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115th Congress } { Rept. 115-359
HOUSE OF REPRESENTATIVES
1st Session } { Part 1
======================================================================
COMMUNITY HEALTH AND MEDICAL PROFESSIONALS IMPROVE OUR NATION ACT OF
2017
_______
October 19, 2017.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Walden, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
together with
MINORITY VIEWS
[To accompany H.R. 3922]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 3922) to extend funding for certain public
health programs, and for other purposes, having considered the
same, report favorably thereon with an amendment and recommend
that the bill as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 10
Background and Need for Legislation.............................. 10
Committee Action................................................. 10
Committee Votes.................................................. 10
Oversight Findings and Recommendations........................... 20
New Budget Authority, Entitlement Authority, and Tax Expenditures 20
Congressional Budget Office Estimate............................. 20
Federal Mandates Statement....................................... 25
Statement of General Performance Goals and Objectives............ 25
Duplication of Federal Programs.................................. 25
Committee Cost Estimate.......................................... 25
Earmark, Limited Tax Benefits, and Limited Tariff Benefits....... 25
Disclosure of Directed Rule Makings.............................. 25
Advisory Committee Statement..................................... 25
Applicability to Legislative Branch.............................. 26
Section-by-Section Analysis of the Legislation................... 26
Changes in Existing Law Made by the Bill, as Reported............ 28
Minority Views................................................... 77
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Community Health And Medical
Professionals Improve Our Nation Act of 2017'' or the ``CHAMPION Act''.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--EXTENSION OF PUBLIC HEALTH PROGRAMS
Sec. 101. Extension for community health centers and the National
Health Service Corps.
Sec. 102. Extension for special diabetes programs.
Sec. 103. Reauthorization of program of payments to teaching health
centers that operate graduate medical education programs.
Sec. 104. Extension for family-to-family health information centers.
Sec. 105. Youth empowerment program; personal responsibility education.
TITLE II--OFFSETS
Sec. 201. Providing for qualified health plan grace period requirements
for issuer receipt of advance payments of cost-sharing reductions and
premium tax credits that are more consistent with State law grace
period requirements.
Sec. 202. Prevention and Public Health Fund.
TITLE I--EXTENSION OF PUBLIC HEALTH PROGRAMS
SEC. 101. EXTENSION FOR COMMUNITY HEALTH CENTERS AND THE NATIONAL
HEALTH SERVICE CORPS.
(a) Community Health Centers Funding.--Section 10503(b)(1)(E) of the
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2(b)(1)(E))
is amended by striking ``2017'' and inserting ``2019''.
(b) Other Community Health Centers Provisions.--Section 330 of the
Public Health Service Act (42 U.S.C. 254b) is amended--
(1) in subsection (b)(1)(A)(ii), by striking ``abuse'' and
inserting ``use disorder'';
(2) in subsection (b)(2)(A), by striking ``abuse'' and
inserting ``use disorder'';
(3) in subsection (c)--
(A) in paragraph (1), by striking subparagraphs (B)
through (D);
(B) by striking ``(1) In general'' and all that
follows through ``The Secretary'' and inserting the
following:
``(1) Centers.--The Secretary''; and
(C) in paragraph (1), as amended, by redesignating
clauses (i) through (v) as subparagraphs (A) through
(E) and moving the margin of each of such redesignated
subparagraph 2 ems to the left;
(4) by striking subsection (d) and inserting the following:
``(d) Improving Quality of Care.--
``(1) Supplemental awards.--The Secretary may award
supplemental grant funds to health centers funded under this
section to implement evidence-based models for increasing
access to high-quality primary care services, which may include
models related to--
``(A) improving the delivery of care for individuals
with multiple chronic conditions;
``(B) workforce configuration;
``(C) reducing the cost of care;
``(D) enhancing care coordination;
``(E) expanding the use of telehealth and technology-
enabled collaborative learning and capacity building
models;
``(F) care integration, including integration of
behavioral health, mental health, or substance use
disorder services; and
``(G) addressing emerging public health or substance
use disorder issues to meet the health needs of the
population served by the health center.
``(2) Sustainability.--In making supplemental awards under
this subsection, the Secretary may consider whether the health
center involved has submitted a plan for continuing the
activities funded under this subsection after supplemental
funding is expended.
``(3) Special consideration.--The Secretary may give special
consideration to applications for supplemental funding under
this subsection that seek to address significant barriers to
access to care in areas with a greater shortage of health care
providers and health services relative to the national
average.'';
(5) in subsection (e)(1)--
(A) in subparagraph (B)--
(i) by striking ``2 years'' and inserting ``1
year''; and
(ii) by adding at the end the following:
``The Secretary shall not make a grant under
this paragraph unless the applicant provides
assurances to the Secretary that within 120
days of receiving grant funding for the
operation of the health center, the applicant
will submit, for approval by the Secretary, an
implementation plan to meet the requirements of
subsection (l)(3). The Secretary may extend
such 120-day period for achieving compliance
upon a demonstration of good cause by the
health center.''; and
(B) in subparagraph (C)--
(i) in the subparagraph heading, by striking
``and plans'';
(ii) by striking ``or plan (as described in
subparagraphs (B) and (C) of subsection
(c)(1))'';
(iii) by striking ``or plan, including the
purchase'' and inserting the following:
``including--
``(i) the purchase'';
(iv) by inserting ``, which may include data
and information systems'' after ``of
equipment'';
(v) by striking the period at the end and
inserting a semicolon; and
(vi) by adding at the end the following:
``(ii) the provision of training and
technical assistance; and
``(iii) other activities that--
``(I) reduce costs associated with
the provision of health services;
``(II) improve access to, and
availability of, health services
provided to individuals served by the
centers;
``(III) enhance the quality and
coordination of health services; or
``(IV) improve the health status of
communities.'';
(6) in subsection (e)(5)(B)--
(A) in the heading of subparagraph (B), by striking
``and plans''; and
(B) by striking ``and subparagraphs (B) and (C) of
subsection (c)(1) to a health center or to a network or
plan'' and inserting ``to a health center or to a
network'';
(7) by striking subsection (s);
(8) by redesignating subsections (g) through (r) as
subsections (h) through (s), respectively;
(9) by inserting after subsection (f), the following:
``(g) New Access Points and Expanded Services.--
``(1) Approval of new access points.--
``(A) In general.--The Secretary may approve
applications for grants under subparagraph (A) or (B)
of subsection (e)(1) to establish new delivery sites.
``(B) Special consideration.--In carrying out
subparagraph (A), the Secretary may give special
consideration to applicants that have demonstrated the
new delivery site will be located within a sparsely
populated area, or an area which has a level of unmet
need that is higher relative to other applicants.
``(C) Consideration of applications.--In carrying out
subparagraph (A), the Secretary shall approve
applications for grants under subparagraphs (A) and (B)
of subsection (e)(1) in such a manner that the ratio of
the medically underserved populations in rural areas
which may be expected to use the services provided by
the applicants involved to the medically underserved
populations in urban areas which may be expected to use
the services provided by the applicants is not less
than two to three or greater than three to two.
``(D) Service area overlap.--If in carrying out
subparagraph (A) the applicant proposes to serve an
area that is currently served by another health center
funded under this section, the Secretary may consider
whether the award of funding to an additional health
center in the area can be justified based on the unmet
need for additional services within the catchment area.
``(2) Approval of expanded service applications.--
``(A) In general.--The Secretary may approve
applications for grants under subparagraph (A) or (B)
of subsection (e)(1) to expand the capacity of the
applicant to provide required primary health services
described in subsection (b)(1) or additional health
services described in subsection (b)(2).
``(B) Priority expansion projects.--In carrying out
subparagraph (A), the Secretary may give special
consideration to expanded service applications that
seek to address emerging public health or behavioral
health, mental health, or substance abuse issues
through increasing the availability of additional
health services described in subsection (b)(2) in an
area in which there are significant barriers to
accessing care.
``(C) Consideration of applications.--In carrying out
subparagraph (A), the Secretary shall approve
applications for applicants in such a manner that the
ratio of the medically underserved populations in rural
areas which may be expected to use the services
provided by the applicants involved to the medically
underserved populations in urban areas which may be
expected to use the services provided by such
applicants is not less than two to three or greater
than three to two.'';
(10) in subsection (i) (as so redesignated)--
(A) in paragraph (1), by striking ``and children and
youth at risk of homelessness'' and inserting ``,
children and youth at risk of homelessness, homeless
veterans, and veterans at risk of homelessness''; and
(B) in paragraph (5)--
(i) by striking subparagraph (B);
(ii) by redesignating subparagraph (C) as
subparagraph (B); and
(iii) in subparagraph (B) (as so
redesignated)--
(I) in the subparagraph heading, by
striking ``abuse'' and inserting ``use
disorder''; and
(II) by striking ``abuse'' and
inserting ``use disorder'';
(11) in subsection (l) (as so redesignated)--
(A) in paragraph (2)--
(i) in the paragraph heading, by inserting
``unmet'' before ``need'';
(ii) in the matter preceding subparagraph
(A), by inserting ``and an application for a
grant under subsection (g)'' after ``subsection
(e)(1)'';
(iii) in subparagraph (A), by inserting
``unmet'' before ``need for health services'';
(iv) in subparagraph (B), by striking ``and''
at the end;
(v) in subparagraph (C), by striking the
period at the end and inserting ``; and''; and
(vi) by adding after subparagraph (C) the
following:
``(D) in the case of an application for a grant
pursuant to subsection (g)(1), a demonstration that the
applicant has consulted with appropriate State and
local government agencies, and health care providers
regarding the need for the health services to be
provided at the proposed delivery site.'';
(B) in paragraph (3)--
(i) in the matter preceding subparagraph (A),
by inserting ``or subsection (g)'' after
``subsection (e)(1)(B)'';
(ii) in subparagraph (B), by striking ``in
the catchment area of the center'' and
inserting ``, including other health care
providers that provide care within the
catchment area, local hospitals, and specialty
providers in the catchment area of the center,
to provide access to services not available
through the health center and to reduce the
non-urgent use of hospital emergency
departments'';
(iii) in subparagraph (H)(ii), by inserting
``who shall be directly employed by the
center'' after ``approves the selection of a
director for the center'';
(iv) in subparagraph (L), by striking ``and''
at the end;
(v) in subparagraph (M), by striking the
period and inserting ``; and''; and
(vi) by inserting after subparagraph (M), the
following:
``(N) the center has written policies and procedures
in place to ensure the appropriate use of Federal funds
in compliance with applicable Federal statutes,
regulations, and the terms and conditions of the
Federal award.''; and
(C) by striking paragraph (4);
(12) in subsection (m) (as so redesignated), by adding at the
end the following: ``Funds expended to carry out activities
under this subsection and operational support activities under
subsection (n) shall not exceed 3 percent of the amount
appropriated for this section for the fiscal year involved.'';
(13) in subsection (q) (as so redesignated), by striking
``grants for new health centers under subsections (c) and (e)''
and inserting ``operating grants under subsection (e),
applications for new access points and expanded service
pursuant to subsection (g)'';
(14) in subsection (r)(4) (as so redesignated), by adding at
the end the following: ``A waiver provided by the Secretary
under this paragraph may not remain in effect for more than 1
year and may not be extended after such period. An entity may
not receive more than one waiver under this paragraph in
consecutive years.'';
(15) in subsection (s)(3) (as so redesignated)--
(A) by striking ``appropriate committees of Congress
a report concerning the distribution of funds under
this section'' and inserting the following: ``Committee
on Health, Education, Labor, and Pensions of the
Senate, and the Committee on Energy and Commerce of the
House of Representatives, a report including, at a
minimum--
``(A) the distribution of funds for carrying out this
section'';
(B) by striking ``populations. Such report shall
include an assessment'' and inserting the following:
``populations;
``(B) an assessment'';
(C) by striking ``and the rationale for any
substantial changes in the distribution of funds.'' and
inserting a semicolon; and
(D) by adding at the end the following:
``(C) the distribution of awards and funding for new
or expanded services in each of rural areas and urban
areas;
``(D) the distribution of awards and funding for
establishing new access points, and the number of new
access points created;
``(E) the amount of unexpended funding for loan
guarantees and loan guarantee authority under title
XVI;
``(F) the rationale for any substantial changes in
the distribution of funds;
``(G) the rate of closures for health centers and
access points;
``(H) the number and reason for any grants awarded
pursuant to subsection (e)(1)(B); and
``(I) the number and reason for any waivers provided
pursuant to subsection (r)(4).''; and
(16) in subsection (s) (as so redesignated) by adding at the
end the following new paragraph:
``(5) Funding for participation of health centers in all of
us research program.--In addition to any amounts made available
pursuant to subsection (d) of this section, paragraph (1) of
this subsection, section 402A of this Act, or section 10503 of
the Patient Protection and Affordable Care Act, there is
authorized to be appropriated, and there is appropriated, out
of any monies in the Treasury not otherwise appropriated, to
the Secretary $25,000,000 for fiscal year 2018 to support the
participation of health centers in the All of Us Research
Program under the Precision Medicine Initiative under section
498E of this Act.''.
(c) National Health Service Corps.--Section 10503(b)(2)(E) of the
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2(b)(2)(E))
is amended by striking ``2017'' and inserting ``2019''.
(d) Application.--Amounts appropriated pursuant to this section for
fiscal year 2018 or 2019 are subject to the requirements contained in
Public Law 115-31 for funds for programs authorized under sections 330
through 340 of the Public Health Service Act (42 U.S.C. 254b-256).
(e) Conforming Amendments.--Section 3014(h) of title 18, United
States Code, is amended--
(1) in paragraph (1), by striking ``, as amended by section
221 of the Medicare Access and CHIP Reauthorization Act of
2015,''; and
(2) in paragraph (4), by inserting ``and section 101(d) of
the Community Health And Medical Professionals Improve Our
Nation Act of 2017'' after ``section 221(c) of the Medicare
Access and CHIP Reauthorization Act of 2015''.
SEC. 102. EXTENSION FOR SPECIAL DIABETES PROGRAMS.
(a) Special Diabetes Program for Type I Diabetes.--Section
330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 254c-
2(b)(2)(C)) is amended by striking ``2017'' and inserting ``2019''.
(b) Special Diabetes Program for Indians.--Section 330C(c)(2) of the
Public Health Service Act (42 U.S.C. 254c-3(c)(2)) is amended--
(1) in subparagraph (C), by striking ``and'' at the end;
(2) in subparagraph (D), by striking the period at the end
and inserting ``and $112,500,000 for the period consisting of
the second, third, and fourth quarters of fiscal year 2018;
and''; and
(3) by adding at the end the following:
``(E) $150,000,000 for fiscal year 2019.''.
SEC. 103. REAUTHORIZATION OF PROGRAM OF PAYMENTS TO TEACHING HEALTH
CENTERS THAT OPERATE GRADUATE MEDICAL EDUCATION
PROGRAMS.
(a) Payments.--Subsection (a) of section 340H of the Public Health
Service Act (42 U.S.C. 256h) is amended to read as follows:
``(a) Payments.--
``(1) In general.--Subject to subsection (h)(2), the
Secretary shall make payments under this section for direct
expenses and indirect expenses to qualified teaching health
centers that are listed as sponsoring institutions by the
relevant accrediting body for--
``(A) maintenance of existing approved graduate
medical residency training programs;
``(B) expansion of existing approved graduate medical
residency training programs; and
``(C) establishment of new approved graduate medical
residency training programs, as appropriate.
``(2) Priority.--In making payments pursuant to paragraph
(1)(C), the Secretary shall give priority to qualified teaching
health centers that--
``(A) serve a health professional shortage area with
a designation in effect under section 332 or a
medically underserved community (as defined in section
799B); or
``(B) are located in a rural area (as defined in
section 1886(d)(2)(D) of the Social Security Act).''.
(b) Funding.--Subsection (g) of section 340H of the Public Health
Service Act (42 U.S.C. 256h) is amended--
(1) by striking ``To carry out'' and inserting the following:
``(1) In general.--To carry out'';
(2) by striking ``and $15,000,000 for the first quarter of
fiscal year 2018'' and inserting ``, $15,000,000 for the first
quarter of fiscal year 2018, $111,500,000 for the period
consisting of the second, third, and fourth quarters of fiscal
year 2018, and $126,500,000 for fiscal year 2019, to remain
available until expended''; and
(3) by adding at the end the following:
``(2) Administrative expenses.--Of the amount made available
to carry out this section for any fiscal year, the Secretary
may not use more than 5 percent of such amount for the expenses
of administering this section.''.
(c) Annual Reporting.--Subsection (h)(1) of section 340H of the
Public Health Service Act (42 U.S.C. 256h) is amended--
(1) by redesignating subparagraph (D) as subparagraph (H);
and
(2) by inserting after subparagraph (C) the following:
``(D) The number of patients treated by residents
described in paragraph (4).
``(E) The number of visits by patients treated by
residents described in paragraph (4).
``(F) Of the number of residents described in
paragraph (4) who completed their residency training at
the end of such residency academic year, the number and
percentage of such residents entering primary care
practice (meaning any of the areas of practice listed
in the definition of a primary care residency program
in section 749A).
``(G) Of the number of residents described in
paragraph (4) who completed their residency training at
the end of such residency academic year, the number and
percentage of such residents who entered practice at a
health care facility--
``(i) primarily serving a health professional
shortage area with a designation in effect
under section 332 or a medically underserved
community (as defined in section 799B); or
``(ii) located in a rural area (as defined in
section 1886(d)(2)(D) of the Social Security
Act).''.
(d) Report on Training Costs.--Not later than March 31, 2019, the
Secretary of Health and Human Services shall submit to the Congress a
report on the direct graduate expenses of approved graduate medical
residency training programs, and the indirect expenses associated with
the additional costs of teaching residents, of qualified teaching
health centers (as such terms are used or defined in section 340H of
the Public Health Service Act (42 U.S.C. 256h)).
(e) Definition.--Subsection (j) of section 340H of the Public Health
Service Act (42 U.S.C. 256h) is amended--
(1) by redesignating paragraphs (2) and (3) as paragraphs (3)
and (4), respectively; and
(2) by inserting after paragraph (1) the following:
``(2) New approved graduate medical residency training
program.--The term `new approved graduate medical residency
training program' means an approved graduate medical residency
training program for which the sponsoring qualified teaching
health center has not received a payment under this section for
a previous fiscal year (other than pursuant to subsection
(a)(1)(C)).''.
(f) Technical Correction.--Subsection (f) of section 340H (42 U.S.C.
256h) is amended by striking ``hospital'' each place it appears and
inserting ``teaching health center''.
(g) Payments for Previous Fiscal Years.--The provisions of section
340H of the Public Health Service Act (42 U.S.C. 256h), as in effect on
the day before the date of enactment of this Act, shall continue to
apply with respect to payments under such section for fiscal years
before fiscal year 2018.
SEC. 104. EXTENSION FOR FAMILY-TO-FAMILY HEALTH INFORMATION CENTERS.
