subpart i—health centers
Editorial Notes
Codification
§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 comprised of migratory and seasonal agricultural workers, the homeless, and residents of public housing, by providing, either through the staff and supporting resources of the center or through contracts or cooperative arrangements—
(A) required primary health services (as defined in subsection (b)(1)); and
(B) as may be appropriate for particular centers, additional health services (as defined in subsection (b)(2)) necessary for the adequate support of the primary health services required under subparagraph (A);
for all residents of the area served by the center (hereafter referred to in this section as the "catchment area").
(2) Limitation
The requirement in paragraph (1) to provide services for all residents within a catchment area shall not apply in the case of a health center receiving a grant only under subsection (g), (h), or (i).
(b) Definitions
For purposes of this section:
(1) Required primary health services
(A) In general
The term "required primary health services" means—
(i) basic health services which, for purposes of this section, shall consist of—
(I) health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology that are furnished by physicians and where appropriate, physician assistants, nurse practitioners, and nurse midwives;
(II) diagnostic laboratory and radiologic services;
(III) preventive health services, including—
(aa) prenatal and perinatal services;
(bb) appropriate cancer screening;
(cc) well-child services;
(dd) immunizations against vaccine-preventable diseases;
(ee) screenings for elevated blood lead levels, communicable diseases, and cholesterol;
(ff) pediatric eye, ear, and dental screenings to determine the need for vision and hearing correction and dental care;
(gg) voluntary family planning services; and
(hh) preventive dental services;
(IV) emergency medical services; and
(V) pharmaceutical services as may be appropriate for particular centers;
(ii) referrals to providers of medical services (including specialty referral when medically indicated) and other health-related services (including substance use disorder and mental health services);
(iii) patient case management services (including counseling, referral, and follow-up services) and other services designed to assist health center patients in establishing eligibility for and gaining access to Federal, State, and local programs that provide or financially support the provision of medical, social, housing, educational, or other related services;
(iv) services that enable individuals to use the services of the health center (including outreach and transportation services and, if a substantial number of the individuals in the population served by a center are of limited English-speaking ability, the services of appropriate personnel fluent in the language spoken by a predominant number of such individuals); and
(v) education of patients and the general population served by the health center regarding the availability and proper use of health services.
(B) Exception
With respect to a health center that receives a grant only under subsection (g), the Secretary, upon a showing of good cause, shall—
(i) waive the requirement that the center provide all required primary health services under this paragraph; and
(ii) approve, as appropriate, the provision of certain required primary health services only during certain periods of the year.
(2) Additional health services
The term "additional health services" means services that are not included as required primary health services and that are appropriate to meet the health needs of the population served by the health center involved. Such term may include—
(A) behavioral and mental health and substance use disorder services;
(B) recuperative care services;
(C) environmental health services, including—
(i) the detection and alleviation of unhealthful conditions associated with—
(I) water supply;
(II) chemical and pesticide exposures;
(III) air quality; or
(IV) exposure to lead;
(ii) sewage treatment;
(iii) solid waste disposal;
(iv) rodent and parasitic infestation;
(v) field sanitation;
(vi) housing; and
(vii) other environmental factors related to health; and
(D) in the case of health centers receiving grants under subsection (g), special occupation-related health services for migratory and seasonal agricultural workers, including—
(i) screening for and control of infectious diseases, including parasitic diseases; and
(ii) injury prevention programs, including prevention of exposure to unsafe levels of agricultural chemicals including pesticides.
(3) Medically underserved populations
(A) In general
The term "medically underserved population" means the population of an urban or rural area designated by the Secretary as an area with a shortage of personal health services or a population group designated by the Secretary as having a shortage of such services.
(B) Criteria
In carrying out subparagraph (A), the Secretary shall prescribe criteria for determining the specific shortages of personal health services of an area or population group. Such criteria shall—
(i) take into account comments received by the Secretary from the chief executive officer of a State and local officials in a State; and
(ii) include factors indicative of the health status of a population group or residents of an area, the ability of the residents of an area or of a population group to pay for health services and their accessibility to them, and the availability of health professionals to residents of an area or to a population group.
(C) Limitation
The Secretary may not designate a medically underserved population in a State or terminate the designation of such a population unless, prior to such designation or termination, the Secretary provides reasonable notice and opportunity for comment and consults with—
(i) the chief executive officer of such State;
(ii) local officials in such State; and
(iii) the organization, if any, which represents a majority of health centers in such State.
(D) Permissible designation
The Secretary may designate a medically underserved population that does not meet the criteria established under subparagraph (B) if the chief executive officer of the State in which such population is located and local officials of such State recommend the designation of such population based on unusual local conditions which are a barrier to access to or the availability of personal health services.
(c) Planning grants
(1) Centers
The Secretary may make grants to public and nonprofit private entities for projects to plan and develop health centers which will serve medically underserved populations. A project for which a grant may be made under this subsection may include the cost of the acquisition and lease of buildings and equipment (including the costs of amortizing the principal of, and paying the interest on, loans) and shall include—
(A) an assessment of the need that the population proposed to be served by the health center for which the project is undertaken has for required primary health services and additional health services;
(B) the design of a health center program for such population based on such assessment;
(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 continuing community involvement in the development 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 coordinated, higher quality, and more cost-effective health care services.
(2) Limitation
Not more than two grants may be made under this subsection for the same project, except that upon a showing of good cause, the Secretary may make additional grant awards.
(3) Recognition of high poverty
(A) In general
In making grants under this subsection, the Secretary may recognize the unique needs of high poverty areas.
(B) High poverty area defined
For purposes of subparagraph (A), the term "high poverty area" means a catchment area which is established in a manner that is consistent with the factors in subsection (k)(3)(J), and the poverty rate of which is greater than the national average poverty rate as determined by the Bureau of the Census.
(d) Improving quality of care
(1) Supplemental awards
The Secretary may award supplemental grant funds to health centers funded under this section to implement evidence-based models for increasing access to high-quality primary care services, which may include models related to—
(A) improving the delivery of care for individuals with multiple chronic conditions;
(B) workforce configuration;
(C) reducing the cost of care;
(D) enhancing care coordination;
(E) expanding the use of telehealth and technology-enabled collaborative learning and capacity building models;
(F) care integration, including integration of behavioral health, mental health, or substance use disorder services;
(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 immunizations.
(2) Sustainability
In making supplemental awards under this subsection, the Secretary may consider whether the health center involved has submitted a plan for continuing the activities funded under this subsection after supplemental funding is expended.
(3) Special consideration
The Secretary may give special consideration to applications for supplemental funding under this subsection that seek to address significant barriers to access to care in areas with a greater shortage of health care providers and health services relative to the national average.
(e) Operating grants
(1) Authority
(A) In general
The Secretary may make grants for the costs of the operation of public and nonprofit private health centers that provide health services to medically underserved populations.
(B) Entities that fail to meet certain requirements
The Secretary may make grants, for a period of not to exceed 1 year, for the costs of the operation of public and nonprofit private entities which provide health services to medically underserved populations but with respect to which the Secretary is unable to make each of the determinations required by subsection (k)(3). The Secretary shall not make a grant under this paragraph unless the applicant provides assurances to the Secretary that within 120 days of receiving grant funding for the operation of the health center, the applicant will submit, for approval by the Secretary, an implementation plan to meet the requirements of subsection (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 centers, 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 technical assistance; and
(iii) other activities that—
(I) reduce costs associated with the provision of health services;
(II) improve access to, and availability of, health services provided to individuals served by the centers;
(III) enhance the quality and coordination of health services; or
(IV) improve the health status of communities.
(2) Use of funds
The costs for which a grant may be made under subparagraph (A) or (B) of paragraph (1) may include the costs of acquiring and leasing buildings and equipment (including the costs of amortizing the principal of, and paying interest on, loans), and the costs of providing training related to the provision of required primary health services and additional health services and to the management of health center programs.
(3) Construction
The Secretary may award grants which may be used to pay the costs associated with expanding and modernizing existing buildings or constructing new buildings (including the costs of amortizing the principal of, and paying the interest on, loans) for projects approved prior to October 1, 1996.
(4) Limitation
Not more than two grants may be made under subparagraph (B) of paragraph (1) for the same entity.
(5) Amount
(A) In general
The amount of any grant made in any fiscal year under subparagraphs (A) and (B) of paragraph (1) to a health center shall be determined by the Secretary, but may not exceed the amount by which the costs of operation of the center in such fiscal year exceed the total of—
(i) State, local, and other operational funding provided to the center; and
(ii) the fees, premiums, and third-party reimbursements, which the center may reasonably be expected to receive for its operations in such fiscal year.
(B) Networks
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 subparagraph (A) or (B) of paragraph (1) shall be made in advance or by way of reimbursement and in such installments as the Secretary finds necessary and adjustments may be made for overpayments or underpayments.
(D) Use of nongrant funds
Nongrant funds described in clauses (i) and (ii) of subparagraph (A), including any such funds in excess of those originally expected, shall be used as permitted under this section, and may be used for such other purposes as are not specifically prohibited under this section if such use furthers the objectives of the project.
(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 applicants that have demonstrated the new delivery site will be located within a sparsely populated area, or an area which has a level of unmet need that is higher relative to other applicants.
(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 medically underserved populations in rural areas which may be expected to use the services provided by the applicants involved to the medically underserved populations in urban areas which may be expected to use the services provided by the applicants is not less than two to three or greater than three to two.
(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 consider whether the award of funding to an additional health center in the area can be justified based on the unmet need for additional services within the catchment area.
(v) Mobile units
An existing health center may be awarded funds under clause (i) to establish a new delivery site that is a mobile unit, regardless 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 applications
(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 described in subsection (b)(2).
(ii) Priority expansion projects
In carrying out clause (i), the Secretary may give special consideration to expanded service applications that seek to address emerging public health or behavioral health, mental health, or substance abuse issues through increasing the availability of additional health services described in subsection (b)(2) in an area in which there are significant barriers to accessing care.
(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 medically underserved populations in rural areas which may be expected to use the services provided by the applicants involved to the medically underserved populations in urban areas which may be expected to use the services provided by such applicants is not less than two to three or greater than three to two.
(f) Infant mortality grants
(1) In general
The Secretary may make grants to health centers for the purpose of assisting such centers in—
(A) providing comprehensive health care and support services for the reduction of—
(i) the incidence of infant mortality; and
(ii) morbidity among children who are less than 3 years of age; and
(B) developing and coordinating service and referral arrangements between health centers and other entities for the health management of pregnant women and children described in subparagraph (A).
(2) Priority
In making grants under this subsection the Secretary shall give priority to health centers providing services to any medically underserved population among which there is a substantial incidence of infant mortality or among which there is a significant increase in the incidence of infant mortality.
(3) Requirements
The Secretary may make a grant under this subsection only if the health center involved agrees that—
(A) the center will coordinate the provision of services under the grant to each of the recipients of the services;
(B) such services will be continuous for each such recipient;
(C) the center will provide follow-up services for individuals who are referred by the center for services described in paragraph (1);
(D) the grant will be expended to supplement, and not supplant, the expenditures of the center for primary health services (including prenatal care) with respect to the purpose described in this subsection; and
(E) the center will coordinate the provision of services with other maternal and child health providers operating in the catchment area.
(g) Migratory and seasonal agricultural workers
(1) In general
The Secretary may award grants for the purposes described in subsections (c), (e), and (f) for the planning and delivery of services to a special medically underserved population comprised of—
(A) migratory agricultural workers, seasonal agricultural workers, and members of the families of such migratory and seasonal agricultural workers who are within a designated catchment area; and
(B) individuals who have previously been migratory agricultural workers but who no longer meet the requirements of subparagraph (A) of paragraph (3) because of age or disability and members of the families of such individuals who are within such catchment area.
(2) Environmental concerns
The Secretary may enter into grants or contracts under this subsection with public and private entities to—
(A) assist the States in the implementation and enforcement of acceptable environmental health standards, including enforcement of standards for sanitation in migratory agricultural worker and seasonal agricultural worker labor camps, and applicable Federal and State pesticide control standards; and
(B) conduct projects and studies to assist the several States and entities which have received grants or contracts under this section in the assessment of problems related to camp and field sanitation, exposure to unsafe levels of agricultural chemicals including pesticides, and other environmental health hazards to which migratory agricultural workers and seasonal agricultural workers, and members of their families, are exposed.
(3) Definitions
For purposes of this subsection:
(A) Migratory agricultural worker
The term "migratory agricultural worker" means an individual whose principal employment is in agriculture, who has been so employed within the last 24 months, and who establishes for the purposes of such employment a temporary abode.
(B) Seasonal agricultural worker
The term "seasonal agricultural worker" means an individual whose principal employment is in agriculture on a seasonal basis and who is not a migratory agricultural worker.
(C) Agriculture
The term "agriculture" means farming in all its branches, including—
(i) cultivation and tillage of the soil;
(ii) the production, cultivation, growing, and harvesting of any commodity grown on, in, or as an adjunct to or part of a commodity grown in or on, the land; and
(iii) any practice (including preparation and processing for market and delivery to storage or to market or to carriers for transportation to market) performed by a farmer or on a farm incident to or in conjunction with an activity described in clause (ii).
(h) Homeless population
(1) In general
The Secretary may award grants for the purposes described in subsections (c), (e), and (f) for the planning and delivery of services to a special medically underserved population comprised of homeless individuals, including grants for innovative programs that provide outreach and comprehensive primary health services to homeless children and youth, children and youth at risk of homelessness, homeless veterans, and veterans at risk of homelessness.
(2) Required services
In addition to required primary health services (as defined in subsection (b)(1)), an entity that receives a grant under this subsection shall be required to provide substance abuse services as a condition of such grant.
(3) Supplement not supplant requirement
A grant awarded under this subsection shall be expended to supplement, and not supplant, the expenditures of the health center and the value of in kind contributions for the delivery of services to the population described in paragraph (1).
(4) Temporary continued provision of services to certain former homeless individuals
If any grantee under this subsection has provided services described in this section under the grant to a homeless individual, such grantee may, notwithstanding that the individual is no longer homeless as a result of becoming a resident in permanent housing, expend the grant to continue to provide such services to the individual for not more than 12 months.
(5) Definitions
For purposes of this section:
(A) Homeless individual
The term "homeless individual" means an individual who lacks housing (without regard to whether the individual is a member of a family), including an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations and an individual who is a resident in transitional housing.
(B) Substance use disorder services
The term "substance use disorder services" includes detoxification, risk reduction, outpatient treatment, residential treatment, and rehabilitation for substance abuse provided in settings other than hospitals.
(i) Residents of public housing
(1) In general
The Secretary may award grants for the purposes described in subsections (c), (e), and (f) for the planning and delivery of services to a special medically underserved population comprised of residents of public housing (such term, for purposes of this subsection, shall have the same meaning given such term in
(2) Supplement not supplant
A grant awarded under this subsection shall be expended to supplement, and not supplant, the expenditures of the health center and the value of in kind contributions for the delivery of services to the population described in paragraph (1).
