Part D—Primary Health Care
Editorial Notes
Codification
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
Statutory Notes and Related Subsidiaries
Dissemination of Best Practices
subpart ii—national health service corps program
Editorial Notes
Codification
§254d. National Health Service Corps
(a) Establishment; composition; purpose; definitions
(1) For the purpose of eliminating health manpower shortages in health professional shortage areas, there is established, within the Service, the National Health Service Corps, which shall consist of—
(A) such officers of the Regular and Reserve Corps 1 of the Service as the Secretary may designate,
(B) such civilian employees of the United States as the Secretary may appoint, and
(C) such other individuals who are not employees of the United States.
(2) The Corps shall be utilized by the Secretary to provide primary health services in health professional shortage areas.
(3) For purposes of this subpart and subpart III:
(A) The term "Corps" means the National Health Service Corps.
(B) The term "Corps member" means each of the officers, employees, and individuals of which the Corps consists pursuant to paragraph (1).
(C) The term "health professional shortage area" has the meaning given such term in
(D) The term "primary health services" means health services regarding family medicine, internal medicine, pediatrics, obstetrics and gynecology, dentistry, or mental health, that are provided by physicians or other health professionals.
(E)(i) The term "behavioral and mental health professionals" means health service psychologists, licensed clinical social workers, licensed professional counselors, marriage and family therapists, psychiatric nurse specialists, and psychiatrists.
(ii) The term "graduate program of behavioral and mental health" means a program that trains behavioral and mental health professionals.
(b) Recruitment and fellowship programs
(1) The Secretary may conduct at schools of medicine, osteopathic medicine, dentistry, and, as appropriate, nursing and other schools of the health professions, including schools at which graduate programs of behavioral and mental health are offered, and at entities which train allied health personnel, recruiting programs for the Corps, the Scholarship Program, and the Loan Repayment Program. Such recruiting programs shall include efforts to recruit individuals who will serve in the Corps other than pursuant to obligated service under the Scholarship or Loan Repayment Program.
(2) In the case of physicians, dentists, behavioral and mental health professionals, certified nurse midwives, certified nurse practitioners, and physician assistants who have an interest and a commitment to providing primary health care, the Secretary may establish fellowship programs to enable such health professionals to gain exposure to and expertise in the delivery of primary health services in health professional shortage areas. To the maximum extent practicable, the Secretary shall ensure that any such programs are established in conjunction with accredited residency programs, and other training programs, regarding such health professions.
(c) Travel and moving expenses; persons entitled; reimbursement; limitation
(1) The Secretary may reimburse an applicant for a position in the Corps (including an individual considering entering into a written agreement pursuant to
(2) The Secretary may also reimburse the applicant for the actual and reasonable expenses incurred for the travel of 1 family member to accompany the applicant to such site. The Secretary may establish a maximum total amount that may be paid to an individual as reimbursement for such expenses.
(3) In the case of an individual who has entered into a contract for obligated service under the Scholarship Program or under the Loan Repayment Program, the Secretary may reimburse such individual for all or part of the actual and reasonable expenses incurred in transporting the individual, the individual's family, and the family's possessions to the site of the individual's assignment under
(d) Monthly pay adjustments of members directly engaged in delivery of health services in health professional shortage area; "monthly pay" defined; monthly pay adjustment of member with service obligation incurred under Scholarship Program or Loan Repayment Program; personnel system applicable
(1) The Secretary may, under regulations promulgated by the Secretary, adjust the monthly pay of each member of the Corps (other than a member described in subsection (a)(1)(C)) who is directly engaged in the delivery of health services in a health professional shortage area as follows:
(A) During the first 36 months in which such a member is so engaged in the delivery of health services, his monthly pay may be increased by an amount which when added to the member's monthly pay and allowances will provide a monthly income competitive with the average monthly income from a practice of an individual who is a member of the profession of the Corps member, who has equivalent training, and who has been in practice for a period equivalent to the period during which the Corps member has been in practice.
(B) During the period beginning upon the expiration of the 36 months referred to in subparagraph (A) and ending with the month in which the member's monthly pay and allowances are equal to or exceed the monthly income he received for the last of such 36 months, the member may receive in addition to his monthly pay and allowances an amount which when added to such monthly pay and allowances equals the monthly income he received for such last month.
(C) For each month in which a member is directly engaged in the delivery of health services in a health professional shortage area in accordance with an agreement with the Secretary entered into under section 294n(f)(1)(C) 2 of this title, under which the Secretary is obligated to make payments in accordance with section 294n(f)(2) 2 of this title, the amount of any monthly increase under subparagraph (A) or (B) with respect to such member shall be decreased by an amount equal to one-twelfth of the amount which the Secretary is obligated to pay upon the completion of the year of practice in which such month occurs.
For purposes of subparagraphs (A) and (B), the term "monthly pay" includes special pay received under
(2) In the case of a member of the Corps who is directly engaged in the delivery of health services in a health professional shortage area in accordance with a service obligation incurred under the Scholarship Program or the Loan Repayment Program, the adjustment in pay authorized by paragraph (1) may be made for such a member only upon satisfactory completion of such service obligation, and the first 36 months of such member's being so engaged in the delivery of health services shall, for purposes of paragraph (1)(A), be deemed to begin upon such satisfactory completion.
(3) A member of the Corps described in subparagraph (C) of subsection (a)(1) shall when assigned to an entity under
(e) Employment ceiling of Department not affected by Corps members
Corps members assigned under
(f) Assignment of personnel provisions inapplicable to members whose service obligation incurred under Scholarship Program or Loan Repayment Program
(g) Conversion from Corps member to commissioned officer; retirement credits
(1) The Secretary shall, by rule, prescribe conversion provisions applicable to any individual who, within a year after completion of service as a member of the Corps described in subsection (a)(1)(C), becomes a commissioned officer in the Regular or Reserve Corps 1 of the Service.
(2) The rules prescribed under paragraph (1) shall provide that in applying the appropriate provisions of this chapter which relate to retirement, any individual who becomes such an officer shall be entitled to have credit for any period of service as a member of the Corps described in subsection (a)(1)(C).
(h) Effective administration of program
The Secretary shall ensure that adequate staff is provided to the Service with respect to effectively administering the program for the Corps.
(i) Demonstration projects; waivers
(1) In carrying out subpart III, the Secretary may, in accordance with this subsection, issue waivers to individuals who have entered into a contract for obligated service under the Scholarship Program or the Loan Repayment Program under which the individuals are authorized to satisfy the requirement of obligated service through providing clinical practice that is half time.
(2) A waiver described in paragraph (1) may be provided by the Secretary only if—
(A) the entity for which the service is to be performed—
(i) has been approved under
(ii) has requested in writing assignment of a health professional who would serve half time;
(B) the Secretary has determined that assignment of a health professional who would serve half time would be appropriate for the area where the entity is located;
(C) a Corps member who is required to perform obligated service has agreed in writing to be assigned for half-time service to an entity described in subparagraph (A);
(D) the entity and the Corps member agree in writing that the Corps member will perform half-time clinical practice;
(E) the Corps member agrees in writing to fulfill all of the service obligations under
(i) double the period of obligated service that would otherwise be required; or
(ii) in the case of contracts entered into under
(F) the Corps member agrees in writing that if the Corps member begins providing half-time service but fails to begin or complete the period of obligated service, the method stated in 254o(c) of this title for determining the damages for breach of the individual's written contract will be used after converting periods of obligated service or of service performed into their full-time equivalents.
(3) In evaluating waivers issued under paragraph (1), the Secretary shall examine the effect of multidisciplinary teams.
(j) Definitions
For the purposes of this subpart and subpart III:
(1) The term "Department" means the Department of Health and Human Services.
(2) The term "Loan Repayment Program" means the National Health Service Corps Loan Repayment Program established under
(3) The term "Scholarship Program" means the National Health Service Corps Scholarship Program established under
(4) The term "State" includes, in addition to the several States, only the District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, and the Trust Territory of the Pacific Islands.
(5) The terms "full time" and "full-time" mean a minimum of 40 hours per week in a clinical practice, for a minimum of 45 weeks per year.
(6) The terms "half time" and "half-time" mean a minimum of 20 hours per week (not to exceed 39 hours per week) in a clinical practice, for a minimum of 45 weeks per year.
(July 1, 1944, ch. 373, title III, §331, as added
Editorial Notes
References in Text
Amendments
2010—Subsec. (i)(1).
Subsec. (i)(2)(A)(ii), (B).
Subsec. (i)(2)(C).
Subsec. (i)(2)(D), (E).
"(D) the entity and the Corps member agree in writing that the less than full-time service provided by the Corps member will not be less than 16 hours of clinical service per week;
"(E) the Corps member agrees in writing that the period of obligated service pursuant to
Subsec. (i)(2)(F).
Subsec. (i)(3).
Subsec. (j)(5), (6).
2006—Subsec. (f).
2002—Subsec. (a)(3)(E).
Subsec. (b)(1).
Subsec. (b)(2).
Subsec. (c).
Subsecs. (i), (j).
1990—Subsec. (a).
Subsec. (b).
Subsec. (c).
Subsec. (d)(1).
Subsec. (d)(1)(A).
Subsecs. (d)(2), (e).
Subsec. (h).
"(1) give priority to meeting the needs of the Indian Health Service and the needs of health programs or facilities operated by tribes or tribal organizations under the Indian Self-Determination Act (
"(2) provide special consideration to the homeless populations who do not have access to primary health care services."
Subsec. (i).
1988—Subsec. (b).
1987—Subsec. (b).
Subsec. (c).
Subsecs. (d)(2), (f).
Subsec. (h).
Subsec. (i).
1981—Subsec. (a)(1).
Subsec. (b).
Subsec. (c).
Subsec. (d).
Subsec. (g).
Subsec. (h).
Statutory Notes and Related Subsidiaries
Change of Name
Reference to Reserve Corps of the Public Health Service deemed to be a reference to the Ready Reserve Corps, see
Effective Date of 1990 Amendment
Special Report on Present and Future Direction of National Health Service Corps; Submission to Congress Not Later Than February 1, 1979
Effective Date; Other Provisions: Health Manpower Shortage Area; Approval of Applications for Assignment of Corps Personnel; Assignment Period, Commencement; Credit for Months of Prior Health Care and Services for Additional Pay Benefit; National Advisory Council on the National Health Service Corps, Continuation of Council and Appointment of Members
"(1) The amendment made by subsections (a) and (b) [enacting this subpart and repealing
"(2)(A) Any area for which a designation under section 329(b) of the Public Health Service Act (as in effect on September 30, 1977) [former
"(B) The assignment period (within the meaning of such section 334) [former
"(C) In the case of any physician or dentist member of the Corps who was providing health care and services on September 30, 1977, under an assignment made under section 329(b) of such Act (as in effect on September 30, 1977) [former
"(3) The amendment made by subsection (b) which established an Advisory Council previously established under section 329 of the Public Health Service Act [former
Executive Documents
Termination of Trust Territory of the Pacific Islands
For termination of Trust Territory of the Pacific Islands, see note set out preceding
1 See Change of Name note below.
2 See References in Text note below.
3 So in original. The word "the" probably should appear.
§254e. Health professional shortage areas
(a) Designation by Secretary; removal from areas designated; "medical facility" defined
(1) For purposes of this subpart the term "health professional shortage area" means (A) an area in an urban or rural area (which need not conform to the geographic boundaries of a political subdivision and which is a rational area for the delivery of health services) which the Secretary determines has a health manpower shortage and which is not reasonably accessible to an adequately served area, (B) a population group which the Secretary determines has such a shortage, or (C) a public or nonprofit private medical facility or other public facility which the Secretary determines has such a shortage. All Federally qualified health centers and rural health clinics, as defined in section 1861(aa) of the Social Security Act (
(2) For purposes of this subsection, the term "medical facility" means a facility for the delivery of health services and includes—
(A) a hospital, State mental hospital, public health center, outpatient medical facility, rehabilitation facility, facility for long-term care, community mental health center, migrant health center, facility operated by a city or county health department, and community health center;
(B) such a facility of a State correctional institution or of the Indian Health Service, and a health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act [
(C) such a facility used in connection with the delivery of health services under
(D) a Federal medical facility.
(3) Homeless individuals (as defined in
(b) Criteria for designation of health professional shortage areas; promulgation of regulations
The Secretary shall establish by regulation criteria for the designation of areas, population groups, medical facilities, and other public facilities, in the States, as health professional shortage areas. In establishing such criteria, the Secretary shall take into consideration the following:
(1) The ratio of available health manpower to the number of individuals in an area or population group, or served by a medical facility or other public facility under consideration for designation.
(2) Indicators of a need, notwithstanding the supply of health manpower, for health services for the individuals in an area or population group or served by a medical facility or other public facility under consideration for designation.
(3) The percentage of physicians serving an area, population group, medical facility, or other public facility under consideration for designation who are employed by hospitals and who are graduates of foreign medical schools.
(c) Considerations in determination of designation
In determining whether to make a designation, the Secretary shall take into consideration the following:
(1) The recommendations of the Governor of each State in which the area, population group, medical facility, or other public facility under consideration for designation is in whole or part located.
(2) The extent to which individuals who are (A) residents of the area, members of the population group, or patients in the medical facility or other public facility under consideration for designation, and (B) entitled to have payment made for medical services under title XVIII, XIX, or XXI of the Social Security Act [
(d) Designation; publication of descriptive lists
(1) In accordance with the criteria established under subsection (b) and the considerations listed in subsection (c), the Secretary shall designate health professional shortage areas in the States, publish a descriptive list of the areas, population groups, medical facilities, and other public facilities so designated, and at least annually review and, as necessary, revise such designations.
(2) For purposes of paragraph (1), a complete descriptive list shall be published in the Federal Register not later than July 1 of 1991 and each subsequent year.
(e) Notice of proposed designation of areas and facilities; time for comment
(1) Prior to the designation of a public facility, including a Federal medical facility, as a health professional shortage area, the Secretary shall give written notice of such proposed designation to the chief administrative officer of such facility and request comments within 30 days with respect to such designation.
(2) Prior to the designation of a health professional shortage area under this section, the Secretary shall, to the extent practicable, give written notice of the proposed designation of such area to appropriate public or private nonprofit entities which are located or have a demonstrated interest in such area and request comments from such entities with respect to the proposed designation of such area.
(f) Notice of designation
The Secretary shall give written notice of the designation of a health professional shortage area, not later than 60 days from the date of such designation, to—
(1) the Governor of each State in which the area, population group, medical facility, or other public facility so designated is in whole or part located; and
(2) appropriate public or nonprofit private entities which are located or which have a demonstrated interest in the area so designated.
(g) Recommendations to Secretary
Any person may recommend to the Secretary the designation of an area, population group, medical facility, or other public facility as a health professional shortage area.
(h) Public information programs in designated areas
The Secretary may conduct such information programs in areas, among population groups, and in medical facilities and other public facilities designated under this section as health professional shortage areas as may be necessary to inform public and nonprofit private entities which are located or have a demonstrated interest in such areas of the assistance available under this subchapter by virtue of the designation of such areas.
(i) Dissemination
The Administrator of the Health Resources and Services Administration shall disseminate information concerning the designation criteria described in subsection (b) to—
(1) the Governor of each State;
(2) the representative of any area, population group, or facility selected by any such Governor to receive such information;
(3) the representative of any area, population group, or facility that requests such information; and
(4) the representative of any area, population group, or facility determined by the Administrator to be likely to meet the criteria described in subsection (b).
(j) Regulations and report
(1) The Secretary shall submit the report described in paragraph (2) if the Secretary, acting through the Administrator of the Health Resources and Services Administration, issues—
(A) a regulation that revises the definition of a health professional shortage area for purposes of this section; or
(B) a regulation that revises the standards concerning priority of such an area under
(2) On issuing a regulation described in paragraph (1), the Secretary shall prepare and submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report that describes the regulation.
(3) Each regulation described in paragraph (1) shall take effect 180 days after the committees described in paragraph (2) receive a report referred to in such paragraph describing the regulation.
(k) Maternity care health professional target areas
(1) The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall identify, based on the data collected under paragraph (3), maternity care health professional target areas that satisfy the criteria described in paragraph (2) for purposes of, in connection with receipt of assistance under this subchapter, assigning to such identified areas maternity care health professionals who, without application of this subsection, would otherwise be eligible for such assistance. The Secretary shall distribute maternity care health professionals within health professional shortage areas using the maternity care health professional target areas so identified.
(2) For purposes of paragraph (1), the Secretary shall establish criteria for maternity care health professional target areas that identify geographic areas within health professional shortage areas that have a shortage of maternity care health professionals.
(3) For purposes of this subsection, the Secretary shall collect and publish in the Federal Register data comparing the availability and need of maternity care health services in health professional shortage areas and in areas within such health professional shortage areas.
(4) In carrying out paragraph (1), the Secretary shall seek input from relevant provider organizations, including medical societies, organizations representing medical facilities, and other organizations with expertise in maternity care.
(5) For purposes of this subsection, the term 'full scope maternity care health services' includes during labor care, birthing, prenatal care, and postpartum care.
(6) Nothing in this subsection shall be construed as—
(A) requiring the identification of a maternity care health professional target area in an area not otherwise already designated as a health professional shortage area; or
(B) affecting the types of health professionals, without application of this subsection, otherwise eligible for assistance, including a loan repayment or scholarship, pursuant to the application of this section.
(July 1, 1944, ch. 373, title III, §332, as added
Editorial Notes
References in Text
The Indian Self-Determination Act, referred to in subsec. (a)(2)(B), is title I of
The Social Security Act, referred to in subsec. (c)(2), is act Aug. 14, 1935, ch. 531,
Prior Provisions
A prior section 332 of act July 1, 1944, was renumbered section 340, and was classified to
Amendments
2018—Subsec. (k).
2008—Subsec. (a)(1).
2003—Subsec. (a)(1).
Subsec. (a)(3).
Subsec. (b)(2).
Subsec. (j).
2002—Subsec. (a)(1).
Subsec. (a)(2)(C).
Subsec. (a)(3).
Subsec. (b)(2).
"(A) infant mortality,
"(B) access to health services,
"(C) health status, and
"(D) ability to pay for health services".
Subsec. (c)(2)(B).
Subsec. (i).
1990—Subsec. (a)(1).
Subsec. (a)(2)(A).
Subsec. (a)(2)(B).
Subsec. (a)(2)(C).
Subsec. (b).
Subsec. (c).
"(A) The recommendations of each health systems agency (designated under
"(B) The recommendations of the State health planning and development agency (designated under
Subsec. (d).
Subsec. (e).
Subsec. (f).
"(A) each health systems agency (designated under
"(B) the State health planning and development agency of the State (designated under
Subsecs. (g), (h).
1988—Subsec. (a)(3).
1987—Subsec. (a)(1).
Subsec. (a)(3).
Subsec. (b)(2)(D).
1981—Subsec. (a)(1)(A).
Subsec. (a)(2)(C).
Subsec. (e).
Subsec. (h).
1979—Subsec. (a)(2)(C).
1977—Subsec. (c)(3).
Statutory Notes and Related Subsidiaries
Effective Date of 2003 Amendment
Amendments by
Effective Date of 1988 Amendments
Effective Date of 1981 Amendment
Amendment by section 986(b)(4) of
Effective Date of 1977 Amendment
Regulations
Improvement of Site Designation Process
GAO Study
Reference to Community, Migrant, Public Housing, or Homeless Health Center Considered Reference to Health Center
Reference to community health center, migrant health center, public housing health center, or homeless health center, considered reference to health center, see section 4(c) of
Evaluation of Criteria Used To Designate Health Manpower Shortage Areas; Report to Congress
§254f. Corps personnel
(a) Conditions necessary for assignment of Corps personnel to area; contents of application for assignment; assignment to particular facility; approval of applications
(1) The Secretary may assign members of the Corps to provide, under regulations promulgated by the Secretary, health services in or to a health professional shortage area during the assignment period only if—
(A) a public or private entity, which is located or has a demonstrated interest in such area makes application to the Secretary for such assignment;
(B) such application has been approved by the Secretary;
(C) the entity agrees to comply with the requirements of
(D) the Secretary has (i) conducted an evaluation of the need and demand for health manpower for the area, the intended use of Corps members to be assigned to the area, community support for the assignment of Corps members to the area, the area's efforts to secure health manpower for the area, and the fiscal management capability of the entity to which Corps members would be assigned and (ii) on the basis of such evaluation has determined that—
(I) there is a need and demand for health manpower for the area;
(II) there has been appropriate and efficient use of any Corps members assigned to the entity for the area;
(III) there is general community support for the assignment of Corps members to the entity;
(IV) the area has made unsuccessful efforts to secure health manpower for the area;
(V) there is a reasonable prospect of sound fiscal management, including efficient collection of fee-for-service, third-party, and other appropriate funds, by the entity with respect to Corps members assigned to such entity; and
(VI) the entity demonstrates willingness to support or facilitate mentorship, professional development, and training opportunities for Corps members.
An application for assignment of a Corps member to a health professional shortage area shall include a demonstration by the applicant that the area or population group to be served by the applicant has a shortage of personal health services and that the Corps member will be located so that the member will provide services to the greatest number of persons residing in such area or included in such population group. Such a demonstration shall be made on the basis of the criteria prescribed by the Secretary under
(2) Corps members may be assigned to a Federal health care facility, but only upon the request of the head of the department or agency of which such facility is a part.
(3) In approving applications for assignment of members of the Corps the Secretary shall not discriminate against applications from entities which are not receiving Federal financial assistance under this chapter. In approving such applications, the Secretary shall give preference to applications in which a nonprofit entity or public entity shall provide a site to which Corps members may be assigned.
(b) Corps member income assurances; grants respecting sufficiency of financial resources
(1) The Secretary may not approve an application for the assignment of a member of the Corps described in subparagraph (C) of
(2)(A) If in approving an application of an entity for the assignment of a member of the Corps described in subparagraph (C) of
(B) The amount of any grant under subparagraph (A) shall be determined by the Secretary. Payments under such a grant may be made in advance or by way of reimbursement, and at such intervals and on such conditions, as the Secretary finds necessary. No grant may be made unless an application therefor is submitted to and approved by the Secretary. Such an application shall be in such form, submitted in such manner, and contain such information, as the Secretary shall by regulation prescribe.
(c) Assignment of members without regard to ability of area to pay for services
The Secretary shall assign Corps members to entities in health professional shortage areas without regard to the ability of the individuals in such areas, population groups, medical facilities, or other public facilities to pay for such services.
(d) Entities entitled to aid; forms of assistance; coordination of efforts; agreements for assignment of Corps members; qualified entity
(1) The Secretary may provide technical assistance to a public or private entity which is located in a health professional shortage area and which desires to make an application under this section for assignment of a Corps member to such area. Assistance provided under this paragraph may include assistance to an entity in (A) analyzing the potential use of health professions personnel in defined health services delivery areas by the residents of such areas, (B) determining the need for such personnel in such areas, (C) determining the extent to which such areas will have a financial base to support the practice of such personnel and the extent to which additional financial resources are needed to adequately support the practice, (D) determining the types of inpatient and other health services that should be provided by such personnel in such areas, and (E) developing long-term plans for addressing health professional shortages and improving access to health care. The Secretary shall encourage entities that receive technical assistance under this paragraph to communicate with other communities, State Offices of Rural Health, State Primary Care Associations and Offices, and other entities concerned with site development and community needs assessment.
(2) The Secretary may provide, to public and private entities which are located in a health professional shortage area to which area a Corps member has been assigned, technical assistance to assist in the retention of such member in such area after the completion of such member's assignment to the area.
(3) The Secretary may provide, to health professional shortage areas to which no Corps member has been assigned, (A) technical assistance to assist in the recruitment of health manpower for such areas, and (B) current information on public and private programs which provide assistance in the securing of health manpower.
(4)(A) The Secretary shall undertake to demonstrate the improvements that can be made in the assignment of members of the Corps to health professional shortage areas and in the delivery of health care by Corps members in such areas through coordination with States, political subdivisions of States, agencies of States and political subdivisions, and other public and private entities which have expertise in the planning, development, and operation of centers for the delivery of primary health care. In carrying out this subparagraph, the Secretary shall enter into agreements with qualified entities which provide that if—
(i) the entity places in effect a program for the planning, development, and operation of centers for the delivery of primary health care in health professional shortage areas which reasonably addresses the need for such care in such areas, and
(ii) under the program the entity will perform the functions described in subparagraph (B),
the Secretary will assign under this section members of the Corps in accordance with the program.