Section 501(c) of the Social Security Act (42 U.S.C. 701(c)) is
amended--
(1) in paragraph (1)(A)--
(A) in clause (v), by striking ``and'' at the end;
(B) in clause (vi), by striking the period at the end
and inserting ``; and''; and
(C) by adding at the end the following new clause:
``(vii) $6,000,000 for each of fiscal years 2018 and 2019.'';
(2) in paragraph (3)(C), by inserting before the period the
following: ``, and with respect to fiscal years 2018 and 2019,
such centers shall also be developed in all territories and at
least one such center shall be developed for Indian tribes'';
and
(3) by amending paragraph (5) to read as follows:
``(5) For purposes of this subsection--
``(A) the term `Indian tribe' has the meaning given such term
in section 4 of the Indian Health Care Improvement Act (25
U.S.C. 1603);
``(B) the term `State' means each of the 50 States and the
District of Columbia; and
``(C) the term `territory' means Puerto Rico, Guam, American
Samoa, the Virgin Islands, and the Northern Mariana Islands.''.
SEC. 105. YOUTH EMPOWERMENT PROGRAM; PERSONAL RESPONSIBILITY EDUCATION.
(a) Youth Empowerment Program.--
(1) In general.--Section 510 of the Social Security Act (42
U.S.C. 710) is amended to read as follows:
``SEC. 510. YOUTH EMPOWERMENT PROGRAM.
``(a) In General.--
``(1) Allotments to states.--For the purpose described in
subsection (b), the Secretary shall, for each of fiscal years
2018 and 2019, allot to each State which has transmitted an
application for the fiscal year under section 505(a) an amount
equal to the product of--
``(A) the amount appropriated pursuant to subsection
(e)(1) for the fiscal year, minus the amount reserved
under subsection (e)(2) for the fiscal year; and
``(B) the proportion that the number of low-income
children in the State bears to the total of such
numbers of children for all the States.
``(2) Other allotments.--
``(A) Other entities.--For the purpose described in
subsection (b), the Secretary shall, for each of fiscal
years 2018 and 2019, for any State which has not
transmitted an application for the fiscal year under
section 505(a), allot to one or more entities in the
State the amount that would have been allotted to the
State under paragraph (1) if the State had submitted
such an application.
``(B) Process.--The Secretary shall select the
recipients of allotments under subparagraph (A) by
means of a competitive grant process under which--
``(i) not later than 30 days after the
deadline for the State involved to submit an
application for the fiscal year under section
505(a), the Secretary publishes a notice
soliciting grant applications; and
``(ii) not later than 120 days after such
deadline, all such applications must be
submitted.
``(b) Purpose.--
``(1) In general.--Except for research under paragraph (5)
and information collection and reporting under paragraph (6),
the purpose of an allotment under subsection (a) to a State (or
to another entity in the State pursuant to subsection (a)(2))
is to enable the State or other entity to implement education
exclusively on sexual risk avoidance (meaning voluntarily
refraining from sexual activity).
``(2) Required components.--Education on sexual risk
avoidance pursuant to an allotment under this section shall--
``(A) ensure that the unambiguous and primary
emphasis and context for each topic described in
paragraph (3) is a message to youth that normalizes the
optimal health behavior of avoiding nonmarital sexual
activity;
``(B) be medically accurate and complete;
``(C) be age-appropriate; and
``(D) be based on adolescent learning and
developmental theories for the age group receiving the
education.
``(3) Topics.--Education on sexual risk avoidance pursuant to
an allotment under this section shall address each of the
following topics:
``(A) The holistic individual and societal benefits
associated with personal responsibility, self-
regulation, goal setting, healthy decisionmaking, and a
focus on the future.
``(B) The advantage of refraining from nonmarital
sexual activity in order to improve the future
prospects and physical and emotional health of youth.
``(C) The increased likelihood of avoiding poverty
when youth attain self-sufficiency and emotional
maturity before engaging in sexual activity.
``(D) The foundational components of healthy
relationships and their impact on the formation of
healthy marriages and safe and stable families.
``(E) How other youth risk behaviors, such as drug
and alcohol usage, increase the risk for teen sex.
``(F) How to resist and avoid, and receive help
regarding, sexual coercion and dating violence,
recognizing that even with consent teen sex remains a
youth risk behavior.
``(4) Contraception.--Education on sexual risk avoidance
pursuant to an allotment under this section shall ensure that--
``(A) any information provided on contraception is
medically accurate and ensures that students understand
that contraception offers physical risk reduction, but
not risk elimination; and
``(B) the education does not include demonstrations,
simulations, or distribution of contraceptive devices.
``(5) Research.--
``(A) In general.--A State or other entity receiving
an allotment pursuant to subsection (a) may use up to
20 percent of such allotment to build the evidence base
for sexual risk avoidance education by conducting or
supporting research.
``(B) Requirements.--Any research conducted or
supported pursuant to subparagraph (A) shall be--
``(i) rigorous;
``(ii) evidence-based; and
``(iii) designed and conducted by independent
researchers who have experience in conducting
and publishing research in peer-reviewed
outlets.
``(6) Information collection and reporting.--A State or other
entity receiving an allotment pursuant to subsection (a) shall,
as specified by the Secretary--
``(A) collect information on the programs and
activities funded through the allotment; and
``(B) submit reports to the Secretary on the data
from such programs and activities.
``(c) National Evaluation.--
``(1) In general.--The Secretary shall--
``(A) in consultation with appropriate State and
local agencies, conduct one or more rigorous
evaluations of the education funded through this
section and associated data; and
``(B) submit a report to the Congress on the results
of such evaluations, together with a summary of the
information collected pursuant to subsection (b)(6).
``(2) Consultation.--In conducting the evaluations required
by paragraph (1), including the establishment of evaluation
methodologies, the Secretary shall consult with relevant
stakeholders.
``(d) Applicability of Certain Provisions.--
``(1) Sections 503, 507, and 508 apply to allotments under
subsection (a) to the same extent and in the same manner as
such sections apply to allotments under section 502(c).
``(2) Sections 505 and 506 apply to allotments under
subsection (a) to the extent determined by the Secretary to be
appropriate.
``(e) Funding.--
``(1) In general.--To carry out this section, there is
appropriated, out of any money in the Treasury not otherwise
appropriated, $75,000,000 for each of fiscal years 2018 and
2019.
``(2) Reservation.--The Secretary shall reserve, for each of
fiscal years 2018 and 2019, not more than 20 percent of the
amount appropriated pursuant to paragraph (1) for administering
the program under this section, including the conducting of
national evaluations and the provision of technical assistance
to the recipients of allotments.''.
(2) Effective date.--The amendment made by this section takes
effect on October 1, 2017.
(b) Personal Responsibility Education.--
(1) In general.--Section 513 of the Social Security Act (42
U.S.C. 713) is amended--
(A) in subsection (a)(1)(A), by striking ``2017'' and
inserting ``2019''; and
(B) in subsection (a)(4)--
(i) in subparagraph (A), by striking ``2017''
each place it appears and inserting ``2019'';
and
(ii) in subparagraph (B)--
(I) in the subparagraph heading, by
striking ``3-year grants'' and
inserting ``Competitive prep grants'';
and
(II) in clause (i), by striking
``solicit applications to award 3-year
grants in each of fiscal years 2012
through 2017'' and inserting ``continue
through fiscal year 2019 grants awarded
for any of fiscal years 2015 through
2017'';
(C) in subsection (c)(1), by inserting after ``youth
with HIV/AIDS,'' the following: ``victims of human
trafficking,''; and
(D) in subsection (f), by striking ``2017'' and
inserting ``2019''.
(2) Effective date.--The amendments made by this subsection
take effect on October 1, 2017.
TITLE II--OFFSETS
SEC. 201. PROVIDING FOR QUALIFIED HEALTH PLAN GRACE PERIOD REQUIREMENTS
FOR ISSUER RECEIPT OF ADVANCE PAYMENTS OF COST-
SHARING REDUCTIONS AND PREMIUM TAX CREDITS THAT ARE
MORE CONSISTENT WITH STATE LAW GRACE PERIOD
REQUIREMENTS.
(a) In General.--Section 1412(c) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18082(c)) is amended--
(1) in paragraph (2)--
(A) in subparagraph (B)(iv)(II), by striking ``a 3-
month grace period'' and inserting ``a grace period
specified in subparagraph (C)''; and
(B) by adding at the end the following new
subparagraphs:
``(C) Grace period specified.--For purposes of
subparagraph (B)(iv)(II), the grace period specified in
this subparagraph is--
``(i) for plan years beginning before January
1, 2018, a 3-month grace period; and
``(ii) for plan years beginning on or after
January 1, 2018--
``(I) in the case of an Exchange
operating in a State that has a State
law grace period in place, such State
law grace period; and
``(II) in the case of an Exchange
operating in a State that does not have
a State law grace period in place, a 1-
month grace period.
``(D) State law grace period.--For purposes of
subparagraph (C), the term `State law grace period'
means, with respect to a State, a grace period for
nonpayment of premiums before discontinuing coverage
that is applicable under the State law to health
insurance coverage offered in the individual market of
the State.''; and
(2) in paragraph (3), by adding at the end the following new
sentence: ``The requirements of paragraph (2)(B)(iv) apply to
an issuer of a qualified health plan receiving an advanced
payment under this paragraph in the same manner and to the same
extent that such requirements apply to an issuer of a qualified
health plan receiving an advanced payment under paragraph
(2)(A).''.
(b) Report on Aligning Grace Periods for Medicaid, Medicare, and
Exchange Plans.--Not later than two years after the date of full
implementation of subsection (a), the Comptroller General of the United
States shall submit to Congress a report on--
(1) the effects on consumers of aligning grace periods
applied under the Medicaid program under title XIX of the
Social Security Act, under the Medicare program under parts C
and D of title XVIII of such Act, and under qualified health
plans offered on an Exchange established under title I of the
Patient Protection and Affordable Care Act, including the
extent to which such an alignment of grace periods may help to
avoid enrollment status confusion for individuals under such
Medicaid program, Medicare program, and qualified health plans;
and
(2) the extent to which such an alignment of grace periods
may reduce fraud, waste, and abuse under the Medicaid program.
SEC. 202. PREVENTION AND PUBLIC HEALTH FUND.
Section 4002(b) of the Patient Protection and Affordable Care Act (42
U.S.C. 300u-11(b)) is amended by striking paragraphs (3) through (8)
and inserting the following new paragraphs:
``(3) for fiscal year 2018, $900,000,000;
``(4) for fiscal year 2019, $500,000,000;
``(5) for fiscal year 2020, $500,000,000;
``(6) for fiscal year 2021, $500,000,000;
``(7) for fiscal year 2022, $500,000,000;
``(8) for fiscal year 2023, $500,000,000;
``(9) for fiscal year 2024, $500,000,000;
``(10) for fiscal year 2025, $750,000,000;
``(11) for fiscal year 2026, $1,000,000,000; and
``(12) for fiscal year 2027 and each fiscal year thereafter,
$2,000,000,000.''.
Purpose and Summary
H.R. 3922 was introduced on October 3, 2017, by
Representative Greg Walden (R-OR). The bill extends federal
funding for important public health priorities, including
Community Health Centers, the Special Diabetes Programs, the
National Health Service Corps, the Teaching Health Center
Graduate Medical Education Program, Family-to-Family Health
Information Centers, the Youth Empowerment Program, and the
Personal Responsibility Education Program.
Background and Need for Legislation
On September 30, 2017, the funding for several important
programs authorized under the Public Health Service Act
expired. These critical programs, such as the Community Health
Centers program and the Special Diabetes Program, have helped
to reduce costs, improve health outcomes, and deliver cost-
effective care. Programs like the National Health Service Corps
and the Teaching Health Center Graduate Medical Education
Program play a critical role in training and placing primary
care providers in underserved areas.
Committee Action
The Committee on Energy and Commerce has not held hearings
on the legislation.
On October 4, 2017, the full Committee on Energy and
Commerce met in open markup session and ordered H.R. 3922, as
amended, favorably reported to the House by a recorded vote of
28 yeas and 23 nays.
Committee Votes
Clause 3(b) of rule XIII requires the Committee to list the
record votes on the motion to report legislation and amendments
thereto. The following reflects the record votes taken during
the Committee consideration:
Oversight Findings and Recommendations
Pursuant to clause 2(b)(1) of rule X and clause 3(c)(1) of
rule XIII, the Committee has not held hearings on this
legislation.
New Budget Authority, Entitlement Authority, and Tax Expenditures
Pursuant to clause 3(c)(2) of rule XIII, the Committee
finds that H.R. 3922 would result in no new or increased budget
authority, entitlement authority, or tax expenditures or
revenues.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII, the following is
the cost estimate provided by the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974.
U.S. Congress,
Congressional Budget Office,
Washington, DC, October 19, 2017.
Hon. Greg Walden,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 3922, the CHAMPION
Act of 2017.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Emily King.
Sincerely,
Keith Hall,
Director.
Enclosure.
H.R. 3922--CHAMPION Act of 2017
Summary: H.R. 3922 would extend funding for Community
Health Centers and several other public health programs for two
years, through 2019. It also would shorten the grace period
during which premiums can be paid and reduce funding available
for the Prevention and Public Health Fund. On net, CBO
estimates that implementing the legislation would reduce the
deficit by $1.4 billion over the 2018-2027 period.
Enacting H.R. 3922 would affect direct spending and
revenues; therefore, pay-as-you-go procedures apply.
CBO estimates that enacting H.R. 3922 would not increase
net direct spending or on-budget deficits in one or more of the
four consecutive 10-year periods beginning in 2028.
H.R. 3922 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Estimated cost to the Federal Government: The estimated
budgetary effect of H.R. 3922 is shown in the following table.
The costs of this legislation fall within budget functions 550
(health) and 500 (education, training, employment, and social
services).
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------------------------------------------------------------------------------------------
2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2018-2022 2018-2027
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
INCREASES OR DECREASES (-) IN DIRECT SPENDING
Sec. 101--Community Health Centers and the National Health
Service Corps:
Estimated Budget Authority.............................. 3,935 3,910 0 0 0 0 0 0 0 0 7,845 7,845
Estimated Outlays....................................... 1,124 2,733 2,780 1,181 16 0 0 0 0 0 7,833 7,833
Sec. 102--Special Diabetes Program:
Budget Authority........................................ 263 300 0 0 0 0 0 0 0 0 563 563
Estimated Outlays....................................... 76 233 198 42 9 4 0 0 0 0 558 563
Sec. 103--Teaching Health Centers GME:
Budget Authority........................................ 112 127 0 0 0 0 0 0 0 0 238 238
Estimated Outlays....................................... 45 92 72 29 0 0 0 0 0 0 238 238
Sec. 104--Family-to-Family Health Information Centers:
Budget Authority........................................ 6 6 0 0 0 0 0 0 0 0 12 12
Estimated Outlays....................................... 3 5 3 1 0 0 0 0 0 0 12 12
Sec. 105--Youth Empowerment Program and PREP:
Budget Authority........................................ 150 150 0 0 0 0 0 0 0 0 300 300
Estimated Outlays....................................... 5 69 122 74 18 0 0 0 0 0 288 288
Sec. 201--QHP Grace Period Requirements:
Estimated Budget Authority.............................. -262 -387 -394 -409 -424 -431 -447 -458 -463 -478 -1,876 -4,153
Estimated Outlays....................................... -262 -387 -394 -409 -424 -431 -447 -458 -463 -478 -1,876 -4,153
Sec. 202--Prevention and Public Health Fund:
Budget Authority........................................ 0 -400 -500 -500 -1,000 -500 -1,200 -1,250 -1,000 0 -2,400 -6,350
Estimated Outlays....................................... 0 -60 -193 -367 -548 -642 -779 -902 -1,045 -968 -1,168 -5,504
Total Changes:
Estimated Budget Authority.......................... 4,204 3,706 -894 -909 -1,424 -931 -1,647 -1,708 -1,463 -478 4,682 -1,545
Estimated Outlays................................... 991 2,685 2,588 551 -929 -1,069 -1,226 -1,360 -1,508 -1,446 5,885 -723
INCREASES IN REVENUES
Sec. 201--QHP Grace Period Requirements..................... 34 65 68 71 74 77 79 80 83 86 313 717
NET INCREASE OR DECREASE (-) IN THE DEFICIT FROM INCREASES OR DECREASES (-) IN DIRECT SPENDING AND REVENUES
Impact on Deficit........................................... 957 2,620 2,520 480 -1,003 -1,146 -1,305 -1,440 -1,591 -1,532 5,572 -1,440
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Notes: Components may not add to totals because of rounding; GME = Graduate Medical Education; PREP = Personal Responsibility Education Program; QHP = Qualified Health Plan.
Basis of estimate: For this estimate, CBO assumes that H.R.
3922 will be enacted near the start of calendar year 2018.
Estimated outlays are based on historical spending patterns for
the affected programs.
Extension of expiring provisions
H.R. 3922 would extend several public health provisions
that would otherwise expire under current law. In total, CBO
estimates that enacting those extensions would increase federal
spending by about $8.9 billion over the 2018-2027 period. The
budget authority for those extensions include:
$3.6 billion per year in 2018 and 2019 for
the Community Health Center Fund, which provides grants
to health centers that can be used for infrastructure,
management, training, and other expenses related to
providing health care services;
$310 million per year in 2018 and 2019 for
the National Health Service Corps, which funds
scholarships for primary care providers that serve in
underserved communities;
$263 million in 2018 and $300 million in
2019 for the Special Diabetes Program, which funds
research on the prevention and cure of type 1 diabetes
at the National Institutes of Health and funds diabetes
treatment and prevention programs for American Indians
through Indian Health Service, Tribal, and Urban Indian
health providers;
$111.5 million in 2018 and $126.5 million in
2019 for the Teaching Health Center Graduate Medical
Education program, which supports training for medical
and dental residents in primary care settings;
$75 million per year for 2018 and 2019 for
the Youth Empowerment Program (known as the Abstinence
Education program under current law), which funds
education on avoiding sexual risk;
$75 million per year for 2018 and 2019 for
the Personal Responsibility Education Program, which
funds youth education about abstinence, contraception,
and topics to prepare youth for adulthood; and
$6 million per year for 2018 and 2019 to
fund the Family-to-Family Health Information Centers,
which support families of children with special health
care needs.
Qualified health plan grace period requirements
Under current law, people who enroll in subsidized health
insurance purchased through a marketplace established under the
Affordable Care Act (ACA) and pay the premium for at least
their first month of coverage are granted a grace period of
three months if they miss a subsequent payment. If they pay
their premiums in full during that grace period, their coverage
continues normally. If, at the end of three months, they have
not made their premium payments, their coverage is terminated
retroactively to the end of the first month of their grace
period.
H.R. 3922 would shorten the grace period to one month
unless a state sets a different one. CBO and the staff of the
Joint Committee on Taxation (JCT) estimate that many people
who, under current law, would have paid their delinquent
premiums during the second or third month of their grace period
would instead have their coverage terminated under this bill.
CBO and JCT estimate that the subsidies those people would have
received for coverage during the remainder of the calendar year
would no longer be paid, resulting in a reduction in the
federal deficit. In addition, some of those people who became
uninsured would pay a penalty for not maintaining health
insurance coverage under provisions known as the individual
mandate, which would increase revenues. Based on information
from states, insurers, surveys, and the Department of Health
and Human Services, CBO and JCT estimate that fewer than
500,000 people would have their coverage terminated at some
point each year. As a result, CBO and JCT estimate that this
provision would reduce the deficit by about $4.9 billion over
the 2018-2027 period; that estimated savings includes about
$4.2 billion in reduced outlays and about $700 million in
increased revenues.
