit private entity.
__(2) Limitation on administrative expenses._A funding agreement for a grant under subsection (a) is that the State involved will not expend more than 10 percent of the grant for administrative expenses with respect to the grant.
__(d) Maintenance of Effort._A funding agreement for a grant under subsection (a) is that the State involved will maintain expenditures of non-Federal amounts for core health functions at a level that is not less than the level of such expenditures maintained by the State for the fiscal year preceding the first fiscal year for which the State receives such a grant.
SEC. 3313. SUBMISSION OF INFORMATION.
__The Secretary may make a grant under section 3312 only if the State involved submits to the Secretary the following information:
__(1) A description of existing deficiencies in the State's public health system (at the State level and the local level), using standards of sufficiency developed by the Secretary.
__(2) A description of health status measures to be improved within the State (at the State level and the local level) through expanded public health functions.
__(3) Measurable outcomes and process objectives for improving health status and core health functions for which the grant is to be expended.
__(4) Information regarding each such function, which_
__(A) identifies the amount of State and local funding expended on each such function for the fiscal year preceding the fiscal year for which the grant is sought; and
__(B) provides a detailed description of how additional Federal funding will improve each such function by both the State and local public health agencies.
__(5) A description of the core health functions to be carried out at the local level, and a specification for each such function of_
__(A) the communities in which the function will be carried out; and
__(B) the amount of the grant to be expended for the function in each community so specified.
SEC. 3314. REPORTS.
__A funding agreement for a grant under section 3312 is that the States involved will, not later than the date specified by the Secretary, submit to the Secretary a report describing_
__(1) the purposes for which the grant was expended; and
__(2) describing the extent of progress made by the State in achieving measurable outcomes and process objectives described in section 3313(3).
SEC. 3315. APPLICATION FOR GRANT.
__The Secretary may make a grant under section 3312 only if an application for the grant is submitted to the Secretary, the application contains each agreement described in this part, the application contains the information required in section 3314, and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this part.
SEC. 3316. GENERAL PROVISIONS.
__(a) Uniform Data Sets._The Secretary, in consultation with the States, shall develop uniform sets of data for the purpose of monitoring the core health functions carried out with grants under section 3312.
__(b) Duration of Grant._The period during which payments are made to a State from a grant under section 3312 may not exceed 5 years. The provision of such payments shall be subject to annual approval by the Secretary of the payments. This subsection may not be construed as establishing a limitation on the number of grants under such section that may be made to the State.
SEC. 3317. ALLOCATIONS FOR CERTAIN ACTIVITIES.
__Of the amounts made available under section 3301 for a fiscal year for carrying out this part, the Secretary may reserve not more than 5 percent for carrying out the following activities:
__(1) Technical assistance with respect to planning, development, and operation of core health functions carried out under section 3312, including provision of biostatistical and epidemiological expertise and provision of laboratory expertise.
__(2) Development and operation of a national information network among State and local health agencies.
__(3) Program monitoring and evaluation of core health functions carried out under section 3312.
__(4) Development of a unified electronic reporting mechanism to improve the efficiency of administrative management requirements regarding the provision of Federal grants to State public health agencies.
SEC. 3318. DEFINITIONS.
__For purposes of this part:
__(1) The term ``funding agreement'', with respect to a grant under section 3312 to a State, means that the Secretary may make the grant only if the State makes the agreement involved.
__(2) The term ``core health functions'', with respect to a State, means the functions described in section 3312(b).
PART 3_NATIONAL INITIATIVES REGARDING HEALTH PROMOTION AND DISEASE PREVENTION
SEC. 3331. GRANTS FOR NATIONAL PREVENTION INITIATIVES.
__(a) In General._The Secretary may make grants to entities described in subsection (b) for the purpose of carrying out projects to develop and implement innovative community-based strategies to provide for health promotion and disease prevention activities for which there is a significant need, as identified under section 1701 of the Public Health Service Act.
__(b) Eligible Entities._The entities referred to in subsection (a) are agencies of State or local government, private nonprofit organizations (including research institutions), and coalitions that link two or more of these groups.
__(c) Certain Activities._The Secretary shall ensure that projects carried out under subsection (a)_
__(1) reflect approaches that take into account the special needs and concerns of the affected populations;
__(2) are targeted to the most needy and vulnerable population groups and geographic areas of the Nation;
__(3) examine links between various high priority preventable health problems and the potential community-based remedial actions; and
__(4) establish or strengthen the links between the activities of agencies engaged in public health activities with those of health alliances, health care providers, and other entities involved in the personal health care delivery system described in title I.
SEC. 3332. PRIORITIES.
__(a) Establishment._
__(1) Annual statement._After consultation with the advisory board established in section 3335, the Secretary shall for each fiscal year develop a statement of proposed priorities for grants under section 3331 for the fiscal year.
__(2) Allocations among priorities._With respect to the amounts available under section 3301 for the fiscal year for carrying out this part, each statement under paragraph (1) for a fiscal year shall include a specification of the percentage of the amount to be devoted to projects addressing each of the proposed priorities established in the statement.
__(3) Process for establishing priorities._Not later than January 1 of each fiscal year, the Secretary shall publish a statement under paragraph (1) in the Federal Register. A period of 60 days shall be allowed for the submission of public comments and suggestions concerning the proposed priorities. After analyzing and considering comments on the proposed priorities, the Secretary shall publish in the Federal Register final priorities (and associated reservations of funds) for approval of projects for the following fiscal year.
__(b) Applicability to Making of Grants._
__(1) In general._Subject to paragraph (3), the Secretary may make grants under section 3331 for projects that the Secretary determines_
__(A) are consistent with the applicable final statement of priorities and otherwise meets the objectives described in subsection (a); and
__(B) will assist in meeting a health need or concern of a population served by a health plan or health alliance established under title I.
__(2) Special consideration for certain projects._In making grants under section 3331, the Secretary shall, subject to paragraph (3), give special consideration to applicants that will carry out projects that, in addition to being consistent with the applicable published priorities under subsection (a) and otherwise meeting the requirements of this part, have the potential for replication in other communities.
SEC. 3333. SUBMISSION OF INFORMATION.
__The Secretary may make a grant under section 3331 only if the applicant involved submits to the Secretary the following information:
__(1) A description of the activities to be conducted, and the manner in which the activities are expected to contribute to meeting one or more of the priority health needs specified under section 3332 for the fiscal year for which the grant is initially sought.
__(2) A description of the total amount of Federal funding requested, the geographic area and populations to be served, and the evaluation procedures to be followed.
__(3) Such other information as the Secretary determines to be appropriate.
SEC. 3334. APPLICATION FOR GRANT.
__The Secretary may make a grant under section 3331 only if an application for the grant is submitted to the Secretary, the application contains each agreement described in this part, the application contains the information required in section 3333, and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this part.
Title III, Subtitle E
Subtitle E_Health Services for Medically Underserved Populations
PART 1_COMMUNITY AND MIGRANT HEALTH CENTERS
SEC. 3401. AUTHORIZATIONS REGARDING PUBLIC HEALTH SERVICE INITIATIVES FUND.
__(a) Grants to Community and Migrant Health Centers._The Secretary shall make grants in accordance with this part to migrant health centers and community health centers.
__(b) Authorization of Appropriations._For the purpose of carrying out subsection (a), there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $100,000,000 for each of the fiscal years 1995 through 2000.
__(c) Relation to Other Funds._The authorizations of appropriations established in subsection (b) for the purpose described in such subsection are in addition to any other authorizations of appropriations that are available for such purpose.
__(d) Definitions._For purposes of this subtitle, the terms ``migrant health center'' and ``community health center'' have the meanings given such terms in sections 329(a)(1) and 330(a) of the Public Health Service Act, respectively.
SEC. 3402. USE OF FUNDS.
__(a) Development, Operation, and Other Purposes Regarding Centers._Subject to subsection (b), grants under section 3401 to migrant health centers and community health centers may be made only in accordance with the conditions upon which grants are made under sections 329 and 330 of the Public Health Service Act, respectively.
__(b) Required Financial Reserves._The Secretary may authorize migrant health centers and community health centers to expend a grant under section 3401 to establish and maintain the financial reserves required under title I for providers of health services.
PART 2_INITIATIVES FOR ACCESS TO HEALTH CARE
Subpart A_Purposes; Funding
SEC. 3411. PURPOSES.
__Subject to the provisions of subparts B through D, the purposes of this part are as follows:
__(1) To improve access to health services for urban and rural medically-underserved populations through a program of flexible grants, contracts, and loans.
__(2) To facilitate transition to a system in which medically-underserved populations have an adequate choice of community-oriented providers and health plans.
__(3) To promote the development of community practice networks and community health plans that integrate health professionals and health care organizations supported through public funding with other providers in medically underserved areas.
__(4) To support linkages between providers of health care for medically-underserved populations and regional and corporate alliance health plans.
__(5) To expand the capacity of community practice networks and community health plans in underserved areas by increasing the number of practice sites and by renovating and converting substandard inpatient and outpatient facilities.
__(6) To link providers in underserved areas with each other and with regional health care institutions and academic health centers through information systems and telecommunications.
__(7) To support activities that enable medically underserved populations to gain access to the health care system and use it effectively.
SEC. 3412. AUTHORIZATIONS REGARDING PUBLIC HEALTH SERVICE INITIATIVES FUND.
__(a) Development of Qualified Community Health Plans and Practice Groups._For the purpose of carrying out subparts B and C, there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $200,000,000 for fiscal year 1995, $500,000,000 for fiscal year 1996, $600,000,000 for fiscal year 1997, $700,000,000 for fiscal year 1998, $500,000,000 for fiscal year 1999, and $200,000,000 for fiscal year 2000.
__(b) Relation to Other Funds._The authorizations of appropriations established in subsection (a) are in addition to any other authorizations of appropriations that are available for the purpose described in such subsection.
__(c) Relationship to Program Regarding School-Related Health Services._This section is subject to section 3692.
Subpart B_Development of Qualified Community Health Plans and Practice Networks
SEC. 3421. GRANTS AND CONTRACTS FOR DEVELOPMENT OF PLANS AND NETWORKS.
__(a) In General._The Secretary may make grants to and enter into contracts with consortia of public or private health care providers for the development of qualified community health plans and qualified community practice networks. For purposes of this subtitle, the term ``qualified community health group'' means such a health plan or such a practice network.