(B) For purposes of subparagraph (A), the term "qualified entity" means a State, political subdivision of a State, an agency of a State or political subdivision, or other public or private entity operating solely within one State, which the Secretary determines is able—
(i) to analyze the potential use of health professions personnel in defined health services delivery areas by the residents of such areas;
(ii) to determine the need for such personnel in such areas and to recruit, select, and retain health professions personnel (including members of the National Health Service Corps) to meet such need;
(iii) to determine the extent to which such areas will have a financial base to support the practice of such personnel and the extent to which additional financial resources are needed to adequately support the practice;
(iv) to determine the types of inpatient and other health services that should be provided by such personnel in such areas;
(v) to assist such personnel in the development of their clinical practice and fee schedules and in the management of their practice;
(vi) to assist in the planning and development of facilities for the delivery of primary health care; and
(vii) to assist in establishing the governing bodies of centers for the delivery of such care and to assist such bodies in defining and carrying out their responsibilities.
(e) Practice within State by Corps member
Notwithstanding any other law, any member of the Corps licensed to practice medicine, osteopathic medicine, dentistry, or any other health profession in any State shall, while serving in the Corps, be allowed to practice such profession in any State.
(July 1, 1944, ch. 373, title III, §333, as added
Editorial Notes
Amendments
2008—Subsec. (a)(1)(D)(ii)(VI).
2003—Subsec. (a)(1)(C).
2002—Subsec. (a)(1).
Subsec. (a)(1)(A).
Subsec. (a)(1)(C).
Subsec. (a)(3).
Subsec. (d)(1).
Subsec. (d)(2).
Subsec. (d)(4).
1990—Subsec. (a)(1).
Subsec. (a)(1)(D)(ii)(II).
Subsec. (b).
Subsec. (c).
Subsec. (d).
Subsec. (e).
Subsec. (f).
Subsec. (g).
Subsec. (h).
Subsec. (i).
Subsecs. (j), (k).
1988—Subsec. (i).
1987—Subsec. (j).
Subsec. (k).
1981—Subsec. (a).
Subsec. (c).
Subsecs. (d) to (f).
Subsec. (g).
Subsec. (h).
Subsec. (i).
Statutory Notes and Related Subsidiaries
Effective Date of 2003 Amendment
Amendment by
Effective Date of 1981 Amendment
Flexibility for Members of National Health Service Corps During Emergency Period
§254f–1. Priorities in assignment of Corps personnel
(a) In general
In approving applications made under
(1) give priority to any such application that—
(A) is made regarding the provision of primary health services to a health professional shortage area with the greatest such shortage; and
(B) is made by an entity that—
(i) serves a health professional shortage area described in subparagraph (A);
(ii) coordinates the delivery of primary health services with related health and social services;
(iii) has a documented record of sound fiscal management; and
(iv) will experience a negative impact on its capacity to provide primary health services if a Corps member is not assigned to the entity;
(2) with respect to the geographic area in which the health professional shortage area is located, take into consideration the willingness of individuals in the geographic area, and of the appropriate governmental agencies or health entities in the area, to assist and cooperate with the Corps in providing effective primary health services; and
(3) take into consideration comments of medical, osteopathic, dental, or other health professional societies whose members deliver services to the health professional shortage area, or if no such societies exist, comments of physicians, dentists, or other health professionals delivering services to the area.
(b) Establishment of criteria for determining priorities
(1) In general
The Secretary shall establish criteria specifying the manner in which the Secretary makes a determination under subsection (a)(1)(A) of the health professional shortage areas with the greatest such shortages.
(2) Publication of criteria
The criteria required in paragraph (1) shall be published in the Federal Register not later than July 1, 1991. Any revisions made in the criteria by the Secretary shall be effective upon publication in the Federal Register.
(c) Notifications regarding priorities
(1) Proposed list
The Secretary shall prepare and publish a proposed list of health professional shortage areas and entities that would receive priority under subsection (a)(1) in the assignment of Corps members. The list shall contain the information described in paragraph (2), and the relative scores and relative priorities of the entities submitting applications under
(2) Preparation of list for applicable period
For the purpose of carrying out paragraph (3), the Secretary shall prepare and, as appropriate, update a list of health professional shortage areas and entities that are receiving priority under subsection (a)(1) in the assignment of Corps members. Such list—
(A) shall include a specification, for each such health professional shortage area, of the entities for which the Secretary has provided an authorization to receive assignments of Corps members in the event that Corps members are available for the assignments; and
(B) shall, of the entities for which an authorization described in subparagraph (A) has been provided, specify—
(i) the entities provided such an authorization for the assignment of Corps members who are participating in the Scholarship Program;
(ii) the entities provided such an authorization for the assignment of Corps members who are participating in the Loan Repayment Program; and
(iii) the entities provided such an authorization for the assignment of Corps members who have become Corps members other than pursuant to contractual obligations under the Scholarship or Loan Repayment Programs.
The Secretary may set forth such specifications by medical specialty.
(3) Notification of affected parties
(A) Entities
Not later than 30 days after the Secretary has added to a list under paragraph (2) an entity specified as described in subparagraph (A) of such paragraph, the Secretary shall notify such entity that the entity has been provided an authorization to receive assignments of Corps members in the event that Corps members are available for the assignments.
(B) Individuals
In the case of an individual obligated to provide service under the Scholarship Program, not later than 3 months before the date described in
(4) Revisions
If the Secretary proposes to make a revision in the list under paragraph (2), and the revision would adversely alter the status of an entity with respect to the list, the Secretary shall notify the entity of the revision. Any entity adversely affected by such a revision shall be notified in writing by the Secretary of the reasons for the revision and shall have 30 days from such notification to file a written appeal of the determination involved which shall be reasonably considered by the Secretary before the revision to the list becomes final. The revision to the list shall be effective with respect to assignment of Corps members beginning on the date that the revision becomes final.
(d) Limitation on number of entities offered as assignment choices in Scholarship Program
(1) Determination of available Corps members
By April 1 of each calendar year, the Secretary shall determine the number of participants in the Scholarship Program who will be available for assignments under
(2) Determination of number of entities
At all times during a program year, the number of entities specified under subsection (c)(2)(B)(i) shall be—
(A) not less than the number of participants determined with respect to that program year under paragraph (1); and
(B) not greater than twice the number of participants determined with respect to that program year under paragraph (1).
(July 1, 1944, ch. 373, title III, §333A, as added and amended
Editorial Notes
Amendments
2003—Subsec. (c)(4).
2002—Subsec. (a)(1)(A).
Subsec. (b).
"(1) The ratio of available health manpower to the number of individuals in the area or population group involved, or served by the medical facility or other public facility involved.
"(2) Indicators of need as follows:
"(A) The rate of low birthweight births.
"(B) The rate of infant mortality.
"(C) The rate of poverty.
"(D) Access to primary health services, taking into account the distance to such services."
Subsec. (c).
Subsec. (c)(1).
Subsec. (d).
Subsec. (d)(1).
Subsec. (d)(2).
Subsec. (d)(3).
"(A) Not later than 30 days after the preparation of each list under paragraph (1), the Secretary shall notify entities specified for purposes of subparagraph (A) of such paragraph of the fact that the entities have been provided an authorization to receive assignments of Corps members in the event that Corps members are available for the assignments.
"(B) In the case of individuals with respect to whom a period of obligated service under the Scholarship Program will begin during the period under subsection (f) of this section for which a list under paragraph (1) is prepared, the Secretary shall, not later than 30 days after the preparation of each such list, provide to such individuals the names of each of the entities specified for purposes of paragraph (1)(B)(i) that is appropriate to the medical specialty of the individuals."
Subsec. (d)(4).
Subsec. (e).
Subsec. (f).
1990—
Statutory Notes and Related Subsidiaries
Effective Date of 2003 Amendment
Amendment by
§254g. Charges for services by entities using Corps members
(a) Availability of services regardless of ability to pay or payment source
An entity to which a Corps member is assigned shall not deny requested health care services, and shall not discriminate in the provision of services to an individual—
(1) because the individual is unable to pay for the services; or
(2) because payment for the services would be made under—
(A) the medicare program under title XVIII of the Social Security Act (
(B) the medicaid program under title XIX of such Act (
(C) the State children's health insurance program under title XXI of such Act (
(b) Charges for services
The following rules shall apply to charges for health care services provided by an entity to which a Corps member is assigned:
(1) In general
(A) Schedule of fees or payments
Except as provided in paragraph (2), the entity shall prepare a schedule of fees or payments for the entity's services, consistent with locally prevailing rates or charges and designed to cover the entity's reasonable cost of operation.
(B) Schedule of discounts
Except as provided in paragraph (2), the entity shall prepare a corresponding schedule of discounts (including, in appropriate cases, waivers) to be applied to the payment of such fees or payments. In preparing the schedule, the entity shall adjust the discounts on the basis of a patient's ability to pay.
(C) Use of schedules
The entity shall make every reasonable effort to secure from patients fees and payments for services in accordance with such schedules, and fees or payments shall be sufficiently discounted in accordance with the schedule described in subparagraph (B).
(2) Services to beneficiaries of Federal and federally assisted programs
In the case of health care services furnished to an individual who is a beneficiary of a program listed in subsection (a)(2), the entity—
(A) shall accept an assignment pursuant to section 1842(b)(3)(B)(ii) of the Social Security Act (
(B) shall enter into an appropriate agreement with—
(i) the State agency administering the program under title XIX of such Act [
(ii) the State agency administering the program under title XXI of such Act [
(3) Collection of payments
The entity shall take reasonable and appropriate steps to collect all payments due for health care services provided by the entity, including payments from any third party (including a Federal, State, or local government agency and any other third party) that is responsible for part or all of the charge for such services.
(July 1, 1944, ch. 373, title III, §334, as added
Editorial Notes
References in Text
The Social Security Act, referred to in subsecs. (a)(2) and (b)(2)(B), is act Aug. 14, 1935, ch. 531,
Prior Provisions
A prior section 254g, act July 1, 1944, ch. 373, title III, §334, as added
Amendments
2003—Subsec. (b)(1)(B).
Statutory Notes and Related Subsidiaries
Effective Date of 2003 Amendment
Amendment by
§254h. Provision of health services by Corps members
(a) Means of delivery of services; cooperation with other health care providers
In providing health services in a health professional shortage area, Corps members shall utilize the techniques, facilities, and organizational forms most appropriate for the area, population group, medical facility, or other public facility, and shall, to the maximum extent feasible, provide such services (1) to all individuals in, or served by, such health professional shortage area regardless of their ability to pay for the services, and (2) in a manner which is cooperative with other health care providers serving such health professional shortage area.
(b) Utilization of existing health facilities; lease, acquisition, and use of equipment and supplies; permanent and temporary professional services
(1) Notwithstanding any other provision of law, the Secretary may (A) to the maximum extent feasible make such arrangements as he determines necessary to enable Corps members to utilize the health facilities in or serving the health professional shortage area in providing health services; (B) make such arrangements as he determines are necessary for the use of equipment and supplies of the Service and for the lease or acquisition of other equipment and supplies; and (C) secure the permanent or temporary services of physicians, dentists, nurses, administrators, and other health personnel. If there are no health facilities in or serving such area, the Secretary may arrange to have Corps members provide health services in the nearest health facilities of the Service or may lease or otherwise provide facilities in or serving such area for the provision of health services.
(2) If the individuals in or served by a health professional shortage area are being served (as determined under regulations of the Secretary) by a hospital or other health care delivery facility of the Service, the Secretary may, in addition to such other arrangements as he may make under paragraph (1), arrange for the utilization of such hospital or facility by Corps members in providing health services, but only to the extent that such utilization will not impair the delivery of health services and treatment through such hospital or facility to individuals who are entitled to health services and treatment through such hospital or facility.
(c) Loan; purposes; limitations
The Secretary may make one loan to any entity with an approved application under
(d) Property and equipment disposal; fair market value; sale at less than full market value
Upon the expiration of the assignment of all Corps members to a health professional shortage area, the Secretary may (notwithstanding any other provision of law) sell, to any appropriate local entity, equipment and other property of the United States utilized by such members in providing health services. Sales made under this subsection shall be made at the fair market value (as determined by the Secretary) of the equipment or such other property; except that the Secretary may make such sales for a lesser value to an appropriate local entity, if he determines that the entity is financially unable to pay the full market value.
(e) Admitting privileges denied to Corps member by hospital; notice and hearing; denial of Federal funds for violation; "hospital" defined
(1)(A) It shall be unlawful for any hospital to deny an authorized Corps member admitting privileges when such Corps member otherwise meets the professional qualifications established by the hospital for granting such privileges and agrees to abide by the published bylaws of the hospital and the published bylaws, rules, and regulations of its medical staff.
(B) Any hospital which is found by the Secretary, after notice and an opportunity for a hearing on the record, to have violated this subsection shall upon such finding cease, for a period to be determined by the Secretary, to receive and to be eligible to receive any Federal funds under this chapter or under titles XVIII, XIX, or XXI of the Social Security Act [
(2) For purposes of this subsection, the term "hospital" includes a State or local public hospital, a private profit hospital, a private nonprofit hospital, a general or special hospital, and any other type of hospital (excluding a hospital owned or operated by an agency of the Federal Government), and any related facilities.
(July 1, 1944, ch. 373, title III, §335, as added
Editorial Notes
References in Text
The Social Security Act, referred to in subsec. (e)(1)(B), is act Aug. 14, 1935, ch. 531,
Amendments
2002—Subsec. (e)(1)(B).
1990—Subsecs. (a), (b)(1)(A), (2), (d).
Subsec. (e)(1)(A).
1981—Subsec. (a)(2).
Subsec. (c)(4).
§254h–1. Facilitation of effective provision of Corps services
(a) Consideration of individual characteristics of members in making assignments
In making an assignment of a Corps member to an entity that has had an application approved under
(b) Counseling on service in Corps
(1) In general
The Secretary shall, subject to paragraph (3), offer appropriate counseling on service in the Corps to individuals during the period of membership in the Corps, particularly during the initial period of each assignment.
(2) Career advisor regarding obligated service
(A) In the case of individuals who have entered into contracts for obligated service under the Scholarship or Loan Repayment Program, counseling under paragraph (1) shall include appropriate counseling on matters particular to such obligated service. The Secretary shall ensure that career advisors for providing such counseling are available to such individuals throughout the period of participation in the Scholarship or Loan Repayment Program.
(B) With respect to the Scholarship Program, counseling under paragraph (1) shall include counseling individuals during the period in which the individuals are pursuing an educational degree in the health profession involved, including counseling to prepare the individual for service in the Corps.
(3) Extent of counseling services
With respect to individuals who have entered into contracts for obligated service under the Scholarship or Loan Repayment Program, this subsection shall be carried out regarding such individuals throughout the period of obligated service (and, additionally, throughout the period specified in paragraph (2)(B), in the case of the Scholarship Program). With respect to Corps members generally, this subsection shall be carried out to the extent practicable.
(c) Grants regarding preparation of students for practice
With respect to individuals who have entered into contracts for obligated service under the Scholarship or Loan Repayment Program, the Secretary may make grants to, and enter into contracts with, public and nonprofit private entities (including health professions schools) for the conduct of programs designed to prepare such individuals for the effective provision of primary health services in the health professional shortage areas to which the individuals are assigned.
(d) Professional development and training
(1) In general
The Secretary shall assist Corps members in establishing and maintaining professional relationships and development opportunities, including by—
(A) establishing appropriate professional relationships between the Corps member involved and the health professions community of the geographic area with respect to which the member is assigned;
(B) establishing professional development, training, and mentorship linkages between the Corps member involved and the larger health professions community, including through distance learning, direct mentorship, and development and implementation of training modules designed to meet the educational needs of offsite Corps members;
(C) establishing professional networks among Corps members; or
(D) engaging in other professional development, mentorship, and training activities for Corps members, at the discretion of the Secretary.
(2) Assistance in establishing professional relationships
In providing such assistance under paragraph (1), the Secretary shall focus on establishing relationships with hospitals, with academic medical centers and health professions schools, with area health education centers under
(3) Supplement not supplant
Such efforts under this subsection shall supplement, not supplant, non-government efforts by professional health provider societies to establish and maintain professional relationships and development opportunities.
(e) Temporary relief from Corps duties
(1) In general
The Secretary shall, subject to paragraph (4), provide assistance to Corps members in establishing arrangements through which Corps members may, as appropriate, be provided temporary relief from duties in the Corps in order to pursue continuing education in the health professions, to participate in exchange programs with teaching centers, to attend professional conferences, or to pursue other interests, including vacations.
(2) Assumption of duties of member
(A) Temporary relief under paragraph (1) may be provided only if the duties of the Corps member involved are assumed by another health professional. With respect to such temporary relief, the duties may be assumed by Corps members or by health professionals who are not Corps members, if the Secretary approves the professionals for such purpose. Any health professional so approved by the Secretary shall, during the period of providing such temporary relief, be deemed to be a Corps member for purposes of
(B) In carrying out paragraph (1), the Secretary shall provide for the formation and continued existence of a group of health professionals to provide temporary relief under such paragraph.
(3) Recruitment from general health professions community
In carrying out paragraph (1), the Secretary shall—
(A) encourage health professionals who are not Corps members to enter into arrangements under which the health professionals temporarily assume the duties of Corps members for purposes of paragraph (1); and
(B) with respect to the entities to which Corps members have been assigned under
(4) Limitation
In carrying out paragraph (1), the Secretary may not, except as provided in paragraph (5), obligate any amounts (other than for incidental expenses) for the purpose of—
(A) compensating a health professional who is not a Corps member for assuming the duties of a Corps member; or
(B) paying the costs of a vacation, or other interests that a Corps member may pursue during the period of temporary relief under such paragraph.
(5) Sole providers of health services
In the case of any Corps member who is the sole provider of health services in the geographic area involved, the Secretary may, from amounts appropriated under
(f) Determinations regarding effective service
In carrying out subsection (a) and
(1) the characteristics of physicians, dentists, and other health professionals who are more likely to remain in practice in health professional shortage areas after the completion of the period of service in the Corps;
(2) the characteristics of health manpower shortage areas, and of entities seeking assignments of Corps members, that are more likely to retain Corps members after the members have completed the period of service in the Corps; and
(3) the appropriate conditions for the assignment and utilization in health manpower shortage areas of certified nurse practitioners, certified nurse midwives, and physician assistants.
(July 1, 1944, ch. 373, title III, §336, as added
Editorial Notes
References in Text
Prior Provisions
A prior section 336 of act July 1, 1944, was renumbered section 336A by
Amendments
2008—Subsec. (d).
2002—Subsecs. (c), (f)(1).
1990—
"(a) The Secretary may make grants to and enter into contracts with public and private nonprofit entities for the conduct of programs which are designed to prepare individuals subject to a service obligation under the National Health Service Corps Scholarship Program or Loan Repayment Program to effectively provide health services in the health manpower shortage area to which they are assigned.
"(b) No grant may be made or contract entered into under subsection (a) of this section unless an application therefor is submitted to and approved by the Secretary. Such an application shall be in such form, submitted in such manner, and contain such information, as the Secretary shall by regulation prescribe."
Subsec. (a).
1987—Subsec. (a).
1 See References in Text note below.
§254i. Annual report to Congress; contents
The Secretary shall submit an annual report to Congress, and shall include in such report with respect to the previous calendar year—
(1) the number, identity, and priority of all health professional shortage areas designated in such year and the number of health professional shortage areas which the Secretary estimates will be designated in the subsequent year;
(2) the number of applications filed under
(3) the number and types of Corps members assigned in such year to health professional shortage areas, the number and types of additional Corps members which the Secretary estimates will be assigned to such areas in the subsequent year, and the need for additional members for the Corps;
(4) the recruitment efforts engaged in for the Corps in such year and the number of qualified individuals who applied for service in the Corps in such year;
(5) the number of patients seen and the number of patient visits recorded during such year with respect to each health professional shortage area to which a Corps member was assigned during such year;
(6) the number of Corps members who elected, and the number of Corps members who did not elect, to continue to provide health services in health professional shortage areas after termination of their service in the Corps and the reasons (as reported to the Secretary) of members who did not elect for not making such election;
(7) the results of evaluations and determinations made under
(8) the amount charged during such year for health services provided by Corps members, the amount which was collected in such year by entities in accordance with
(July 1, 1944, ch. 373, title III, §336A, formerly §336, as added
Editorial Notes
Amendments
2002—Par. (8).
1990—Pars. (1), (3), (5), (6).
1982—
§254j. National Advisory Council on National Health Service Corps
(a) Establishment; appointment of members
There is established a council to be known as the National Advisory Council on the National Health Service Corps (hereinafter in this section referred to as the "Council"). The Council shall be composed of not more than 15 members appointed by the Secretary. The Council shall consult with, advise, and make recommendations to, the Secretary with respect to his responsibilities in carrying out this subpart (other than section 254r 1 of this title), and shall review and comment upon regulations promulgated by the Secretary under this subpart.
(b) Term of members; compensation; expenses
(1) Members of the Council shall be appointed for a term of three years, except that any member appointed to fill a vacancy occurring prior to the expiration of the term for which the member's predecessor was appointed shall be appointed for the remainder of such term. No member shall be removed, except for cause.
(2) Members of the Council (other than members who are officers or employees of the United States), while attending meetings or conferences thereof or otherwise serving on the business of the Council, shall be entitled to receive for each day (including traveltime) in which they are so serving compensation at a rate fixed by the Secretary (but not to exceed the daily equivalent of the annual rate of basic pay in effect for grade GS–18 of the General Schedule); and while so serving away from their homes or regular places of business all members may be allowed travel expenses, including per diem in lieu of subsistence, as authorized by
(c) Termination
(July 1, 1944, ch. 373, title III, §337, as added
Editorial Notes
References in Text
Amendments
2022—Subsec. (c).
2010—Subsec. (b)(1).
1993—Subsec. (b)(2).
1983—Subsec. (a).
1981—Subsec. (a).
Subsec. (b)(1).
1979—Subsec. (b)(2).
Statutory Notes and Related Subsidiaries
Termination of Advisory Committees
References in Other Laws to GS–16, 17, or 18 Pay Rates
References in laws to the rates of pay for GS–16, 17, or 18, or to maximum rates of pay under the General Schedule, to be considered references to rates payable under specified sections of Title 5, Government Organization and Employees, see section 529 [title I, §101(c)(1)] of
1 See References in Text note below.
§254k. Authorization of appropriations
(a) For the purpose of carrying out this subpart, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2008 through 2012.
(b) An appropriation under an authorization under subsection (a) for any fiscal year may be made at any time before that fiscal year and may be included in an Act making an appropriation under an authorization under subsection (a) for another fiscal year; but no funds may be made available from any appropriation under such authorization for obligation under sections 254d through 254h, section 254i, and
(July 1, 1944, ch. 373, title III, §338, as added
Editorial Notes
Amendments
2008—Subsec. (a).
2002—Subsec. (a).
1990—Subsec. (a).
1987—Subsec. (a).
1981—Subsec. (a).
Subsec. (b).
1979—Subsec. (a).
1978—Subsec. (a).
subpart iii—scholarship program and loan repayment program
Editorial Notes
Codification
§254l. National Health Service Corps Scholarship Program
(a) Establishment
The Secretary shall establish the National Health Service Corps Scholarship Program to assure, with respect to the provision of primary health services pursuant to
(1) an adequate supply of physicians, dentists, behavioral and mental health professionals, certified nurse midwives, certified nurse practitioners, and physician assistants; and
(2) if needed by the Corps, an adequate supply of other health professionals.
(b) Eligibility; application; written contract
To be eligible to participate in the Scholarship Program, an individual must—
(1) be accepted for enrollment, or be enrolled, as a full-time student (A) in an accredited (as determined by the Secretary) educational institution in a State and (B) in a course of study or program, offered by such institution and approved by the Secretary, leading to a degree in medicine, osteopathic medicine, dentistry, or other health profession, or an appropriate degree from a graduate program of behavioral and mental health;
(2) be eligible for, or hold, an appointment as a commissioned officer in the Regular or Reserve Corps 1 of the Service or be eligible for selection for civilian service in the Corps;
(3) submit an application to participate in the Scholarship Program; and
(4) sign and submit to the Secretary, at the time of submittal of such application, a written contract (described in subsection (f)) to accept payment of a scholarship and to serve (in accordance with this subpart) for the applicable period of obligated service in a health professional shortage area.