(3) Consultation with residents
The Secretary may not make a grant under paragraph (1) unless, with respect to the residents of the public housing involved, the applicant for the grant—
(A) has consulted with the residents in the preparation of the application for the grant; and
(B) agrees to provide for ongoing consultation with the residents regarding the planning and administration of the program carried out with the grant.
(j) Access grants
(1) In general
The Secretary may award grants to eligible health centers with a substantial number of clients with limited English speaking proficiency to provide translation, interpretation, and other such services for such clients with limited English speaking proficiency.
(2) Eligible health center
In this subsection, the term "eligible health center" means an entity that—
(A) is a health center as defined under subsection (a);
(B) provides health care services for clients for whom English is a second language; and
(C) has exceptional needs with respect to linguistic access or faces exceptional challenges with respect to linguistic access.
(3) Grant amount
The amount of a grant awarded to a center under this subsection shall be determined by the Administrator. Such determination of such amount shall be based on the number of clients for whom English is a second language that is served by such center, and larger grant amounts shall be awarded to centers serving larger numbers of such clients.
(4) Use of funds
An eligible health center that receives a grant under this subsection may use funds received through such grant to—
(A) provide translation, interpretation, and other such services for clients for whom English is a second language, including hiring professional translation and interpretation services; and
(B) compensate bilingual or multilingual staff for language assistance services provided by the staff for such clients.
(5) Application
An eligible health center desiring a grant under this subsection shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require, including—
(A) an estimate of the number of clients that the center serves for whom English is a second language;
(B) the ratio of the number of clients for whom English is a second language to the total number of clients served by the center;
(C) a description of any language assistance services that the center proposes to provide to aid clients for whom English is a second language; and
(D) a description of the exceptional needs of such center with respect to linguistic access or a description of the exceptional challenges faced by such center with respect to linguistic access.
(6) Authorization of appropriations
There are authorized to be appropriated to carry out this subsection, in addition to any funds authorized to be appropriated or appropriated for health centers under any other subsection of this section, such sums as may be necessary for each of fiscal years 2002 through 2006.
(k) Applications
(1) Submission
No grant may be made under this section unless an application therefore is submitted to, and approved by, the Secretary. Such an application shall be submitted in such form and manner and shall contain such information as the Secretary shall prescribe.
(2) Description of unmet need
An application for a grant under subparagraph (A) or (B) of subsection (e)(1) or subsection (e)(6) for a health center shall include—
(A) a description of the unmet need for health services in the catchment area of the center;
(B) a demonstration by the applicant that the area or the population group to be served by the applicant has a shortage of personal health services;
(C) a demonstration that the center will be located so that it will provide services to the greatest number of individuals residing in the catchment area or included in such population group; and
(D) in the case of an application for a grant pursuant to subsection (e)(6), a demonstration that the applicant has consulted with appropriate State and local government agencies, and health care providers regarding the need for the health services to be provided at the proposed delivery site.
Such a demonstration shall be made on the basis of the criteria prescribed by the Secretary under subsection (b)(3) or on any other criteria which the Secretary may prescribe to determine if the area or population group to be served by the applicant has a shortage of personal health services. In considering an application for a grant under subparagraph (A) or (B) of subsection (e)(1), the Secretary may require as a condition to the approval of such application an assurance that the applicant will provide any health service defined under paragraphs (1) and (2) of subsection (b) that the Secretary finds is needed to meet specific health needs of the area to be served by the applicant. Such a finding shall be made in writing and a copy shall be provided to the applicant.
(3) Requirements
Except as provided in subsection (e)(1)(B) or subsection (e)(6), the Secretary may not approve an application for a grant under subparagraph (A) or (B) of subsection (e)(1) unless the Secretary determines that the entity for which the application is submitted is a health center (within the meaning of subsection (a)) and that—
(A) the required primary health services of the center will be available and accessible in the catchment area of the center promptly, as appropriate, and in a manner which assures continuity;
(B) the center has made and will continue to make every reasonable effort to establish and maintain collaborative relationships with other health care providers, including other health care providers that provide care within the catchment area, local hospitals, and specialty providers in the catchment area of the center, to provide access to services not available through the health center and to reduce the non-urgent use of hospital emergency departments;
(C) the center will have an ongoing quality improvement system that includes clinical services and management, and that maintains the confidentiality of patient records;
(D) the center will demonstrate its financial responsibility by the use of such accounting procedures and other requirements as may be prescribed by the Secretary;
(E) the center—
(i)(I) has or will have a contractual or other arrangement with the agency of the State, in which it provides services, which administers or supervises the administration of a State plan approved under title XIX of the Social Security Act [
(II) has or will have a contractual or other arrangement with the State agency administering the program under title XXI of such Act (
(ii) has made or will make every reasonable effort to enter into arrangements described in subclauses (I) and (II) of clause (i);
(F) the center has made or will make and will continue to make every reasonable effort to collect appropriate reimbursement for its costs in providing health services to persons who are entitled to insurance benefits under title XVIII of the Social Security Act [
(G) the center—
(i) has prepared a schedule of fees or payments for the provision of its services consistent with locally prevailing rates or charges and designed to cover its reasonable costs of operation and has prepared a corresponding schedule of discounts to be applied to the payment of such fees or payments, which discounts are adjusted on the basis of the patient's ability to pay;
(ii) has made and will continue to make every reasonable effort—
(I) to secure from patients payment for services in accordance with such schedules; and
(II) to collect reimbursement for health services to persons described in subparagraph (F) on the basis of the full amount of fees and payments for such services without application of any discount;
(iii)(I) will assure that no patient will be denied health care services due to an individual's inability to pay for such services; and
(II) will assure that any fees or payments required by the center for such services will be reduced or waived to enable the center to fulfill the assurance described in subclause (I); and
(iv) has submitted to the Secretary such reports as the Secretary may require to determine compliance with this subparagraph;
(H) the center has established a governing board which except in the case of an entity operated by an Indian tribe or tribal or Indian organization under the Indian Self-Determination Act [
(i) is composed of individuals, a majority of whom are being served by the center and who, as a group, represent the individuals being served by the center;
(ii) meets at least once a month, selects the services to be provided by the center, schedules the hours during which such services will be provided, approves the center's annual budget, approves the selection of a director for the center who shall be directly employed by the center, and, except in the case of a governing board of a public center (as defined in the second sentence of this paragraph), establishes general policies for the center; and
(iii) in the case of an application for a second or subsequent grant for a public center, has approved the application or if the governing body has not approved the application, the failure of the governing body to approve the application was unreasonable;
except that, upon a showing of good cause the Secretary shall waive, for the length of the project period, all or part of the requirements of this subparagraph in the case of a health center that receives a grant pursuant to subsection (g), (h), (i), or (p);
(I) the center has developed—
(i) an overall plan and budget that meets the requirements of the Secretary; and
(ii) an effective procedure for compiling and reporting to the Secretary such statistics and other information as the Secretary may require relating to—
(I) the costs of its operations;
(II) the patterns of use of its services;
(III) the availability, accessibility, and acceptability of its services; and
(IV) such other matters relating to operations of the applicant as the Secretary may require;
(J) the center will review periodically its catchment area to—
(i) ensure that the size of such area is such that the services to be provided through the center (including any satellite) are available and accessible to the residents of the area promptly and as appropriate;
(ii) ensure that the boundaries of such area conform, to the extent practicable, to relevant boundaries of political subdivisions, school districts, and Federal and State health and social service programs; and
(iii) ensure that the boundaries of such area eliminate, to the extent possible, barriers to access to the services of the center, including barriers resulting from the area's physical characteristics, its residential patterns, its economic and social grouping, and available transportation;
(K) in the case of a center which serves a population including a substantial proportion of individuals of limited English-speaking ability, the center has—
(i) developed a plan and made arrangements responsive to the needs of such population for providing services to the extent practicable in the language and cultural context most appropriate to such individuals; and
(ii) identified an individual on its staff who is fluent in both that language and in English and whose responsibilities shall include providing guidance to such individuals and to appropriate staff members with respect to cultural sensitivities and bridging linguistic and cultural differences;
(L) the center, has developed an ongoing referral relationship with one or more hospitals;
(M) the center encourages persons receiving or seeking health services from the center to participate in any public or private (including employer-offered) health programs or plans for which the persons are eligible, so long as the center, in complying with this subparagraph, does not violate the requirements of subparagraph (G)(iii)(I); and
(N) the center has written policies and procedures in place to ensure the appropriate use of Federal funds in compliance with applicable Federal statutes, regulations, and the terms and conditions of the Federal award.
For purposes of subparagraph (H), the term "public center" means a health center funded (or to be funded) through a grant under this section to a public agency.
(l) Technical assistance
The Secretary shall establish a program through which the Secretary shall provide (either through the Department of Health and Human Services or by grant or contract) technical and other assistance to eligible entities to assist such entities to meet the requirements of subsection (k)(3). Services provided through the program may include necessary technical and nonfinancial assistance, including fiscal and program management assistance, training in fiscal and program management, operational and administrative support, and the provision of information to the entities of the variety of resources available under this 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 services for medically underserved populations within such State;
(2) assist in the planning and development of new health centers;
(3) review and comment upon annual program plans and budgets of health centers, including comments upon allocations of health care resources in the State;
(4) assist health centers in the development of clinical practices and fiscal and administrative systems through a technical assistance plan which is responsive to the requests of health centers; and
(5) share information and data relevant to the operation of new and existing health centers.
(n) Records
(1) In general
Each entity which receives a grant under subsection (e) shall establish and maintain such records as the Secretary shall require.
(2) Availability
Each entity which is required to establish and maintain records under this subsection shall make such books, documents, papers, and records available to the Secretary or the Comptroller General of the United States, or any of their duly authorized representatives, for examination, copying or mechanical reproduction on or off the premises of such entity upon a reasonable request therefore. The Secretary and the Comptroller General of the United States, or any of their duly authorized representatives, shall have the authority to conduct such examination, copying, and reproduction.
(o) Delegation of authority
The Secretary may delegate the authority to administer the programs authorized by this section to any office, except that the authority to enter into, modify, or issue approvals with respect to grants or contracts may be delegated only within the central office of the Health Resources and Services Administration.
(p) Special consideration
In making grants under this section, the Secretary shall give special consideration to the unique needs of sparsely populated rural areas, including giving priority in the awarding of grants for new health centers under subsections (c) and (e), and the granting of waivers as appropriate 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 accepted accounting principles. Each audit shall evaluate—
(A) the entity's implementation of the guidelines established by the Secretary respecting cost accounting,
(B) the processes used by the entity to meet the financial and program reporting requirements of the Secretary, and
(C) the billing and collection procedures of the entity and the relation of the procedures to its fee schedule and schedule of discounts and to the availability of health insurance and public programs to pay for the health services it provides.
A report of each such audit shall be filed with the Secretary at such time and in such manner as the Secretary may require.
(2) Records
Each entity which receives a grant under this section shall establish and maintain such records as the Secretary shall by regulation require to facilitate the audit required by paragraph (1). The Secretary may specify by regulation the form and manner in which such records shall be established and maintained.
(3) Availability of records
Each entity which is required to establish and maintain records or to provide for and 1 audit under this subsection shall make such books, documents, papers, and records available to the Secretary or the Comptroller General of the United States, or any of their duly authorized representatives, for examination, copying or mechanical reproduction on or off the premises of such entity upon a reasonable request therefore. The Secretary and the Comptroller General of the United States, or any of their duly authorized representatives, shall have the authority to conduct such examination, copying, and reproduction.
(4) Waiver
The Secretary may, under appropriate circumstances, waive the application of all or part of the requirements of this subsection with respect to an entity. A waiver provided by the Secretary under this paragraph may not remain in effect for more than 1 year and may not be extended after such period. An entity may not receive more than one waiver under this paragraph in consecutive years.
(r) Authorization of appropriations
(1) General amounts for grants
For the purpose of carrying out this section, in addition to the amounts authorized to be appropriated under subsection (d), there is authorized to be appropriated the following:
(A) For fiscal year 2010, $2,988,821,592.
(B) For fiscal year 2011, $3,862,107,440.
(C) For fiscal year 2012, $4,990,553,440.
(D) For fiscal year 2013, $6,448,713,307.
(E) For fiscal year 2014, $7,332,924,155.
(F) For fiscal year 2015, $8,332,924,155.
(G) For fiscal year 2016, and each subsequent fiscal year, the amount appropriated for the preceding fiscal year adjusted by the product of—
(i) one plus the average percentage increase in costs incurred per patient served; and
(ii) one plus the average percentage increase in the total number of patients served.
(2) Special provisions
(A) Public centers
The Secretary may not expend in any fiscal year, for grants under this section to public centers (as defined in the second sentence of subsection (k)(3)) the governing boards of which (as described in subsection (k)(3)(H)) do not establish general policies for such centers, an amount which exceeds 5 percent of the amounts appropriated under this section for that fiscal year. For purposes of applying the preceding sentence, the term "public centers" shall not include health centers that receive grants pursuant to subsection (h) or (i).
(B) Distribution of grants
For fiscal year 2002 and each of the following fiscal years, the Secretary, in awarding grants under this section, shall ensure that the proportion of the amount made available under each of subsections (g), (h), and (i), relative to the total amount appropriated to carry out this section for that fiscal year, is equal to the proportion of the amount made available under that subsection for fiscal year 2001, relative to the total amount appropriated to carry out this section for fiscal year 2001.
(3) Funding report
The Secretary shall annually prepare and submit to the Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce of the House of Representatives, a report including, at a minimum—
(A) the distribution of funds for carrying out this section that are provided to meet the health care needs of medically underserved populations, including the homeless, residents of public housing, and migratory and seasonal agricultural workers, and the appropriateness of the delivery systems involved in responding to the needs of the particular populations;
(B) an assessment of the relative health care access needs of the targeted populations;
(C) the distribution of awards and funding for new or expanded services in each of rural areas and urban areas;
(D) the distribution of awards and funding for establishing new access points, and the number of new access points created;
(E) the amount of unexpended funding for loan guarantees and loan guarantee authority under 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 [
(B) Assurances
In order for a clinic or hospital to receive funds under this section through a contract with a community health center under subparagraph (A), such clinic or hospital shall establish policies to ensure—
(i) nondiscrimination based on the ability of a patient to pay; and
(ii) the establishment of a sliding fee scale for low-income patients.
(5) Funding for participation of health centers in All of Us Research Program
In addition to any amounts made available pursuant to paragraph (1) of this subsection,
(6) Additional amounts for supplemental awards
In addition to any amounts made available pursuant to this subsection,
(July 1, 1944, ch. 373, title III, §330, as added
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,
The Indian Self-Determination Act, referred to in subsec. (k)(3)(H), is title I of
The Indian Health Care Improvement Act, referred to in subsec. (k)(3)(H), is
Prior Provisions
A prior section 254a–1, act July 1, 1944, ch. 373, title III, §328, as added Nov. 10, 1978,
A prior section 254b, act July 1, 1944, ch. 373, title III, §329, formerly §310, as added Sept. 25, 1962,
Another prior section 254b, act July 1, 1944, ch. 373, title III, §329, as added Dec. 31, 1970,
A prior section 330 of act July 1, 1944, was classified to
Amendments
2022—Subsec. (e)(6)(A)(v).
