§254c. Community health centers

(a) Definitions

For purposes of this section, the term "community health center" means an entity which either through its staff and supporting resources or through contracts or cooperative arrangements with other public or private entities provides-

(1) primarily health services,

(2) as may be appropriate for particular centers, supplemental health services necessary for the adequate support of primary health services,

(3) referral to providers of supplemental health services and payment, as appropriate and feasible, for their provision of such services,

(4) environmental health services, including, as may be appropriate for particular centers (as determined by the centers), the detection and alleviation of unhealthful conditions associated with water supply, sewage treatment, solid waste disposal, rodent and parasitic infestation, field sanitation, housing, and other environmental factors related to health,

(5) information on the availability and proper use of health services and services which promote and facilitate optimal use of health services, including, 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

(6) patient case management services (including outreach, counseling, referral, and follow-up services),

for all residents of the area it serves (referred to in this section as a "catchment area").

(b) Additional definitions; criteria to determine specific shortages of personal health services; designation of medically underserved population or termination of such designation

For purposes of this section:

(1) The term "primary health services" means-

(A) services of physicians and, where feasible, services of physicians' assistants and nurse clinicians;

(B) diagnostic laboratory and radiologic services;

(C) preventive health services (including children's eye and ear examinations to determine the need for vision and hearing correction, perinatal services, well child services, immunizations against vaccine-preventable diseases, screenings for elevated blood lead levels, and family planning services);

(D) emergency medical services;

(E) transportation services as required for adequate patient care;

(F) preventive dental services; and

(G) pharmaceutical services, as may be appropriate for particular centers.

(2) The term "supplemental health services" means services which are not included as primary health services and which are-

(A) hospital services;

(B) home health services;

(C) extended care facility services;

(D) rehabilitative services (including physical therapy) and long-term physical medicine;

(E) mental health services;

(F) dental services;

(G) vision services;

(H) allied health services;

(I) therapeutic radiologic services;

(J) public health services (including, for the social and other nonmedical needs which affect health status, counseling, referral for assistance, and followup services);

(K) ambulatory surgical services;

(L) health education services (including nutrition education); and

(M) other services appropriate to meet the health needs of the medically underserved population served by the community health center involved.

(3) 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.

(4) In carrying out paragraph (3), the Secretary shall by regulation prescribe criteria for determining the specific shortages of personal health services of an area or population group. Such criteria shall-

(A) take into account comments received by the Secretary from the chief executive officer of a State and local officials in a State; and

(B) include infant mortality in an area or population group, other 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.

The Secretary may modify the criteria established in regulations issued under this paragraph only after affording public notice and an opportunity for comment on any such proposed modifications.

(5) 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-

(A) the chief executive officer of such State;

(B) local officials in such State; and

(C) the State organization, if any, which represents a majority of community health centers in such State.

(6) The Secretary may designate a medically underserved population that does not meet the criteria established under paragraph (4) 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) Grants to public and nonprofit private entities for projects to plan and develop centers; costs includable and criteria for grants; number of grants; determination of amount of grants

(1) The Secretary may make grants to public and nonprofit private entities for projects to plan and develop community 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, expansion, and modernization of existing buildings and construction of new buildings (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 community health center for which the project is undertaken has for primary health services, supplemental health services, and environmental health services;

(B) the design of a community 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; and

(D) initiation and encouragement of continuing community involvement in the development and operation of the project.

(2) Not more than two grants may be made under this subsection for the same project.

(3) The amount of any grant made under this subsection for any project shall be determined by the Secretary.

(d) Grants to public and nonprofit private centers and related entities functioning without center determination for costs of operation; prepayment; costs includable for grants; number of grants; determination of amount of grants; payments

(1)(A) The Secretary may make grants for the costs of operation of public and nonprofit private community health centers which serve medically underserved populations.

(B) The Secretary may make grants 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 he is unable to make each of the determinations required by subsection (e)(3) of this section.

(C) The Secretary may make grants to community health centers to enable the centers to plan and develop the provision of health services on a prepaid basis to some or to all of the individuals which the centers serve. Such a grant may only be made for such a center if-

(i) the center has received grants under subparagraph (A) of this paragraph for at least two consecutive years preceding the year of the grant under this subparagraph;

(ii) the governing board of the center (described in subsection (e)(3)(G) of this section) requests, in a manner prescribed by the Secretary, that the center provide health services on a prepaid basis to some or to all of the population which the center serves; and

(iii) the center provides assurances satisfactory to the Secretary that the provision of such services on a prepaid basis will not result in the diminution of health services provided by the center to the population the center served prior to the grant under this subparagraph.