(c) Review and evaluation of information and forms by prospective applicant
(1) In disseminating application forms and contract forms to individuals desiring to participate in the Scholarship Program, the Secretary shall include with such forms—
(A) a fair summary of the rights and liabilities of an individual whose application is approved (and whose contract is accepted) by the Secretary, including in the summary a clear explanation of the damages to which the United States is entitled under
(B) information respecting meeting a service obligation through private practice under an agreement under
(2) The application form, contract form, and all other information furnished by the Secretary under this subpart shall be written in a manner calculated to be understood by the average individual applying to participate in the Scholarship Program. The Secretary shall make such application forms, contract forms, and other information available to individuals desiring to participate in the Scholarship Program on a date sufficiently early to insure that such individuals have adequate time to carefully review and evaluate such forms and information.
(3)(A) The Secretary shall distribute to health professions schools materials providing information on the Scholarship Program and shall encourage the schools to disseminate the materials to the students of the schools.
(B)(i) In the case of any health professional whose period of obligated service under the Scholarship Program is nearing completion, the Secretary shall encourage the individual to remain in a health professional shortage area and to continue providing primary health services.
(ii) During the period in which a health professional is planning and making the transition to private practice from obligated service under the Scholarship Program, the Secretary may provide assistance to the professional regarding such transition if the professional is remaining in a health professional shortage area and is continuing to provide primary health services.
(C) In the case of entities to which participants in the Scholarship Program are assigned under
(d) Factors considered in providing contracts; priorities
(1) Subject to
(A) the Secretary shall consider the extent of the demonstrated interest of the applicants for the contracts in providing primary health services;
(B) the Secretary, in considering applications from individuals accepted for enrollment or enrolled in dental school, shall consider applications from all individuals accepted for enrollment or enrolled in any accredited dental school in a State; and
(C) may 2 consider such other factors regarding the applicants as the Secretary determines to be relevant to selecting qualified individuals to participate in such Program.
(2) In providing contracts under the Scholarship Program, the Secretary shall give priority—
(A) first, to any application for such a contract submitted by an individual who has previously received a scholarship under this section or under section 294z 3 of this title;
(B) second, to any application for such a contract submitted by an individual who has characteristics that increase the probability that the individual will continue to serve in a health professional shortage area after the period of obligated service pursuant to subsection (f) is completed; and
(C) third, subject to subparagraph (B), to any application for such a contract submitted by an individual who is from a disadvantaged background.
(e) Commencement of participation in Scholarship Program; notice
(1) An individual becomes a participant in the Scholarship Program only upon the Secretary's approval of the individual's application submitted under subsection (b)(3) and the Secretary's acceptance of the contract submitted by the individual under subsection (b)(4).
(2) The Secretary shall provide written notice to an individual promptly upon the Secretary's approving, under paragraph (1), of the individual's participation in the Scholarship Program.
(f) Written contract; contents
The written contract (referred to in this subpart) between the Secretary and an individual shall contain—
(1) an agreement that—
(A) subject to paragraph (2), the Secretary agrees (i) to provide the individual with a scholarship (described in subsection (g)) in each such school year or years for a period of years (not to exceed four school years) determined by the individual, during which period the individual is pursuing a course of study described in subsection (b)(1)(B), and (ii) to accept (subject to the availability of appropriated funds for carrying out sections 254d through 254h and
(B) subject to paragraph (2), the individual agrees—
(i) to accept provision of such a scholarship to the individual;
(ii) to maintain enrollment in a course of study described in subsection (b)(1)(B) until the individual completes the course of study;
(iii) while enrolled in such course of study, to maintain an acceptable level of academic standing (as determined under regulations of the Secretary by the educational institution offering such course of study);
(iv) if pursuing a degree from a school of medicine or osteopathic medicine, to complete a residency in a specialty that the Secretary determines is consistent with the needs of the Corps; and
(v) to serve for a time period (hereinafter in the subpart referred to as the "period of obligated service") equal to—
(I) one year for each school year for which the individual was provided a scholarship under the Scholarship Program, or
(II) two years,
whichever is greater, as a provider of primary health services in a health professional shortage area (designated under
(2) a provision that any financial obligation of the United States arising out of a contract entered into under this subpart and any obligation of the individual which is conditioned thereon, is contingent upon funds being appropriated for scholarships under this subpart and to carry out the purposes of sections 254d through 254h and
(3) a statement of the damages to which the United States is entitled, under
(4) such other statements of the rights and liabilities of the Secretary and of the individual, not inconsistent with the provisions of this subpart.
(g) Scholarship provisions; contract with educational institution; increase in monthly stipend
(1) A scholarship provided to a student for a school year under a written contract under the Scholarship Program shall consist of—
(A) payment to, or (in accordance with paragraph (2)) on behalf of, the student of the amount (except as provided in section 292k 2 of this title) of—
(i) the tuition of the student in such school year; and
(ii) all other reasonable educational expenses, including fees, books, and laboratory expenses, incurred by the student in such school year; and
(B) payment to the student of a stipend of $400 per month (adjusted in accordance with paragraph (3)) for each of the 12 consecutive months beginning with the first month of such school year.
(2) The Secretary may contract with an educational institution, in which a participant in the Scholarship Program is enrolled, for the payment to the educational institution of the amounts of tuition and other reasonable educational expenses described in paragraph (1)(A). Payment to such an educational institution may be made without regard to section 3324(a) and (b) of title 31.
(3) The amount of the monthly stipend, specified in paragraph (1)(B) and as previously adjusted (if at all) in accordance with this paragraph, shall be increased by the Secretary for each school year ending in a fiscal year beginning after September 30, 1978, by an amount (rounded to the next highest multiple of $1) equal to the amount of such stipend multiplied by the overall percentage (under
(h) Employment ceiling of Department unaffected
Notwithstanding any other provision of law, individuals who have entered into written contracts with the Secretary under this section, while undergoing academic training, shall not be counted against any employment ceiling affecting the Department.
(July 1, 1944, ch. 373, title III, §338A, formerly title VII, §751, as added
Editorial Notes
References in Text
The General Schedule, referred to in subsec. (g)(3), is set out under
Codification
In subsec. (g)(2), "section 3324(a) and (b) of title 31" substituted for "section 3648 of the Revised Statutes (
Section was formerly classified to
Amendments
2003—Subsec. (d)(1)(B).
2002—Subsec. (a)(1).
Subsec. (b)(1)(B).
Subsec. (c)(1).
Subsec. (d)(1)(B), (C).
Subsec. (f)(1)(B)(iv), (v).
Subsec. (f)(3).
Subsec. (i).
1990—Subsec. (a).
Subsec. (b)(4).
Subsec. (c).
Subsec. (d).
"(1) first, to applications made (and contracts submitted) by individuals who have previously received scholarships under the Scholarship Program or under
"(2) second, to applications made (and contracts submitted)—
"(A) for the school year beginning in calendar year 1978, by individuals who are entering their first, second, or third year of study in a course of study or program described in subsection (b)(1)(B) of this section in such school year;
"(B) for the school year beginning in calendar year 1979, by individuals who are entering their first or second year of study in a course of study or program described in subsection (b)(1)(B) of this section in such school year; and
"(C) for each school year thereafter, by individuals who are entering their first year of study in a course of study or program described in subsection (b)(1)(B) of this section in such school year."
Subsec. (f)(1)(B)(iv).
Subsec. (g)(3).
Subsec. (i).
Subsec. (i)(4), (5).
Subsec. (i)(6).
1988—Subsec. (b)(1).
1985—Subsec. (g)(1).
1981—Subsec. (a).
Subsec. (c).
Subsec. (f).
Subsec. (j).
1979—Subsec. (g)(3).
1978—Subsec. (f).
Subsec. (i).
1977—Subsec. (d)(2).
Statutory Notes and Related Subsidiaries
Change of Name
Reference to Reserve Corps of the Public Health Service deemed to be a reference to the Ready Reserve Corps, see
Effective Date of 2003 Amendment
Amendment by
Effective Date of 1990 Amendment
Amendment by
Effective Date of 1985 Amendment
"(a) Except as provided in subsection (b), this Act and the amendments and repeals made by this Act [enacting
"(b)(1) The amendments made by section 101(a) of this Act [amending
"(2) The amendments made by section 208(e) of this Act [amending
"(3) The amendment made by section 208(h) of this Act [amending
"(4) The provisions of section 746 of the Public Health Service Act (as added by the amendment made by section 209(h)(2) of this Act) [former
"(5) The amendments made by section 209(j) of this Act [amending
"(6) The amendments made by section 213(a) of this Act [amending
Effective Date of 1977 Amendment
Effective Date
Effective Date; Savings Provision; Credit for Period of Internship or Residency Before September 30, 1977, Towards Service Obligation
"(A) Except as provided in subparagraphs (B) and (C), the amendment made by paragraph (1) of this subsection [enacting this section and
"(B) The provisions of section 225(f)(1) of the Public Health Service Act (as in effect on September 30, 1977) [former
"(C) If an individual received a scholarship under the Public Health and National Health Service Corps Scholarship Program for any school year beginning before the date of the enactment of this Act [Oct. 12, 1976], periods of internship or residency served by such individual in a facility of the National Health Service Corps or other facility of the Public Health Service shall be creditable in satisfying such individual's service obligation incurred under that Program for such scholarship or for any scholarship received under the National Health Service Corps Scholarship Program for any subsequent school year. If an individual received a scholarship under the Public Health and National Health Service Corps Program for the first time from appropriations for such Program for the fiscal year ending September 30, 1977, periods of internship or residency served by such individual in such a facility shall be creditable in satisfying such individual's service obligation incurred under that Program for such scholarship."
Scholarship and Loan Repayment Programs
1 See Change of Name note below.
3 See References in Text note below.
§254l–1. National Health Service Corps Loan Repayment Program
(a) Establishment
The Secretary shall establish a program to be known as the National Health Service Corps Loan Repayment Program to assure, with respect to the provision of primary health services pursuant to
(1) an adequate supply of physicians, dentists, behavioral and mental health professionals, certified nurse midwives, certified nurse practitioners, and physician assistants; and
(2) if needed by the Corps, an adequate supply of other health professionals.
(b) Eligibility
To be eligible to participate in the Loan Repayment Program, an individual must—
(1)(A) have a degree in medicine, osteopathic medicine, dentistry, or another health profession, or an appropriate degree from a graduate program of behavioral and mental health, or be certified as a nurse midwife, nurse practitioner, or physician assistant;
(B) be enrolled in an approved graduate training program in medicine, osteopathic medicine, dentistry, behavioral and mental health, or other health profession; or
(C) be enrolled as a full-time student—
(i) in an accredited (as determined by the Secretary) educational institution in a State; and
(ii) in the final year of a course of a study or program, offered by such institution and approved by the Secretary, leading to a degree in medicine, osteopathic medicine, dentistry, or other health profession;
(2) be eligible for, or hold, an appointment as a commissioned officer in the Regular or Reserve Corps 1 of the Service or be eligible for selection for civilian service in the Corps; and
(3) submit to the Secretary an application for a contract described in subsection (f) (relating to the payment by the Secretary of the educational loans of the individual in consideration of the individual serving for a period of obligated service).
(c) Information to be included with application and contract forms; understandability; availability
(1) Summary and information
In disseminating application forms and contract forms to individuals desiring to participate in the Loan Repayment Program, the Secretary shall include with such forms—
(A) a fair summary of the rights and liabilities of an individual whose application is approved (and whose contract is accepted) by the Secretary, including in the summary a clear explanation of the damages to which the United States is entitled under
(B) information respecting meeting a service obligation through private practice under an agreement under
(2) Understandability
The application form, contract form, and all other information furnished by the Secretary under this subpart shall be written in a manner calculated to be understood by the average individual applying to participate in the Loan Repayment Program.
(3) Availability
The Secretary shall make such application forms, contract forms, and other information available to individuals desiring to participate in the Loan Repayment Program on a date sufficiently early to ensure that such individuals have adequate time to carefully review and evaluate such forms and information.
(4) Recruitment and retention
(A) The Secretary shall distribute to health professions schools materials providing information on the Loan Repayment Program and shall encourage the schools to disseminate the materials to the students of the schools.
(B)(i) In the case of any health professional whose period of obligated service under the Loan Repayment Program is nearing completion, the Secretary shall encourage the individual to remain in a health professional shortage area and to continue providing primary health services.
(ii) During the period in which a health professional is planning and making the transition to private practice from obligated service under the Loan Repayment Program, the Secretary may provide assistance to the professional regarding such transition if the professional is remaining in a health professional shortage area and is continuing to provide primary health services.
(C) In the case of entities to which participants in the Loan Repayment Program are assigned under
(d) Factors considered in providing contracts; priorities
(1) Subject to
(A) the Secretary shall consider the extent of the demonstrated interest of the applicants for the contracts in providing primary health services; and
(B) may consider such other factors regarding the applicants as the Secretary determines to be relevant to selecting qualified individuals to participate in such Program.
(2) In providing contracts under the Loan Repayment Program, the Secretary shall give priority—
(A) to any application for such a contract submitted by an individual whose training is in a health profession or specialty determined by the Secretary to be needed by the Corps;
(B) to any application for such a contract submitted by an individual who has (and whose spouse, if any, has) characteristics that increase the probability that the individual will continue to serve in a health professional shortage area after the period of obligated service pursuant to subsection (f) is completed; and
(C) subject to subparagraph (B), to any application for such a contract submitted by an individual who is from a disadvantaged background.
(e) Approval required for participation
An individual becomes a participant in the Loan Repayment Program only upon the Secretary and the individual entering into a written contract described in subsection (f).
(f) Contents of contracts
The written contract (referred to in this subpart) between the Secretary and an individual shall contain—
(1) an agreement that—
(A) subject to paragraph (3), the Secretary agrees—
(i) to pay on behalf of the individual loans in accordance with subsection (g); and
(ii) to accept (subject to the availability of appropriated funds for carrying out
(B) subject to paragraph (3), the individual agrees—
(i) to accept loan payments on behalf of the individual;
(ii) in the case of an individual described in subsection (b)(1)(C), to maintain enrollment in a course of study or training described in such subsection until the individual completes the course of study or training;
(iii) in the case of an individual described in subsection (b)(1)(C), while enrolled in such course of study or training, to maintain an acceptable level of academic standing (as determined under regulations of the Secretary by the educational institution offering such course of study or training); and
(iv) to serve for a time period (hereinafter in this subpart referred to as the "period of obligated service") equal to 2 years or such longer period as the individual may agree to, as a provider of primary health services in a health professional shortage area (designated under
(2) a provision permitting the Secretary to extend for such longer additional periods, as the individual may agree to, the period of obligated service agreed to by the individual under paragraph (1)(B)(iv), including extensions resulting in an aggregate period of obligated service in excess of 4 years;
(3) a provision that any financial obligation of the United States arising out of a contract entered into under this subpart and any obligation of the individual that is conditioned thereon, is contingent on funds being appropriated for loan repayments under this subpart and to carry out the purposes of
(4) a statement of the damages to which the United States is entitled, under
(5) such other statements of the rights and liabilities of the Secretary and of the individual, not inconsistent with this subpart.
(g) Payments
(1) In general
A loan repayment provided for an individual under a written contract under the Loan Repayment Program shall consist of payment, in accordance with paragraph (2), on behalf of the individual of the principal, interest, and related expenses on government and commercial loans received by the individual regarding the undergraduate or graduate education of the individual (or both), which loans were made for—
(A) tuition expenses;
(B) all other reasonable educational expenses, including fees, books, and laboratory expenses, incurred by the individual; or
(C) reasonable living expenses as determined by the Secretary.
(2) Payments for years served
(A) In general
For each year of obligated service that an individual contracts to serve under subsection (f) the Secretary may pay up to $50,000, plus, beginning with fiscal year 2012, an amount determined by the Secretary on an annual basis to reflect inflation, on behalf of the individual for loans described in paragraph (1). In making a determination of the amount to pay for a year of such service by an individual, the Secretary shall consider the extent to which each such determination—
(i) affects the ability of the Secretary to maximize the number of contracts that can be provided under the Loan Repayment Program from the amounts appropriated for such contracts;
(ii) provides an incentive to serve in health professional shortage areas with the greatest such shortages; and
(iii) provides an incentive with respect to the health professional involved remaining in a health professional shortage area, and continuing to provide primary health services, after the completion of the period of obligated service under the Loan Repayment Program.
(B) Repayment schedule
Any arrangement made by the Secretary for the making of loan repayments in accordance with this subsection shall provide that any repayments for a year of obligated service shall be made no later than the end of the fiscal year in which the individual completes such year of service.
(3) Tax liability
For the purpose of providing reimbursements for tax liability resulting from payments under paragraph (2) on behalf of an individual—
(A) the Secretary shall, in addition to such payments, make payments to the individual in an amount equal to 39 percent of the total amount of loan repayments made for the taxable year involved; and
(B) may make such additional payments as the Secretary determines to be appropriate with respect to such purpose.
(4) Payment schedule
The Secretary may enter into an agreement with the holder of any loan for which payments are made under the Loan Repayment Program to establish a schedule for the making of such payments.
(h) Employment ceiling
Notwithstanding any other provision of law, individuals who have entered into written contracts with the Secretary under this section, while undergoing academic or other training, shall not be counted against any employment ceiling affecting the Department.
(July 1, 1944, ch. 373, title III, §338B, as added
Editorial Notes
Prior Provisions
A prior section 338B of act July 1, 1944, was renumbered section 338C by section 201(2) of
Amendments
2010—Subsec. (g)(2)(A).
2003—Subsec. (e).
2002—Subsec. (a)(1).
Subsec. (a)(2).
Subsec. (b)(1)(A).
Subsec. (e)(1).
Subsec. (i).
1998—Subsec. (b)(1)(B).
1990—Subsec. (a).
"(1) an adequate supply of trained physicians, dentists, and nurses for the Corps; and
"(2) if needed by the Corps, an adequate supply of podiatrists, optometrists, pharmacists, clinical psychologists, graduates of schools of veterinary medicine, graduates of schools of public health, graduates of programs in health administration, graduates of programs for the training of physician assistants, expanded function dental auxiliaries, and nurse practitioners (as defined in
Subsec. (b)(1).
"(A) be enrolled—
"(i) as a full-time student—
"(I) in an accredited (as determined by the Secretary) educational institution in a State; and
"(II) in the final year of a course of study or program, offered by such institution and approved by the Secretary, leading to a degree in medicine, osteopathic medicine, dentistry, or other health profession; or
"(ii) in an approved graduate training program in medicine, osteopathic medicine, dentistry, or other health profession; or
"(B) have—
"(i) a degree in medicine, osteopathic medicine, dentistry, or other health profession;
"(ii) completed an approved graduate training program in medicine, osteopathic medicine, dentistry, or other health profession in a State, except that the Secretary may waive the completion requirement of this clause for good cause; and
"(iii) a license to practice medicine, osteopathic medicine, dentistry, or other health profession in a State;".
Subsec. (b)(2) to (4).
"(3) submit an application to participate in the Loan Repayment Program; and
"(4) sign and submit to the Secretary, at the time of the submission of such application, a written contract (described in subsection (f) of this section) to accept repayment of educational loans and to serve (in accordance with this subpart) for the applicable period of obligated service in a health manpower shortage area."
Subsec. (c)(4).
Subsec. (d).
"(1) individuals whose training is in a health profession or specialty determined by the Secretary to be needed by the Corps; and
"(2) individuals who are committed to service in medically underserved areas."
Subsec. (e).
"(A) the Secretary's approving, under paragraph (1), of the individual's participation in the Loan Repayment Program; or
"(B) the Secretary's disapproving an individual's participation in such Program."
Subsec. (f)(1)(B)(ii), (iii).
Subsec. (f)(1)(B)(iv).
Subsec. (f)(2).
Subsec. (g)(1).
Subsec. (g)(2)(A).
Subsec. (g)(2)(B), (C).
Subsec. (g)(3).
Subsec. (i).
"(1) the number, and type of health profession training, of individuals receiving loan payments under the Loan Repayment Program;
"(2) the educational institution at which such individuals are receiving their training;
"(3) the number of applications filed under this section in the school year beginning in such year and in prior school years; and
"(4) the amount of loan payments made in the year reported on."
1988—Subsec. (b)(1).
Statutory Notes and Related Subsidiaries
Change of Name
Reference to Reserve Corps of the Public Health Service deemed to be a reference to the Ready Reserve Corps, see
Effective Date of 2003 Amendment
Amendment by
Effective Date of 1990 Amendment
Regulations
Clarification on Current Eligibility for Loan Repayment Programs
1 See Change of Name note below.
§254m. Obligated service under contract
(a) Service in full-time clinical practice
Except as provided in
(b) Notice to individual; information for informed decision; eligibility; notice to Secretary; qualification and appointment as commissioned officer; appointment as civilian member; designation of non-United States employee as member; deferment of obligated service
(1) If an individual is required under subsection (a) to provide service as specified in
(A) as a member of the Corps who is a commissioned officer in the Regular or Reserve Corps 1 of the Service or who is a civilian employee of the United States, or
(B) as a member of the Corps who is not such an officer or employee,
and shall notify such individual of such determination.
(2) If the Secretary determines that an individual shall provide obligated service as a member of the Corps who is a commissioned officer in the Service or a civilian employee of the United States, the Secretary shall, not later than sixty days before the date described in paragraph (5), provide such individual with sufficient information regarding the advantages and disadvantages of service as such a commissioned officer or civilian employee to enable the individual to make a decision on an informed basis. To be eligible to provide obligated service as a commissioned officer in the Service, an individual shall notify the Secretary, not later than thirty days before the date described in paragraph (5), of the individual's desire to provide such service as such an officer. If an individual qualifies for an appointment as such an officer, the Secretary shall, as soon as possible after the date described in paragraph (5), appoint the individual as a commissioned officer of the Regular or Reserve Corps 1 of the Service and shall designate the individual as a member of the Corps.
(3) If an individual provided notice by the Secretary under paragraph (2) does not qualify for appointment as a commissioned officer in the Service, the Secretary shall, as soon as possible after the date described in paragraph (5), appoint such individual as a civilian employee of the United States and designate the individual as a member of the Corps.
(4) If the Secretary determines that an individual shall provide obligated service as a member of the Corps who is not an employee of the United States, the Secretary shall, as soon as possible after the date described in paragraph (5), designate such individual as a member of the Corps to provide such service.
(5)(A) In the case of the Scholarship Program, the date referred to in paragraphs (1) through (4) shall be the date on which the individual completes the training required for the degree for which the individual receives the scholarship, except that—
(i) for an individual receiving such a degree after September 30, 2000, from a school of medicine or osteopathic medicine, such date shall be the date the individual completes a residency in a specialty that the Secretary determines is consistent with the needs of the Corps; and
(ii) at the request of an individual, the Secretary may, consistent with the needs of the Corps, defer such date until the end of a period of time required for the individual to complete advanced training (including an internship or residency).
(B) No period of internship, residency, or other advanced clinical training shall be counted toward satisfying a period of obligated service under this subpart.
(C) In the case of the Loan Repayment Program, if an individual is required to provide obligated service under such Program, the date referred to in paragraphs (1) through (4)—
(i) shall be the date determined under subparagraph (A) in the case of an individual who is enrolled in the final year of a course of study;
(ii) shall, in the case of an individual who is enrolled in an approved graduate training program in medicine, osteopathic medicine, dentistry, or other health profession, be the date the individual completes such training program; and
(iii) shall, in the case of an individual who has a degree in medicine, osteopathic medicine, dentistry, or other health profession and who has completed graduate training, be the date the individual enters into an agreement with the Secretary under
(c) Obligated service period; commencement
An individual shall be considered to have begun serving a period of obligated service—
(1) on the date such individual is appointed as an officer in a Regular or Reserve Corps 1 of the Service or is designated as a member of the Corps under subsection (b)(3) or (b)(4), or
(2) in the case of an individual who has entered into an agreement with the Secretary under
whichever is earlier.
