§254b. Migrant health centers

(a) Definitions

For purposes of this section:

(1) The term "migrant 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-

(A) primary health services,

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

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

(D) 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,

(E) as may be appropriate for particular centers (as determined by the centers), infectious and parasitic disease screening and control,

(F) as may be appropriate for particular centers, accident prevention programs, including prevention of excessive pesticide exposure,

(G) 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

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

for migratory agricultural workers, seasonal agricultural workers, and the members of the families of such migratory and seasonal workers, within the area it serves (referred to in this section as a "catchment area") and individuals who have previously been migratory agricultural workers but can no longer meet the requirements of paragraph (2) of this subsection because of age or disability and members of their families within the area it serves.

(2) The term "migratory agricultural worker" means an individual whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last twentyfour months, and who establishes for the purposes of such employment a temporary abode.

(3) The term "seasonal agricultural workers" ¹ means an individual whose principal employment is in agriculture on a seasonal basis and who is not a migratory agricultural worker.

(4) The term "agriculture" means farming in all its branches, including-

(A) cultivation and tillage of the soil,

(B) 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

(C) 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 subparagraph (B).

(5) The term "high impact area" means a health service area or other area which has not less than four thousand migratory agricultural workers and seasonal agricultural workers residing within its boundaries for more than two months in any calendar year. In computing the number of workers residing in an area, there shall be included as workers the members of the families of such workers.

(6) 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.

(7) 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 population served by the migrant health center involved.

(b) Priority areas for project and program assistance; assignment and determination of priorities; approval of application for grant to area without migratory agricultural workers

(1) The Secretary shall assign to high impact areas and any other areas (where appropriate) priorities for the provision of assistance under this section to projects and programs in such areas. The highest priorities for such assistance shall be assigned to areas where the Secretary determines the greatest need exists.

(2) No application for a grant under subsection (c) or (d) of this section for a project in an area which has no migratory agricultural workers may be approved unless grants have been provided for all approved applications under such subsections for projects in areas with migratory agricultural workers.

(c) Grants pursuant to assigned priorities to public and nonprofit private entities for projects to plan and develop centers; costs includable and criteria for grants; grants or contracts with public and nonprofit private entities for projects to plan and develop programs in areas without centers and specified migratory population; scope of programs for grants or contracts; number of grants or contracts; determination of amount of grants

(1)(A) The Secretary may, in accordance with the priorities assigned under subsection (b)(1) of this section, make grants to public and nonprofit private entities for projects to plan and develop migrant health centers which will serve migratory agricultural workers, seasonal agricultural workers, and the members of the families of such migratory and seasonal workers, in high impact areas. A project for which a grant may be made under this subparagraph 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 the costs of providing training related to the management of migrant health center programs, and shall include-

(i) an assessment of the need that the workers (and the members of the families of such workers) proposed to be served by the migrant health center for which the project is undertaken have for primary health services, supplemental health services, and environmental health services;

(ii) the design of a migrant health center program for such workers and the members of their families, based on such assessment;

(iii) efforts to secure, within the proposed catchment area of such center, financial and professional assistance and support for the project; and

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

(B) The Secretary may make grants to or enter into contracts with public and nonprofit private entities for projects to plan and develop programs in areas in which no migrant health center exists and in which not more than four thousand migratory agricultural workers and their families reside for more than two months-

(i) for the provision of emergency care to migratory agricultural workers, seasonal agricultural workers, and the members of families of such migratory and seasonal workers;

(ii) for the provision of primary care (as defined in regulations of the Secretary) for such workers and the members of their families;

(iii) for the development of arrangements with existing facilities to provide primary health services (not included as primary care as defined under regulations under clause (ii)) to such workers and the members of their families; or

(iv) which otherwise improve the health of such workers and their families.

Any such program may include the acquisition, expansion, and modernization of existing buildings, construction of new buildings, and providing training related to the management of programs assisted under this subparagraph.

(2) Not more than two grants may be made under paragraph (1)(A) for the same project, and if a grant or contract is made or entered into under paragraph (1)(B) for a project, no other grant or contract under that paragraph may be made or entered into for the project.

(3) The amount of any grant made under paragraph (1) for any project shall be determined by the Secretary.

