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Page:United States Statutes at Large Volume 95.djvu/578

 95 STAT. 552

PUBLIC LAW 97-35—AUG. 13, 1981 of law referred to in subsection (a)(1) or in violation of subsection (a)(2), the Attorney General may bring a civil action in any appropriate district court of the United States for such relief as may be appropriate, including injunctive relief. "CRIMINAL PENALTY FOR FALSE STATEMENTS

42 USC 300X-8.

"SEC. 1919. Whoever— "(1) knowingly and willfuUjj^ makes or causes to be made any false statement or representation of a material fact in connection with the furnishing of items or services for which payment may be made by a State from funds allotted to the State under thM part, or "(2) having knowledge of the occurrence of any event affecting his initial or continued right to any such payment conceals or fails to disclose such event with an intent fraudulently to secure such payment either in a greater amount than is due or when no such payment is authorized, shall be fined not more than $25,000 or imprisoned for not more than five years, or both. "TRANSITION PROVISION

42 USC 300X-9. Post, p. 753.

"SEC. 1920. If at the request of a State the Secretary uses the allotment of the State during the transition period prescribed by title XVII of the Omnibus Budget Reconciliation Act of 1981 for grants under this part, the Secretary shall make the grants in accordance with the requirements of paragraphs (6), (7), and (8) of section 1915(c). The Secretary shall deduct from the allotment of the State the amount the Secretary (after consultation with the State) requires to fund such programs.'. "PART C—PRIMARY CARE BLOCK GRANTS "PLANNING GRANTS

42 USC 300y.

"SEC. 1921. (a) The Secretary may make grants to any State to undertake planning and other administrative activities to enable the State to administer allotments provided to it under this part. The amount of any grant to a State shall be determined by the Secretary but may not exceed $150,000. "(b) No grant may be made under subsection (a) unless an application therefore is submitted to, and approved by, the Secretary. Such an application shall be submitted in such form and manner and shall contain such information as the Secretary shall prescribe. "(c) For grants under subsection (a), there are authorized to be appropriated $2,500,000 for fiscal year 1982. "AUTHORIZATION OF APPROPRIATIONS

42 USC 300y-l.

42 USC 254c.

42 USC 300y-2.

"SEC. 1922. For allotments under section 1924 and for grants under section 330, there is authorized to be appropriated $302,500,000 for fiscal year 1983, and $327,000,000 for fiscal year 1984. "GRANTS UNDER SECTION 330

SEC. 1923, If a State does not submit an application for an allotment under section 1924 for a fiscal year or does not qualify for such an allotment for such fiscal year, the Secretary shall use funds appropriated under section 1922 to make grants under section 330 to commu-

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Page:United States Statutes at Large Volume 95.djvu/579

 PUBLIC LAW 97-35—AUG. 13, 1981

95 STAT. 553

nity health centers within the State. Before making grants under section 330 for community health centers within a State the Secre- 42 USC 254c. tary shall consult with the chief executive officer of the State and with appropriate local officials. The amount of funds from appropriations under section 1922 which may be used for grants for a fiscal year under section 330 for community health centers shall be the amount remaining after allotments are made under section 1924 for suchfiscalyear. "ALLOTMENTS

"SEC. 1924 (a). If a State submits an application under section 1927 42 USC 300y-3. for an allotment for a fiscal year and is determined by the Secretary to be eligible under such section for such an allotment, the Secretary shall allot to such State from the amount appropriated under section 1922 for such fiscal year an amount which bears the same ratio to the amount appropriated under section 1922 for that fiscal year as the amount granted for fiscal year 1982 by the Secretary to community health centers in the State under section 330 bore to the amount granted for that fiscal year by the Secretary under such section to centers in all States from appropriations for that fiscal year. "(b)(1) If the Secretary— "(A) receives a request from the governing body of an Indian tribe or tribal organization within any State that funds under this part be provided directly by the Secretary to such tribe or organization, and "(B) determines that the members of such tribe or tribal organization would be better served by means of grants made directly by the Secretary under this part, the Secretary shall reserve from amounts which would otherwise be allotted to such State under subsection (a) for the fiscal year the amount determined under paragraph (2). "(2) The Secretary shall reserve for the purpose of paragraph (1) from amounts that would otherwise be allotted to such State under subsection (a) an amount equal to the amount which bears the same ratio to the State's allotment for the fiscal year involved as the total amount granted for fiscal year 1982 by the Secretary to such tribe or tribal organization under section 330 bore to the total amount granted for such fiscal year by the Secretary to the State and entities (including Indian tribes and tribal organizations) in the State under section 330. "(3) From the amount reserved by the Secretary on the basis of a determination under this subsection, the Secretary shall make grants under section 330 to the Indian tribe or tribal organization serving the individuals for whom such a determination has been made. "(4) The terms Indian tribe' and 'tribal organization' have the same meaning given such terms in section 4(b) and section 4(c) of the Indian Self-Determination and Education Assistance Act. 25 USC 450b. "PAYMENTS UNDER ALLOTMENTS TO STATES