__(b) Qualified Community Health Plans._For purposes of this subtitle, the term ``qualified community health plan'' means a health plan that meets the following conditions:
__(1) The health plan is a public or nonprofit private entity whose principal purpose is, with respect to the items and services included in the comprehensive benefit package under title I, to provide each of such items and services in one or more health professional shortage areas or to provide such items and services to a significant number of individuals who are members of a medically underserved population.
__(2) The health plan is a participant in one or more health alliances.
__(3) Two or more of the categories specified in subsection (d) are represented among the entities providing health services through the health plan.
__(c) Qualified Community Practice Networks._For purposes of this subtitle, the term ``qualified community practice network'' means a consortium of health care providers meeting the following conditions:
__(1) The consortium is a public or nonprofit private entity whose principal purpose is the purpose described in subsection (b)(1).
__(2) The consortium has an agreement with one or more health plans that are participating in one or more health alliances.
__(3) The participation of health care providers in the consortium is governed by a written agreement to which each of the participating providers is a party.
__(4) Two or more of the categories described in subsection (d) are represented among the entities participating in the consortium.
__(d) Relevant Categories of Entities._For purposes of subsections (b)(3) and (c)(4), the categories described in this subsection are the following categories of entities:
__(1) Physicians, other health professionals, or health care institutions that provide health services in one or more health professional shortage areas or provide such services to a significant number of individuals who are members of a medically underserved population, and that do not provide health services under any of the programs specified in paragraphs (2) through (7) or as employees of public entities.
__(2) Entities providing health services under grants under sections 329 and 330 of the Public Health Service Act.
__(3) Entities providing health services under grants under sections 340 and 340A of such Act.
__(4) Entities providing health services under grants under section 1001 or title XXIII of such Act.
__(5) Entities providing health services under title V of the Social Security Act.
__(6) Entities providing health services through rural health clinics and other federally qualified health centers.
__(7) Entities providing health services in urban areas through programs under title V of the Indian Health Care Improvement Act, and entities providing outpatient health services through programs under the Indian Self-Determination Act.
__(8) Programs providing personal health services and operating through State or local public health agencies.
__(e) Rule of Construction._The consortia to which the Secretary may make an award of financial assistance under subsection (a) for the development of qualified community practice networks include any health plan that participates in one or more health alliances, without regard to whether the health plan is a qualified community health plan.
__(f) Service Area._In making an award of financial assistance under subsection (a), the Secretary shall designate the geographic area with respect to which the qualified community health group involved is to provide health services. A funding agreement for such an award is that the qualified community health group involved will provide such services in the area so designated.
__(g) Definitions._For purposes of this subtitle:
__(1) The term ``health professional shortage areas'' means health professional shortage areas designated under section 332 of the Public Health Service Act.
__(2) The term ``medically underserved population'' means a medically underserved population designated under section 330 of the Public Health Service Act.
__(3) The term ``rural health clinic'' has the meaning given such term in section 1861(aa)(2) of the Social Security Act.
__(4) The term ``federally qualified health centers'' has the meaning given such term in section 1861(aa)(4) of the Social Security Act.
__(5) The term ``service area'', with respect to a qualified community health group, means the geographic area designated under subsection (g).
__(6) The term ``funding agreement'', with respect to an award of financial assistance under this section, means that the Secretary may make the award only if the applicant for the award makes the agreement involved.
__(7) The term ``financial assistance'', with respect to awards under subsection (a), means a grant or contract.
SEC. 3422. PREFERENCES IN MAKING AWARDS OF ASSISTANCE.
__In making awards of financial assistance under section 3421, the Secretary shall give preference to applicants in accordance with the following:
__(1) The Secretary shall give preference if 3 or more of the categories described in subsection (d) of such section will be represented in the qualified community health group involved (pursuant to subsection (b)(3) or (c)(4), as the case may be).
__(2) Of applicants receiving preference under paragraph (1), the Secretary shall give a greater degree of preference according to the extent to which a greater number of categories are represented.
__(3) Of applicants receiving preference under paragraph (1), the Secretary shall give a greater degree of preference if one of the categories represented is the category described in subsection (d)(1) of such section.
SEC. 3423. CERTAIN USES OF AWARDS.
__(a) In General._Subject to subsection (b), the purposes for which an award of financial assistance under section 3421 may be expended in developing a qualified community health group include the following:
__(1) Planning such group, including entering into contracts between the recipient of the award and health care providers who are to participate in the group.
__(2) Recruitment, compensation, and training of health professionals and administrative staff.
__(3) Acquisition, expansion, modernization, and conversion of facilities, including for purposes of providing for sites at which health services are to be provided through such group.
__(4) Acquisition and development of information systems (exclusive of systems that the Secretary determines are information highways).
__(5) Such other expenditures as the Secretary determines to be appropriate.
__(b) Twenty-year Obligation Regarding Significant Capital Expenditures; Right of Recovery._
__(1) In general._With respect to a facility for which substantial capital costs are to paid from an award of financial assistance under section 3421, the Secretary may make the award only if the applicant involved agrees that the applicant will be liable to the United States for the amount of the award expended for such costs, together with an amount representing interest, if at any time during the 20-period beginning on the date of completion of the activities involved, the facility_
__(A) ceases to be a facility utilized by a qualified community health group, or by another public or nonprofit private entity that provides health services in one or more health professional shortage areas or that provides such services to a significant number of individuals who are members of a medically underserved population; or
__(B) is sold or transferred to any entity other than an entity that is_
__(i) a qualified community health group or other entity described in subparagraph (A); and
__(ii) approved by the Secretary as a purchaser or transferee regarding the facility.
__(2) Subordination; waivers._The Secretary may subordinate or waive the right of recovery under paragraph (1), and any other Federal interest that may be derived by virtue of an award of financial assistance under section 3421 from which substantial capital costs are to paid from an award, if the Secretary determines that subordination or waiver will further the objectives of this part.
SEC. 3424. ACCESSIBILITY OF SERVICES.
__(a) Services for Certain Individuals._A funding agreement for an award of financial assistance under section 3421 is that the qualified community health group involved will ensure that the services of the group will be accessible directly or through formal contractual arrangements with its participating providers regardless of whether individuals who seek care from the applicant are eligible persons under title I.
__(b) Use of Third-Party Payors._A funding agreement for an award of financial assistance under section 3421 is that the qualified community health group involved will ensure that the health care providers of the group are all approved by the Secretary as providers under title XVIII of the Social Security Act and by the appropriate State agency as providers under title XIX of the Social Security Act, and the applicant has made or will make every reasonable effort to collect appropriate reimbursement for its costs in providing health services to individuals who are entitled to health benefits under title I of this Act, insurance benefits under title XVIII of the Social Security Act, medical assistance under a State plan approved under title XIX of the Social Security Act, or to assistance for medical expenses under any other public assistance program or private health insurance program.
__(c) Schedule of Fees._A funding agreement for an award of financial assistance under section 3421 is that the qualified community health group involved will_
__(1) prepare a schedule of fees or payments for the provision of health services not covered by title I that is 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 (or payments of cost sharing amounts owed in the case of covered benefits) which discounts are applied on the basis of the patient's ability to pay; and
__(2) make every reasonable effort to secure from patients payment in accordance with such schedules, and to collect reimbursement for services to persons entitled to public or private insurance benefits or other medical assistance on the basis of full fees without application of discounts, except that the applicant will ensure that no person is denied service based on the person's inability to pay therefor.
__(d) Barriers Within Service Area._A funding agreement for an award of financial assistance under section 3421 is that the qualified community health group involved will ensure that the following conditions are met:
__(1) In the service area of the group, the group will ensure that_
__(A) the services of the group are accessible to all residents; and
__(B) to the maximum extent possible, barriers to access to the services of the group are eliminated, including barriers resulting from the area's physical characteristics, its residential patterns, its economic, social and cultural groupings, and available transportation.
__(2) The group will periodically conduct reviews within the service area of the group to determine whether the conditions described in paragraph (1) are being met.
__(e) Limited Ability to Speak English Language._A funding agreement for an award of financial assistance under section 3421 is that, if the service area of the qualified community health group involved serves a substantial number of individuals who have a limited ability to speak the English language, the applicant will_
__(1) maintain arrangements responsive to the needs of such individuals for providing services to the extent practicable in the language and cultural context most appropriate to such individuals; and
__(2) maintain a sufficient number of staff members who are fluent in both English and the languages spoken by such individuals, and will ensure that the responsibilities of the employees include providing guidance and assistance to such individuals and to other staff members of the group.
SEC. 3425. ADDITIONAL AGREEMENTS.
__(a) Required Services._A funding agreement for an award of financial assistance under section 3421 is that the qualified community health group involved will provide enabling services (as defined in section 3461(g)) and all of the items and services identified by the Secretary in rules regarding qualified community health plans and practice networks.
__(b) Quality Control System._A funding agreement for an award of financial assistance under section 3421 is that the qualified community health group involved will maintain a community-oriented, patient responsive, quality control system under which the group, in accordance with regulations prescribed by the Secretary_
__(1) conducts an ongoing quality assurance program for the health services delivered by participating provider entities;
__(2) maintains a continuous community health status improvement process; and
__(3) maintains a system for development, compilation, evaluation and reporting of information to the public regarding the costs of operation, service utilization patterns, availability, accessibility and acceptability of services, developments in the health status of the populations served, uniform health and clinical performance measures and financial performance of the network or plan.
__(c) Use of Existing Resources._A funding agreement for an award of financial assistance under section 3421 is that the applicant will, in developing the qualified community health group involved, utilize existing resources to the maximum extent practicable.
SEC. 3426. SUBMISSION OF CERTAIN INFORMATION.
__(a) Assessment of Need._The Secretary may make an award of financial assistance under section 3421 only if the applicant involved submits to the Secretary an assessment of the need that the medically underserved population or populations proposed to be served by the applicant have for health services and for enabling services (as defined in section 3461(g)).
__(b) Description of Intended Expenditures; Related Information._The Secretary may make an award of financial assistance under section 3421 only if the applicant involved submits to the Secretary the following information:
__(1) A description of how the applicant will design the proposed quality community health plan or practice network (including the service sites involved) for such populations based on the assessment of need.
__(2) A description of efforts to secure, within the proposed service area of such health plan or practice network (including the service sites involved), financial and professional assistance and support for the project.
__(3) Evidence of significant community involvement in the initiation, development and ongoing operation of the project.
SEC. 3427. REPORTS; AUDITS.