(d) Grants for centers in high impact areas; programs in areas in which no migrant health center exists; health services provided on a prepaid basis; two-grant maximum; maximum amount of grant; payments

(1)(A)(i) The Secretary may, in accordance with priorities assigned under subsection (b)(1) of this section, make grants for the costs of operation of public and nonprofit private migrant health centers in high impact areas.

(ii) If the Secretary makes a determination that an area is a high impact area, the Secretary may alter the determination only after providing to the grantee under subclause (i) for the area, and to other interested entities in the area, reasonable notice with respect to such determination and a reasonable opportunity to offer information with respect to such determination.

(B) The Secretary may make grants to and enter into contracts with public and nonprofit private entities for projects for the operation of programs in areas in which no migrant health center exists and in which not more than four thousand migratory agricultural workers and their families reside for more than two months-

(i) for the provision of emergency care to migratory agricultural workers, seasonal agricultural workers, and the members of the families of such migratory and seasonal workers;

(ii) for the provision of primary care (as defined in regulations of the Secretary) for such workers and the members of their families;

(iii) for the development of arrangements with existing facilities to provide primary health services (not included as primary care as defined under regulations under clause (ii)) to such workers and the members of their families; or

(iv) which otherwise improve the health of such workers and the members of their families.

Any such program may include the acquisition, expansion, and modernization of existing buildings, construction of new buildings, and providing training related to the management of programs assisted under this subparagraph.

(C) The Secretary may make grants to migrant 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 (f)(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 the 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) 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 the interest on, loans) and the costs of repaying loans made by the Farmers Home Administration for buildings; and the costs for which a grant or contract may be made under paragraph (1) may include 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 migrant health center programs.

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

(4)(A) The amount of any grant made in any fiscal year under subparagraph (A) 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, 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 subparagraph (D) or (E) of subsection (a)(1) 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), (J), or (L) of subsection (a)(7) 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) 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) of this paragraph 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 under subsection (a) of this section 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)(A) 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) Contracts with public and private entities for implementation and enforcement of environmental health standards and projects and studies related to environmental health hazard problems

The Secretary may enter into contracts with public and private entities to-

(1) assist the States in the implementation and enforcement of acceptable environmental health standards, including enforcement of standards for sanitation in migrant labor camps and applicable Federal and State pesticide control standards; and

(2) 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, pesticide hazards, and other environmental health hazards to which migratory agricultural workers, seasonal agricultural workers, and members of their families are exposed.

(f) Approval of application as prerequisite for grant or contract; form and manner of submission and contents of application; determination of entity as center as prerequisite for approval of application; criteria for determination; priorities for applications; improvements of private property; nonapplicability of statutory provisions to contracts; new building grant conditions

(1) No grant may be made under subsection (c) or (d) of this section and no contract may be entered into under subsection (c)(1)(B), (d)(1)(B), or (e) of this section unless an application therefore ² 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 or contract 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) of subsection (d)(1) of this section for a migrant health center shall include-

(A) a description of the need in the center's catchment area for each of the health services described in subparagraphs (D) and (E) of subsection (a)(1) of this section and in subparagraphs (B), (F), (J), and (L) of subsection (a)(7) 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.

In considering an application for a grant under subparagraph (A) 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 service described in subsection (a) 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) The Secretary may not approve an application for a grant under subsection (d)(1)(A) of this section unless the Secretary determines that the entity for which the application is submitted is a migrant health center (within the meaning of subsection (a)(1) 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 of the Secretary, for (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) 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) 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 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 of the 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;

(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 migratory agricultural workers, seasonal agricultural workers, and the members of the families of such migratory and seasonal workers, in 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; and

(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 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.

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

(4) In considering applications for grants and contracts under subsection (c) or (d)(1)(B) of this section, the Secretary shall give priority to applications submitted by community-based organizations which are representative of the populations to be served through the projects, programs, or centers to be assisted by such grants or contracts.

(5) The Secretary, in making a grant under this section to a migrant health center for the provision of environmental health services described in subsection (a)(1)(D) 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) Contracts may be entered into under this section without regard to section 3324(a) and (b) of title 31 and section 5 of title 41.

(7) The Secretary may make a grant under subsection (c) or (d) of this section for the construction of new buildings for a migrant health center or a migrant health program 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.