(d) Assignment of personnel
The Secretary shall assign individuals performing obligated service in accordance with a written contract under the Scholarship Program to health professional shortage areas in accordance with sections 254d through 254h and
(July 1, 1944, ch. 373, title III, §338C, formerly title VII, §752, as added
Editorial Notes
Codification
Section was formerly classified to
Prior Provisions
A prior section 338C of act July 1, 1944, was renumbered section 338D by section 201(2) of
Amendments
2010—Subsec. (a).
2002—Subsec. (b)(1).
Subsec. (b)(5)(A).
"(i) at the request of such an individual with whom the Secretary has entered into a contract under
"(ii) at the request of such an individual with whom the Secretary has entered into a contract under
Subsec. (b)(5)(B).
"(B)(i) In the case of the Scholarship Program, with respect to an individual receiving a degree from a school of medicine, osteopathic medicine, or dentistry, the number of years referred to in subparagraph (A)(i) shall be 3 years.
"(ii) In the case of the Scholarship Program, with respect to an individual receiving a degree from a school of veterinary medicine, optometry, podiatry, or pharmacy, the number of years referred to in subparagraph (A)(i) shall be 1 year."
Subsec. (b)(5)(C).
Subsec. (b)(5)(C)(i).
Subsec. (b)(5)(D).
Subsec. (b)(5)(E).
Subsec. (e).
1990—Subsec. (d).
1988—Subsec. (b)(5).
1987—Subsec. (a).
Subsec. (b)(1).
Subsec. (b)(5).
Subsec. (c)(2).
1983—Subsec. (e).
1981—Subsec. (a).
Subsec. (b).
Subsec. (c).
Subsec. (d).
Subsec. (e).
1979—Subsec. (b)(5)(A).
Subsec. (b)(5)(B).
1978—Subsec. (d).
Statutory Notes and Related Subsidiaries
Change of Name
Reference to Reserve Corps of the Public Health Service deemed to be a reference to the Ready Reserve Corps, see
Effective Date of 1981 Amendment
Effective Date
Section effective Oct. 1, 1977, see section 408(b)(1) of
Effective Date; Savings Provision; Credit for Period of Internship or Residency Before September 30, 1977, Towards Service Obligation
See section 408(b)(2) of
Special Retention Pay for Regular or Reserve Officers for Period Officer Is Obligated Under This Section
Similar provisions were contained in the following prior appropriation acts:
1 See Change of Name note below.
§254n. Private practice
(a) Application for release of obligations; conditions
The Secretary shall, to the extent permitted by, and consistent with, the requirements of applicable State law, release an individual from all or part of his service obligation under
(1) in the case of an individual who received a scholarship under the Scholarship Program or a loan repayment under the Loan Repayment Program and who is performing obligated service as a member of the Corps in a health professional shortage area on the date of his application for such a release, in the health professional shortage area in which such individual is serving on such date or in the case of an individual for whom a loan payment was made under the Loan Repayment Program and who is performing obligated service as a member of the Corps in a health professional shortage area on the date of the application of the individual for such a release, in the health professional shortage area selected by the Secretary; or
(2) in the case of any other individual, in a health professional shortage area (designated under
(b) Written agreement; actions to ensure compliance
(1) The written agreement described in subsection (a) shall—
(A) provide that, during the period of private practice by an individual pursuant to the agreement, the individual shall comply with the requirements of
(B) contain such additional provisions as the Secretary may require to carry out the objectives of this section.
(2) The Secretary shall take such action as may be appropriate to ensure that the conditions of the written agreement prescribed by this subsection are adhered to.
(c) Breach of service contract
If an individual breaches the contract entered into under
(d) Travel expenses
The Secretary may pay an individual who has entered into an agreement with the Secretary under subsection (a) an amount to cover all or part of the individual's expenses reasonably incurred in transporting himself, his family, and his possessions to the location of his private clinical practice.
(e) Sale of equipment and supplies
Upon the expiration of the written agreement under subsection (a), the Secretary may (notwithstanding any other provision of law) sell to the individual who has entered into an agreement with the Secretary under subsection (a), equipment and other property of the United States utilized by such individual in providing health services. Sales made under this subsection shall be made at the fair market value (as determined by the Secretary) of the equipment or such other property, except that the Secretary may make such sales for a lesser value to the individual if he determines that the individual is financially unable to pay the full market value.
(f) Malpractice insurance
The Secretary may, out of appropriations authorized under
(1)(A) $10,000 in the first year of obligated service;
(B) $7,500 in the second year of obligated service;
(C) $5,000 in the third year of obligated service; and
(D) $2,500 in the fourth year of obligated service; or
(2) an amount determined by subtracting such individual's net income before taxes from the income the individual would have received as a member of the Corps for each such year of obligated service.
(g) Technical assistance
The Secretary shall, upon request, provide to each individual released from service obligation under this section technical assistance to assist such individual in fulfilling his or her agreement under this section.
(July 1, 1944, ch. 373, title III, §338D, formerly title VII, §753, as added
Editorial Notes
References in Text
Codification
Section was formerly classified to
Prior Provisions
A prior section 338D of act July 1, 1944, was renumbered section 338E by section 201(2) of
Amendments
2002—Subsec. (b).
1990—Subsec. (a)(1), (2).
1987—Subsec. (a).
Subsec. (b).
Subsec. (c).
Subsec. (e).
1981—Subsec. (a).
Subsec. (b)(1)(B).
Subsecs. (c) to (g).
1980—Subsec. (a).
Statutory Notes and Related Subsidiaries
Effective Date
Section effective Oct. 1, 1977, see section 408(b)(1) of
Effective Date; Savings Provision; Credit for Period of Internship or Residency Before September 30, 1977, Towards Service Obligation
See section 408(b)(2) of
1 See References in Text note below.
§254o. Breach of scholarship contract or loan repayment contract
(a) Failure to maintain academic standing; dismissal from institution; voluntary termination; liability; failure to accept payment
(1) An individual who has entered into a written contract with the Secretary under
(A) fails to maintain an acceptable level of academic standing in the educational institution in which he is enrolled (such level determined by the educational institution under regulations of the Secretary);
(B) is dismissed from such educational institution for disciplinary reasons; or
(C) voluntarily terminates the training in such an educational institution for which he is provided a scholarship under such contract, before the completion of such training,
in lieu of any service obligation arising under such contract, shall be liable to the United States for the amount which has been paid to him, or on his behalf, under the contract.
(2) An individual who has entered into a written contract with the Secretary under
(A) in the case of an individual who is enrolled in the final year of a course of study, fails to maintain an acceptable level of academic standing in the educational institution in which such individual is enrolled (such level determined by the educational institution under regulations of the Secretary) or voluntarily terminates such enrollment or is dismissed from such educational institution before completion of such course of study; or
(B) in the case of an individual who is enrolled in a graduate training program, fails to complete such training program and does not receive a waiver from the Secretary under
in lieu of any service obligation arising under such contract shall be liable to the United States for the amount that has been paid on behalf of the individual under the contract.
(b) Failure to commence or complete service obligations; formula to determine liability; payment to United States; recovery of delinquent damages; disclosure to credit reporting agencies
(1)(A) Except as provided in paragraph (2), if an individual breaches his written contract by failing (for any reason not specified in subsection (a) or
t−s
A= 3φ (——)
t
in which "A" is the amount the United States is entitled to recover, "φ" is the sum of the amounts paid under this subpart to or on behalf of the individual and the interest on such amounts which would be payable if at the time the amounts were paid they were loans bearing interest at the maximum legal prevailing rate, as determined by the Treasurer of the United States; "t" is the total number of months in the individual's period of obligated service; and "s" is the number of months of such period served by him in accordance with
(B)(i) Any amount of damages that the United States is entitled to recover under this subsection or under subsection (c) shall, within the 1-year period beginning on the date of the breach of the written contract (or such longer period beginning on such date as specified by the Secretary), be paid to the United States. Amounts not paid within such period shall be subject to collection through deductions in Medicare payments pursuant to
(ii) If damages described in clause (i) are delinquent for 3 months, the Secretary shall, for the purpose of recovering such damages—
(I) utilize collection agencies contracted with by the Administrator of the General Services Administration; or
(II) enter into contracts for the recovery of such damages with collection agencies selected by the Secretary.
(iii) Each contract for recovering damages pursuant to this subsection shall provide that the contractor will, not less than once each 6 months, submit to the Secretary a status report on the success of the contractor in collecting such damages.
(iv) To the extent not otherwise prohibited by law, the Secretary shall disclose to all appropriate credit reporting agencies information relating to damages of more than $100 that are entitled to be recovered by the United States under this subsection and that are delinquent by more than 60 days or such longer period as is determined by the Secretary.
(2) If an individual is released under section 254n 1 of this title from a service obligation under section 234 1 of this title (as in effect on September 30, 1977) and if the individual does not meet the service obligation incurred under section 254n 1 of this title, subsection (f) of such section 234 1 of this title shall apply to such individual in lieu of paragraph (1) of this subsection.
(3) The Secretary may terminate a contract with an individual under
(A) submits a written request for such termination; and
(B) repays all amounts paid to, or on behalf of, the individual under
(c) Failure to commence or complete service obligations for other reasons; determination of liability; payment to United States; waiver of recovery for extreme hardship or good cause shown
(1) If (for any reason not specified in subsection (a) or
(A) the total of the amounts paid by the United States under
(B) an amount equal to the product of the number of months of obligated service that were not completed by the individual, multiplied by $7,500; and
(C) the interest on the amounts described in subparagraphs (A) and (B), at the maximum legal prevailing rate, as determined by the Treasurer of the United States, from the date of the breach;
except that the amount the United States is entitled to recover under this paragraph shall not be less than $31,000.
(2) The Secretary may terminate a contract with an individual under
(A) submits a written request for such termination; and
(B) repays all amounts paid on behalf of the individual under
(3) Damages that the United States is entitled to recover shall be paid in accordance with subsection (b)(1)(B).
(d) Cancellation of obligation upon death of individual; waiver or suspension of obligation for impossibility, hardship, or unconscionability; release of debt by discharge in bankruptcy, time limitations
(1) Any obligation of an individual under the Scholarship Program (or a contract thereunder) or the Loan Repayment Program (or a contract thereunder) for service or payment of damages shall be canceled upon the death of the individual.
(2) The Secretary shall by regulation provide for the partial or total waiver or suspension of any obligation of service or payment by an individual under the Scholarship Program (or a contract thereunder) or the Loan Repayment Program (or a contract thereunder) whenever compliance by the individual is impossible or would involve extreme hardship to the individual and if enforcement of such obligation with respect to any individual would be unconscionable.
(3)(A) Any obligation of an individual under the Scholarship Program (or a contract thereunder) or the Loan Repayment Program (or a contract thereunder) for payment of damages may be released by a discharge in bankruptcy under title 11 only if such discharge is granted after the expiration of the 7-year period beginning on the first date that payment of such damages is required, and only if the bankruptcy court finds that nondischarge of the obligation would be unconscionable.
(B)(i) Subparagraph (A) shall apply to any financial obligation of an individual under the provision of law specified in clause (ii) to the same extent and in the same manner as such subparagraph applies to any obligation of an individual under the Scholarship or Loan Repayment Program (or contract thereunder) for payment of damages.
(ii) The provision of law referred to in clause (i) is subsection (f) of section 234 1 of this title, as in effect prior to the repeal of such section by section 408(b)(1) of
(e) Inapplicability of Federal and State statute of limitations on actions for collection
Notwithstanding any other provision of Federal or State law, there shall be no limitation on the period within which suit may be filed, a judgment may be enforced, or an action relating to an offset or garnishment, or other action, may be initiated or taken by the Secretary, the Attorney General, or the head of another Federal agency, as the case may be, for the repayment of the amount due from an individual under this section.
(f) Effective date
The amendment made by section 313(a)(4) of the Health Care Safety Net Amendments of 2002 (
(July 1, 1944, ch. 373, title III, §338E, formerly title VII, §754, as added
Editorial Notes
References in Text
Section 313(a)(4) of the Health Care Safety Net Amendments of 2002, referred to in subsec. (f), is section 313(a)(4) of
Codification
Section was formerly classified to
Prior Provisions
A prior section 338E of act July 1, 1944, was renumbered section 338F by
Amendments
2003—Subsec. (c)(1).
Subsec. (f).
2002—Subsec. (a)(1).
Subsec. (b)(1)(A).
Subsec. (b)(3).
Subsec. (c)(1).
Subsec. (c)(2).
Subsec. (c)(3), (4).
Subsec. (d)(3)(A).
Subsec. (e).
1990—Subsec. (d)(3).
1988—Subsec. (b)(1)(B)(i).
1987—
Subsec. (a).
Subsec. (b)(1).
Subsec. (b)(1)(B)(i).
Subsec. (c).
Subsec. (d).
1983—Subsec. (b)(1).
1981—Subsec. (a).
Subsec. (b).
Subsecs. (c), (d).
1977—Subsec. (c).
Statutory Notes and Related Subsidiaries
Effective Date of 2003 Amendment
Amendments by
Effective Date of 2002 Amendment
Effective Date of 1990 Amendment
Effective Date of 1988 Amendment
Except as specifically provided in section 411 of
Effective Date
Section effective Oct. 1, 1977, see section 408(b)(1) of
Effective Date; Savings Provision; Credit for Period of Internship or Residency Before September 30, 1977, Towards Service Obligation
See section 408(b)(2) of
Special Repayment Provisions
Existing Proceedings
1 See References in Text note below.
§254o–1. Fund regarding use of amounts recovered for contract breach to replace services lost as result of breach
(a) Establishment of Fund
There is established in the Treasury of the United States a fund to be known as the National Health Service Corps Member Replacement Fund (hereafter in this section referred to as the "Fund"). The Fund shall consist of such amounts as may be appropriated under subsection (b) to the Fund. Amounts appropriated for the Fund shall remain available until expended.
(b) Authorization of appropriations to Fund
For each fiscal year, there is authorized to be appropriated to the Fund an amount equal to the sum of—
(1) the amount collected during the preceding fiscal year by the Federal Government pursuant to the liability of individuals under
(2) the amount by which grants under
(3) the aggregate of the amount of interest accruing during the preceding fiscal year on obligations held in the Fund pursuant to subsection (d) and the amount of proceeds from the sale or redemption of such obligations during such fiscal year.
(c) Use of Fund
(1) Payments to certain health facilities
Amounts in the Fund and available pursuant to appropriations Act may, subject to paragraph (2), be expended by the Secretary to make payments to any entity—
(A) to which a Corps member has been assigned under
(B) that has a need for a health professional to provide primary health services as a result of the Corps member having breached the contract entered into under
(2) Purpose of payments
An entity receiving payments pursuant to paragraph (1) may expend the payments to recruit and employ a health professional to provide primary health services to patients of the entity, or to enter into a contract with such a professional to provide the services to the patients.
(d) Investment
(1) In general
The Secretary of the Treasury shall invest such amounts of the Fund as such Secretary determines are not required to meet current withdrawals from the Fund. Such investments may be made only in interest-bearing obligations of the United States. For such purpose, such obligations may be acquired on original issue at the issue price, or by purchase of outstanding obligations at the market price.
(2) Sale of obligations
Any obligation acquired by the Fund may be sold by the Secretary of the Treasury at the market price.
(July 1, 1944, ch. 373, title III, §338F, as added
Editorial Notes
Prior Provisions
A prior section 338F of act July 1, 1944, was renumbered section 338G by
Another prior section 338F of act July 1, 1944, was renumbered section 338G by section 201(2) of
§254p. Special loans for former Corps members to enter private practice
(a) Persons entitled; conditions
The Secretary may, out of appropriations authorized under
(1) to engage in the private full-time clinical practice of the profession of the member in a health professional shortage area (designated under
(A) in the case of a Corps member who is required to complete a period of obligated service under this subpart, begins not later than 1 year after the date on which such individual completes such period of obligated service; and
(B) in the case of an individual who is not required to complete a period of obligated service under this subpart, begins at such time as the Secretary considers appropriate;
(2) to conduct such practice in accordance with
(3) to such additional conditions as the Secretary may require to carry out this section.
Such a loan shall be used to assist such individual in meeting the costs of beginning the practice of such individual's profession in accordance with such agreement, including the costs of acquiring equipment and renovating facilities for use in providing health services, and of hiring nurses and other personnel to assist in providing health services. Such loan may not be used for the purchase or construction of any building.
(b) Amount of loan; maximum interest rate
(1) The amount of a loan under subsection (a) to an individual shall not exceed $25,000.
(2) The interest rate for any such loan shall not exceed an annual rate of 5 percent.
(c) Application for loan; submission and approval; interest rates and repayment terms
The Secretary may not make a loan under this section unless an application therefor has been submitted to, and approved by, the Secretary. The Secretary shall, by regulation, set interest rates and repayment terms for loans under this section.
(d) Breach of agreement; notice; determination of liability
If the Secretary determines that an individual has breached a written agreement entered into under subsection (a), he shall, as soon as practicable after making such determination, notify the individual of such determination. If within 60 days after the date of giving such notice, such individual is not practicing his profession in accordance with the agreement under such subsection and has not provided assurances satisfactory to the Secretary that he will not knowingly violate such agreement again, the United States shall be entitled to recover from such individual—
(1) in the case of an individual who has received a grant under this section (as in effect prior to October 1, 1984), an amount determined under
(2) in the case of an individual who has received a loan under this section, the full amount of the principal and interest owed by such individual under this section.
(July 1, 1944, ch. 373, title III, §338G, formerly title VII, §755, as added
Editorial Notes
Codification
Section was formerly classified to
Prior Provisions
A prior section 338G of act July 1, 1944, was renumbered section 338H by
Another prior section 338G of act July 1, 1944, was renumbered section 338I by section 201(1) of
Another prior section 338G of act July 1, 1944, was classified to
Amendments
1990—Subsec. (a)(1).
1987—Subsec. (a).
Subsec. (b).
"(1) $12,500 if the individual agrees to practice his profession in accordance with the agreement for a period of at least one year, but less than two years; or
"(2) $25,000 if the individual agrees to practice his profession in accordance with the agreement for a period of at least two years."
Subsec. (c).
Subsec. (d)(1).
1983—Subsec. (d)(1).
1981—Subsec. (a).
Subsec. (b).
Subsec. (c).
Subsec. (d).
Statutory Notes and Related Subsidiaries
Effective Date
Section effective Oct. 1, 1977, see section 408(b)(1) of
Effective Date; Savings Provision; Credit for Period of Internship or Residency Before September 30, 1977, Towards Service Obligation
See section 408(b)(2) of
§254q. Authorization of appropriations
(a) Authorization of appropriations
For the purpose of carrying out this section,1 there is authorized to be appropriated, out of any funds in the Treasury not otherwise appropriated, the following:
(1) For fiscal year 2010, $320,461,632.
(2) For fiscal year 2011, $414,095,394.
(3) For fiscal year 2012, $535,087,442.
(4) For fiscal year 2013, $691,431,432.
(5) For fiscal year 2014, $893,456,433.
(6) For fiscal year 2015, $1,154,510,336.
(7) For fiscal year 2016, and each subsequent fiscal year, the amount appropriated for the preceding fiscal year adjusted by the product of—
(A) one plus the average percentage increase in the costs of health professions education during the prior fiscal year; and
(B) one plus the average percentage change in the number of individuals residing in health professions shortage areas designated under
(b) Scholarships for new participants
Of the amounts appropriated under subsection (a) for a fiscal year, the Secretary shall obligate not less than 10 percent for the purpose of providing contracts for—
(1) scholarships under this subpart to individuals who have not previously received such scholarships; or
(2) scholarships or loan repayments under the Loan Repayment Program under
(c) Scholarships and loan repayments
With respect to certification as a nurse practitioner, nurse midwife, or physician assistant, the Secretary shall, from amounts appropriated under subsection (a) for a fiscal year, obligate not less than a total of 10 percent for contracts for both scholarships under the Scholarship Program under
(July 1, 1944, ch. 373, title III, §338H, formerly §338G, as added
Editorial Notes
Prior Provisions
A prior section 254q, act July 1, 1944, ch. 373, title III, §338G, formerly title VII, §756, as added Oct. 12, 1976,
A prior section 338H of act July 1, 1944, was renumbered section 338I by
Amendments
2010—Subsec. (a).
2008—Subsec. (a).
2002—
1990—Subsec. (a).
Subsec. (b).
1 So in original. Probably should be "subpart,".
§254q–1. Grants to States for loan repayment programs
(a) In general
(1) Authority for grants
The Secretary, acting through the Administrator of the Health Resources and Services Administration, may make grants to States for the purpose of assisting the States in operating programs described in paragraph (2) in order to provide for the increased availability of primary health care services in health professional shortage areas. The National Advisory Council established under
(2) Loan repayment programs
The programs referred to in paragraph (1) are, subject to subsection (c), programs of entering into contracts under which the State involved agrees to pay all or part of the principal, interest, and related expenses of the educational loans of health professionals in consideration of the professionals agreeing to provide primary health services in health professional shortage areas.
(3) Direct administration by State agency
The Secretary may not make a grant under paragraph (1) unless the State involved agrees that the program operated with the grant will be administered directly by a State agency.
(b) Requirement of matching funds
(1) In general
The Secretary may not make a grant under subsection (a) unless the State agrees that, with respect to the costs of making payments on behalf of individuals under contracts made pursuant to paragraph (2) of such subsection, the State will make available (directly or through donations from public or private entities) non-Federal contributions in cash toward such costs in an amount equal to not less than $1 for each $1 of Federal funds provided in the grant.
(2) Determination of amount of non-Federal contribution
In determining the amount of non-Federal contributions in cash that a State has provided pursuant to paragraph (1), the Secretary may not include any amounts provided to the State by the Federal Government.
(c) Coordination with Federal program
(1) Assignments for health professional shortage areas under Federal program
The Secretary may not make a grant under subsection (a) unless the State involved agrees that, in carrying out the program operated with the grant, the State will assign health professionals participating in the program only to public and nonprofit private entities located in and providing health services in health professional shortage areas.
(2) Remedies for breach of contracts
The Secretary may not make a grant under subsection (a) unless the State involved agrees that the contracts provided by the State pursuant to paragraph (2) of such subsection will provide remedies for any breach of the contracts by the health professionals involved.
(3) Limitation regarding contract inducements
(A) Except as provided in subparagraph (B), the Secretary may not make a grant under subsection (a) unless the State involved agrees that the contracts provided by the State pursuant to paragraph (2) of such subsection will not be provided on terms that are more favorable to health professionals than the most favorable terms that the Secretary is authorized to provide for contracts under the Loan Repayment Program under
(i) the annual amount of payments provided on behalf of the professionals regarding educational loans; and
(ii) the availability of remedies for any breach of the contracts by the health professionals involved.
(B) With respect to the limitation established in subparagraph (A) regarding the annual amount of payments that may be provided to a health professional under a contract provided by a State pursuant to subsection (a)(2), such limitation shall not apply with respect to a contract if—
(i) the excess of such annual payments above the maximum amount authorized in
(ii) the contract provides that the health professional involved will satisfy the requirement of obligated service under the contract solely through the provision of primary health services in a health professional shortage area that is receiving priority for purposes of
(d) Restrictions on use of funds
The Secretary may not make a grant under subsection (a) unless the State involved agrees that the grant will not be expended—
(1) to conduct activities for which Federal funds are expended—
(A) within the State to provide technical or other nonfinancial assistance under subsection (f) of section 254c 1 of this title;
(B) under a memorandum of agreement entered into with the State under subsection (h) of such section; or
(C) under a grant under
(2) for any purpose other than making payments on behalf of health professionals under contracts entered into pursuant to subsection (a)(2).
(e) Reports
The Secretary may not make a grant under subsection (a) unless the State involved agrees—
(1) to submit to the Secretary such reports regarding the States loan repayment program, as are determined to be appropriate by the Secretary; and
(2) to submit such a report not later than January 10 of each fiscal year immediately following any fiscal year for which the State has received such a grant.
(f) Requirement of application
The Secretary may not make a grant under subsection (a) unless 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 such subsection.