Any such grant may include the acquisition, expansion, and modernization of existing buildings, construction of new buildings, and providing training related to management of the provision of health services on a prepaid basis.

(2) The costs for which a grant may be made under paragraph (1)(A) or (1)(B) may include the costs of acquiring, expanding, and modernizing existing buildings and constructing new buildings (including the costs of amortizing the principal of, and paying interest on, loans), the costs of repaying loans made by the Farmers Home Administration for buildings, and the costs of providing training related to the provision of primary health services, supplemental health services and environmental health services, and to the management of community health center programs.

(3) Not more than two grants may be made under paragraph (1)(B) or (1)(C) for the same entity.

(4)(A) The amount of any grant made in any fiscal year under paragraph (1) (other than subparagraph (C)) to a community 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, 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. In determining the amount of such a grant for a center, if the application for the grant requests funds for a service described in subsection (a)(4) of this section (other than to the extent the funds would be used for the improvement of private property) or a supplemental health service described in subparagraph (B), (F), (L), or (M) of subsection (b)(2) of this section, the Secretary shall include, in an amount determined by the Secretary and to the extent funds are available under appropriation Acts, funds for such service unless the Secretary makes a written finding that such service is not needed and provides the applicant with a copy of such finding.

(B) 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, except that if in any fiscal year the sum of-

(i) the total of the amounts described in clauses (i) and (ii) of subparagraph (A) received by a center in such fiscal year, and

(ii) the amount of the grant to the center in such fiscal year,

exceeded the costs of the center's operation in such fiscal year because the amount received by the center from fees, premiums, and third-party reimbursements was greater than expected, an adjustment in the amount of the grant to the center in the succeeding fiscal year shall be made in such a manner that the center shall be entitled to retain the additional amount of fees, premiums, and other third party reimbursements as the center will use (I) to expand and improve its services, (II) to increase the number of persons (eligible to receive services from such a center) it is able to serve, (III) to construct, expand, and modernize its facilities, (IV) to improve the administration of its service programs, and (V) to establish the financial reserve required for the furnishing of services on a prepaid basis. Without the approval of the Secretary, not more than one-half of such retained sum may be used for construction and modernization of its facilities.

(C) With respect to amounts described in clauses (i) and (ii) of subparagraph (A), the Secretary may not restrict expenditures of such amounts by any grantee under paragraph (1) for-

(i) repair or minor renovation of the physical plant;

(ii) establishment of a financial reserve as required for the furnishing of services on a prepaid basis or as needed to cover unanticipated expenses;

(iii) interest payments on short-term loans to cover cash shortfalls; or

(iv) necessary salary requirements to remain competitive in hiring health care practitioners.

(e) Approval of application as prerequisite for grant; form and manner of submission and contents of application; determination of entity as center as prerequisite for approval of application; "public center" defined; improvement of private property; new building grant conditions

(1) No grant may be made under subsection (c) or (d) of this section unless an application therefor 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. An application for a grant which will cover the costs of modernizing a building shall include, in addition to other information required by the Secretary-

(A) a description of the site of the building,

(B) plans and specifications for its modernization, and

(C) reasonable assurance that all laborers and mechanics employed by contractors or subcontractors in the performance of work on the modernization of the building will be paid wages at rates not less than those prevailing on similar work in the locality as determined by the Secretary of Labor in accordance with the Act of March 3, 1931 (40 U.S.C. 276a-276a–5, known as the Davis-Bacon Act).

The Secretary of Labor shall have with respect to the labor standards referred to in subparagraph (C) the authority and functions set forth in Reorganization Plan Numbered 14 of 1950 (15 F.R. 3176, 5 U.S.C. Appendix) and section 276c of title 40.

(2) An application for a grant under subparagraph (A) or (B) of subsection (d)(1) of this section for a community health center shall include-

(A) a description of the need in the center's catchment area for each of the health services described in subsection (a)(4) of this section and in subparagraphs (B), (F), (L), and (M) of subsection (b)(2) of this section,

(B) if the applicant determines that any such service is not needed, the basis for such determination, and

(C) if the applicant does not request funds for any such service which the applicant determines is needed, the reason for not making such a request.