(g) Technical and other nonfinancial assistance for centers or public or private nonprofit entities operating as centers without determination of status; 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 migrant health center or to any public or private nonprofit entity to assist it in developing plans for, and in operating as, a migrant health center, and in meeting the requirements of subsection (f)(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.

(h) Authorization of appropriations; reduction in infant mortality and health management for infants and pregnant women; obligation for grants and contracts

(1)(A) For the purposes of subsections (c) through (e) of this section, there are authorized to be appropriated $48,500,000 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) Of the amounts appropriated pursuant to subparagraph (A) for a fiscal year, the Secretary may obligate for grants and contracts under subsection (c)(1) of this section not more than 2 percent, for grants under subsection (d)(1)(C) of this section not more than 5 percent, and for contracts under subsection (e) of this section not more than 10 percent.

(2)(A) For the purpose of carrying out subparagraph (B), there are authorized to be appropriated $1,500,000 for fiscal year 1989, $2,000,000 for fiscal year 1990, $2,500,000 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 migrant 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 migrant 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 migrant health centers providing services in any catchment area in which there is a substantial incidence of infant mortality or in 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 migrant 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 migrant 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 migrant 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 (f)(3) of this section) the governing boards of which (as described in subsection (f)(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.

(i) 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.

(July 1, 1944, ch. 373, title III, §329, formerly §310, as added Sept. 25, 1962, Pub. L. 87–692, 76 Stat. 592 ; amended Aug. 5, 1965, Pub. L. 89–109, §3, 79 Stat. 436 ; Oct. 15, 1968, Pub. L. 90–574, title II, §201, 82 Stat. 1006 ; Mar. 12, 1970, Pub. L. 91–209, 84 Stat. 52 ; June 18, 1973, Pub. L. 93–45, title I, §105, 87 Stat. 91 ; renumbered §319, July 23, 1974, Pub. L. 93–353, title I, §102(d), 88 Stat. 362 ; amended July 29, 1975, Pub. L. 94–63, title IV, §401(a), title VII, §701(c), 89 Stat. 334 , 352; Apr. 22, 1976, Pub. L. 94–278, title VIII, §801(a), 90 Stat. 414 ; Aug. 1, 1977, Pub. L. 95–83, title III, §303, 91 Stat. 388 ; renumbered §329 and amended Nov. 10, 1978, Pub. L. 95–626, title I, §§102(a), 103(a)–(g)(1)(B), (2), (h), (i), 92 Stat. 3551–3555 ; July 10, 1979, Pub. L. 96–32, §6(a), 93 Stat. 83 ; Oct. 17, 1979, Pub. L. 96–88, title V, §509(b), 93 Stat. 695 ; Aug. 13, 1981, Pub. L. 97–35, title IX, §930, 95 Stat. 569 ; Dec. 21, 1982, Pub. L. 97–375, title I, §107(b), 96 Stat. 1820 ; Apr. 24, 1986, Pub. L. 99–280, §§6, 7, 100 Stat. 400 , 401; Aug. 10, 1988, Pub. L. 100–386, §2, 102 Stat. 919 ; Nov. 6, 1990, Pub. L. 101–527, §9(b), 104 Stat. 2333 ; Oct. 27, 1992, Pub. L. 102–531, title III, §309(a), 106 Stat. 3499 .)

References in Text

The Social Security Act, referred to in subsec. (f)(3)(D), (E), is act Aug. 14, 1935, ch. 531, 49 Stat. 620 , as amended. Titles XVIII and XIX of the 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.

Codification

In subsec. (f)(6), "section 3324(a) and (b) of title 31" substituted for reference to section 3648 of the Revised Statutes (31 U.S.C. 529) on authority of Pub. L. 97–258, §4(b), Sept. 13, 1982, 96 Stat. 1067 , the first section of which enacted Title 31, Money and Finance.

Prior to its renumbering as section 329 of act July 1, 1944 by section 102(a) of Pub. L. 95–626, this section was designated as section 310 of act July 1, 1944, and set out as section 242h of this title, and was subsequently renumbered as section 319 of act July 1, 1944 and set out as section 247d of this title.