2020—Subsec. (d)(1)(H).
Subsec. (r)(6).
2018—Subsec. (b)(1)(A)(ii), (2)(A).
Subsec. (c)(1).
Subsec. (d).
Subsec. (e)(1)(B).
Subsec. (e)(1)(C).
Subsec. (e)(5)(B).
Subsec. (e)(6).
Subsec. (h)(1).
Subsec. (h)(5)(B).
Subsec. (h)(5)(C).
Subsec. (k)(2).
Subsec. (k)(2)(A).
Subsec. (k)(2)(D).
Subsec. (k)(3).
Subsec. (k)(3)(B).
Subsec. (k)(3)(H)(ii).
Subsec. (k)(3)(N).
Subsec. (k)(4).
Subsec. (l).
Subsec. (q)(4).
Subsec. (r)(3).
Subsec. (r)(5).
Subsec. (s).
2010—Subsec. (r)(1).
"(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).
Subsec. (s).
2008—Subsec. (c)(3).
Subsec. (r)(1).
2003—Subsec. (c)(1)(B).
Subsec. (d)(1)(B)(iii)(I).
Subsec. (e)(3) to (5).
Subsec. (j).
Subsec. (j)(3)(H).
Subsec. (k).
Subsec. (l).
Subsecs. (m) to (o).
Subsec. (p).
Subsec. (q).
Subsec. (r).
Subsec. (r)(1).
Subsec. (r)(2)(A).
Subsec. (r)(2)(B).
Subsec. (s).
2002—Subsec. (b)(1)(A)(i)(III)(bb).
Subsec. (b)(1)(A)(ii).
Subsec. (b)(1)(A)(iii).
Subsec. (b)(2)(A).
Subsec. (b)(2)(A)(i).
Subsec. (b)(2)(B) to (D).
Subsec. (c)(1)(B).
Subsec. (c)(1)(C), (D).
Subsec. (d).
Subsec. (d)(1)(A).
Subsec. (d)(1)(B)(iii).
Subsec. (d)(1)(D), (E).
Subsec. (d)(6) to (8).
Subsec. (e)(1)(B).
Subsec. (e)(1)(C).
Subsec. (e)(3).
Subsec. (e)(4).
Subsec. (e)(5).
Subsec. (g)(2)(A).
Subsec. (g)(2)(B).
Subsec. (g)(3)(A).
Subsec. (h)(1).
Subsec. (h)(4).
Subsec. (h)(5).
Subsec. (j).
Subsec. (j)(3)(E)(i).
Subsec. (j)(3)(E)(ii).
Subsec. (j)(3)(G)(iii), (iv).
Subsec. (j)(3)(H).
Subsec. (j)(3)(M).
Subsec. (k).
Subsec. (l).
Subsec. (m).
Subsecs. (n) to (p).
Subsec. (q).
Subsec. (r).
Subsec. (s).
Subsec. (s)(1).
Subsec. (s)(2)(A).
Subsec. (s)(2)(B).
Statutory Notes and Related Subsidiaries
Effective Date of 2022 Amendment
Effective Date of 2008 Amendment
Effective Date of 2003 Amendment
Amendments by
Effective Date
Section effective Oct. 1, 1996, see section 5 of
Savings Provision for Current Grants, Contracts, and Cooperative Agreements
Negotiated Rulemaking for Development of Methodology and Criteria for Designating Medically Underserved Populations and Health Professions Shortage Areas
"(a)
"(1)
"(A) medically underserved populations in accordance with section 330(b)(3) of the Public Health Service Act (
"(B) health professions shortage areas under section 332 of the Public Health Service Act (
"(2)
"(A) shall consult with relevant stakeholders who will be significantly affected by a rule (such as national, State and regional organizations representing 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 potential 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 accurately measures various barriers that confront individuals and population groups in seeking health care services.
"(b)
"(c)
"(d)
"(1) the appointment of a negotiated rulemaking committee under
"(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)
"(f)
"(g)
"(h)
Funding for Community Health Centers and Community Care
"(a)
"(b)
"(1) to plan, prepare for, promote, distribute, administer, 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 activities related to, and equipment or supplies purchased for, testing, contact tracing, surveillance, mitigation, and treatment of COVID–19;
"(3) to purchase equipment and supplies to conduct mobile testing or vaccinations for COVID–19, to purchase 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)
Studies Relating to Community Health Centers
"(1)
"(A) the term 'community health center' means a health center receiving assistance under section 330 of the Public Health Service Act (
"(B) the term 'medically underserved population' has the meaning given that term in such section 330.
"(2)
"(A)
"(B)
"(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 nutrition 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)
"(A)
"(B)
"(i) Federal efforts, as of the date of enactment of this Act, regarding health care quality in community health centers, including quality data collection, 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 management, and other services demonstrated to improve care;
"(II) are designed to address multiple, co-occurring diseases and conditions;
"(III) improve access to providers through non-traditional means, such as the use of remote monitoring equipment;
"(IV) target various medically underserved populations, including uninsured patient populations;
"(V) increase access to specialty care, including referrals and diagnostic testing; and
"(VI) enhance the use of electronic health records to improve quality;
"(iii) efforts to determine how effective quality improvement models may be adapted for implementation by community health centers that vary by size, budget, staffing, services offered, populations served, and other characteristics determined appropriate by the Secretary;
"(iv) types of technical assistance and resources provided to community health centers that may facilitate the implementation of quality improvement interventions;
"(v) proposed or adopted methodologies for community health center evaluations of quality improvement interventions, including any development 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 appropriate, to enhance health care quality in community health centers.
"(C)
Guarantee Study
Reference to Community, Migrant, Public Housing, or Homeless Health Center Considered Reference to Health Center
Legislative Proposal for Changes Conforming to Pub. L. 104–299
Executive Documents
Ex. Ord. No. 13937. Access to Affordable Life-Saving Medications
Ex. Ord. No. 13937, July 24, 2020, 85 F.R. 45755, provided:
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:
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 defined in section 1905(l)(2)(B)(i) and (ii) of the Social Security Act, as amended,
(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.
(i) the authority granted by law to an executive department or agency, or the head thereof;
(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.
(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.
(c) This order 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 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 access 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 populations 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 homelessness, and individuals living in public housing. There are over 1,100 health centers across the country, delivering 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' services to over 2 million new patients by opening new health center sites, adding new providers, and improving hours of operations. An additional $1.5 billion is supporting much-needed capital improvements, including funding to buy equipment, modernize clinic facilities, expand into new facilities, and adopt or expand the use of health information technology and electronic 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 excellent environment to demonstrate the further improvements to health care that may be offered by the medical homes approach. In general, this approach emphasizes 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 related to quality improvement, access to care, communication with patients, and care management and coordination. These activities are expected to improve the quality and efficiency of care and to help avoid preventable emergency and inpatient hospital care. Demonstration programs establishing the medical homes approach have been recommended by the Medicare Payment Advisory Commission, an independent advisory body to the Congress.
Therefore, I direct you to implement a Medicare Federally 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 comprehensive, 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 entities, its officers, employees, or agents, or any other person.
You are authorized and directed to publish this memorandum in the Federal Register.
Barack Obama.
1 So in original. Probably should be "an".
2 So in original. Probably should be "hospital".
§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 providers who treat a high percentage, as determined 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 (
(
Editorial Notes
References in Text
The Social Security Act, referred to in subsec. (b), is act Aug. 14, 1935, ch. 531,
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 National Health Service Corps Fund
(a) Purpose
It is the purpose of this section to establish a Community Health Center Fund (referred to in this section as the "CHC Fund"), to be administered through the Office of the Secretary of the Department of Health and Human Services to provide for expanded and sustained national investment in community health centers under
(b) Funding
There is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, to the CHC Fund—
(1) to be transferred to the Secretary of Health and Human Services to provide enhanced funding for the community health center program under
(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; and
(F) $3,800,000,000 for fiscal year 2018, $4,000,000,000 for each of fiscal years 2019 through 2023, $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 beginning on October 1, 2023,1 and ending on December 31, 2024; and
(2) to be transferred to the Secretary of Health and Human Services to provide enhanced funding for the National Health Service Corps—
(A) $290,000,000 for fiscal year 2011;
(B) $295,000,000 for fiscal year 2012;
(C) $300,000,000 for fiscal year 2013;
(D) $305,000,000 for fiscal year 2014;
(E) $310,000,000 for each of fiscal years 2015 through 2017;
(F) $310,000,000 for each of fiscal years 2018 and 2019;
(G) $310,000,000 for fiscal year 2020;
(H) $310,000,000 for each of fiscal years 2021 through 2023; and
(I) $40,767,123 for the period beginning on October 1, 2023, and ending on November 17, 2023, $53,506,849 for the period beginning on November 18, 2023, and ending on January 19, 2024, $41,616,438 for the period beginning on January 20, 2024, and ending on March 8, 2024, and $297,013,699 for the period beginning on October 1, 2023,1 and ending on December 31, 2024.
(c) Construction
There is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $1,500,000,000 to be available for fiscal years 2011 through 2015 to be used by the Secretary of Health and Human Services for the construction and renovation of community health centers.
(d) Use of fund
The Secretary of Health and Human Services shall transfer amounts in the CHC Fund to accounts within the Department of Health and Human Services to increase funding, over the fiscal year 2008 level, for community health centers and the National Health Service Corps.
(e) Availability
Amounts appropriated under subsections (b) and (c) shall remain available until expended.
(
Editorial Notes
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.
Amendments
2024—Subsec. (b)(1)(F).
Subsec. (b)(2)(I).
2023—Subsec. (b)(1)(F).
Subsec. (b)(2)(I).
2020—Subsec. (b)(1)(F).
Subsec. (b)(2)(G).
Subsec. (b)(2)(H).
2019—Subsec. (b)(1)(F).
Subsec. (b)(2)(G).
2018—Subsec. (b)(1)(F).
Subsec. (b)(2)(F).
2017—Subsec. (b)(1)(F).
Subsec. (b)(2)(F).
2015—Subsec. (b)(1)(E), (2)(E).
2010—Subsec. (b)(1)(A).
Subsec. (b)(1)(B).
Subsec. (b)(1)(C).
Subsec. (b)(1)(D).
Subsec. (b)(1)(E).
§254c. Rural health care services outreach, rural health network development, and small health care provider quality improvement grant programs
(a) Purpose
The purpose of this section is to provide grants for expanded delivery of health care services in rural areas, for the planning and implementation of integrated health care networks in rural areas, and for the planning and implementation of small health care provider quality improvement activities.
(b) Definitions
(1) Director
The term "Director" means the Director specified in subsection (d).
(2) Federally qualified health center; rural health clinic
The terms "Federally qualified health center" and "rural health clinic" have the meanings given the terms in
(3) Health professional shortage area
The term "health professional shortage area" means a health professional shortage area designated under
(4) Medically underserved community
The term "medically underserved community" has the meaning given the term in
(5) Medically underserved population
The term "medically underserved population" has the meaning given the term in
(c) Program
The Secretary shall establish, under
(d) Administration
(1) Programs
The rural health care services outreach, rural health network development, and small health care provider quality improvement grant programs established under
(2) Grants
(A) In general
In carrying out the programs described in paragraph (1), the Director may award grants under subsections (e), (f), and (g) to expand access to, coordinate, and improve the quality of basic health care services, and enhance the delivery of health care, in rural areas.
(B) Types of grants
The Director may award the grants to—
(i) promote expanded delivery of health care services in rural areas under subsection (e);
(ii) provide for the planning and implementation of integrated health care networks in rural areas under subsection (f); and
(iii) provide for the planning and implementation of small health care provider quality improvement activities under subsection (g).
(e) Rural health care services outreach grants
(1) Grants
The Director may award grants to eligible entities to promote rural health care services outreach by improving and expanding the delivery of health care services to include new and enhanced services in rural areas, through community engagement and evidence-based or innovative, evidence-informed models. The Director may award the grants for periods of not more than 5 years.
(2) Eligibility
To be eligible to receive a grant under this subsection for a project, an entity shall—
(A) be an entity with demonstrated experience serving, or the capacity to serve, rural underserved populations;
(B) represent a consortium composed of members that—
(i) include 3 or more health care providers; and
(ii) may be nonprofit or for-profit entities; and
(C) not previously have received a grant under this subsection for the same or a similar project, unless the entity is proposing to expand the scope of the project or the area that will be served through the project.
(3) Applications
To be eligible to receive a grant under this subsection, an eligible entity, in consultation with the appropriate State office of rural health or another appropriate State entity, shall prepare and submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require, including—
(A) a description of the project that the eligible entity will carry out using the funds provided under the grant;
(B) a description of the manner in which the project funded under the grant will meet the health care needs of rural underserved populations in the local community or region to be served;
(C) a description of how the rural underserved populations in the local community or region to be served will be involved in the development and ongoing operations of the project;
(D) a plan for sustaining the project after Federal support for the project has ended;
(E) a description of how the project will be evaluated; and
(F) other such information as the Secretary determines to be appropriate.
(f) Rural health network development grants
(1) Grants
(A) In general
The Director may award rural health network development grants to eligible entities to plan, develop, and implement integrated health care networks that collaborate in order to—
(i) achieve efficiencies;
(ii) expand access to, coordinate, and improve the quality of basic health care services and associated health outcomes; and
(iii) strengthen the rural health care system as a whole.
(B) Grant periods
The Director may award grants under this subsection for periods of not more than 5 years.
(2) Eligibility
To be eligible to receive a grant under this subsection, an entity shall—
(A) be an entity with demonstrated experience serving, or the capacity to serve, rural underserved populations;
(B) represent a network composed of participants that—
(i) include 3 or more health care providers; and
(ii) may be nonprofit or for-profit entities; and
(C) not previously have received a grant under this subsection (other than a grant for planning activities) for the same or a similar project.
(3) Applications
To be eligible to receive a grant under this subsection, an eligible entity, in consultation with the appropriate State office of rural health or another appropriate State entity, shall prepare and submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require, including—
(A) a description of the project that the eligible entity will carry out using the funds provided under the grant;
(B) an explanation of the reasons why Federal assistance is required to carry out the project;
(C) a description of—
(i) the history of collaborative activities carried out by the participants in the network;
(ii) the degree to which the participants are ready to integrate their functions; and
(iii) how the rural underserved populations in the local community or region to be served will benefit from and be involved in the development and ongoing operations of the network;
(D) a description of how the rural underserved populations in the local community or region to be served will experience increased access to quality health care services across the continuum of care as a result of the integration activities carried out by the network;
(E) a plan for sustaining the project after Federal support for the project has ended;
(F) a description of how the project will be evaluated; and
(G) other such information as the Secretary determines to be appropriate.