Such an application shall also include a demonstration by the applicant that the area or a population group to be served by the applicant has a shortage of personal health services and that the center will be located so that it 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 subsection (b)(3) of this section 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 (d)(1) of this section, the Secretary may require as a condition to the approval of such application assurance that the applicant will provide any specified health services described in subsection (a) or (b) of this section which 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 the applicant.

(3) Except as provided in subsection (d)(1)(B) of this section, the Secretary may not approve an application for a grant under paragraph (1)(A) or (1)(B) of subsection (d) of this section unless the Secretary determines that the entity for which the application is submitted is a community health center (within the meaning of subsection (a) of this section) and that-

(A) the primary health services of the center will be available and accessible in the center's catchment area promptly, as appropriate, and in a manner which assures continuity;

(B) the center will have organizational arrangements, established in accordance with regulations prescribed by the Secretary, or (i) an ongoing quality assurance program (including utilization and peer review systems) respecting the center's services, and (ii) maintaining the confidentiality of patient records;

(C) the center will demonstrate its financial responsibility by the use of such accounting procedures and other requirements as may be prescribed by the Secretary;

(D) the center (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 [42 U.S.C. 1396 et seq.] for the payment of all or a part of the center's costs in providing health services to persons who are eligible for medical assistance under such a State plan, or (ii) has made or will make every reasonable effort to enter into such an arrangement;

(E) 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 [42 U.S.C. 1395 et seq.], to medical assistance under a State plan approved under title XIX of such Act [42 U.S.C. 1396 et seq.], or to assistance for medical expenses under any other public assistance program or private health insurance program;

(F) 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 (E) on the basis of the full amount of fees and payments for such services without application of any discount, and (iii) has submitted to the Secretary such reports as he may require to determine compliance with this subparagraph;

(G) the center has established a governing board which (i) except in the case of an entity operated by an Indian tribe or tribal or Indian organization under the Indian Self-Determination Act [25 U.S.C. 450f et seq.], 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, and (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, 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 if the application is for a second or subsequent grant for a public center, the governing body 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;

(H) the center has developed, in accordance with regulations of the Secretary, (i) an overall plan and budget that meets the requirements of section 1861(z) of the Social Security Act [42 U.S.C. 1395x(z)], 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, (IV) such other matters relating to operations of the applicant as the Secretary may, by regulation, require, and (V) expenditures made from any amount the center was permitted to retain under subsection (d)(4)(B) of this section;

(I) the center will review periodically its catchment area to (i) insure 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) insure 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) insure 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 groupings, and available transportation;

(J) 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; and

(K) the center, in accordance with regulations prescribed by the Secretary, has developed an on-going referral relationship with one or more hospitals.

For purposes of subparagraph (G) and subsection (g)(4) of this section, the term "public center" means a community health center funded (or to be funded) through a grant under this section to a public agency.

(4) The Secretary shall approve applications for grants under paragraph (1)(A) or (1)(B) of subsection (d) of this section for community health centers which-

(A) have not received a previous grant under such paragraph, or

(B) have applied for such a grant to expand their services,

in such a manner that the ratio of the medical underserved populations in rural areas which may be expected to use the services provided by such centers to the medical underserved populations in urban areas which may be expected to use the services provided by such centers is not less than two to three or greater than three to two.

(5) The Secretary, in making a grant under this section to a community health center for the provision of environmental health services described in subsection (a)(4) of this section, may designate a portion of the grant to be expended for improvements to private property for which the written consent of the owner has been obtained and which are necessary to alleviate a hazard to the health of those residing on, or otherwise using, the property and of other persons in the center's catchment area. A center may make such an expenditure for an improvement under a grant only after the Secretary has specifically approved such expenditure and has determined that funds for the improvement are not available from any other source.

(6) The Secretary may make a grant under subsection (c) or (d) of this section for the construction of new buildings for a community health center only if the Secretary determines that appropriate facilities are not available through acquiring, modernizing, or expanding existing buildings and that the entity to which the grant will be made has made reasonable efforts to secure from other sources funds, in lieu of the grant, to construct such facilities.

(f) Technical and other nonfinancial assistance; resources list

(1) The Secretary may provide (either through the Department of Health and Human Services or by grant or contract) all necessary technical and other nonfinancial assistance (including fiscal and program management assistance and training in such management) to any public or private nonprofit entity to assist it in developing plans for, and in operating as, a community health center, and in meeting requirements of subsection (e)(2) of this section.

