42 U.S.C. § 254b — Health centers

Page 340 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b Health Service for the year in which such pro- ceeds are received. (July 1, 1944, ch. 373, title III, § 327A, formerly § 328, as added Pub. L. 90–174, § 7, Dec. 5, 1967, 81 Stat. 539; renumbered § 327A, Pub. L. 95–626, title I, § 113(a)(2), Nov. 10, 1978, 92 Stat. 3562; amended Pub. L. 100–607, title VI, § 629(a)(1), Nov. 4, 1988, 102 Stat. 3146.) Editorial Notes AMENDMENTS 1988—Subsec. (b)(1). Pub. L. 100–607 inserted ‘‘schools of osteopathic medicine,’’ after ‘‘schools of medicine,’’ and ‘‘professions’’ after ‘‘health’’. Statutory Notes and Related Subsidiaries AVAILABILITY OF APPROPRIATIONS FOR EXPENSES OF SHARING MEDICAL CARE FACILITIES AND RESOURCES Pub. L. 102–394, title II, § 204, Oct. 6, 1992, 106 Stat. 1811, provided that: ‘‘Funds advanced to the National Institutes of Health Management Fund from appropria- tions in this Act or subsequent Departments of Labor, Health and Human Services, and Education, and Re- lated Agencies Appropriations Acts shall be available for the expenses of sharing medical care facilities and resources pursuant to section 327A of the Public Health Service Act [42 U.S.C. 254a].’’ Similar provisions were contained in the following prior appropriation acts: Pub. L. 102–170, title II, § 204, Nov. 26, 1991, 105 Stat. 1126. Pub. L. 101–517, title II, § 204, Nov. 5, 1990, 104 Stat. 2208. Pub. L. 101–166, title II, § 205, Nov. 21, 1989, 103 Stat. 1177. Pub. L. 100–202, § 101(h) [title II, § 205], Dec. 22, 1987, 101 Stat. 1329–256, 1329–274. Pub. L. 99–500, § 101(i) [H.R. 5233, title II, § 205], Oct. 18, 1986, 100 Stat. 1783–287, and Pub. L. 99–591, § 101(i) [H.R. 5233, title II, § 205], Oct. 30, 1986, 100 Stat. 3341–287. Pub. L. 99–178, title II, § 205, Dec. 12, 1985, 99 Stat. 1119. Pub. L. 98–619, title II, § 205, Nov. 8, 1984, 98 Stat. 3321. Pub. L. 98–139, title II, § 205, Oct. 31, 1983, 97 Stat. 887. Pub. L. 97–377, title I, § 101(e)(1) [title II, § 205], Dec. 21, 1982, 96 Stat. 1878, 1894. PART D—PRIMARY HEALTH CARE Editorial Notes CODIFICATION Pub. L. 95–626, title I, § 113(a)(3), Nov. 10, 1978, 92 Stat. 3562, added heading ‘‘Part D—Primary Health Care’’. SUBPART I—HEALTH CENTERS Editorial Notes CODIFICATION Pub. L. 104–299, § 2, Oct. 11, 1996, 110 Stat. 3626, sub- stituted ‘‘Health Centers’’ for ‘‘Primary Health Cen- ters’’ in subpart heading. Pub. L. 95–626, title I, § 113(a)(3), Nov. 10, 1978, 92 Stat. 3562, added heading ‘‘Subpart I—Primary Health Cen- ters’’. § 254b. Health centers (a) ‘‘Health center’’ defined (1) In general For purposes of this section, the term ‘‘health center’’ means an entity that serves a population that is medically underserved, or a special medically underserved population com- prised 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 arrange- ments— (A) required primary health services (as defined in subsection (b)(1)); and (B) as may be appropriate for particular centers, additional health services (as de- fined in subsection (b)(2)) necessary for the adequate support of the primary health serv- ices required under subparagraph (A); for all residents of the area served by the cen- ter (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 serv- ices’’ means— (i) basic health services which, for pur- poses of this section, shall consist of— (I) health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology that are fur- nished by physicians and where appro- priate, physician assistants, nurse prac- titioners, and nurse midwives; (II) diagnostic laboratory and radiologic services; (III) preventive health services, includ- ing— (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 den- tal care; (gg) voluntary family planning serv- ices; 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 serv- ices (including specialty referral when medically indicated) and other health-re- lated services (including substance use dis- order and mental health services); (iii) patient case management services (including counseling, referral, and follow- up services) and other services designed to Page 341 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b assist health center patients in estab- lishing eligibility for and gaining access to Federal, State, and local programs that provide or financially support the provi- sion of medical, social, housing, edu- cational, or other related services; (iv) services that enable individuals to use the services of the health center (in- cluding outreach and transportation serv- ices and, if a substantial number of the in- dividuals in the population served by a center are of limited English-speaking ability, the services of appropriate per- sonnel 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 re- garding the availability and proper use of health services. (B) Exception With respect to a health center that re- ceives 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 serv- ices under this paragraph; and (ii) approve, as appropriate, the provi- sion 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 re- quired primary health services and that are appropriate to meet the health needs of the population served by the health center in- volved. Such term may include— (A) behavioral and mental health and sub- stance use disorder services; (B) recuperative care services; (C) environmental health services, includ- ing— (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 occupa- tion-related health services for migratory and seasonal agricultural workers, includ- ing— (i) screening for and control of infectious diseases, including parasitic diseases; and (ii) injury prevention programs, includ- ing prevention of exposure to unsafe levels of agricultural chemicals including pes- ticides. (3) Medically underserved populations (A) In general The term ‘‘medically underserved popu- lation’’ means the population of an urban or rural area designated by the Secretary as an area with a shortage of personal health serv- ices or a population group designated by the Secretary as having a shortage of such serv- ices. (B) Criteria In carrying out subparagraph (A), the Sec- retary shall prescribe criteria for deter- mining 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 resi- dents of an area, the ability of the resi- dents of an area or of a population group to pay for health services and their acces- sibility 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 medi- cally underserved population in a State or terminate the designation of such a popu- lation unless, prior to such designation or termination, the Secretary provides reason- able 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 rep- resents 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 des- ignation of such population based on un- usual local conditions which are a barrier to access to or the availability of personal health services. (c) Planning grants (1) 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 ac- quisition and lease of buildings and equipment (including the costs of amortizing the prin- cipal of, and paying the interest on, loans) and shall include— (A) an assessment of the need that the pop- ulation proposed to be served by the health center for which the project is undertaken Page 342 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b has for required primary health services and additional health services; (B) the design of a health center program for such population based on such assess- ment; (C) efforts to secure, within the proposed catchment area of such center, financial and professional assistance and support for the project; (D) initiation and encouragement of con- tinuing community involvement in the de- velopment and operation of the project; and (E) proposed linkages between the center and other appropriate provider entities, such as health departments, local hospitals, and rural health clinics, to provide better coordi- nated, higher quality, and more cost-effec- tive health care services. (2) Limitation Not more than two grants may be made under this subsection for the same project, ex- cept 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 Cen- sus. (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 mod- els for increasing access to high-quality pri- mary care services, which may include models related to— (A) improving the delivery of care for indi- viduals 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 sub- stance use disorder services; (G) addressing emerging public health or substance use disorder issues to meet the health needs of the population served by the health center; and (H) improving access to recommended im- munizations. (2) Sustainability In making supplemental awards under this subsection, the Secretary may consider wheth- er 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 consider- ation to applications for supplemental funding under this subsection that seek to address sig- nificant barriers to access to care in areas with a greater shortage of health care pro- viders and health services relative to the na- tional average. (e) Operating grants (1) Authority (A) In general The Secretary may make grants for the costs of the operation of public and non- profit private health centers that provide health services to medically underserved populations. (B) Entities that fail to meet certain require- ments The Secretary may make grants, for a pe- riod of not to exceed 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 ap- proval by the Secretary, an implementation plan to meet the requirements of subsection (k)(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 The Secretary may make grants to health centers that receive assistance under this section, or at the request of the health cen- ters, directly to a network 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 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 tech- nical 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 individ- uals served by the centers; (III) enhance the quality and coordina- tion of health services; or (IV) improve the health status of com- munities. (2) Use of funds The costs for which a grant may be made under subparagraph (A) or (B) of paragraph (1) Page 343 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b may include the costs of acquiring and leasing buildings and equipment (including the costs of amortizing the principal of, and paying in- terest 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 cen- ter programs. (3) Construction