"SEC. 1925. (a)(1) For each fiscal year, the Secretary shall make 42 USC 300y-4. payments, as provided by section 203 of the Intergovernmental Cooperation Act of 1968 (42 U.S.C. 4213), from amounts appropriated for allotments (other than any amount reserved under section 1924(b)) under section 1924(a) to each State which receives such an allotment. "(2) Any amount paid to a State for a fiscal year and remaining unobligated at the end of such year shall remain available to such

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license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/


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Page:United States Statutes at Large Volume 95.djvu/580

 95 STAT. 554

PUBLIC LAW 97-35—AUG. 13, 1981 State for the purposes for which it was made for the next fiscal year if the Secretary determines that the State acted in accordance with section 1926(a)(1) and there is good cause for funds remaining unobligated. "(b) The Secretary, at the request of a State, may reduce the amount of payments under subsection (a) by— "(1) the fair market value of any supplies or equipment furnished to the State, and "(2) the amount of the pay, allowances, and travel expenses of any officer or employee of the Government when detailed to the State and the amount of any other costs incurred in connection with the detail of such officer or employee, when the furnishing of supplies or equipment or the detail of an officer or employee is for the convenience of and at the request of the State and for the purpose of conducting activities described in section 1926. The amount by which any payment is so reduced shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment or in detailing the personnel, on which the reduction of the payment is based, and the amount shall be deemed to be part of the payment and shall be deemed to have been paid to the State. "GRANTS TO COMMUNITY HEALTH CENTERS

42 USC 300y-5.

42 USC 254c.

"SEC. 1926. (a)(1) In fiscal years 1983 and 1984 each State shall use for grants under paragraphs (2) and (3) the entire amount allotted to it under section 1924 for such fiscal year and the entire amount required to be made available under paragraph (4). "(2) From the amounts paid to it under section 1925 for fiscal year 1983 and from the State funds required to be made available under paragraph (4) for such fiscal year, each State shall make grants to each community health center which received a grant for its operation under section 330(d) for fiscal year 1982 and which meets the requirements of this paragraph. A grant may be made under this paragraph to a community health center only— "(A) if the center has made an application to the State in accordance with section 330(e), and "(B) if the center meets the requirements for receiving a grant under section 330 for its operation. The amount of a grant under this paragraph to a center shall be not less than the amount the center received under section 330(d) for fiscal year 1982. If the State determines under subparagraph (B) that a community health center which has applied for a grant does not meet the requirements referred to in that subparagraph, the Secretary shall review the State's determination. If the Secretary finds that the center does not meet such requirements, the State may withhold a grant to the center under this paragraph. "(3) In fiscal years 1983 and 1984, each State shall make grants to community health centers within the State which serve medically underserved populations and which meet the requirements of this paragraph. A grant under this paragraph for fiscal year 1983 shall be made from any amount not obligated under paragraph (2) or (4) for such fiscal year, and a grant for fiscal year 1984 shall be made from the amounts paid to it under section 1925 for the fiscal year and from the State funds required to be made available under paragraph (4) for the fiscal year. A grant may be made under this paragraph to a community health center only—

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Page:United States Statutes at Large Volume 95.djvu/581