(2) The Secretary shall make available to each grant recipient under this section a list of available Federal and non-Federal resources to improve the environmental and nutritional status of individuals in the recipient's catchment area.

(g) Authorization of appropriations; establishment of general policies by governing boards; reduction in infant mortality and health management for infants and pregnant women

(1)(A) For the purpose of payments under grants under this section, there are authorized to be appropriated $440,000,000 for fiscal year 1989, such sums as may be necessary for fiscal years 1990 and 1991, and such sums as may be necessary for each of the fiscal years 1992 through 1994.

(B) The Secretary may not in any fiscal year-

(i) expend for grants to serve medically underserved populations designated under subsection (b)(6) of this section an amount which exceeds 5 percent of the funds appropriated under paragraph (1) for that fiscal year; and

(ii) expend for grants under subsection (d)(1)(C) of this section an amount which exceeds 5 percent of the funds appropriated under paragraph (1) for that fiscal year.

(2)(A) For the purpose of carrying out subparagraph (B), there are authorized to be appropriated $25,000,000 for fiscal year 1989, $30,000,000 for fiscal year 1990, $35,000,000 for fiscal year 1991, and such sums as may be necessary for each of the fiscal years 1992 through 1994.

(B) The Secretary may make grants to community health centers for the purpose of assisting such centers in-

(i) 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

(ii) developing and coordinating service and referral arrangements between community health centers and other entities for the health management of pregnant women and children described in clause (i).

(C) In making grants under subparagraph (B), the Secretary shall give priority to community 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.

(D) The Secretary may make a grant under subparagraph (B) only if the community health center involved agrees to expend the grant for the following activities with respect to the purpose described in such subparagraph:

(i) Primary health services, including prenatal care.

(ii) Community education, outreach, and case finding.

(iii) Case management services.

(iv) Client education, including parenting and child development education.

(E) The purposes for which a community health center may expend a grant under subparagraph (B) include, with respect to the purpose described in such subparagraph, substance abuse screening, counseling and referral services, and other necessary nonmedical support services, including child care, translation services, and housing assistance.

(F) The Secretary may make a grant under subparagraph (B) only if the community health center involved agrees that-

(i) the center will coordinate the provision of services under the grant to each of the recipients of the services;

(ii) such services will be continuous for each such recipient;

(iii) the center will provide follow-up services for individuals who are referred by the center for services described in subparagraph (E); and

(iv) 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 such subparagraph.

(3) 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 (e)(3) of this section) the governing boards of which (as described in subsection (e)(3)(G)(ii) of this section) do not establish general policies for such centers, an amount which exceeds 5 per centum of the funds appropriated under this section for that fiscal year.

(h) 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 community health centers;

(3) review and comment upon annual program plans and budgets of community health centers, including comments upon allocations of health care resources in the State;

(4) assist community 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 community health centers; and

(5) share information and data relevant to the operation of new and existing community health centers.

(i) Audit of grants; reports; records; waiver of audit

(1) Each entity which receives a grant under subsection (d) of 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) Each entity which receives a grant under subsection (d) of 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) Each entity which is required to establish and maintain records or to provide for an 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 therefor. 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) The Secretary may, under appropriate circumstances, waive the application of all or part of the requirements of this subsection to a community health center.

(j) Delegation of authority to administer programs; exception

The Secretary may delegate the authority to administer the programs authorized by this section to any office within the Service, 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.

(k) Special consideration of needs of frontier areas

In making grants under this section, the Secretary shall give special consideration to the unique needs of frontier areas.