Prevention and Public Health Fund
The legislation would reduce funding available to the
Prevention and Public Health Fund. The Department of Health and
Human Services awards grants through that fund to public and
private entities to carry out prevention, wellness, and other
public health activities. Under current law, annual funding
available for these purposes totals $900 million in 2018, and
rises to $2.0 billion in 2027 and each year thereafter. Over
the 2019-2026 period, the legislation would reduce that funding
by $6.3 billion. CBO estimates that enacting the provision
would reduce direct spending by $5.5 billion over the 2018-2027
period.
Pay-As-You-Go considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget-reporting and enforcement
procedures for legislation affecting direct spending or
revenues. The net changes in outlays and revenues that are
subject to those pay-as-you-go procedures are shown in the
following table.
CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 3922, AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON ENERGY AND COMMERCE ON OCTOBER 4, 2017
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------------------------------------------------------------------------------------------
2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2018-2022 2018-2027
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
NET INCREASE OR DECREASE (-) IN THE DEFICIT
Statutory Pay-As-You-Go Impact.............................. 957 2,620 2,520 480 -1,003 -1,146 -1,305 -1,440 -1,591 -1,532 5,572 -1,440
Memorandum:
Changes in Outlays...................................... 991 2,685 2,588 551 -929 -1,069 -1,226 -1,360 -1,508 -1,446 5,885 -723
Changes in Revenues..................................... 34 65 68 71 74 77 79 80 83 86 313 717
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Increase in long-term direct spending and deficits: CBO
estimates that enacting the legislation would not increase net
direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2028.
Intergovernmental and private-sector impact: H.R. 3922
contains no intergovernmental or private-sector mandates as
defined in UMRA.
Estimate prepared by: Federal costs: Kate Fritzsche,
Jennifer Gray, Emily King, Lisa Ramirez-Branum, Robert Stewart,
and Ellen Werble and the staff of the Joint Committee on
Taxation; intergovernmental and private-sector impact: Amy
Petz.
Estimate approved by: Holly Harvey, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
Statement of General Performance Goals and Objectives
Pursuant to clause 3(c)(4) of rule XIII, the general
performance goal or objective of this legislation is to extend
funding for certain public health programs.
Duplication of Federal Programs
Pursuant to clause 3(c)(5) of rule XIII, no provision of
H.R. 3922 is known to be duplicative of another Federal
program, including any program that was included in a report to
Congress pursuant to section 21 of Public Law 111-139 or the
most recent Catalog of Federal Domestic Assistance.
Committee Cost Estimate
Pursuant to clause 3(d)(1) of rule XIII, the Committee
adopts as its own the cost estimate prepared by the Director of
the Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974.
Earmark, Limited Tax Benefits, and Limited Tariff Benefits
Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the
Committee finds that H.R. 3922 contains no earmarks, limited
tax benefits, or limited tariff benefits.
Disclosure of Directed Rule Makings
Pursuant to section 3(i) of H. Res. 5, the Committee finds
that H.R. 3922 contains no directed rule makings.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 provides that the Act may be cited as the
``Community Health And Medical Professionals Improve Our Nation
Act of 2017'' or the ``CHAMPION Act''.
Section 2. Table of contents
Section 2 lists the table of contents.
Section 101. Extension for community health centers and the National
Health Service Corps
Section 101 extends the funding for Community Health
Centers and the National Health Service Corps (NHSC) for two
years, at $3.6 billion a year for Community Health Centers, and
$310 million a year for the NHSC.
In addition, section 101 includes technical and
programmatic changes that improve the health centers ability to
function in the modern health care landscape. Specifically,
this section provides the Health Resources and Services
Administration (HRSA) with explicit authority to make
supplemental awards to Health Centers focused on quality
improvement, and to make grants for New Access Points and
Expanded Services. It clarifies the focus on unmet need and
extends the current rural to urban statutory ratio guardrails
for New Access Points and Expanded Services.
This section adds homeless veterans and veterans at risk of
homelessness to the list of focus populations for grants
focused on care to the homeless. It provides $25 million for
health centers to participate in the All of Us Research
Program, an effort to accelerate health research and medical
breakthroughs by creating the most diverse biomedical data
resource in history. It requires health centers to consult and
collaborate with existing local providers, programs and
agencies with respect to the services and programs offered by a
new site, and it requires health centers to have written
policies and procedures around appropriate use of federal funds
to ensure that the center is operated in compliance with
applicable federal laws and regulations.
Finally, this section provides the legal authority for HRSA
to require direct employment of health center CEOs and
Executive Directors.
Section 102. Extension for special diabetes programs
Section 102 extends the funding for two years for the
Special Diabetes Program for Type 1 Diabetes and the Special
Diabetes Program for Indians at $150 million a year each.
Section 103. Reauthorization of program of payments to teaching health
centers that operate graduate medical education programs
Section 103 extends the funding for the Teaching Health
Center Graduate Medical Education Program for two years, at
$126.5 million a year.
Section 104. Extension for family-to-family health information centers
Section 104 extends the Family-to-Family Health Information
Center program for two years at $6 million a year. This section
also establishes Family-to-Family Health Information Centers in
all of the territories and for the Indian tribes.
Section 105. Youth empowerment program; personal responsibility
education
Section 105 extends the Personal Responsibility Education
Program for two years at $75 million a year. This section also
renames the Abstinence Education Program as the Youth
Empowerment Program (PREP) and extends its funding for two
years at $75 million a year. In addition, section 105 includes
technical and programmatic changes to the Youth Empowerment
Program, that better reflects the intent of the program to
empower youth to make healthy decisions, resist sexual risk,
and set goals for the future.
Similar to PREP, if a State does not apply for grant
funding, the Secretary shall allot to one or more entities in
the State, through a competitive grant process, the amount that
would have been allocated to the State had it applied for the
funding. A State or entity that receives funding must collect
information on the programs and activities funded through its
allotment and submit a report to the Secretary on the data from
such programs and activities. In consultation with relevant
stakeholders, the Secretary must also establish and conduct one
or more national evaluations of the education funded through
the Youth Empowerment Program and submit a report to Congress
on the collected information.
Section 201. Providing for qualified health plan grace period
requirements for issuer receipt of advance payments of cost-
sharing reductions and premium tax credits that are more
consistent with State law grace period requirements
Under current law, subsidized patients with exchange plans
have a three-month grace period when they do not pay their
health insurance premiums. During these three months, their
plan cannot discontinue coverage for nonpayment of premiums.
This means that patients receiving the advance premium tax
credits (APTCs) and cost sharing reductions (CSRs) can pay for
only nine months of health insurance, but receive a full year's
coverage. According to one McKinsey report, one-in-five
exchange enrollees stopped payment in 2015 with nearly 90
percent of these individuals repurchasing a plan the following
year. Of this group, half enrolled in the same plan they
stopped payment for in 2015. Section 201 allows States to
define their grace period, or move to a default of one month.
Section 202. Prevention and Public Health Fund
The Prevention and Public Health Fund (PPHF) was created in
the Affordable Care Act to fund ``programs authorized by the
Public Health Service Act for prevention, wellness, and public
health activities.'' Section 202 allocates $6.35 billion from
the PPHF to support the public health programs in the CHAMPION
Act.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, and existing law in which no
change is proposed is shown in roman):
PATIENT PROTECTION AND AFFORDABLE CARE ACT
* * * * * * *
TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS
* * * * * * *
Subtitle E--Affordable Coverage Choices for All Americans
PART I--PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS
* * * * * * *
Subpart B--Eligibility Determinations
* * * * * * *
SEC. 1412. ADVANCE DETERMINATION AND PAYMENT OF PREMIUM TAX CREDITS AND
COST-SHARING REDUCTIONS.
(a) In General.--The Secretary, in consultation with the
Secretary of the Treasury, shall establish a program under
which--
(1) upon request of an Exchange, advance
determinations are made under section 1411 with respect
to the income eligibility of individuals enrolling in a
qualified health plan in the individual market through
the Exchange for the premium tax credit allowable under
section 36B of the Internal Revenue Code of 1986 and
the cost-sharing reductions under section 1402;
(2) the Secretary notifies--
(A) the Exchange and the Secretary of the
Treasury of the advance determinations; and
(B) the Secretary of the Treasury of the name
and employer identification number of each
employer with respect to whom 1 or more
employee of the employer were determined to be
eligible for the premium tax credit under
section 36B of the Internal Revenue Code of
1986 and the cost-sharing reductions under
section 1402 because--
(i) the employer did not provide
minimum essential coverage; or
(ii) the employer provided such
minimum essential coverage but it was
determined under section 36B(c)(2)(C)
of such Code to either be unaffordable
to the employee or not provide the
required minimum actuarial value; and
(3) the Secretary of the Treasury makes advance
payments of such credit or reductions to the issuers of
the qualified health plans in order to reduce the
premiums payable by individuals eligible for such
credit.
(b) Advance Determinations.--
(1) In general.--The Secretary shall provide under
the program established under subsection (a) that
advance determination of eligibility with respect to
any individual shall be made--
(A) during the annual open enrollment period
applicable to the individual (or such other
enrollment period as may be specified by the
Secretary); and
(B) on the basis of the individual's
household income for the most recent taxable
year for which the Secretary, after
consultation with the Secretary of the
Treasury, determines information is available.
(2) Changes in circumstances.--The Secretary shall
provide procedures for making advance determinations on
the basis of information other than that described in
paragraph (1)(B) in cases where information included
with an application form demonstrates substantial
changes in income, changes in family size or other
household circumstances, change in filing status, the
filing of an application for unemployment benefits, or
other significant changes affecting eligibility,
including--
(A) allowing an individual claiming a
decrease of 20 percent or more in income, or
filing an application for unemployment
benefits, to have eligibility for the credit
determined on the basis of household income for
a later period or on the basis of the
individual's estimate of such income for the
taxable year; and
(B) the determination of household income in
cases where the taxpayer was not required to
file a return of tax imposed by this chapter
for the second preceding taxable year.
(c) Payment of Premium Tax Credits and Cost-Sharing
Reductions.--
(1) In general.--The Secretary shall notify the
Secretary of the Treasury and the Exchange through
which the individual is enrolling of the advance
determination under section 1411.
(2) Premium tax credit.--
(A) In general.--The Secretary of the
Treasury shall make the advance payment under
this section of any premium tax credit allowed
under section 36B of the Internal Revenue Code
of 1986 to the issuer of a qualified health
plan on a monthly basis (or such other periodic
basis as the Secretary may provide).
(B) Issuer responsibilities.--An issuer of a
qualified health plan receiving an advance
payment with respect to an individual enrolled
in the plan shall--
(i) reduce the premium charged the
insured for any period by the amount of
the advance payment for the period;
(ii) notify the Exchange and the
Secretary of such reduction;
(iii) include with each billing
statement the amount by which the
premium for the plan has been reduced
by reason of the advance payment; and
(iv) in the case of any nonpayment of
premiums by the insured--
(I) notify the Secretary of
such nonpayment; and
(II) allow [a 3-month grace
period] a grace period
specified in subparagraph (C)
for nonpayment of premiums
before discontinuing coverage.
(C) Grace period specified.--For purposes of
subparagraph (B)(iv)(II), the grace period
specified in this subparagraph is--
(i) for plan years beginning before
January 1, 2018, a 3-month grace
period; and
(ii) for plan years beginning on or
after January 1, 2018--
(I) in the case of an
Exchange operating in a State
that has a State law grace
period in place, such State law
grace period; and
(II) in the case of an
Exchange operating in a State
that does not have a State law
grace period in place, a 1-
month grace period.
(D) State law grace period.--For purposes of
subparagraph (C), the term ``State law grace
period'' means, with respect to a State, a
grace period for nonpayment of premiums before
discontinuing coverage that is applicable under
the State law to health insurance coverage
offered in the individual market of the State.
(3) Cost-sharing reductions.--The Secretary shall
also notify the Secretary of the Treasury and the
Exchange under paragraph (1) if an advance payment of
the cost-sharing reductions under section 1402 is to be
made to the issuer of any qualified health plan with
respect to any individual enrolled in the plan. The
Secretary of the Treasury shall make such advance
payment at such time and in such amount as the
Secretary specifies in the notice. The requirements of
paragraph (2)(B)(iv) apply to an issuer of a qualified
health plan receiving an advanced payment under this
paragraph in the same manner and to the same extent
that such requirements apply to an issuer of a
qualified health plan receiving an advanced payment
under paragraph (2)(A).
(d) No Federal Payments for Individuals Not Lawfully
Present.--Nothing in this subtitle or the amendments made by
this subtitle allows Federal payments, credits, or cost-sharing
reductions for individuals who are not lawfully present in the
United States.
(e) State Flexibility.--Nothing in this subtitle or the
amendments made by this subtitle shall be construed to prohibit
a State from making payments to or on behalf of an individual
for coverage under a qualified health plan offered through an
Exchange that are in addition to any credits or cost-sharing
reductions allowable to the individual under this subtitle and
such amendments.
* * * * * * *
TITLE IV--PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC HEALTH
Subtitle A--Modernizing Disease Prevention and Public Health Systems
* * * * * * *
SEC. 4002. PREVENTION AND PUBLIC HEALTH FUND.
(a) Purpose.--It is the purpose of this section to establish
a Prevention and Public Health Fund (referred to in this
section as the ``Fund''), to be administered through the
Department of Health and Human Services, Office of the
Secretary, to provide for expanded and sustained national
investment in prevention and public health programs to improve
health and help restrain the rate of growth in private and
public sector health care costs.
(b) Funding.--There are hereby authorized to be appropriated,
and appropriated, to the Fund, out of any monies in the
Treasury not otherwise appropriated--
(1) for fiscal year 2010, $500,000,000;
(2) for each of fiscal years 2012 through 2017,
$1,000,000,000;
[(3) for each of fiscal years 2018 and 2019,
$900,000,000;
[(4) for each of fiscal years 2020 and 2021,
$1,000,000,000; and
[(5) for fiscal year 2022, $1,500,000,000;
[(6) for fiscal year 2023, $1,000,000,000;
[(7) for fiscal year 2024, $1,700,000,000; and
[(8) for fiscal year 2025 and each fiscal year
thereafter, $2,000,000,000.]
(3) for fiscal year 2018, $900,000,000;
(4) for fiscal year 2019, $500,000,000;
(5) for fiscal year 2020, $500,000,000;
(6) for fiscal year 2021, $500,000,000;
(7) for fiscal year 2022, $500,000,000;
(8) for fiscal year 2023, $500,000,000;
(9) for fiscal year 2024, $500,000,000;
(10) for fiscal year 2025, $750,000,000;
(11) for fiscal year 2026, $1,000,000,000; and
(12) for fiscal year 2027 and each fiscal year
thereafter, $2,000,000,000.
(c) Use of Fund.--The Secretary shall transfer amounts in the
Fund to accounts within the Department of Health and Human
Services to increase funding, over the fiscal year 2008 level,
for programs authorized by the Public Health Service Act, for
prevention, wellness, and public health activities including
prevention research, health screenings, and initiatives, such
as the Community Transformation grant program, the Education
and Outreach Campaign Regarding Preventive Benefits, and
immunization programs.
(d) Transfer Authority.--The Committee on Appropriations of
the Senate and the Committee on Appropriations of the House of
Representatives may provide for the transfer of funds in the
Fund to eligible activities under this section, subject to
subsection (c).
* * * * * * *
TITLE X--STRENGTHENING QUALITY, AFFORDABLE HEALTH CARE FOR ALL
AMERICANS
* * * * * * *
Subtitle E--Provisions Relating to Title V
* * * * * * *
SEC. 10503. COMMUNITY HEALTH CENTERS AND THE NATIONAL HEALTH SERVICE
CORPS FUND.
(a) Purpose.--It is the purpose of this section to establish
a Community Health Center Fund (referred to in this section as
the ``CHC Fund''), to be administered through the Office of the
Secretary of the Department of Health and Human Services to
provide for expanded and sustained national investment in
community health centers under section 330 of the Public Health
Service Act and the National Health Service Corps.
(b) Funding.--There is authorized to be appropriated, and
there is appropriated, out of any monies in the Treasury not
otherwise appropriated, to the CHC Fund--
(1) to be transferred to the Secretary of Health and
Human Services to provide enhanced funding for the
community health center program under section 330 of
the Public Health Service Act--
(A) $1,000,000,000 for fiscal year 2011;
(B) $1,200,000,000 for fiscal year 2012;
(C) $1,500,000,000 for fiscal year 2013;
(D) $2,200,000,000 for fiscal year 2014; and
(E) $3,600,000,000 for each of fiscal years
2015 through [2017] 2019; and
(2) to be transferred to the Secretary of Health and
Human Services to provide enhanced funding for the
National Health Service Corps--
(A) $290,000,000 for fiscal year 2011;
(B) $295,000,000 for fiscal year 2012;
(C) $300,000,000 for fiscal year 2013;
(D) $305,000,000 for fiscal year 2014; and
(E) $310,000,000 for each of fiscal years
2015 through [2017] 2019.
(c) Construction.--There is authorized to be appropriated,
and there is appropriated, out of any monies in the Treasury
not otherwise appropriated, $1,500,000,000 to be available for
fiscal years 2011 through 2015 to be used by the Secretary of
Health and Human Services for the construction and renovation
of community health centers.
(d) Use of Fund.--The Secretary of Health and Human Services
shall transfer amounts in the CHC Fund to accounts within the
Department of Health and Human Services to increase funding,
over the fiscal year 2008 level, for community health centers
and the National Health Service Corps.
(e) Availability.--Amounts appropriated under subsections (b)
and (c) shall remain available until expended.
* * * * * * *
----------
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
* * * * * * *
Part D--Primary Health Care
Subpart I--Health Centers
SEC. 330. HEALTH CENTERS.
(a) Definition of Health Center.--
(1) In general.--For purposes of this section, the
term ``health center'' means an entity that serves a
population that is medically underserved, or a special
medically underserved population comprised of migratory
and seasonal agricultural workers, the homeless, and
residents of public housing, by providing, either
through the staff and supporting resources of the
center or through contracts or cooperative
arrangements--
(A) required primary health services (as
defined in subsection (b)(1)); and
(B) as may be appropriate for particular
centers, additional health services (as defined
in subsection (b)(2)) necessary for the
adequate support of the primary health services
required under subparagraph (A);
for all residents of the area served by the center
(hereafter referred to in this section as the
``catchment area'').
(2) Limitation.--The requirement in paragraph (1) to
provide services for all residents within a catchment
area shall not apply in the case of a health center
receiving a grant only under subsection (g), (h), or
(i).
(b) Definitions.--For purposes of this section:
(1) Required primary health services.--
(A) In general.--The term ``required primary
health services'' means--
(i) basic health services which, for
purposes of this section, shall consist
of--
(I) health services related
to family medicine, internal
medicine, pediatrics,
obstetrics, or gynecology that
are furnished by physicians and
where appropriate, physician
assistants, nurse
practitioners, and nurse
midwives;
(II) diagnostic laboratory
and radiologic services;
(III) preventive health
services, including--
(aa) prenatal and
perinatal services;
(bb) appropriate
cancer screening;
(cc) well-child
services;
(dd) immunizations
against vaccine-
preventable diseases;
(ee) screenings for
elevated blood lead
levels, communicable
diseases, and
cholesterol;
(ff) pediatric eye,
ear, and dental
screenings to determine
the need for vision and
hearing correction and
dental care;
(gg) voluntary family
planning services; and
(hh) preventive
dental services;
(IV) emergency medical
services; and
(V) pharmaceutical services
as may be appropriate for
particular centers;
(ii) referrals to providers of
medical services (including specialty
referral when medically indicated) and
other health-related services
(including substance [abuse] use
disorder and mental health services);
(iii) patient case management
services (including counseling,
referral, and follow-up services) and
other services designed to assist
health center patients in establishing
eligibility for and gaining access to
Federal, State, and local programs that
provide or financially support the
provision of medical, social, housing,
educational, or other related services;
(iv) services that enable individuals
to use the services of the health
center (including outreach and
transportation services and, if a
substantial number of the individuals
in the population served by a center
are of limited English-speaking
ability, the services of appropriate
personnel fluent in the language spoken
by a predominant number of such
individuals); and
(v) education of patients and the
general population served by the health
center regarding the availability and
proper use of health services.