(g) Small health care provider quality improvement grants
(1) Grants
The Director may award grants to provide for the planning and implementation of small health care provider quality improvement activities, including activities related to increasing care coordination, enhancing chronic disease management, and improving patient health outcomes. The Director may award the grants for periods of 1 to 5 years.
(2) Eligibility
To be eligible for a grant under this subsection, an entity shall—
(A)(i) be a rural public or rural nonprofit private health care provider or provider of health care services, such as a critical access hospital or a rural health clinic; or
(ii) be another rural provider or network of small rural providers identified by the Secretary as a key source of local or regional care; and
(B) not previously have received a grant under this subsection for the same or a similar project.
(3) Applications
To be eligible to receive a grant under this subsection, an eligible entity, in consultation with the appropriate State office of rural health or another appropriate State entity shall prepare and submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require, including—
(A) a description of the project that the eligible entity will carry out using the funds provided under the grant;
(B) an explanation of the reasons why Federal assistance is required to carry out the project;
(C) a description of the manner in which the project funded under the grant will assure continuous quality improvement in the provision of services by the entity;
(D) a description of how the rural underserved populations in the local community or region to be served will experience increased access to quality health care services across the continuum of care as a result of the activities carried out by the entity;
(E) a plan for sustaining the project after Federal support for the project has ended;
(F) a description of how the project will be evaluated; and
(G) other such information as the Secretary determines to be appropriate.
(4) Expenditures for small health care provider quality improvement grants
In awarding a grant under this subsection, the Director shall ensure that the funds made available through the grant will be used to provide services to residents of rural areas. The Director shall award not less than 50 percent of the funds made available under this subsection to providers located in and serving rural areas.
(h) General requirements
(1) Prohibited uses of funds
An entity that receives a grant under this section may not use funds provided through the grant—
(A) to build or acquire real property; or
(B) for construction.
(2) Coordination with other agencies
The Secretary shall coordinate activities carried out under grant programs described in this section, to the extent practicable, with Federal and State agencies and nonprofit organizations that are operating similar grant programs, to maximize the effect of public dollars in funding meritorious proposals.
(3) Preference
In awarding grants under this section, the Secretary, as appropriate, shall give preference to entities that—
(A) are located in health professional shortage areas or medically underserved communities, or serve medically underserved populations; or
(B) propose to develop projects with a focus on primary care, and wellness and prevention strategies.
(i) Report
Not later than 4 years after March 27, 2020, and every 5 years thereafter, the Secretary 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 on the activities and outcomes of the grant programs under subsections (e), (f), and (g), including the impact of projects funded under such programs on the health status of rural residents with chronic conditions.
(j) Authorization of appropriations
There are authorized to be appropriated to carry out this section $79,500,000 for each of fiscal years 2021 through 2025.
(July 1, 1944, ch. 373, title III, §330A, as added
Editorial Notes
Prior Provisions
A prior section 254c, act July 1, 1944, ch. 373, title III, §330, as added July 29, 1975,
Amendments
2020—Subsec. (d)(2)(A).
Subsec. (d)(2)(B).
Subsec. (e)(1).
Subsec. (e)(2).
Subsec. (e)(2)(A).
Subsec. (e)(2)(B).
Subsec. (e)(2)(C).
Subsec. (e)(3)(C).
Subsec. (f)(1)(A).
Subsec. (f)(1)(A)(ii).
Subsec. (f)(1)(B).
Subsec. (f)(2).
Subsec. (f)(2)(A).
Subsec. (f)(2)(B).
Subsec. (f)(2)(C).
Subsec. (f)(3)(C)(iii).
Subsec. (f)(3)(D).
Subsec. (g)(1).
Subsec. (g)(2).
Subsec. (g)(2)(A).
Subsec. (g)(2)(B).
Subsec. (g)(3)(D).
Subsec. (h)(3).
Subsec. (i).
Subsec. (j).
2008—Subsec. (j).
2003—Subsec. (b)(4).
2002—
Statutory Notes and Related Subsidiaries
Effective Date of 2003 Amendment
Amendment by
Effective Date
Section effective Oct. 1, 1996, see section 5 of
Rural Access to Emergency Devices
"SEC. 411. SHORT TITLE.
"This subtitle may be cited as the 'Rural Access to Emergency Devices Act' or the 'Rural AED Act'.
"SEC. 412. FINDINGS.
"Congress makes the following findings:
"(1) Heart disease is the leading cause of death in the United States.
"(2) The American Heart Association estimates that 250,000 Americans die from sudden cardiac arrest each year.
"(3) A cardiac arrest victim's chance of survival drops 10 percent for every minute that passes before his or her heart is returned to normal rhythm.
"(4) Because most cardiac arrest victims are initially in ventricular fibrillation, and the only treatment for ventricular fibrillation is defibrillation, prompt access to defibrillation to return the heart to normal rhythm is essential.
"(5) Lifesaving technology, the automated external defibrillator, has been developed to allow trained lay rescuers to respond to cardiac arrest by using this simple device to shock the heart into normal rhythm.
"(6) Those people who are likely to be first on the scene of a cardiac arrest situation in many communities, particularly smaller and rural communities, lack sufficient numbers of automated external defibrillators to respond to cardiac arrest in a timely manner.
"(7) The American Heart Association estimates that more than 50,000 deaths could be prevented each year if defibrillators were more widely available to designated responders.
"(8) Legislation should be enacted to encourage greater public access to automated external defibrillators in communities across the United States.
"SEC. 413. GRANTS.
"(a)
"(b)
"(1) is composed of local emergency response entities such as community training facilities, local emergency responders, fire and rescue departments, police, community hospitals, and local non-profit entities and for-profit entities concerned about cardiac arrest survival rates;
"(2) evaluates the local community emergency response times to assess whether they meet the standards established by national public health organizations such as the American Heart Association and the American Red Cross; and
"(3) submits to the Secretary of Health and Human Services an application at such time, in such manner, and containing such information as the Secretary may require.
"(c)
"(1) to purchase automated external defibrillators that have been approved, or cleared for marketing, by the Food and Drug Administration; and
"(2) to provide defibrillator and basic life support training in automated external defibrillator usage through the American Heart Association, the American Red Cross, or other nationally recognized training courses.
"(d)
"(e)
Report on Telemedicine
"(1) identifies any factors that inhibit the expansion and accessibility of telemedicine services, including factors relating to telemedicine networks;
"(2) identifies any factors that, in addition to geographical isolation, should be used to determine which patients need or require access to telemedicine care;
"(3) determines the extent to which—
"(A) patients receiving telemedicine service have benefited from the services, and are satisfied with the treatment received pursuant to the services; and
"(B) the medical outcomes for such patients would have differed if telemedicine services had not been available to the patients;
"(4) determines the extent to which physicians involved with telemedicine services have been satisfied with the medical aspects of the services;
"(5) determines the extent to which primary care physicians are enhancing their medical knowledge and experience through the interaction with specialists provided by telemedicine consultations; and
"(6) identifies legal and medical issues relating to State licensing of health professionals that are presented by telemedicine services, and provides any recommendations of the Secretary for responding to such issues."
Executive Documents
Ex. Ord. No. 13941. Improving Rural Health and Telehealth Access
Ex. Ord. No. 13941, Aug. 3, 2020, 85 F.R. 47881, provided:
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:
Since 2010, the year the [Patient Protection and] Affordable Care Act [
During the COVID–19 public health emergency (PHE), hospitals curtailed elective medical procedures and access to in-person clinical care was limited. To help patients better access healthcare providers, my Administration implemented new flexibility regarding what services may be provided via telehealth, who may provide them, and in what circumstances, and the use of telehealth increased dramatically across the Nation. Internal analysis by the Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services (HHS) showed a weekly jump in virtual visits for CMS beneficiaries, from approximately 14,000 pre-PHE to almost 1.7 million in the last week of April. Additionally, a recent report by HHS shows that nearly half (43.5 percent) of Medicare fee-for-service primary care visits were provided through telehealth in April, compared with far less than one percent (0.1 percent) in February before the PHE. Importantly, the report finds that telehealth visits continued to be frequent even after in-person primary care visits resumed in May, indicating that the expansion of telehealth services is likely to be a more permanent feature of the healthcare delivery system.
Rural healthcare providers, in particular, need these types of flexibilities to provide continuous care to patients in their communities. It is the purpose of this order to increase access to, improve the quality of, and improve the financial economics of rural healthcare, including by increasing access to high-quality care through telehealth.
(a) increase rural access to healthcare by eliminating regulatory burdens that limit the availability of clinical professionals;
(b) prevent disease and mortality by developing rural-specific efforts to drive improved health outcomes;
(c) reduce maternal mortality and morbidity; and
(d) improve mental health in rural communities.
(a) the additional telehealth services offered to Medicare beneficiaries; and
(b) the services, reporting, staffing, and supervision flexibilities offered to Medicare providers in rural areas.
(i) the authority granted by law to an executive department or agency, or the head thereof; or
(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.
(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.
(c) This order 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 entities, its officers, employees, or agents, or any other person.
Donald J. Trump.
§254c–1. Grants for health services for Pacific Islanders
(a) Grants
The Secretary of Health and Human Services (hereafter in this section referred to as the "Secretary") shall provide grants to, or enter into contracts with, public or private nonprofit agencies that have demonstrated experience in serving the health needs of Pacific Islanders living in the Territory of American Samoa, the Commonwealth of Northern Mariana Islands, the Territory of Guam, the Republic of the Marshall Islands, the Republic of Palau, and the Federated States of Micronesia.
(b) Use of grants or contracts
Grants or contracts made or entered into under subsection (a) shall be used, among other items—
(1) to continue, as a priority, the medical officer training program in Pohnpei, Federated States of Micronesia;
(2) to improve the quality and availability of health and mental health services and systems, with an emphasis therein on preventive health services and health promotion programs and projects, including improved health data systems;
(3) to improve the quality and availability of health manpower, including programs and projects to train new and upgrade the skills of existing health professionals by—
(A) establishing dental officer, dental assistant, nurse practitioner, or nurse clinical specialist training programs;
(B) providing technical training of new auxiliary health workers;
(C) upgrading the training of currently employed health personnel in special areas of need;
(D) developing long-term plans for meeting health profession needs;
(E) developing or improving programs for faculty enhancement or post-doctoral training; and
(F) providing innovative health professions training initiatives (including scholarships) targeted toward ensuring that residents of the Pacific Basin attend and graduate from recognized health professional programs;
(4) to improve the quality of health services, including laboratory, x-ray, and pharmacy, provided in ambulatory and inpatient settings through quality assurance, standard setting, and other culturally appropriate means;
(5) to improve facility and equipment repair and maintenance systems;
(6) to improve alcohol, drug abuse, and mental health prevention and treatment services and systems;
(7) to improve local and regional health planning systems; and
(8) to improve basic local public health systems, with particular attention to primary care and services to those most in need.
No funds under subsection (b) shall be used for capital construction.
(c) Advisory Council
The Secretary of Health and Human Services shall establish a "Pacific Health Advisory Council" which shall consist of 12 members and shall include—
(1) the Directors of the Health Departments for the entities identified in subsection (a); and
(2) 6 members, including a representative of the Rehabilitation Hospital of the Pacific, representing organizations in the State of Hawaii actively involved in the provision of health services or technical assistance to the entities identified in subsection (a). The Secretary shall solicit the advice of the Governor of the State of Hawaii in appointing the 5 Council members in addition to the representative of the Rehabilitation Hospital of the Pacific from the State of Hawaii.
The Secretary shall be responsible for providing sufficient staff support to the Council.
(d) Advisory Council functions
The Council shall meet at least annually to—
(1) recommend priority areas of need for funding by the Public Health Service under this section; and
(2) review progress in addressing priority areas and make recommendations to the Secretary for needed program modifications.
(e) Omitted
(f) Authorization of appropriation
There is authorized to be appropriated to carry out this section $10,000,000 for each of the fiscal years 1991 through 1993.
(
Editorial Notes
Codification
Section was enacted as part of the Disadvantaged Minority Health Improvement Act of 1990, and not as part of the Public Health Service Act which comprises this chapter.
Subsec. (e) of this section, which required the Secretary, in consultation with the Council, to annually prepare and submit to appropriate committees of Congress a report describing the expenditure of funds authorized to be appropriated under this section, with any recommendations of the Secretary, terminated, effective May 15, 2000, pursuant to section 3003 of
Statutory Notes and Related Subsidiaries
Termination of Advisory Councils
Advisory councils established after Jan. 5, 1973, to terminate not later than the expiration of the 2-year period beginning on the date of their establishment, unless, in the case of a council established by the President or an officer of the Federal Government, such council is renewed by appropriate action prior to the expiration of such 2-year period, or in the case of a council established by Congress, its duration is otherwise provided by law. See
§254c–1a. Grants to nurse-managed health clinics
(a) Definitions
(1) Comprehensive primary health care services
In this section, the term "comprehensive primary health care services" means the primary health services described in
(2) Nurse-managed health clinic
The term "nurse-managed health clinic" means a nurse-practice arrangement, managed by advanced practice nurses, that provides primary care or wellness services to underserved or vulnerable populations and that is associated with a school, college, university or department of nursing, federally qualified health center, or independent nonprofit health or social services agency.
(b) Authority to award grants
The Secretary shall award grants for the cost of the operation of nurse-managed health clinics that meet the requirements of this section.
(c) Applications
To be eligible to receive a grant under this section, an entity shall—
(1) be an NMHC; and
(2) submit to the Secretary an application at such time, in such manner, and containing—
(A) assurances that nurses are the major providers of services at the NMHC and that at least 1 advanced practice nurse holds an executive management position within the organizational structure of the NMHC;
(B) an assurance that the NMHC will continue providing comprehensive primary health care services or wellness services without regard to income or insurance status of the patient for the duration of the grant period; and
(C) an assurance that, not later than 90 days of receiving a grant under this section, the NMHC will establish a community advisory committee, for which a majority of the members shall be individuals who are served by the NMHC.
(d) Grant amount
The amount of any grant made under this section for any fiscal year shall be determined by the Secretary, taking into account—
(1) the financial need of the NMHC, considering State, local, and other operational funding provided to the NMHC; and
(2) other factors, as the Secretary determines appropriate.
(e) Authorization of appropriations
For the purposes of carrying out this section, there are authorized to be appropriated $50,000,000 for the fiscal year 2010 and such sums as may be necessary for each of the fiscal years 2011 through 2014.
(July 1, 1944, ch. 373, title III, §330A–1, as added
Statutory Notes and Related Subsidiaries
Purpose
§254c–1b. Rural obstetric network grants
(a) Program established
The Secretary shall award grants or cooperative agreements to eligible entities to establish collaborative improvement and innovation networks (referred to in this section as "rural obstetric networks") to improve maternal and infant health outcomes and reduce preventable maternal mortality and severe maternal morbidity by improving maternity care and access to care in rural areas, frontier areas, maternity care health professional target areas, or jurisdictions of Indian Tribes and Tribal organizations.