__A funding agreement for an award of financial assistance under section 3421 is that the applicant involved will_
__(1) provide such reports and information on activities carried out under this section in a manner and form required by the Secretary; and
__(2) provide an annual organization-wide audit that meets applicable standards of the Secretary.
SEC. 3428. APPLICATION FOR ASSISTANCE.
__The Secretary may make an award of financial assistance under section 3421 only if an application for the award is submitted to the Secretary, the application contains each funding agreement described in this subpart, the application contains the information required in section 3426, and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this subpart.
SEC. 3429. GENERAL PROVISIONS.
__(a) Limitation on Number of Awards._The Secretary may not make more than two awards of financial assistance under section 3421 for the same project.
__(b) Amount._The amount of any award of financial assistance under section 3421 for any project shall be determined by the Secretary.
Subpart C_Capital Cost of Development of Qualified Community Health Plans and Practice Networks
SEC. 3441. LOANS AND LOAN GUARANTEES REGARDING PLANS AND NETWORKS.
__(a) In General._The Secretary may make loans to, and guarantee the payment of principal and interest to Federal and non-Federal lenders on behalf of, public and private entities for the capital costs of developing qualified community health groups (as defined in section 3421(a)).
__(b) Preferences; Accessibility of Services; Certain Other Provisions._The provisions of subpart B apply to loans and loan guarantees under subsection (a) to the same extent and in the same manner as such provisions apply to awards of grants and contracts under section 3421.
__(c) Use of Assistance._
__(1) In general._With respect to the development of qualified community health groups, the capital costs for which loans made pursuant to subsection (a) may be expended are, subject to paragraphs (2) and (3), the following:
__(A) The acquisition, modernization, expansion or construction of facilities, or the conversion of unneeded hospital facilities to facilities that will assure or enhance the provision and accessibility of health care and enabling services to medically underserved populations.
__(B) The purchase of major equipment, including equipment necessary for the support of external and internal information systems.
__(C) The establishment of reserves required for furnishing services on a prepaid basis.
__(D) Such other capital costs as the Secretary may determine are necessary to achieve the objectives of this section.
__(2) Priorities regarding use of funds._In providing loans or loan guarantees under subsection (a) for an entity, the Secretary shall give priority to authorizing the use of amounts for projects for the renovation and modernization of medical facilities necessary to prevent or eliminate safety hazards, avoid noncompliance with licensure or accreditation standards, or projects to replace obsolete facilities.
__(3) Limitation._The Secretary may authorize the use of amounts under subsection (a) for the construction of new buildings only if the Secretary determines that appropriate facilities are not available through acquiring, modernizing, expanding or converting existing buildings, or that construction new buildings will cost less.
__(d) Amount of assistance._The principal amount of loans or loan guarantees under subsection (a) may, when added to any other assistance under this section, cover up to 100 percent of the costs involved.
SEC. 3442. CERTAIN REQUIREMENTS.
__(a) Loans._
__(1) In general._The Secretary may approve a loan under section 3441 only if_
__(A) the Secretary is reasonably satisfied that the applicant for the project for which the loan would be made will be able to make payments of principal and interest thereon when due; and
__(B) the applicant provides the Secretary with reasonable assurances that there will be available to it such additional funds as may be necessary to complete the project or undertaking with respect to which such loan is requested.
__(2) Terms and conditions._Any loan made under section 3441 shall meet such terms and conditions (including provisions for recovery in case of default) as the Secretary determines to be necessary to carry out the purposes of such section while adequately protecting the financial interests of the United States. Terms and conditions for such loans shall include provisions regarding the following:
__(A) Security.
__(B) Maturity date.
__(C) Amount and frequency of installments.
__(D) Rate of interest, which shall be at a rate comparable to the rate of interest prevailing on the date the loan is made.
__(b) Loan Guarantees._The Secretary may not approve a loan guarantee under section 3441 unless the Secretary determines that the terms, conditions, security (if any), 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. Such loan guarantees shall be subject to such further terms and conditions as the Secretary determines to be necessary to ensure that the purposes of this section will be achieved.
__(c) Use of Existing Resources._The Secretary may provide a loan or loan guarantee under section 3441 only if the applicant involved agrees that, in developing the qualified community health group involved, the applicant will utilize existing resources to the maximum extent practicable.
SEC. 3443. DEFAULTS; RIGHT OF RECOVERY.
__(a) Defaults._
__(1) In general._The Secretary may take such action as may be necessary to prevent a default on loans or loan guarantees under section 3441, 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.
__(2) Foreclosure._The Secretary may take such action, consistent with State law respecting foreclosure procedures, as the Secretary deems appropriate to protect the interest of the United States in the event of a default on a loan made pursuant to section 3441, including selling real property pledged as security for such a loan or loan guarantee and for a reasonable period of time taking possession of, holding, and using real property pledged as security for such a loan or loan guarantee.
__(3) Waivers._The Secretary may, for good cause, but with due regard to the financial interests of the United States, waive any right of recovery which the Secretary has by reasons of the failure of a borrower to make payments of principal of and interest on a loan made pursuant to section 3441, except that if such loan is sold and guaranteed, any such waiver shall have no effect upon the Secretary's guarantee of timely payment of principal and interest.
__(b) Twenty-year Obligation; Right of Recovery._
__(1) In general._With respect to a facility for which a loan is to be made pursuant to section 3441, the Secretary may provide the loan or loan guarantee only if the applicant involved agrees that the applicant will be liable to the United States for the amount of the loan or loan guarantee, together with an amount representing interest, if at any time during the 20-period beginning on the date of completion of the activities involved, the facility_
__(A) ceases to be a facility utilized by a qualified community health group, or by another public or nonprofit private entity that provides health services in one or more health professional shortage areas or that provides such services to a significant number of individuals who are members of a medically underserved population; or
__(B) is sold or transferred to any entity other than an entity that is_
__(i) a qualified community health group or other entity described in subparagraph (A); and
__(ii) approved by the Secretary as a purchaser or transferee regarding the facility.
__(2) Subordination; waivers._The Secretary may subordinate or waive the right of recovery under paragraph (1), and any other Federal interest that may be derived by virtue of a loan or loan guarantee under subsection (a), if the Secretary determines that subordination or waiver will further the objectives of this part.
SEC. 3444. PROVISIONS REGARDING CONSTRUCTION OR EXPANSION OF FACILITIES.
__(a) Submission of Information._In the case of a project for construction, conversion, expansion or modernization of a facility, the Secretary may provide loans or loan guarantees under section 3441 only if the applicant submits to the Secretary the following:
__(1) A description of the site.
__(2) Plans and specifications which meet requirements prescribed by the Secretary.
__(3) Information reasonably demonstrating that title to such site is vested in one or more of the entities filing the application (unless the agreement described in subsection (b)(1) is made).
__(4) A specification of the type of assistance being requested under section 3441.
__(b) Agreements._In the case of a project for construction, conversion, expansion or modernization of a facility, the Secretary may provide loans or loan guarantees under section 3441 only if the applicant makes the following agreements:
__(1) Title to such site will be vested in one or more of the entities filing the application (unless the assurance described in subsection (a)(3) has been submitted under such subsection).
__(2) Adequate financial support will be available for completion of the project and for its maintenance and operation when completed.
__(3) All laborers and mechanics employed by contractors or subcontractors in the performance of work on a project will be paid wages at rates not less than those prevailing on similar construction in the locality as determined by the Secretary of Labor in accordance with the Act of March 3, 1931 (40 U.S.C. 276a et seq; commonly known as the Davis-Bacon Act), and the Secretary of Labor shall have with respect to such labor standards the authority and functions set forth in Reorganization Plan Numbered 14 of 1950 (15 FR 3176; 5 U.S.C. Appendix) and section 276c of title 40.
__(4) The facility will be made available to all persons seeking service regardless of their ability to pay.
SEC. 3445. APPLICATION FOR ASSISTANCE.
__The Secretary may provide loans or loan guarantees under section 3441 only if an application for such assistance is submitted to the Secretary, the application contains each agreement described in this subpart, the application contains the information required in section 3444(a), and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this subpart.
SEC. 3446. ADMINISTRATION OF PROGRAMS.
__This subpart, and any other program of the Secretary that provides loans or loan guarantees, shall be carried out by a centralized loan unit established within the Department of Health and Human Services.
Subpart D_Enabling Services
SEC. 3461. GRANTS AND CONTRACTS FOR ENABLING SERVICES.
__(a) In General._
__(1) Grants and contracts._The Secretary may make grants to and enter into contracts with entities described in paragraph (2) to assist such entities in providing the services described in subsection (b) for the purpose of increasing the capacity of individuals to utilize the items and services included in the comprehensive benefits package under title I.
__(2) Relevant entities._For purposes of paragraph (1), the entities described in this paragraph are qualified community health groups (as defined in section 3421(a)), and other public or nonprofit private entities, that_
__(A) provide health services in one or more health professional shortage areas or that provide such services to a significant number of individuals who are members of a medically underserved population; and
__(B) are experienced in providing services to increase the capacity of individuals to utilize health services.
__(b) Enabling Services._The services referred to in subsection (a)(1) are transportation, community and patient outreach, patient education, translation services, and such other services as the Secretary determines to be appropriate in carrying out the purpose described in such subsection.
__(c) Certain Requirements Regarding Project Area._The Secretary may make an award of a grant or contract under subsection (a) only if the applicant involved_
__(1) submits to the Secretary_
__(A) information demonstrating that the medically underserved populations in the community to be served under the award have a need for enabling services; and
__(B) a proposed budget for providing such services; and
__(2) the applicant for the award agrees that the residents of the community will be significantly involved in the project carried out with the award.
__(d) Imposition of Fees._The Secretary may make an award of a grant or contract under subsection (a) only if the applicant involved agrees that, in the project carried out under such subsection, enabling services will be provided without charge to the recipients of the services.
__(e) Use of Existing Resources._The Secretary may make an award of a grant or contract under subsection (a) only if the applicant involved agrees that, in carrying out the project under such subsection, the applicant will utilize existing resources to the maximum extent practicable.
__(f) Application for Awards of Assistance._The Secretary may make an award of a grant or contract under subsection (a) only if an application for the award is submitted to the Secretary, the application contains each agreement described in this subpart, the application contains the information required in subsection (d)(1), and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this subpart.
__(g) Definition._For purposes of this section, the term ``enabling services'' means services described in subsection (b) that are provided for the purpose described in subsection (a)(1).