(g) Noncompliance
(1) In general
The Secretary may not make payments under subsection (a) to a State for any fiscal year subsequent to the first fiscal year of such payments unless the Secretary determines that, for the immediately preceding fiscal year, the State has complied with each of the agreements made by the State under this section.
(2) Reduction in grant relative to number of breached contracts
(A) Before making a grant under subsection (a) to a State for a fiscal year, the Secretary shall determine the number of contracts provided by the State under paragraph (2) of such subsection with respect to which there has been an initial breach by the health professionals involved during the fiscal year preceding the fiscal year for which the State is applying to receive the grant.
(B) Subject to paragraph (3), in the case of a State with 1 or more initial breaches for purposes of subparagraph (A), the Secretary shall reduce the amount of a grant under subsection (a) to the State for the fiscal year involved by an amount equal to the sum of the expenditures of Federal funds made regarding the contracts involved and an amount representing interest on the amount of such expenditures, determined with respect to each contract on the basis of the maximum legal rate prevailing for loans made during the time amounts were paid under the contract, as determined by the Treasurer of the United States.
(3) Waiver regarding reduction in grant
The Secretary may waive the requirement established in paragraph (2)(B) with respect to the initial breach of a contract if the Secretary determines that such breach by the health professional involved was attributable solely to the professional having a serious illness.
(h) "State" defined
For purposes of this section, the term "State" means each of the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the United States Virgin Islands, Guam, American Samoa, Palau, the Marshall Islands, and the Commonwealth of the Northern Mariana Islands.
(i) Authorization of appropriations
(1) In general
For the purpose of making grants under subsection (a), there are authorized to be appropriated $12,000,000 for fiscal year 2008, and such sums as may be necessary for each of fiscal years 2009 through 2012.
(2) Availability
Amounts appropriated under paragraph (1) shall remain available until expended.
(j) Public health loan repayment
(1) In general
The Secretary may award grants to States for the purpose of assisting such States in operating loan repayment programs under which such States enter into contracts to repay all or part of the eligible loans borrowed by, or on behalf of, individuals who agree to serve in State, local, or tribal health departments that serve health professional shortage areas or other areas at risk of a public health emergency, as designated by the Secretary.
(2) Loans eligible for repayment
To be eligible for repayment under this subsection, a loan shall be a loan made, insured, or guaranteed by the Federal Government that is borrowed by, or on behalf of, an individual to pay the cost of attendance for a program of education leading to a degree appropriate for serving in a State, local, or tribal health department as determined by the Secretary and the chief executive officer of the State in which the grant is administered, at an institution of higher education (as defined in
(3) Applicability of existing requirements
With respect to awards made under paragraph (1)—
(A) the requirements of subsections (b), (f), and (g) shall apply to such awards; and
(B) the requirements of subsection (c) shall apply to such awards except that with respect to paragraph (1) of such subsection, the State involved may assign an individual only to public and nonprofit private entities that serve health professional shortage areas or areas at risk of a public health emergency, as determined by the Secretary.
(4) Authorization of appropriations
There are authorized to be appropriated to carry out this subsection, such sums as may be necessary for each of fiscal years 2007 through 2010.
(July 1, 1944, ch. 373, title III, §338I, formerly §338H, as added
Editorial Notes
References in Text
Prior Provisions
A prior section 338I of act July 1, 1944, was classified to
Amendments
2008—Subsec. (h).
Subsec. (i)(1).
2006—Subsec. (j).
2002—Subsec. (a)(1).
Subsec. (e)(1).
Subsec. (i)(1).
1998—Subsec. (i)(1).
1990—
1 See References in Text note below.
§254r. Grants to State Offices of Rural Health
(a) In general
The Secretary, acting through the Director of the Federal Office of Rural Health Policy (established under
(b) Requirement of matching funds
(1) In general
Subject to paragraph (2), the Secretary may not make a grant under subsection (a) unless the State office of rural health involved agrees, with respect to the costs to be incurred in carrying out the purpose described in such subsection, to provide non-Federal contributions toward such costs in an amount equal to $3 for each $1 of Federal funds provided in the grant.
(2) Waiver or reduction
The Secretary may waive or reduce the non-Federal contribution if the Secretary determines that requiring matching funds would limit the State office of rural health's ability to carry out the purpose described in subsection (a).
(3) Determination of amount of non-Federal contribution
Non-Federal contributions required in paragraph (1) 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 non-Federal contributions.
(c) Certain required activities
Recipients of a grant under subsection (a) shall use the grant funds for purposes of—
(1) maintaining within the State office of rural health a clearinghouse for collecting and disseminating information on—
(A) rural health care issues;
(B) research findings relating to rural health care; and
(C) innovative approaches to the delivery of health care in rural areas;
(2) coordinating the activities carried out in the State that relate to rural health care, including providing coordination for the purpose of avoiding redundancy in such activities; and
(3) identifying Federal and State programs regarding rural health, and providing technical assistance to public and nonprofit private entities regarding participation in such programs.
(d) Requirement regarding annual budget for office
The Secretary may not make a grant under subsection (a) unless the State involved agrees that, for any fiscal year for which the State office of rural health receives such a grant, the office operated pursuant to subsection (a) of this section will be provided with an annual budget of not less than $150,000.
(e) Certain uses of funds
(1) Restrictions
The Secretary may not make a grant under subsection (a) unless the State office of rural health involved agrees that the grant will not be expended—
(A) to provide health care (including providing cash payments regarding such care);
(B) to conduct activities for which Federal funds are expended—
(i) within the State to provide technical and other nonfinancial assistance under
(ii) under a memorandum of agreement entered into with the State office of rural health under
(iii) under a grant under
(C) to purchase medical equipment, to purchase ambulances, aircraft, or other vehicles, or to purchase major communications equipment;
(D) to purchase or improve real property; or
(E) to carry out any activity regarding a certificate of need.
(2) Authorities
Activities for which a State office of rural health may expend a grant under subsection (a) include—
(A) paying the costs of maintaining an office of rural health for purposes of subsection (a);
(B) subject to paragraph (1)(B)(iii), paying the costs of any activity carried out with respect to recruiting and retaining health professionals to serve in rural areas of the State; and
(C) providing grants and contracts to public and nonprofit private entities to carry out activities authorized in this section.
(3) Limit on indirect costs
The Secretary may impose a limit of no more than 15 percent on indirect costs claimed by the recipient of the grant.
(f) Reports
The Secretary may not make a grant under subsection (a) unless the State office of rural health involved agrees—
(1) to submit to the Secretary reports or performance data containing such information as the Secretary may require regarding activities carried out under this section; and
(2) to submit such a report or performance data not later than September 30 of each fiscal year immediately following any fiscal year for which the State office of rural health has received such a grant.
(g) Requirement of application
The Secretary may not make a grant under subsection (a) unless 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 such subsection.
(h) Noncompliance
The Secretary may not make payments under subsection (a) to a State office of rural health for any fiscal year subsequent to the first fiscal year of such payments unless the Secretary determines that, for the immediately preceding fiscal year, the State office of rural health has complied with each of the agreements made by the State office of rural health under this section.
(i) Authorization of appropriations
(1) In general
For the purpose of making grants under subsection (a), there are authorized to be appropriated $12,500,000 for each of fiscal years 2023 through 2027.
(2) Availability
Amounts appropriated under paragraph (1) shall remain available until expended.
(July 1, 1944, ch. 373, title III, §338J, as added
Editorial Notes
Prior Provisions
A prior section 254r, act July 1, 1944, ch. 373, title III, §338I, formerly title VII, §757, as added Aug. 1, 1977,
A prior section 338J of act July 1, 1944, was renumbered section 338K by
Amendments
2023—Subsec. (i)(1).
2018—
1998—Subsec. (b)(1).
Subsec. (j)(1).
Subsec. (k).
Statutory Notes and Related Subsidiaries
Communications for Rural Health Providers
Similar provisions were contained in
§254s. Native Hawaiian Health Scholarships
(a) Eligibility
Subject to the availability of funds appropriated under the authority of subsection (d), the Secretary shall provide funds to Papa Ola Lokahi for the purpose of providing scholarship assistance to students who—
(1) meet the requirements of
(2) are Native Hawaiians.
(b) Terms and conditions
(1) The scholarship assistance provided under subsection (a) shall be provided under the same terms and subject to the same conditions, regulations, and rules that apply to scholarship assistance provided under
(2) The Native Hawaiian Health Scholarship program shall not be administered by or through the Indian Health Service.
(c) "Native Hawaiian" defined
For purposes of this section, the term "Native Hawaiian" means any individual who is—
(1) a citizen of the United States,
(2) a resident of the State of Hawaii, and
(3) a descendant of the aboriginal people, who prior to 1778, occupied and exercised sovereignty in the area that now constitutes the State of Hawaii, as evidenced by—
(A) genealogical records,
(B) Kupuna (elders) or Kama'aina (long-term community residents) verification, or
(C) birth records of the State of Hawaii.
(d) Authorization of appropriations
There are authorized to be appropriated $1,800,000 for each of the fiscal years 1990, 1991, and 1992 for the purpose of funding the scholarship assistance provided under subsection (a).
(July 1, 1944, ch. 373, title III, §338K, formerly §338J, as added
Editorial Notes
Amendments
2002—Subsec. (a).
1990—Subsec. (a).
"(1) meet the requirements of
"(2) are Native Hawaiians."
§254t. Demonstration project
(a) Program authorized
The Secretary shall establish a demonstration project to provide for the participation of individuals who are chiropractic doctors or pharmacists in the Loan Repayment Program described in
(b) Procedure
An individual that receives assistance under this section with regard to the program described in
(c) Limitations
(1) In general
The demonstration project described in this section shall provide for the participation of individuals who shall provide services in rural and urban areas.
(2) Availability of other health professionals
The Secretary may not assign an individual receiving assistance under this section to provide obligated service at a site unless—
(A) the Secretary has assigned a physician (as defined in
(B) such physician or other health professional will provide obligated service at such site concurrently with the individual receiving assistance under this section.
(3) Rules of construction
(A) Supervision of individuals
Nothing in this section shall be construed to require or imply that a physician or other health professional licensed to prescribe drugs must supervise an individual receiving assistance under the demonstration project under this section, with respect to such project.
(B) Licensure of health professionals
Nothing in this section shall be construed to supersede State law regarding licensure of health professionals.
(d) Designations
The demonstration project described in this section, and any providers who are selected to participate in such project, shall not be considered by the Secretary in the designation of a health professional shortage area under
(e) Rule of construction
This section shall not be construed to require any State to participate in the project described in this section.
(f) Report
(1) In general
The Secretary shall evaluate the participation of individuals in the demonstration projects under this section and prepare and submit a report containing the information described in paragraph (2) to—
(A) the Committee on Health, Education, Labor, and Pensions of the Senate;
(B) the Subcommittee on Labor, Health and Human Services, and Education of the Committee on Appropriations of the Senate;
(C) the Committee on Energy and Commerce of the House of Representatives; and
(D) the Subcommittee on Labor, Health and Human Services, and Education of the Committee on Appropriations of the House of Representatives.
(2) Content
The report described in paragraph (1) shall detail—
(A) the manner in which the demonstration project described in this section has affected access to primary care services, patient satisfaction, quality of care, and health care services provided for traditionally underserved populations;
(B) how the participation of chiropractic doctors and pharmacists in the Loan Repayment Program might affect the designation of health professional shortage areas; and
(C) whether adding chiropractic doctors and pharmacists as permanent members of the National Health Service Corps would be feasible and would enhance the effectiveness of the National Health Service Corps.
(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 fiscal years 2002 through 2004.
(2) Fiscal year 2005
If the Secretary determines and certifies to Congress by not later than September 30, 2004, that the number of individuals participating in the demonstration project established under this section is insufficient for purposes of performing the evaluation described in subsection (f)(1), the authorization of appropriations under paragraph (1) shall be extended to include fiscal year 2005.
(July 1, 1944, ch. 373, title III, §338L, as added
Editorial Notes
Prior Provisions
A prior section 254t, act July 1, 1944, ch. 373, title III, §338L, as added
§254u. Public health departments
(a) In general
To the extent that funds are appropriated under subsection (e), the Secretary shall establish a demonstration project to provide for the participation of individuals who are eligible for the Loan Repayment Program described in
(b) Procedure
To be eligible to receive assistance under subsection (a), with respect to the program described in
(1) comply with all rules and requirements described in such section (other than
(2) agree to serve for a time period equal to 2 years, or such longer period as the individual may agree to, in a State, local, or tribal health department, described in subsection (a).
(c) Designations
The demonstration project described in subsection (a), and any healthcare providers who are selected to participate in such project, shall not be considered by the Secretary in the designation of health professional shortage areas under
(d) Report
Not later than 3 years after December 19, 2006, the Secretary shall submit a report to the relevant committees of Congress that evaluates the participation of individuals in the demonstration project under subsection (a), the impact of such participation on State, local, and tribal health departments, and the benefit and feasibility of permanently allowing such placements in the Loan Repayment Program.
(e) Authorization of appropriations
There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2007 through 2010.
(July 1, 1944, ch. 373, title III, §338M, as added
§254v. Clarification regarding service in schools and other community-based settings
(a) Schools and community-based settings
An entity to which a participant in the Scholarship Program or the Loan Repayment Program (referred to in this section as a "participant") is assigned under
(b) Obligated service
(1) In general
Any service described in subsection (a) that a participant provides may count towards such participant's completion of any obligated service requirements under the Scholarship Program or the Loan Repayment Program, subject to any limitation imposed under paragraph (2).
(2) Limitation
The Secretary may impose a limitation on the number of hours of service described in subsection (a) that a participant may credit towards completing obligated service requirements, provided that the limitation allows a member to credit service described in subsection (a) for not less than 50 percent of the total hours required to complete such obligated service requirements.
(c) Rule of construction
The authorization under subsection (a) shall be notwithstanding any other provision of this subpart or subpart II.
(July 1, 1944, ch. 373, title III, §338N, as added
subpart iv—home health services
Editorial Notes
Codification
§255. Home health services
(a) Purpose; authorization of grants and loans; considerations; conditions on loans; appropriations
(1) For the purpose of encouraging the establishment and initial operation of home health programs to provide home health services in areas in which such services are inadequate or not readily accessible, the Secretary may, in accordance with the provisions of this section, make grants to public and nonprofit private entities and loans to proprietary entities to meet the initial costs of establishing and operating such home health programs. Such grants and loans may include funds to provide training for paraprofessionals (including homemaker home health aides) to provide home health services.
(2) In making grants and loans under this subsection, the Secretary shall—
(A) consider the relative needs of the several States for home health services;
(B) give preference to areas in which a high percentage of the population proposed to be served is composed of individuals who are elderly, medically indigent, or disabled; and
(C) give special consideration to areas with inadequate means of transportation to obtain necessary health services.
(3)(A) No loan may be made to a proprietary entity under this section unless the application of such entity for such loan contains assurances satisfactory to the Secretary that—
(i) at the time the application is made the entity is fiscally sound;
(ii) the entity is unable to secure a loan for the project for which the application is submitted from non-Federal lenders at the rate of interest prevailing in the area in which the entity is located; and
(iii) during the period of the loan, such entity will remain fiscally sound.
(B) Loans under this section shall be made at an interest rate comparable to the rate of interest prevailing on the date the loan is made with respect to the marketable obligations of the United States of comparable maturities, adjusted to provide for administrative costs.
(4) Applications for grants and loans under this subsection shall be in such form and contain such information as the Secretary shall prescribe.
(5) There are authorized to be appropriated for grants and loans under this subsection $5,000,000 for each of the fiscal years ending on September 30, 1983, September 30, 1984, September 30, 1985, September 30, 1986, and September 30, 1987.
(b) Grants and contracts for training programs for paraprofessionals; considerations; applications; appropriations
(1) The Secretary may make grants to and enter into contracts with public and private entities to assist them in developing appropriate training programs for paraprofessionals (including homemaker home health aides) to provide home health services.
(2) Any program established with a grant or contract under this subsection to train homemaker home health aides shall—
(A) extend for at least forty hours, and consist of classroom instruction and at least twenty hours (in the aggregate) of supervised clinical instruction directed toward preparing students to deliver home health services;
(B) be carried out under appropriate professional supervision and be designed to train students to maintain or enhance the personal care of an individual in his home in a manner which promotes the functional independence of the individual; and
(C) include training in—
(i) personal care services designed to assist an individual in the activities of daily living such as bathing, exercising, personal grooming, and getting in and out of bed; and
(ii) household care services such as maintaining a safe living environment, light housekeeping, and assisting in providing good nutrition (by the purchasing and preparation of food).
(3) In making grants and entering into contracts under this subsection, special consideration shall be given to entities which establish or will establish programs to provide training for persons fifty years of age and older who wish to become paraprofessionals (including homemaker home health aides) to provide home health services.
(4) Applications for grants and contracts under this subsection shall be in such form and contain such information as the Secretary shall prescribe.
(5) There are authorized to be appropriated for grants and contracts under this subsection $2,000,000 for each of the fiscal years ending September 30, 1983, September 30, 1984, September 30, 1985, September 30, 1986, and September 30, 1987.
(c) Report to Congress with respect to grants and loans and training of personnel
The Secretary shall report to the Committee on Labor and Human Resources of the Senate and the Committee on Energy and Commerce of the House of Representatives on or before January 1, 1984, with respect to—
(1) the impact of grants made and contracts entered into under subsections (a) and (b) (as such subsections were in effect prior to October 1, 1981);
(2) the need to continue grants and loans under subsections (a) and (b) (as such subsections are in effect on the day after January 4, 1983); and
(3) the extent to which standards have been applied to the training of personnel who provide home health services.
(d) "Home health services" defined
For purposes of this section, the term "home health services" has the meaning prescribed for the term by
(July 1, 1944, ch. 373, title III, §339, as added
Editorial Notes
References in Text
Subsections (a) and (b) (as such subsections were in effect prior to October 1, 1981), referred to in subsec. (c)(1), mean subsections (a) and (b) of
Prior Provisions
A prior section 255, act July 1, 1944, ch. 373, title III, §339, as added Nov. 10, 1978,
Another prior section 339 of act July 1, 1944, ch. 373, title III, formerly §331,
Amendments
1984—Subsecs. (a)(5), (b)(5).
Statutory Notes and Related Subsidiaries
Change of Name
Committee on Labor and Human Resources of Senate changed to Committee on Health, Education, Labor, and Pensions of Senate by Senate Resolution No. 20, One Hundred Sixth Congress, Jan. 19, 1999.
Committee on Energy and Commerce of House of Representatives treated as referring to Committee on Commerce of House of Representatives by section 1(a) of
Report to Congress Concerning Results of Studies Evaluating Home and Community Based Health Services; Studies of Reimbursement Methodologies; Investigation of Fraud; Demonstration Projects; Home Health Services, Defined
subpart v—healthy communities access program
Editorial Notes
Prior Provisions
A prior subpart VI, consisting of section 256a, related to health services for residents of public housing, prior to repeal by
§256. Grants to strengthen the effectiveness, efficiency, and coordination of services for the uninsured and underinsured
(a) In general
The Secretary may award grants to eligible entities to assist in the development of integrated health care delivery systems to serve communities of individuals who are uninsured and individuals who are underinsured—
(1) to improve the efficiency of, and coordination among, the providers providing services through such systems;
(2) to assist communities in developing programs targeted toward preventing and managing chronic diseases; and
(3) to expand and enhance the services provided through such systems.
(b) Eligible entities
To be eligible to receive a grant under this section, an entity shall be an entity that—
(1) represents a consortium—
(A) whose principal purpose is to provide a broad range of coordinated health care services for a community defined in the entity's grant application as described in paragraph (2); and
(B) that includes at least one of each of the following providers that serve the community (unless such provider does not exist within the community, declines or refuses to participate, or places unreasonable conditions on their participation)—
(i) a Federally qualified health center (as defined in
(ii) a hospital with a low-income utilization rate (as defined in
(iii) a public health department; and
(iv) an interested public or private sector health care provider or an organization that has traditionally served the medically uninsured and underserved; and
(2) submits to the Secretary an application, in such form and manner as the Secretary shall prescribe, that—
(A) defines a community or geographic area of uninsured and underinsured individuals;
(B) identifies the providers who will participate in the consortium's program under the grant, and specifies each provider's contribution to the care of uninsured and underinsured individuals in the community, including the volume of care the provider provides to beneficiaries under the medicare, medicaid, and State child health insurance programs and to patients who pay privately for services;
(C) describes the activities that the applicant and the consortium propose to perform under the grant to further the objectives of this section;
(D) demonstrates the consortium's ability to build on the current system (as of the date of submission of the application) for serving a community or geographic area of uninsured and underinsured individuals by involving providers who have traditionally provided a significant volume of care for that community;
(E) demonstrates the consortium's ability to develop coordinated systems of care that either directly provide or ensure the prompt provision of a broad range of high-quality, accessible services, including, as appropriate, primary, secondary, and tertiary services, as well as substance abuse treatment and mental health services in a manner that assures continuity of care in the community or geographic area;
(F) provides evidence of community involvement in the development, implementation, and direction of the program that the entity proposes to operate;
(G) demonstrates the consortium's ability to ensure that individuals participating in the program are enrolled in public insurance programs for which the individuals are eligible or know of private insurance programs where available;
(H) presents a plan for leveraging other sources of revenue, which may include State and local sources and private grant funds, and integrating current and proposed new funding sources in a way to assure long-term sustainability of the program;
(I) describes a plan for evaluation of the activities carried out under the grant, including measurement of progress toward the goals and objectives of the program and the use of evaluation findings to improve program performance;
(J) demonstrates fiscal responsibility through the use of appropriate accounting procedures and appropriate management systems;
(K) demonstrates the consortium's commitment to serve the community without regard to the ability of an individual or family to pay by arranging for or providing free or reduced charge care for the poor; and
(L) includes such other information as the Secretary may prescribe.
(c) Limitations
(1) Number of awards
(A) In general
For each of fiscal years 2003, 2004, 2005, and 2006, the Secretary may not make more than 35 new awards under subsection (a) (excluding renewals of such awards).
(B) Rule of construction
This paragraph shall not be construed to affect awards made before fiscal year 2003.
(2) In general
An eligible entity may not receive a grant under this section (including with respect to any such grant made before fiscal year 2003) for more than 3 consecutive fiscal years, except that such entity may receive such a grant award for not more than 1 additional fiscal year if—
(A) the eligible entity submits to the Secretary a request for a grant for such an additional fiscal year;
(B) the Secretary determines that extraordinary circumstances (as defined in paragraph (3)) justify the granting of such request; and
(C) the Secretary determines that granting such request is necessary to further the objectives described in subsection (a).
(3) Extraordinary circumstances
(A) In general
In paragraph (2), the term "extraordinary circumstances" means an event (or events) that is outside of the control of the eligible entity that has prevented the eligible entity from fulfilling the objectives described by such entity in the application submitted under subsection (b)(2).
(B) Examples
Extraordinary circumstances include—
(i) natural disasters or other major disruptions to the security or health of the community or geographic area served by the eligible entity; or
(ii) a significant economic deterioration in the community or geographic area served by such eligible entity, that directly and adversely affects the entity receiving an award under subsection (a).
(d) Priorities
In awarding grants under this section, the Secretary—
(1) shall accord priority to applicants that demonstrate the extent of unmet need in the community involved for a more coordinated system of care; and
(2) may accord priority to applicants that best promote the objectives of this section, taking into consideration the extent to which the application involved—
(A) identifies a community whose geographical area has a high or increasing percentage of individuals who are uninsured;
(B) demonstrates that the applicant has included in its consortium providers, support systems, and programs that have a tradition of serving uninsured individuals and underinsured individuals in the community;
(C) shows evidence that the program would expand utilization of preventive and primary care services for uninsured and underinsured individuals and families in the community, including behavioral and mental health services, oral health services, or substance abuse services;
(D) proposes a program that would improve coordination between health care providers and appropriate social service providers;
(E) demonstrates collaboration with State and local governments;
(F) demonstrates that the applicant makes use of non-Federal contributions to the greatest extent possible; or
(G) demonstrates a likelihood that the proposed program will continue after support under this section ceases.