(July 1, 1944, ch. 373, title III, §330, as added July 29, 1975, Pub. L. 94–63, title V, §501(a), 89 Stat. 342 ; amended Apr. 22, 1976, Pub. L. 94–278, title VIII, §801(b), 90 Stat. 415 ; Aug. 1, 1977, Pub. L. 95–83, title III, §304, 91 Stat. 388 ; Nov. 10, 1978, Pub. L. 95–626, title I, §104(a)–(d)(3)(B), (4), (5), (e), (f), 92 Stat. 3556–3559 ; July 10, 1979, Pub. L. 96–32, §§6(b)–(d), 7(c), 93 Stat. 83 , 84; Oct. 17, 1979, Pub. L. 96–88, title V, §509(b), 93 Stat. 695 ; Oct. 19, 1980, Pub. L. 96–470, title I, §106(e), 94 Stat. 2238 ; Aug. 13, 1981, Pub. L. 97–35, title IX, §§903(a), 905, 906, 95 Stat. 561 , 562; Jan. 4, 1983, Pub. L. 97–414, §8(e), 96 Stat. 2060 ; Apr. 24, 1986, Pub. L. 99–280, §§2–4, 100 Stat. 399 , 400; Aug. 10, 1988, Pub. L. 100–386, §§3, 4, 102 Stat. 921 , 923; Nov. 4, 1988, Pub. L. 100–607, title I, §163(3), 102 Stat. 3062 ; Dec. 19, 1989, Pub. L. 101–239, title VI, §6103(e)(5), 103 Stat. 2207 ; Nov. 6, 1990, Pub. L. 101–527, §9(a), 104 Stat. 2332 ; Oct. 27, 1992, Pub. L. 102–531, title III, §309(b), 106 Stat. 3500 .)

References in Text

The Social Security Act, referred to in subsec. (e)(3)(D), (E), is act Aug. 14, 1935, ch. 531, 49 Stat. 620 , as amended. Titles XVIII and XIX of the Social Security Act are classified generally to subchapters XVIII (§1395 et seq.) and XIX (§1396 et seq.) of chapter 7 of this title, respectively. For complete classification of this Act to the Code, see section 1305 of this title and Tables.

Act of March 3, 1931 (40 U.S.C. 276a-276a–5, known as the Davis-Bacon Act), referred to in subsec. (e)(1)(C), is act Mar. 3, 1931, ch. 411, 46 Stat. 1494 , as amended, which is classified generally to sections 276a to 276a–5 of Title 40, Public Buildings, Property, and Works. For complete classification of this Act to the Code, see Short Title note set out under section 276a of Title 40 and Tables.

The Indian Self-Determination Act, referred to in subsec. (e)(3)(G)(i), is title I of Pub. L. 93–638, Jan. 4, 1975, 88 Stat. 2206 , which is classified principally to part A (§450f et seq.) of subchapter II of chapter 14 of Title 25, Indians. For complete classification of this Act to the Code, see Short Title note set out under section 450 of Title 25 and Tables.

Amendments

1992-Subsec. (b)(1)(C). Pub. L. 102–531, §309(b)(2), inserted "immunizations against vaccine-preventable diseases, screenings for elevated blood lead levels," after "well child services,".

Subsec. (d)(4)(C). Pub. L. 102–531, §309(b)(3), added subpar. (C).

Subsec. (g)(2)(B). Pub. L. 102–531, §309(b)(1)(A), amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: "The Secretary may make grants to community health centers to assist such centers in-

"(i) providing services for the reduction of the incidence of infant mortality; and

"(ii) developing and coordinating referral arrangements between community health centers and other entities for the health management of infants and pregnant women."

Subsec. (g)(2)(D) to (F). Pub. L. 102–531, §309(b)(1)(B), added subpars. (D) to (F).

1990-Subsec. (a)(5). Pub. L. 101–527, §9(a)(1)(A), amended par. (5) generally. Prior to amendment, par. (5) read as follows: "information on the availability and proper use of health services, and".

Subsec. (b)(2)(M), (N). Pub. L. 101–527, §9(a)(1)(B), redesignated subpar. (N) as (M) and struck out former subpar. (M) which related to services which promoted optimal use of health services.

Subsec. (g)(1)(A), (2)(A). Pub. L. 101–527, §9(a)(2), inserted provisions authorizing such sums as necessary for fiscal years 1992 through 1994.

1989-Subsec. (e)(3)(G). Pub. L. 101–239 inserted "except in the case of an entity operated by an Indian tribe or tribal or Indian organization under the Indian Self-Determination Act," after "(i)".

1988-Subsec. (a)(6). Pub. L. 100–386, §3(a), which directed amendment of subsec. "(a)(1)" by adding a new par. (6) after par. (5), was executed by adding par. (6) after par. (5) of subsec. (a).

Subsec. (b)(2)(N). Pub. L. 100–386, §3(b), added subpar. (N).

Subsec. (b)(4). Pub. L. 100–386, §3(c), inserted concluding provision permitting Secretary to modify criteria established in regulations only after public notice and opportunity for comment on any such modification.