SEC. 3462. AUTHORIZATIONS REGARDING PUBLIC HEALTH SERVICE INITIATIVES FUND.
__(a) Enabling Services._For the purpose of carrying out section 3461, there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $200,000,000 for fiscal year 1996, $300,000,000 for each of the fiscal years 1997 through 1999, and $100,000,000 for fiscal year 2000.
__(b) Relation to Other Funds._The authorizations of appropriations established in subsection (a) are in addition to any other authorizations of appropriations that are available for the purpose described in such subsection.
PART 3_NATIONAL HEALTH SERVICE CORPS
SEC. 3471. AUTHORIZATIONS REGARDING PUBLIC HEALTH SERVICE INITIATIVES FUND.
__(a) Additional Funding; General Corps Program; Allocations Regarding Nurses._For the purpose of carrying out subpart II of part D of title III of the Public Health Service Act, and for the purpose of carrying out section 3472, there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $50,000,000 for fiscal year 1995, $100,000,000 for fiscal year 1996, and $200,000,000 for each of the fiscal years 1997 through 2000.
__(b) Relation to Other Funds._The authorizations of appropriations established in subsection (a) are in addition to any other authorizations of appropriations that are available for the purpose described in such subsection.
__(c) Availability of Funds._An appropriation under this section for any fiscal year may be made at any time before that fiscal year and may be included in an Act making an appropriation under an authorization under subsection (a) for another fiscal year; but no funds may be made available from any appropriation under this section for obligation under sections 331 through 335, section 336A, and section 337 before the fiscal year involved.
SEC. 3472. ALLOCATION FOR PARTICIPATION OF NURSES IN SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS.
__Of the amounts appropriated under section 3471, the Secretary shall reserve such amounts as may be necessary to ensure that, of the aggregate number of individuals who are participants in the Scholarship Program under section 338A of the Public Health Service Act, or in the Loan Repayment Program under section 338B of such Act, the total number who are being educated as nurses or are serving as nurses, respectively, is increased to 20 percent.
PART 4_PAYMENTS TO HOSPITALS SERVING VULNERABLE POPULATIONS
SEC. 3481. PAYMENTS TO HOSPITALS.
__(a) Entitlement Status._The Secretary shall make payments in accordance with this part to eligible hospitals described in section 3482. The preceding sentence_
__(1) is an entitlement in the Secretary on behalf of such eligible hospitals (but is not an entitlement in the State in which any such hospital is located or in any individual receiving services from any such hospital); and
__(2) constitutes budget authority in advance of appropriations Acts and represents the obligation of the Federal Government to provide funding for such payments in the amounts, and for the fiscal years, specified in subsection (b).
__(b) Amount of Entitlement._
__(1) In general._For purposes of subsection (a)(2), the amounts and fiscal years specified in this subsection are (in the aggregate for all eligible hospitals) $800,000,000 for the fiscal year in which the general effective date occurs and for each subsequent fiscal year.
__(2) Special rule for years before general effective date._
__(A) In general._For any fiscal year that begins prior to the general effective date, the amount specified in this subsection for purposes of subsection (a)(2) shall be equal to the aggregate DSH percentage of the amount otherwise determined under paragraph (1).
__(B) Aggregate DSH percentage defined._In subparagraph (A), the ``aggregate DSH percentage'' for a year is the amount (expressed as a percentage) equal to_
__(i) the total amount of payment made by the Secretary under section 1903(a) of the Social Security Act during the base year with respect to payment adjustments made under section 1923(c) of such Act for hospitals in the States in which eligible hospitals for the year are located; divided by
__(ii) the total amount of payment made by the Secretary under section 1903(a) of such Act during the base year with respect to payment adjustments made under section 1923(c) of such Act for hospitals in all States.
__(c) Period of Payment._An eligible hospital shall receive a payment under this section for a period of 5 years, without regard to the year for which the hospital first receives a payment.
__(d) Payments Made on Quarterly Basis._Payments to an eligible hospital under this section for a year shall be made on a quarterly basis during the year.
SEC. 3482. IDENTIFICATION OF ELIGIBLE HOSPITALS.
__(a) Hospitals in Participating States._In order to be an eligible hospital under this part, a hospital must be located in a State that is a participating State under this Act, except that an eligible hospital remains eligible to receive a payment under this part notwithstanding that, during the 5-year period for which the payment is to be made, the State in which it is located no longer meets the requirements for participating States under this Act.
__(b) State Identification._In accordance with the criteria described in subsection (c) and such procedures as the Secretary may require, each State shall identify the hospitals in the State that meet such criteria and provide the Secretary with a list of such hospitals.
__(c) Criteria for Eligibility._A hospital meets the criteria described in this subsection if the hospital's low-income utilization rate for the base year under section 1923(b)(3) of the Social Security Act (as such section is in effect on the day before the date of the enactment of this Act) is not less than 25 percent.
SEC. 3483. AMOUNT OF PAYMENTS.
__(a) Distribution of Allocation for Low-Income Assistance._
__(1) Allocation from total amount._Of the total amount available for payments under this section in a year, 75 percent shall be allocated to hospitals for low-income assistance in accordance with this subsection.
__(2) Determination of hospital payment amount._The amount of payment to an eligible hospital from the allocation made under paragraph (1) during a year shall be the equal to the hospital's low-income percentage of the allocation for the year.
__(b) Distribution of Allocation for Assistance for Uncovered Services._
__(1) Allocation from total amount; determination of State-specific portion of allocation._Of the total amount available for payments under this section in a year, 25 percent shall be allocated to hospitals for assistance in furnishing inpatient hospital services that are not covered services under title I (in accordance with regulations of the Secretary) in accordance with this subsection. The amount available for payments to eligible hospitals in a State shall be equal to an amount determined in accordance with a methodology specified by the Secretary.
__(2) Determination of hospital payment amount._The amount of payment to an eligible hospital in a State from the amount available for payments to eligible hospitals in the State under paragraph (1) during a year shall be the equal to the hospital's low-income percentage of such amount for the year.
__(c) Low-Income Percentage Defined._
__(1) In general._In this subsection, an eligible hospital's ``low-income percentage'' for a year is equal to the amount (expressed as a percentage) of the total low-income days for all eligible hospitals for the year that are attributable to the hospital.
__(2) Low-income days described._For purposes of paragraph (1), an eligible hospital's low-income days for a year shall be equal to the product of_
__(A) the total number of inpatient days for the hospital for the year (as reported to the Secretary by the State in which the hospital is located, in accordance with a reporting schedule and procedures established by the Secretary); and
__(B) the hospital's low-income utilization rate for the base year under section 1923(b)(3) of the Social Security Act (as such section is in effect on the day before the date of the enactment of this Act).
SEC. 3484. BASE YEAR.
__In this part, the ``base year'' is, with respect to a State and hospitals in a State, the year immediately prior to the year in which the general effective date occurs.
Title III, Subtitle F
Subtitle F_Mental Health; Substance Abuse
PART 1_FINANCIAL ASSISTANCE
SEC. 3501. AUTHORIZATIONS REGARDING PUBLIC HEALTH SERVICE INITIATIVES FUND.
__(a) In General._For the purpose of carrying out this part, there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $100,000,000 for fiscal year 1995, $150,000,000 for fiscal year 1996, and $250,000,000 for each of the fiscal years 1997 through 2000.
__(b) Allocation Among Programs._Of the amounts made available under subsection (a) for a fiscal year_
__(1) the Secretary may reserve for carrying out section 3503 such amounts as the Secretary determines to be appropriate; and
__(2) the Secretary shall, of the remaining amounts, reserve 50 percent for carrying out subsection (a) of section 3502 and 50 percent for carrying out subsection (b) of such section.
__(c) Relation to Other Funds._The authorizations of appropriations established in subsection (a) are in addition to any other authorizations of appropriations that are available for the purpose described in such subsection.
SEC. 3502. SUPPLEMENTAL FORMULA GRANTS FOR STATES REGARDING ACTIVITIES UNDER PART B OF TITLE XIX OF PUBLIC HEALTH SERVICE ACT.
__(a) Mental Health._
__(1) In general._In the case of any State that submits to the Secretary an application in accordance with subsection (e) for a fiscal year with respect to mental health, the Secretary shall make a grant to the State for the purposes authorized in subsection (c) with respect to mental health. The grant shall consist of the allotment determined under paragraph (2) for the State for such year.
__(2) Determination of allotment._For purposes of paragraph (1), the allotment under this paragraph for a State for a fiscal year shall be determined as follows: With respect to the amount reserved under section 3501(c)(2) for carrying out this subsection, section 1918 of the Public Health Service Act shall be applied to such amount to the same extent and in the same manner as such section 1918 is applied to the amount determined under section 1918(a)(2) of such Act.
__(b) Substance Abuse._
__(1) In general._In the case of any State that submits to the Secretary an application in accordance with subsection (e) for a fiscal year with respect to substance abuse, the Secretary shall make a grant to the State for the purposes authorized in subsection (c) with respect to substance abuse. The grant shall consist of the allotment determined under paragraph (2) for the State for such year.
__(2) Determination of allotment._For purposes of paragraph (1), the allotment under this paragraph for a State for a fiscal year shall be determined as follows: With respect to the amount reserved under section 3501(c)(2) for carrying out this subsection, section 1933 of the Public Health Service Act shall be applied to such amount to the same extent and in the same manner as such section 1933 is applied to the amount determined pursuant to sections 1933(a)(1)(B)(i) and 1918(a)(2)(A) of such Act.
__(c) Use of Grants._
__(1) In general._With respect to the expenditure of a grant to a State under subsection (a) or (b), the Secretary_
__(A) shall designate as authorized expenditures such of the activities described in paragraph (2) with respect to mental health and substance abuse, respectively, as the Secretary determines to be appropriate; and
__(B) may make the grant only if the State agrees to expend the grant in accordance with the activities so designated.
__(2) Description of activities._The activities referred to in paragraph (1) are (as applicable to the grant involved) the following:
__(A) For the purpose of increasing the access of individuals to services relating to mental health and substance abuse, the following services: Transportation, community and patient outreach, patient education, translation services, and such other services as the Secretary determines to be appropriate regarding such purpose.
__(B) Improving the capacity of State and local service systems to coordinate and monitor mental health and substance abuse services, including improvement of management information systems, and establishment of linkages between providers of mental health and substance abuse services and primary care providers and health plans.
__(C) Providing incentives to integrate public and private systems for the treatment of mental health and substance abuse disorders.