The Secretary may award grants which may be used to pay the costs associated with ex- panding and modernizing existing buildings or constructing new buildings (including the costs of amortizing the principal of, and pay- ing the interest on, loans) for projects ap- proved 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 fis- cal year under subparagraphs (A) and (B) of paragraph (1) to a health center shall be de- termined by the Secretary, but may not ex- ceed the amount by which the costs of oper- ation 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 The total amount of grant funds made available for any fiscal year under paragraph (1)(C) 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 subpara- graph (A) or (B) of paragraph (1) shall be made in advance or by way of reimburse- ment and in such installments as the Sec- retary finds necessary and adjustments may be made for overpayments or underpay- ments. (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 sec- tion, and may be used for such other pur- poses as are not specifically prohibited under this section if such use furthers the objectives of the project. (6) New access points and expanded services (A) Approval of new access points (i) In general The Secretary may approve applications for grants under subparagraph (A) or (B) of paragraph (1) to establish new delivery sites. (ii) Special consideration In carrying out clause (i), the Secretary may give special consideration to appli- cants that have demonstrated the new de- livery site will be located within a sparse- ly populated area, or an area which has a level of unmet need that is higher relative to other applicants. (iii) Consideration of applications In carrying out clause (i), the Secretary shall approve applications for grants in such a manner that the ratio of the medi- cally underserved populations in rural areas which may be expected to use the services provided by the applicants in- volved to the medically underserved popu- lations in urban areas which may be ex- pected to use the services provided by the applicants is not less than two to three or greater than three to two. (iv) Service area overlap If in carrying out clause (i) the applicant proposes to serve an area that is currently served by another health center funded under this section, the Secretary may con- sider whether the award of funding to an additional health center in the area can be justified based on the unmet need for addi- tional services within the catchment area. (v) Mobile units An existing health center may be award- ed funds under clause (i) to establish a new delivery site that is a mobile unit, regard- less of whether the applicant additionally proposes to establish a permanent, full- time site. In the case of a health center that is not currently receiving funds under this section, such health center may be awarded funds under clause (i) to establish a new delivery site that is a mobile unit only if such health center uses a portion of such funds to also establish a permanent, full-time site. (B) Approval of expanded service applica- tions (i) In general The Secretary may approve applications for grants under subparagraph (A) or (B) of paragraph (1) to expand the capacity of the applicant to provide required primary health services described in subsection (b)(1) or additional health services de- scribed in subsection (b)(2). (ii) Priority expansion projects In carrying out clause (i), the Secretary may give special consideration to ex- panded service applications that seek to address emerging public health or behav- ioral health, mental health, or substance abuse issues through increasing the avail- ability of additional health services de- scribed in subsection (b)(2) in an area in which there are significant barriers to ac- cessing care. Page 344 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b (iii) Consideration of applications In carrying out clause (i), the Secretary shall approve applications for grants in such a manner that the ratio of the medi- cally underserved populations in rural areas which may be expected to use the services provided by the applicants in- volved to the medically underserved popu- lations in urban areas which may be ex- pected to use the services provided by such applicants is not less than two to three or greater than three to two. (f) Infant mortality grants (1) In general The Secretary may make grants to health centers for the purpose of assisting such cen- ters 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 chil- dren 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 under- served population among which there is a sub- stantial 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 provi- sion 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 serv- ices for individuals who are referred by the center for services described in paragraph (1); (D) the grant will be expended to supple- ment, and not supplant, the expenditures of the center for primary health services (in- cluding prenatal care) with respect to the purpose described in this subsection; and (E) the center will coordinate the provi- sion of services with other maternal and child health providers operating in the catchment area. (g) Migratory and seasonal agricultural workers (1) In general The Secretary may award grants for the pur- poses described in subsections (c), (e), and (f) for the planning and delivery of services to a special medically underserved population com- prised of— (A) migratory agricultural workers, sea- sonal agricultural workers, and members of the families of such migratory and seasonal agricultural workers who are within a des- ignated catchment area; and (B) individuals who have previously been migratory agricultural workers but who no longer meet the requirements of subpara- graph (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 con- tracts under this subsection with public and private entities to— (A) assist the States in the implementa- tion and enforcement of acceptable environ- mental health standards, including enforce- ment of standards for sanitation in migra- tory agricultural worker and seasonal agri- cultural worker labor camps, and applicable Federal and State pesticide control stand- ards; and (B) conduct projects and studies to assist the several States and entities which have received grants or contracts under this sec- tion in the assessment of problems related to camp and field sanitation, exposure to un- safe levels of agricultural chemicals includ- ing pesticides, and other environmental health hazards to which migratory agricul- tural 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 employ- ment is in agriculture, who has been so em- ployed within the last 24 months, and who establishes for the purposes of such employ- ment a temporary abode. (B) Seasonal agricultural worker The term ‘‘seasonal agricultural worker’’ means an individual whose principal employ- ment 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 com- modity 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 con- junction with an activity described in clause (ii). (h) Homeless population (1) In general The Secretary may award grants for the pur- poses described in subsections (c), (e), and (f) for the planning and delivery of services to a Page 345 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b special medically underserved population com- prised of homeless individuals, including grants for innovative programs that provide outreach and comprehensive primary health services to homeless children and youth, chil- dren and youth at risk of homelessness, home- less veterans, and veterans at risk of home- lessness. (2) Required services In addition to required primary health serv- ices (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 para- graph (1). (4) Temporary continued provision of services to certain former homeless individuals If any grantee under this subsection has pro- vided services described in this section under the grant to a homeless individual, such grant- ee 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 re- gard to whether the individual is a member of a family), including an individual whose primary residence during the night is a su- pervised public or private facility that pro- vides temporary living accommodations and an individual who is a resident in transi- tional housing. (B) Substance use disorder services The term ‘‘substance use disorder serv- ices’’ includes detoxification, risk reduction, outpatient treatment, residential treatment, and rehabilitation for substance abuse pro- vided in settings other than hospitals. (i) Residents of public housing (1) In general The Secretary may award grants for the pur- poses described in subsections (c), (e), and (f) for the planning and delivery of services to a special medically underserved population com- prised of residents of public housing (such term, for purposes of this subsection, shall have the same meaning given such term in section 1437a(b)(1) of this title) and individuals living in areas immediately accessible to such public housing. (2) Supplement not supplant A grant awarded under this subsection shall be expended to supplement, and not supplant, the expenditures of the health center and the value of in kind contributions for the delivery of services to the population described in para- graph (1). (3) Consultation with residents The Secretary may not make a grant under paragraph (1) unless, with respect to the resi- dents of the public housing involved, the appli- cant 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 consulta- tion with the residents regarding the plan- ning and administration of the program car- ried out with the grant. (j) Access grants (1) In general The Secretary may award grants to eligible health centers with a substantial number of clients with limited English speaking pro- ficiency 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 sub- section (a); (B) provides health care services for cli- ents for whom English is a second language; and (C) has exceptional needs with respect to linguistic access or faces exceptional chal- lenges 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 re- ceived through such grant to— (A) provide translation, interpretation, and other such services for clients for whom English is a second language, including hir- ing professional translation and interpreta- tion services; and (B) compensate bilingual or multilingual staff for language assistance