Subsec. (c)(1). Pub. L. 100–386, §3(e)(1)(A), substituted "acquisition, expansion, and modernization of existing buildings and construction of new buildings" for "acquisition and modernization of existing buildings".

Subsec. (d)(1)(C). Pub. L. 100–386, §3(e)(1)(B), substituted "acquisition, expansion, and modernization of existing buildings, construction of new buildings," for "acquisition and modernization of existing buildings" in concluding provisions.

Subsec. (d)(2). Pub. L. 100–386, §3(e)(1)(C), substituted "acquiring, expanding, and modernizing existing buildings and constructing new buildings" for "acquiring and modernizing existing buildings".

Subsec. (d)(4)(A)(i). Pub. L. 100–386, §3(f)(1), amended cl. (i) generally, substituting "State, local, and other operational funding" for "the State, local, and other funds".

Subsec. (d)(4)(B). Pub. L. 100–386, §3(f)(2), substituted "shall be entitled to retain the additional amount of fees, premiums, and other third party reimbursements as the center will use" for "may retain such an amount (equal to not less than one-half of the amount by which such sum exceeded such costs) as the center can demonstrate to the satisfaction of the Secretary will be used to enable the center" in concluding provisions.

Subsec. (d)(4)(B)(III). Pub. L. 100–386, §3(e)(1)(D), substituted "construct, expand, and modernize" for "construct and modernize".

Subsec. (e)(3)(F)(i). Pub. L. 100–386, §3(d), inserted "consistent with locally prevailing rates or charges and" after "provision of its services" and substituted "operation and has prepared" for "operation and".

Subsec. (e)(6). Pub. L. 100–386, §3(e)(2), added par. (6).

Subsec. (g)(1)(A). Pub. L. 100–386, §3(h)(1), redesignated former par. (1) as subpar. (A) and amended text generally. Prior to amendment, text read as follows: "There are authorized to be appropriated for payments pursuant to grants under this section $400,000,000 for fiscal year 1987 and $400,000,000 for fiscal year 1988."

Subsec. (g)(1)(B). Pub. L. 100–386, §3(h)(2), redesignated former par. (2) as par. (1)(B) and former subpars. (A) and (B) thereof as cls. (i) and (ii), respectively, and in cls. (i) and (ii) substituted "under paragraph (1)" for "under this section".

Subsec. (g)(2). Pub. L. 100–386, §3(h)(2)(B), (3), added par. (2) and redesignated former par. (2) as par. (1)(B).

Subsec. (j). Pub. L. 100–607 redesignated subsec. (j) relating to special consideration of needs of frontier areas, as (k).

Pub. L. 100–386, §4, added subsec. (j) relating to special consideration of needs of frontier areas.

Pub. L. 100–386, §3(g), added subsec. (j) relating to delegation of authority to administer programs.

Subsec. (k). Pub. L. 100–607 redesignated subsec. (j) relating to special consideration of needs of frontier areas, as (k).

1986-Subsec. (b)(3) to (6). Pub. L. 99–280, §2, struck out provisions in par. (3) requiring the Secretary to take into account unusual local conditions that act as a barrier to accessibility to personal health services, directing that, after Aug. 13, 1981, the Secretary not designate a medically underserved population or remove such designation without reasonable opportunity for comment and consultation, and authorizing the Secretary to prescribe criteria for determining specific shortages of personal health services, which criteria was to include infant mortality, other factors indicative of health status, ability of residents to pay for health services and their accessibility to them, and availability of health professionals to residents, and added pars. (4) to (6).

Subsec. (g)(1), (2). Pub. L. 99–280, §4, amended pars. (1) and (2) generally. Prior to amendment, pars. (1) and (2) read as follows:

"(1) There are authorized to be appropriated for payments pursuant to grants under subsection (c) of this section $5,000,000 for fiscal year 1976, $5,000,000 for the fiscal year ending September 30, 1977, $5,880,000 for the fiscal year ending September 30, 1978, $6,300,000 for the fiscal year ending September 30, 1979, $7,500,000 for the fiscal year ending September 30, 1980, and $9,000,000 for the fiscal year ending September 30, 1981.