(b) Use of funds
Grants or cooperative agreements awarded pursuant to this section shall be used for the establishment or continuation of collaborative improvement and innovation networks to improve maternal and infant health outcomes and reduce preventable maternal mortality and severe maternal morbidity by improving prenatal care, labor care, birthing, and postpartum care services in rural areas. Rural obstetric networks established in accordance with this section may—
(1) develop a network to improve coordination and increase access to maternal health care and assist pregnant women in the areas described in subsection (a) with accessing and utilizing prenatal care, labor care, birthing, and postpartum care services to improve outcomes in birth and maternal mortality and morbidity;
(2) identify and implement evidence-based and sustainable delivery models for providing prenatal care, labor care, birthing, and postpartum care services, including home visiting programs and culturally appropriate care models that reduce health disparities;
(3) develop a model for maternal health care collaboration between health care settings to improve access to care in areas described in subsection (a), which may include the use of telehealth;
(4) provide training for professionals in health care settings that do not have specialty maternity care;
(5) collaborate with academic institutions that can provide regional expertise and help identify barriers to providing maternal health care, including strategies for addressing such barriers; and
(6) assess and address disparities in infant and maternal health outcomes, including among racial and ethnic minority populations and underserved populations in such areas described in subsection (a).
(c) Definitions
In this section:
(1) Eligible entities
The term "eligible entities" means entities providing prenatal care, labor care, birthing, and postpartum care services in rural areas, frontier areas, or medically underserved areas, or to medically underserved populations or Indian Tribes or Tribal organizations.
(2) Frontier area
The term "frontier area" means a frontier county, as defined in
(3) Indian Tribes; Tribal organization
The terms "Indian Tribe" and "Tribal organization" have the meanings given the terms "Indian tribe" and "tribal organization" in
(4) Maternity care health professional target area
The term "maternity care health professional target area" has the meaning described in
(d) Report to Congress
Not later than September 30, 2026, the Secretary shall submit to Congress a report on activities supported by grants awarded under this section, including—
(1) a description of activities conducted pursuant to paragraphs (1) through (6) of subsection (b); and
(2) an analysis of the effects of rural obstetric networks on improving maternal and infant health outcomes.
(e) Authorization of appropriations
There are authorized to be appropriated to carry out this section $3,000,000 for each of fiscal years 2023 through 2027.
(July 1, 1944, ch. 373, title III, §330A–2, as added
§254c–2. Special diabetes programs for type I diabetes
(a) In general
The Secretary, directly or through grants, shall provide for research into the prevention and cure of Type 1 I diabetes.
(b) Funding
(1) Transferred funds
Notwithstanding
(2) Appropriations
For the purpose of making grants under this section, there is appropriated, out of any funds in the Treasury not otherwise appropriated—
(A) $70,000,000 for each of fiscal years 2001 and 2002 (which shall be combined with amounts transferred under paragraph (1) for each such fiscal years);
(B) $100,000,000 for fiscal year 2003;
(C) $150,000,000 for each of fiscal years 2004 through 2017;
(D) $150,000,000 for each of fiscal years 2018 through 2023, to remain available until expended; and
(E) $19,726,027 for the period beginning on October 1, 2023, and ending on November 17, 2023, $25,890,411 for the period beginning on November 18, 2023, and ending on January 19, 2024, $20,136,986 for the period beginning on January 20, 2024, and ending on March 8, 2024, and $130,000,000 for the period beginning on March 9, 2024, and ending on December 31, 2024, to remain available until expended.
(July 1, 1944, ch. 373, title III, §330B, as added
Editorial Notes
Amendments
2024—Subsec. (b)(2)(E).
2023—Subsec. (b)(2)(E).
2020—Subsec. (b)(2)(D).
2019—Subsec. (b)(2)(D).
2018—Subsec. (b)(2)(D).
2017—Subsec. (b)(2)(D).
2015—Subsec. (b)(2)(C).
2014—Subsec. (b)(2)(C).
2013—Subsec. (b)(2)(C).
2010—Subsec. (b)(2)(C).
2008—Subsec. (b)(2)(C).
2007—Subsec. (b)(2)(C).
2002—Subsec. (b)(2)(C).
2000—Subsec. (b).
1997—
Subsec. (a).
Statutory Notes and Related Subsidiaries
Effective Date of 1997 Amendment
Report on Diabetes Grant Programs
"(a)
"[(b) Repealed.
[
1 So in original. Probably should not be capitalized.
§254c–3. Special diabetes programs for Indians
(a) In general
The Secretary shall make grants for providing services for the prevention and treatment of diabetes in accordance with subsection (b).
(b) Services through Indian health facilities
For purposes of subsection (a), services under such subsection are provided in accordance with this subsection if the services are provided through any of the following entities:
(1) The Indian Health Service.
(2) An Indian health program operated by an Indian tribe or tribal organization pursuant to a contract, grant, cooperative agreement, or compact with the Indian Health Service pursuant to the Indian Self-Determination Act [
(3) An urban Indian health program operated by an urban Indian organization pursuant to a grant or contract with the Indian Health Service pursuant to title V of the Indian Health Care Improvement Act [
(c) Funding
(1) Transferred funds
Notwithstanding
(2) Appropriations
For the purpose of making grants under this section, there is appropriated, out of any money in the Treasury not otherwise appropriated—
(A) $70,000,000 for each of fiscal years 2001 and 2002 (which shall be combined with amounts transferred under paragraph (1) for each such fiscal years);
(B) $100,000,000 for fiscal year 2003;
(C) $150,000,000 for each of fiscal years 2004 through 2017;
(D) $150,000,000 for each of fiscal years 2018 through 2023, to remain available until expended; and
(E) $19,726,027 for the period beginning on October 1, 2023, and ending on November 17, 2023, $25,890,411 for the period beginning on November 18, 2023, and ending on January 19, 2024, $20,136,986 for the period beginning on January 20, 2024, and ending on March 8, 2024, and $130,000,000 for the period beginning on March 9, 2024, and ending on December 31, 2024, to remain available until expended.
(July 1, 1944, ch. 373, title III, §330C, as added
Editorial Notes
References in Text
The Indian Self-Determination Act, referred to in subsec. (b)(2), is title I of
The Indian Health Care Improvement Act, referred to in subsec. (b)(3), is
Amendments
2024—Subsec. (c)(2)(E).
2023—Subsec. (c)(2)(E).
2020—Subsec. (c)(2)(D).
2019—Subsec. (c)(2)(D).
2018—Subsec. (c)(2)(D).
2017—Subsec. (c)(2)(D).
2015—Subsec. (c)(2)(C).
2014—Subsec. (c)(2)(C).
2013—Subsec. (c)(2)(C).
2010—Subsec. (c)(2)(C).
2008—Subsec. (c)(2)(C).
2007—Subsec. (c)(2)(C).
2002—Subsec. (c)(2)(C).
2000—Subsec. (c).
1998—Subsec. (c).
Statutory Notes and Related Subsidiaries
Funds Available Until Expended
§254c–4. Repealed. Pub. L. 117–328, div. FF, title II, §2201(a)(2), Dec. 29, 2022, 136 Stat. 5729
Section, act July 1, 1944, ch. 373, title III, §330D, as added
Editorial Notes
Codification
§254c–5. Epilepsy; seizure disorder
(a) National public health campaign
(1) In general
The Secretary shall develop and implement public health surveillance, education, research, and intervention strategies to improve the lives of persons with epilepsy, with a particular emphasis on children. Such projects may be carried out by the Secretary directly and through awards of grants or contracts to public or nonprofit private entities. The Secretary may directly or through such awards provide technical assistance with respect to the planning, development, and operation of such projects.
(2) Certain activities
Activities under paragraph (1) shall include—
(A) expanding current surveillance activities through existing monitoring systems and improving registries that maintain data on individuals with epilepsy, including children;
(B) enhancing research activities on the diagnosis, treatment, and management of epilepsy;
(C) implementing public and professional information and education programs regarding epilepsy, including initiatives which promote effective management of the disease through children's programs which are targeted to parents, schools, daycare providers, patients;
(D) undertaking educational efforts with the media, providers of health care, schools and others regarding stigmas and secondary disabilities related to epilepsy and seizures, and its effects on youth;
(E) utilizing and expanding partnerships with organizations with experience addressing the health and related needs of people with disabilities; and
(F) other activities the Secretary deems appropriate.
(3) Coordination of activities
The Secretary shall ensure that activities under this subsection are coordinated as appropriate with other agencies of the Public Health Service that carry out activities regarding epilepsy and seizure.
(b) Seizure disorder; demonstration projects in medically underserved areas
(1) In general
The Secretary, acting through the Administrator of the Health Resources and Services Administration, may make grants for the purpose of carrying out demonstration projects to improve access to health and other services regarding seizures to encourage early detection and treatment in children and others residing in medically underserved areas.
(2) Application for grant
A grant may not be awarded under paragraph (1) unless an application therefore is submitted to the Secretary and the Secretary approves such application. Such application shall be submitted in such form and manner and shall contain such information as the Secretary may prescribe.
(c) Definitions
For purposes of this section:
(1) The term "epilepsy" refers to a chronic and serious neurological condition characterized by excessive electrical discharges in the brain causing recurring seizures affecting all life activities. The Secretary may revise the definition of such term to the extent the Secretary determines necessary.
(2) The term "medically underserved" has the meaning applicable under
(d) Authorization of appropriations
For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2001 through 2005.
(July 1, 1944, ch. 373, title III, §330E, as added
§254c–6. Certain services for pregnant women
(a) Infant adoption awareness
(1) In general
The Secretary shall make grants to national, regional, or local adoption organizations for the purpose of developing and implementing programs to train the designated staff of eligible health centers in providing adoption information and referrals to pregnant women on an equal basis with all other courses of action included in nondirective counseling to pregnant women.
(2) Best-practices guidelines
(A) In general
A condition for the receipt of a grant under paragraph (1) is that the adoption organization involved agree that, in providing training under such paragraph, the organization will follow the guidelines developed under subparagraph (B).
(B) Process for development of guidelines
(i) In general
The Secretary shall establish and supervise a process described in clause (ii) in which the participants are—
(I) an appropriate number and variety of adoption organizations that, as a group, have expertise in all models of adoption practice and that represent all members of the adoption triad (birth mother, infant, and adoptive parent); and
(II) affected public health entities.
(ii) Description of process
The process referred to in clause (i) is a process in which the participants described in such clause collaborate to develop best-practices guidelines on the provision of adoption information and referrals to pregnant women on an equal basis with all other courses of action included in nondirective counseling to pregnant women.
(iii) Date certain for development
The Secretary shall ensure that the guidelines described in clause (ii) are developed not later than 180 days after October 17, 2000.
(C) Relation to authority for grants
The Secretary may not make any grant under paragraph (1) before the date on which the guidelines under subparagraph (B) are developed.
(3) Use of grant
(A) In general
With respect to a grant under paragraph (1)—
(i) an adoption organization may expend the grant to carry out the programs directly or through grants to or contracts with other adoption organizations;
(ii) the purposes for which the adoption organization expends the grant may include the development of a training curriculum, consistent with the guidelines developed under paragraph (2)(B); and
(iii) a condition for the receipt of the grant is that the adoption organization agree that, in providing training for the designated staff of eligible health centers, such organization will make reasonable efforts to ensure that the individuals who provide the training are individuals who are knowledgeable in all elements of the adoption process and are experienced in providing adoption information and referrals in the geographic areas in which the eligible health centers are located, and that the designated staff receive the training in such areas.
(B) Rule of construction regarding training of trainers
With respect to individuals who under a grant under paragraph (1) provide training for the designated staff of eligible health centers (referred to in this subparagraph as "trainers"), subparagraph (A)(iii) may not be construed as establishing any limitation regarding the geographic area in which the trainers receive instruction in being such trainers. A trainer may receive such instruction in a different geographic area than the area in which the trainer trains (or will train) the designated staff of eligible health centers.
(4) Adoption organizations; eligible health centers; other definitions
For purposes of this section:
(A) The term "adoption organization" means a national, regional, or local organization—
(i) among whose primary purposes are adoption;
(ii) that is knowledgeable in all elements of the adoption process and on providing adoption information and referrals to pregnant women; and
(iii) that is a nonprofit private entity.
(B) The term "designated staff", with respect to an eligible health center, means staff of the center who provide pregnancy or adoption information and referrals (or will provide such information and referrals after receiving training under a grant under paragraph (1)).
(C) The term "eligible health centers" means public and nonprofit private entities that provide health services to pregnant women.
(5) Training for certain eligible health centers
A condition for the receipt of a grant under paragraph (1) is that the adoption organization involved agree to make reasonable efforts to ensure that the eligible health centers with respect to which training under the grant is provided include—
(A) eligible health centers that receive grants under
(B) eligible health centers that receive grants under
(C) eligible health centers that receive grants under this chapter for the provision of services in schools.
(6) Participation of certain eligible health clinics
In the case of eligible health centers that receive grants under
(A) Within a reasonable period after the Secretary begins making grants under paragraph (1), the Secretary shall provide eligible health centers with complete information about the training available from organizations receiving grants under such paragraph. The Secretary shall make reasonable efforts to encourage eligible health centers to arrange for designated staff to participate in such training. Such efforts shall affirm Federal requirements, if any, that the eligible health center provide nondirective counseling to pregnant women.
(B) All costs of such centers in obtaining the training shall be reimbursed by the organization that provides the training, using grants under paragraph (1).
(C) Not later than 1 year after October 17, 2000, the Secretary shall submit to the appropriate committees of the Congress a report evaluating the extent to which adoption information and referral, upon request, are provided by eligible health centers. Within a reasonable time after training under this section is initiated, the Secretary shall submit to the appropriate committees of the Congress a report evaluating the extent to which adoption information and referral, upon request, are provided by eligible health centers in order to determine the effectiveness of such training and the extent to which such training complies with subsection (a)(1). In preparing the reports required by this subparagraph, the Secretary shall in no respect interpret the provisions of this section to allow any interference in the provider-patient relationship, any breach of patient confidentiality, or any monitoring or auditing of the counseling process or patient records which breaches patient confidentiality or reveals patient identity. The reports required by this subparagraph shall be conducted by the Secretary acting through the Administrator of the Health Resources and Services Administration and in collaboration with the Director of the Agency for Healthcare Research and Quality.
(b) Application for grant
The Secretary may make a grant under subsection (a) only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section.
(c) Authorization of appropriations
For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2001 through 2005.
(July 1, 1944, ch. 373, title III, §330F, as added
§254c–7. Special needs adoption programs; public awareness campaign and other activities
(a) Special needs adoption awareness campaign
(1) In general
The Secretary shall, through making grants to nonprofit private entities, provide for the planning, development, and carrying out of a national campaign to provide information to the public regarding the adoption of children with special needs.