Prior Provisions

A prior section 254b, act July 1, 1944, ch. 373, title III, §329, as added Dec. 31, 1970, Pub. L. 91–623, §2, 84 Stat. 1868 ; amended Nov. 18, 1971, Pub. L. 92–157, title II, §203, 85 Stat. 462 ; Oct. 27, 1972, Pub. L. 92–585, §2, 86 Stat. 1290 ; July 29, 1975, Pub. L. 94–63, title VIII, §§801–803, 89 Stat. 353 , 354; Oct. 12, 1976, Pub. L. 94–484, title I, §101(b), 90 Stat. 2244 , related to establishment of National Health Service Corps, assignment of personnel and statement of purpose, prior to repeal by Pub. L. 94–484, title IV, §407(b)(1), Oct. 12, 1976, 90 Stat. 2268 . See section 254d et seq. of this title.

Amendments

1992-Subsec. (a)(6)(C). Pub. L. 102–531, §309(a)(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(a)(3), added subpar. (C).

Subsec. (h)(2)(B). Pub. L. 102–531, §309(a)(1)(A), amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: "The Secretary may make grants to migrant 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 migrant health centers and other entities for the health management of infants and pregnant women."

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

1990-Subsec. (h)(1)(A), (2)(A). Pub. L. 101–527 inserted provisions authorizing such sums as necessary for fiscal years 1992 through 1994.

1988-Subsec. (a)(1)(H). Pub. L. 100–386, §2(a), added subpar. (H).

Subsec. (a)(7)(M). Pub. L. 100–386, §2(b), added subpar. (M).

Subsec. (c)(1)(A). Pub. L. 100–386, §2(e)(1)(A), substituted "acquisition, expansion, and modernization of existing buildings and construction of new buildings" for "acquisition and modernization of existing buildings" in introductory provisions.

Subsec. (c)(1)(B). Pub. L. 100–386, §2(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)(1)(A). Pub. L. 100–386, §2(c), designated existing provision as cl. (i) and added cl. (ii).

Subsec. (d)(1)(B). Pub. L. 100–386, §2(e)(1)(C), substituted "acquisition, expansion, and modernization of existing buildings, construction of new buildings," for "acquisition and modernization of existing buildings" in concluding provisions.

Subsec. (d)(1)(C). Pub. L. 100–386, §2(e)(1)(D), 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, §2(e)(1)(E), 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, §2(f)(1), amended cl. (i) generally, substituting "State, local, and operational funding" for "the State, local, and other funds".

Subsec. (d)(4)(B). Pub. L. 100–386, §2(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, §2(e)(1)(F), substituted "construct, expand, and modernize" for "construct and modernize".

Subsec. (f)(3)(F)(i). Pub. L. 100–386, §2(d), inserted "consistent with locally prevailing rates or charges and" and substituted "operation and has prepared" for "operation and".

Subsec. (f)(7). Pub. L. 100–386, §2(e)(2), added par. (7).

Subsec. (h)(1). Pub. L. 100–386, §2(h)(1), amended par. (1) generally. Prior to amendment, par. (1) read as follows: "For the purposes of subsections (c), (d), and (e) of this section, there are authorized to be appropriated $43,000,000 for the fiscal year ending September 30, 1982, $47,500,000 for the fiscal year ending September 30, 1983, $51,000,000 for the fiscal year ending September 30, 1984, $45,400,000 for fiscal year 1987 and $45,400,000 for fiscal year 1988. The Secretary may not obligate for grants and contracts under subsection (c)(1) of this section in any fiscal year an amount which exceeds 2 per centum of the funds appropriated under this paragraph for that fiscal year, the Secretary may not obligate for grants under subsection (d)(1)(C) of this section in any fiscal year an amount which exceeds 5 per centum of such funds, and the Secretary may not obligate for contracts under subsection (e) of this section in any fiscal year an amount which exceeds 10 per centum of such funds."

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

Subsec. (i). Pub. L. 100–386, §2(g), added subsec. (i).

1986-Subsec. (d)(2). Pub. L. 99–280, §7, inserted "and the costs of repaying loans made by the Farmers Home Administration for buildings" before the semicolon.

Subsec. (h)(1). Pub. L. 99–280, §6, struck out "and" after "1983," and inserted ", $45,400,000 for fiscal year 1987 and $45,400,000 for fiscal year 1988".