"(2) There are authorized to be appropriated for payments pursuant to grants under subsection (d) of this section $215,000,000 for fiscal year 1976, $235,000,000 for the fiscal year ending September 30, 1977, $256,840,000 for the fiscal year ending September 30, 1978, $341,700,000 for the fiscal year ending September 30, 1979, $397,500,000 for the fiscal year ending September 30, 1980, $463,000,000 for the fiscal year ending September 30, 1981 and $280,000,000 for the fiscal year ending September 30, 1982. For authorizations for appropriations for fiscal years 1983 and 1984, see section 300y–1 of this title. The Secretary may not expend for grants under subsection (d)(1)(C) of this section in any fiscal year an amount which exceeds 5 per centum of the funds appropriated under this paragraph for that fiscal year."

Subsecs. (h), (i). Pub. L. 99–280, §3, added subsec. (h) and redesignated former subsec. (h) as (i).

1983-Subsec. (d)(2). Pub. L. 97–414 inserted ", the costs of repaying loans made by the Farmers Home Administration for buildings," before "and the costs".

1981-Subsec. (b)(3). Pub. L. 97–35, §905(a), inserted provisions relating to designations or their removals after Aug. 13, 1981.

Subsec. (e)(2). Pub. L. 97–35, §905(b), inserted provisions relating to demonstrations by applicant.

Subsec. (g)(2). Pub. L. 97–35, §903(a), inserted provisions respecting appropriations for fiscal year ending Sept. 30, 1982, and for fiscal years 1983 and 1984.

Subsec. (h). Pub. L. 97–35, §906, added subsec. (h).

1980-Subsec. (e)(5). Pub. L. 96–470 struck out provision requiring Secretary to notify annually appropriate committees of Congress of amounts expended and improvements for which they were spent.

1979-Subsec. (d)(1)(B). Pub. L. 96–32, §7(c), substituted "subsection (e)(3) of this section" for "subsection (e)(2) of this section".

Subsec. (e)(3). Pub. L. 96–32, §6(b), amended directory language of Pub. L. 95–623, §(d)(5)(A), and required no change in text. See 1978 Amendment note below.

Subsec. (g)(2). Pub. L. 96–32, §6(c), substituted "funds appropriated under this paragraph" for "funds appropriated under this subsection".

Subsec. (g)(3). Pub. L. 96–32, §6(d), substituted "(3)" for "(4)" as number designation of paragraph added by Pub. L. 95–626, 104(f)(4), thereby correcting paragraph designation.

1978-Subsec. (a)(4). Pub. L. 95–626, §104(a), substituted "environmental health services, including, as may be appropriate for particular centers (as determined by the centers), the detection and alleviation of unhealthful conditions associated with water supply, sewage treatment, solid waste disposal, rodent and parasitic infestation, field sanitation, housing, and other environmental factors related to health" for "as may be appropriate for particular centers, environmental health services".

Subsec. (b)(1)(G). Pub. L. 95–626, §104(b)(1), added subpar. (G).

Subsec. (b)(2). Pub. L. 95–626, §104(b)(2), struck out subpar. (I) relating to pharmaceutical services, redesignated subpars. (J) to (N) as (I) to (M), respectively, in subpar. (J) as so redesignated, substituted "(including for the social and other nonmedical needs which affect health status, counseling, referral for assistance, and followup services)" for "(including nutrition education and social services)", in subpar. (L) as so redesignated, inserted "(including nutrition education)" after "health education services" and, in subpar. (M) as so redesignated, substituted "appropriate personnel" for "outreach workers".

Subsec. (d)(1)(C). Pub. L. 95–626, §104(c)(1)(A), added subpar. (C).

Subsec. (d)(2). Pub. L. 95–626, §104(c)(1)(B), substituted "paragraph (1)(A) or (1)(B)" for "paragraph (1)".

Subsec. (d)(3). Pub. L. 95–626, §104(c)(1)(C), substituted "paragraph (1)(B) or (1)(C)" for "paragraph (1)(B)".

Subsec. (d)(4). Pub. L. 95–626, §104(c)(2), added par. (4). A prior par. (4), providing that the amount of any grant made under paragraph (1) be determined by the Secretary, was struck out.

Subsec. (e)(2). Pub. L. 95–626, §104(d)(2), added par. (2). Former par. (2) redesignated (3).