services pro- vided by the staff for such clients. (5) Application An eligible health center desiring a grant under this subsection shall submit an applica- tion to the Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require, includ- ing— (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; Page 346 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b (C) a description of any language assist- ance 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 ac- cess or a description of the exceptional chal- lenges 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 appro- priated for health centers under any other sub- section of this section, such sums as may be necessary for each of fiscal years 2002 through 2006. (k) Applications (1) Submission No grant may be made under this section un- less an application therefore is submitted to, and approved by, the Secretary. Such an appli- cation 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 subpara- graph (A) or (B) of subsection (e)(1) or sub- section (e)(6) for a health center shall in- clude— (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; (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 pop- ulation group; and (D) in the case of an application for a grant pursuant to subsection (e)(6), a dem- onstration that the applicant has consulted with appropriate State and local govern- ment agencies, and health care providers re- garding 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 Sec- retary 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 ap- plication 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 ap- plicant. (3) Requirements Except as provided in subsection (e)(1)(B) or subsection (e)(6), the Secretary may not ap- prove an application for a grant under sub- paragraph (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, 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 serv- ices 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 main- tains the confidentiality of patient records; (D) the center will demonstrate its finan- cial responsibility by the use of such ac- counting 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 administra- tion of a State plan approved under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] for the payment of all or a part of the center’s costs in providing health services to persons who are eligible for medical assistance under such a State plan; and (II) has or will have a contractual or other arrangement with the State agency administering the program under title XXI of such Act (42 U.S.C. 1397aa et seq.) with respect to individuals who are State chil- dren’s health insurance program bene- ficiaries; or (ii) has made or will make every reason- able effort to enter into arrangements de- scribed in subclauses (I) and (II) of clause (i); (F) the center has made or will make and will continue to make every reasonable ef- fort to collect appropriate reimbursement for its costs in providing health services to persons who are entitled to insurance bene- fits under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.], to medical assist- ance under a State plan approved under title XIX of such Act [42 U.S.C. 1396 et seq.], or to assistance for medical expenses under any other public assistance program or private health insurance program; (G) the center— (i) has prepared a schedule of fees or pay- ments for the provision of its services con- sistent with locally prevailing rates or charges and designed to cover its reason- able costs of operation and has prepared a Page 347 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b corresponding schedule of discounts to be applied to the payment of such fees or pay- ments, 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 sched- ules; 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 dis- count; (iii)(I) will assure that no patient will be denied health care services due to an indi- vidual’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 subpara- graph; (H) the center has established a governing board which except in the case of an entity operated by an Indian tribe or tribal or In- dian organization under the Indian Self-De- termination Act [25 U.S.C. 5321 et seq.] or an urban Indian organization under the Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.)— (i) is composed of individuals, a majority of whom are being served by the center and who, as a group, represent the individ- uals 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 cen- ter’s annual budget, approves the selection of a director for the center who shall be di- rectly 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 unrea- sonable; except that, upon a showing of good cause the Secretary shall waive, for the length of the project period, all or part of the require- ments 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 statis- tics and other information as the Sec- retary 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 op- erations of the applicant as the Sec- retary 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 sat- ellite) are available and accessible to the residents of the area promptly and as ap- propriate; (ii) ensure that the boundaries of such area conform, to the extent practicable, to relevant boundaries of political subdivi- sions, 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, bar- riers to access to the services of the cen- ter, including barriers resulting from the area’s physical characteristics, its residen- tial patterns, its economic and social grouping, and available transportation; (K) in the case of a center which serves a population including a substantial propor- tion of individuals of limited English-speak- ing ability, the center has— (i) developed a plan and made arrange- ments responsive to the needs of such pop- ulation for providing services to the extent practicable in the language and cultural context most appropriate to such individ- uals; 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 individ- uals and to appropriate staff members with respect to cultural sensitivities and bridg- ing linguistic and cultural differences; (L) the center, has developed an ongoing referral relationship with one or more hos- pitals; (M) the center encourages persons receiv- ing or seeking health services from the cen- ter to participate in any public or private (including employer-offered) health pro- grams or plans for which the persons are eli- gible, 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 pro- cedures in place to ensure the appropriate use of Federal funds in compliance with ap- plicable 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. (l) Technical assistance The Secretary shall establish a program through which the Secretary shall provide (ei- Page 348 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b 1 So in original. Probably should be ‘‘an’’. ther through the Department of Health and Human Services or by grant or contract) tech- nical 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 fis- cal and program management, operational and administrative support, and the provision of in- formation to the entities of the variety of re- sources available under this subchapter 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 (m) shall not exceed 3 percent of the amount appropriated for this section for the fiscal year involved. (m) Memorandum of agreement In carrying out this section, the Secretary may enter into a memorandum of agreement with a State. Such memorandum may include, where appropriate, provisions permitting such State to— (1) analyze the need for primary health serv- ices for medically underserved populations within such State; (2) assist in the planning and development of new health centers; (3) review and comment upon annual pro- gram plans and budgets of health centers, in- cluding comments upon allocations of health care resources in the State; (4) assist health centers in the development of clinical practices and fiscal and administra- tive 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 cen- ters. (n) 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 repro- duction on or off the premises of such entity upon a reasonable request therefore. The Sec- retary 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 repro- duction. (o) Delegation of authority The Secretary may delegate the authority to administer the programs authorized by this sec- tion to any office, except that the authority to enter into, modify, or issue approvals with re- spect to grants or contracts may be delegated only within the central office of the Health Re- sources and Services Administration. (p) Special consideration In making grants under this section, the Sec- retary 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), and the granting of waivers as appro- priate and permitted under subsections (b)(1)(B)(i) and (k)(3)(G). (q) Audits (1) In general Each entity which receives a grant under this section shall provide for an independent annual financial audit of any books, accounts, financial records, files, and other papers and property which relate to the disposition or use of the funds received under such grant and such other funds received by or allocated to the project for which such grant was made. For purposes of assuring accurate, current, and complete disclosure of the disposition or use of the funds received, each such audit shall be conducted in accordance with generally ac- cepted accounting principles. Each audit shall evaluate— (A) the entity’s implementation of the guidelines established by the Secretary re- specting cost accounting, (B) the processes used by the entity to meet the financial and program reporting re- quirements 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 man- ner 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 1 audit under this subsection shall make such books, documents, papers, and records avail- able to the Secretary or the Comptroller Gen- eral 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 ex- amination, copying, and reproduction. Page 349 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b 2 So in original. Probably should be ‘‘hospital’’. (4) Waiver The Secretary may, under appropriate cir- cumstances, 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 en- tity may not receive more than one waiver under this paragraph in consecutive years. (r) 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 au- thorized 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 