(e) Use of funds
(1) Use by grantees
(A) In general
Except as provided in paragraphs (2) and (3), a grantee may use amounts provided under this section only for—
(i) direct expenses associated with achieving the greater integration of a health care delivery system so that the system either directly provides or ensures the provision of a broad range of culturally competent services, as appropriate, including primary, secondary, and tertiary services, as well as substance abuse treatment and mental health services; and
(ii) direct patient care and service expansions to fill identified or documented gaps within an integrated delivery system.
(B) Specific uses
The following are examples of purposes for which a grantee may use grant funds under this section, when such use meets the conditions stated in subparagraph (A):
(i) Increases in outreach activities and closing gaps in health care service.
(ii) Improvements to case management.
(iii) Improvements to coordination of transportation to health care facilities.
(iv) Development of provider networks and other innovative models to engage physicians in voluntary efforts to serve the medically underserved within a community.
(v) Recruitment, training, and compensation of necessary personnel.
(vi) Acquisition of technology for the purpose of coordinating care.
(vii) Improvements to provider communication, including implementation of shared information systems or shared clinical systems.
(viii) Development of common processes for determining eligibility for the programs provided through the system, including creating common identification cards and single sliding scale discounts.
(ix) Development of specific prevention and disease management tools and processes.
(x) Translation services.
(xi) Carrying out other activities that may be appropriate to a community and that would increase access by the uninsured to health care, such as access initiatives for which private entities provide non-Federal contributions to supplement the Federal funds provided through the grants for the initiatives.
(2) Direct patient care limitation
Not more than 15 percent of the funds provided under a grant awarded under this section may be used for providing direct patient care and services.
(3) Reservation of funds for national program purposes
The Secretary may use not more than 3 percent of funds appropriated to carry out this section for providing technical assistance to grantees, obtaining assistance of experts and consultants, holding meetings, developing of tools, disseminating of information, evaluation, and carrying out activities that will extend the benefits of programs funded under this section to communities other than the community served by the program funded.
(f) Grantee requirements
(1) Evaluation of effectiveness
A grantee under this section shall—
(A) report to the Secretary annually regarding—
(i) progress in meeting the goals and measurable objectives set forth in the grant application submitted by the grantee under subsection (b); and
(ii) the extent to which activities conducted by such grantee have—
(I) improved the effectiveness, efficiency, and coordination of services for uninsured and underinsured individuals in the communities or geographic areas served by such grantee;
(II) resulted in the provision of better quality health care for such individuals; and
(III) resulted in the provision of health care to such individuals at lower cost than would have been possible in the absence of the activities conducted by such grantee; and
(B) provide for an independent annual financial audit of all records that relate to the disposition of funds received through the grant.
(2) Progress
The Secretary may not renew an annual grant under this section for an entity for a fiscal year unless the Secretary is satisfied that the consortium represented by the entity has made reasonable and demonstrable progress in meeting the goals and measurable objectives set forth in the entity's grant application for the preceding fiscal year.
(g) Maintenance of effort
With respect to activities for which a grant under this section is authorized, the Secretary may award such a grant only if the applicant for the grant, and each of the participating providers, agree that the grantee and each such provider will maintain its expenditures of non-Federal funds for such activities at a level that is not less than the level of such expenditures during the fiscal year immediately preceding the fiscal year for which the applicant is applying to receive such grant.
(h) Technical assistance
The Secretary may, either directly or by grant or contract, provide any entity that receives a grant under this section with technical and other nonfinancial assistance necessary to meet the requirements of this section.
(i) Evaluation of program
Not later than September 30, 2005, the Secretary shall prepare and submit to the appropriate committees of Congress a report that describes the extent to which projects funded under this section have been successful in improving the effectiveness, efficiency, and coordination of services for uninsured and underinsured individuals in the communities or geographic areas served by such projects, including whether the projects resulted in the provision of better quality health care for such individuals, and whether such care was provided at lower costs, than would have been provided in the absence of such projects.
(j) Demonstration authority
The Secretary may make demonstration awards under this section to historically black health professions schools for the purposes of—
(1) developing patient-based research infrastructure at historically black health professions schools, which have an affiliation, or affiliations, with any of the providers identified in subsection (b)(1)(B);
(2) establishment of joint and collaborative programs of medical research and data collection between historically black health professions schools and such providers, whose goal is to improve the health status of medically underserved populations; or
(3) supporting the research-related costs of patient care, data collection, and academic training resulting from such affiliations.
(k) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2002 through 2006.
(l) Date certain for termination of program
Funds may not be appropriated to carry out this section after September 30, 2006.
(July 1, 1944, ch. 373, title III, §340, as added
Editorial Notes
Prior Provisions
A prior section 256, act July 1, 1944, ch. 373, title III, §340, as added July 22, 1987,
Another prior section 256, act July 1, 1944, ch. 373, title III, §340, as added Nov. 10, 1978,
Another prior section 256, act July 1, 1944, ch. 373, title III, §340, formerly §332,
Statutory Notes and Related Subsidiaries
Demonstration Project To Provide Access to Affordable Care
"(a)
"(b)
"(c)
Purpose
"(1) coordination of services to allow individuals to receive efficient and higher quality care and to gain entry into and receive services from a comprehensive system of care;
"(2) development of the infrastructure for a health care delivery system characterized by effective collaboration, information sharing, and clinical and financial coordination among all providers of care in the community; and
"(3) provision of new Federal resources that do not supplant funding for existing Federal categorical programs that support entities providing services to low-income populations."
§256a. Patient navigator grants
(a) Grants
The Secretary, acting through the Administrator of the Health Resources and Services Administration, may make grants to eligible entities for the development and operation of demonstration programs to provide patient navigator services to improve health care outcomes. The Secretary shall coordinate with, and ensure the participation of, the Indian Health Service, the National Cancer Institute, the Office of Rural Health Policy, and such other offices and agencies as deemed appropriate by the Secretary, regarding the design and evaluation of the demonstration programs.
(b) Use of funds
The Secretary shall require each recipient of a grant under this section to use the grant to recruit, assign, train, and employ patient navigators who have direct knowledge of the communities they serve to facilitate the care of individuals, including by performing each of the following duties:
(1) Acting as contacts, including by assisting in the coordination of health care services and provider referrals, for individuals who are seeking prevention or early detection services for, or who following a screening or early detection service are found to have a symptom, abnormal finding, or diagnosis of, cancer or other chronic disease.
(2) Facilitating the involvement of community organizations in assisting individuals who are at risk for or who have cancer or other chronic diseases to receive better access to high-quality health care services (such as by creating partnerships with patient advocacy groups, charities, health care centers, community hospice centers, other health care providers, or other organizations in the targeted community).
(3) Notifying individuals of clinical trials and, on request, facilitating enrollment of eligible individuals in these trials.
(4) Anticipating, identifying, and helping patients to overcome barriers within the health care system to ensure prompt diagnostic and treatment resolution of an abnormal finding of cancer or other chronic disease.
(5) Coordinating with the relevant health insurance ombudsman programs to provide information to individuals who are at risk for or who have cancer or other chronic diseases about health coverage, including private insurance, health care savings accounts, and other publicly funded programs (such as Medicare, Medicaid, health programs operated by the Department of Veterans Affairs or the Department of Defense, the State children's health insurance program, and any private or governmental prescription assistance programs).
(6) Conducting ongoing outreach to health disparity populations, including the uninsured, rural populations, and other medically underserved populations, in addition to assisting other individuals who are at risk for or who have cancer or other chronic diseases to seek preventative care.
(c) Prohibitions
(1) Referral fees
The Secretary shall require each recipient of a grant under this section to prohibit any patient navigator providing services under the grant from accepting any referral fee, kickback, or other thing of value in return for referring an individual to a particular health care provider.
(2) Legal fees and costs
The Secretary shall prohibit the use of any grant funds received under this section to pay any fees or costs resulting from any litigation, arbitration, mediation, or other proceeding to resolve a legal dispute.
(d) Grant period
(1) In general
Subject to paragraphs (2) and (3), the Secretary may award grants under this section for periods of not more than 3 years.
(2) Extensions
Subject to paragraph (3), the Secretary may extend the period of a grant under this section. Each such extension shall be for a period of not more than 1 year.
(3) Limitations on grant period
In carrying out this section, the Secretary shall ensure that the total period of a grant does not exceed 4 years.
(e) Application
(1) In general
To seek a grant under this section, an eligible entity shall submit an application to the Secretary in such form, in such manner, and containing such information as the Secretary may require.
(2) Contents
At a minimum, the Secretary shall require each such application to outline how the eligible entity will establish baseline measures and benchmarks that meet the Secretary's requirements to evaluate program outcomes.
(3) Minimum core proficiencies
The Secretary shall not award a grant to an entity under this section unless such entity provides assurances that patient navigators recruited, assigned, trained, or employed using grant funds meet minimum core proficiencies, as defined by the entity that submits the application, that are tailored for the main focus or intervention of the navigator involved.
(f) Uniform baseline measures
The Secretary shall establish uniform baseline measures in order to properly evaluate the impact of the demonstration projects under this section.
(g) Preference
In making grants under this section, the Secretary shall give preference to eligible entities that demonstrate in their applications plans to utilize patient navigator services to overcome significant barriers in order to improve health care outcomes in their respective communities.
(h) Duplication of services
An eligible entity that is receiving Federal funds for activities described in subsection (b) on the date on which the entity submits an application under subsection (e) may not receive a grant under this section unless the entity can demonstrate that amounts received under the grant will be utilized to expand services or provide new services to individuals who would not otherwise be served.
(i) Coordination with other programs
The Secretary shall ensure coordination of the demonstration grant program under this section with existing authorized programs in order to facilitate access to high-quality health care services.
(j) Study; reports
(1) Final report by Secretary
Not later than 6 months after the completion of the demonstration grant program under this section, the Secretary shall conduct a study of the results of the program and submit to the Congress a report on such results that includes the following:
(A) An evaluation of the program outcomes, including—
(i) quantitative analysis of baseline and benchmark measures; and
(ii) aggregate information about the patients served and program activities.
(B) Recommendations on whether patient navigator programs could be used to improve patient outcomes in other public health areas.
(2) Interim reports by Secretary
The Secretary may provide interim reports to the Congress on the demonstration grant program under this section at such intervals as the Secretary determines to be appropriate.
(3) Reports by grantees
The Secretary may require grant recipients under this section to submit interim and final reports on grant program outcomes.
(k) Rule of construction
This section shall not be construed to authorize funding for the delivery of health care services (other than the patient navigator duties listed in subsection (b)).
(l) Definitions
In this section:
(1) The term "eligible entity" means a public or nonprofit private health center (including a Federally qualified health center (as that term is defined in
(2) The term "health disparity population" means a population that, as determined by the Secretary, has a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates as compared to the health status of the general population.
(3) The term "patient navigator" means an individual who has completed a training program approved by the Secretary to perform the duties listed in subsection (b).
(m) Authorization of appropriations
(1) In general
To carry out this section, there are authorized to be appropriated $2,000,000 for fiscal year 2006, $5,000,000 for fiscal year 2007, $8,000,000 for fiscal year 2008, $6,500,000 for fiscal year 2009, $3,500,000 for fiscal year 2010, and such sums as may be necessary for each of fiscal years 2011 through 2015.
(2) Availability
The amounts appropriated pursuant to paragraph (1) shall remain available for obligation through the end of fiscal year 2015.
(July 1, 1944, ch. 373, title III, §340A, as added
Editorial Notes
Prior Provisions
A prior section 256a, act July 1, 1944, ch. 373, title III, §340A, as added Nov. 6, 1990,
Another prior section 256a, act July 1, 1944, ch. 373, title III, §340A, as added Nov. 10, 1978,
Amendments
2010—Subsec. (d)(3).
"(A) shall ensure that the total period of a grant does not exceed 4 years; and
"(B) may not authorize any grant period ending after September 30, 2010."
Subsec. (e)(3).
Subsec. (m)(1).
Subsec. (m)(2).
§256a–1. Establishing community health teams to support the patient-centered medical home
(a) In general
The Secretary of Health and Human Services (referred to in this section as the "Secretary") shall establish a program to provide grants to or enter into contracts with eligible entities to establish community-based interdisciplinary, interprofessional teams (referred to in this section as "health teams") to support primary care practices, including obstetrics and gynecology practices, within the hospital service areas served by the eligible entities. Grants or contracts shall be used to—
(1) establish health teams to provide support services to primary care providers; and
(2) provide capitated payments to primary care providers as determined by the Secretary.
(b) Eligible entities
To be eligible to receive a grant or contract under subsection (a), an entity shall—
(1)(A) be a State or State-designated entity; or
(B) be an Indian tribe or tribal organization, as defined in
(2) submit a plan for achieving long-term financial sustainability within 3 years;
(3) submit a plan for incorporating prevention initiatives and patient education and care management resources into the delivery of health care that is integrated with community-based prevention and treatment resources, where available;
(4) ensure that the health team established by the entity includes an interdisciplinary, interprofessional team of health care providers, as determined by the Secretary; such team may include medical specialists, nurses, pharmacists, nutritionists, dieticians, social workers, behavioral and mental health providers (including substance use disorder prevention and treatment providers), doctors of chiropractic, licensed complementary and alternative medicine practitioners, and physicians' assistants;
(5) agree to provide services to eligible individuals with chronic conditions, as described in
(6) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c) Requirements for health teams
A health team established pursuant to a grant or contract under subsection (a) shall—
(1) establish contractual agreements with primary care providers to provide support services;
(2) support patient-centered medical homes, defined as a mode of care that includes—
(A) personal physicians or other primary care providers;
(B) whole person orientation;
(C) coordinated and integrated care;
(D) safe and high-quality care through evidence-informed medicine, appropriate use of health information technology, and continuous quality improvements;
(E) expanded access to care; and
(F) payment that recognizes added value from additional components of patient-centered care;
(3) collaborate with local primary care providers and existing State and community based resources to coordinate disease prevention, chronic disease management, transitioning between health care providers and settings and case management for patients, including children, with priority given to those amenable to prevention and with chronic diseases or conditions identified by the Secretary;
(4) in collaboration with local health care providers, develop and implement interdisciplinary, interprofessional care plans that integrate clinical and community preventive and health promotion services for patients, including children, with a priority given to those amenable to prevention and with chronic diseases or conditions identified by the Secretary;
(5) incorporate health care providers, patients, caregivers, and authorized representatives in program design and oversight;
(6) provide support necessary for local primary care providers to—
(A) coordinate and provide access to high-quality health care services;
(B) coordinate and provide access to preventive and health promotion services;
(C) provide access to appropriate specialty care and inpatient services;
(D) provide quality-driven, cost-effective, culturally appropriate, and patient- and family-centered health care;
(E) provide access to pharmacist-delivered medication management services, including medication reconciliation;
(F) provide coordination of the appropriate use of complementary and alternative (CAM) services to those who request such services;
(G) promote effective strategies for treatment planning, monitoring health outcomes and resource use, sharing information, treatment decision support, and organizing care to avoid duplication of service and other medical management approaches intended to improve quality and value of health care services;
(H) provide local access to the continuum of health care services in the most appropriate setting, including access to individuals that implement the care plans of patients and coordinate care, such as integrative health care practitioners;
(I) collect and report data that permits evaluation of the success of the collaborative effort on patient outcomes, including collection of data on patient experience of care, and identification of areas for improvement; and
(J) establish a coordinated system of early identification and referral for children at risk for developmental or behavioral problems such as through the use of infolines, health information technology, or other means as determined by the Secretary;
(7) provide 24-hour care management and support during transitions in care settings including—
(A) a transitional care program that provides onsite visits from the care coordinator,1 assists with the development of discharge plans and medication reconciliation upon admission to and discharge from the hospitals,2 nursing home, or other institution setting;
(B) discharge planning and counseling support to providers, patients, caregivers, and authorized representatives;
(C) assuring that post-discharge care plans include medication management, as appropriate;
(D) referrals for mental and behavioral health services, which may include the use of infolines; and
(E) transitional health care needs from adolescence to adulthood;
(8) serve as a liaison to community prevention and treatment programs;
(9) demonstrate a capacity to implement and maintain health information technology that meets the requirements of certified EHR technology (as defined in
(10) where applicable, report to the Secretary information on quality measures used under
(d) Requirement for primary care providers
A provider who contracts with a care team shall—
(1) provide a care plan to the care team for each patient participant;
(2) provide access to participant health records; and
(3) meet regularly with the care team to ensure integration of care.
(e) Reporting to Secretary
An entity that receives a grant or contract under subsection (a) shall submit to the Secretary a report that describes and evaluates, as requested by the Secretary, the activities carried out by the entity under subsection (c).
(f) Definition of primary care
In this section, the term "primary care" means the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.
(
Editorial Notes
References in Text
Section 2703, referred to in subsec. (b)(5), means section 2703 of
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
2010—Subsec. (c)(2)(A).
1 So in original. The comma probably should be "and".
2 So in original. Probably should be "hospital,".
subpart vii—drug pricing agreements
§256b. Limitation on prices of drugs purchased by covered entities
(a) Requirements for agreement with Secretary
(1) In general
The Secretary shall enter into an agreement with each manufacturer of covered outpatient drugs under which the amount required to be paid (taking into account any rebate or discount, as provided by the Secretary) to the manufacturer for covered outpatient drugs (other than drugs described in paragraph (3)) purchased by a covered entity on or after the first day of the first month that begins after November 4, 1992, does not exceed an amount equal to the average manufacturer price for the drug under title XIX of the Social Security Act [
(2) "Rebate percentage" defined
(A) In general
For a covered outpatient drug purchased in a calendar quarter, the "rebate percentage" is the amount (expressed as a percentage) equal to—
(i) the average total rebate required under section 1927(c) of the Social Security Act [
(ii) the average manufacturer price for such a unit of the drug during such quarter.
(B) Over the counter drugs
(i) In general
For purposes of subparagraph (A), in the case of over the counter drugs, the "rebate percentage" shall be determined as if the rebate required under section 1927(c) of the Social Security Act [
(ii) "Over the counter drug" defined
The term "over the counter drug" means a drug that may be sold without a prescription and which is prescribed by a physician (or other persons authorized to prescribe such drug under State law).
(3) Drugs provided under State medicaid plans
Drugs described in this paragraph are drugs purchased by the entity for which payment is made by the State under the State plan for medical assistance under title XIX of the Social Security Act [
(4) "Covered entity" defined
In this section, the term "covered entity" means an entity that meets the requirements described in paragraph (5) and is one of the following:
(A) A Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act [
(B) An entity receiving a grant under section 256a 1 of this title.
(C) A family planning project receiving a grant or contract under
(D) An entity receiving a grant under subpart II 1 of part C of subchapter XXIV (relating to categorical grants for outpatient early intervention services for HIV disease).
(E) A State-operated AIDS drug purchasing assistance program receiving financial assistance under subchapter XXIV.
(F) A black lung clinic receiving funds under
(G) A comprehensive hemophilia diagnostic treatment center receiving a grant under section 501(a)(2) of the Social Security Act [
(H) A Native Hawaiian Health Center receiving funds under the Native Hawaiian Health Care Act of 1988.
(I) An urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act [
(J) Any entity receiving assistance under subchapter XXIV (other than a State or unit of local government or an entity described in subparagraph (D)), but only if the entity is certified by the Secretary pursuant to paragraph (7).
(K) An entity receiving funds under
(L) A subsection (d) hospital (as defined in section 1886(d)(1)(B) of the Social Security Act [
(i) is owned or operated by a unit of State or local government, is a public or private non-profit corporation which is formally granted governmental powers by a unit of State or local government, or is a private non-profit hospital which has a contract with a State or local government to provide health care services to low income individuals who are not entitled to benefits under title XVIII of the Social Security Act [
(ii) for the most recent cost reporting period that ended before the calendar quarter involved, had a disproportionate share adjustment percentage (as determined under section 1886(d)(5)(F) of the Social Security Act [
(iii) does not obtain covered outpatient drugs through a group purchasing organization or other group purchasing arrangement.
(M) A children's hospital excluded from the Medicare prospective payment system pursuant to section 1886(d)(1)(B)(iii) of the Social Security Act [
(N) An entity that is a critical access hospital (as determined under section 1820(c)(2) of the Social Security Act [
(O) An entity that is a rural referral center, as defined by section 1886(d)(5)(C)(i) of the Social Security Act [
(5) Requirements for covered entities
(A) Prohibiting duplicate discounts or rebates
(i) In general
A covered entity shall not request payment under title XIX of the Social Security Act [
(ii) Establishment of mechanism
The Secretary shall establish a mechanism to ensure that covered entities comply with clause (i). If the Secretary does not establish a mechanism within 12 months under the previous sentence, the requirements of section 1927(a)(5)(C) of the Social Security Act [
(B) Prohibiting resale of drugs
With respect to any covered outpatient drug that is subject to an agreement under this subsection, a covered entity shall not resell or otherwise transfer the drug to a person who is not a patient of the entity.
(C) Auditing
A covered entity shall permit the Secretary and the manufacturer of a covered outpatient drug that is subject to an agreement under this subsection with the entity (acting in accordance with procedures established by the Secretary relating to the number, duration, and scope of audits) to audit at the Secretary's or the manufacturer's expense the records of the entity that directly pertain to the entity's compliance with the requirements described in subparagraphs 2 (A) or (B) with respect to drugs of the manufacturer.
(D) Additional sanction for noncompliance
If the Secretary finds, after audit as described in subparagraph (C) and after notice and hearing, that a covered entity is in violation of a requirement described in subparagraphs 2 (A) or (B), the covered entity shall be liable to the manufacturer of the covered outpatient drug that is the subject of the violation in an amount equal to the reduction in the price of the drug (as described in subparagraph (A)) provided under the agreement between the entity and the manufacturer under this paragraph.
(6) Treatment of distinct units of hospitals
In the case of a covered entity that is a distinct part of a hospital, the hospital shall not be considered a covered entity under this paragraph unless the hospital is otherwise a covered entity under this subsection.
(7) Certification of certain covered entities
(A) Development of process
Not later than 60 days after November 4, 1992, the Secretary shall develop and implement a process for the certification of entities described in subparagraphs (J) and (K) of paragraph (4).
(B) Inclusion of purchase information
The process developed under subparagraph (A) shall include a requirement that an entity applying for certification under this paragraph submit information to the Secretary concerning the amount such entity expended for covered outpatient drugs in the preceding year so as to assist the Secretary in evaluating the validity of the entity's subsequent purchases of covered outpatient drugs at discounted prices.
(C) Criteria
The Secretary shall make available to all manufacturers of covered outpatient drugs a description of the criteria for certification under this paragraph.
(D) List of purchasers and dispensers
The certification process developed by the Secretary under subparagraph (A) shall include procedures under which each State shall, not later than 30 days after the submission of the descriptions under subparagraph (C), prepare and submit a report to the Secretary that contains a list of entities described in subparagraphs (J) and (K) of paragraph (4) that are located in the State.
(E) Recertification
The Secretary shall require the recertification of entities certified pursuant to this paragraph on a not more frequent than annual basis, and shall require that such entities submit information to the Secretary to permit the Secretary to evaluate the validity of subsequent purchases by such entities in the same manner as that required under subparagraph (B).
(8) Development of prime vendor program
The Secretary shall establish a prime vendor program under which covered entities may enter into contracts with prime vendors for the distribution of covered outpatient drugs. If a covered entity obtains drugs directly from a manufacturer, the manufacturer shall be responsible for the costs of distribution.
(9) Notice to manufacturers
The Secretary shall notify manufacturers of covered outpatient drugs and single State agencies under section 1902(a)(5) of the Social Security Act [
(10) No prohibition on larger discount
Nothing in this subsection shall prohibit a manufacturer from charging a price for a drug that is lower than the maximum price that may be charged under paragraph (1).
(b) Other definitions
(1) In general
In this section, the terms "average manufacturer price", "covered outpatient drug", and "manufacturer" have the meaning given such terms in section 1927(k) of the Social Security Act [
(2) Covered drug
In this section, the term "covered drug"—
(A) means a covered outpatient drug (as defined in section 1927(k)(2) of the Social Security Act [
(B) includes, notwithstanding paragraph (3)(A) of section 1927(k) of such Act [
(c) Repealed. Pub. L. 111–152, title II, §2302(2), Mar. 30, 2010, 124 Stat. 1083
(d) Improvements in program integrity
(1) Manufacturer compliance
(A) In general
From amounts appropriated under paragraph (4), the Secretary shall provide for improvements in compliance by manufacturers with the requirements of this section in order to prevent overcharges and other violations of the discounted pricing requirements specified in this section.