(B) Exception.--With respect to a health
center that receives a grant only under
subsection (g), the Secretary, upon a showing
of good cause, shall--
(i) waive the requirement that the
center provide all required primary
health services under this paragraph;
and
(ii) approve, as appropriate, the
provision of certain required primary
health services only during certain
periods of the year.
(2) Additional health services.--The term
``additional health services'' means services that are
not included as required primary health services and
that are appropriate to meet the health needs of the
population served by the health center involved. Such
term may include--
(A) behavioral and mental health and
substance [abuse] use disorder services;
(B) recuperative care services;
(C) environmental health services,
including--
(i) the detection and alleviation of
unhealthful conditions associated
with--
(I) water supply;
(II) chemical and pesticide
exposures;
(III) air quality; or
(IV) exposure to lead;
(ii) sewage treatment;
(iii) solid waste disposal;
(iv) rodent and parasitic
infestation;
(v) field sanitation;
(vi) housing; and
(vii) other environmental factors
related to health; and
(D) in the case of health centers receiving
grants under subsection (g), special
occupation-related health services for
migratory and seasonal agricultural workers,
including--
(i) screening for and control of
infectious diseases, including
parasitic diseases; and
(ii) injury prevention programs,
including prevention of exposure to
unsafe levels of agricultural chemicals
including pesticides.
(3) Medically underserved populations.--
(A) In general.--The term ``medically
underserved population'' means the population
of an urban or rural area designated by the
Secretary as an area with a shortage of
personal health services or a population group
designated by the Secretary as having a
shortage of such services.
(B) Criteria.--In carrying out subparagraph
(A), the Secretary shall prescribe criteria for
determining the specific shortages of personal
health services of an area or population group.
Such criteria shall--
(i) take into account comments
received by the Secretary from the
chief executive officer of a State and
local officials in a State; and
(ii) include factors indicative of
the health status of a population group
or residents of an area, the ability of
the residents of an area or of a
population group to pay for health
services and their accessibility to
them, and the availability of health
professionals to residents of an area
or to a population group.
(C) Limitation.--The Secretary may not
designate a medically underserved population in
a State or terminate the designation of such a
population unless, prior to such designation or
termination, the Secretary provides reasonable
notice and opportunity for comment and consults
with--
(i) the chief executive officer of
such State;
(ii) local officials in such State;
and
(iii) the organization, if any, which
represents a majority of health centers
in such State.
(D) Permissible designation.--The Secretary
may designate a medically underserved
population that does not meet the criteria
established under subparagraph (B) if the chief
executive officer of the State in which such
population is located and local officials of
such State recommend the designation of such
population based on unusual local conditions
which are a barrier to access to or the
availability of personal health services.
(c) Planning Grants.--
(1) [In general.--] Centers._
[(A) Centers.--]The Secretary may make grants
to public and nonprofit private entities for
projects to plan and develop health centers
which will serve medically underserved
populations. A project for which a grant may be
made under this subsection may include the cost
of the acquisition and lease of buildings and
equipment (including the costs of amortizing
the principal of, and paying the interest on,
loans) and shall include--
[(i)] (A) an assessment of the need that the
population proposed to be served by the health
center for which the project is undertaken has
for required primary health services and
additional health services;
[(ii)] (B) the design of a health center
program for such population based on such
assessment;
[(iii)] (C) efforts to secure, within the
proposed catchment area of such center,
financial and professional assistance and
support for the project;
[(iv)] (D) initiation and encouragement of
continuing community involvement in the
development and operation of the project; and
[(v)] (E) proposed linkages between the
center and other appropriate provider entities,
such as health departments, local hospitals,
and rural health clinics, to provide better
coordinated, higher quality, and more cost-
effective health care services.
[(B) Managed care networks and plans.--The
Secretary may make grants to health centers
that receive assistance under this section to
enable the centers to plan and develop a
managed care network or plan. Such a grant may
only be made for such a center if--
[(i) the center has received grants
under subsection (e)(1)(A) for at least
2 consecutive years preceding the year
of the grant under this subparagraph or
has otherwise demonstrated, as required
by the Secretary, that such center has
been providing primary care services
for at least the 2 consecutive years
immediately preceding such year; and
[(ii) the center provides assurances
satisfactory to the Secretary that the
provision of such services on a prepaid
basis, or under another managed care
arrangement, will not result in the
diminution of the level or quality of
health services provided to the
medically underserved population served
prior to the grant under this
subparagraph.
[(C) Practice management networks.--The
Secretary may make grants to health centers
that receive assistance under this section to
enable the centers to plan and develop practice
management networks that will enable the
centers to--
[(i) reduce costs associated with the
provision of health care services;
[(ii) improve access to, and
availability of, health care services
provided to individuals served by the
centers;
[(iii) enhance the quality and
coordination of health care services;
or
[(iv) improve the health status of
communities.
[(D) Use of funds.--The activities for which
a grant may be made under subparagraph (B) or
(C) may include the purchase or lease of
equipment, which may include data and
information systems (including paying for the
costs of amortizing the principal of, and
paying the interest on, loans for equipment),
the provision of training and technical
assistance related to the provision of health
care services on a prepaid basis or under
another managed care arrangement, and other
activities that promote the development of
practice management or managed care networks
and plans.]
(2) Limitation.--Not more than two grants may be made
under this subsection for the same project, except that
upon a showing of good cause, the Secretary may make
additional grant awards.
(3) Recognition of high poverty.--
(A) In general.--In making grants under this
subsection, the Secretary may recognize the
unique needs of high poverty areas.
(B) High poverty area defined.--For purposes
of subparagraph (A), the term ``high poverty
area'' means a catchment area which is
established in a manner that is consistent with
the factors in subsection (k)(3)(J), and the
poverty rate of which is greater than the
national average poverty rate as determined by
the Bureau of the Census.
[(d) Loan Guarantee Program.--
[(1) Establishment.--
[(A) In general.--The Secretary shall
establish a program under which the Secretary
may, in accordance with this subsection and to
the extent that appropriations are provided in
advance for such program, guarantee up to 90
percent of the principal and interest on loans
made by non-Federal lenders to health centers,
funded under this section, for the costs of
developing and operating managed care networks
or plans described in subsection (c)(1)(B), or
practice management networks described in
subsection (c)(1)(C).
[(B) Use of funds.--Loan funds guaranteed
under this subsection may be used--
[(i) to establish reserves for the
furnishing of services on a pre-paid
basis;
[(ii) for costs incurred by the
center or centers, otherwise permitted
under this section, as the Secretary
determines are necessary to enable a
center or centers to develop, operate,
and own the network or plan; or
[(iii) to refinance an existing loan
(as of the date of refinancing) to the
center or centers, if the Secretary
determines--
[(I) that such refinancing
will be beneficial to the
health center and the Federal
Government; or
[(II) that the center (or
centers) can demonstrate an
ability to repay the refinanced
loan equal to or greater than
the ability of the center (or
centers) to repay the original
loan on the date the original
loan was made.
[(C) Publication of guidance.--Prior to
considering an application submitted under this
subsection, the Secretary shall publish
guidelines to provide guidance on the
implementation of this section. The Secretary
shall make such guidelines available to the
universe of parties affected under this
subsection, distribute such guidelines to such
parties upon the request of such parties, and
provide a copy of such guidelines to the
appropriate committees of Congress.
[(D) Provision directly to networks or
plans.--At the request of health centers
receiving assistance under this section, loan
guarantees provided under this paragraph may be
made directly to networks or plans that are at
least majority controlled and, as applicable,
at least majority owned by those health
centers.
[(E) Federal credit reform.--The requirements
of the Federal Credit Reform Act of 1990 (2
U.S.C. 661 et seq.) shall apply with respect to
loans refinanced under subparagraph (B)(iii).
[(2) Protection of financial interests.--
[(A) In general.--The Secretary may not
approve a loan guarantee for a project under
this subsection unless the Secretary determines
that--
[(i) the terms, conditions, security
(if any), and schedule and amount of
repayments with respect to the loan are
sufficient to protect the financial
interests of the United States and are
otherwise reasonable, including a
determination that the rate of interest
does not exceed such percent per annum
on the principal obligation outstanding
as the Secretary determines to be
reasonable, taking into account the
range of interest rates prevailing in
the private market for similar loans
and the risks assumed by the United
States, except that the Secretary may
not require as security any center
asset that is, or may be, needed by the
center or centers involved to provide
health services;
[(ii) the loan would not be available
on reasonable terms and conditions
without the guarantee under this
subsection; and
[(iii) amounts appropriated for the
program under this subsection are
sufficient to provide loan guarantees
under this subsection.
[(B) Recovery of payments.--
[(i) In general.--The United States
shall be entitled to recover from the
applicant for a loan guarantee under
this subsection the amount of any
payment made pursuant to such
guarantee, unless the Secretary for
good cause waives such right of
recovery (subject to appropriations
remaining available to permit such a
waiver) and, upon making any such
payment, the United States shall be
subrogated to all of the rights of the
recipient of the payments with respect
to which the guarantee was made.
Amounts recovered under this clause
shall be credited as reimbursements to
the financing account of the program.
[(ii) Modification of terms and
conditions.--To the extent permitted by
clause (iii) and subject to the
requirements of section 504(e) of the
Credit Reform Act of 1990 (2 U.S.C.
661c(e)), any terms and conditions
applicable to a loan guarantee under
this subsection (including terms and
conditions imposed under clause (iv))
may be modified or waived by the
Secretary to the extent the Secretary
determines it to be consistent with the
financial interest of the United
States.
[(iii) Incontestability.--Any loan
guarantee made by the Secretary under
this subsection shall be
incontestable--
[(I) in the hands of an
applicant on whose behalf such
guarantee is made unless the
applicant engaged in fraud or
misrepresentation in securing
such guarantee; and
[(II) as to any person (or
successor in interest) who
makes or contracts to make a
loan to such applicant in
reliance thereon unless such
person (or successor in
interest) engaged in fraud or
misrepresentation in making or
contracting to make such loan.
[(iv) Further terms and conditions.--
Guarantees of loans under this
subsection shall be subject to such
further terms and conditions as the
Secretary determines to be necessary to
assure that the purposes of this
section will be achieved.
[(3) Loan origination fees.--
[(A) In general.--The Secretary shall collect
a loan origination fee with respect to loans to
be guaranteed under this subsection, except as
provided in subparagraph (C).
[(B) Amount.--The amount of a loan
origination fee collected by the Secretary
under subparagraph (A) shall be equal to the
estimated long term cost of the loan guarantees
involved to the Federal Government (excluding
administrative costs), calculated on a net
present value basis, after taking into account
any appropriations that may be made for the
purpose of offsetting such costs, and in
accordance with the criteria used to award loan
guarantees under this subsection.
[(C) Waiver.--The Secretary may waive the
loan origination fee for a health center
applicant who demonstrates to the Secretary
that the applicant will be unable to meet the
conditions of the loan if the applicant incurs
the additional cost of the fee.
[(4) Defaults.--
[(A) In general.--Subject to the requirements
of the Credit Reform Act of 1990 (2 U.S.C. 661
et seq.), the Secretary may take such action as
may be necessary to prevent a default on a loan
guaranteed under this subsection, including the
waiver of regulatory conditions, deferral of
loan payments, renegotiation of loans, and the
expenditure of funds for technical and
consultative assistance, for the temporary
payment of the interest and principal on such a
loan, and for other purposes. Any such
expenditure made under the preceding sentence
on behalf of a health center or centers shall
be made under such terms and conditions as the
Secretary shall prescribe, including the
implementation of such organizational,
operational, and financial reforms as the
Secretary determines are appropriate and the
disclosure of such financial or other
information as the Secretary may require to
determine the extent of the implementation of
such reforms.
[(B) Foreclosure.--The Secretary may take
such action, consistent with State law
respecting foreclosure procedures and, with
respect to reserves required for furnishing
services on a prepaid basis, subject to the
consent of the affected States, as the
Secretary determines appropriate to protect the
interest of the United States in the event of a
default on a loan guaranteed under this
subsection, except that the Secretary may only
foreclose on assets offered as security (if
any) in accordance with paragraph (2)(A)(i).
[(5) Limitation.--Not more than one loan guarantee
may be made under this subsection for the same network
or plan, except that upon a showing of good cause the
Secretary may make additional loan guarantees.
[(6) Authorization of appropriations.--There are
authorized to be appropriated to carry out this
subsection such sums as may be necessary.]
(d) Improving Quality of Care.--
(1) Supplemental awards.--The Secretary may award
supplemental grant funds to health centers funded under
this section to implement evidence-based models for
increasing access to high-quality primary care
services, which may include models related to--
(A) improving the delivery of care for
individuals with multiple chronic conditions;
(B) workforce configuration;
(C) reducing the cost of care;
(D) enhancing care coordination;
(E) expanding the use of telehealth and
technology-enabled collaborative learning and
capacity building models;
(F) care integration, including integration
of behavioral health, mental health, or
substance use disorder services; and
(G) addressing emerging public health or
substance use disorder issues to meet the
health needs of the population served by the
health center.
(2) Sustainability.--In making supplemental awards
under this subsection, the Secretary may consider
whether the health center involved has submitted a plan
for continuing the activities funded under this
subsection after supplemental funding is expended.
(3) Special consideration.--The Secretary may give
special consideration to applications for supplemental
funding under this subsection that seek to address
significant barriers to access to care in areas with a
greater shortage of health care providers and health
services relative to the national average.
(e) Operating Grants.--
(1) Authority.--
(A) In general.--The Secretary may make
grants for the costs of the operation of public
and nonprofit private health centers that
provide health services to medically
underserved populations.
(B) Entities that fail to meet certain
requirements.--The Secretary may make grants,
for a period of not to exceed [2 years] 1 year,
for the costs of the operation of public and
nonprofit private entities which provide health
services to medically underserved populations
but with respect to which the Secretary is
unable to make each of the determinations
required by subsection (k)(3). The Secretary
shall not make a grant under this paragraph
unless the applicant provides assurances to the
Secretary that within 120 days of receiving
grant funding for the operation of the health
center, the applicant will submit, for approval
by the Secretary, an implementation plan to
meet the requirements of subsection (l)(3). The
Secretary may extend such 120-day period for
achieving compliance upon a demonstration of
good cause by the health center.
(C) Operation of networks [and plans].--The
Secretary may make grants to health centers
that receive assistance under this section, or
at the request of the health centers, directly
to a network [or plan (as described in
subparagraphs (B) and (C) of subsection
(c)(1))] that is at least majority controlled
and, as applicable, at least majority owned by
such health centers receiving assistance under
this section, for the costs associated with the
operation of such network [or plan, including
the purchase] including--
(i) the purchase or lease of
equipment, which may include data and
information systems (including the
costs of amortizing the principal of,
and paying the interest on, loans for
equipment)[.];
(ii) the provision of training and
technical assistance; and
(iii) other activities that--
(I) reduce costs associated
with the provision of health
services;
(II) improve access to, and
availability of, health
services provided to
individuals served by the
centers;
(III) enhance the quality and
coordination of health
services; or
(IV) improve the health
status of communities.
(2) Use of funds.--The costs for which a grant may be
made under subparagraph (A) or (B) of paragraph (1) may
include the costs of acquiring and leasing buildings
and equipment (including the costs of amortizing the
principal of, and paying interest on, loans), and the
costs of providing training related to the provision of
required primary health services and additional health
services and to the management of health center
programs.
(3) Construction.--The Secretary may award grants
which may be used to pay the costs associated with
expanding and modernizing existing buildings or
constructing new buildings (including the costs of
amortizing the principal of, and paying the interest
on, loans) for projects approved prior to October 1,
1996.
(4) Limitation.--Not more than two grants may be made
under subparagraph (B) of paragraph (1) for the same
entity.
(5) Amount.--
(A) In general.--The amount of any grant made
in any fiscal year under subparagraphs (A) and
(B) of paragraph (1) to a health center shall
be determined by the Secretary, but may not
exceed the amount by which the costs of
operation of the center in such fiscal year
exceed the total of--
(i) State, local, and other
operational funding provided to the
center; and
(ii) the fees, premiums, and third-
party reimbursements, which the center
may reasonably be expected to receive
for its operations in such fiscal year.
(B) Networks [and plans].--The total amount
of grant funds made available for any fiscal
year under paragraph (1)(C) [and subparagraphs
(B) and (C) of subsection (c)(1) to a health
center or to a network or plan] to a health
center or to a network shall be determined by
the Secretary, but may not exceed 2 percent of
the total amount appropriated under this
section for such fiscal year.
(C) Payments.--Payments under grants under
subparagraph (A) or (B) of paragraph (1) shall
be made in advance or by way of reimbursement
and in such installments as the Secretary finds
necessary and adjustments may be made for
overpayments or underpayments.
(D) Use of nongrant funds.--Nongrant funds
described in clauses (i) and (ii) of
subparagraph (A), including any such funds in
excess of those originally expected, shall be
used as permitted under this section, and may
be used for such other purposes as are not
specifically prohibited under this section if
such use furthers the objectives of the
project.
(f) Infant Mortality Grants.--
(1) In general.--The Secretary may make grants to
health centers for the purpose of assisting such
centers in--
(A) providing comprehensive health care and
support services for the reduction of--
(i) the incidence of infant
mortality; and
(ii) morbidity among children who are
less than 3 years of age; and
(B) developing and coordinating service and
referral arrangements between health centers
and other entities for the health management of
pregnant women and children described in
subparagraph (A).
(2) Priority.--In making grants under this subsection
the Secretary shall give priority to health centers
providing services to any medically underserved
population among which there is a substantial incidence
of infant mortality or among which there is a
significant increase in the incidence of infant
mortality.
(3) Requirements.--The Secretary may make a grant
under this subsection only if the health center
involved agrees that--
(A) the center will coordinate the provision
of services under the grant to each of the
recipients of the services;
(B) such services will be continuous for each
such recipient;
(C) the center will provide follow-up
services for individuals who are referred by
the center for services described in paragraph
(1);
(D) the grant will be expended to supplement,
and not supplant, the expenditures of the
center for primary health services (including
prenatal care) with respect to the purpose
described in this subsection; and
(E) the center will coordinate the provision
of services with other maternal and child
health providers operating in the catchment
area.
(g) New Access Points and Expanded Services.--
(1) Approval of new access points.--
(A) In general.--The Secretary may approve
applications for grants under subparagraph (A)
or (B) of subsection (e)(1) to establish new
delivery sites.
(B) Special consideration.--In carrying out
subparagraph (A), the Secretary may give
special consideration to applicants that have
demonstrated the new delivery site will be
located within a sparsely populated area, or an
area which has a level of unmet need that is
higher relative to other applicants.
