HIV AIDS Resource Guide/HIV-AIDS Resource Guide.iso/STAT/PROP_FED/HSA03_2.ASC

Text File | 1993-01-14 | 105KB | 2,436 lines

/* The final section of Title III of the Health Security Act
follows. */
            Section 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 XXVI 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 participate
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 (f).
        (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.

            Section 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 (b)(3) or (c)(4) of such
section, 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.
           Section 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, if
the Secretary determines that subordination or waiver will
further the objectives of this part.

          Section 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 includes 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.
            Section 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
communityoriented, 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.

            Section 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.

            Section 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.

         Section 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.

            Section 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

            Section 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.

            Section 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, subject to the Federal Credit Reform Act
of 1990, meet such terms and conditions (including
provisions for recovery in case of default) as the
Secretary, in consultation with the Secretary of the
Treasury, 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, in consultation with
the Secretary of the Treasury, and subject to the Federal
Credit Reform Act of 1990, 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.

         Section 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.

            Section 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.

         Section 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.

         Section 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

            Section 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).

            Section 3462   AUTHORIZATIONS OF APPROPRIATIONS.

   (a)  Enabling Services. For the purpose of carrying out
section 3461, there are authorized to be appropriated
$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
            Section 3471   AUTHORIZATIONS OF APPROPRIATIONS.
 (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 $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.

            Section 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

            Section 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.
            Section 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.
            Section 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
Statespecific 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).
            Section 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

            Section 3501   AUTHORIZATIONS OF APPROPRIATIONS.
    (a)  In General. For the purpose of carrying out this
    part,
there are authorized to be appropriated $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.

            Section 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(b)(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(b)(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.

            Section 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

            Section 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 report on (including a plan
for) the measures to be implemented by the State to achieve the
integration of the mental illness and substance abuse services
of the State and its political subdivisions with the mental
illness and substance abuse services that are included in the
comprehensive benefit package under title I. The plan required
in the preceding sentence shall meet the conditions described
in section 3074(b).

    (b)  Required Contents.With respect to the provision of
items and services relating to mental illness 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 illness 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 illness 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 illness 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 illness 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 illness 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 illness and substance abuse
programs funded by the State will be enrolled in a health plan
and how mental illness 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 illness 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 illness 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 time and in the manner prescribed by the
Secretary.

        Subpart B    Pilot Program

            Section 3521   PILOT PROGRAM.

    (a)  In General. The Secretary shall establish a pilot
program to demonstrate model methods of achieving the
integration of the mental illness and substance abuse services
of the States with the mental illness 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 illness 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

            Section 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

/* An institutionalization of aids education in schools. */

            (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.
            Section 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. (H)  Safety and prevention of injuries.

            (I)  Substance abuse, including tobacco and alcohol
use.


            (J)  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
            Section 3611   AUTHORIZATIONS OF APPROPRIATIONS.
    (a)  Funding for School Health Education. For the purpose
of carrying out parts 3 and 4, there are authorized to be
appropriated $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.
            Section 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 STATE EDUCATION
AGENCIES

        Subpart A    Planning Grants for State Education
            Agencies Section 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 the State's school improvement
plan, if any, under title III of 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.

             Section 3622   APPROVAL OF SECRETARY.

  The Secretary may approve the application of a State under
section 3621 if 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.

            Section 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.

             Section 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 State Education
Agencies

             Section 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 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).

             Section 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).

            Section 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.

            Section 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.
            Section 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 schoolsto 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

            Section 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

            Section 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

             Section 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.

             Section 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.

            Section 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.
             Section 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

             Section 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).

             Section 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).

            Section 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.

             Section 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.

            Section 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

            Section 3681   AUTHORIZATIONS OF APPROPRIATIONS.

    (a)  Funding for School-Related Health Services. For the
purpose of carrying out this subpart, there are authorized to
be appropriated $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.

            Section 3682   ELIGIBILITY FOR DEVELOPMENT AND
OPERATION GRANTS.

  (a)  In General. Entities eligible to apply for and receive
grants under section 3484 or 3485 are the following:

        (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.
            Section 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.

/* This section pairs HIV as a priority with several other
contemporary hot issues. */

  (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)).

            Section 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)  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 subpart for administrative
costs.

    (d)  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)  A description 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.

  (e)  Number of Grants. Not more than one planning grant may
be made to a single applicant. A planning grant may not exceed
two years in duration.

            Section 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(g).

        (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(g).

            (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
costsharing 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.

            Section 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

            Section 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.
            Section 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

            Section 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 the programs of subtitles C through G of
this title and the programs of subtitle D of title VIII.

  (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


           Section 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.
300bb092(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. 300bb098(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.
300bb091 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.