subse- quent fiscal year, the amount appropriated for the preceding fiscal year adjusted by the product of— (i) one plus the average percentage in- crease in costs incurred per patient served; and (ii) one plus the average percentage in- crease in the total number of patients served. (2) Special provisions (A) Public centers The Secretary may not expend in any fis- cal year, for grants under this section to public centers (as defined in the second sen- tence 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 pur- poses 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 fol- lowing fiscal years, the Secretary, in award- ing 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 appro- priated to carry out this section for that fis- cal year, is equal to the proportion of the amount made available under that sub- section 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 Committee on Health, Edu- cation, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce of the House of Representatives, a report includ- ing, at a minimum— (A) the distribution of funds for carrying out this section that are provided to meet the health care needs of medically under- served populations, including the homeless, residents of public housing, and migratory and seasonal agricultural workers, and the appropriateness of the delivery systems in- volved in responding to the needs of the par- ticular populations; (B) an assessment of the relative health care access needs of the targeted popu- lations; (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 author- ity under subchapter XIV; (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 (q)(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 [42 U.S.C. 1395x(aa)(2)]), a low-volume hospital (as de- fined for purposes of section 1886 of such Act [42 U.S.C. 1395ww]), a critical access hos- pital, 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 individ- uals 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 serv- ices available in that clinic or hospitals.2 (B) Assurances In order for a clinic or hospital to receive funds under this section through a contract with a community health center under sub- paragraph (A), such clinic or hospital shall establish policies to ensure— (i) nondiscrimination based on the abil- ity 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 paragraph (1) of this subsection, Page 350 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b section 282a of this title, or section 254b–2 of this title, there is authorized to be appro- priated, and there is appropriated, out of any monies in the Treasury not otherwise appro- priated, to the Secretary $25,000,000 for fiscal year 2018 to support the participation of health centers in the All of Us Research Pro- gram under the Precision Medicine Initiative under section 289g–5 of this title. (6) Additional amounts for supplemental awards In addition to any amounts made available pursuant to this subsection, section 282a of this title, or section 254b—2 of this title, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treas- ury not otherwise appropriated, $1,320,000,000 for fiscal year 2020 for supplemental awards under subsection (d) for the detection of SARS–CoV–2 or the prevention, diagnosis, and treatment of COVID–19. (July 1, 1944, ch. 373, title III, § 330, as added Pub. L. 104–299, § 2, Oct. 11, 1996, 110 Stat. 3626; amend- ed Pub. L. 107–251, title I, § 101, Oct. 26, 2002, 116 Stat. 1622; Pub. L. 108–163, § 2(a), Dec. 6, 2003, 117 Stat. 2020; Pub. L. 110–355, § 2(a), (c)(1), Oct. 8, 2008, 122 Stat. 3988, 3992; Pub. L. 111–148, title IV, § 4206, title V, § 5601, Mar. 23, 2010, 124 Stat. 576, 676; Pub. L. 115–123, div. E, title IX, § 50901(b), Feb. 9, 2018, 132 Stat. 283; Pub. L. 116–136, div. A, title III, § 3211(a), Mar. 27, 2020, 134 Stat. 368; Pub. L. 116–260, div. BB, title III, § 311(c), Dec. 27, 2020, 134 Stat. 2925; Pub. L. 117–204, § 2(a), Oct. 17, 2022, 136 Stat. 2231.) Editorial Notes REFERENCES IN TEXT The Social Security Act, referred to in subsec. (k)(3)(E)(i), (F), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XVIII, XIX, and XXI of the Act are classified generally to subchapters XVIII (§ 1395 et seq.), XIX (§ 1396 et seq.), and XXI (§ 1397aa et seq.), respectively, of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables. The Indian Self-Determination Act, referred to in subsec. (k)(3)(H), is title I of Pub. L. 93–638, Jan. 4, 1975, 88 Stat. 2206, which is classified principally to sub- chapter I (§ 5321 et seq.) of chapter 46 of Title 25, Indi- ans. For complete classification of this Act to the Code, see Short Title note set out under section 5301 of Title 25 and Tables. The Indian Health Care Improvement Act, referred to in subsec. (k)(3)(H), is Pub. L. 94–437, Sept. 30, 1976, 90 Stat. 1400, which is classified principally to chapter 18 (§ 1601 et seq.) of Title 25. For complete classification of this Act to the Code, see Short Title note set out under section 1601 of Title 25 and Tables. PRIOR PROVISIONS A prior section 254a–1, act July 1, 1944, ch. 373, title III, § 328, as added Nov. 10, 1978, Pub. L. 95–626, title I, § 114, 92 Stat. 3563; amended Pub. L. 96–88, title V, § 509(b), Oct. 17, 1979, 93 Stat. 695, related to hospital-af- filiated primary care centers, prior to repeal by Pub. L. 99–117, § 12(c), Oct. 7, 1985, 99 Stat. 495. A prior section 254b, act July 1, 1944, ch. 373, title III, § 329, formerly § 310, as added Sept. 25, 1962, Pub. L. 87–692, 76 Stat. 592; amended Aug. 5, 1965, Pub. L. 89–109, § 3, 79 Stat. 436; Oct. 15, 1968, Pub. L. 90–574, title II, § 201, 82 Stat. 1006; Mar. 12, 1970, Pub. L. 91–209, 84 Stat. 52; June 18, 1973, Pub. L. 93–45, title I, § 105, 87 Stat. 91; renumbered § 319, July 23, 1974, Pub. L. 93–353, title I, § 102(d), 88 Stat. 362; amended July 29, 1975, Pub. L. 94–63, title IV, § 401(a), title VII, § 701(c), 89 Stat. 334, 352; Apr. 22, 1976, Pub. L. 94–278, title VIII, § 801(a), 90 Stat. 414; Aug. 1, 1977, Pub. L. 95–83, title III, § 303, 91 Stat. 388; renumbered § 329 and amended Nov. 10, 1978, Pub. L. 95–626, title I, §§ 102(a), 103(a)–(g)(1)(B), (2), (h), (i), 92 Stat. 3551–3555; July 10, 1979, Pub. L. 96–32, § 6(a), 93 Stat. 83; Oct. 17, 1979, Pub. L. 96–88, title V, § 509(b), 93 Stat. 695; Aug. 13, 1981, Pub. L. 97–35, title IX, § 930, 95 Stat. 569; Dec. 21, 1982, Pub. L. 97–375, title I, § 107(b), 96 Stat. 1820; Apr. 24, 1986, Pub. L. 99–280, §§ 6, 7, 100 Stat. 400, 401; Aug. 10, 1988, Pub. L. 100–386, § 2, 102 Stat. 919; Nov. 6, 1990, Pub. L. 101–527, § 9(b), 104 Stat. 2333; Oct. 27, 1992, Pub. L. 102–531, title III, § 309(a), 106 Stat. 3499, re- lated to migrant health centers, prior to the general amendment of this subpart by Pub. L. 104–299, § 2. Another prior section 254b, act July 1, 1944, ch. 373, title III, § 329, as added Dec. 31, 1970, Pub. L. 91–623, § 2, 84 Stat. 1868; amended Nov. 18, 1971, Pub. L. 92–157, title II, § 203, 85 Stat. 462; Oct. 27, 1972, Pub. L. 92–585, § 2, 86 Stat. 1290; July 29, 1975, Pub. L. 94–63, title VIII, §§ 801–803, 89 Stat. 353, 354; Oct. 12, 1976, Pub. L. 94–484, title I, § 101(b), 90 Stat. 2244, related to establishment of National Health Service Corps, assignment of personnel and statement of purpose, prior to repeal by Pub. L. 94–484, title IV, § 407(b)(1), Oct. 12, 1976, 90 Stat. 2268. See section 254d et seq. of this title. A prior section 330 of act July 1, 1944, was classified to section 254c of this title prior to the general amend- ment of this subpart by Pub. L. 104–299. AMENDMENTS 2022—Subsec. (e)(6)(A)(v). Pub. L. 117–204 added cl. (v). 2020—Subsec. (d)(1)(H). Pub. L. 116–260 added subpar. (H). Subsec. (r)(6). Pub. L. 116–136 added par. (6). 2018—Subsec. (b)(1)(A)(ii), (2)(A). Pub. L. 115–123, § 50901(b)(1), (2), substituted ‘‘use disorder’’ for ‘‘abuse’’. Subsec. (c)(1). Pub. L. 115–123, § 50901(b)(3), substituted ‘‘Centers’’ for ‘‘In general’’ in heading, struck out sub- par. (A) designation and heading, redesignated cls. (i) to (v) of former subpar. (A) as subpars. (A) to (E), re- spectively, realigned margins, and struck out former subpars. (B) to (D) which related to managed care net- works and plans, practice management networks, and use of funds, respectively. Subsec. (d). Pub. L. 115–123, § 50901(b)(4), added subsec. (d) and struck out former subsec. (d) which related to loan guarantee program. Subsec. (e)(1)(B). Pub. L. 115–123, § 50901(b)(5)(A), sub- stituted ‘‘1 year’’ for ‘‘2 years’’ and inserted at end ‘‘The Secretary shall not make a grant under this para- graph unless the applicant provides assurances to the Secretary that within 120 days of receiving grant fund- ing for the operation of the health center, the applicant will submit, for approval by the Secretary, an imple- mentation plan to meet the requirements of subsection (k)(3). The Secretary may extend such 120-day period for achieving compliance upon a demonstration of good cause by the health center.’’ Subsec. (e)(1)(C). Pub. L. 115–123, § 50901(b)(5)(B), in heading, struck out ‘‘and plans’’ after ‘‘networks’’, and in text, struck out ‘‘or plan (as described in subpara- graphs (B) and (C) of subsection (c)(1))’’ after ‘‘to a net- work’’, substituted ‘‘including—’’ for ‘‘or plan, includ- ing’’, inserted cl. (i) designation before ‘‘the purchase’’ and ‘‘, which may include data and information sys- tems’’ after ‘‘of equipment’’, and added cls. (ii) and (iii). Subsec. (e)(5)(B). Pub. L. 115–123, § 50901(b)(6), in head- ing, struck out ‘‘and plans’’ after ‘‘Networks’’ and in text, substituted ‘‘to a health center or to a network’’ for ‘‘and subparagraphs (B) and (C) of subsection (c)(1) to a health center or to a network or plan’’. Subsec. (e)(6). Pub. L. 115–123, § 50901(b)(7), added par. (6). Subsec. (h)(1). Pub. L. 115–123, § 50901(b)(8)(A), sub- stituted ‘‘, children and youth at risk of homelessness, homeless veterans, and veterans at risk of homeless- ness’’ for ‘‘and children and youth at risk of homeless- ness’’. Page 351 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b Subsec. (h)(5)(B). Pub. L. 115–123, § 50901(b)(8)(B)(iii)(II), which directed substitution of ‘‘use disorder’’ for ‘‘abuse’’, was executed by making the substitution the first place it appeared, to reflect the probable intent of Congress. Pub. L. 115–123, § 50901(b)(8)(B)(iii)(I), substituted ‘‘use disorder’’ for ‘‘abuse’’ in heading. Pub. L. 115–123, § 50901(b)(8)(B)(i), (ii), redesignated subpar. (C) as (B) and struck out former subpar. (B). Prior to amendment, text of subpar. (B) read as follows: ‘‘The term ‘substance abuse’ has the same meaning given such term in section 290cc–34(4) of this title.’’ Subsec. (h)(5)(C). Pub. L. 115–123, § 50901(b)(8)(B)(ii), redesignated subpar. (C) as (B). Subsec. (k)(2). Pub. L. 115–123, § 50901(b)(9)(A)(i), (ii), in heading, inserted ‘‘unmet’’ before ‘‘need’’, and in in- troductory provisions, inserted ‘‘or subsection (e)(6)’’ after ‘‘subsection (e)(1)’’. Subsec. (k)(2)(A). Pub. L. 115–123, § 50901(b)(9)(A)(iii), inserted ‘‘unmet’’ before ‘‘need for health services’’. Subsec. (k)(2)(D). Pub. L. 115–123, § 50901(b)(9)(A)(iv)–(vi), added subpar. (D). Subsec. (k)(3). Pub. L. 115–123, § 50901(b)(9)(B)(i), in- serted ‘‘or subsection (e)(6)’’ after ‘‘subsection (e)(1)(B)’’ in introductory provisions. Subsec. (k)(3)(B). Pub. L. 115–123, § 50901(b)(9)(B)(ii), substituted ‘‘, including other health care providers that provide care within the catchment area, local hos- pitals, 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’’ for ‘‘in the catchment area of the center’’. Subsec. (k)(3)(H)(ii). Pub. L. 115–123, § 50901(b)(9)(B)(iii), inserted ‘‘who shall be directly em- ployed by the center’’ after ‘‘approves the selection of a director for the center’’. Subsec. (k)(3)(N). Pub. L. 115–123, § 50901(b)(9)(B)(iv)–(vi), added subpar. (N). Subsec. (k)(4). Pub. L. 115–123, § 50901(b)(9)(C), struck out par. (4) which related to approval of new or ex- panded service applications. Subsec. (l). Pub. L. 115–123, § 50901(b)(10), inserted at end ‘‘Funds expended to carry out activities under this subsection and operational support activities under subsection (m) shall not exceed 3 percent of the amount appropriated for this section for the fiscal year in- volved.’’ Subsec. (q)(4). Pub. L. 115–123, § 50901(b)(11), inserted at end ‘‘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 en- tity may not receive more than one waiver under this paragraph in consecutive years.’’ Subsec. (r)(3). Pub. L. 115–123, § 50901(b)(12), sub- stituted ‘‘Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce of the House of Representatives, a re- port including, at a minimum—’’ for ‘‘appropriate com- mittees of Congress a report concerning the distribu- tion of funds under this section’’, inserted ‘‘(A) the dis- tribution of funds for carrying out this section’’ before ‘‘that are provided’’, substituted ‘‘particular popu- lations;’’ for ‘‘particular populations. Such report shall include’’, inserted subsec. (B) designation before ‘‘an assessment’’, substituted ‘‘targeted populations;’’ for ‘‘targeted populations and the rationale for any sub- stantial changes in the distribution of funds.’’, and added subpars. (C) to (I). Subsec. (r)(5). Pub. L. 115–123, § 50901(b)(13), added par. (5). Subsec. (s). Pub. L. 115–123, § 50901(b)(14), struck out subsec. (s) which related to demonstration program for individualized wellness plans. 2010—Subsec. (r)(1). Pub. L. 111–148, § 5601(a), added par. (1) and struck out former par. (1). Prior to amend- ment, text read as follows: ‘‘For the purpose of car- rying out this section, in addition to the amounts au- thorized to be appropriated under subsection (d), there are authorized to be appropriated— ‘‘(A) $2,065,000,000 for fiscal year 2008; ‘‘(B) $2,313,000,000 for fiscal year 2009; ‘‘(C) $2,602,000,000 for fiscal year 2010; ‘‘(D) $2,940,000,000 for fiscal year 2011; and ‘‘(E) $3,337,000,000 for fiscal year 2012.’’ Subsec. (r)(4). Pub. L. 111–148, § 5601(b), added par. (4). Subsec. (s). Pub. L. 111–148, § 4206, added subsec. (s). 2008—Subsec. (c)(3). Pub. L. 110–355, § 2(c)(1), added par. (3). Subsec. (r)(1). Pub. L. 110–355, § 2(a), amended par. (1) generally. Prior to amendment, text read as follows: ‘‘For the purpose of carrying out this section, in addi- tion to the amounts authorized to be appropriated under subsection (d) of this section, there are author- ized to be appropriated $1,340,000,000 for fiscal year 2002 and such sums as may be necessary for each of the fis- cal years 2003 through 2006.’’ 2003—Subsec. (c)(1)(B). Pub. L. 108–163, § 2(a)(2)(A), substituted ‘‘plan.’’ for ‘‘plan..’’ in introductory provi- sions. Subsec. (d)(1)(B)(iii)(I). Pub. L. 108–163, § 2(a)(2)(B), in- serted ‘‘or’’ at end. Subsec. (e)(3) to (5). Pub. L. 108–163, § 2(a)(1)(A), amended pars. (3) to (5) to read as if subpar. (C) of the second par. (4) of section 101 of Pub. L. 107–251 had not been enacted. See 2002 Amendment notes below. Subsec. (j). Pub. L. 108–163, § 2(a)(2)(E), added subsec. (j) identical to the subsec. (j) appearing in the amend- ment by section 101(8)(C) of Pub. L. 107–251. See 2002 Amendment notes below. Former subsec. (j) redesig- nated (k). Pub. L. 108–163, § 2(a)(1)(C), amended subsec. (j) to read as if pars. (8) through (11) of section 101 of Pub. L. 107–251 had not been enacted. See 2002 Amendment notes below. Subsec. (j)(3)(H). Pub. L. 108–163, § 2(a)(1)(B), amended subpar. (H) to read as if subpar. (C) of par. (7) of section 101 of Pub. L. 107–251 had not been enacted. See 2002 Amendment note below. Subsec. (k). Pub. L. 108–163, § 2(a)(2)(C), (D), redesig- nated subsec. (j) as (k) and struck out heading and text of former subsec. (k). Text read as follows: ‘‘The Sec- retary may provide (either through the Department of Health and Human Services or by grant or contract) all necessary technical and other nonfinancial assistance (including fiscal and program management assistance and training in such management) to any public or pri- vate nonprofit entity to assist entities in developing plans for, or operating as, health centers, and in meet- ing the requirements of subsection (j)(2) of this sec- tion.’’ Pub. L. 108–163, § 2(a)(1)(C), amended subsec. (k) to read as if pars. (8) through (11) of section 101 of Pub. L. 107–251 had not been enacted. See 2002 Amendment notes below. Subsec. (l). Pub. L. 108–163, § 2(a)(2)(H), inserted ‘‘(ei- ther through the Department of Health and Human Services or by grant or contract)’’ after ‘‘shall provide’’ and substituted ‘‘(k)(3)’’ for ‘‘(l)(3)’’. Pub. L. 108–163, § 2(a)(2)(G), added subsec. (l) identical to the subsec. (m) appearing in the amendment by sec- tion 101(9) of Pub. L. 107–251. See 2002 Amendment notes below. Former subsec. (l) redesignated (r). Pub. L. 108–163, § 2(a)(1)(C), amended subsec. (l) to read as if pars. (8) through (11) of section 101 of Pub. L. 107–251 had not been enacted. See 2002 Amendment note below. Subsecs. (m) to (o). Pub. L. 108–163, § 2(a)(1)(C), amend- ed subsecs. (m) to (o) to read as if pars. (8) through (11) of section 101 of Pub. L. 107–251 had not been enacted. See 2002 Amendment notes below. Subsec. (p). Pub. L. 108–163, § 2(a)(2)(I), substituted ‘‘(k)(3)(G)’’ for ‘‘(j)(3)(G)’’. Pub. L. 108–163, § 2(a)(1)(C), amended subsec. (p) to read as if pars. (8) through (11) of section 101 of Pub. L. 107–251 had not been enacted. See 2002 Amendment note below. Subsec. (q). Pub. L. 108–163, § 2(a)(1)(C), amended sub- sec. (q) to read as if pars. (8) through (11) of section 101 of Pub. L. 107–251 had not been enacted. See 2002 Amendment note below. Page 352 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b Subsec. (r). Pub. L. 108–163, § 2(a)(2)(F), redesignated subsec. (l) as (r). Pub. L. 108–163, § 2(a)(1)(C), amended subsec. (r) to read as if pars. (8) through (11) of section 101 of Pub. L. 107–251 had not been enacted. See 2002 Amendment note below. Subsec. (r)(1). Pub. L. 108–163, § 2(a)(2)(J)(i), sub- stituted ‘‘$1,340,000,000 for fiscal year 2002 and such sums as may be necessary for each of the fiscal years 2003 through 2006’’ for ‘‘$802,124,000 for fiscal year 1997, and such sums as may be necessary for each of the fis- cal years 1998 through 2001’’. Subsec. (r)(2)(A). Pub. L. 108–163, § 2(a)(2)(J)(ii), sub- stituted ‘‘(k)(3)’’ for ‘‘(j)(3)’’ and ‘‘(k)(3)(H)’’ for ‘‘(j)(3)(G)(ii)’’. Subsec. (r)(2)(B). Pub. L. 108–163, § 2(a)(2)(J)(iii), added subpar. (B) identical to the subpar. (B) appearing in the amendment by section 101(11)(B)(ii) of Pub. L. 107–251 and struck out heading and text of former subpar. (B) relating to distribution of grants for fiscal years 1997 through 1999. See 2002 Amendment note below. Subsec. (s). Pub. L. 108–163, § 2(a)(1)(C), amended sub- sec. (s) to read as if pars. (8) through (11) of section 101 of Pub. L. 107–251 had not been enacted. See 2002 Amendment notes below. 2002—Subsec. (b)(1)(A)(i)(III)(bb). Pub. L. 107–251, § 101(1)(A), substituted ‘‘appropriate cancer screening’’ for ‘‘screening for breast and cervical cancer’’. Subsec. (b)(1)(A)(ii). Pub. L. 107–251, § 101(1)(B), in- serted ‘‘(including specialty referral when medically in- dicated)’’ after ‘‘medical services’’. Subsec. (b)(1)(A)(iii). Pub. L. 107–251, § 101(1)(C), in- serted ‘‘housing,’’ after ‘‘social,’’. Subsec. (b)(2)(A). Pub. L. 107–251, § 101(2)(C), added subpar. (A). Former subpar. (A) redesignated (C). Subsec. (b)(2)(A)(i). Pub. L. 107–251, § 101(2)(A), sub- stituted ‘‘associated with—’’ and subcls. (I) to (IV) for ‘‘associated with water supply;’’. Subsec. (b)(2)(B) to (D). Pub. L. 107–251, § 101(2)(B), (C), added subpar. (B) and redesignated former subpars. (A) and (B) as (C) and (D), respectively. Subsec. (c)(1)(B). Pub. L. 107–251, § 101(3)(A)(iii), struck out concluding provisions which read as follows: ‘‘Any such grant may include the acquisition and lease of buildings and equipment which may include data and information systems (including the costs of amortizing the principal of, and paying the interest on, loans), and providing training and technical assistance related to the provision of health services on a prepaid basis or under another managed care arrangement, and for other purposes that promote the development of man- aged care networks and plans.’’ Pub. L. 107–251, § 101(3)(A)(ii), in introductory provi- sions, substituted ‘‘managed care network or plan.’’ for ‘‘network or plan for the provision of health services, which may include the provision of health services on a prepaid basis or through another managed care ar- rangement, to some or to all of the individuals which the centers serve’’. Pub. L. 107–251, § 101(3)(A)(i), substituted ‘‘Managed care’’ for ‘‘Comprehensive service delivery’’ in heading. Subsec. (c)(1)(C), (D). Pub. L. 107–251, § 101(3)(B), added subpars. (C) and (D). Subsec. (d). Pub. L. 107–251, § 101(4)(A), substituted ‘‘Loan guarantee program’’ for ‘‘Managed care loan guarantee program’’ in heading. Subsec. (d)(1)(A). Pub. L. 107–251, § 101(4)(B)(i), sub- stituted ‘‘up to 90 percent of the principal and interest on loans made by non-Federal lenders to health cen- ters, funded under this section, for the costs of devel- oping and operating managed care networks or plans described in subsection (c)(1)(B), or practice manage- ment networks described in subsection (c)(1)(C)’’ for ‘‘the principal and interest on loans made by non-Fed- eral lenders to health centers funded under this section for the costs of developing and operating managed care networks or plans’’. Subsec. (d)(1)(B)(iii). Pub. L. 107–251, § 101(4)(B)(ii), added cl. (iii). Subsec. (d)(1)(D), (E). Pub. L. 107–251, § 101(4)(B)(iii), added subpars. (D) and (E). Subsec. (d)(6) to (8). Pub. L. 107–251, § 101(4)(C), redes- ignated par. (8) as (6) and struck out headings and text of former pars. (6) and (7) which related to annual re- ports and program evaluation, respectively. Subsec. (e)(1)(B). Pub. L. 107–251, § 101(4)(A)(i), sub- stituted ‘‘subsection (k)(3)’’ for ‘‘subsection (j)(3)’’. Subsec. (e)(1)(C). Pub. L. 107–251, § 101(4)(A)(ii), added subpar. (C). Subsec. (e)(3). Pub. L. 107–251, § 101(4)(C), redesignated par. (4), relating to limitation, as (3). Subsec. (e)(4). Pub. L. 107–251, § 101(4)(C), redesignated par. (5) as (4). Former par. (4) redesignated (3). Subsec. (e)(5). Pub. L. 107–251, § 101(4)(B), (C), redesig- nated par. (5) as (4), inserted ‘‘subparagraphs (A) and (B) of’’ after ‘‘any fiscal year under’’ in subpar. (A), added subpar. (B), and redesignated former subpars. (B) and (C) as (C) and (D), respectively. Subsec. (g)(2)(A). Pub. L. 107–251, § 101(5)(A)(i), in- serted ‘‘and seasonal agricultural worker’’ after ‘‘mi- gratory agricultural worker’’. Subsec. (g)(2)(B). Pub. L. 107–251, § 101(5)(A)(ii), sub- stituted ‘‘and seasonal agricultural workers, and mem- bers of their families,’’ for ‘‘and members of their fami- lies’’. Subsec. (g)(3)(A). Pub. L. 107–251, § 101(5)(B), struck out ‘‘on a seasonal basis’’ after ‘‘in agriculture’’. Subsec. (h)(1). Pub. L. 107–251, § 101(6)(A), substituted ‘‘homeless children and youth and children and youth at risk of homelessness’’ for ‘‘homeless children and children at risk of homelessness’’. Subsec. (h)(4). Pub. L. 107–251, § 101(6)(B)(ii), added par. (4). Former par. (4) redesignated (5). Subsec. (h)(5). Pub. L. 107–251, § 101(6)(B)(i), (C), redes- ignated par. (4) as (5) and substituted ‘‘, risk reduction, outpatient treatment, residential treatment, and reha- bilitation’’ for ‘‘and residential treatment’’ in subpar. (C). Subsec. (j). Pub. L. 107–251, § 101(8)(C), added subsec. (j) relating to access grants. Pub. L. 107–251, § 101(8)(B), which directed the redesig- nation of subsecs. (j), (k), and (m) through (q) as sub- secs. (n), (o), and (p) through (s), respectively, could not be executed. Subsec. (j)(3)(E)(i). Pub. L. 107–251, § 101(7)(A)(i), des- ignated existing provisions as subcl. (I) and added subcl. (II). Subsec. (j)(3)(E)(ii). Pub. L. 107–251, § 101(7)(A)(ii), sub- stituted ‘‘arrangements described in subclauses (I) and (II) of clause (i)’’ for ‘‘such an arrangement’’. Subsec. (j)(3)(G)(iii), (iv). Pub. L. 107–251, § 101(7)(B), added cl. (iii) and redesignated former cl. (iii) as (iv). Subsec. (j)(3)(H). Pub. L. 107–251, § 101(7)(C), sub- stituted ‘‘or (q)’’ for ‘‘or (p)’’ in concluding provisions. Subsec. (j)(3)(M). Pub. L. 107–251, § 101(7)(D)–(F), added subpar. (M). Subsec. (k). Pub. L. 107–251, § 101(8)(B), which directed the redesignation of subsecs. (j), (k), and (m) through (q) as subsecs. (n), (o), and (p) through (s), respectively, could not be executed. Subsec. (l). Pub. L. 107–251, § 101(8)(A), redesignated subsec. (l) as (s). Subsec. (m). Pub. L. 107–251, § 101(9), which directed striking subsec. (m) (as redesignated by paragraph (9)(B)) and adding a new subsec. (m), could not be exe- cuted. The new subsec. (m) to be added read as follows: ‘‘(m) TECHNICAL ASSISTANCE.—The Secretary shall es- tablish a program through which the Secretary shall provide technical and other assistance to eligible enti- ties to assist such entities to meet the requirements of subsection (l)(3). Services provided through the pro- gram 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 provi- sion of information to the entities of the variety of re- sources available under this subchapter and how those resources can be best used to meet the health needs of the communities served by the entities.’’ Pub. L. 107–251, § 101(8)(B), which directed the redesig- nation of subsecs. (j), (k), and (m) through (q) as sub- Page 353 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b secs. (n), (o), and (p) through (s), respectively, could not be executed. Subsecs. (n) to (p). Pub. L. 107–251, § 101(8)(B), which directed the redesignation of subsecs. (j), (k), and (m) through (q) as subsecs. (n), (o), and (p) through (s), re- spectively, could not be executed. Subsec. (q). Pub. L. 107–251, § 101(10), which directed the substitution of ‘‘(l)(3)(G)’’ for ‘‘(j)(3)(G)’’ in subsec. (q) ‘‘(as redesignated by paragraph (9)(B))’’, could not be executed. Pub. L. 107–251, § 101(8)(B), which directed the redesig- nation of subsecs. (j), (k), and (m) through (q) as sub- secs. (n), (o), and (p) through (s), respectively, could not be executed. Subsec. (r). Pub. L. 107–251, § 101(8)(B), which directed the redesignation of subsecs. (j), (k), and (m) through (q) as subsecs. (n), (o), and (p) through (s), respectively, could not be executed. Subsec. (s). Pub. L. 107–251, § 101(8)(B), which directed the redesignation of subsecs. (j), (k), and (m) through (q) as subsecs. (n), (o), and (p) through (s), respectively, could not be executed. Subsec. (s)(1). Pub. L. 107–251, § 101(11)(A), substituted ‘‘$1,340,000,000 for fiscal year 2002 and such sums as may be necessary for each of the fiscal years 2003 through 2006’’ for ‘‘$802,124,000 for fiscal year 1997, and such sums as may be necessary for each of the fiscal years 1998 through 2001’’. Subsec. (s)(2)(A). Pub. L. 107–251, § 101(11)(B)(i), sub- stituted ‘‘(l)(3)’’ for ‘‘(j)(3)’’ and ‘‘(l)(3)(H)’’ for ‘‘(j)(3)(G)(ii)’’. Subsec. (s)(2)(B). Pub. L. 107–251, § 101(11)(B)(ii), added subpar. (B) and struck out heading and text of former subpar. (B) relating to distribution of grants for fiscal years 1997 through 1999. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2022 AMENDMENT Pub. L. 117–204, § 2(b), Oct. 17, 2022, 136 Stat. 2231, pro- vided that: ‘‘The amendment made by subsection (a) [amending this section] shall take effect on January 1, 2024.’’ EFFECTIVE DATE OF 2008 AMENDMENT Pub. L. 110–355, § 2(c)(2), Oct. 8, 2008, 122 Stat. 3992, provided that: ‘‘The amendment made by paragraph (1) [amending this section] shall apply to grants made on or after January 1, 2009.’’ EFFECTIVE DATE OF 2003 AMENDMENT Amendments by Pub. L. 108–163 deemed to have taken effect immediately after the enactment of Pub. L. 107–251, see section 3 of Pub. L. 108–163, set out as a note under section 233 of this title. EFFECTIVE DATE Section effective Oct. 1, 1996, see section 5 of Pub. L. 104–299, as amended, set out as an Effective Date of 1996 Amendment note under section 233 of this title. SAVINGS PROVISION FOR CURRENT GRANTS, CONTRACTS, AND COOPERATIVE AGREEMENTS Pub. L. 104–299, § 3(b), Oct. 11, 1996, 110 Stat. 3644, pro- vided that: ‘‘The Secretary of Health and Human Serv- ices shall ensure the continued funding of grants made, or contracts or cooperative agreements entered into, under subpart I of part D of title III of the Public Health Service Act (42 U.S.C. 254b et seq.) (as such sub- part existed on the day prior to the date of enactment of this Act [Oct. 11, 1996]), until the expiration of the grant period or the term of the contract or cooperative agreement. Such funding shall be continued under the same terms and conditions as were in effect on the date on which the grant, contract or cooperative agreement was awarded, subject to the availability of appropria- tions.’’ NEGOTIATED RULEMAKING FOR DEVELOPMENT OF METH- ODOLOGY AND CRITERIA FOR DESIGNATING MEDICALLY UNDERSERVED POPULATIONS AND HEALTH PROFES- SIONS SHORTAGE AREAS Pub. L. 111–148, title V, § 5602, Mar. 23, 2010, 124 Stat. 677, provided that: ‘‘(a) ESTABLISHMENT.— ‘‘(1) IN GENERAL.—The Secretary of Health and Human Services (in this section referred to as the ‘Secretary’) shall establish, through a negotiated rulemaking process under subchapter 3 [III] of chap- ter 5 of title 5, United States Code, a comprehensive methodology and criteria for designation of— ‘‘(A) medically underserved populations in ac- cordance with section 330(b)(3) of the Public Health Service Act (42 U.S.C. 254b(b)(3)); ‘‘(B) health professions shortage areas under sec- tion 332 of the Public Health Service Act (42 U.S.C. 254e). ‘‘(2) FACTORS TO CONSIDER.—In establishing the methodology and criteria under paragraph (1), the Secretary— ‘‘(A) shall consult with relevant stakeholders who will be significantly affected by a rule (such as na- tional, State and regional organizations rep- resenting affected entities), State health offices, community organizations, health centers and other affected entities, and other interested parties; and ‘‘(B) shall take into account— ‘‘(i) the timely availability and appropriateness of data used to determine a designation to poten- tial applicants for such designations; ‘‘(ii) the impact of the methodology and criteria on communities of various types and on health centers and other safety net providers; ‘‘(iii) the degree of ease or difficulty that will face potential applicants for such designations in securing the necessary data; and ‘‘(iv) the extent to which the methodology accu- rately measures various barriers that confront in- dividuals and population groups in seeking health care services. ‘‘(b) PUBLICATION OF NOTICE.—In carrying out the rulemaking process under this subsection, the Sec- retary shall publish the notice provided for under sec- tion 564(a) of title 5, United States Code, by not later than 45 days after the date of the enactment of this Act [Mar. 23, 2010]. ‘‘(c) TARGET DATE FOR PUBLICATION OF RULE.—As part of the notice under subsection (b), and for purposes of this subsection, the ‘target date for publication’, as re- ferred to in section 564(a)(5) of title 5, United Sates [sic] Code, shall be July 1, 2010. ‘‘(d) APPOINTMENT OF NEGOTIATED RULEMAKING COM- MITTEE AND FACILITATOR.