 PUBLIC LAW 97-35—AUG. 13, 1981

95 STAT. 555

"(A) if the center has made an application to the State in accordance with section 330(e), and 42 USC 254c. "(B) if the center meets the requirements for receiving a grant under section 330 for its operation. The limitation prescribed by section 330(g)(3) shall apply with respect to grants under this paragraph. States shall make grants under this paragraph in such a manner that medically underserved populations which have been served by community health centers and which are still medically underserved populations will continue to receive health care, and in making such grants a State shall not, to the extent practicable, disrupt established provider-patient relationships. "(4)(A) In fiscal year 1983 a State which receives an allotment under section 1924 for that fiscal year shall make available, from State funds, for the grants described in paragraphs (2) and (3) and for State administrative expenses for such grants for such fiscal year an amount equal to 20 percent of its allotment. In fiscal year 1984 a State which receives an allotment under section 1924 for that fiscal year shall make available, from State funds, for the grants described in paragraphs (2) and (3) and for State administrative expenses for such grants for such fiscal year an amount equal to one-third of its allotment. "(B) A State, at the request of a community heedth center, may reduce the amount of the State's contribution under subparagraph (A) to the center by— "(i) the fair market value of any supplies or equipment furnished to the center, and "(ii) the amount of the pay, allowances, and travel expenses of any officer or employee of the State when detailed to the center and the amount of any other costs incurred in connection with the detail of such officer or employee, when the furnishing of supplies or equipment or the detail of an officer or employee is for the convenience of and at the request of the center and for the purpose of activities centers assisted under this section. The amount by which any payment is so reduced shall be available for payment by the State of the costs incurred in furnishing the supplies or equipment or in detailing the personnel, on which the reduction of the payment is based, and the amount shall be deemed to be part of the payment and shall be deemed to have been paid by the State under subparagraph (A). "(5) A State may not use any funds paid to it under section 1925 for the purposes of administration of the grants required by paragraphs (2) and (3). "(6) For purposes of this part— "(A) the term 'community health center' has the same mean- "Community health center. ing as that term has under section 330(a), and '(B) a medically underserved population is such a population designated by the Secretary under section 330(b)(3). "(b) A State may not use amounts paid to it under section 1925 to— "(1) provide inpatient services, except in fiscal year 1983 in the case of a community health center which used funds provided under section 330 for fiscal year 1982 to provide such services, "(2) make cash payments to intended recipients of health services, "(3) purchase or improve land, purchase, construct, or permanently improve (other than minor remodeling) any building or other facility, or purchase major medical equipment, "(4) satisfy any requirement for the expenditure of nonFederal funds as a condition for the receipt of Federal funds, or

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Page:United States Statutes at Large Volume 95.djvu/582

 95 STAT. 556

PUBLIC LAW 97-35—AUG. 13, 1981 "(5) provide financial assistance to any entity other than a public or nonprofit private community health center. The Secretary may waive the limitation contained in paragraph (3) upon the request of a State if the Secretary finds that there are extraordinary circumstances to justify the waiver and that granting the waiver will assist in carrying out this part. The prohibition prescribed by this subsection (other than paragraph (4)) shall apply with respect to any amount required to be made available under subsection (a)(4). "APPLICATION; ASSURANCES; DESCRIPTION OF ACTIVITIES

42 USC 300y-6.

"SEC. 1927. (a) No state may receive an allotment for a fiscal year under section 1924(a) unless an application therefor has been submitted to and approved by the Secretary. Such an application shall be submitted before the beginning of the fiscal year for which the allotment applied for will be made. Each such application shall be in such form and submitted by such date as the Secretary shall require. Each such application shall contain assurances that the legislature of the State has complied with the provisions of subsection (b) and that the State will meet the requirements of subsection (c). "(b) After the expiration of the first fiscal year in which a State receives an allotment under section 1924, no funds shall be allotted to such State for any fiscal year under such section unless the legislature of the State conducts public hearings on the proposed use and distribution of funds to be provided under section 1925 for such fiscal year. "(c) As part of the annual application required by subsection (a), the chief executive officer of each State shall certify that the State agrees— "(1) to use the funds alloted to it under section 1924 in accordance with the requirements of section 1926; and "(2) to establish, after providing reasonable notice and opportunity for the submission of comments, reasonable criteria to evaluate the fiscal, managerial, and clinical performance of community health centers; and "(3) to establish procedural and substantive independent State review procedures relating to the failure by the State to provide funds for any such center and to the reduction of the funds paid to a community health center in fiscal year 1984 to an amount which is significantly less than the amount paid to the center by the State under section 1926 in fiscal year 1983. The application of a State shall also contain assurances, satisfactory to the Secretary, that the State has the administrative capability to administer grants under section 1926, to determine the need for services of community health centers by medically underserved populations, and to evaluate the performance of community health centers. "(d)(1) The chief executive officer of the State shall, as part of the application required by subsection (a), prepare and furnish to the Secretary (in accordance with such form as the Secretary shall provide) a description of the intended use of the payments the State will receive under section 1925 for that fiscal year and the funds the State is required to obligate under section 1926(a)(4) for that fiscal year. "(2) The description required by paragraph (1) shall be made public within the State in such manner as to facilitate comment from any person (including any Federal or other public agency) during develop-