__(D) Any activity for which a grant under section 1911 or section 1921 of the Public Health Service Act is authorized to be expended.
__(d) Maintenance of Effort._
__(1) In general._With respect to the activities for which a grant under subsection (a) or (b) is to be made, the Secretary may make the grant only if the State involved agrees to maintain expenditures of non-Federal amounts for such activities at a level that is not less than the level of such expenditures maintained by the State for the fiscal year preceding the first fiscal year for which the State receives such a grant.
__(2) Waiver._The Secretary may waive all or part of the requirement established for a State under paragraph (1) if_
__(A) the State agrees that the amounts that otherwise would have been subject to such requirement will be expended for the purpose of developing community-based systems of care to promote the eventual integration of the public and private systems for treatment of mental health, or substance abuse, as applicable to the grant;
__(B) the State submits to the Secretary a request for the waiver and a description of the manner in which the State will carry out such purpose; and
__(C) the Secretary approves the waiver.
__(e) Application for Grant._For purposes of subsection (a)(1) and (b)(1), an application for a grant under this section regarding mental health or substance abuse, respectively, is in accordance with this subsection if the State involved submits the application not later than the date specified by the Secretary, the application contains each applicable agreement described in this section, and the application otherwise is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out the purpose involved.
SEC. 3503. CAPITAL COSTS OF DEVELOPMENT OF CERTAIN CENTERS AND CLINICS.
__(a) In General._The Secretary may make loans to, and guarantee the payment of principal and interest to Federal and non-Federal lenders on behalf of, public and private entities for the capital costs to be incurred by the entities in the development of non-acute, residential treatment centers and community-based ambulatory clinics.
__(b) Priorities Regarding Use of Funds._In providing loans or loan guarantees under subsection (a), the Secretary shall give priority to authorizing the use of amounts for projects in health professional shortage areas or in geographic area in which there resides a significant number of individuals who are members of a medically underserved population.
__(c) Applicability of Certain Provisions._The Secretary may provide loans or loan guarantees under subsection (a) only if the applicant involved agrees that, except to the extent inconsistent with the purpose described in subsection (a), subpart C of part 2 of subtitle E applies to such assistance to the same extent and in the same manner as such subpart applies to loans and loan guarantees under section 3441.
PART 2_AUTHORITIES REGARDING PARTICIPATING STATES
Subpart A_Report
SEC. 3511. REPORT ON INTEGRATION OF MENTAL HEALTH SYSTEMS.
__(a) In General._As a condition of being a participating State under title I, each State shall, not later than October 1, 1998, submit to the Secretary a plan to achieve the integration of the mental health and substance abuse services of the State and its political subdivisions with the mental health and substance abuse services that are included in the comprehensive benefit package under title I.
__(b) Required Contents._With respect to the provision of items and services relating to mental health and substance abuse, the report of a State under subsection (a) shall, at a minimum, contain the following information:
__(1) Information on the number of individuals served by or through mental health and substance abuse programs administered by State and local agencies and the proportion who are eligible persons under title I.
__(2) The following information on services furnished to eligible persons:
__(A) Each type of benefit furnished.
__(B) The mental health diagnoses for which each type of benefit is covered, the amount, duration and scope of coverage for each covered benefit, and any applicable limits on benefits.
__(C) Cost sharing rules that apply.
__(3) Information on the extent to which each health provider furnishing mental health and substance abuse services under a State program participates in one or more regional or corporate alliance health plans, and, in the case of providers that do not so participate, the reasons for the lack of participation.
__(4) The amount of revenues from health plans received by mental health and substance abuse providers that are participating in such health plans and are funded under one or more State programs.
__(5) With respect to the two years preceding the year in which the State becomes a participating State under title I_
__(A) the amount of funds expended by the State and its political subdivisions for each of such years for items and services that are included in the comprehensive benefit package under such title;
__(B) the amount of funds expended for medically necessary and appropriate items and services not included in such benefit package, including medical care, other health care, and supportive services related to the provision of health care.
__(6) An estimate of the amount that the State will expend to furnish items and services not included in such package once the expansion of coverage for mental health and substance abuse services is implemented in the year 2001.
__(7) A description of how the State will assure that all individuals served by mental health and substance abuse programs funded by the State will be enrolled in a health plan and how mental health and substance abuse services not covered under the benefit package will continue to be furnished to such enrollees.
__(8) A description of the conditions under which the integration of mental health and substance abuse providers into regional and corporate alliances can be achieved, and an identification of changes in participation and certification requirements that are needed to achieve the integration of such programs and providers into health plans.
__(9) If the integration of mental health and substance abuse programs operated by the State into one or more health plans is not medically appropriate or feasible for one or more groups of individuals treated under State programs, a description of the reasons that integration is not feasible or appropriate and a plan for assuring the coordination for such individuals of the care and services covered under the comprehensive benefit package with the additional items and services furnished by such programs.
__(c) General Provisions._Reports under subsection (a) shall be provided at the a time and in the manner prescribed by the Secretary.
Subpart B_Pilot Program
SEC. 3521. PILOT PROGRAM.
__(a) In General._The Secretary shall establish a pilot program to demonstrate model methods of achieving the integration of the mental health and substance abuse services of the States with the mental health and substance abuse services that are included in the comprehensive benefit package under title I.
__(b) Certain Considerations,_With respect to the provision of items and services relating to mental health and substance abuse, the Secretary, in carrying out subsection (a), shall consider the following:
__(1) The types of items and services needed in addition to the items and services included in the comprehensive benefits package under title I.
__(2) The optimal methods of treatment for individuals with long-term conditions.
__(3) The capacity of alliance health plans to furnish such treatment.
__(4) The modifications that should be made in the items and services furnished by such health plans.
__(5) The role of publicly-funded health providers in the integration of acute and long-term treatment.
Title III, Subtitle G
Subtitle G_Comprehensive School Health Education; School-Related Health Services
PART 1_GENERAL PROVISIONS
SEC. 3601. PURPOSES.
__Subject to the subsequent provisions of this subtitle, the purposes of this subtitle are as follows:
__(1) To support the provision in kindergarten through grade 12 of sequential, age-appropriate, comprehensive health education programs that address locally relevant priorities.
__(2) To establish a national framework within which States can create comprehensive school health education programs that_
__(A) target the health risk behaviors accounting for the majority of the morbidity and mortality among youth and adults, including the following: Tobacco use; alcohol and other drug abuse; sexual behaviors resulting in infection with the human immunodeficiency virus, in other sexually transmitted diseases or in unintended pregnancy; behaviors resulting in intentional and unintentional injuries; dietary patterns resulting in disease; and sedentary lifestyles; and
__(B) are integrated with plans and programs in the State, if any, under title III of the Goals 2000: Educate America Act and those targeting health promotion and disease prevention goals related to the national health objectives set forth in Healthy People 2000.
__(3) To pay the initial costs of planning and establishing Statewide comprehensive school health education programs that will be implemented and maintained with local, State, and other Federal resources.
__(4) To support Federal activities such as research and demonstrations, evaluations, and training and technical assistance regarding comprehensive school health education.
__(5) To motivate youth, especially low-achieving youth, to stay in school, avoid teen pregnancy, and strive for success by providing intensive, high-quality health education programs that include peer-teaching, family, and community involvement.
__(6) To improve the knowledge and skills of children and youth by integrating academic and experiential learning in health education with other elements of a comprehensive school health program.
__(7) To further the National Education Goals set forth in title I of the Goals 2000: Educate America Act and the national health objectives set forth in Healthy People 2000.
__(8) With respect to health services, to make awards of financial assistance to eligible State health agencies and local community partnerships to provide for the development and operation of projects to coordinate and deliver comprehensive health services to children or youth in school-based, school-linked, or community-based locations.
SEC. 3602. DEFINITIONS.
__(a) Comprehensive School Health Education Program._For purposes of this subtitle, the term ``comprehensive school health education program'' means a program that addresses locally relevant priorities and meets the following conditions:
__(1) The program is sequential, and age and developmentally appropriate.
__(2) The program is provided, in the area served by the program, every year for all students from kindergarten through grade 12.
__(3) The program provides comprehensive health education, including the following components:
__(A) Community health.
__(B) Environmental health.
__(C) Personal health.
__(D) Family life.
__(E) Growth and development.
__(F) Nutritional health.
__(G) Prevention and control of disease and disorders.
__(I) Safety and prevention of injuries.
__(J) Substance abuse, including tobacco and alcohol use.
__(K) Consumer health, including education to ensure that students understand the benefits and appropriate use of medical services, including immunizations and other clinical preventive services.
__(4) The program promotes personal responsibility for a healthy lifestyle and provides the knowledge and skills necessary to adopt a healthy lifestyle, including teaching the legal, social, and health consequences of behaviors that pose health risks.
__(5) The program is sensitive to cultural and ethnic issues in the content of instructional materials and approaches.
__(6) The program includes activities that support instruction.
__(7) The program includes activities to promote involvement by parents, families, community organizations, and other appropriate entities.
__(8) The program is coordinated with other Federal, State, and local health education and prevention programs and with other Federal, State and local education programs, including those carried out under title I of the Elementary and Secondary Education Act of 1965.
__(9) The program focuses on the particular health concerns of the students in the State, school district, or school, as the case may be.
__(b) Other Definitions._For purposes of this subtitle:
__(1) The term ``local educational agency'' has the meaning given such term in section 1471(12) of the Elementary and Secondary Education Act of 1965.
__(2) The term ``State educational agency'' has the meaning given such term in section 1471(23) of the Elementary and Secondary Education Act of 1965.
PART 2_SCHOOL HEALTH EDUCATION; GENERAL PROVISIONS
SEC. 3611. AUTHORIZATIONS REGARDING PUBLIC HEALTH SERVICE INITIATIVES FUND..
__(a) Funding for School Health Education._For the purpose of carrying out parts 3 and 4, there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $50,000,000 for each of the fiscal year 1995 through 2000.
__(b) Allocations._Of the amounts appropriated under subsection (a) for a fiscal year_
__(1) the Secretary may reserve not more than $13,000,000 for carrying out part 4;
__(2) the Secretary may reserve not more than $5,000,000 to support national leadership activities, such as research and demonstration, evaluation, and training and technical assistance in comprehensive school health education; and
__(3) the Secretary may reserve not more than 5 percent for administrative expenses regarding parts 3 and 4.
__(c) Relation to Other Funds._The authorizations of appropriations established in subsection (a) are in addition to any other authorizations of appropriations that are available for the purpose described in such subsection.