(C) Consideration of applications.--In
carrying out subparagraph (A), the Secretary
shall approve applications for grants under
subparagraphs (A) and (B) of subsection (e)(1)
in such a manner that the ratio of the
medically underserved populations in rural
areas which may be expected to use the services
provided by the applicants involved to the
medically underserved populations in urban
areas which may be expected to use the services
provided by the applicants is not less than two
to three or greater than three to two.
(D) Service area overlap.--If in carrying out
subparagraph (A) the applicant proposes to
serve an area that is currently served by
another health center funded under this
section, the Secretary may consider whether the
award of funding to an additional health center
in the area can be justified based on the unmet
need for additional services within the
catchment area.
(2) Approval of expanded service applications.--
(A) In general.--The Secretary may approve
applications for grants under subparagraph (A)
or (B) of subsection (e)(1) to expand the
capacity of the applicant to provide required
primary health services described in subsection
(b)(1) or additional health services described
in subsection (b)(2).
(B) Priority expansion projects.--In carrying
out subparagraph (A), the Secretary may give
special consideration to expanded service
applications that seek to address emerging
public health or behavioral health, mental
health, or substance abuse issues through
increasing the availability of additional
health services described in subsection (b)(2)
in an area in which there are significant
barriers to accessing care.
(C) Consideration of applications.--In
carrying out subparagraph (A), the Secretary
shall approve applications for applicants in
such a manner that the ratio of the medically
underserved populations in rural areas which
may be expected to use the services provided by
the applicants involved to the medically
underserved populations in urban areas which
may be expected to use the services provided by
such applicants is not less than two to three
or greater than three to two.
[(g)] (h) Migratory and Seasonal Agricultural Workers.--
(1) In general.--The Secretary may award grants for
the purposes described in subsections (c), (e), and (f)
for the planning and delivery of services to a special
medically underserved population comprised of--
(A) migratory agricultural workers, seasonal
agricultural workers, and members of the
families of such migratory and seasonal
agricultural workers who are within a
designated catchment area; and
(B) individuals who have previously been
migratory agricultural workers but who no
longer meet the requirements of subparagraph
(A) of paragraph (3) because of age or
disability and members of the families of such
individuals who are within such catchment area.
(2) Environmental concerns.--The Secretary may enter
into grants or contracts under this subsection with
public and private entities to--
(A) assist the States in the implementation
and enforcement of acceptable environmental
health standards, including enforcement of
standards for sanitation in migratory
agricultural worker and seasonal agricultural
worker labor camps, and applicable Federal and
State pesticide control standards; and
(B) conduct projects and studies to assist
the several States and entities which have
received grants or contracts under this section
in the assessment of problems related to camp
and field sanitation, exposure to unsafe levels
of agricultural chemicals including pesticides,
and other environmental health hazards to which
migratory agricultural workers and seasonal
agricultural workers, and members of their
families, are exposed.
(3) Definitions.--For purposes of this subsection:
(A) Migratory agricultural worker.--The term
``migratory agricultural worker'' means an
individual whose principal employment is in
agriculture, who has been so employed within
the last 24 months, and who establishes for the
purposes of such employment a temporary abode.
(B) Seasonal agricultural worker.--The term
``seasonal agricultural worker'' means an
individual whose principal employment is in
agriculture on a seasonal basis and who is not
a migratory agricultural worker.
(C) Agriculture.--The term ``agriculture''
means farming in all its branches, including--
(i) cultivation and tillage of the
soil;
(ii) the production, cultivation,
growing, and harvesting of any
commodity grown on, in, or as an
adjunct to or part of a commodity grown
in or on, the land; and
(iii) any practice (including
preparation and processing for market
and delivery to storage or to market or
to carriers for transportation to
market) performed by a farmer or on a
farm incident to or in conjunction with
an activity described in clause (ii).
[(h)] (i) Homeless Population.--
(1) In general.--The Secretary may award grants for
the purposes described in subsections (c), (e), and (f)
for the planning and delivery of services to a special
medically underserved population comprised of homeless
individuals, including grants for innovative programs
that provide outreach and comprehensive primary health
services to homeless children and youth [and children
and youth at risk of homelessness], children and youth
at risk of homelessness, homeless veterans, and
veterans at risk of homelessness.
(2) Required services.--In addition to required
primary health services (as defined in subsection
(b)(1)), an entity that receives a grant under this
subsection shall be required to provide substance abuse
services as a condition of such grant.
(3) Supplement not supplant requirement.--A grant
awarded under this subsection shall be expended to
supplement, and not supplant, the expenditures of the
health center and the value of in kind contributions
for the delivery of services to the population
described in paragraph (1).
(4) Temporary continued provision of services to
certain former homeless individuals.--If any grantee
under this subsection has provided services described
in this section under the grant to a homeless
individual, such grantee may, notwithstanding that the
individual is no longer homeless as a result of
becoming a resident in permanent housing, expend the
grant to continue to provide such services to the
individual for not more than 12 months.
(5) Definitions.--For purposes of this section:
(A) Homeless individual.--The term ``homeless
individual'' means an individual who lacks
housing (without regard to whether the
individual is a member of a family), including
an individual whose primary residence during
the night is a supervised public or private
facility that provides temporary living
accommodations and an individual who is a
resident in transitional housing.
[(B) Substance abuse.--The term ``substance
abuse'' has the same meaning given such term in
section 534(4).
[(C)] (B) Substance [abuse] use disorder
services.--The term ``substance abuse
services'' includes detoxification, risk
reduction, outpatient treatment, residential
treatment, and rehabilitation for substance
[abuse] use disorder provided in settings other
than hospitals.
[(i)] (j) Residents of Public Housing.--
(1) In general.--The Secretary may award grants for
the purposes described in subsections (c), (e), and (f)
for the planning and delivery of services to a special
medically underserved population comprised of residents
of public housing (such term, for purposes of this
subsection, shall have the same meaning given such term
in section 3(b)(1) of the United States Housing Act of
1937) and individuals living in areas immediately
accessible to such public housing.
(2) Supplement not supplant.--A grant awarded under
this subsection shall be expended to supplement, and
not supplant, the expenditures of the health center and
the value of in kind contributions for the delivery of
services to the population described in paragraph (1).
(3) Consultation with residents.--The Secretary may
not make a grant under paragraph (1) unless, with
respect to the residents of the public housing
involved, the applicant for the grant--
(A) has consulted with the residents in the
preparation of the application for the grant;
and
(B) agrees to provide for ongoing
consultation with the residents regarding the
planning and administration of the program
carried out with the grant.
[(j)] (k) Access Grants.--
(1) In general.--The Secretary may award grants to
eligible health centers with a substantial number of
clients with limited English speaking proficiency to
provide translation, interpretation, and other such
services for such clients with limited English speaking
proficiency.
(2) Eligible health center.--In this subsection, the
term ``eligible health center'' means an entity that--
(A) is a health center as defined under
subsection (a);
(B) provides health care services for clients
for whom English is a second language; and
(C) has exceptional needs with respect to
linguistic access or faces exceptional
challenges with respect to linguistic access.
(3) Grant amount.--The amount of a grant awarded to a
center under this subsection shall be determined by the
Administrator. Such determination of such amount shall
be based on the number of clients for whom English is a
second language that is served by such center, and
larger grant amounts shall be awarded to centers
serving larger numbers of such clients.
(4) Use of funds.--An eligible health center that
receives a grant under this subsection may use funds
received through such grant to--
(A) provide translation, interpretation, and
other such services for clients for whom
English is a second language, including hiring
professional translation and interpretation
services; and
(B) compensate bilingual or multilingual
staff for language assistance services provided
by the staff for such clients.
(5) Application.--An eligible health center desiring
a grant under this subsection shall submit an
application to the Secretary at such time, in such
manner, and containing such information as the
Secretary may reasonably require, including--
(A) an estimate of the number of clients that
the center serves for whom English is a second
language;
(B) the ratio of the number of clients for
whom English is a second language to the total
number of clients served by the center;
(C) a description of any language assistance
services that the center proposes to provide to
aid clients for whom English is a second
language; and
(D) a description of the exceptional needs of
such center with respect to linguistic access
or a description of the exceptional challenges
faced by such center with respect to linguistic
access.
(6) Authorization of appropriations.--There are
authorized to be appropriated to carry out this
subsection, in addition to any funds authorized to be
appropriated or appropriated for health centers under
any other subsection of this section, such sums as may
be necessary for each of fiscal years 2002 through
2006.
[(k)] (l) Applications.--
(1) Submission.--No grant may be made under this
section unless an application therefore is submitted
to, and approved by, the Secretary. Such an application
shall be submitted in such form and manner and shall
contain such information as the Secretary shall
prescribe.
(2) Description of unmet need.--An application for a
grant under subparagraph (A) or (B) of subsection
(e)(1) and an application for a grant under subsection
(g) for a health center shall include--
(A) a description of the unmet need for
health services in the catchment area of the
center;
(B) a demonstration by the applicant that the
area or the population group to be served by
the applicant has a shortage of personal health
services; [and]
(C) a demonstration that the center will be
located so that it will provide services to the
greatest number of individuals residing in the
catchment area or included in such population
group[.]; and
(D) in the case of an application for a grant
pursuant to subsection (g)(1), a demonstration
that the applicant has consulted with
appropriate State and local government
agencies, and health care providers regarding
the need for the health services to be provided
at the proposed delivery site.
Such a demonstration shall be made on the basis of the
criteria prescribed by the Secretary under subsection
(b)(3) or on any other criteria which the Secretary may
prescribe to determine if the area or population group
to be served by the applicant has a shortage of
personal health services. In considering an application
for a grant under subparagraph (A) or (B) of subsection
(e)(1), the Secretary may require as a condition to the
approval of such application an assurance that the
applicant will provide any health service defined under
paragraphs (1) and (2) of subsection (b) that the
Secretary finds is needed to meet specific health needs
of the area to be served by the applicant. Such a
finding shall be made in writing and a copy shall be
provided to the applicant.
(3) Requirements.--Except as provided in subsection
(e)(1)(B) or subsection (g), the Secretary may not
approve an application for a grant under subparagraph
(A) or (B) of subsection (e)(1) unless the Secretary
determines that the entity for which the application is
submitted is a health center (within the meaning of
subsection (a)) and that--
(A) the required primary health services of
the center will be available and accessible in
the catchment area of the center promptly, as
appropriate, and in a manner which assures
continuity;
(B) the center has made and will continue to
make every reasonable effort to establish and
maintain collaborative relationships with other
health care providers [in the catchment area of
the center], including other health care
providers that provide care within the
catchment area, local hospitals, and specialty
providers in the catchment area of the center,
to provide access to services not available
through the health center and to reduce the
non-urgent use of hospital emergency
departments;
(C) the center will have an ongoing quality
improvement system that includes clinical
services and management, and that maintains the
confidentiality of patient records;
(D) the center will demonstrate its financial
responsibility by the use of such accounting
procedures and other requirements as may be
prescribed by the Secretary;
(E) the center--
(i)(I) has or will have a contractual
or other arrangement with the agency of
the State, in which it provides
services, which administers or
supervises the administration of a
State plan approved under title XIX of
the Social Security Act for the payment
of all or a part of the center's costs
in providing health services to persons
who are eligible for medical assistance
under such a State plan; and
(II) has or will have a
contractual or other
arrangement with the State
agency administering the
program under title XXI of such
Act (42 U.S.C. 1397aa et seq.)
with respect to individuals who
are State children's health
insurance program
beneficiaries; or
(ii) has made or will make every
reasonable effort to enter into
arrangements described in subclauses
(I) and (II) of clause (i);
(F) the center has made or will make and will
continue to make every reasonable effort to
collect appropriate reimbursement for its costs
in providing health services to persons who are
entitled to insurance benefits under title
XVIII of the Social Security Act, to medical
assistance under a State plan approved under
title XIX of such Act, or to assistance for
medical expenses under any other public
assistance program or private health insurance
program;
(G) the center--
(i) has prepared a schedule of fees
or payments for the provision of its
services consistent with locally
prevailing rates or charges and
designed to cover its reasonable costs
of operation and has prepared a
corresponding schedule of discounts to
be applied to the payment of such fees
or payments, which discounts are
adjusted on the basis of the patient's
ability to pay;
(ii) has made and will continue to
make every reasonable effort--
(I) to secure from patients
payment for services in
accordance with such schedules;
and
(II) to collect reimbursement
for health services to persons
described in subparagraph (F)
on the basis of the full amount
of fees and payments for such
services without application of
any discount;
(iii)(I) will assure that no patient
will be denied health care services due
to an individual's inability to pay for
such services; and
(II) will assure that any fees or
payments required by the center for
such services will be reduced or waived
to enable the center to fulfill the
assurance described in subclause (I);
and
(iv) has submitted to the Secretary
such reports as the Secretary may
require to determine compliance with
this subparagraph;
(H) the center has established a governing
board which except in the case of an entity
operated by an Indian tribe or tribal or Indian
organization under the Indian Self-
Determination Act or an urban Indian
organization under the Indian Health Care
Improvement Act (25 U.S.C. 1651 et seq.)--
(i) is composed of individuals, a
majority of whom are being served by
the center and who, as a group,
represent the individuals being served
by the center;
(ii) meets at least once a month,
selects the services to be provided by
the center, schedules the hours during
which such services will be provided,
approves the center's annual budget,
approves the selection of a director
for the center who shall be directly
employed by the center, and, except in
the case of a governing board of a
public center (as defined in the second
sentence of this paragraph),
establishes general policies for the
center; and
(iii) in the case of an application
for a second or subsequent grant for a
public center, has approved the
application or if the governing body
has not approved the application, the
failure of the governing body to
approve the application was
unreasonable;
except that, upon a showing of good cause the
Secretary shall waive, for the length of the
project period, all or part of the requirements
of this subparagraph in the case of a health
center that receives a grant pursuant to
subsection (g), (h), (i), or (p);
(I) the center has developed--
(i) an overall plan and budget that
meets the requirements of the
Secretary; and
(ii) an effective procedure for
compiling and reporting to the
Secretary such statistics and other
information as the Secretary may
require relating to--
(I) the costs of its
operations;
(II) the patterns of use of
its services;
(III) the availability,
accessibility, and
acceptability of its services;
and
(IV) such other matters
relating to operations of the
applicant as the Secretary may
require;
(J) the center will review periodically its
catchment area to--
(i) ensure that the size of such area
is such that the services to be
provided through the center (including
any satellite) are available and
accessible to the residents of the area
promptly and as appropriate;
(ii) ensure that the boundaries of
such area conform, to the extent
practicable, to relevant boundaries of
political subdivisions, school
districts, and Federal and State health
and social service programs; and
(iii) ensure that the boundaries of
such area eliminate, to the extent
possible, barriers to access to the
services of the center, including
barriers resulting from the area's
physical characteristics, its
residential patterns, its economic and
social grouping, and available
transportation;
(K) in the case of a center which serves a
population including a substantial proportion
of individuals of limited English-speaking
ability, the center has--
(i) developed a plan and made
arrangements responsive to the needs of
such population for providing services
to the extent practicable in the
language and cultural context most
appropriate to such individuals; and
(ii) identified an individual on its
staff who is fluent in both that
language and in English and whose
responsibilities shall include
providing guidance to such individuals
and to appropriate staff members with
respect to cultural sensitivities and
bridging linguistic and cultural
differences;
(L) the center, has developed an ongoing
referral relationship with one or more
hospitals; [and]
(M) the center encourages persons receiving
or seeking health services from the center to
participate in any public or private (including
employer-offered) health programs or plans for
which the persons are eligible, so long as the
center, in complying with this subparagraph,
does not violate the requirements of
subparagraph (G)(iii)(I)[.]; and
(N) the center has written policies and
procedures in place to ensure the appropriate
use of Federal funds in compliance with
applicable Federal statutes, regulations, and
the terms and conditions of the Federal award.
For purposes of subparagraph (H), the term ``public
center'' means a health center funded (or to be funded)
through a grant under this section to a public agency.
[(4) Approval of new or expanded service
applications.--The Secretary shall approve applications
for grants under subparagraph (A) or (B) of subsection
(e)(1) for health centers which--
[(A) have not received a previous grant under
such subsection; or
[(B) have applied for such a grant to expand
their services;
in such a manner that the ratio of the medically
underserved populations in rural areas which may be
expected to use the services provided by such centers
to the medically underserved populations in urban areas
which may be expected to use the services provided by
such centers is not less than two to three or greater
than three to two.]
[(l)] (m) Technical Assistance.--The Secretary shall
establish a program through which the Secretary shall provide
(either through the Department of Health and Human Services or
by grant or contract) technical and other assistance to
eligible entities to assist such entities to meet the
requirements of subsection (k)(3). Services provided through
the program may include necessary technical and nonfinancial
assistance, including fiscal and program management assistance,
training in fiscal and program management, operational and
administrative support, and the provision of information to the
entities of the variety of resources available under this title
and how those resources can be best used to meet the health
needs of the communities served by the entities. Funds expended
to carry out activities under this subsection and operational
support activities under subsection (n) shall not exceed 3
percent of the amount appropriated for this section for the
fiscal year involved.
[(m)] (n) Memorandum of Agreement.--In carrying out this
section, the Secretary may enter into a memorandum of agreement
with a State. Such memorandum may include, where appropriate,
provisions permitting such State to--
(1) analyze the need for primary health services for
medically underserved populations within such State;
(2) assist in the planning and development of new
health centers;
(3) review and comment upon annual program plans and
budgets of health centers, including comments upon
allocations of health care resources in the State;
(4) assist health centers in the development of
clinical practices and fiscal and administrative
systems through a technical assistance plan which is
responsive to the requests of health centers; and
(5) share information and data relevant to the
operation of new and existing health centers.
[(n)] (o) Records.--
(1) In general.--Each entity which receives a grant
under subsection (e) shall establish and maintain such
records as the Secretary shall require.
(2) Availability.--Each entity which is required to
establish and maintain records under this subsection
shall make such books, documents, papers, and records
available to the Secretary or the Comptroller General
of the United States, or any of their duly authorized
representatives, for examination, copying or mechanical
reproduction on or off the premises of such entity upon
a reasonable request therefore. The Secretary and the
Comptroller General of the United States, or any of
their duly authorized representatives, shall have the
authority to conduct such examination, copying, and
reproduction.
[(o)] (p) Delegation of Authority.--The Secretary may
delegate the authority to administer the programs authorized by
this section to any office, except that the authority to enter
into, modify, or issue approvals with respect to grants or
contracts may be delegated only within the central office of
the Health Resources and Services Administration.
[(p)] (q) Special Consideration.--In making grants under this
section, the Secretary shall give special consideration to the
unique needs of sparsely populated rural areas, including
giving priority in the awarding of [grants for new health
centers under subsections (c) and (e)] operating grants under
subsection (e), applications for new access points and expanded
service pursuant to subsection (g), and the granting of waivers
as appropriate and permitted under subsections (b)(1)(B)(i) and
(k)(3)(G).
[(q)] (r) Audits.--
(1) In general.--Each entity which receives a grant
under this section shall provide for an independent
annual financial audit of any books, accounts,
financial records, files, and other papers and property
which relate to the disposition or use of the funds
received under such grant and such other funds received
by or allocated to the project for which such grant was
made. For purposes of assuring accurate, current, and
complete disclosure of the disposition or use of the
funds received, each such audit shall be conducted in
accordance with generally accepted accounting
principles. Each audit shall evaluate--
(A) the entity's implementation of the
guidelines established by the Secretary
respecting cost accounting,
(B) the processes used by the entity to meet
the financial and program reporting
requirements of the Secretary, and
(C) the billing and collection procedures of
the entity and the relation of the procedures
to its fee schedule and schedule of discounts
and to the availability of health insurance and
public programs to pay for the health services
it provides.