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Page:United States Statutes at Large Volume 95.djvu/583

 PUBLIC LAW 97-35—AUG. 13, 1981

95 STAT. 557

ment of the description and after its transmittal. The description shall be revised (consistent with this section) throughout the year as may be necessary to reflect substantial changes in the programs and activities assisted under this part, and any revision shall be subject to the requirements of the preceding sentence. "REPORTS AND AUDITS

"SEC. 1928. (a)(1) Each State shall prepare and submit to the 42 USC 300y-7. Secretary annual reports on its activities under this part. Such reports shall be in such form and contain such information as the Secretary determines (after consultation with the States and the Comptroller General) to be necessary (A) to determine whether funds were expended in accordance with sections 1926 and 1927(c), (B) to secure a description of the activities under this part, and (C) to secure a record of the purposes for which funds were spent, of the recipients of such funds and of the progress made toward achieving the purposes for which the funds were provided. Copies of the report shall be provided, upon request, to any interested person (including any public agency). "(2) In determining the information that States must include in the report required by this subsection, the Secretary may not establish reporting requirements which are burdensome. "(b)(1) Each State shall establish fiscal control and fund accounting procedures as may be necessary to assure the proper disbursal of and accounting for Federal funds paid to the State under section 1925. "(2) Each State shall annually audit its expenditures from payments received under section 1925. Such State audits shall be conducted by an entity independent of any agency administering a program funded under this part and, to the extent practicable, in accordance with the Comptroller's General standards for auditing governmental organizations, programs, activities, and functions. Within 30 days following the date each audit is completed, the chief executive officer of the State shall transmit a copy of that audit to the Secretary. "(3) Each State shall, after being provided by the Secretary with adequate notice and opportunity for a hearing within the affected State, repay to the United States amounts found not to have been expended in accordance with the requirements of section 1926 or the certification and assurances provided under section 1927. If such repayment is not made, the Secretary shall, after providing the State with adequate notice and opportunity for a hearing, offset such amounts against the amount of any allotment to which the State is or may become entitled under section 1924. "(4) The State shall make copies of the reports and audits required Public by this section available for public inspection within the State, inspection. "(5) The Comptroller General of the United States shall, from time to time, evaluate the expenditures by States of grants under this part in order to assure that expenditures are consistent with the provisions of this part. "(6) Not later than January 1, 1984, the Secretary shall report to the Congress on the activities of the States which have received funds under this part and may include in the report any recommendations for appropriate changes in legislation.

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Page:United States Statutes at Large Volume 95.djvu/584

 95 STAT. 558

PUBLIC LAW 97-35—AUG. 13, 1981 WITHHOLDING

Notice and hearing. 42 USC 300y-8.