1982-Subsec. (f)(5). Pub. L. 97–375 struck out direction to the Secretary to annually notify the appropriate committees of Congress of the amounts expended and the improvements for which they were spent.

1981-Subsec. (h). Pub. L. 97–35 in par. (1) substituted provisions respecting appropriations for fiscal years ending Sept. 30, 1982, 1983, and 1984, for provisions respecting appropriations for fiscal year 1976, and fiscal years ending Sept. 30, 1977, 1978, 1979, 1980, and 1981, struck out par. (2) which related to appropriations for grants and contracts under subsec. (d)(1) of this section, struck out par. (3) which related to minimum obligations under subsec. (d)(1) of this section, and redesignated par. (4) as (2).

1979-Subsec. (a)(7)(L). Pub. L. 96–32 substituted a period for "; and" at end.

1978-Subsec. (a)(1)(D), (E). Pub. L. 95–626, §103(a)(1)(A), inserted "(as determined by the centers)" after "as may be appropriate for particular centers".

Subsec. (a)(1)(G). Pub. L. 95–626, §103(a)(1)(B), inserted "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".

Pub. L. 95–626, §103(a)(1)(C), in provision following subpar. (G), inserted "and individuals who have previously been migratory agricultural workers but can no longer meet the requirements of paragraph (2) of this subsection because of age or disability and members of their families within the area it serves".

Subsec. (a)(5). Pub. L. 95–626, §103(c), substituted "four thousand" for "six thousand".

Subsec. (a)(6)(G). Pub. L. 95–626, §103(a)(2), added subpar. (G).

Subsec. (a)(7). Pub. L. 95–626, §103(a)(3), struck out subpar. (I) relating to pharmaceutical services and subpar. (N) relating to services which promote and facilitate optimal use of primary health services, redesignated subpars. (J), (K), (L), and (M) as (I), (J), (K), and (L), 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)" and in subpar. (L) as so redesignated, inserted "(including nutrition education)" after "health education services".

Subsec. (b)(1). Pub. L. 95–626, §103(b), substituted "areas where the Secretary determines the greatest need exists" for "areas in which reside the greatest number of migratory agricultural workers and the members of their families for the longest period of time".

Subsec. (c)(1)(B). Pub. L. 95–626, §103(c), substituted "four thousand" for "six thousand".

Subsec. (d)(1). Pub. L. 95–626, §103(c), (d)(1), (3)(A), struck out subpar. (B) relating to the power of the Secretary to make grants for the costs of the operation of public and nonprofit entities which intend to become migrant health centers, redesignated subpar. (C) as (B), and in subpar. (B) as so redesignated, substituted "four thousand" for "six thousand" and added subpar. (C).

Subsec. (d)(2). Pub. L. 95–626, §103(d)(2)(A), substituted "made under paragraph (1)(A) may include" for "made under paragraph (1)(A) or (1)(B) may include".

Subsec. (d)(3). Pub. L. 95–626, §103(e), substituted "Not more than two grants may be made under paragraph (1)(C) for the same entity" for "The amount of any grant made under paragraph (1) shall be determined by the Secretary".

Subsec. (d)(4). Pub. L. 95–626, §103(e), added par. (4).

Subsec. (f). Pub. L. 95–626, §103(d)(2)(B), (f), (g)(1)(A), (B), (2), redesignated pars. (2), (3), and (4) as (3), (4), and (6), respectively, added pars. (2) and (5), substituted "(d)(1)(B)" for "(d)(1)(C)" in par. (1), in par. (3)(G) as so redesignated, substituted "(ii) 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 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 of the center has approved the application or if the governing has not approved the application, the failure of the governing body to approve the application was unreasonable" for "(ii) 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", added cl. (V) in par. (3)(H), and inserted definition of "public center" following par. (3)(J), and, in par. (4) as so redesignated, substituted "(d)(1)(B)" for "(d)(1)(C)".

Subsec. (g). Pub. L. 95–626, §103(h), designated existing provisions as par. (1) and added par. (2).

Subsec. (h)(1). Pub. L. 95–626, §103(i)(1), inserted provisions authorizing appropriations of $2,200,000 for fiscal year ending Sept. 30, 1979, $2,500,000 for fiscal year ending Sept. 30, 1980, and $2,900,000 for fiscal year ending Sept. 30, 1981, and substituted "the next five fiscal years" for "the next two fiscal years".