(2) Input on planning and development
In providing for the planning and development of the national campaign under paragraph (1), the Secretary shall provide for input from a number and variety of adoption organizations throughout the States in order that the full national diversity of interests among adoption organizations is represented in the planning and development of the campaign.
(3) Certain features
With respect to the national campaign under paragraph (1):
(A) The campaign shall be directed at various populations, taking into account as appropriate differences among geographic regions, and shall be carried out in the language and cultural context that is most appropriate to the population involved.
(B) The means through which the campaign may be carried out include—
(i) placing public service announcements on television, radio, and billboards; and
(ii) providing information through means that the Secretary determines will reach individuals who are most likely to adopt children with special needs.
(C) The campaign shall provide information on the subsidies and supports that are available to individuals regarding the adoption of children with special needs.
(D) The Secretary may provide that the placement of public service announcements, and the dissemination of brochures and other materials, is subject to review by the Secretary.
(4) Matching requirement
(A) In general
With respect to the costs of the activities to be carried out by an entity pursuant to paragraph (1), a condition for the receipt of a grant under such paragraph is that the entity agree to make available (directly or through donations from public or private entities) non-Federal contributions toward such costs in an amount that is not less than 25 percent of such costs.
(B) Determination of amount contributed
Non-Federal contributions under subparagraph (A) may be in cash or in kind, fairly evaluated, including plant, equipment, or services. Amounts provided by the Federal Government, or services assisted or subsidized to any significant extent by the Federal Government, may not be included in determining the amount of such contributions.
(b) National resources program
The Secretary shall (directly or through grant or contract) carry out a program that, through toll-free telecommunications, makes available to the public information regarding the adoption of children with special needs. Such information shall include the following:
(1) A list of national, State, and regional organizations that provide services regarding such adoptions, including exchanges and other information on communicating with the organizations. The list shall represent the full national diversity of adoption organizations.
(2) Information beneficial to individuals who adopt such children, including lists of support groups for adoptive parents and other postadoptive services.
(c) Other programs
With respect to the adoption of children with special needs, the Secretary shall make grants—
(1) to provide assistance to support groups for adoptive parents, adopted children, and siblings of adopted children; and
(2) to carry out studies to identify—
(A) the barriers to completion of the adoption process; and
(B) those components that lead to favorable long-term outcomes for families that adopt children with special needs.
(d) Application for grant
The Secretary may make an award of a grant or contract under this section only if an application for the award is submitted to the Secretary and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section.
(e) Funding
For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2001 through 2005.
(July 1, 1944, ch. 373, title III, §330G, as added
§254c–8. Healthy start for infants
(a) In general
(1) Continuation and expansion of program
The Secretary, acting through the Administrator of the Health Resources and Services Administration, Maternal and Child Health Bureau, shall under authority of this section continue in effect the Healthy Start Initiative and may carry out such program on a national basis.
(2) Definition
For purposes of paragraph (1), the term "Healthy Start Initiative" is a reference to the program that, as an initiative to reduce the rate of infant mortality and improve perinatal outcomes, makes grants for project areas with high or increasing above the national average annual rates of infant mortality and that, prior to the effective date of this section, was a demonstration program carried out under
(b) Considerations in making grants
(1) Requirements
In making grants under subsection (a), the Secretary shall require that applicants (in addition to meeting all eligibility criteria established by the Secretary) establish, for project areas under such subsection, community-based consortia of individuals and organizations (including agencies responsible for administering block grant programs under title V of the Social Security Act [
(2) Other considerations
In making grants under subsection (a), the Secretary shall take into consideration the following:
(A) Factors that contribute to infant mortality, including poor birth outcomes (such as low birthweight and preterm birth) and social determinants of health.
(B) Communities with—
(i) high rates of infant mortality or poor perinatal outcomes; or
(ii) high rates of infant mortality or poor perinatal outcomes in specific subpopulations within the community.
(C) The extent to which applicants for such grants facilitate—
(i) collaboration with the local community in the development of the project;
(ii) a community-based approach to the delivery of services;
(iii) a comprehensive approach to women's health care to improve perinatal outcomes; and
(iv) the use and collection of data demonstrating the effectiveness of such program in decreasing infant mortality rates and improving perinatal outcomes, as applicable, or the process by which new applicants plan to collect this data.
(3) Special projects
Nothing in paragraph (2) shall be construed to prevent the Secretary from awarding grants under subsection (a) for special projects that are intended to address significant disparities in perinatal health indicators in communities along the United States-Mexico border or in Alaska or Hawaii.
(c) Coordination
(1) In general
Recipients of grants under subsection (a) shall coordinate their services and activities with the State agency or agencies that administer block grant programs under title V of the Social Security Act [
(2) Other programs
The Secretary shall ensure coordination of the program carried out pursuant to this section with other programs and activities related to the reduction of the rate of infant mortality and improved perinatal and infant health outcomes supported by the Department.
(d) Rule of construction
Except to the extent inconsistent with this section, this section may not be construed as affecting the authority of the Secretary to make modifications in the program carried out under subsection (a).
(e) Funding
(1) Authorization of appropriations
For the purpose of carrying out this section, there are authorized to be appropriated $125,500,000 for each of fiscal years 2021 through 2025.
(2) Allocation
(A) Program administration
Of the amounts appropriated under paragraph (1) for a fiscal year, the Secretary may reserve up to 5 percent for coordination, dissemination, technical assistance, and data activities that are determined by the Secretary to be appropriate for carrying out the program under this section.
(B) Evaluation
Of the amounts appropriated under paragraph (1) for a fiscal year, the Secretary may reserve up to 1 percent for evaluations of projects carried out under subsection (a). Each such evaluation shall include a determination of whether such projects have been effective in reducing the disparity in health status between the general population and individuals who are members of racial or ethnic minority groups. Evaluations may also include, to the extent practicable, information related to—
(i) progress toward achieving any grant metrics or outcomes related to reducing infant mortality rates, improving perinatal outcomes, or reducing the disparity in health status;
(ii) recommendations on potential improvements that may assist with addressing gaps, as applicable and appropriate; and
(iii) the extent to which the grantee coordinated with the community in which the grantee is located in the development of the project and delivery of services, including with respect to technical assistance and mentorship programs.
(f) GAO report
(1) In general
Not later than 4 years after March 27, 2020, the Comptroller General of the United States shall conduct an independent evaluation, and submit to the appropriate Committees of Congress a report, concerning the Healthy Start program under this section.
(2) Evaluation
In conducting the evaluation under paragraph (1), the Comptroller General shall consider, as applicable and appropriate, information from the evaluations under subsection (e)(2)(B).
(3) Report
The report described in paragraph (1) shall review, assess, and provide recommendations, as appropriate, on the following:
(A) The allocation of Healthy Start program grants by the Health Resources and Services Administration, including considerations made by such Administration regarding disparities in infant mortality or perinatal outcomes among urban and rural areas in making such awards.
(B) Trends in the progress made toward meeting the evaluation criteria pursuant to subsection (e)(2)(B), including programs which decrease infant mortality rates and improve perinatal outcomes, programs that have not decreased infant mortality rates or improved perinatal outcomes, and programs that have made an impact on disparities in infant mortality or perinatal outcomes.
(C) The ability of grantees to improve health outcomes for project participants, promote the awareness of the Healthy Start program services, incorporate and promote family participation, facilitate coordination with the community in which the grantee is located, and increase grantee accountability through quality improvement, performance monitoring, evaluation, and the effect such metrics may have toward decreasing the rate of infant mortality and improving perinatal outcomes.
(D) The extent to which such Federal programs are coordinated across agencies and the identification of opportunities for improved coordination in such Federal programs and activities.
(July 1, 1944, ch. 373, title III, §330H, as added
Editorial Notes
References in Text
The effective date of this section, referred to in subsec. (a)(2), is the date of enactment of
The Social Security Act, referred to in subsecs. (b)(1) and (c)(1), is act Aug. 14, 1935, ch. 531,
Amendments
2020—Subsec. (a)(1).
Subsec. (a)(2).
Subsec. (b)(1).
Subsec. (b)(2)(A).
Subsec. (b)(2)(B).
Subsec. (b)(2)(C).
Subsec. (c).
Subsec. (e)(1).
"(A) $120,000,000 for fiscal year 2008; and
"(B) for each of fiscal years 2009 through 2013, the amount authorized for the preceding fiscal year increased by the percentage increase in the Consumer Price Index for all urban consumers for such year."
Subsec. (e)(2)(B).
Subsec. (f).
2008—Subsec. (a)(3).
Subsec. (b).
Subsec. (e).
Subsec. (f).
2004—Subsec. (e)(3).
§254c–9. Establishment of program of grants
(a) In general
The Secretary of Health and Human Services shall in accordance with
(b) Recipients of grants
A grant under subsection (a) may be made to an entity only if the entity is a public or nonprofit private entity, which may include a State or local government; a public or nonprofit private hospital, community-based organization, hospice, ambulatory care facility, community health center, migrant health center, or homeless health center; or other appropriate public or nonprofit private entity.
(c) Certain activities
To the extent practicable and appropriate, the Secretary shall ensure that projects under subsection (a) provide services for the diagnosis and disease management of lupus. Activities that the Secretary may authorize for such projects may also include the following:
(1) Delivering or enhancing outpatient, ambulatory, and home-based health and support services, including case management and comprehensive treatment services, for individuals with lupus; and delivering or enhancing support services for their families.
(2) Delivering or enhancing inpatient care management services that prevent unnecessary hospitalization or that expedite discharge, as medically appropriate, from inpatient facilities of individuals with lupus.
(3) Improving the quality, availability, and organization of health care and support services (including transportation services, attendant care, homemaker services, day or respite care, and providing counseling on financial assistance and insurance) for individuals with lupus and support services for their families.
(d) Integration with other programs
To the extent practicable and appropriate, the Secretary shall integrate the program under
(
Editorial Notes
Codification
Section was enacted as part of the Lupus Research and Care Amendments of 2000, and also as part of the Public Health Improvement Act, and not as part of the Public Health Service Act which comprises this chapter.
§254c–10. Certain requirements
A grant may be made under
(1) Not more than 5 percent of the grant will be used for administration, accounting, reporting, and program oversight functions.
(2) The grant will be used to supplement and not supplant funds from other sources related to the treatment of lupus.
(3) The applicant will abide by any limitations deemed appropriate by the Secretary on any charges to individuals receiving services pursuant to the grant. As deemed appropriate by the Secretary, such limitations on charges may vary based on the financial circumstances of the individual receiving services.
(4) The grant will not be expended to make payment for services authorized under
(A) under any State compensation program, under an insurance policy, or under any Federal or State health benefits program; or
(B) by an entity that provides health services on a prepaid basis.
(5) The applicant will, at each site at which the applicant provides services under
(
Editorial Notes
Codification
Section was enacted as part of the Lupus Research and Care Amendments of 2000, and also as part of the Public Health Improvement Act, and not as part of the Public Health Service Act which comprises this chapter.
§254c–11. Technical assistance
The Secretary may provide technical assistance to assist entities in complying with the requirements of
(
Editorial Notes
Codification
Section was enacted as part of the Lupus Research and Care Amendments of 2000, and also as part of the Public Health Improvement Act, and not as part of the Public Health Service Act which comprises this chapter.
§254c–12. Definitions
For purposes of
(1) Official poverty line
The term "official poverty line" means the poverty line established by the Director of the Office of Management and Budget and revised by the Secretary in accordance with
(2) Secretary
The term "Secretary" means the Secretary of Health and Human Services.
(
Editorial Notes
Codification
Section was enacted as part of the Lupus Research and Care Amendments of 2000, and also as part of the Public Health Improvement Act, and not as part of the Public Health Service Act which comprises this chapter.
§254c–13. Authorization of appropriations
For the purpose of carrying out
(
Editorial Notes
Codification
Section was enacted as part of the Lupus Research and Care Amendments of 2000, and also as part of the Public Health Improvement Act, and not as part of the Public Health Service Act which comprises this chapter.
§254c–14. Telehealth network and telehealth resource centers grant programs
(a) Definitions
In this section:
(1) Director; Office
The terms "Director" and "Office" mean the Director and Office specified in subsection (c).
(2) Federally qualified health center and rural health clinic
The term "Federally qualified health center" and "rural health clinic" have the meanings given the terms in
(3) Frontier community
The term "frontier community" shall have the meaning given the term in regulations issued under subsection (r).
(4) Medically underserved area
The term "medically underserved area" has the meaning given the term "medically underserved community" in
(5) Medically underserved population
The term "medically underserved population" has the meaning given the term in
(6) Telehealth services
The term "telehealth services" means services provided through telehealth technologies.
(7) Telehealth technologies
The term "telehealth technologies" means technologies relating to the use of electronic information, and telecommunications technologies, to support and promote, at a distance, health care, patient and professional health-related education, health administration, and public health.
(b) Programs
The Secretary shall establish, under
(c) Administration
(1) Establishment
There is established in the Health Resources and Services Administration an Office for the Advancement of Telehealth. The Office shall be headed by a Director.
(2) Duties
The telehealth network and telehealth resource centers grant programs established under
(d) Grants
(1) Telehealth network grants
The Director may, in carrying out the telehealth network grant program referred to in subsection (b), award grants to eligible entities for evidence-based projects that utilize telehealth technologies through telehealth networks in rural areas, frontier communities, and medically underserved areas, and for medically underserved populations, to—
(A) expand access to, coordinate, and improve access to, and the quality of, health care services; and
(B) expand and improve the quality of health information available to health care providers,,1 patients, and their families.
(2) Telehealth resource centers grants
The Director may, in carrying out the telehealth resource centers grant program referred to in subsection (b), award grants to eligible entities for projects to support initiatives that utilize telehealth technologies in the areas and communities, and for the populations, described in paragraph (1).
(e) Grant periods
The Director may award grants under this section for periods of not more than 5 years.
(f) Eligible entities
(1) In general
To be eligible to receive a grant under subsection (d)(1), an entity shall demonstrate that the entity will provide services through a telehealth network.
(2) Nature of entities
Each entity participating in the telehealth network may be a nonprofit or for-profit entity.
(3) Composition of network
The telehealth network shall include at least 2 of the following entities (at least 1 of which shall be a community-based health care provider):
(A) Community or migrant health centers or other Federally qualified health centers.
(B) Health care providers, including pharmacists, in private practice.
(C) Entities operating clinics, including rural health clinics.
(D) Local health departments.
(E) Nonprofit hospitals, including community access hospitals.
(F) Other publicly funded health or social service agencies.
(G) Long-term care providers.
(H) Providers of health care services in the home.
(I) Providers of outpatient mental health and substance use disorder services and entities operating outpatient mental health and substance use disorder facilities.
(J) Local or regional emergency health care providers.
(K) Institutions of higher education.
(L) Entities operating dental clinics.
(M) Providers of prenatal, labor care, birthing, and postpartum care services, including hospitals that operate obstetric care units.