A report of each such audit shall be filed with the
Secretary at such time and in such manner as the
Secretary may require.
(2) Records.--Each entity which receives a grant
under this section shall establish and maintain such
records as the Secretary shall by regulation require to
facilitate the audit required by paragraph (1). The
Secretary may specify by regulation the form and manner
in which such records shall be established and
maintained.
(3) Availability of records.--Each entity which is
required to establish and maintain records or to
provide for and audit under this subsection shall make
such books, documents, papers, and records available to
the Secretary or the Comptroller General of the United
States, or any of their duly authorized
representatives, for examination, copying or mechanical
reproduction on or off the premises of such entity upon
a reasonable request therefore. The Secretary and the
Comptroller General of the United States, or any of
their duly authorized representatives, shall have the
authority to conduct such examination, copying, and
reproduction.
(4) Waiver.--The Secretary may, under appropriate
circumstances, waive the application of all or part of
the requirements of this subsection with respect to an
entity. A waiver provided by the Secretary under this
paragraph may not remain in effect for more than 1 year
and may not be extended after such period. An entity
may not receive more than one waiver under this
paragraph in consecutive years.
[(r)] (s) Authorization of Appropriations.--
(1) General amounts for grants.--For the purpose of
carrying out this section, in addition to the amounts
authorized to be appropriated under subsection (d),
there is authorized to be appropriated the following:
(A) For fiscal year 2010, $2,988,821,592.
(B) For fiscal year 2011, $3,862,107,440.
(C) For fiscal year 2012, $4,990,553,440.
(D) For fiscal year 2013, $6,448,713,307.
(E) For fiscal year 2014, $7,332,924,155.
(F) For fiscal year 2015, $8,332,924,155.
(G) For fiscal year 2016, and each subsequent
fiscal year, the amount appropriated for the
preceding fiscal year adjusted by the product
of--
(i) one plus the average percentage
increase in costs incurred per patient
served; and
(ii) one plus the average percentage
increase in the total number of
patients served.
(2) Special provisions.--
(A) Public centers.--The Secretary may not
expend in any fiscal year, for grants under
this section to public centers (as defined in
the second sentence of subsection (k)(3)) the
governing boards of which (as described in
subsection (k)(3)(H)) do not establish general
policies for such centers, an amount which
exceeds 5 percent of the amounts appropriated
under this section for that fiscal year. For
purposes of applying the preceding sentence,
the term ``public centers'' shall not include
health centers that receive grants pursuant to
subsection (h) or (i).
(B) Distribution of grants.--For fiscal year
2002 and each of the following fiscal years,
the Secretary, in awarding grants under this
section, shall ensure that the proportion of
the amount made available under each of
subsections (g), (h), and (i), relative to the
total amount appropriated to carry out this
section for that fiscal year, is equal to the
proportion of the amount made available under
that subsection for fiscal year 2001, relative
to the total amount appropriated to carry out
this section for fiscal year 2001.
(3) Funding report.--The Secretary shall annually
prepare and submit to the [appropriate committees of
Congress a report concerning the distribution of funds
under this section] Committee on Health, Education,
Labor, and Pensions of the Senate, and the Committee on
Energy and Commerce of the House of Representatives, a
report including, at a minimum--
(A) the distribution of funds for carrying
out this section that are provided to meet the
health care needs of medically underserved
populations, including the homeless, residents
of public housing, and migratory and seasonal
agricultural workers, and the appropriateness
of the delivery systems involved in responding
to the needs of the particular [populations.
Such report shall include an assessment]
populations;
(B) an assessment of the relative health
care access needs of the targeted populations
[and the rationale for any substantial changes
in the distribution of funds.];
(C) the distribution of awards and funding
for new or expanded services in each of rural
areas and urban areas;
(D) the distribution of awards and funding
for establishing new access points, and the
number of new access points created;
(E) the amount of unexpended funding for loan
guarantees and loan guarantee authority under
title XVI;
(F) the rationale for any substantial changes
in the distribution of funds;
(G) the rate of closures for health centers
and access points;
(H) the number and reason for any grants
awarded pursuant to subsection (e)(1)(B); and
(I) the number and reason for any waivers
provided pursuant to subsection (r)(4).
(4) Rule of construction with respect to rural health
clinics.--
(A) In general.--Nothing in this section
shall be construed to prevent a community
health center from contracting with a Federally
certified rural health clinic (as defined in
section 1861(aa)(2) of the Social Security
Act), a low-volume hospital (as defined for
purposes of section 1886 of such Act), a
critical access hospital, a sole community
hospital (as defined for purposes of section
1886(d)(5)(D)(iii) of such Act), or a medicare-
dependent share hospital (as defined for
purposes of section 1886(d)(5)(G)(iv) of such
Act) for the delivery of primary health care
services that are available at the clinic or
hospital to individuals who would otherwise be
eligible for free or reduced cost care if that
individual were able to obtain that care at the
community health center. Such services may be
limited in scope to those primary health care
services available in that clinic or hospitals.
(B) Assurances.--In order for a clinic or
hospital to receive funds under this section
through a contract with a community health
center under subparagraph (A), such clinic or
hospital shall establish policies to ensure--
(i) nondiscrimination based on the
ability of a patient to pay; and
(ii) the establishment of a sliding
fee scale for low-income patients.
(5) Funding for participation of health centers in
all of us research program.--In addition to any amounts
made available pursuant to subsection (d) of this
section, paragraph (1) of this subsection, section 402A
of this Act, or section 10503 of the Patient Protection
and Affordable Care Act, there is authorized to be
appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, to
the Secretary $25,000,000 for fiscal year 2018 to
support the participation of health centers in the All
of Us Research Program under the Precision Medicine
Initiative under section 498E of this Act.
[(s) Demonstration Program for Individualized Wellness
Plans.--
[(1) In general.--The Secretary shall establish a
pilot program to test the impact of providing at-risk
populations who utilize community health centers funded
under this section an individualized wellness plan that
is designed to reduce risk factors for preventable
conditions as identified by a comprehensive risk-factor
assessment.
[(2) Agreements.--The Secretary shall enter into
agreements with not more than 10 community health
centers funded under this section to conduct activities
under the pilot program under paragraph (1).
[(3) Wellness plans.--
[(A) In general.--An individualized wellness
plan prepared under the pilot program under
this subsection may include one or more of the
following as appropriate to the individual's
identified risk factors:
[(i) Nutritional counseling.
[(ii) A physical activity plan.
[(iii) Alcohol and smoking cessation
counseling and services.
[(iv) Stress management.
[(v) Dietary supplements that have
health claims approved by the
Secretary.
[(vi) Compliance assistance provided
by a community health center employee.
[(B) Risk factors.--Wellness plan risk
factors shall include--
[(i) weight;
[(ii) tobacco and alcohol use;
[(iii) exercise rates;
[(iv) nutritional status; and
[(v) blood pressure.
[(C) Comparisons.--Individualized wellness
plans shall make comparisons between the
individual involved and a control group of
individuals with respect to the risk factors
described in subparagraph (B).
[(4) Authorization of appropriations.--There is
authorized to be appropriated to carry out this
subsection, such sums as may be necessary.]
* * * * * * *
SEC. 330B. SPECIAL DIABETES PROGRAMS FOR TYPE I DIABETES.
(a) In General.--The Secretary, directly or through grants,
shall provide for research into the prevention and cure of Type
I diabetes.
(b) Funding.--
(1) Transferred funds.--Notwithstanding section
2104(a) of the Social Security Act, from the amounts
appropriated in such section for each of fiscal years
1998 through 2002, $30,000,000 is hereby transferred
and made available in such fiscal year for grants under
this section.
(2) Appropriations.--For the purpose of making grants
under this section, there is appropriated, out of any
funds in the Treasury not otherwise appropriated--
(A) $70,000,000 for each of fiscal years 2001
and 2002 (which shall be combined with amounts
transferred under paragraph (1) for each such
fiscal years);
(B) $100,000,000 for fiscal year 2003; and
(C) $150,000,000 for each of fiscal years
2004 through [2017] 2019.
SEC. 330C. SPECIAL DIABETES PROGRAMS FOR INDIANS.
(a) In General.--The Secretary shall make grants for
providing services for the prevention and treatment of diabetes
in accordance with subsection (b).
(b) Services Through Indian Health Facilities.--For purposes
of subsection (a), services under such subsection are provided
in accordance with this subsection if the services are provided
through any of the following entities:
(1) The Indian Health Service.
(2) An Indian health program operated by an Indian
tribe or tribal organization pursuant to a contract,
grant, cooperative agreement, or compact with the
Indian Health Service pursuant to the Indian Self-
Determination Act.
(3) An urban Indian health program operated by an
urban Indian organization pursuant to a grant or
contract with the Indian Health Service pursuant to
title V of the Indian Health Care Improvement Act.
(c) Funding.--
(1) Transferred funds.--Notwithstanding section
2104(a) of the Social Security Act, from the amounts
appropriated in such section for each of fiscal years
1998 through 2002, $30,000,000, to remain available
until expended, is hereby transferred and made
available in such fiscal year for grants under this
section.
(2) Appropriations.--For the purpose of making grants
under this section, there is appropriated, out of any
money in the Treasury not otherwise appropriated--
(A) $70,000,000 for each of fiscal years 2001
and 2002 (which shall be combined with amounts
transferred under paragraph (1) for each such
fiscal years);
(B) $100,000,000 for fiscal year 2003;
(C) $150,000,000 for each of fiscal years
2004 through 2017; [and]
(D) $37,500,000 for the first quarter of
fiscal year 2018[.] and $112,500,000 for the
period consisting of the second, third, and
fourth quarters of fiscal year 2018; and
(E) $150,000,000 for fiscal year 2019.
* * * * * * *
Subpart XI --Support of Graduate Medical Education in Qualified
Teaching Health Centers
SEC. 340H. PROGRAM OF PAYMENTS TO TEACHING HEALTH CENTERS THAT OPERATE
GRADUATE MEDICAL EDUCATION PROGRAMS.
[(a) Payments.--Subject to subsection (h)(2), the Secretary
shall make payments under this section for direct expenses and
for indirect expenses to qualified teaching health centers that
are listed as sponsoring institutions by the relevant
accrediting body for expansion of existing or establishment of
new approved graduate medical residency training programs.]
(a) Payments.--
(1) In general.--Subject to subsection (h)(2), the
Secretary shall make payments under this section for
direct expenses and indirect expenses to qualified
teaching health centers that are listed as sponsoring
institutions by the relevant accrediting body for--
(A) maintenance of existing approved graduate
medical residency training programs;
(B) expansion of existing approved graduate
medical residency training programs; and
(C) establishment of new approved graduate
medical residency training programs, as
appropriate.
(2) Priority.--In making payments pursuant to
paragraph (1)(C), the Secretary shall give priority to
qualified teaching health centers that--
(A) serve a health professional shortage area
with a designation in effect under section 332
or a medically underserved community (as
defined in section 799B); or
(B) are located in a rural area (as defined
in section 1886(d)(2)(D) of the Social Security
Act).
(b) Amount of Payments.--
(1) In general.--Subject to paragraph (2), the
amounts payable under this section to qualified
teaching health centers for an approved graduate
medical residency training program for a fiscal year
are each of the following amounts:
(A) Direct expense amount.--The amount
determined under subsection (c) for direct
expenses associated with sponsoring approved
graduate medical residency training programs.
(B) Indirect expense amount.--The amount
determined under subsection (d) for indirect
expenses associated with the additional costs
relating to teaching residents in such
programs.
(2) Capped amount.--
(A) In general.--The total of the payments
made to qualified teaching health centers under
paragraph (1)(A) or paragraph (1)(B) in a
fiscal year shall not exceed the amount of
funds appropriated under subsection (g) for
such payments for that fiscal year.
(B) Limitation.--The Secretary shall limit
the funding of full-time equivalent residents
in order to ensure the direct and indirect
payments as determined under subsection (c) and
(d) do not exceed the total amount of funds
appropriated in a fiscal year under subsection
(g).
(c) Amount of Payment for Direct Graduate Medical
Education.--
(1) In general.--The amount determined under this
subsection for payments to qualified teaching health
centers for direct graduate expenses relating to
approved graduate medical residency training programs
for a fiscal year is equal to the product of--
(A) the updated national per resident amount
for direct graduate medical education, as
determined under paragraph (2); and
(B) the average number of full-time
equivalent residents in the teaching health
center's graduate approved medical residency
training programs as determined under section
1886(h)(4) of the Social Security Act (without
regard to the limitation under subparagraph (F)
of such section) during the fiscal year.
(2) Updated national per resident amount for direct
graduate medical education.--The updated per resident
amount for direct graduate medical education for a
qualified teaching health center for a fiscal year is
an amount determined as follows:
(A) Determination of qualified teaching
health center per resident amount.--The
Secretary shall compute for each individual
qualified teaching health center a per resident
amount--
(i) by dividing the national average
per resident amount computed under
section 340E(c)(2)(D) into a wage-
related portion and a non-wage related
portion by applying the proportion
determined under subparagraph (B);
(ii) by multiplying the wage-related
portion by the factor applied under
section 1886(d)(3)(E) of the Social
Security Act (but without application
of section 4410 of the Balanced Budget
Act of 1997 (42 U.S.C. 1395ww note))
during the preceding fiscal year for
the teaching health center's area; and
(iii) by adding the non-wage-related
portion to the amount computed under
clause (ii).
(B) Updating rate.--The Secretary shall
update such per resident amount for each such
qualified teaching health center as determined
appropriate by the Secretary.
(d) Amount of Payment for Indirect Medical Education.--
(1) In general.--The amount determined under this
subsection for payments to qualified teaching health
centers for indirect expenses associated with the
additional costs of teaching residents for a fiscal
year is equal to an amount determined appropriate by
the Secretary.
(2) Factors.--In determining the amount under
paragraph (1), the Secretary shall--
(A) evaluate indirect training costs relative
to supporting a primary care residency program
in qualified teaching health centers; and
(B) based on this evaluation, assure that the
aggregate of the payments for indirect expenses
under this section and the payments for direct
graduate medical education as determined under
subsection (c) in a fiscal year do not exceed
the amount appropriated for such expenses as
determined in subsection (g).
(3) Interim payment.--Before the Secretary makes a
payment under this subsection pursuant to a
determination of indirect expenses under paragraph (1),
the Secretary may provide to qualified teaching health
centers a payment, in addition to any payment made
under subsection (c), for expected indirect expenses
associated with the additional costs of teaching
residents for a fiscal year, based on an estimate by
the Secretary.
(e) Clarification Regarding Relationship to Other Payments
for Graduate Medical Education.--Payments under this section--
(1) shall be in addition to any payments--
(A) for the indirect costs of medical
education under section 1886(d)(5)(B) of the
Social Security Act;
(B) for direct graduate medical education
costs under section 1886(h) of such Act; and
(C) for direct costs of medical education
under section 1886(k) of such Act;
(2) shall not be taken into account in applying the
limitation on the number of total full-time equivalent
residents under subparagraphs (F) and (G) of section
1886(h)(4) of such Act and clauses (v), (vi)(I), and
(vi)(II) of section 1886(d)(5)(B) of such Act for the
portion of time that a resident rotates to a hospital;
and
(3) shall not include the time in which a resident is
counted toward full-time equivalency by a hospital
under paragraph (2) or under section 1886(d)(5)(B)(iv)
of the Social Security Act, section 1886(h)(4)(E) of
such Act, or section 340E of this Act.
(f) Reconciliation.--The Secretary shall determine any
changes to the number of residents reported by a [hospital]
teaching health center in the application of the [hospital]
teaching health center for the current fiscal year to determine
the final amount payable to the [hospital] teaching health
center for the current fiscal year for both direct expense and
indirect expense amounts. Based on such determination, the
Secretary shall recoup any overpayments made to pay any balance
due to the extent possible. The final amount so determined
shall be considered a final intermediary determination for the
purposes of section 1878 of the Social Security Act and shall
be subject to administrative and judicial review under that
section in the same manner as the amount of payment under
section 1186(d) of such Act is subject to review under such
section.
(g) Funding.--[To carry out]
(1) In general._To carry out this section, there are
appropriated such sums as may be necessary, not to
exceed $230,000,000, for the period of fiscal years
2011 through 2015, $60,000,000 for each of fiscal years
2016 and 2017, [and $15,000,000 for the first quarter
of fiscal year 2018], $15,000,000 for the first quarter
of fiscal year 2018, $111,500,000 for the period
consisting of the second, third, and fourth quarters of
fiscal year 2018, and $126,500,000 for fiscal year
2019, to remain available until expended.
(2) Administrative expenses.--Of the amount made
available to carry out this section for any fiscal
year, the Secretary may not use more than 5 percent of
such amount for the expenses of administering this
section.
(h) Annual Reporting Required.--
(1) Annual report.--The report required under this
paragraph for a qualified teaching health center for a
fiscal year is a report that includes (in a form and
manner specified by the Secretary) the following
information for the residency academic year completed
immediately prior to such fiscal year:
(A) The types of primary care resident
approved training programs that the qualified
teaching health center provided for residents.
(B) The number of approved training positions
for residents described in paragraph (4).
(C) The number of residents described in
paragraph (4) who completed their residency
training at the end of such residency academic
year and care for vulnerable populations living
in underserved areas.
(D) The number of patients treated by
residents described in paragraph (4).
(E) The number of visits by patients treated
by residents described in paragraph (4).
(F) Of the number of residents described in
paragraph (4) who completed their residency
training at the end of such residency academic
year, the number and percentage of such
residents entering primary care practice
(meaning any of the areas of practice listed in
the definition of a primary care residency
program in section 749A).
(G) Of the number of residents described in
paragraph (4) who completed their residency
training at the end of such residency academic
year, the number and percentage of such
residents who entered practice at a health care
facility--
(i) primarily serving a health
professional shortage area with a
designation in effect under section 332
or a medically underserved community
(as defined in section 799B); or
(ii) located in a rural area (as
defined in section 1886(d)(2)(D) of the
Social Security Act).
[(D)] (H) Other information as deemed
appropriate by the Secretary.
(2) Audit authority; limitation on payment.--
(A) Audit authority.--The Secretary may audit
a qualified teaching health center to ensure
the accuracy and completeness of the
information submitted in a report under
paragraph (1).
(B) Limitation on payment.--A teaching health
center may only receive payment in a cost
reporting period for a number of such resident
positions that is greater than the base level
of primary care resident positions, as
determined by the Secretary. For purposes of
this subparagraph, the ``base level of primary
care residents'' for a teaching health center
is the level of such residents as of a base
period.
(3) Reduction in payment for failure to report.--
(A) In general.--The amount payable under
this section to a qualified teaching health
center for a fiscal year shall be reduced by at
least 25 percent if the Secretary determines
that--
(i) the qualified teaching health
center has failed to provide the
Secretary, as an addendum to the
qualified teaching health center's
application under this section for such
fiscal year, the report required under
paragraph (1) for the previous fiscal
year; or
(ii) such report fails to provide
complete and accurate information
required under any subparagraph of such
paragraph.