Subsec. (h)(2). Pub. L. 95–626, §103(d)(2)(C), (3)(B), (i)(2), inserted provisions authorizing appropriations of $40,800,000 for fiscal year ending Sept. 30, 1979, $46,000,000 for fiscal year ending Sept. 30, 1980, and $52,100,000 for fiscal year ending Sept. 30, 1981, substituted "any fiscal year" for "fiscal years ending September 30, 1977, and September 30, 1978" after "Of the funds appropriated under the first sentence for", substituted "(d)(1)(B)" for "(d)(1)(C)" wherever appearing in existing provisions, and inserted provision that not more than 5 per centum of appropriated funds be made available for grants under subsection (d)(1)(C) of this section.

Subsec. (h)(3). Pub. L. 95–626, §103(i)(3), substituted "In any fiscal year, the Secretary shall obligate for payments under grants and contracts in such fiscal year under subsection (d)(1) of this section for the provision of inpatient and outpatient hospital services not less than 10 per centum of the amount appropriated in such fiscal year under paragraph (2)" for "There are authorized to be appropriated for payments under grants and contracts under subsection (d)(1) of this section for the provision of inpatient and outpatient hospital services $5,000,000 for fiscal year 1976, $5,000,000 for the fiscal year ending September 30, 1977, and $4,230,000 for the fiscal year ending September 30, 1978".

Subsec. (h)(4). Pub. L. 95–626, §103(i)(4), added par. (4).

1977-Subsec. (h)(1). Pub. L. 95–83, §303(a), substituted provision for an appropriation authorization for fiscal year ending Sept. 30, 1977, for prior such authorization for fiscal year 1977, authorized appropriation of $2,950,000 for fiscal year ending Sept. 30, 1978, and substituted in second sentence "each of the next two fiscal years" for "the next fiscal year".

Subsec. (h)(2). Pub. L. 95–83, §303(b), substituted provision for an appropriation authorization for fiscal year ending Sept. 30, 1977, for prior such authorization for fiscal year 1977, authorized appropriation of $32,080,000 for fiscal year ending Sept. 30, 1978, and substituted in third sentence "fiscal years ending September 30, 1977, and September 30, 1978" for "fiscal year 1977".

Subsec. (h)(3). Pub. L. 95–83, §303(c), substituted provision for an appropriation authorization for fiscal year ending Sept. 30, 1977, for prior such authorization for fiscal year 1977, and authorized appropriation of $4,230,000 for fiscal year ending Sept. 30, 1978.

1976-Subsec. (a)(7). Pub. L. 94–278 added subpar. (L) and redesignated former subpars. (L) and (M) as (M) and (N), respectively.

1975-Subsec. (a). Pub. L. 94–63, §§401(a), 701(c), designated existing provision as subsec. (a) and, as so designated, substituted provisions defining specified terms, for provisions setting forth health services for domestic agricultural migrants and authorizing appropriations from fiscal year ending June 30, 1966 through fiscal year ending June 30, 1975 for implementation of programs and projects.

Subsecs. (b) to (h). Pub. L. 94–63, §401(a), added subsecs. (b) to (h).

1973-Pub. L. 93–45 authorized appropriations of $26,750,000 for fiscal year ending June 30, 1974.

1970-Pub. L. 91–209 substituted "Secretary" for "Surgeon General", authorized appropriations of $20,000,000, $25,000,000, and $30,000,000 for fiscal years ending June 3, 1971, June 30, 1972, and June 30, 1973, respectively, made bringing about of continuity in health services one of the objects of the Secretary's grants for special projects, inserted parenthetical reference to allied health professions personnel, authorized the Secretary to provide funds towards health services for those performing seasonal agricultural services, and provided for the representation of all elements of the migratory worker population, whose health needs are to be met, in the development of health programs and that such persons be given an opportunity to participate in the implementation of such programs.

1968-Pub. L. 90–574 inserted provisions authorizing appropriations of $9,000,000 for fiscal year ending June 30, 1969, and $15,000,000 for fiscal year ending June 30, 1970.