(B) Improvements
The improvements described in subparagraph (A) shall include the following:
(i) The development of a system to enable the Secretary to verify the accuracy of ceiling prices calculated by manufacturers under subsection (a)(1) and charged to covered entities, which shall include the following:
(I) Developing and publishing through an appropriate policy or regulatory issuance, precisely defined standards and methodology for the calculation of ceiling prices under such subsection.
(II) Comparing regularly the ceiling prices calculated by the Secretary with the quarterly pricing data that is reported by manufacturers to the Secretary.
(III) Performing spot checks of sales transactions by covered entities.
(IV) Inquiring into the cause of any pricing discrepancies that may be identified and either taking, or requiring manufacturers to take, such corrective action as is appropriate in response to such price discrepancies.
(ii) The establishment of procedures for manufacturers to issue refunds to covered entities in the event that there is an overcharge by the manufacturers, including the following:
(I) Providing the Secretary with an explanation of why and how the overcharge occurred, how the refunds will be calculated, and to whom the refunds will be issued.
(II) Oversight by the Secretary to ensure that the refunds are issued accurately and within a reasonable period of time, both in routine instances of retroactive adjustment to relevant pricing data and exceptional circumstances such as erroneous or intentional overcharging for covered outpatient drugs.
(iii) The provision of access through the Internet website of the Department of Health and Human Services to the applicable ceiling prices for covered outpatient drugs as calculated and verified by the Secretary in accordance with this section, in a manner (such as through the use of password protection) that limits such access to covered entities and adequately assures security and protection of privileged pricing data from unauthorized re-disclosure.
(iv) The development of a mechanism by which—
(I) rebates and other discounts provided by manufacturers to other purchasers subsequent to the sale of covered outpatient drugs to covered entities are reported to the Secretary; and
(II) appropriate credits and refunds are issued to covered entities if such discounts or rebates have the effect of lowering the applicable ceiling price for the relevant quarter for the drugs involved.
(v) Selective auditing of manufacturers and wholesalers to ensure the integrity of the drug discount program under this section.
(vi) The imposition of sanctions in the form of civil monetary penalties, which—
(I) shall be assessed according to standards established in regulations to be promulgated by the Secretary not later than 180 days after March 23, 2010;
(II) shall not exceed $5,000 for each instance of overcharging a covered entity that may have occurred; and
(III) shall apply to any manufacturer with an agreement under this section that knowingly and intentionally charges a covered entity a price for purchase of a drug that exceeds the maximum applicable price under subsection (a)(1).
(2) Covered entity compliance
(A) In general
From amounts appropriated under paragraph (4), the Secretary shall provide for improvements in compliance by covered entities with the requirements of this section in order to prevent diversion and violations of the duplicate discount provision and other requirements specified under subsection (a)(5).
(B) Improvements
The improvements described in subparagraph (A) shall include the following:
(i) The development of procedures to enable and require covered entities to regularly update (at least annually) the information on the Internet website of the Department of Health and Human Services relating to this section.
(ii) The development of a system for the Secretary to verify the accuracy of information regarding covered entities that is listed on the website described in clause (i).
(iii) The development of more detailed guidance describing methodologies and options available to covered entities for billing covered outpatient drugs to State Medicaid agencies in a manner that avoids duplicate discounts pursuant to subsection (a)(5)(A).
(iv) The establishment of a single, universal, and standardized identification system by which each covered entity site can be identified by manufacturers, distributors, covered entities, and the Secretary for purposes of facilitating the ordering, purchasing, and delivery of covered outpatient drugs under this section, including the processing of chargebacks for such drugs.
(v) The imposition of sanctions, in appropriate cases as determined by the Secretary, additional to those to which covered entities are subject under subsection (a)(5)(D), through one or more of the following actions:
(I) Where a covered entity knowingly and intentionally violates subsection (a)(5)(B), the covered entity shall be required to pay a monetary penalty to a manufacturer or manufacturers in the form of interest on sums for which the covered entity is found liable under subsection (a)(5)(D), such interest to be compounded monthly and equal to the current short term interest rate as determined by the Federal Reserve for the time period for which the covered entity is liable.
(II) Where the Secretary determines a violation of subsection (a)(5)(B) was systematic and egregious as well as knowing and intentional, removing the covered entity from the drug discount program under this section and disqualifying the entity from re-entry into such program for a reasonable period of time to be determined by the Secretary.
(III) Referring matters to appropriate Federal authorities within the Food and Drug Administration, the Office of Inspector General of Department of Health and Human Services, or other Federal agencies for consideration of appropriate action under other Federal statutes, such as the Prescription Drug Marketing Act (
(3) Administrative dispute resolution process
(A) In general
Not later than 180 days after March 23, 2010, the Secretary shall promulgate regulations to establish and implement an administrative process for the resolution of claims by covered entities that they have been overcharged for drugs purchased under this section, and claims by manufacturers, after the conduct of audits as authorized by subsection (a)(5)(C), of violations of subsections 3 (a)(5)(A) or (a)(5)(B), including appropriate procedures for the provision of remedies and enforcement of determinations made pursuant to such process through mechanisms and sanctions described in paragraphs (1)(B) and (2)(B).
(B) Deadlines and procedures
Regulations promulgated by the Secretary under subparagraph (A) shall—
(i) designate or establish a decision-making official or decision-making body within the Department of Health and Human Services to be responsible for reviewing and finally resolving claims by covered entities that they have been charged prices for covered outpatient drugs in excess of the ceiling price described in subsection (a)(1), and claims by manufacturers that violations of subsection (a)(5)(A) or (a)(5)(B) have occurred;
(ii) establish such deadlines and procedures as may be necessary to ensure that claims shall be resolved fairly, efficiently, and expeditiously;
(iii) establish procedures by which a covered entity may discover and obtain such information and documents from manufacturers and third parties as may be relevant to demonstrate the merits of a claim that charges for a manufacturer's product have exceeded the applicable ceiling price under this section, and may submit such documents and information to the administrative official or body responsible for adjudicating such claim;
(iv) require that a manufacturer conduct an audit of a covered entity pursuant to subsection (a)(5)(C) as a prerequisite to initiating administrative dispute resolution proceedings against a covered entity;
(v) permit the official or body designated under clause (i), at the request of a manufacturer or manufacturers, to consolidate claims brought by more than one manufacturer against the same covered entity where, in the judgment of such official or body, consolidation is appropriate and consistent with the goals of fairness and economy of resources; and
(vi) include provisions and procedures to permit multiple covered entities to jointly assert claims of overcharges by the same manufacturer for the same drug or drugs in one administrative proceeding, and permit such claims to be asserted on behalf of covered entities by associations or organizations representing the interests of such covered entities and of which the covered entities are members.
(C) Finality of administrative resolution
The administrative resolution of a claim or claims under the regulations promulgated under subparagraph (A) shall be a final agency decision and shall be binding upon the parties involved, unless invalidated by an order of a court of competent jurisdiction.
(4) Authorization of appropriations
There are authorized to be appropriated to carry out this subsection, such sums as may be necessary for fiscal year 2010 and each succeeding fiscal year.
(e) Exclusion of orphan drugs for certain covered entities
For covered entities described in subparagraph (M) (other than a children's hospital described in subparagraph (M)), (N), or (O) of subsection (a)(4), the term "covered outpatient drug" shall not include a drug designated by the Secretary under
(July 1, 1944, ch. 373, title III, §340B, as added
Editorial Notes
References in Text
The Social Security Act, referred to in subsec. (a)(1), (3), (4)(L)(i), (5)(A)(i), is act Aug. 14, 1935, ch. 531,
Subpart II of part C of subchapter XXIV, referred to in subsec. (a)(4)(D), was redesignated subpart I of part C of subchapter XXIV of this chapter by
The Native Hawaiian Health Care Act of 1988, referred to in subsec. (a)(4)(H), was
The Indian Health Care Improvement Act, referred to in subsec. (a)(4)(I), is
The Prescription Drug Marketing Act, referred to in subsec. (d)(2)(B)(v)(III), probably means the Prescription Drug Marketing Act of 1987,
Codification
Another section 340B of act July 1, 1944, was renumbered section 340C and is classified to
Amendments
2010—Subsec. (a)(1).
Subsec. (a)(2)(A).
Subsec. (a)(2)(B)(i).
Subsec. (a)(4)(L).
Subsec. (a)(4)(M) to (O).
Subsec. (a)(5)(B).
Subsec. (a)(5)(C).
"(i)
"(ii)
"(iii)
"(I) with respect to a covered outpatient drug that is unavailable to be purchased through the program under this section due to a drug shortage problem, manufacturer noncompliance, or any other circumstance beyond the hospital's control;
"(II) to facilitate generic substitution when a generic covered outpatient drug is available at a lower price; or
"(III) to reduce in other ways the administrative burdens of managing both inventories of drugs subject to this section and inventories of drugs that are not subject to this section, so long as the exceptions do not create a duplicate discount problem in violation of subparagraph (A) or a diversion problem in violation of subparagraph (B).
"(iv)
Subsec. (a)(5)(C)(iv).
Subsec. (a)(5)(D).
Subsec. (a)(5)(E).
Subsec. (a)(7).
Subsec. (a)(9).
Subsec. (b).
Subsec. (b)(2).
Subsec. (c).
Subsec. (d).
Subsec. (e).
1993—
Statutory Notes and Related Subsidiaries
Effective Date of 2010 Amendment
"(1)
"(2)
Eligibility Exception for the Drug Discount Program Due to the COVID–19 Public Health Emergency
"(a)
"(1) beginning on the date of the enactment of this Act [Mar. 15, 2022] (or, if later, with the first of such cost reporting periods for which the hospital does not so meet such applicable requirement for the disproportionate share adjustment percentage, but otherwise meets all other such requirements for being such a covered entity and of such program); and
"(2) ending with the last of such cost reporting periods (ending not later than December 31, 2022) for which the hospital does not so meet such applicable requirement for the disproportionate share adjustment percentage, but otherwise meets all other such requirements for being such a covered entity and of such program.
"(b)
"(c)
"(1) in the case of a hospital described in subsection (a) that otherwise meets the requirements under subparagraph (L) or (M) of section 340B(a)(4) of the Public Health Service Act, the requirement under subparagraph (L)(ii) of such section; and
"(2) in the case of a hospital described in subsection (a) that otherwise meets the requirements under subparagraph (O) of such section 340B(a)(4), the requirement with respect to the disproportionate share adjustment percentage described in such subparagraph (O).
"(d)
"(1)
"(2)
"(e)
"(1)
"(2)
Pricing of Diagnostic Testing
"(a)
"(1) If the health plan or issuer has a negotiated rate with such provider in effect before the public health emergency declared under section 319 of the Public Health Service Act (
"(2) If the health plan or issuer does not have a negotiated rate with such provider, such plan or issuer shall reimburse the provider in an amount that equals the cash price for such service as listed by the provider on a public internet website, or such plan or issuer may negotiate a rate with such provider for less than such cash price.
"(b)
"(1)
"(2)
Study of Treatment of Certain Clinics as Covered Entities Eligible for Prescription Drug Discounts
1 See References in Text note below.
2 So in original. Probably should be "subparagraph".
3 So in original. Probably should be "subsection".
subpart viii—bulk purchases of vaccines for certain programs
Editorial Notes
Codification
§256c. Bulk purchases of vaccines for certain programs
(a) Agreements for purchases
(1) In general
Not later than 180 days after October 27, 1992, the Secretary, acting through the Director of the Centers for Disease Control and Prevention and in consultation with the Administrator of the Health Resources and Services Administration, shall enter into negotiations with manufacturers of vaccines for the purpose of establishing and maintaining agreements under which entities described in paragraph (2) may purchase vaccines from the manufacturers at the prices specified in the agreements.
(2) Relevant entities
The entities referred to in paragraph (1) are entities that provide immunizations against vaccine-preventable diseases with assistance provided under
(b) Negotiation of prices
In carrying out subsection (a), the Secretary shall, to the extent practicable, ensure that the prices provided for in agreements under such subsection are comparable to the prices provided for in agreements negotiated by the Secretary on behalf of grantees under
(c) Authority of Secretary
In carrying out subsection (a), the Secretary, in the discretion of the Secretary, may enter into the agreements described in such subsection (and may decline to enter into such agreements), may modify such agreements, may extend such agreements, and may terminate such agreements.
(d) Rule of construction
This section may not be construed as requiring any State to reduce or terminate the supply of vaccines provided by the State to any of the entities described in subsection (a)(2).
(July 1, 1944, ch. 373, title III, §340C, formerly §340B, as added
Editorial Notes
Amendments
1996—Subsec. (a)(2).
Statutory Notes and Related Subsidiaries
Effective Date of 1996 Amendment
Amendment by
§256d. Breast and cervical cancer information
(a) In general
As a condition of receiving grants, cooperative agreements, or contracts under this chapter, each of the entities specified in subsection (c) shall, to the extent determined to be appropriate by the Secretary, make available information concerning breast and cervical cancer.
(b) Certain authorities
In carrying out subsection (a), an entity specified in subsection (c)—
(1) may make the information involved available to such individuals as the entity determines appropriate;
(2) may, as appropriate, provide information under subsection (a) on the need for self-examination of the breasts and on the skills for such self-examinations;
(3) shall provide information under subsection (a) in the language and cultural context most appropriate to the individuals to whom the information is provided; and
(4) shall refer such clients as the entities determine appropriate for breast and cervical cancer screening, treatment, or other appropriate services.
(c) Relevant entities
The entities specified in this subsection are the following:
(1) Entities receiving assistance under section 247b–7 1 of this title (relating to tuberculosis).
(2) Entities receiving assistance under
(3) Migrant health centers receiving assistance under section 254b 1 of this title.
(4) Community health centers receiving assistance under section 254c 1 of this title.
(5) Entities receiving assistance under
(6) Entities receiving assistance under section 256a 1 of this title (relating to health services for residents of public housing).
(7) Entities providing services with assistance under subchapter III–A or subchapter XVII.
(8) Entities receiving assistance under
(9) Entities receiving assistance under subchapter XXIV (relating to services with respect to acquired immune deficiency syndrome).
(10) Non-Federal entities authorized under the Indian Self-Determination Act [
(July 1, 1944, ch. 373, title III, §340D, as added
Editorial Notes
References in Text
The Indian Self-Determination Act, referred to in subsec. (c)(10), is title I of
Amendments
2002—Subsec. (c)(5).
2000—Subsec. (c)(1).
Statutory Notes and Related Subsidiaries
Reference to Community, Migrant, Public Housing, or Homeless Health Center Considered Reference to Health Center
Reference to community health center, migrant health center, public housing health center, or homeless health center, considered reference to health center, see section 4(c) of
1 See References in Text note below.
subpart ix—support of graduate medical education programs in children's hospitals
§256e. Program of payments to children's hospitals that operate graduate medical education programs
(a) Payments
The Secretary shall make two payments under this section to each children's hospital for each of fiscal years 2000 through 2005, each of fiscal years 2007 through 2011, each of fiscal years 2014 through 2018, and each of fiscal years 2019 through 2023, one for the direct expenses and the other for indirect expenses associated with operating approved graduate medical residency training programs. The Secretary shall promulgate regulations pursuant to the rulemaking requirements of title 5 which shall govern payments made under this subpart.
(b) Amount of payments
(1) In general
Subject to paragraphs (2) and (3), the amounts payable under this section to a children's hospital for an approved graduate medical residency training program for a fiscal year are each of the following amounts:
(A) Direct expense amount
The amount determined under subsection (c) for direct expenses associated with operating approved graduate medical residency training programs.
(B) Indirect expense amount
The amount determined under subsection (d) for indirect expenses associated with the treatment of more severely ill patients and the additional costs relating to teaching residents in such programs.
(2) Capped amount
(A) In general
The total of the payments made to children's hospitals under paragraph (1)(A) or paragraph (1)(B) in a fiscal year shall not exceed the funds appropriated under paragraph (1) or (2), respectively, of subsection (f) for such payments for that fiscal year.
(B) Pro rata reductions of payments for direct expenses
If the Secretary determines that the amount of funds appropriated under subsection (f)(1) for a fiscal year is insufficient to provide the total amount of payments otherwise due for such periods under paragraph (1)(A), the Secretary shall reduce the amounts so payable on a pro rata basis to reflect such shortfall.
(3) Annual reporting required
(A) Reduction in payment for failure to report
(i) In general
The amount payable under this section to a children's hospital for a fiscal year (beginning with fiscal year 2008 and after taking into account paragraph (2)) shall be reduced by 25 percent if the Secretary determines that—
(I) the hospital has failed to provide the Secretary, as an addendum to the hospital's application under this section for such fiscal year, the report required under subparagraph (B) for the previous fiscal year; or
(II) such report fails to provide the information required under any clause of such subparagraph.
(ii) Notice and opportunity to provide missing information
Before imposing a reduction under clause (i) on the basis of a hospital's failure to provide information described in clause (i)(II), the Secretary shall provide notice to the hospital of such failure and the Secretary's intention to impose such reduction and shall provide the hospital with the opportunity to provide the required information within a period of 30 days beginning on the date of such notice. If the hospital provides such information within such period, no reduction shall be made under clause (i) on the basis of the previous failure to provide such information.
(B) Annual report
The report required under this subparagraph for a children's hospital for a fiscal year is a report that includes (in a form and manner specified by the Secretary) the following information for the residency academic year completed immediately prior to such fiscal year:
(i) The types of resident training programs that the hospital provided for residents described in subparagraph (C), such as general pediatrics, internal medicine/pediatrics, and pediatric subspecialties, including both medical subspecialties certified by the American Board of Pediatrics (such as pediatric gastroenterology) and non-medical subspecialties approved by other medical certification boards (such as pediatric surgery).
(ii) The number of training positions for residents described in subparagraph (C), the number of such positions recruited to fill, and the number of such positions filled.
(iii) The types of training that the hospital provided for residents described in subparagraph (C) related to the health care needs of different populations, such as children who are underserved for reasons of family income or geographic location, including rural and urban areas.
(iv) The changes in residency training for residents described in subparagraph (C) which the hospital has made during such residency academic year (except that the first report submitted by the hospital under this subparagraph shall be for such changes since the first year in which the hospital received payment under this section), including—
(I) changes in curricula, training experiences, and types of training programs, and benefits that have resulted from such changes; and
(II) changes for purposes of training the residents in the measurement and improvement of the quality and safety of patient care.
(v) The numbers of residents described in subparagraph (C) who completed their residency training at the end of such residency academic year and care for children within the borders of the service area of the hospital or within the borders of the State in which the hospital is located. Such numbers shall be disaggregated with respect to residents who completed residencies in general pediatrics or internal medicine/pediatrics, subspecialty residencies, and dental residencies.
(C) Residents
The residents described in this subparagraph are those who—
(i) are in full-time equivalent resident training positions in any training program sponsored by the hospital; or
(ii) are in a training program sponsored by an entity other than the hospital, but who spend more than 75 percent of their training time at the hospital.
(D) Report to Congress
Not later than the end of fiscal year 2018, and the end of fiscal year 2022, the Secretary, acting through the Administrator of the Health Resources and Services Administration, shall submit a report to the Congress—
(i) summarizing the information submitted in reports to the Secretary under subparagraph (B);
(ii) describing the results of the program carried out under this section; and
(iii) making recommendations for improvements to the program.
(c) Amount of payment for direct graduate medical education
(1) In general
The amount determined under this subsection for payments to a children's hospital for direct graduate expenses relating to approved graduate medical residency training programs for a fiscal year is equal to the product of—
(A) the updated per resident amount for direct graduate medical education, as determined under paragraph (2); and
(B) the average number of full-time equivalent residents in the hospital's graduate approved medical residency training programs (as determined under
(2) Updated per resident amount for direct graduate medical education
The updated per resident amount for direct graduate medical education for a hospital for a fiscal year is an amount determined as follows:
(A) Determination of hospital single per resident amount
The Secretary shall compute for each hospital operating an approved graduate medical education program (regardless of whether or not it is a children's hospital) a single per resident amount equal to the average (weighted by number of full-time equivalent residents) of the primary care per resident amount and the non-primary care per resident amount computed under
(B) Determination of wage and non-wage-related proportion of the single per resident amount
The Secretary shall estimate the average proportion of the single per resident amounts computed under subparagraph (A) that is attributable to wages and wage-related costs.
(C) Standardizing per resident amounts
The Secretary shall establish a standardized per resident amount for each such hospital—
(i) by dividing the single per resident amount computed under subparagraph (A) into a wage-related portion and a non-wage-related portion by applying the proportion determined under subparagraph (B);
(ii) by dividing the wage-related portion by the factor applied under
(iii) by adding the non-wage-related portion to the amount computed under clause (ii).
(D) Determination of national average
The Secretary shall compute a national average per resident amount equal to the average of the standardized per resident amounts computed under subparagraph (C) for such hospitals, with the amount for each hospital weighted by the average number of full-time equivalent residents at such hospital.
(E) Application to individual hospitals
The Secretary shall compute for each such hospital that is a children's hospital a per resident amount—
(i) by dividing the national average per resident amount computed under subparagraph (D) into a wage-related portion and a non-wage-related portion by applying the proportion determined under subparagraph (B);
(ii) by multiplying the wage-related portion by the factor applied under
(iii) by adding the non-wage-related portion to the amount computed under clause (ii).
(F) Updating rate
The Secretary shall update such per resident amount for each such children's hospital by the estimated percentage increase in the consumer price index for all urban consumers during the period beginning October 1997 and ending with the midpoint of the Federal fiscal year for which payments are made.
(d) Amount of payment for indirect medical education
(1) In general
The amount determined under this subsection for payments to a children's hospital for indirect expenses associated with the treatment of more severely ill patients and the additional costs associated with the teaching of residents for a fiscal year is equal to an amount determined appropriate by the Secretary.
(2) Factors
In determining the amount under paragraph (1), the Secretary shall—
(A) take into account variations in case mix among children's hospitals and the ratio of the number of full-time equivalent residents in the hospitals' approved graduate medical residency training programs to beds (but excluding beds or bassinets assigned to healthy newborn infants); and
(B) assure that the aggregate of the payments for indirect expenses associated with the treatment of more severely ill patients and the additional costs related to the teaching of residents under this section in a fiscal year are equal to the amount appropriated for such expenses for the fiscal year involved under subsection (f)(2).
(e) Making of payments
(1) Interim payments
The Secretary shall determine, before the beginning of each fiscal year involved for which payments may be made for a hospital under this section, the amounts of the payments for direct graduate medical education and indirect medical education for such fiscal year and shall (subject to paragraph (2)) make the payments of such amounts in 12 equal interim installments during such period. Such interim payments to each individual hospital shall be based on the number of residents reported in the hospital's most recently filed Medicare cost report prior to the application date for the Federal fiscal year for which the interim payment amounts are established. In the case of a hospital that does not report residents on a Medicare cost report, such interim payments shall be based on the number of residents trained during the hospital's most recently completed Medicare cost report filing period.
(2) Withholding
The Secretary shall withhold up to 25 percent from each interim installment for direct and indirect graduate medical education paid under paragraph (1) as necessary to ensure a hospital will not be overpaid on an interim basis.
(3) Reconciliation
Prior to the end of each fiscal year, the Secretary shall determine any changes to the number of residents reported by a hospital in the application of the hospital for the current fiscal year to determine the final amount payable to the hospital for the current fiscal year for both direct expense and indirect expense amounts. Based on such determination, the Secretary shall recoup any overpayments made and pay any balance due to the extent possible. The final amount so determined shall be considered a final intermediary determination for the purposes of
(f) Authorization of appropriations
(1) Direct graduate medical education
(A) In general
There are hereby authorized to be appropriated, out of any money in the Treasury not otherwise appropriated, for payments under subsection (b)(1)(A)—
(i) for fiscal year 2000, $90,000,000;
(ii) for fiscal year 2001, $95,000,000;
(iii) for each of the fiscal years 2002 through 2005, such sums as may be necessary;
(iv) for each of fiscal years 2007 through 2011, $110,000,000;
(v) for each of fiscal years 2014 through 2018, $100,000,000; and
(vi) for each of fiscal years 2019 through 2023, $105,000,000.