—The Secretary shall provide for— ‘‘(1) the appointment of a negotiated rulemaking committee under section 565(a) of title 5, United States Code, by not later than 30 days after the end of the comment period provided for under section 564(c) of such title; and ‘‘(2) the nomination of a facilitator under section 566(c) of such title 5 by not later than 10 days after the date of appointment of the committee. ‘‘(e) PRELIMINARY COMMITTEE REPORT.—The nego- tiated rulemaking committee appointed under sub- section (d) shall report to the Secretary, by not later than April 1, 2010, regarding the committee’s progress on achieving a consensus with regard to the rule- making proceeding and whether such consensus is like- ly to occur before one month before the target date for publication of the rule. If the committee reports that the committee has failed to make significant progress toward such consensus or is unlikely to reach such con- sensus by the target date, the Secretary may terminate such process and provide for the publication of a rule under this section through such other methods as the Secretary may provide. Page 354 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b ‘‘(f) FINAL COMMITTEE REPORT.—If the committee is not terminated under subsection (e), the rulemaking committee shall submit a report containing a proposed rule by not later than one month before the target pub- lication date. ‘‘(g) INTERIM FINAL EFFECT.—The Secretary shall publish a rule under this section in the Federal Reg- ister by not later than the target publication date. Such rule shall be effective and final immediately on an interim basis, but is subject to change and revision after public notice and opportunity for a period (of not less than 90 days) for public comment. In connection with such rule, the Secretary shall specify the process for the timely review and approval of applications for such designations pursuant to such rules and consistent with this section. ‘‘(h) PUBLICATION OF RULE AFTER PUBLIC COMMENT.— The Secretary shall provide for consideration of such comments and republication of such rule by not later than 1 year after the target publication date.’’ FUNDING FOR COMMUNITY HEALTH CENTERS AND COMMUNITY CARE Pub. L. 117–2, title II, § 2601, Mar. 11, 2021, 135 Stat. 43, provided that: ‘‘(a) IN GENERAL.—In addition to amounts otherwise available, there is appropriated to the Secretary of Health and Human Services (in this subtitle [subtitle G (§§ 2601–2605) of title II of Pub. L 117–2, see Tables for classification] referred to as the ‘Secretary’) for fiscal year 2021, out of any money in the Treasury not other- wise appropriated, $7,600,000,000, to remain available until expended, for necessary expenses for awarding grants and cooperative agreements under section 330 of the Public Health Service Act (42 U.S.C. 254b) to be awarded without regard to the time limitation in sub- section (e)(3) and subsections (e)(6)(A)(iii), (e)(6)(B)(iii), and (r)(2)(B) of such section 330, and for necessary ex- penses for awarding grants to Federally qualified health centers, as described in section 1861(aa)(4)(B) of the Social Security Act (42 U.S.C. 1395x(aa)(4)(B)), and for awarding grants or contracts to Papa Ola Lokahi and to qualified entities under sections 4 and 6 of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11703, 11705). Of the total amount appropriated by the preceding sentence, not less than $20,000,000 shall be for grants or contracts to Papa Ola Lokahi and to qualified entities under sections 4 and 6 of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11703, 11705). ‘‘(b) USE OF FUNDS.—Amounts made available to an awardee pursuant to subsection (a) shall be used— ‘‘(1) to plan, prepare for, promote, distribute, ad- minister, and track COVID–19 vaccines, and to carry out other vaccine-related activities; ‘‘(2) to detect, diagnose, trace, and monitor COVID–19 infections and related activities necessary to mitigate the spread of COVID–19, including activi- ties related to, and equipment or supplies purchased for, testing, contact tracing, surveillance, mitiga- tion, and treatment of COVID–19; ‘‘(3) to purchase equipment and supplies to conduct mobile testing or vaccinations for COVID–19, to pur- chase and maintain mobile vehicles and equipment to conduct such testing or vaccinations, and to hire and train laboratory personnel and other staff to conduct such mobile testing or vaccinations, particularly in medically underserved areas; ‘‘(4) to establish, expand, and sustain the health care workforce to prevent, prepare for, and respond to COVID–19, and to carry out other health workforce- related activities; ‘‘(5) to modify, enhance, and expand health care services and infrastructure; and ‘‘(6) to conduct community outreach and education activities related to COVID–19. ‘‘(c) PAST EXPENDITURES.—An awardee may use amounts awarded pursuant to subsection (a) to cover the costs of the awardee carrying out any of the activi- ties described in subsection (b) during the period begin- ning on the date of the declaration of a public health emergency by the Secretary under section 319 of the Public Health Service Act (42 U.S.C. 247d) on January 31, 2020, with respect to COVID–19 and ending on the date of such award.’’ STUDIES RELATING TO COMMUNITY HEALTH CENTERS Pub. L. 110–355, § 2(b)(1)–(3), Oct. 8, 2008, 122 Stat. 3988, 3989, provided that: ‘‘(1) DEFINITIONS.—For purposes of this subsection— ‘‘(A) the term ‘community health center’ means a health center receiving assistance under section 330 of the Public Health Service Act (42 U.S.C. 254b); and ‘‘(B) the term ‘medically underserved population’ has the meaning given that term in such section 330. ‘‘(2) SCHOOL-BASED HEALTH CENTER STUDY.— ‘‘(A) IN GENERAL.—Not later than 2 years after the date of enactment of this Act [Oct. 8, 2008], the Comp- troller General of the United States shall issue a study of the economic costs and benefits of school- based health centers and the impact on the health of students of these centers. ‘‘(B) CONTENT.—In conducting the study under sub- paragraph (A), the Comptroller General of the United States shall analyze— ‘‘(i) the impact that Federal funding could have on the operation of school-based health centers; ‘‘(ii) any cost savings to other Federal programs derived from providing health services in school- based health centers; ‘‘(iii) the effect on the Federal Budget and the health of students of providing Federal funds to school-based health centers and clinics, including the result of providing disease prevention and nu- trition information; ‘‘(iv) the impact of access to health care from school-based health centers in rural or underserved areas; and ‘‘(v) other sources of Federal funding for school- based health centers. ‘‘(3) HEALTH CARE QUALITY STUDY.— ‘‘(A) IN GENERAL.—Not later than 1 year after the date of enactment of this Act [Oct. 8, 2008], the Sec- retary of Health and Human Services (referred to in this Act [see Short Title of 2008 Amendment note set out under section 201 of this title] as the ‘Secretary’), acting through the Administrator of the Health Re- sources and Services Administration, and in collabo- ration with the Agency for Healthcare Research and Quality, shall prepare and submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report that de- scribes agency efforts to expand and accelerate qual- ity improvement activities in community health cen- ters. ‘‘(B) CONTENT.—The report under subparagraph (A) shall focus on— ‘‘(i) Federal efforts, as of the date of enactment of this Act, regarding health care quality in commu- nity health centers, including quality data collec- tion, analysis, and reporting requirements; ‘‘(ii) identification of effective models for quality improvement in community health centers, which may include models that— ‘‘(I) incorporate care coordination, disease man- agement, and other services demonstrated to im- prove care; ‘‘(II) are designed to address multiple, co-occur- ring diseases and conditions; ‘‘(III) improve access to providers through non- traditional means, such as the use of remote mon- itoring equipment; ‘‘(IV) target various medically underserved pop- ulations, including uninsured patient popu- lations; ‘‘(V) increase access to specialty care, including referrals and diagnostic testing; and ‘‘(VI) enhance the use of electronic health records to improve quality; Page 355 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b ‘‘(iii) efforts to determine how effective quality improvement models may be adapted for implemen- tation by community health centers that vary by size, budget, staffing, services offered, populations served, and other characteristics determined appro- priate by the Secretary; ‘‘(iv) types of technical assistance and resources provided to community health centers that may fa- cilitate the implementation of quality improve- ment interventions; ‘‘(v) proposed or adopted methodologies for com- munity health center evaluations of quality im- provement interventions, including any develop- ment of new measures that are tailored to safety- net, community-based providers; ‘‘(vi) successful strategies for sustaining quality improvement interventions in the long-term; and ‘‘(vii) partnerships with other Federal agencies and private organizations or networks as appro- priate, to enhance health care quality in commu- nity health centers. ‘‘(C) DISSEMINATION.—The Administrator of the Health Resources and Services Administration shall establish a formal mechanism or mechanisms for the ongoing dissemination of agency initiatives, best practices, and other information that may assist health care quality improvement efforts in commu- nity health centers.’’ GUARANTEE STUDY Pub. L. 107–251, title V, § 501, Oct. 26, 2002, 116 Stat. 1664, as amended by Pub. L. 108–163, § 2(n)(2), Dec. 6, 2003, 117 Stat. 2023, required the Secretary of Health and Human Services to conduct a study regarding the ability of the Department of Health and Human Serv- ices to provide for guarantees of solvency for managed care networks or plans involving health centers receiv- ing funding under this section and to prepare and sub- mit a report to Congress regarding such ability by 2 years after Oct. 26, 2002. REFERENCE TO COMMUNITY, MIGRANT, PUBLIC HOUSING, OR HOMELESS HEALTH CENTER CONSIDERED REF- ERENCE TO HEALTH CENTER Pub. L. 104–299, § 4(c), Oct. 11, 1996, 110 Stat. 3645, pro- vided that: ‘‘Whenever any reference is made in any provision of law, regulation, rule, record, or document to a community health center, migrant health center, public housing health center, or homeless health cen- ter, such reference shall be considered a reference to a health center.’’ LEGISLATIVE PROPOSAL FOR CHANGES CONFORMING TO PUB. L. 104–299 Pub. L. 104–299, § 4(e), Oct. 11, 1996, 110 Stat. 3645, pro- vided that: ‘‘After consultation with the appropriate committees of the Congress, the Secretary of Health and Human Services shall prepare and submit to the Congress a legislative proposal in the form of an imple- menting bill containing technical and conforming amendments to reflect the changes made by this Act [see Short Title of 1996 Amendments note set out under section 201 of this title].’’ Executive Documents EX. ORD. NO. 13937. ACCESS TO AFFORDABLE LIFE-SAVING MEDICATIONS Ex. Ord. No. 13937, July 24, 2020, 85 F.R. 45755, pro- vided: By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows: SECTION 1. Purpose. Insulin is a critical and life-sav- ing medication that approximately 8 million Ameri- cans rely on to manage diabetes. Likewise, injectable epinephrine is a life-saving medication used to stop se- vere allergic reactions. The price of insulin in the United States has risen dramatically over the past decade. The list price for a single vial of insulin today is often more than $250 and most patients use at least two vials per month. As for injectable epinephrine, recent increased competition is helping to drive prices down. Nevertheless, the price for some types of injectable epinephrine remains more than $600 per kit. While Americans with diabetes and severe allergic reactions may have access to affordable insulin and injectable epinephrine through commercial insurance or Federal programs such as Medicare and Medicaid, many Americans still struggle to purchase these products. Federally Qualified Health Centers (FQHCs), as de- fined in section 1905(l)(2)(B)(i) and (ii) of the Social Se- curity Act, as amended, 42 U.S.C. 1396d(l)(2)(B)(i) and (ii), receive discounted prices through the 340B Pre- scription Drug Program on prescription drugs. Due to the sharp increases in list prices for many insulins and some types of injectable epinephrine in recent years, many of these products may be subject to the ‘‘penny pricing’’ policy when distributed to FQHCs, meaning FQHCs may purchase the drug at a price of one penny per unit of measure. These steep discounts, however, are not always passed through to low-income Ameri- cans at the point of sale. Those with low-incomes can be exposed to high insulin and injectable epinephrine prices, as they often do not benefit from discounts ne- gotiated by insurers or the Federal or State govern- ments. SEC. 2. Policy. It is the policy of the United States to enable Americans without access to affordable insulin and injectable epinephrine through commercial insur- ance or Federal programs, such as Medicare and Med- icaid, to purchase these pharmaceuticals from an FQHC at a price that aligns with the cost at which the FQHC acquired the medication. SEC. 3. Improving the Availability of Insulin and Injectable Epinephrine for the Uninsured. To the extent permitted by law, the Secretary of Health and Human Services shall take action to ensure future grants available under section 330(e) of the Public Health Service Act, as amended, 42 U.S.C. 254b(e), are condi- tioned upon FQHCs’ having established practices to make insulin and injectable epinephrine available at the discounted price paid by the FQHC grantee or sub- grantee under the 340B Prescription Drug Program (plus a minimal administration fee) to individuals with low incomes, as determined by the Secretary, who: (a) have a high cost sharing requirement for either insulin or injectable epinephrine; (b) have a high unmet deductible; or (c) have no health care insurance. SEC. 4. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect: (i) the authority granted by law to an executive de- partment or agency, or the head thereof; (ii) the functions of the Director of the Office of Man- agement and Budget relating to budgetary, administra- tive, or legislative proposals. (b) This order shall be implemented consistent with applicable law and subject to the availability of appro- priations. (c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforce- able at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person. DONALD J. TRUMP. MEDICARE DEMONSTRATION TO TEST MEDICAL HOMES IN FEDERALLY QUALIFIED HEALTH CENTERS Memorandum of President of the United States, Dec. 9, 2009, 74 F.R. 66207, provided: Memorandum for the Secretary of Health And Human Services My Administration is committed to building a high- quality, efficient health care system and improving ac- cess to health care for all Americans. Health centers are a vital part of the health care delivery system. For more than 40 years, health centers have served popu- Page 356 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254b–1 1 So in original. lations with limited access to health care, treating all patients regardless of ability to pay. These include low- income populations, the uninsured, individuals with limited English proficiency, migrant and seasonal farm workers, individuals and families experiencing home- lessness, and individuals living in public housing. There are over 1,100 health centers across the country, deliv- ering care at over 7,500 sites. These centers served more than 17 million patients in 2008 and are estimated to serve more than 20 million patients in 2010. The American Recovery and Reinvestment Act of 2009 (Recovery Act) provided $2 billion for health centers, including $500 million to expand health centers’ serv- ices to over 2 million new patients by opening new health center sites, adding new providers, and improv- ing hours of operations. An additional $1.5 billion is supporting much-needed capital improvements, includ- ing funding to buy equipment, modernize clinic facili- ties, expand into new facilities, and adopt or expand the use of health information technology and elec- tronic health records. One of the key benefits health centers provide to the communities they serve is quality primary health care services. Health centers use interdisciplinary teams to treat the ‘‘whole patient’’ and focus on chronic disease management to reduce the use of costlier providers of care, such as emergency rooms and hospitals. Federally qualified health centers provide an excel- lent environment to demonstrate the further improve- ments to health care that may be offered by the med- ical homes approach. In general, this approach empha- sizes the patient’s relationship with a primary care provider who coordinates the patient’s care and serves as the patient’s principal point of contact for care. The medical homes approach also emphasizes activities re- lated to quality improvement, access to care, commu- nication with patients, and care management and co- ordination. These activities are expected to improve the quality and efficiency of care and to help avoid pre- ventable emergency and inpatient hospital care. Dem- onstration programs establishing the medical homes approach have been recommended by the Medicare Pay- ment Advisory Commission, an independent advisory body to the Congress. Therefore, I direct you to implement a Medicare Fed- erally Qualified Health Center Advanced Primary Care Practice demonstration, pursuant to your statutory authority to conduct experiments and demonstrations on changes in payments and services that may improve the quality and efficiency of services to beneficiaries. Health centers participating in this demonstration must have shown their ability to provide comprehen- sive, coordinated, integrated, and accessible health care. This memorandum is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or enti- ties, its officers, employees, or agents, or any other person. You are authorized and directed to publish this memorandum in the Federal Register. BARACK OBAMA. § 254b–1. State grants to health care providers who provide services to a high percentage of medically underserved populations or other special populations (a) In general A State may award grants to health care pro- viders who treat a high percentage, as deter- mined by such State, of medically underserved populations or other special populations in such State. (b) Source of funds A grant program established by a State under subsection (a) may not be established within a department, agency, or other entity of such State that administers the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), and no Federal or State funds allocated to such Medicaid program, the Medicare program under title XVIII of the So- cial Security Act (42 U.S.C. 1395 et seq.), or the TRICARE program under chapter 55 of title 10 may be used to award grants or to pay adminis- trative costs associated with a grant program established under subsection (a). (Pub. L. 111–148, title V, § 5606, as added Pub. L. 111–148, title X, § 10501(k), Mar. 23, 2010, 124 Stat. 999.) Editorial Notes REFERENCES IN TEXT The Social Security Act, referred to in subsec. (b), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XVIII and XIX of the Act are classified generally to subchapters XVIII (§ 1395 et seq.) and XIX (§ 1396 et seq.), respec- tively, of chapter 7 of this title. For complete classi- fication of this Act to the Code, see section 1305 of this title and Tables. CODIFICATION Section was enacted as part of the Patient Protection and Affordable Care Act, and not as part of the Public Health Service Act which comprises this chapter. § 254b–2. Community health centers and the Na- tional 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 adminis- tered through the Office of the Secretary of the Department of Health and Human Services to provide for expanded and sustained national in- vestment in community health centers under section 254b of this title 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 en- hanced funding for the community health cen- ter program under section 254b of this title— (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; (E) $3,600,000,000 for each of fiscal years 2015 through 2017; (F) $3,800,000,000 for fiscal year 2018; (G) $4,000,000,000 for each of fiscal years 2019 through 2023; (H) $526,027,397 for the period beginning on October 1, 2023, and ending on November 17, 2023, $690,410,959 for the period beginning on November 18, 2023, and ending on January 19, 2024, $536,986,301 for the period beginning on January 20, 2024, and ending on March 8, 2024, and $3,592,328,767 for the period begin- ning on October 1, 2023,1 and ending on De- cember 31, 2024; and