SEC. 3612. WAIVERS OF STATUTORY AND REGULATORY REQUIREMENTS.
__(a) In General._
__(1) Waivers._Except as provided in subsection (c), upon the request of an entity receiving funds under part 3 or part 4 and under a program specified in paragraph (2), the Secretary of Health and Human Services or the Secretary of Education (as the case may be, according to which Secretary administers the program so specified) may grant to the entity a waiver of any requirement of such program regarding the use of funds, or of the regulations issued for the program by the Secretary involved, if the following conditions are met with respect to such program:
__(A) The Secretary involved determines that the requirement of such program impedes the ability of the State educational agency or other recipient to achieve more effectively the purposes of part 3 or 4.
__(B) The Secretary involved determines that, with respect to the use of funds under such program, the requested use of the funds by the entity would be consistent with the purposes of part 3 or 4.
__(C) In the case of a request for a waiver submitted by a State educational agency, the State educational agency_
__(i) provides all interested local educational agencies in the State with notice and an opportunity to comment on the proposal; and
__(ii) submits the comments to the Secretary involved.
__(D) In the case of a request for a waiver submitted by a local educational agency or other agency, institution, or organization that receives funds under part 3 from the State educational agency, such request has been reviewed by the State educational agency and is accompanied by the comments, if any, of such agency.
__(2) Relevant programs._For purposes of paragraph (1), the programs specified in this paragraph are as follows:
__(A) In the case of programs administered by the Secretary of Health and Human Services, the following:
__(i) The program known as the Prevention, Treatment, and Rehabilitation Model Projects for High Risk Youth, carried out under section 517 of the Public Health Service Act.
__(ii) The program known as the State and Local Comprehensive School Health Programs to Prevent Important Health Problems and Improve Educational Outcomes, carried out under such Act.
__(B) In the case of programs administered by the Secretary of Education, any program carried out under part B of the Drug-Free Schools and Communities Act of 1986.
__(b) Waiver Period._
__(1) In general._A waiver under this section shall be for a period not to exceed three years.
__(2) Extensions._The Secretary involved under subsection (a) may extend such period if the Secretary determines that_
__(A) the waiver has been effective in enabling the State or affected recipients to carry out the activities for which it was requested and has contributed to improved performance; and
__(B) such extension is in the public interest.
__(c) Waivers Not Authorized._The Secretary involved under subsection (a) may not waive, under this section, any statutory or regulatory requirement relating to_
__(1) comparability of services;
__(2) maintenance of effort;
__(3) the equitable participation of students attending private schools;
__(4) parental participation and involvement;
__(5) the distribution of funds to States or to local educational agencies or other recipients of funds under the programs specified in subsection (a)(2);
__(6) maintenance of records;
__(7) applicable civil rights requirements; or
__(8) the requirements of sections 438 and 439 of the General Education Provisions Act.
__(d) Termination of Waiver._The Secretary involved under subsection (a) shall terminate a waiver under this section if the Secretary determines that the performance of the State or other recipient affected by the waiver has been inadequate to justify a continuation of the waiver or if it is no longer necessary to achieve its original purposes.
PART 3_SCHOOL HEALTH EDUCATION; GRANTS TO STATES
Subpart A_Planning Grants for States
SEC. 3621. APPLICATION FOR GRANT.
__(a) In General._Any State educational agency that wishes to receive a planning grant under this subpart shall submit an application to the Secretary of Health and Human Services, at such time and in such manner as the Secretary may require.
__(b) Application; Joint Development; Contents._An application under subsection (a) shall be jointly developed by the State educational agency and the State health agencies of the State involved, and shall contain the following:
__(1) An assessment of the State's need for comprehensive school health education, using goals established by the Department of Health and Human Services and the Department of Education and goals established under Goals 2000: Educate America Act.
__(2) A description of how the State educational agency will collaborate with the State health agency in the planning and development of a comprehensive school health education program in the State, including coordination of existing health education programs and resources.
__(3) A plan to build capacity at the State and local levels to provide staff development and technical assistance to local educational agency and local health agency personnel involved with comprehensive school health education.
__(4) A preliminary plan for evaluating comprehensive school health education activities.
__(5) Information demonstrating that the State has established a State-level advisory council whose membership includes representatives of the State agencies with principal responsibilities for programs regarding health, education, and mental health.
__(6) A timetable and proposed budget for the planning process.
__(7) Such other information and assurances as the Secretary may require.
__(c) Number of Grants._States may receive one planning grant annually and no more than two planning grants may be awarded to any one State.
SEC. 3622. APPROVAL OF SECRETARY.
__The Secretary may approve the application of a State under section 3621 if the Secretary determines that_
__(1) the application meets the requirements of this subpart; and
__(2) there is a substantial likelihood that the State will be able to develop and implement a comprehensive school health education plan that complies with the requirements of subpart B.
SEC. 3623. AMOUNT OF GRANT.
__For any fiscal year, the minimum grant to any State under this subpart is an amount determined by the Secretary to be necessary to enable the State to conduct the planning process, and the maximum such grant is $500,000.
SEC. 3624. AUTHORIZED ACTIVITIES.
__A State may use funds received under this subpart only for the following:
__(1) To establish and carry out the State planning process.
__(2) To conduct Statewide or sub-State regional coordination and collaboration activities for local educational agencies, local health agencies, and other agencies and organizations, as appropriate.
__(3) To conduct activities to build capacity to provide staff development and technical assistance services to local educational agency and local health agency personnel involved with comprehensive school health education.
__(4) To develop student learning objectives and assessment instruments.
__(5) To work with State and local health agencies and State and local educational agencies to reduce barriers to the implementation of comprehensive school health education programs in schools.
__(6) To prepare the plan required to receive an implementation grant under subpart B.
__(7) To adopt, validate, and disseminate curriculum models and program strategies, if the Secretary determines that such activities are necessary to achieving the objectives of the State's program.
Subpart B_Implementation Grants for States
SEC. 3631. APPLICATION FOR GRANT.
__(a) In General._Any State that wishes to receive an implementation grant under this subpart shall submit an application to the Secretary of Health and Human Services, at such time, in such manner, and containing such information and assurances as the Secretary may require.
__(b) Application and State Plan; Joint Development; Contents._An application under subsection (a) shall be jointly developed by the State educational agency and the State health agencies of the State involved, and shall include a State plan for comprehensive school health education programs (as defined in section 3602) that describes the following:
__(1) The State's goals and objectives for those programs.
__(2) How the State will allocate funds, if any, to local educational agencies in accordance with section 3634.
__(3) How the State will coordinate programs under this subpart with other local, State and Federal health education programs.
__(4) How comprehensive school health education programs will be coordinated with other local, State and Federal education programs, such as programs under title I of the Elementary and Secondary Education Act of 1965, with the State's school improvement plan, if any, under title III of the Goals 2000: Educate America Act, and with any similar programs.
__(5) How the State has worked with State and local education agencies and with State and local health agencies to reduce barriers to implementing comprehensive school health education programs.
__(6) How the State will monitor the implementation of such programs by local educational agencies.
__(7) How the State will build capacity for professional development of health educators.
__(8) How the State will provide staff development and technical assistance to local educational agencies.
__(9) The respective roles of the State educational agency, local educational agencies, the State health agency, and the local health agencies in developing and implementing such school health education programs.
__(10) How such school health education programs will be tailored to the extent practicable to be culturally and linguistically sensitive and responsive to the various needs of the students served, including individuals with disabilities, and individuals from disadvantaged backgrounds (including racial and ethnic minorities). __(11) How the State will evaluate and report on the State's progress toward attaining the goals and objectives described in paragraph (1).
SEC. 3632. SELECTION OF GRANTEES.
__(a) Selection of Grantees._The Secretary shall establish criteria for the competitive selection of grantees under this subpart.
__(b) Opportunity for Planning Grant._If the Secretary does not approve a State's application under this subpart and determines that the State could benefit from a planning grant under subpart A, the Secretary shall inform the State of any planning grant funds that may be available to it under subpart A, subject to section 3621(c).
SEC. 3633. AMOUNT OF GRANT.
__(a) In General._For any fiscal year, the minimum grant to any State under this subpart is an amount determined by the Secretary to be necessary to enable the State to conduct the implementation process.
__(b) Criteria._In determining the amount of any such grant, the Secretary may consider such factors as the number of children enrolled in schools in the State, the number of school-aged children living in poverty in the State, and the scope and quality of the State's plan.
SEC. 3634. AUTHORIZED ACTIVITIES; LIMITATION ON ADMINISTRATIVE COSTS.
__(a) Subgrants to Local Educational Agencies._Each State that receives funds under this subpart for any fiscal year shall retain not more than 75 percent of those funds in the first year, 50 percent of those funds in the second and third years, and 25 percent of those funds in each succeeding year. Those funds not retained by the State shall be used to make grants to local educational agencies in accordance with section 3635.
__b) State-level Activities._Each State shall use retained funds for any fiscal year for the following purposes:
__(1) To conduct Statewide or sub-State regional coordination and collaboration activities.
__(2) To adapt, validate, or disseminate program models or strategies for comprehensive school health education.
__(3) To build capacity to deliver staff development and technical assistance services to local educational agencies, and State and local health agencies.
__(4) To promote program activities involving families and coordinating program activities with community groups and agencies.
__(5) To evaluate and report to the Secretary on the progress made toward attaining the goals and objectives described in section 3621(b)(1).
__(6) To conduct such other activities to achieve the objectives of this subpart as the Secretary may by regulation authorize.
__(c) State Administration._Of the amounts received by a State for a fiscal year under this subpart and remaining after any grants to local educational agencies made from such amounts, the State may use up to 10 percent for the costs of administering such amounts, including the activities of the State advisory council and monitoring the performance of local educational agencies.
SEC. 3635. SUBGRANTS TO LOCAL EDUCATIONAL AGENCIES.
__(a) Application for Grant._Any local educational agency that wishes to receive a grant under this subpart shall submit an application to the State, containing such information and assurances as the State may require, including a description of the following:
__(1) The local educational agency's goals and objectives for comprehensive school health education programs.
__(2) How the local educational agency will concentrate funds in high-need schools and provide sufficient funds to targeted schools to ensure the implementation of comprehensive programs.