1965-Pub. L. 89–109 substituted "not to exceed $7,000,000 for the first year ending June 30, 1966, $8,000,000 for the fiscal year ending June 30, 1967, and $9,000,000 for the fiscal year ending June 30, 1968" for "for the fiscal year ending June 30, 1963, the fiscal year ending June 30, 1964, and the fiscal year ending June 30, 1965, such sums, not to exceed $3,000,000 for any year, as may be necessary", and inserted "including necessary hospital care, and" in cl. (1)(ii).

Change of Name

"Department of Health and Human Services" substituted for "Department of Health, Education, and Welfare" in subsec. (g)(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

Section 5 of Pub. L. 100–386 provided that: "The amendments made by this Act [amending this section and section 254c of this title] shall take effect October 1, 1988, or upon the date of the enactment of this Act [Aug. 10, 1988], whichever occurs later."

Effective Date of 1978 Amendment

Section 103(g)(1)(C) of Pub. L. 95–626 provided that: "The change in the governing board requirements for migrant health centers made by the amendment by subparagraph (A) to section 329(f)(3)(G)(ii) of the Public Health Service Act [subsec. (f)(3)(G)(ii) of this section] shall not apply with respect to any public migrant health center which met the governing board requirements in effect under section 319(f)(2)(G)(ii) of such Act [subsec. (f)(2)(G)(ii) of this section] before October 1, 1978."

Section 103(j) of Pub. L. 95–626 provided that: "The amendments made by this section [amending this section] shall apply with respect to grants and contracts made under section 329 of the Public Health Service Act [this section] from appropriations for the fiscal years ending after September 30, 1978."

Effective Date of 1975 Amendment

Amendment by section 401(a) of Pub. L. 94–63, generally revising and redesignating provisions relating to migrant health centers, effective July 1, 1975, see section 608 of Pub. L. 94–63, set out as a note under section 247b of this title.

Short Title

This section is popularly known as the "Migrant Health Act".

Transfer of Functions

Functions of Public Health Service, Surgeon General of Public Health Service, and all other officers and employees of Public Health Service, and functions of all agencies of or in Public Health Service transferred to Secretary of Health, Education, and Welfare by Reorg, Plan No. 3 of 1966, eff. June 25, 1966, 31 F.R. 8855, 80 Stat. 1610, set out as a note under section 202 of this title. Secretary of Health, Education, and Welfare redesignated Secretary of Health and Human Services by section 509(b) of Pub. L. 96–88 which is classified to section 3508(b) of Title 20, Education.

Study of Hospital Staff Privileges for Physicians Practicing in Community Health Centers

Pub. L. 101–508, title IV, §4161(a)(7), Nov. 5, 1990, 104 Stat. 1388–94 , as amended by Pub. L. 103–432, title I, §147(f)(4)(B), Oct. 31, 1994, 108 Stat. 4431 , directed Comptroller General to conduct a study of whether physicians practicing in community and migrant health centers are able to obtain admitting privileges at local hospitals and, by not later than 18 months after Nov. 5, 1990, to submit a report on the study to Committees on Ways and Means and Energy and Commerce of the House of Representatives and to Committee on Finance of the Senate, with the report to include such recommendations as Comptroller General deems appropriate.

Study of Housing Conditions of Agricultural Migratory Workers; Consultations; Submission of Report to Congressional Committees

Section 401(c) of Pub. L. 94–63, as amended by Pub. L. 96–88, title V, §509(b), Oct. 17, 1979, 93 Stat. 695 , directed Secretary of Health and Human Services, in consultation with Secretary of Housing and Urban Development, to conduct a study of housing conditions of agricultural migratory workers and submit a report to specific Committees of House of Representatives and Senate within 18 months of the first Act making appropriations for the study.

Section Referred to in Other Sections

This section is referred to in sections 218, 233, 247b–1, 247b–6, 247c–1, 254g, 256, 256c, 256d, 290bb–3, 293j, 295p, 297n, 300e–12, 300e–14a, 300ee–16, 300ee–33, 300ff–52, 1395x, 1396b, 1396d, 1396r–1, 1786, 11709 of this title; title 29 section 777b; title 40 section 276d–3.

¹ So in original. Probably should be "worker".

² So in original. Probably should be "therefor".