Subsec. (e)(3). Pub. L. 95–626, §104(d)(1), (2), (3)(A), (B), (4), (5)(A), as amended by Pub. L. 96–32, §6(b), redesignated former par. (2) as (3) and in par. (3) as so redesignated, substituted "paragraph (1)(A) or (1)(B) of subsection (d) of this section unless" for "subsection (d) of this section unless" in the provisions preceding subpar. (A), substituted "(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, 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 if the application is for a second or subsequent grant for a public center, the governing body 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" for "(ii) meets at least once a month, establishes general policies for the center (including the selection of services to be provided by the center and a schedule of hours during which services will be provided), approves the center's annual budget, and approves the selection of a director for the center" in subpar. (G), added cl. (V) in subpar. (H), added subpar. (K), and inserted definition of public center following subpar. (K).

Subsec. (e)(4), (5). Pub. L. 95–626, §104(d)(5)(B), added pars. (4) and (5).

Subsec. (f). Pub. L. 95–626, §104(e), designated existing provisions as par. (1) and added par. (2).

Subsec. (g)(1). Pub. L. 95–626, §104(f)(1), inserted provisions authorizing appropriations of $6,300,000 for fiscal year ending Sept. 30, 1979, $7,500,000 for fiscal year ending Sept. 30, 1980, and $9,000,000 for fiscal year ending Sept. 30, 1981.

Subsec. (g)(2). Pub. L. 95–626, §104(f)(2), (3), inserted provisions authorizing appropriations of $341,700,000 for fiscal year ending Sept. 30, 1979, $397,500,000 for fiscal year ending Sept. 30, 1980, and $463,000,000 for fiscal year ending Sept. 30, 1981, and provided that Secretary may not expend for grants under subsection (d)(1)(C) of this section in any fiscal year an amount which exceeds 5 per centum of the funds appropriated under subsec. (g)(2) of this section for that fiscal year.

Subsec. (g)(3). Pub. L. 95–626, §104(f)(4), as amended by Pub. L. 96–32, §6(d), added par. (3).

1977-Subsec. (b)(3). Pub. L. 95–83, §304(b)(1), required Secretary to take into account unusual local conditions which are a barrier to access to or availability of personal health services.

Subsec. (e)(1). Pub. L. 95–83, §304(b)(2), corrected introductory text, substituting subsection "(c)" for "(e)".

Subsec. (g). Pub. L. 95–83, §304(a), substituted in pars. (1) and (2) provision for an appropriation authorization for fiscal year ending Sept. 30, 1977, for prior such authorization for fiscal year 1977, and authorized appropriation for fiscal year ending Sept. 30, 1978, of $5,880,000 in par. (1) and $256,840,000 in par. (2).

1976-Subsec. (b)(2). Pub. L. 94–278 added subpar. (L) and redesignated former subpars. (L) and (M) as (M) and (N), respectively.

Change of Name

"Department of Health and Human Services" substituted for "Department of Health, Education, and Welfare" in subsec. (f)(1) pursuant to section 509(b) of Pub. L. 96–88 which is classified to section 3508(b) of Title 20, Education.

Effective Date of 1988 Amendment

Amendment by Pub. L. 100–386 effective Oct. 1, 1988, see section 5 of Pub. L. 100–386, set out as a note under section 254b of this title.

Effective Date of 1978 Amendment

Section 104(d)(3)(C) of Pub. L. 95–626 provided that: "The change in the governing board requirements for public community health centers made by the amendment by subparagraph (A) to section 330(e)(3)(G)(ii) of the Public Health Service Act [subsec. (e)(3)(G)(ii) of this section] shall not apply with respect to any public community health center which met the governing board requirements in effect under section 330(e)(2)(G)(ii) of such Act [subsec. (e)(2)(G)(ii) of this section] before October 1, 1978."

Section 104(g) of Pub. L. 95–626 provided that: "The amendments made by this section [amending this section] shall apply with respect to grants made under section 330 of the Public Health Service Act [this section] from appropriations for fiscal years ending after September 30, 1978."

Effective Date

Section effective July 1, 1975, see section 608 of Pub. L. 94–63, set out as an Effective Date of 1975 Amendment note under section 247b of this title.

Section Referred to in Other Sections

This section is referred to in sections 233, 247b–1, 247b–6, 247c–1, 254g, 254q–1, 254r, 256, 256a, 256c, 256d, 290bb–3, 293j, 295p, 297n, 300e–12, 300ee–16, 300ee–33, 300ff–52, 300ff–71, 1395x, 1395ww, 1396b, 1396d, 1396r–1, 1786, 9840 of this title; title 7 section 3178; title 40 section 276d–3.