__(3) How the local educational agency will monitor the implementation of these programs.
__(4) How the local educational agency will ensure that school health education programs are tailored to the extent practicable to be culturally and linguistically sensitive and responsive to the various needs of the students served, including individuals with disabilities, and individuals from disadvantaged backgrounds (including racial and ethnic minorities).
__(5) How the local educational agency, in consultation with the local health agency, will evaluate and report on its progress toward attaining the goals and objectives described in paragraph (1).
__(b) Selection of Subgrantees._Each State shall give priority to applications from local educational agencies serving areas with high needs, as indicated by criteria developed by the State, which shall include, but need not be limited to, high rates of any of the following:
__(1) Poverty among school-aged youth.
__(2) Births to adolescents.
__(3) Sexually transmitted diseases among school-aged youth.
__(4) Drug and alcohol use among school-aged youth.
__(5) Violence among school-aged youth.
__(c) Authorized Activities._Each local educational agency that receives a grant under this subpart shall use the grant funds to implement comprehensive school health education programs, as defined in section 3602.
Subpart C_State and Local Reports
SEC. 3641. STATE AND LOCAL REPORTS.
__(a) State Reports._Each State that receives a grant under this part shall collect and submit to the Secretary such data and other information on State and local programs as the Secretary may require.
__(b) In General._ Each local educational agency that receives a grant under subpart B shall collect and report to the State such data and other information as the Secretary may require.
PART 4_SCHOOL HEALTH EDUCATION; GRANTS TO CERTAIN LOCAL EDUCATIONAL AGENCIES
Subpart A_Eligibility
SEC. 3651. SUBSTANTIAL NEED OF AREA SERVED BY AGENCY.
__Any local educational agency is eligible for a grant under this part for any fiscal year if_
__(1) the agency enrolls at least 25,000 students; and
__(2) the geographic area served by the agency has a substantial need for such a grant, relative to other geographic areas in the United States.
Subpart B_Planning Grants for Local Education Agencies
SEC. 3661. APPLICATION FOR GRANT.
__(a) In General._Any local educational agency that wishes to receive a planning grant under this subpart shall submit an application to the Secretary of Health and Human Services at such time and in such manner as the Secretary may require.
__(b) State Educational Agency Review._Each such local educational agency, before submitting its application to the Secretary, shall submit the application to the State educational agency for comment by such agency and by the State health agencies of the State.
__(c) Contents of Applications._Each such application shall contain the following:
__(1) An assessment of the local educational agency's need for comprehensive school health education, using goals established by the Department of Health and Human Services and the Department of Education, as well as local health and education strategies, such as State school improvement plans, if any, under title III of the Goals 2000: Educate America Act.
__(2) Information demonstrating that the local educational agency has established or selected a community-level advisory council, which shall include representatives of relevant community agencies such as those that administer education, child nutrition, health, and mental health programs.
__(3) A description of how the local educational agency will collaborate with the State educational agency, the State health agency, and the local health agency in the planning and development of a comprehensive school health education program in the local educational agency, including coordination of existing health education programs and resources.
__(4) A plan to build capacity at the local educational agency to provide staff development and technical assistance to local educational agency and local health agency personnel involved with comprehensive school health education.
__(5) A preliminary plan for evaluating comprehensive school health education activities.
__(6) A timetable and proposed budget for the planning process.
__(7) Such other information and assurances as the Secretary may require.
__(d) Number of Grants._Local educational agencies may receive at a maximum two annual planning grants.
SEC. 3662. SELECTION OF GRANTEES.
__(a) Selection Criteria._The Secretary shall establish criteria for the competitive selection of grantees under this part.
__(b) Limitation._The Secretary shall not approve an application from a local educational agency in a State that has an approved plan under subpart A or B of part 3 of this subtitle unless the Secretary determines, after consultation with the State that the local application is consistent with the State plan, if one exists.
SEC. 3663. AMOUNT OF GRANT.
__For any fiscal year, the minimum grant to any local educational agency under this subpart is an amount determined by the Secretary to be necessary to enable the local educational agency to conduct the planning process, and the maximum such grant is $500,000.
SEC. 3664. AUTHORIZED ACTIVITIES.
__A local educational agency may use funds received under this subpart only for the following:
__(1) To establish and carry out the local educational agency planning process.
__(2) To undertake joint training, staffing, administration, and other coordination and collaboration activities for local educational agencies, local health agencies, and other agencies and organizations, as appropriate.
__(3) To conduct activities to build capacity to provide staff development and technical assistance services to local educational agency and local health agency personnel involved with comprehensive school health education.
__(4) To develop student learning objectives and assessment instruments.
__(5) To work with State and local health agencies and State educational agencies to reduce barriers to the implementation of comprehensive school health education programs in schools, by, for example, ensuring that adequate time is a available during the school day for such programs.
__(6) To prepare the plan required to receive an implementation grant under subpart C.
Subpart C_Implementation Grants for Local Educational Agencies
SEC. 3671. APPLICATION FOR GRANT.
__(a) In General._Any local educational agency that wishes to receive an implementation grant under this subpart shall submit an application to the Secretary of Health and Human Services, at such time, in such manner, and containing such information and assurances as the Secretary may require.
__(b) State Educational Agency Review._Each such local educational agency shall submit its application to the State educational agency for comment before submitting it to the Secretary.
__(c) Local Educational Agency Plan._Each such application shall include a local educational agency plan for comprehensive school health education programs (as defined in section 3602) that describes the following:
__(1) The local educational agency's goals and objectives for those programs.
__(2) How the local educational agency will coordinate programs under this subpart with other local, State and Federal health education programs.
__(3) How comprehensive school health education programs will be coordinated with other local, State and Federal education programs, such as programs under title I of the Elementary and Secondary Education Act of 1965, and with State's school improvement plan, if any, under title III of the Goals 2000: Educate America Act.
__(4) How the local educational agency has worked with State educational agencies and with State and local health agencies to reduce barriers to implementing comprehensive school health education programs.
__(5) How local educational agencies will monitor the implementation of such programs.
__(6) How the local educational agency, in consultation with the State educational agency and State and local health agencies and in conjunction with other local professional development activities, will build capacity for professional development of health educators.
__(7) How the local educational agency, in consultation with the State educational agency and State and local health agencies, will provide staff development and technical assistance.
__(8) The respective roles of the State educational agency, local educational agencies, the State health agency, and the local health agencies in developing and implementing such school health education programs.
__(9) How such school health education programs will be tailored to the extent practicable to be culturally and linguistically sensitive and responsive to the various needs of the students served, including individuals with disabilities, and individuals from disadvantaged backgrounds (including racial and ethnic minorities).
__(10) How the local educational agency, in consultation with the local health agency, will evaluate and report on the local educational agency's progress toward attaining the goals and objectives described in paragraph (1).
SEC. 3672. SELECTION OF GRANTEES.
__(a) Selection of Grantees._The Secretary shall establish criteria for the competitive selection of grantees under this subpart.
__(b) Limitation._The Secretary shall not approve an application from a local educational agency in a State that has an approved plan under subpart A or B of part 3 unless the Secretary determines, after consultation with the State that the local application is consistent with such State plan.
__(c) Opportunity for Planning Grant._If the Secretary does not approve a local educational agency's application under this subpart and determines that the local educational agency could benefit from a planning grant under subpart B, the Secretary shall inform the local educational agency of any planning grant funds that may be available to it under subpart B, subject to section 3661(d).
SEC. 3673. AMOUNT OF GRANT.
__(a) In General._For any fiscal year, the minimum grant to any local educational agency under this subpart is an amount determined by the Secretary to be necessary to enable the local educational agency to conduct the implementation process.
__(b) Criteria._In determining the amount of any such grant, the Secretary may consider such factors as the number of children enrolled in schools in the local educational agency, the number of school-aged children living in poverty in the local educational agency, and the scope and quality of the local educational agency's plan.
SEC. 3674. AUTHORIZED ACTIVITIES.
__Each local educational agency that receives a grant under this subpart shall use the grant funds as follows:
__(1) To implement comprehensive school health education programs, as defined in section 3602.
__(2) To conduct local or regional coordination and collaboration activities.
__(3) To provide staff development and technical assistance to schools, local health agencies, and other community agencies involved in providing comprehensive school health education programs.
__(4) To administer the program and monitor program implementation at the local level.
__(5) To evaluate and report to the Secretary on the local educational agency's progress toward attaining the goals and objectives described in section 3671(c)(1).
__(6) To conduct such other activities as the Secretary may by regulation authorize.
SEC. 3675. REPORTS.
__Each local educational agency that receives a grant under this subpart shall collect and report to the Secretary and the State such data and other information as the Secretary may require.
PART 5_SCHOOL-RELATED HEALTH SERVICES
Subpart A_Development and Operation of Projects
SEC. 3681. AUTHORIZATIONS REGARDING PUBLIC HEALTH SERVICE INITIATIVES FUND.
__(a) Funding for School-Related Health Services._For the purpose of carrying out this subpart, there are authorized to be appropriated from the Public Health Service Initiatives Fund (established in section 3701) $100,000,000 for fiscal year 1996, $275,000,000 for fiscal year 1997, $350,000,000 for fiscal year 1998, and $400,000,000 for each of the fiscal years 1999 and 2000.
__(b) Relation to Other Funds._The authorizations of appropriations established in subsection (a) are in addition to any other authorizations of appropriations that are available for the purpose described in such subsection.
SEC. 3682. ELIGIBILITY FOR DEVELOPMENT AND OPERATION GRANTS.
__(a) In General._Entities eligible to apply for and receive grants under section 3484 or 3485 are:
__(1) State health agencies that apply on behalf of local community partnerships and other communities in need of adolescent health services within the State.
__(2) Local community partnerships in States in which health agencies have not applied.
__(b) Local Community Partnerships._
__(1) In general._A local community partnership under subsection (a)(2) is an entity that, at a minimum, includes_
__(A) a local health care provider with experience in delivering services to adolescents;
__(B) one or more local public schools; and
__(C) at least one community based organization located in the community to be served that has a history of providing services to at-risk youth in the community.
__(2) Participation._A partnership described in paragraph (1) shall, to the maximum extent feasible, involve broad based community participation from parents and youth to be served, health and social service providers (including regional alliance health plans and corporate alliance health plans in which families in the community are enrolled), teachers and other public school and school board personnel, the regional health alliance in which the schools participating in the partnership are located, youth development and service organizations, and interested business leaders. Such participation may be evidenced through an expanded partnership, or an advisory board to such partnership.