(B) Carryover of excess
The amounts appropriated under subparagraph (A) for fiscal year 2000 shall remain available for obligation through the end of fiscal year 2001.
(2) Indirect medical education
There are hereby authorized to be appropriated, out of any money in the Treasury not otherwise appropriated, for payments under subsection (b)(1)(B)—
(A) for fiscal year 2000, $190,000,000;
(B) for fiscal year 2001, $190,000,000;
(C) for each of the fiscal years 2002 through 2005, such sums as may be necessary;
(D) for each of fiscal years 2007 through 2011, $220,000,000;
(E) for each of fiscal years 2014 through 2018, $200,000,000; and
(F) for each of fiscal years 2019 through 2023, $220,000,000.
(g) Definitions
In this section:
(1) Approved graduate medical residency training program
The term "approved graduate medical residency training program" has the meaning given the term "approved medical residency training program" in
(2) Children's hospital
The term "children's hospital" means a hospital with a Medicare payment agreement and which is excluded from the Medicare inpatient prospective payment system pursuant to
(3) Direct graduate medical education costs
The term "direct graduate medical education costs" has the meaning given such term in
(h) Additional provisions
(1) In general
The Secretary is authorized to make available up to 25 percent of the total amounts in excess of $245,000,000 appropriated under paragraphs (1) and (2) of subsection (f), but not to exceed $7,000,000, for payments to hospitals qualified as described in paragraph (2), for the direct and indirect expenses associated with operating approved graduate medical residency training programs, as described in subsection (a).
(2) Qualified hospitals
(A) In general
To qualify to receive payments under paragraph (1), a hospital shall be a free-standing hospital—
(i) with a Medicare payment agreement and that is excluded from the Medicare inpatient hospital prospective payment system pursuant to
(ii) whose inpatients are predominantly individuals under 18 years of age;
(iii) that has an approved medical residency training program as defined in
(iv) that is not otherwise qualified to receive payments under this section or
(B) Establishment of residency cap
In the case of a freestanding children's hospital that, on April 7, 2014, meets the requirements of subparagraph (A) but for which the Secretary has not determined an average number of full-time equivalent residents under
(3) Payments
Payments to hospitals made under this subsection shall be made in the same manner as payments are made to children's hospitals, as described in subsections (b) through (e).
(4) Payment amounts
The direct and indirect payment amounts under this subsection shall be determined using per resident amounts that are no greater than the per resident amounts used for determining direct and indirect payment amounts under subsection (a).
(5) Reporting
A hospital receiving payments under this subsection shall be subject to the reporting requirements under subsection (b)(3).
(6) Remaining funds
(A) In general
If the payments to qualified hospitals under paragraph (1) for a fiscal year are less than the total amount made available under such paragraph for that fiscal year, any remaining amounts for such fiscal year may be made available to all hospitals participating in the program under this subsection or subsection (a).
(B) Quality bonus system
For purposes of distributing the remaining amounts described in subparagraph (A), the Secretary may establish a quality bonus system, whereby the Secretary distributes bonus payments to hospitals participating in the program under this subsection or subsection (a) that meet standards specified by the Secretary, which may include a focus on quality measurement and improvement, interpersonal and communications skills, delivering patient-centered care, and practicing in integrated health systems, including training in community-based settings. In developing such standards, the Secretary shall collaborate with relevant stakeholders, including program accrediting bodies, certifying boards, training programs, health care organizations, health care purchasers, and patient and consumer groups.
(July 1, 1944, ch. 373, title III, §340E, as added
Editorial Notes
References in Text
Amendments
2018—Subsec. (a).
Subsec. (b)(3)(D).
Subsec. (f)(1)(A)(vi).
Subsec. (f)(2)(F).
2014—Subsec. (a).
Subsec. (b)(3)(D).
Subsec. (f)(1)(A)(v).
Subsec. (f)(2)(E).
Subsec. (h).
2006—Subsec. (a).
Subsec. (b)(1).
Subsec. (b)(3).
Subsec. (c)(2)(E)(ii).
Subsec. (e)(1).
Subsec. (e)(2).
Subsec. (e)(3).
Subsec. (f)(1)(A)(iv).
Subsec. (f)(2).
Subsec. (f)(2)(D).
2004—Subsec. (d)(1).
Subsec. (d)(2)(A).
2000—Subsec. (a).
Subsec. (c)(2)(F).
Subsec. (e)(1).
Subsec. (e)(2).
Subsec. (e)(3).
Subsec. (f)(1)(A)(iii).
Subsec. (f)(2)(C).
Subsec. (g)(2).
Statutory Notes and Related Subsidiaries
Effective Date of 2004 Amendment
1 See References in Text note below.
subpart x—primary dental programs
§256f. Designated dental health professional shortage area
In this subpart, the term "designated dental health professional shortage area" means an area, population group, or facility that is designated by the Secretary as a dental health professional shortage area under
(July 1, 1944, ch. 373, title III, §340F, as added
§256g. Grants for innovative programs
(a) Grant program authorized
The Secretary, acting through the Administrator of the Health Resources and Services Administration, is authorized to award grants to States for the purpose of helping States develop and implement innovative programs to address the dental workforce needs of designated dental health professional shortage areas in a manner that is appropriate to the States' individual needs.
(b) State activities
A State receiving a grant under subsection (a) may use funds received under the grant for—
(1) loan forgiveness and repayment programs for dentists who—
(A) agree to practice in designated dental health professional shortage areas;
(B) are dental school graduates who agree to serve as public health dentists for the Federal, State, or local government; and
(C) agree to—
(i) provide services to patients regardless of such patients' ability to pay; and
(ii) use a sliding payment scale for patients who are unable to pay the total cost of services;
(2) dental recruitment and retention efforts;
(3) grants and low-interest or no-interest loans to help dentists who participate in the medicaid program under title XIX of the Social Security Act (
(4) the establishment or expansion of dental residency programs in coordination with accredited dental training institutions in States without dental schools;
(5) programs developed in consultation with State and local dental societies to expand or establish oral health services and facilities in designated dental health professional shortage areas, including services and facilities for children with special needs, such as—
(A) the expansion or establishment of a community-based dental facility, free-standing dental clinic, consolidated health center dental facility, school-linked dental facility, or United States dental school-based facility;
(B) the establishment of a mobile or portable dental clinic;
(C) the establishment or expansion of private dental services to enhance capacity through additional equipment or additional hours of operation;
(D) the establishment or development of models for the provision of dental services to children and adults, such as dental homes, including for the elderly, blind, individuals with disabilities, and individuals living in long-term care facilities; and
(E) the establishment of initiatives to reduce the use of emergency departments by individuals who seek dental services more appropriately delivered in a dental primary care setting;
(6) placement and support of dental students, dental residents, and advanced dentistry trainees;
(7) continuing dental education, including distance-based education;
(8) practice support through teledentistry conducted in accordance with State laws;
(9) community-based prevention services such as water fluoridation and dental sealant programs;
(10) coordination with local educational agencies within the State to foster programs that promote children going into oral health or science professions;
(11) the establishment of faculty recruitment programs at accredited dental training institutions whose mission includes community outreach and service and that have a demonstrated record of serving underserved States;
(12) the development of a State dental officer position or the augmentation of a State dental office to coordinate oral health and access issues in the State; and
(13) any other activities determined to be appropriate by the Secretary.
(c) Application
(1) In general
Each State desiring 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 may reasonably require.
(2) Assurances
The application shall include assurances that the State will meet the requirements of subsection (d) and that the State possesses sufficient infrastructure to manage the activities to be funded through the grant and to evaluate and report on the outcomes resulting from such activities.
(d) Matching requirement
The Secretary may not make a grant to a State under this section unless that State agrees that, with respect to the costs to be incurred by the State in carrying out the activities for which the grant was awarded, the State will provide non-Federal contributions in an amount equal to not less than 40 percent of Federal funds provided under the grant. The State may provide the contributions in cash or in kind, fairly evaluated, including plant, equipment, and services and may provide the contributions from State, local, or private sources.
(e) Report
Not later than 5 years after October 26, 2002, the Secretary shall prepare and submit to the appropriate committees of Congress a report containing data relating to whether grants provided under this section have increased access to dental services in designated dental health professional shortage areas.
(f) Authorization of appropriations
There is authorized to be appropriated to carry out this section, $13,903,000 for each of fiscal years 2019 through 2023.
(July 1, 1944, ch. 373, title III, §340G, as added
Editorial Notes
References in Text
The Social Security Act, referred to in subsec. (b)(3), is act Aug. 14, 1935, ch. 531,
Amendments
2018—Subsec. (b)(5)(D), (E).
Subsec. (f).
2008—Subsec. (f).
§256g–1. Demonstration program to increase access to dental health care services
(a) In general
(1) Authorization
The Secretary is authorized to award grants to 15 eligible entities to enable such entities to establish a demonstration program to establish training programs to train, or to employ, alternative dental health care providers in order to increase access to dental health care services in rural and other underserved communities.
(2) Definition
The term "alternative dental health care providers" includes community dental health coordinators, advance practice dental hygienists, independent dental hygienists, supervised dental hygienists, primary care physicians, dental therapists, dental health aides, and any other health professional that the Secretary determines appropriate.
(b) Timeframe
The demonstration projects funded under this section shall begin not later than 2 years after March 23, 2010, and shall conclude not later than 7 years after March 23, 2010.
(c) Eligible entities
To be eligible to receive a grant under subsection (a), an entity shall—
(1) be—
(A) an institution of higher education, including a community college;
(B) a public-private partnership;
(C) a federally qualified health center;
(D) an Indian Health Service facility or a tribe or tribal organization (as such terms are defined in
(E) a State or county public health clinic, a health facility operated by an Indian tribe or tribal organization, or urban Indian organization providing dental services; or
(F) a public hospital or health system;
(2) be within a program accredited by the Commission on Dental Accreditation or within a dental education program in an accredited institution; and
(3) shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
(d) Administrative provisions
(1) Amount of grant
Each grant under this section shall be in an amount that is not less than $4,000,000 for the 5-year period during which the demonstration project 1 being conducted.
(2) Disbursement of funds
(A) Preliminary disbursements
Beginning 1 year after March 23, 2010, the Secretary may disperse to any entity receiving a grant under this section not more than 20 percent of the total funding awarded to such entity under such grant, for the purpose of enabling the entity to plan the demonstration project to be conducted under such grant.
(B) Subsequent disbursements
The remaining amount of grant funds not dispersed under subparagraph (A) shall be dispersed such that not less than 15 percent of such remaining amount is dispersed each subsequent year.
(e) Compliance with State requirements
Each entity receiving a grant under this section shall certify that it is in compliance with all applicable State licensing requirements.
(f) Evaluation
The Secretary shall contract with the Director of the Institute of Medicine to conduct a study of the demonstration programs conducted under this section that shall provide analysis, based upon quantitative and qualitative data, regarding access to dental health care in the United States.
(g) Clarification regarding dental health aide program
Nothing in this section shall prohibit a dental health aide training program approved by the Indian Health Service from being eligible for a grant under this section.
(h) Authorization of appropriations
There is authorized to be appropriated such sums as may be necessary to carry out this section.
(July 1, 1944, ch. 373, title III, §340G–1, as added
1 So in original. The word "is" probably should appear.
subpart xi—support of graduate medical education in qualified teaching health centers
Editorial Notes
Codification
Subpart is comprised of subpart XI of part D of title III of act July 1, 1944. Another subpart XI of part D of title III of the Act was redesignated subpart XII by
§256h. Program of payments to teaching health centers that operate graduate medical education programs
(a) Payments
(1) In general
Subject to subsection (h)(2), the Secretary shall make payments under this section for direct expenses and indirect expenses to qualified teaching health centers that are listed as sponsoring institutions by the relevant accrediting body for, as appropriate—
(A) maintenance of filled positions at existing approved graduate medical residency training programs;
(B) expansion of existing approved graduate medical residency training programs; and
(C) establishment of new approved graduate medical residency training programs.
(2) Per resident amount
In making payments under paragraph (1), the Secretary shall consider the cost of training residents at teaching health centers and the implications of the per resident amount on approved graduate medical residency training programs at teaching health centers.
(3) Priority
In making payments under paragraph (1)(C), the Secretary shall give priority to qualified teaching health centers that—
(A) serve a health professional shortage area with a designation in effect under
(B) are located in a rural area (as defined in
(b) Amount of payments
(1) In general
Subject to paragraph (2), the amounts payable under this section to qualified teaching health centers for an approved graduate medical residency training program for a fiscal year are each of the following amounts:
(A) Direct expense amount
The amount determined under subsection (c) for direct expenses associated with sponsoring approved graduate medical residency training programs.
(B) Indirect expense amount
The amount determined under subsection (d) for indirect expenses associated with the additional costs relating to teaching residents in such programs.
(2) Capped amount
(A) In general
The total of the payments made to qualified teaching health centers under paragraph (1)(A) or paragraph (1)(B) in a fiscal year shall not exceed the amount of funds appropriated under subsection (g) for such payments for that fiscal year.
(B) Limitation
The Secretary shall limit the funding of full-time equivalent residents in order to ensure the direct and indirect payments as determined under subsection 1 (c) and (d) do not exceed the total amount of funds appropriated in a fiscal year under subsection (g).
(C) Addition
Notwithstanding any provision of this section, for the period beginning on October 1, 2023, and ending on December 31, 2024, the Secretary may use any amounts made available in any fiscal year to carry out this section (including amounts recouped under subsection (f)) to make payments described in paragraphs (1)(A) and (1)(B), in addition to the total amount of funds appropriated under subsection (g).
(c) Amount of payment for direct graduate medical education
(1) In general
The amount determined under this subsection for payments to qualified teaching health centers for direct graduate expenses relating to approved graduate medical residency training programs for a fiscal year is equal to the product of—
(A) the updated national per resident amount for direct graduate medical education, as determined under paragraph (2); and
(B) the average number of full-time equivalent residents in the teaching health center's graduate approved medical residency training programs as determined under
(2) Updated national per resident amount for direct graduate medical education
The updated per resident amount for direct graduate medical education for a qualified teaching health center for a fiscal year is an amount determined as follows:
(A) Determination of qualified teaching health center per resident amount
The Secretary shall compute for each individual qualified teaching health center a per resident amount—
(i) by dividing the national average per resident amount computed under
(ii) by multiplying the wage-related portion by the factor applied under
(iii) by adding the non-wage-related portion to the amount computed under clause (ii).
(B) Updating rate
The Secretary shall update such per resident amount for each such qualified teaching health center as determined appropriate by the Secretary.
(d) Amount of payment for indirect medical education
(1) In general
The amount determined under this subsection for payments to qualified teaching health centers for indirect expenses associated with the additional costs of teaching residents for a fiscal year is equal to an amount determined appropriate by the Secretary.
(2) Factors
In determining the amount under paragraph (1), the Secretary shall—
(A) evaluate indirect training costs relative to supporting a primary care residency program in qualified teaching health centers; and
(B) based on this evaluation, assure that the aggregate of the payments for indirect expenses under this section and the payments for direct graduate medical education as determined under subsection (c) in a fiscal year do not exceed the amount appropriated for such expenses as determined in subsection (g).
(3) Interim payment
Before the Secretary makes a payment under this subsection pursuant to a determination of indirect expenses under paragraph (1), the Secretary may provide to qualified teaching health centers a payment, in addition to any payment made under subsection (c), for expected indirect expenses associated with the additional costs of teaching residents for a fiscal year, based on an estimate by the Secretary.
(e) Clarification regarding relationship to other payments for graduate medical education
Payments under this section—
(1) shall be in addition to any payments—
(A) for the indirect costs of medical education under
(B) for direct graduate medical education costs under
(C) for direct costs of medical education under
(2) shall not be taken into account in applying the limitation on the number of total full-time equivalent residents under subparagraphs (F) and (G) of
(3) shall not include the time in which a resident is counted toward full-time equivalency by a hospital under paragraph (2) or under
(f) Reconciliation
The Secretary shall determine any changes to the number of residents reported by a teaching health center in the application of the teaching health center for the current fiscal year to determine the final amount payable to the teaching health center for the current fiscal year for both direct expense and indirect expense amounts. Based on such determination, the Secretary shall recoup any overpayments made to pay any balance due to the extent possible. The final amount so determined shall be considered a final intermediary determination for the purposes of
(g) Funding
(1) In general
To carry out this section, there are appropriated such sums as may be necessary, not to exceed $230,000,000, for the period of fiscal years 2011 through 2015, $60,000,000 for each of fiscal years 2016 and 2017, $126,500,000 for each of fiscal years 2018 through 2023, $16,635,616 for the period beginning on October 1, 2023, and ending on November 17, 2023, $21,834,247 for the period beginning on November 18, 2023, and ending on January 19, 2024, $16,982,192 for the period beginning on January 20, 2024, and ending on March 8, 2024, and $164,136,986 for the period beginning on October 1, 2023,3 and ending on December 31, 2024, to remain available until expended.
(2) Administrative expenses
Of the amount made available to carry out this section for any fiscal year, the Secretary may not use more than 5 percent of such amount for the expenses of administering this section.
(h) Annual reporting required
(1) Annual report
The report required under this paragraph for a qualified teaching health center for a fiscal year is a report that includes (in a form and manner specified by the Secretary) the following information for the residency academic year completed immediately prior to such fiscal year:
(A) The types of primary care resident approved training programs that the qualified teaching health center provided for residents.
(B) The number of approved training positions for residents described in paragraph (4).
(C) The number of residents described in paragraph (4) who completed their residency training at the end of such residency academic year and care for vulnerable populations living in underserved areas.
(D) The number of patients treated by residents described in paragraph (4).
(E) The number of visits by patients treated by residents described in paragraph (4).
(F) Of the number of residents described in paragraph (4) who completed their residency training at the end of such residency academic year, the number and percentage of such residents entering primary care practice (meaning any of the areas of practice listed in the definition of a primary care residency program in
(G) Of the number of residents described in paragraph (4) who completed their residency training at the end of such residency academic year, the number and percentage of such residents who entered practice at a health care facility—
(i) primarily serving a health professional shortage area with a designation in effect under
(ii) located in a rural area (as defined in
(H) Other information as deemed appropriate by the Secretary.
(2) Audit authority; limitation on payment
(A) Audit authority
The Secretary may audit a qualified teaching health center to ensure the accuracy and completeness of the information submitted in a report under paragraph (1).
(B) Limitation on payment
A teaching health center may only receive payment in a cost reporting period for a number of such resident positions that is greater than the base level of primary care resident positions, as determined by the Secretary. For purposes of this subparagraph, the "base level of primary care residents" for a teaching health center is the level of such residents as of a base period.
(3) Reduction in payment for failure to report
(A) In general
The amount payable under this section to a qualified teaching health center for a fiscal year shall be reduced by at least 25 percent if the Secretary determines that—
(i) the qualified teaching health center has failed to provide the Secretary, as an addendum to the qualified teaching health center's application under this section for such fiscal year, the report required under paragraph (1) for the previous fiscal year; or
(ii) such report fails to provide complete and accurate information required under any subparagraph of such paragraph.
(B) Notice and opportunity to provide accurate and missing information
Before imposing a reduction under subparagraph (A) on the basis of a qualified teaching health center's failure to provide complete and accurate information described in subparagraph (A)(ii), the Secretary shall provide notice to the teaching health center of such failure and the Secretary's intention to impose such reduction and shall provide the teaching health center with the opportunity to provide the required information within the period of 30 days beginning on the date of such notice. If the teaching health center provides such information within such period, no reduction shall be made under subparagraph (A) on the basis of the previous failure to provide such information.
(4) Residents
The residents described in this paragraph are those who are in part-time or full-time equivalent resident training positions at a qualified teaching health center in any approved graduate medical residency training program.
(i) Regulations
The Secretary shall promulgate regulations to carry out this section.
(j) Definitions
In this section:
(1) Approved graduate medical residency training program
The term "approved graduate medical residency training program" means a residency or other postgraduate medical training program—
(A) participation in which may be counted toward certification in a specialty or subspecialty and includes formal postgraduate training programs in geriatric medicine approved by the Secretary; and
(B) that meets criteria for accreditation (as established by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or the American Dental Association).
(2) New approved graduate medical residency training program
The term "new approved graduate medical residency training program" means an approved graduate medical residency training program for which the sponsoring qualified teaching health center has not received a payment under this section for a previous fiscal year (other than pursuant to subsection (a)(1)(C)).
(3) Primary care residency program
The term "primary care residency program" has the meaning given that term in
(4) Qualified teaching health center
The term "qualified teaching health center" has the meaning given the term "teaching health center" in
(July 1, 1944, ch. 373, title III, §340H, as added
Editorial Notes
References in Text
Section 4410 of the Balanced Budget Act of 1997, referred to in subsec. (c)(2)(A)(ii), is section 4410 of
Codification
Another section 340H of act July 1, 1944, was renumbered section 340I and is classified to
Amendments
2024—Subsec. (b)(2)(C).
Subsec. (g)(1).
2023—Subsec. (g)(1).
2020—Subsec. (g)(1).
2019—Subsec. (g)(1).
2018—Subsec. (a).
Subsec. (f).
Subsec. (g)(1).
Subsec. (h)(1)(D) to (H).
Subsec. (j)(2) to (4).
2017—Subsec. (g).
2015—Subsec. (g).
Statutory Notes and Related Subsidiaries
Funding for Teaching Health Centers That Operate Graduate Medical Education
"(a)
"(b)
"(1) For making payments to establish new approved graduate medical residency training programs pursuant to section 340H(a)(1)(C) of the Public Health Service Act (
"(2) To provide an increase to the per resident amount described in section 340H(a)(2) of the Public Health Service Act (
"(3) For making payments under section 340H(a)(1)(A) of the Public Health Service Act (
"(4) For making payments under section 340H(a)(1)(B) of the Public Health Service Act (
"(5) For making awards under section 749A of the Public Health Service Act (
"(6) To cover administrative costs and activities necessary for qualified teaching health centers receiving payments under section 340H of the Public Health Service Act (
Payments for Previous Fiscal Years
1 So in original. Probably should be "subsections".
2 See References in Text note below.
subpart xii—community-based collaborative care network program
Editorial Notes
Codification
§256i. Community-based collaborative care network program
(a) In general
The Secretary may award grants to eligible entities to support community-based collaborative care networks that meet the requirements of subsection (b).
(b) Community-based collaborative care networks
(1) Description
A community-based collaborative care network (referred to in this section as a "network") shall be a consortium of health care providers with a joint governance structure (including providers within a single entity) that provides comprehensive coordinated and integrated health care services (as defined by the Secretary) for low-income populations.
(2) Required inclusion
A network shall include the following providers (unless such provider does not exist within the community, declines or refuses to participate, or places unreasonable conditions on their participation):
(A) A hospital that meets the criteria in
(B) All Federally qualified health centers (as defined in
(3) Priority
In awarding grants, the Secretary shall give priority to networks that include—
(A) the capability to provide the broadest range of services to low-income individuals;
(B) the broadest range of providers that currently serve a high volume of low-income individuals; and
(C) a county or municipal department of health.
(c) Application
(1) Application
A network described in subsection (b) shall submit an application to the Secretary.
(2) Renewal
In subsequent years, based on the performance of grantees, the Secretary may provide renewal grants to prior year grant recipients.
(d) Use of funds
(1) Use by grantees
Grant funds may be used for the following activities:
(A) Assist low-income individuals to—
(i) access and appropriately use health services;
(ii) enroll in health coverage programs; and
(iii) obtain a regular primary care provider or a medical home.
(B) Provide case management and care management.
(C) Perform health outreach using neighborhood health workers or through other means.
(D) Provide transportation.
(E) Expand capacity, including through telehealth, after-hours services or urgent care.
(F) Provide direct patient care services.
(2) Grant funds to HRSA grantees
The Secretary may limit the percent of grant funding that may be spent on direct care services provided by grantees of programs administered by the Health Resources and Services Administration or impose other requirements on such grantees deemed necessary.
(e) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2011 through 2015.
(July 1, 1944, ch. 373, title III, §340I, formerly §340H, as added
1 So in original. A closing parenthesis probably should appear.