(B) Notice and opportunity to provide
accurate and missing information.--Before
imposing a reduction under subparagraph (A) on
the basis of a qualified teaching health
center's failure to provide complete and
accurate information described in subparagraph
(A)(ii), the Secretary shall provide notice to
the teaching health center of such failure and
the Secretary's intention to impose such
reduction and shall provide the teaching health
center with the opportunity to provide the
required information within the period of 30
days beginning on the date of such notice. If
the teaching health center provides such
information within such period, no reduction
shall be made under subparagraph (A) on the
basis of the previous failure to provide such
information.
(4) Residents.--The residents described in this
paragraph are those who are in part-time or full-time
equivalent resident training positions at a qualified
teaching health center in any approved graduate medical
residency training program.
(i) Regulations.--The Secretary shall promulgate regulations
to carry out this section.
(j) Definitions.--In this section:
(1) Approved graduate medical residency training
program.--The term ``approved graduate medical
residency training program'' means a residency or other
postgraduate medical training program--
(A) participation in which may be counted
toward certification in a specialty or
subspecialty and includes formal postgraduate
training programs in geriatric medicine
approved by the Secretary; and
(B) that meets criteria for accreditation (as
established by the Accreditation Council for
Graduate Medical Education, the American
Osteopathic Association, or the American Dental
Association).
(2) New approved graduate medical residency training
program.--The term ``new approved graduate medical
residency training program'' means an approved graduate
medical residency training program for which the
sponsoring qualified teaching health center has not
received a payment under this section for a previous
fiscal year (other than pursuant to subsection
(a)(1)(C)).
[(2)] (3) Primary care residency program.--The term
``primary care residency program'' has the meaning
given that term in section 749A.
[(3)] (4) Qualified teaching health center.--The term
``qualified teaching health center'' has the meaning
given the term ``teaching health center'' in section
749A.
* * * * * * *
----------
TITLE 18, UNITED STATES CODE
* * * * * * *
PART II--CRIMINAL PROCEDURE
* * * * * * *
CHAPTER 201--GENERAL PROVISIONS
* * * * * * *
Sec. 3014. Additional special assessment
(a) In General.--Beginning on the date of enactment of the
Justice for Victims of Trafficking Act of 2015 and ending on
September 30, 2019, in addition to the assessment imposed under
section 3013, the court shall assess an amount of $5,000 on any
non-indigent person or entity convicted of an offense under--
(1) chapter 77 (relating to peonage, slavery, and
trafficking in persons);
(2) chapter 109A (relating to sexual abuse);
(3) chapter 110 (relating to sexual exploitation and
other abuse of children);
(4) chapter 117 (relating to transportation for
illegal sexual activity and related crimes); or
(5) section 274 of the Immigration and Nationality
Act (8 U.S.C. 1324) (relating to human smuggling),
unless the person induced, assisted, abetted, or aided
only an individual who at the time of such action was
the alien's spouse, parent, son, or daughter (and no
other individual) to enter the United States in
violation of law.
(b) Satisfaction of Other Court-Ordered Obligations.--An
assessment under subsection (a) shall not be payable until the
person subject to the assessment has satisfied all outstanding
court-ordered fines, orders of restitution, and any other
obligation related to victim-compensation arising from the
criminal convictions on which the special assessment is based.
(c) Establishment of Domestic Trafficking Victims' Fund.--
There is established in the Treasury of the United States a
fund, to be known as the ``Domestic Trafficking Victims' Fund''
(referred to in this section as the ``Fund''), to be
administered by the Attorney General, in consultation with the
Secretary of Homeland Security and the Secretary of Health and
Human Services.
(d) Transfers.--In a manner consistent with section 3302(b)
of title 31, there shall be transferred to the Fund from the
General Fund of the Treasury an amount equal to the amount of
the assessments collected under this section, which shall
remain available until expended.
(e) Use of Funds.--
(1) In general.--From amounts in the Fund, in
addition to any other amounts available, and without
further appropriation, the Attorney General, in
coordination with the Secretary of Health and Human
Services shall, for each of fiscal years 2016 through
2019, use amounts available in the Fund to award grants
or enhance victims' programming under--
(A) section 204 of the Trafficking Victims
Protection Reauthorization Act of 2005 (42
U.S.C. 14044c);
(B) subsections (b)(2) and (f) of section 107
of the Trafficking Victims Protection Act of
2000 (22 U.S.C. 7105);
(C) section 214(b) of the Victims of Child
Abuse Act of 1990 (42 U.S.C. 13002(b)); and
(D) section 106 of the PROTECT Our Children
Act of 2008 (42 U.S.C. 17616).
(2) Limitation.--Except as provided in subsection
(h)(2), none of the amounts in the Fund may be used to
provide health care or medical items or services.
(f) Collection Method.--The amount assessed under subsection
(a) shall, subject to subsection (b), be collected in the
manner that fines are collected in criminal cases.
(g) Duration of Obligation.--Subject to section 3613(b), the
obligation to pay an assessment imposed on or after the date of
enactment of the Justice for Victims of Trafficking Act of 2015
shall not cease until the assessment is paid in full.
(h) Health or Medical Services.--
(1) Transfer of funds.--From amounts appropriated
under section 10503(b)(1)(E) of the Patient Protection
and Affordable Care Act (42 U.S.C. 254b-2(b)(1)(E))[,
as amended by section 221 of the Medicare Access and
CHIP Reauthorization Act of 2015,] there shall be
transferred to the Fund an amount equal to the amount
transferred under subsection (d) for each fiscal year,
except that the amount transferred under this paragraph
shall not be less than $5,000,000 or more than
$30,000,000 in each such fiscal year, and such amounts
shall remain available until expended.
(2) Use of funds.--The Attorney General, in
coordination with the Secretary of Health and Human
Services, shall use amounts transferred to the Fund
under paragraph (1) to award grants that may be used
for the provision of health care or medical items or
services to victims of trafficking under--
(A) sections 202, 203, and 204 of the
Trafficking Victims Protection Reauthorization
Act of 2005 (42 U.S.C. 14044a, 14044b, and
14044c);
(B) subsections (b)(2) and (f) of section 107
of the Trafficking Victims Protection Act of
2000 (22 U.S.C. 7105); and
(C) section 214(b) of the Victims of Child
Abuse Act of 1990 (42 U.S.C. 13002(b)).
(3) Grants.--Of the amounts in the Fund used under
paragraph (1), not less than $2,000,000, if such
amounts are available in the Fund during the relevant
fiscal year, shall be used for grants to provide
services for child pornography victims under section
214(b) of the Victims of Child Abuse Act of 1990 (42
U.S.C. 13002(b)).
(4) Application of provision.--The application of the
provisions of section 221(c) of the Medicare Access and
CHIP Reauthorization Act of 2015 and section 101(d) of
the Community Health And Medical Professionals Improve
Our Nation Act of 2017 shall continue to apply to the
amounts transferred pursuant to paragraph (1).
* * * * * * *
----------
SOCIAL SECURITY ACT
* * * * * * *
TITLE V--MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT
* * * * * * *
authorization of appropriations
Sec. 501. (a) To improve the health of all mothers and
children consistent with the applicable health status goals and
national health objectives established by the Secretary under
the Public Health Service Act for the year 2000, there are
authorized to be appropriated $850,000,000 for fiscal year 2001
and each fiscal year thereafter--
(1) for the purpose of enabling each State--
(A) to provide and to assure mothers and
children (in particular those with low income
or with limited availability of health
services) access to quality maternal and child
health services;
(B) to reduce infant mortality and the
incidence of preventable diseases and
handicapping conditions among children, to
reduce the need for inpatient and long-term
care services, to increase the number of
children (especially preschool children)
appropriately immunized against disease and the
number of low income children receiving health
assessments and follow-up diagnostic and
treatment services, and otherwise to promote
the health of mothers and infants by providing
prenatal, delivery, and postpartum care for low
income, at-risk pregnant women, and to promote
the health of children by providing preventive
and primary care services for low income
children;
(C) to provide rehabilitation services for
blind and disabled individuals under the age of
16 receiving benefits under title XVI, to the
extent medical assistance for such services is
not provided under title XIX; and
(D) to provide and to promote family-
centered, community-based, coordinated care
(including care coordination services, as
defined in subsection (b)(3)) for children with
special health care needs and to facilitate the
development of community-based systems of
services for such children and their families;
(2) for the purpose of enabling the Secretary
(through grants, contracts, or otherwise) to provide
for special projects of regional and national
significance, research, and training with respect to
maternal and child health and children with special
health care needs (including early intervention
training and services development), for genetic disease
testing, counseling, and information development and
dissemination programs, for grants (including funding
for comprehensive hemophilia diagnostic treatment
centers) relating to hemophilia without regard to age,
and for the screening of newborns for sickle cell
anemia, and other genetic disorders and follow-up
services; and
(3) subject to section 502(b) for the purpose of
enabling the Secretary (through grants, contracts, or
otherwise) to provide for developing and expanding the
following--
(A) maternal and infant health home visiting
programs in which case management services as
defined in subparagraphs (A) and (B) of
subsection (b)(4), health education services,
and related social support services are
provided in the home to pregnant women or
families with an infant up to the age one by an
appropriate health professional or by a
qualified nonprofessional acting under the
supervision of a health care professional,
(B) projects designed to increase the
participation of obstetricians and
pediatricians under the program under this
title and under state plans approved under
title XIX,
(C) integrated maternal and child health
service delivery systems (of the type described
in section 1136 and using, once developed, the
model application form developed under section
6506(a) of the Omnibus Budget Reconciliation
Act of 1989),
(D) maternal and child health centers which
(i) provide prenatal, delivery, and postpartum
care for pregnant women and preventive and
primary care services for infants up to age
one, and (ii) operate under the direction of a
not-for-profit hospital,
(E) maternal and child health projects to
serve rural populations, and
(F) outpatient and community based services
programs (including day care services) for
children with special health care needs whose
medical services are provided primarily through
inpatient institutional care.
Funds appropriated under this section may only be used in a
manner consistent with the Assisted Suicide Funding Restriction
Act of 1997.
(b) For purposes of this title:
(1) The term ``consolidated health programs'' means
the programs administered under the provisions of--
(A) this title (relating to maternal and
child health and services for children with
special health care needs),
(B) section 1615(c) of this Act (relating to
supplemental security income for disabled
children),
(C) sections 316 (relating to lead-based
paint poisoning prevention programs), 1101
(relating to genetic disease programs), 1121
(relating to sudden infant death syndrome
programs) and 1131 (relating to hemophilia
treatment centers) of the Public Health Service
Act, and
(D) title VI of the Health Services and
Centers Amendments of 1978 (Public Law 95-626;
relating to adolescent pregnancy grants),
as such provisions were in effect before the date of
the enactment of the Maternal and Child Health Services
Block Grant Act.
(2) The term ``low income'' means, with respect to an
individual or family, such an individual or family with
an income determined to be below the income official
poverty line defined by the Office of Management and
Budget and revised annually in accordance with section
673(2) of the Omnibus Budget Reconciliation Act of
1981.
(3) The term ``care coordination services'' means
services to promote the effective and efficient
organization and utilization of resources to assure
access to necessary comprehensive services for children
with special health care needs and their families.
(4) The term ``case management services'' means--
(A) with respect to pregnant women, services
to assure access to quality prenatal, delivery,
and postpartum care; and
(B) with respect to infants up to age one,
services to assure access to quality preventive
and primary care services.
(c)(1)(A) For the purpose of enabling the Secretary (through
grants, contracts, or otherwise) to provide for special
projects of regional and national significance for the
development and support of family-to-family health information
centers described in paragraph (2), there is appropriated to
the Secretary, out of any money in the Treasury not otherwise
appropriated--
(i) $3,000,000 for fiscal year 2007;
(ii) $4,000,000 for fiscal year 2008;
(iii) $5,000,000 for each of fiscal years 2009
through 2013;
(iv) $2,500,000 for the portion of fiscal year 2014
before April 1, 2014;
(v) $2,500,000 for the portion of fiscal year 2014 on
or after April 1, 2014; [and]
(vi) $5,000,000 for each of fiscal years 2015 through
2017[.]; and
(vii) $6,000,000 for each of fiscal years 2018 and
2019.
(B) Funds appropriated or authorized to be appropriated under
subparagraph (A) shall--
(i) be in addition to amounts appropriated under
subsection (a) and retained under section 502(a)(1) for
the purpose of carrying out activities described in
subsection (a)(2); and
(ii) remain available until expended.
(2) The family-to-family health information centers described
in this paragraph are centers that--
(A) assist families of children with disabilities or
special health care needs to make informed choices
about health care in order to promote good treatment
decisions, cost-effectiveness, and improved health
outcomes for such children;
(B) provide information regarding the health care
needs of, and resources available for, such children;
(C) identify successful health delivery models for
such children;
(D) develop with representatives of health care
providers, managed care organizations, health care
purchasers, and appropriate State agencies, a model for
collaboration between families of such children and
health professionals;
(E) provide training and guidance regarding caring
for such children;
(F) conduct outreach activities to the families of
such children, health professionals, schools, and other
appropriate entities and individuals; and
(G) are staffed--
(i) by such families who have expertise in
Federal and State public and private health
care systems; and
(ii) by health professionals.
(3) The Secretary shall develop family-to-family health
information centers described in paragraph (2) in accordance
with the following:
(A) With respect to fiscal year 2007, such centers
shall be developed in not less than 25 States.
(B) With respect to fiscal year 2008, such centers
shall be developed in not less than 40 States.
(C) With respect to fiscal year 2009 and each fiscal
year thereafter, such centers shall be developed in all
States, and with respect to fiscal years 2018 and 2019,
such centers shall also be developed in all territories
and at least one such center shall be developed for
Indian tribes.
(4) The provisions of this title that are applicable to the
funds made available to the Secretary under section 502(a)(1)
apply in the same manner to funds made available to the
Secretary under paragraph (1)(A).
[(5) For purposes of this subsection, the term ``State''
means each of the 50 States and the District of Columbia.]
(5) For purposes of this subsection--
(A) the term ``Indian tribe'' has the meaning given
such term in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603);
(B) the term ``State'' means each of the 50 States
and the District of Columbia; and
(C) the term ``territory'' means Puerto Rico, Guam,
American Samoa, the Virgin Islands, and the Northern
Mariana Islands.
* * * * * * *
[separate program for abstinence education
[Sec. 510. (a) For the purpose described in subsection (b),
the Secretary shall, for each of fiscal years 2010 through
2017, allot to each State which has transmitted an application
for the fiscal year under section 505(a) an amount equal to the
product of--
[(1) the amount appropriated in subsection (d) for
the fiscal year; and
[(2) the percentage determined for the State under
section 502(c)(1)(B)(ii).
[(b)(1) The purpose of an allotment under subsection (a) to a
State is to enable the State to provide abstinence education,
and at the option of the State, where appropriate, mentoring,
counseling, and adult supervision to promote abstinence from
sexual activity, with a focus on those groups which are most
likely to bear children out-of-wedlock.
[(2) For purposes of this section, the term ``abstinence
education'' means an educational or motivational program
which--
[(A) has as its exclusive purpose, teaching the
social, psychological, and health gains to be realized
by abstaining from sexual activity;
[(B) teaches abstinence from sexual activity outside
marriage as the expected standard for all school age
children;
[(C) teaches that abstinence from sexual activity is
the only certain way to avoid out-of-wedlock pregnancy,
sexually transmitted diseases, and other associated
health problems;
[(D) teaches that a mutually faithful monogamous
relationship in context of marriage is the expected
standard of human sexual activity;
[(E) teaches that sexual activity outside of the
context of marriage is likely to have harmful
psychological and physical effects;
[(F) teaches that bearing children out-of-wedlock is
likely to have harmful consequences for the child, the
child's parents, and society;
[(G) teaches young people how to reject sexual
advances and how alcohol and drug use increases
vulnerability to sexual advances; and
[(H) teaches the importance of attaining self-
sufficiency before engaging in sexual activity.
[(c)(1) Sections 503, 507, and 508 apply to allotments under
subsection (a) to the same extent and in the same manner as
such sections apply to allotments under section 502(c).
[(2) Sections 505 and 506 apply to allotments under
subsection (a) to the extent determined by the Secretary to be
appropriate.
[(d) For the purpose of allotments under subsection (a),
there is appropriated, out of any money in the Treasury not
otherwise appropriated, an additional $50,000,000 for each of
the fiscal years 2010 through 2015 and an additional
$75,000,000 for each of fiscal years 2016 and 2017. The
appropriation under the preceding sentence for a fiscal year is
made on October 1 of the fiscal year (except that such
appropriation shall be made on the date of enactment of the
Patient Protection and Affordable Care Act in the case of
fiscal year 2010).]
SEC. 510. YOUTH EMPOWERMENT PROGRAM.
(a) In General.--
(1) Allotments to states.--For the purpose described
in subsection (b), the Secretary shall, for each of
fiscal years 2018 and 2019, allot to each State which
has transmitted an application for the fiscal year
under section 505(a) an amount equal to the product
of--
(A) the amount appropriated pursuant to
subsection (e)(1) for the fiscal year, minus
the amount reserved under subsection (e)(2) for
the fiscal year; and
(B) the proportion that the number of low-
income children in the State bears to the total
of such numbers of children for all the States.
(2) Other allotments.--
(A) Other entities.--For the purpose
described in subsection (b), the Secretary
shall, for each of fiscal years 2018 and 2019,
for any State which has not transmitted an
application for the fiscal year under section
505(a), allot to one or more entities in the
State the amount that would have been allotted
to the State under paragraph (1) if the State
had submitted such an application.
(B) Process.--The Secretary shall select the
recipients of allotments under subparagraph (A)
by means of a competitive grant process under
which--
(i) not later than 30 days after the
deadline for the State involved to
submit an application for the fiscal
year under section 505(a), the
Secretary publishes a notice soliciting
grant applications; and
(ii) not later than 120 days after
such deadline, all such applications
must be submitted.
(b) Purpose.--
(1) In general.--Except for research under paragraph
(5) and information collection and reporting under
paragraph (6), the purpose of an allotment under
subsection (a) to a State (or to another entity in the
State pursuant to subsection (a)(2)) is to enable the
State or other entity to implement education
exclusively on sexual risk avoidance (meaning
voluntarily refraining from sexual activity).
(2) Required components.--Education on sexual risk
avoidance pursuant to an allotment under this section
shall--
(A) ensure that the unambiguous and primary
emphasis and context for each topic described
in paragraph (3) is a message to youth that
normalizes the optimal health behavior of
avoiding nonmarital sexual activity;
(B) be medically accurate and complete;
(C) be age-appropriate; and
(D) be based on adolescent learning and
developmental theories for the age group
receiving the education.
(3) Topics.--Education on sexual risk avoidance
pursuant to an allotment under this section shall
address each of the following topics:
(A) The holistic individual and societal
benefits associated with personal
responsibility, self-regulation, goal setting,
healthy decisionmaking, and a focus on the
future.
(B) The advantage of refraining from
nonmarital sexual activity in order to improve
the future prospects and physical and emotional
health of youth.
(C) The increased likelihood of avoiding
poverty when youth attain self-sufficiency and
emotional maturity before engaging in sexual
activity.
(D) The foundational components of healthy
relationships and their impact on the formation
of healthy marriages and safe and stable
families.
(E) How other youth risk behaviors, such as
drug and alcohol usage, increase the risk for
teen sex.
(F) How to resist and avoid, and receive help
regarding, sexual coercion and dating violence,
recognizing that even with consent teen sex
remains a youth risk behavior.