SEC. 3683. PREFERENCES
__(a) In General._In making grants under sections 3484 and 3485, the Secretary shall give preference to applicants whose communities to be served show the most substantial level of need for such services among individuals who are between the ages of 10 and 19 (inclusive), as measured by indicators of community health including the following:
__(1) High levels of poverty.
__(2) The presence of a medically underserved area or population (as defined under section 330(a) of the Public Health Service Act).
__(3) A health professional shortage area, as designated under section 332 of the Public Health Service Act.
__(4) High rates of indicators of health risk among children and youth, including a high proportion of children receiving services through the Individuals with Disabilities Education Act, adolescent pregnancy, sexually transmitted disease (including infection with the human immunodeficiency virus), preventable disease, communicable disease, intentional and unintentional injuries among children and youth, community and gang violence, youth unemployment, juvenile justice involvement, and high rates of drug and alcohol exposure.
__(b) Linkage to Qualified Community Health Groups._In making grants under sections 3484 and 3485, the Secretary shall give preference to applicants that demonstrate a linkage to qualified community health groups (as defined in section 3421(a)).
SEC. 3684. GRANTS FOR DEVELOPMENT OF PROJECTS.
__(a) In General._The Secretary may make grants to State health agencies or to local community partnerships to develop school health service sites.
__(b) Use of Funds._A project for which a grant may be made under subsection (a) may include but not be limited to the cost of the following:
__(1) Planning for the provision of school health services.
__(2) Recruitment, compensation, and training of health and administrative staff.
__(3) The development of agreements with regional and corporate alliance health plans and the acquisition and development of equipment and information services necessary to support information exchange between school health service sites and health plans, health providers, and other entities authorized to collect information under this Act.
__(4) In the case of communities described in subsection (d)(2)(B), funds to aid in the establishment of local community partnerships.
__(5) Other activities necessary to assume operational status.
__(c) Authority Regarding Qualified Community Health Groups._A project under subsection (a) may require that, in order to receive services from the project, an individual be enrolled in a health plan of a qualified community health group (as defined in section 3421(a)).
__(d) Application for Grant._
__(1) In general._Applicants shall submit applications in a form and manner prescribed by the Secretary.
__(2) Applications by State health agencies._
__(A) In the case of applicants that are State health agencies, the application shall contain assurances that the State health agency is applying for funds_
__(i) on behalf of at least one local community partnership; and
__(ii) on behalf of at least one other community identified by the State as in need of the services funded under this part but without a local community partnership.
__(B) In the case of communities identified in applications submitted by State health agencies that do not yet have local community partnerships, the State shall describe the steps that will be taken to aid the community in developing a local community partnership.
__(C) A State applying on behalf of local community partnerships and other communities may retain not more than 10 percent of grants awarded under this part for administrative costs.
__(e) Contents of Application._In order to receive a grant under this section, an applicant must include in the application the following information:
__(1) An assessment of the need for school health services in the communities to be served, using the latest available health data and health goals and objectives established by the Secretary.
__(2) A description of how the applicant will design the proposed school health services to reach the maximum number of school-aged children and youth at risk for poor health outcome.
__(3) An explanation of how the applicant will integrate its services with those of other health and social service programs within the community.
__(4) An explanation of how the applicant will link its activities to the regional and corporate alliance health plans serving the communities in which the applicant's program is to be located.
__(5) Evidence of linkages with regional and corporate health alliances in whose areas the applicant's program is to be located.
__(6) A description of a quality assurance program which complies with standards that the Secretary may prescribe.
__(f) Number of Grants._Not more than two planning grants may be made to a single applicant.
SEC. 3685. GRANTS FOR OPERATION OF PROJECTS.
__(a) In General._The Secretary may make grants to State health agencies or to local community partnerships for the cost of operating school health service sites
__(b) Use of Grant._The costs for which a grant may be made under this section include but are not limited to the following:
__(1) The cost of furnishing health services that are not covered under title I of this Act or by any other public or private insurer.
__(2) The cost of furnishing enabling services, as defined in section 3461(h).
__(3) Training, recruitment and compensation of health professionals and other staff.
__(4) Outreach services to at-risk youth and to parents.
__(5) Linkage of individuals to health plans, community health services and social services.
__(6) Other activities deemed necessary by the Secretary.
__(c) Application for Grant._Applicants shall submit applications in a form and manner prescribed by the Secretary. In order to receive a grant under this section, an applicant must include in the application the following information:
__(1) A description of the services to be furnished by the applicant.
__(2) The amounts and sources of funding that the applicant will expend, including estimates of the amount of payments the applicant will received from alliance health plans and from other sources.
__(3) Such other information as the Secretary determines to be appropriate.
__(d) Additional Contents of Application._In order to receive a grant under this section, an applicant must meet the following conditions:
__(1) The applicant furnishes the following services:
__(A) Diagnosis and treatment of simple illnesses and minor injuries.
__(B) Preventive health services, including health screenings.
__(C) Enabling services, as defined in section 3461(h).
__(D) Referrals and followups in situations involving illness or injury.
__(E) Health and social services, counseling services, and necessary referrals, including referrals regarding mental health and substance abuse.
__(F) Such other services as the Secretary determines to be appropriate.
__(2) The applicant maintains agreements with all regional and corporate alliance health plans offering services in the applicant's service area.
__(3) The applicant is a participating provider in the State's program for medical assistance under title XIX of the Social Security Act.
__(4) The applicant does not impose charges on students or their families for services (including collection of any cost-sharing for services under the comprehensive benefit package that otherwise would be required).
__(5) The applicant has reviewed and will periodically review the needs of the population served by the applicant in order to ensure that its services are accessible to the maximum number of school age children and youth in the area, and that, to the maximum extent possible, barriers to access to services of the applicant are removed (including barriers resulting from the area's physical characteristics, its economic, social and cultural grouping, the health care utilization patterns of children and youth, and available transportation).
__(6) In the case of an applicant which serves a population that includes a substantial proportion of individuals of limited English speaking ability, the applicant has developed a plan to meet the needs of such population to the extent practicable in the language and cultural context most appropriate to such individuals.
__(7) The applicant will provide non-Federal contributions toward the cost of the project in an amount determined by the Secretary.
__(8) The applicant will operate a quality assurance program consistent with section 3684(e)(6).
__(e) Duration of Grant._A grant under this section shall be for a period determined by the Secretary.
__(f) Reports._A recipient of funding under this section shall provide such reports and information as are required in regulations of the Secretary.
SEC. 3686. FEDERAL ADMINISTRATIVE COSTS.
__Of the amounts made available under section 3681, the Secretary may reserve not more than 5 percent for administrative expenses regarding this subpart.
Subpart B_Capital Costs of Developing Projects
SEC. 3691. LOANS AND LOAN GUARANTEES REGARDING PROJECTS.
__(a) In General._The Secretary may make loans to, and guarantee the payment of principal and interest to Federal and non-Federal lenders on behalf of, State health agencies and local community partnerships for the capital costs of developing projects in accordance with subpart A.
__(b) Applicability of Certain Provisions._The provisions of subpart A apply to loans and loan guarantees under subsection (a) to the same extent and in the same manner as such provisions apply to grants under subpart A. Except for any provision inconsistent with the purpose described in subsection (a), the provisions of subpart C of part 2 of subtitle E apply to loans and loan guarantees under subsection (a) to the same extent and in the same manner as such provisions apply to loans and loan guarantees under section 3441.
SEC. 3692. FUNDING.
__Amounts available to the Secretary under section 3412 for the purpose of carrying out subparts B and C of part 2 of subtitle E are, in addition to such purpose, available to the Secretary for the purpose of carrying out this subpart.
Title III, Subtitle H
Subtitle H_Public Health Service Initiative
SEC. 3701. PUBLIC HEALTH SERVICE INITIATIVE.
__(a) In General._There is established pursuant to this title a Public Health Service Initiative consisting of the total amounts authorized and described in subsection (b). The Initiative includes all the programs authorized under the previous provisions of this title.
__(b) Total of the Amounts Authorized to be Appropriated._The following is the total of the amounts authorized to be appropriated for the Initiative under the previous subtitles of this title:
__(1) For fiscal year 1995, $1,125,000,000.
__(2) For fiscal year 1996, $2,984,000,000.
__(3) For fiscal year 1997, $3,830,000,000.
__(4) For fiscal year 1998, $4,205,000,000.
__(5) For fiscal year 1999, $4,055,000,000.
__(6) For fiscal year 2000, $3,666,000,000.
__(c) Use of Amounts; Availability._
__(1) Use; annual appropriations._Amounts appropriated to carry out the Initiative, including subtitles A through F of this title, are available to carry out the specific programs for which the amounts are appropriated.
__(2) Availability of appropriated amounts._Amounts appropriated for programs in the Initiative are available until expended.
Title III, Subtitle I
Subtitle I_Coordination With Cobra Continuation Coverage
SEC. 3801. PUBLIC HEALTH SERVICE ACT; COORDINATION WITH COBRA CONTINUATION COVERAGE.
__(a) Period of Coverage._Subparagraph (D) of section 2202(2) of the Public Health Service Act (42 U.S.C. 300bb 2(2)) is amended_
__(1) by striking ``or'' at the end of clause (i), by striking the period at the end of clause (ii) and inserting ``, or'', and by adding at the end the following new clause:
__``(iii) eligible for comprehensive health coverage described in section 1101 of the Health Security Act.'', and
__(2) by striking ``or medicare entitlement'' in the heading and inserting ``, medicare entitlement, or health security act eligibility''.
__(b) Qualified Beneficiary._Section 2208(3) of such Act (42 U.S.C. 300bb 8(3)) is amended by adding at the end the following new subparagraph:
__``(C) Special rule for individuals covered by health security act._The term `qualified beneficiary' shall not include any individual who, upon termination of coverage under a group health plan, is eligible for comprehensive health coverage described in section 1101 of the Health Security Act.''.
__(c) Repeal Upon Implementation of Health Security Act._
__(1) In general._Title XXII of such Act (42 U.S.C. 300bb 1 et seq.) is hereby repealed.
__(2) Conforming amendment._The table of contents of such Act is amended by striking the item relating to title XXII.
__(3) Effective date._The amendments made by this subsection shall take effect on the earlier of_
__(A) January 1, 1998, or
__(B) the first day of the first calendar year following the calendar year in which all States have in effect plans under which individuals are eligible for comprehensive health coverage described in section 1101 of this Act.