(g) Applications
To be eligible to receive a grant under subsection (d), an eligible entity, in consultation with the appropriate State office of rural health or another appropriate State entity, shall prepare and submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require, including—
(1) a description of the project that the eligible entity will carry out using the funds provided under the grant;
(2) a description of the manner in which the project funded under the grant will meet the health care needs of rural or other populations to be served through the project, and improve the access to services of, and the quality of the services received by, those populations;
(3) evidence of local support for the project, and a description of how the areas, communities, or populations to be served will be involved in the development and ongoing operations of the project;
(4) a plan for sustaining the project after Federal support for the project has ended;
(5) information on the source and amount of non-Federal funds that the entity will provide for the project;
(6) information demonstrating the long-term viability of the project, and other evidence of institutional commitment of the entity to the project;
(7) in the case of an application for a project involving a telehealth network, information demonstrating how the project will promote the integration of telehealth technologies into the operations of health care providers, to avoid redundancy, and improve access to and the quality of care; and
(8) other such information as the Secretary determines to be appropriate.
(h) Preferences
(1) Telehealth networks
In awarding grants under subsection (d)(1) for projects involving telehealth networks, the Secretary shall give preference to an eligible entity that meets at least 1 of the following requirements:
(A) Organization
The eligible entity is a rural community-based organization or another community-based organization.
(B) Services
The eligible entity proposes to use Federal funds made available through such a grant to develop plans for, or to establish, telehealth networks that provide mental health care, public health services, long-term care, home care, preventive care, case management services, prenatal care, labor care, birthing care, or postpartum care.
(C) Coordination
The eligible entity demonstrates how the project to be carried out under the grant will be coordinated with other relevant federally funded projects in the areas, communities, and populations to be served through the grant.
(D) Network
The eligible entity demonstrates that the project involves a telehealth network that includes an entity that—
(i) provides clinical health care services, or educational services for health care providers and for patients or their families; and
(ii) is—
(I) a public library;
(II) an institution of higher education; or
(III) a local government entity.
(E) Connectivity
The eligible entity proposes a project that promotes local and regional connectivity within areas, communities, or populations to be served through the project.
(2) Telehealth resource centers
In awarding grants under subsection (d)(2) for projects involving telehealth resource centers, the Secretary shall give preference to an eligible entity that meets at least 1 of the following requirements:
(A) Provision of services
The eligible entity has a record of success in the provision of telehealth services to rural areas, medically underserved areas, or medically underserved populations.
(B) Collaboration and sharing of expertise
The eligible entity has a demonstrated record of collaborating and sharing expertise with providers of telehealth services at the national, regional, State, and local levels.
(C) Broad range of telehealth services
The eligible entity has a record of providing a broad range of telehealth services, which may include—
(i) a variety of clinical specialty services;
(ii) patient or family education;
(iii) health care professional education; and
(iv) rural residency support programs.
(i) Distribution of funds
(1) In general
In awarding grants under this section, the Director shall ensure, to the greatest extent possible, that such grants are equitably distributed among the geographical regions of the United States.
(2) Telehealth networks
In awarding grants under subsection (d)(1) for a fiscal year, the Director shall ensure that not less than 50 percent of the funds awarded shall be awarded for projects in rural areas.
(j) Use of funds
(1) Telehealth network program
The recipient of a grant under subsection (d)(1) may use funds received through such grant for salaries, equipment, and operating or other costs, including the cost of—
(A) developing and delivering clinical telehealth services that enhance access to community-based health care services in rural areas, frontier communities, or medically underserved areas, or for medically underserved populations;
(B) developing and acquiring, through lease or purchase, equipment that furthers the objectives of the telehealth network grant program;
(C)(i) developing and providing distance education, in a manner that enhances access to care in rural areas, frontier communities, or medically underserved areas, or for medically underserved populations; or
(ii) mentoring, precepting, or supervising health care providers and students seeking to become health care providers, in a manner that enhances access to care in the areas and communities, or for the populations, described in clause (i);
(D) developing and acquiring instructional programming;
(E)(i) providing for transmission of medical data, and maintenance of equipment; and
(ii) providing for compensation (including travel expenses) of specialists, and referring health care providers, who are providing telehealth services through the telehealth network, if no third party payment is available for the telehealth services delivered through the telehealth network;
(F) developing projects to use telehealth technology to facilitate collaboration between health care providers;
(G) collecting and analyzing usage statistics and data to document the cost-effectiveness of the telehealth services; and
(H) carrying out such other activities as are consistent with achieving the objectives of this section, as determined by the Secretary.
(2) Telehealth resource centers
The recipient of a grant under subsection (d)(2) may use funds received through such grant for salaries, equipment, and operating or other costs for—
(A) providing technical assistance, training, and support, and providing for travel expenses, for health care providers and a range of health care entities that provide or will provide telehealth services;
(B) disseminating information and research findings related to telehealth services;
(C) promoting effective collaboration among telehealth resource centers and the Office;
(D) conducting evaluations to determine the best utilization of telehealth technologies to meet health care needs;
(E) promoting the integration of the technologies used in clinical information systems with other telehealth technologies;
(F) fostering the use of telehealth technologies to provide health care information and education for consumers in a more effective manner; and
(G) implementing special projects or studies under the direction of the Office.
(k) Prohibited uses of funds
An entity that receives a grant under this section may not use funds made available through the grant—
(1) to acquire real property;
(2) for expenditures to purchase or lease equipment, to the extent that the expenditures would exceed 20 percent of the total grant funds;
(3) in the case of a project involving a telehealth network, to purchase or install transmission equipment;
(4) to pay for any equipment or transmission costs not directly related to the purposes for which the grant is awarded;
(5) to purchase or install general purpose voice telephone systems;
(6) for construction; or
(7) for expenditures for indirect costs (as determined by the Secretary), to the extent that the expenditures would exceed 15 percent of the total grant funds.
(l) Collaboration
In providing services under this section, an eligible entity shall collaborate, if feasible, with entities that—
(1)(A) are private or public organizations, that receive Federal or State assistance; or
(B) are public or private entities that operate centers, or carry out programs, that receive Federal or State assistance; and
(2) provide telehealth services or related activities.
(m) Coordination with other agencies
The Secretary shall coordinate activities carried out under grant programs described in subsection (b), to the extent practicable, with Federal and State agencies and nonprofit organizations that are operating similar programs, to maximize the effect of public dollars in funding meritorious proposals.
(n) Outreach activities
The Secretary shall establish and implement procedures to carry out outreach activities to advise potential end users of telehealth services in rural areas, frontier communities, medically underserved areas, and medically underserved populations in each State about the grant programs described in subsection (b).
(o) Telehealth
It is the sense of Congress that, for purposes of this section, States should develop reciprocity agreements so that a provider of services under this section who is a licensed or otherwise authorized health care provider under the law of 1 or more States, and who, through telehealth technology, consults with a licensed or otherwise authorized health care provider in another State, is exempt, with respect to such consultation, from any State law of the other State that prohibits such consultation on the basis that the first health care provider is not a licensed or authorized health care provider under the law of that State.
(p) Report
Not later than 4 years after March 27, 2020, and every 5 years thereafter, the Secretary 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 on the activities and outcomes of the grant programs under subsection (b).
(q) Authorization of appropriations
There are authorized to be appropriated to carry out this section $29,000,000 for each of fiscal years 2021 through 2025.
(July 1, 1944, ch. 373, title III, §330I, as added
Editorial Notes
Amendments
2022—Subsec. (f)(3)(M).
Subsec. (h)(1)(B).
2020—Subsec. (d)(1).
Subsec. (d)(1)(A).
Subsec. (d)(1)(B), (C).
Subsec. (d)(2).
Subsec. (e).
Subsec. (f).
Subsec. (f)(2).
Subsec. (f)(3)(I).
Subsec. (g)(2).
Subsec. (h).
Subsec. (h)(1)(B).
Subsec. (h)(1)(E).
Subsec. (h)(1)(F).
Subsec. (h)(2)(A).
Subsec. (i).
Subsec. (i)(2).
"(A) not less than 50 percent of the funds awarded shall be awarded for projects in rural areas; and
"(B) the total amount of funds awarded for such projects for that fiscal year shall be not less than the total amount of funds awarded for such projects for fiscal year 2001 under
Subsec. (j).
Subsec. (j)(1)(B).
Subsec. (j)(2)(F).
Subsec. (k).
Subsec. (k)(2).
Subsec. (k)(3).
Subsecs. (l) to (o).
Subsec. (p).
Subsec. (q).
"(1) for grants under subsection (d)(1), $40,000,000 for fiscal year 2002, and such sums as may be necessary for each of fiscal years 2003 through 2006; and
"(2) for grants under subsection (d)(2), $20,000,000 for fiscal year 2002, and such sums as may be necessary for each of fiscal years 2003 through 2006."
Subsec. (r).
Subsec. (s).
2013—Subsec. (i)(1)(B).
2003—Subsec. (a)(4).
Subsec. (c)(1).
Statutory Notes and Related Subsidiaries
Effective Date of 2003 Amendment
Amendments by
§254c–15. Rural emergency medical service training and equipment assistance program
(a) Grants
The Secretary, acting through the Administrator of the Health Resources and Services Administration (referred to in this section as the "Secretary") shall award grants to eligible entities to enable such entities to provide for improved emergency medical services in rural areas or to residents of rural areas.
(b) Eligibility; application
To be eligible to receive grant under this section, an entity shall—
(1) be—
(A) an emergency medical services agency operated by a local or tribal government (including fire-based and non-fire based); or
(B) an emergency medical services agency that is described in
(2) submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
(c) Use of funds
An entity—
(1) shall use amounts received through a grant under subsection (a) to—
(A) train emergency medical services personnel as appropriate to obtain and maintain licenses and certifications relevant to service in an emergency medical services agency described in subsection (b)(1);
(B) conduct courses that qualify graduates to serve in an emergency medical services agency described in subsection (b)(1) in accordance with State and local requirements;
(C) fund specific training to meet Federal or State licensing or certification requirements; and
(D) acquire emergency medical services equipment; and
(2) may use amounts received through a grant under subsection (a) to—
(A) recruit and retain emergency medical services personnel, which may include volunteer personnel;
(B) develop new ways to educate emergency health care providers through the use of technology-enhanced educational methods; or
(C) acquire personal protective equipment for emergency medical services personnel as required by the Occupational Safety and Health Administration.
(d) Grant amounts
Each grant awarded under this section shall be in an amount not to exceed $200,000.
(e) Definitions
In this section:
(1) The term "emergency medical services"—
(A) means resources used by a public or private nonprofit licensed entity to deliver medical care outside of a medical facility under emergency conditions that occur as a result of the condition of the patient; and
(B) includes services delivered (either on a compensated or volunteer basis) by an emergency medical services provider or other provider that is licensed or certified by the State involved as an emergency medical technician, a paramedic, or an equivalent professional (as determined by the State).
(2) The term "rural area" means—
(A) a nonmetropolitan statistical area;
(B) an area designated as a rural area by any law or regulation of a State; or
(C) a rural census tract of a metropolitan statistical area (as determined under the most recent rural urban commuting area code as set forth by the Office of Management and Budget).
(f) Matching requirement
The Secretary may not award a grant under this section to an entity unless the entity agrees that the entity will make available (directly or through contributions from other public or private entities) non-Federal contributions toward the activities to be carried out under the grant in an amount equal to 10 percent of the amount received under the grant.
(g) Authorization of appropriations
(1) In general
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2019 through 2023.
(2) Administrative costs
The Secretary may use not more than 10 percent of the amount appropriated under paragraph (1) for a fiscal year for the administrative expenses of carrying out this section.
(July 1, 1944, ch. 373, title III, §330J, as added
Editorial Notes
Amendments
2018—Subsec. (a).
Subsecs. (b) to (f).
Subsec. (g)(1).
§254c–16. Mental health services delivered via telehealth
(a) Definitions
In this section:
(1) Eligible entity
The term "eligible entity" means a public or nonprofit private telehealth provider network that offers services that include mental health services provided by qualified mental health providers.
(2) Qualified mental health professionals
The term "qualified mental health professionals" refers to providers of mental health services reimbursed under the medicare program carried out under title XVIII of the Social Security Act (
(3) Special populations
The term "special populations" refers to the following 2 distinct groups:
(A) Children and adolescents in mental health underserved rural areas or in mental health underserved urban areas.
(B) Elderly individuals located in long-term care facilities in mental health underserved rural or urban areas.
(4) Telehealth
The term "telehealth" means the use of electronic information and telecommunications technologies to support long distance clinical health care, patient and professional health-related education, public health, and health administration.
(b) Program authorized
(1) In general
The Secretary, acting through the Director of the Office for the Advancement of Telehealth of the Health Resources and Services Administration, shall award grants to eligible entities to establish demonstration projects for the provision of mental health services to special populations as delivered remotely by qualified mental health professionals using telehealth and for the provision of education regarding mental illness as delivered remotely by qualified mental health professionals using telehealth.
(2) Populations served
The Secretary shall award the grants under paragraph (1) in a manner that distributes the grants so as to serve equitably the populations described in subparagraphs (A) and (B) of subsection (a)(3).
(c) Use of funds
(1) In general
An eligible entity that receives a grant under this section shall use the grant funds—
(A) for the populations described in subsection (a)(3)(A)—
(i) to provide mental health services, including diagnosis and treatment of mental illness, as delivered remotely by qualified mental health professionals using telehealth; and
(ii) to collaborate with local public health entities to provide the mental health services; and
(B) for the populations described in subsection (a)(3)(B)—
(i) to provide mental health services, including diagnosis and treatment of mental illness, in long-term care facilities as delivered remotely by qualified mental health professionals using telehealth; and
(ii) to collaborate with local public health entities to provide the mental health services.
(2) Other uses
An eligible entity that receives a grant under this section may also use the grant funds to—
(A) pay telecommunications costs; and
(B) pay qualified mental health professionals on a reasonable cost basis as determined by the Secretary for services rendered.
(3) Prohibited uses
An eligible entity that receives a grant under this section shall not use the grant funds to—
(A) purchase or install transmission equipment (other than such equipment used by qualified mental health professionals to deliver mental health services using telehealth under the project involved); or
(B) build upon or acquire real property.
(d) Equitable distribution
In awarding grants under this section, the Secretary shall ensure, to the greatest extent possible, that such grants are equitably distributed among geographical regions of the United States.
(e) Application
An entity that desires a grant under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary determines to be reasonable.
(f) Report
Not later than 4 years after October 26, 2002, the Secretary shall prepare and submit to the appropriate committees of Congress a report that shall evaluate activities funded with grants under this section.
(g) Authorization of appropriations
There are authorized to be appropriated to carry out this section, $20,000,000 for fiscal year 2002 and such sums as may be necessary for fiscal years 2003 through 2006.