(4) Contraception.--Education on sexual risk
avoidance pursuant to an allotment under this section
shall ensure that--
(A) any information provided on contraception
is medically accurate and ensures that students
understand that contraception offers physical
risk reduction, but not risk elimination; and
(B) the education does not include
demonstrations, simulations, or distribution of
contraceptive devices.
(5) Research.--
(A) In general.--A State or other entity
receiving an allotment pursuant to subsection
(a) may use up to 20 percent of such allotment
to build the evidence base for sexual risk
avoidance education by conducting or supporting
research.
(B) Requirements.--Any research conducted or
supported pursuant to subparagraph (A) shall
be--
(i) rigorous;
(ii) evidence-based; and
(iii) designed and conducted by
independent researchers who have
experience in conducting and publishing
research in peer-reviewed outlets.
(6) Information collection and reporting.--A State or
other entity receiving an allotment pursuant to
subsection (a) shall, as specified by the Secretary--
(A) collect information on the programs and
activities funded through the allotment; and
(B) submit reports to the Secretary on the
data from such programs and activities.
(c) National Evaluation.--
(1) In general.--The Secretary shall--
(A) in consultation with appropriate State
and local agencies, conduct one or more
rigorous evaluations of the education funded
through this section and associated data; and
(B) submit a report to the Congress on the
results of such evaluations, together with a
summary of the information collected pursuant
to subsection (b)(6).
(2) Consultation.--In conducting the evaluations
required by paragraph (1), including the establishment
of evaluation methodologies, the Secretary shall
consult with relevant stakeholders.
(d) Applicability of Certain Provisions.--
(1) Sections 503, 507, and 508 apply to allotments
under subsection (a) to the same extent and in the same
manner as such sections apply to allotments under
section 502(c).
(2) Sections 505 and 506 apply to allotments under
subsection (a) to the extent determined by the
Secretary to be appropriate.
(e) Funding.--
(1) In general.--To carry out this section, there is
appropriated, out of any money in the Treasury not
otherwise appropriated, $75,000,000 for each of fiscal
years 2018 and 2019.
(2) Reservation.--The Secretary shall reserve, for
each of fiscal years 2018 and 2019, not more than 20
percent of the amount appropriated pursuant to
paragraph (1) for administering the program under this
section, including the conducting of national
evaluations and the provision of technical assistance
to the recipients of allotments.
* * * * * * *
SEC. 513. PERSONAL RESPONSIBILITY EDUCATION.
(a) Allotments to States.--
(1) Amount.--
(A) In general.--For the purpose described in
subsection (b), subject to the succeeding
provisions of this section, for each of fiscal
years 2010 through [2017] 2019, the Secretary
shall allot to each State an amount equal to
the product of--
(i) the amount appropriated under
subsection (f) for the fiscal year and
available for allotments to States
after the application of subsection
(c); and
(ii) the State youth population
percentage determined under paragraph
(2).
(B) Minimum allotment.--
(i) In general.--Each State allotment
under this paragraph for a fiscal year
shall be at least $250,000.
(ii) Pro rata adjustments.--The
Secretary shall adjust on a pro rata
basis the amount of the State
allotments determined under this
paragraph for a fiscal year to the
extent necessary to comply with clause
(i).
(C) Application required to access
allotments.--
(i) In general.--A State shall not be
paid from its allotment for a fiscal
year unless the State submits an
application to the Secretary for the
fiscal year and the Secretary approves
the application (or requires changes to
the application that the State
satisfies) and meets such additional
requirements as the Secretary may
specify.
(ii) Requirements.--The State
application shall contain an assurance
that the State has complied with the
requirements of this section in
preparing and submitting the
application and shall include the
following as well as such additional
information as the Secretary may
require:
(I) Based on data from the
Centers for Disease Control and
Prevention National Center for
Health Statistics, the most
recent pregnancy rates for the
State for youth ages 10 to 14
and youth ages 15 to 19 for
which data are available, the
most recent birth rates for
such youth populations in the
State for which data are
available, and trends in those
rates for the most recently
preceding 5-year period for
which such data are available.
(II) State-established goals
for reducing the pregnancy
rates and birth rates for such
youth populations.
(III) A description of the
State's plan for using the
State allotments provided under
this section to achieve such
goals, especially among youth
populations that are the most
high-risk or vulnerable for
pregnancies or otherwise have
special circumstances,
including youth in foster care,
homeless youth, youth with HIV/
AIDS, pregnant youth who are
under 21 years of age, mothers
who are under 21 years of age,
and youth residing in areas
with high birth rates for
youth.
(2) State youth population percentage.--
(A) In general.--For purposes of paragraph
(1)(A)(ii), the State youth population
percentage is, with respect to a State, the
proportion (expressed as a percentage) of--
(i) the number of individuals who
have attained age 10 but not attained
age 20 in the State; to
(ii) the number of such individuals
in all States.
(B) Determination of number of youth.--The
number of individuals described in clauses (i)
and (ii) of subparagraph (A) in a State shall
be determined on the basis of the most recent
Bureau of the Census data.
(3) Availability of state allotments.--Subject to
paragraph (4)(A), amounts allotted to a State pursuant
to this subsection for a fiscal year shall remain
available for expenditure by the State through the end
of the second succeeding fiscal year.
(4) Authority to award grants from state allotments
to local organizations and entities in nonparticipating
states.--
(A) Grants from unexpended allotments.--If a
State does not submit an application under this
section for fiscal year 2010 or 2011, the State
shall no longer be eligible to submit an
application to receive funds from the amounts
allotted for the State for each of fiscal years
2010 through [2017] 2019 and such amounts shall
be used by the Secretary to award grants under
this paragraph for each of fiscal years 2012
through [2017] 2019. The Secretary also shall
use any amounts from the allotments of States
that submit applications under this section for
a fiscal year that remain unexpended as of the
end of the period in which the allotments are
available for expenditure under paragraph (3)
for awarding grants under this paragraph.
(B) [3-year grants] Competitive prep
grants.--
(i) In general.--The Secretary shall
[solicit applications to award 3-year
grants in each of fiscal years 2012
through 2017] continue through fiscal
year 2019 grants awarded for any of
fiscal years 2015 through 2017 to local
organizations and entities to conduct,
consistent with subsection (b),
programs and activities in States that
do not submit an application for an
allotment under this section for fiscal
year 2010 or 2011.
(ii) Faith-based organizations or
consortia.--The Secretary may solicit
and award grants under this paragraph
to faith-based organizations or
consortia.
(C) Evaluation.--An organization or entity
awarded a grant under this paragraph shall
agree to participate in a rigorous Federal
evaluation.
(5) Maintenance of effort.--No payment shall be made
to a State from the allotment determined for the State
under this subsection or to a local organization or
entity awarded a grant under paragraph (4), if the
expenditure of non-federal funds by the State,
organization, or entity for activities, programs, or
initiatives for which amounts from allotments and
grants under this subsection may be expended is less
than the amount expended by the State, organization, or
entity for such programs or initiatives for fiscal year
2009.
(6) Data collection and reporting.--A State or local
organization or entity receiving funds under this
section shall cooperate with such requirements relating
to the collection of data and information and reporting
on outcomes regarding the programs and activities
carried out with such funds, as the Secretary shall
specify.
(b) Purpose.--
(1) In general.--The purpose of an allotment under
subsection (a)(1) to a State is to enable the State
(or, in the case of grants made under subsection
(a)(4)(B), to enable a local organization or entity) to
carry out personal responsibility education programs
consistent with this subsection.
(2) Personal responsibility education programs.--
(A) In general.--In this section, the term
``personal responsibility education program''
means a program that is designed to educate
adolescents on--
(i) both abstinence and contraception
for the prevention of pregnancy and
sexually transmitted infections,
including HIV/AIDS, consistent with the
requirements of subparagraph (B); and
(ii) at least 3 of the adulthood
preparation subjects described in
subparagraph (C).
(B) Requirements.--The requirements of this
subparagraph are the following:
(i) The program replicates evidence-
based effective programs or
substantially incorporates elements of
effective programs that have been
proven on the basis of rigorous
scientific research to change behavior,
which means delaying sexual activity,
increasing condom or contraceptive use
for sexually active youth, or reducing
pregnancy among youth.
(ii) The program is medically-
accurate and complete.
(iii) The program includes activities
to educate youth who are sexually
active regarding responsible sexual
behavior with respect to both
abstinence and the use of
contraception.
(iv) The program places substantial
emphasis on both abstinence and
contraception for the prevention of
pregnancy among youth and sexually
transmitted infections.
(v) The program provides age-
appropriate information and activities.
(vi) The information and activities
carried out under the program are
provided in the cultural context that
is most appropriate for individuals in
the particular population group to
which they are directed.
(C) Adulthood preparation subjects.--The
adulthood preparation subjects described in
this subparagraph are the following:
(i) Healthy relationships, including
marriage and family interactions.
(ii) Adolescent development, such as
the development of healthy attitudes
and values about adolescent growth and
development, body image, racial and
ethnic diversity, and other related
subjects.
(iii) Financial literacy.
(iv) Parent-child communication.
(v) Educational and career success,
such as developing skills for
employment preparation, job seeking,
independent living, financial self-
sufficiency, and workplace
productivity.
(vi) Healthy life skills, such as
goal-setting, decision making,
negotiation, communication and
interpersonal skills, and stress
management.
(c) Reservations of Funds.--
(1) Grants to implement innovative strategies.--From
the amount appropriated under subsection (f) for the
fiscal year, the Secretary shall reserve $10,000,000 of
such amount for purposes of awarding grants to entities
to implement innovative youth pregnancy prevention
strategies and target services to high-risk,
vulnerable, and culturally under-represented youth
populations, including youth in foster care, homeless
youth, youth with HIV/AIDS, victims of human
trafficking, pregnant women who are under 21 years of
age and their partners, mothers who are under 21 years
of age and their partners, and youth residing in areas
with high birth rates for youth. An entity awarded a
grant under this paragraph shall agree to participate
in a rigorous Federal evaluation of the activities
carried out with grant funds.
(2) Other reservations.--From the amount appropriated
under subsection (f) for the fiscal year that remains
after the application of paragraph (1), the Secretary
shall reserve the following amounts:
(A) Grants for indian tribes or tribal
organizations.--The Secretary shall reserve 5
percent of such remainder for purposes of
awarding grants to Indian tribes and tribal
organizations in such manner, and subject to
such requirements, as the Secretary, in
consultation with Indian tribes and tribal
organizations, determines appropriate.
(B) Secretarial responsibilities.--
(i) Reservation of funds.--The
Secretary shall reserve 10 percent of
such remainder for expenditures by the
Secretary for the activities described
in clauses (ii) and (iii).
(ii) Program support.--The Secretary
shall provide, directly or through a
competitive grant process, research,
training and technical assistance,
including dissemination of research and
information regarding effective and
promising practices, providing
consultation and resources on a broad
array of teen pregnancy prevention
strategies, including abstinence and
contraception, and developing resources
and materials to support the activities
of recipients of grants and other
State, tribal, and community
organizations working to reduce teen
pregnancy. In carrying out such
functions, the Secretary shall
collaborate with a variety of entities
that have expertise in the prevention
of teen pregnancy, HIV and sexually
transmitted infections, healthy
relationships, financial literacy, and
other topics addressed through the
personal responsibility education
programs.
(iii) Evaluation.--The Secretary
shall evaluate the programs and
activities carried out with funds made
available through allotments or grants
under this section.
(d) Administration.--
(1) In general.--The Secretary shall administer this
section through the Assistant Secretary for the
Administration for Children and Families within the
Department of Health and Human Services.
(2) Application of other provisions of title.--
(A) In general.--Except as provided in
subparagraph (B), the other provisions of this
title shall not apply to allotments or grants
made under this section.
(B) Exceptions.--The following provisions of
this title shall apply to allotments and grants
made under this section to the same extent and
in the same manner as such provisions apply to
allotments made under section 502(c):
(i) Section 504(b)(6) (relating to
prohibition on payments to excluded
individuals and entities).
(ii) Section 504(c) (relating to the
use of funds for the purchase of
technical assistance).
(iii) Section 504(d) (relating to a
limitation on administrative
expenditures).
(iv) Section 506 (relating to reports
and audits), but only to the extent
determined by the Secretary to be
appropriate for grants made under this
section.
(v) Section 507 (relating to
penalties for false statements).
(vi) Section 508 (relating to
nondiscrimination).
(e) Definitions.--In this section:
(1) Age-appropriate.--The term ``age-appropriate'',
with respect to the information in pregnancy
prevention, means topics, messages, and teaching
methods suitable to particular ages or age groups of
children and adolescents, based on developing
cognitive, emotional, and behavioral capacity typical
for the age or age group.
(2) Medically accurate and complete.--The term
``medically accurate and complete'' means verified or
supported by the weight of research conducted in
compliance with accepted scientific methods and--
(A) published in peer-reviewed journals,
where applicable; or
(B) comprising information that leading
professional organizations and agencies with
relevant expertise in the field recognize as
accurate, objective, and complete.
(3) Indian tribes; tribal organizations.--The terms
``Indian tribe'' and ``Tribal organization'' have the
meanings given such terms in section 4 of the Indian
Health Care Improvement Act (25 U.S.C. 1603)).
(4) Youth.--The term ``youth'' means an individual
who has attained age 10 but has not attained age 20.
(f) Appropriation.--For the purpose of carrying out this
section, there is appropriated, out of any money in the
Treasury not otherwise appropriated, $75,000,000 for each of
fiscal years 2010 through [2017] 2019. Amounts appropriated
under this subsection shall remain available until expended.
* * * * * * *
MINORITY VIEWS
Committee Democrats unanimously oppose H.R. 3922, the
``Community Health and Medical Professionals Improve Our Nation
Act of 2017,'' or the CHAMPION Act. While we support the
reauthorization of the critical public health programs included
in the CHAMPION Act, we cannot support doing so using the
partisan offsets the Republicans have proposed in this bill.
Rather than working together to identify offsets that we all
could support, the Committee Republicans chose to continue
their efforts to repeal and undermine the Affordable Care Act
(ACA) through this legislation.
THE MINORITY MEMBERS OPPOSE PAYING FOR CRITICAL PUBLIC HEALTH PROGRAMS
WITH CUTS TO THE AFFORDABLE CARE ACT
The CHAMPION Act would cut $6.35 billion or nearly half of
the funding from the Prevention and Public Health Fund
(Prevention Fund) over the next decade, which will harm efforts
to improve America's health and to prepare and respond to
public health crises. The Prevention Fund was created by the
ACA and is the federal government's only dedicated mandatory
investment in improving our nation's public health system. As a
result of the Republican proposed cuts to the Prevention Fund,
funding would not be available to invest in critical preventive
and public health programs such as efforts to reduce tobacco
use, increase physical activity, expand mental health and
injury prevention, and improve our ability to detect and
respond to infectious disease and other public health threats.
Therefore this legislation is forcing Congress to make a false
choice between cutting funding for important public health
programs in order to provide funding to maintain others. We
reject this harmful action.
Cutting nearly half of the funding from Prevention Fund
could cripple our public health prevention, preparedness, and
response capabilities. The Centers for Disease Control and
Prevention (CDC) plays a critical role in saving the lives and
protecting the health of Americans. Currently, the Prevention
Fund provides 12 percent of the annual budget of CDC. The
proposed $400 million cut to the Prevention Fund next year
included in the CHAMPION Act would require CDC to roll back
their public health programs as well as cut the funding it
provides to states, communities, and tribal and community
organizations.
Such a cut could not come at a worse time as we are in the
midst of a near endless series of public health crises. From
the lead crisis in Flint, to the international Zika and Ebola
outbreaks, to the opioid epidemic, and now to our response to
the trio of hurricanes that have devastated Texas, Florida,
Puerto Rico, and the Virgin Islands, we have relied on CDC to
be on the front lines to help protect the health of all
Americans. Cutting funding to CDC as proposed by this
legislation could mean that CDC and its state and local
partners will not have the resources necessary to prepare and
mount a timely response to such events.
In addition to helping us prepare and respond to emerging
public health crises, CDC is leading efforts to prevent and
control chronic disease. Today in America, chronic disease,
such as heart disease, diabetes, and cancer, are among the
nation's most common, costly, and preventable health problems.
Unsurprisingly, spending on chronic disease alone accounts for
roughly 86 percent of all health care expenditures in the
United States.\1\ Chronic diseases also take a toll on American
lives. In fact, chronic diseases account for 7 out of 10 deaths
in the United States. Yet, despite the harms caused by chronic
diseases, only a small percentage of government health
expenditures are directed at preventing these diseases before
they happen.
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\1\Centers for Disease Control and Prevention (CDC), Chronic
Disease Prevention and Health Promotion (Nov. 2016) (https://
www.cdc.gov/chronicdisease/index.htm).
---------------------------------------------------------------------------
Using funding from the Prevention Fund, CDC supports public
health programs like the highly successful Tips from Former
Smokers national campaign. A recent study published in the
Lancet found that the first three months of the national ad
campaign led an estimated 1.6 million smokers to attempt to
quit smoking and helped more than 100,000 Americans quit
smoking permanently.\2\ Another study published in the American
Journal of Preventive Medicine found that the campaign
prevented more than 17,000 premature deaths in the United
States.\3\ Slashing nearly half of the funding to the
Prevention Fund over the next decade could prevent CDC from
implementing other successful public health interventions like
Tips from Former Smokers.
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\2\Tim McAfee, et al., Effect of the First Federally Funded US
Antismoking National Media Campaign, The Lancet (Sept. 9, 2013).
\3\Xin Xu, et al., A Cost-Effectiveness Analysis of the First
Federally Funded Antismoking Campaign, American Journal of Preventive
Medicine (Dec. 9, 2014).
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Compounding the harmful cuts to the Prevention Fund is that
the Republican proposed cuts would further strain the safety
net health care system. Cutting nearly half the funding from
the Prevention Fund could mean that more people would need
health services from community health centers and other safety
net programs. However, this legislation provides level funding
needed to meet the current demand for services provided by
community health centers--not increased funding to take on the
additional burden that would result from cuts to the Prevention
Fund. Therefore we reject this proposal that would require us
to cut important investments in certain public health programs
to fund needed investments in others.
Additionally, the minority members oppose paying for these
important public health priorities by cutting funding for
financial assistance for low and middle-income Americans who
purchase subsidized coverage in the Marketplaces. Under the
ACA, individuals have up to 90 days in order to pay premiums
before insurers can terminate their coverage. These grace
periods are important to ensure that low and middle-income
families facing temporary difficulties paying premiums are not
unfairly excluded from coverage. Shortening grace periods to 30
days could result in harsh consequences for these families, who
would lose coverage and would be barred from reenrolling until
the next open enrollment season.
The minority members oppose the majority's continued
attempts to repeal and undermine the ACA. We urge Committee
Republicans to turn to the important task of stabilizing the
Marketplaces and ending the widespread uncertainty due to the
Trump Administration's continual threats to unilaterally end
the payment of cost-sharing reductions. Failure to provide this
certainty is resulting in significantly higher premiums and
fewer choices for consumers.\4\
\4\Congressional Budget Office, Federal Subsidies for Health
Insurance Coverage for People Under Age 65: 2017 to 2027 (Sept. 2017);
Kaiser Family Foundation, An Early Look at 2018 Premium Changes and
Insurer Participation on ACA Exchanges (Aug. 10, 2017).
Frank Pallone, Jr.,
Ranking Member.
Gene Green,
Ranking Member, Subcommittee
on Health.