(July 1, 1944, ch. 373, title III, §330K, as added
Editorial Notes
References in Text
The Social Security Act, referred to in subsec. (a)(2), is act Aug. 14, 1935, ch. 531,
Amendments
2003—Subsec. (b)(2).
Subsec. (c)(1)(A).
Subsec. (c)(1)(B).
Statutory Notes and Related Subsidiaries
Effective Date of 2003 Amendment
Amendments by
§254c–17. Repealed. Pub. L. 108–163, §2(e)(2), Dec. 6, 2003, 117 Stat. 2021
Section,
Statutory Notes and Related Subsidiaries
Effective Date of Repeal
Repeal deemed to have taken effect immediately after the enactment of
§254c–18. Telemedicine; incentive grants regarding coordination among States
(a) In general
The Secretary may make grants to State professional licensing boards to carry out programs under which such licensing boards of various States cooperate to develop and implement State policies that will reduce statutory and regulatory barriers to telemedicine.
(b) Authorization of appropriations
For the purpose of carrying out subsection (a), there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2002 through 2006.
(July 1, 1944, ch. 373, title III, §330L, as added
Statutory Notes and Related Subsidiaries
Effective Date
Section deemed to have taken effect immediately after the enactment of
§254c–19. Pediatric mental health care access grants
(a) In general
The Secretary, acting through the Administrator of the Health Resources and Services Administration and in coordination with other relevant Federal agencies, shall award grants or cooperative agreements to States, political subdivisions of States, and Indian Tribes and Tribal organizations (for purposes of this section, as such terms are defined in
(1) supporting the development of statewide or regional pediatric mental health care telehealth access programs; and
(2) supporting the improvement of existing statewide or regional pediatric mental health care telehealth access programs.
(b) Program requirements
(1) In general
A pediatric mental health care telehealth access program referred to in subsection (a), with respect to which an award under such subsection may be used, shall—
(A) be a statewide or regional network of pediatric mental health teams that provide support to pediatric primary care sites as an integrated team;
(B) support and further develop organized State or regional networks of pediatric mental health teams to provide consultative support to pediatric primary care sites;
(C) conduct an assessment of critical behavioral consultation needs among pediatric providers and such providers' preferred mechanisms for receiving consultation, training, and technical assistance;
(D) develop an online database and communication mechanisms, including telehealth, to facilitate consultation support to pediatric practices;
(E) provide rapid statewide or regional clinical telephone or telehealth consultations when requested between the pediatric mental health teams and pediatric primary care providers;
(F) conduct training and provide technical assistance to pediatric primary care providers to support the early identification, diagnosis, treatment, and referral of children with behavioral health conditions;
(G) provide information to pediatric providers about, and assist pediatric providers in accessing, pediatric mental health care providers, including child and adolescent psychiatrists, developmental-behavioral pediatricians, and licensed mental health professionals, such as psychologists, social workers, or mental health counselors and in scheduling and conducting technical assistance;
(H) provide information to pediatric health care providers about available mental health services for children in the community and assist with referrals to specialty care and community or behavioral health resources; and
(I) establish mechanisms for measuring and monitoring increased access to pediatric mental health care services by pediatric primary care providers and expanded capacity of pediatric primary care providers to identify, treat, and refer children with mental health conditions.
(2) Support to schools and emergency departments
(A) In general
In addition to the activities required under paragraph (1), a pediatric mental health care access program referred to in subsection (a), with respect to which an award under such subsection may be used, may provide information, consultative support, training, and technical assistance to—
(i) emergency departments; and
(ii) State educational agencies, local educational agencies, Tribal educational agencies, and elementary and secondary schools.
(B) Requirements for certain recipients
An entity receiving information, consultative support, training, and technical assistance under subparagraph (A)(ii) shall operate in a manner consistent with, and shall ensure consistency with, the requirements of subsections (a) and (c) of
(3) Pediatric mental health teams
In this subsection, the term "pediatric mental health team" means a team consisting of at least one case coordinator, at least one child and adolescent psychiatrist, and at least one licensed clinical mental health professional, such as a psychologist, social worker, or mental health counselor, and which may include a developmental-behavioral pediatrician. Such a team may be regionally based.
(c) Application
A State, political subdivision of a State, Indian Tribe, or Tribal organization seeking an award under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including a plan for the comprehensive evaluation of activities that are carried out with funds received under such award.
(d) Evaluation
A State, political subdivision of a State, Indian Tribe, or Tribal organization that receives an award under this section shall prepare and submit an evaluation of activities that are carried out with funds received under such award to the Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require, including a process and outcome evaluation.
(e) Access to broadband
In administering awards under this section, the Secretary may coordinate with other agencies to ensure that funding opportunities are available to support access to reliable, high-speed Internet for providers.
(f) Matching requirement
The Secretary may not make an award under this section unless the State, political subdivision of a State, Indian Tribe, or Tribal organization involved agrees, with respect to the costs to be incurred by the State, political subdivision of a State, Indian Tribe, or Tribal organization in carrying out the purpose described in this section, to make available non-Federal contributions (in cash or in kind) toward such costs in an amount that is not less than 20 percent of Federal funds provided in the award.
(g) Technical assistance
The Secretary may—
(1) provide, or continue to provide, technical assistance to recipients of awards under subsection (a); and
(2) award a grant or contract to an eligible public or nonprofit private entity (as determined by the Secretary) for the purpose of providing such technical assistance pursuant to this subsection.
(h) Authorization of appropriations
To carry out this section, there are authorized to be appropriated, $31,000,000 for each of fiscal years 2023 through 2027.
(July 1, 1944, ch. 373, title III, §330M, as added
Editorial Notes
References in Text
Amendments
2022—
Subsec. (a).
Subsec. (b)(1).
Subsec. (b)(1)(G).
Subsec. (b)(1)(H).
Subsec. (b)(1)(I).
Subsec. (b)(2).
Subsec. (b)(3).
Subsecs. (c), (d).
Subsec. (e).
Subsec. (f).
Subsec. (g).
Subsec. (h).
1 See References in Text note below.
§254c–20. Expanding capacity for health outcomes
(a) Definitions
In this section:
(1) Eligible entity
The term "eligible entity" means an entity that provides, or supports the provision of, health care services in rural areas, frontier areas, health professional shortage areas, or medically underserved areas, or to medically underserved populations or Native Americans, including Indian Tribes, Tribal organizations, and urban Indian organizations, and which may include entities leading, or capable of leading, a technology-enabled collaborative learning and capacity building model or engaging in technology-enabled collaborative training of participants in such model.
(2) Health professional shortage area
The term "health professional shortage area" means a health professional shortage area designated under
(3) Indian Tribe
The terms "Indian Tribe" and "Tribal organization" have the meanings given the terms "Indian tribe" and "tribal organization" in
(4) Medically underserved population
The term "medically underserved population" has the meaning given the term in
(5) Native Americans
The term "Native Americans" has the meaning given the term in
(6) Technology-enabled collaborative learning and capacity building model
The term "technology-enabled collaborative learning and capacity building model" means a distance health education model that connects health care professionals, and particularly specialists, with multiple other health care professionals through simultaneous interactive videoconferencing for the purpose of facilitating case-based learning, disseminating best practices, and evaluating outcomes.
(7) Urban Indian organization
The term "urban Indian organization" has the meaning given the term in
(b) Program established
The Secretary shall, as appropriate, award grants to evaluate, develop, and, as appropriate, expand the use of technology-enabled collaborative learning and capacity building models, to improve retention of health care providers and increase access to health care services, such as those to address chronic diseases and conditions, infectious diseases, mental health, substance use disorders, prenatal and maternal health, pediatric care, pain management, palliative care, and other specialty care in rural areas, frontier areas, health professional shortage areas, or medically underserved areas and for medically underserved populations or Native Americans.
(c) Use of funds
(1) In general
Grants awarded under subsection (b) shall be used for—
(A) the development and acquisition of instructional programming, and the training of health care providers and other professionals that provide or assist in the provision of services through models described in subsection (b), such as training on best practices for data collection and leading or participating in such technology-enabled activities consistent with technology-enabled collaborative learning and capacity-building models;
(B) information collection and evaluation activities to study the impact of such models on patient outcomes and health care providers, and to identify best practices for the expansion and use of such models; or
(C) other activities consistent with achieving the objectives of the grants awarded under this section, as determined by the Secretary.
(2) Other uses
In addition to any of the uses under paragraph (1), grants awarded under subsection (b) may be used for—
(A) equipment to support the use and expansion of technology-enabled collaborative learning and capacity building models, including for hardware and software that enables distance learning, health care provider support, and the secure exchange of electronic health information; or
(B) support for health care providers and other professionals that provide or assist in the provision of services through such models.
(d) Length of grants
Grants awarded under subsection (b) shall be for a period of up to 5 years.
(e) Grant requirements
The Secretary may require entities awarded a grant under this section to collect information on the effect of the use of technology-enabled collaborative learning and capacity building models, such as on health outcomes, access to health care services, quality of care, and provider retention in areas and populations described in subsection (b). The Secretary may award a grant or contract to assist in the coordination of such models, including to assess outcomes associated with the use of such models in grants awarded under subsection (b), including for the purpose described in subsection (c)(1)(B).
(f) Application
An eligible entity that seeks to receive a grant under subsection (b) shall submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require. Such application shall include plans to assess the effect of technology-enabled collaborative learning and capacity building models on patient outcomes and health care providers.
(g) Access to broadband
In administering grants under this section, the Secretary may coordinate with other agencies to ensure that funding opportunities are available to support access to reliable, high-speed internet for grantees.
(h) Technical assistance
The Secretary shall provide (either directly through the Department of Health and Human Services or by contract) technical assistance to eligible entities, including recipients of grants under subsection (b), on the development, use, and evaluation of technology-enabled collaborative learning and capacity building models in order to expand access to health care services provided by such entities, including for medically underserved areas and to medically underserved populations or Native Americans.
(i) Research and evaluation
The Secretary, in consultation with stakeholders with appropriate expertise in such models, shall develop a strategic plan to research and evaluate the evidence for such models. The Secretary shall use such plan to inform the activities carried out under this section.
(j) Report by Secretary
Not later than 4 years after December 27, 2020, the Secretary 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, and post on the internet website of the Department of Health and Human Services, a report including, at minimum—
(1) a description of any new and continuing grants awarded to entities under subsection (b) and the specific purpose and amounts of such grants;
(2) an overview of—
(A) the evaluations conducted under subsections (b);
(B) technical assistance provided under subsection (h); and
(C) activities conducted by entities awarded grants under subsection (b); and
(3) a description of any significant findings or developments related to patient outcomes or health care providers and best practices for eligible entities expanding, using, or evaluating technology-enabled collaborative learning and capacity building models, including through the activities described in subsection (h).
(k) Authorization of appropriations
There are authorized to be appropriated to carry out this section $10,000,000 for each of fiscal years 2022 through 2026.
(July 1, 1944, ch. 373, title III, §330N, as added
§254c–21. Innovation for maternal health
(a) In general
The Secretary, in consultation with experts representing a variety of clinical specialties, State, Tribal, or local public health officials, researchers, epidemiologists, statisticians, and community organizations, shall establish or continue a program to award competitive grants to eligible entities for the purpose of—
(1) identifying, developing, or disseminating best practices to improve maternal health care quality and outcomes, improve maternal and infant health, and eliminate preventable maternal mortality and severe maternal morbidity, which may include—
(A) information on evidence-based practices to improve the quality and safety of maternal health care in hospitals and other health care settings of a State or health care system by addressing topics commonly associated with health complications or risks related to prenatal care, labor care, birthing, and postpartum care;
(B) best practices for improving maternal health care based on data findings and reviews conducted by a State maternal mortality review committee that address topics of relevance to common complications or health risks related to prenatal care, labor care, birthing, and postpartum care; and
(C) information on addressing determinants of health that impact maternal health outcomes for women before, during, and after pregnancy;
(2) collaborating with State maternal mortality review committees to identify issues for the development and implementation of evidence-based practices to improve maternal health outcomes and reduce preventable maternal mortality and severe maternal morbidity, consistent with
(3) providing technical assistance and supporting the implementation of best practices identified in paragraph (1) to entities providing health care services to pregnant and postpartum women; and
(4) identifying, developing, and evaluating new models of care that improve maternal and infant health outcomes, which may include the integration of community-based services and clinical care.
(b) Eligible entities
To be eligible for a grant under subsection (a), an entity shall—
(1) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require; and
(2) demonstrate in such application that the entity is capable of carrying out data-driven maternal safety and quality improvement initiatives in the areas of obstetrics and gynecology or maternal health.
(c) Report
Not later than September 30, 2025, and every 2 years thereafter, the Secretary shall submit a report to Congress on the practices described in paragraphs (1) and (2) of subsection (a). Such report shall include a description of the extent to which such practices reduced preventable maternal mortality and severe maternal morbidity, and whether such practices improved maternal and infant health. The Secretary shall disseminate information on such practices, as appropriate.
(d) Authorization of appropriations
To carry out this section, there are authorized to be appropriated $9,000,000 for each of fiscal years 2023 through 2027.
(July 1, 1944, ch. 373, title III, §330O, as added
§254c–22. Integrated services for pregnant and postpartum women
(a) In general
The Secretary may award grants for the purpose of establishing or operating evidence-based or innovative, evidence-informed programs to deliver integrated health care services to pregnant and postpartum women to optimize the health of women and their infants, including to reduce adverse maternal health outcomes, pregnancy-related deaths, and related health disparities (including such disparities associated with racial and ethnic minority populations), and, as appropriate, by addressing issues researched under subsection (b)(2) of
(b) Integrated services for pregnant and postpartum women
(1) Eligibility
To be eligible to receive a grant under subsection (a), a State, Indian Tribe, or Tribal organization (as such terms are defined in
(A) State, Tribal, and local agencies responsible for Medicaid, public health, social services, mental health, and substance use disorder treatment and services;
(B) health care providers who serve pregnant and postpartum women; and
(C) community-based health organizations and health workers, including providers of home visiting services and individuals representing communities with disproportionately high rates of maternal mortality and severe maternal morbidity, and including those representing racial and ethnic minority populations.
(2) Terms
(A) Period
A grant awarded under subsection (a) shall be made for a period of 5 years. Any supplemental award made to a grantee under subsection (a) may be made for a period of less than 5 years.
(B) Priorities
In awarding grants under subsection (a), the Secretary shall—
(i) give priority to States, Indian Tribes, and Tribal organizations that have the highest rates of maternal mortality and severe maternal morbidity relative to other such States, Indian Tribes, or Tribal organizations, respectively; and
(ii) shall consider health disparities related to maternal mortality and severe maternal morbidity, including such disparities associated with racial and ethnic minority populations.
(C) Evaluation
The Secretary shall require grantees to evaluate the outcomes of the programs supported under the grant.
(c) Authorization of appropriations
There are authorized to be appropriated to carry out this section $10,000,000 for each of fiscal years 2023 through 2027.
(July 1, 1944, ch. 373, title III, §330P, as added