"SEC. 1929. (a)(1) The Secretary shall, after adequate notice and an opportunity for a hearing conducted within the affected State and subject to paragraphs (2) and (3) of this subsection, withhold funds from any State which does not use its allotment in accordance with the requirements of section 1926 or 1927. The Secretary shall withhold such funds until the Secretary finds that the reason for the withholding has been removed and there is reasonable assurance that it will not recur. If the Secretary withholds funds from a State for its failure to provide grants to community health centers in accordance with section 1926, the Secretary shall use the funds withheld to make such grants in accordance with such section. "(2) The Secretary may not institute proceedings to withhold funds under this section unless the Secretary has conducted an investigation concerning whether the State has used its allotment in accordance with this part. Investigations required by this paragraph shall be conducted within the affected State by qualified investigators. "(3) The Secretary may not withhold funds under this subsection from a State for a minor failure to comply with the provisions of this part. "(4) The Secretary shall respond in an expeditious manner to complaints of a substantial or serious nature that a State has failed to use funds in accordance with the requirements of this part. "(b)(1) The Secretary shall conduct in several States in each fiscal year investigations of the use of funds received by the States under this part in order to evaluate compliance with the requirements of this part. "(2) The Comptroller General of the United States may conduct an investigation of the use of funds received under this part by a State in order to insure compliance with the requirements of this part. "(c) A State shall make appropriate 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 the appropriate entity upon a reasonable request therefor. "(d)(1) In conducting any investigation, the Secretary or the Comptroller General of the United States may not request any information not readily available to such State or to any community health center which has received a grant under this part and may not make an unreasonable request for information to be compiled, collected, or transmitted in any form not readily available. "(2) Paragraph (1) does not apply to the collection, compilation, or transmittal of data in the course of a judicial proceeding. NONDISCRIMINATION

42 USC 300y-9. 42 USC 6101 note. 29 USC 794. 20 USC 1681. 42 USC 2000d.

"SEC. 1930. (a)(l) For the purpose of applying the prohibitions against discrimination on the basis of age under the Age Discrimination Act of 1975, on the basis of handicap under section 504 of the Rehabilitation Act of 1973, on the basis of sex under title IX of the Education Amendments of 1972, or on the basis of race, color, or national origin under title VI of the Civil Rights Act of 1964, programs and activities funded in whole or in part with funds made available under this part are considered to be programs and activities receiving Federal financial assistance.

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Page:United States Statutes at Large Volume 95.djvu/585

 PUBLIC LAW 97-35—AUG. 13, 1981 "(2) No person shall on the ground of sex or religion be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any program or activity funded in whole or in part with funds made available under this part. "(b) Whenever the Secretary finds that a State or an entity that has received a pa3niient from an allotment to a State under section 1924 has failed to comply with a provision of law referred to in subsection (a)(D, with subsection (a)(2), or with an applicable regulation (including one prescribed to carry out subsection (a)(2)), the Secretary shall notify the chief executive officer of the State and shall request him to secure compliance. If within a reasonable period of time, not to exceed sixty days, the chief executive officer fails or refuses to secure compliance, the Secretary may— "(1) refer the matter to the Attorney General with a recommendation that an appropriate civil action be instituted, "(2) exercise the powers and functions provided by title VI of the Civil Rights Act of 1964, the Age Discrimination Act of 1975, or section 504 of the Rehabilitation Act of 1973, as may be applicable, or "(3) take such other action as may be provided by law. "(c) When a matter is referred to the Attorney General pursuant to subsection (b)(D, or whenever he has reason to believe that a State or an entity is engaged in a pattern or practice in violation of a provision of law referred to in subsection (a)(1) or in violation of subsection (a)(2), the Attorney General may bring a civil action in any appropriate district court of the United States for such relief as may be appropriate, including injunctive relief.

95 STAT. 559

42 USC 2000d. 42 USC 6ioi "°*® ^^ ^^^ ^^'*-

"CRIMINAL PENALTY FOR FALSE STATEMENTS

"SEC. 1931. Whoever— 42 USC 300y-io. "(1) knowingly and willfully makes or causes to be made any false statement or representation of a material fact in connection with the furnishing of items or services for which payment may be made by a State from funds allotted to the State under this part, or "(2) having knowledge of the occurrence of any event affecting his initial or continued right to any such payment conceals or fails to disclose such event with an intent fraudulently to secure such payment either in a greater amount than is due or when no such payment is authorized, shall be fined not more than $25,000 or imprisoned for not more than five years, or both. ' 'ADMINISTRATION

"SEC. 1932. Title XVII of the Omnibus Budget Reconciliation Act of 42 USC 300y-li. 1981 shall not apply with respect to the grant program authorized by Post, p. 753. this part.". REPEALS AND CONFORMING AMENDMENTS

SEC. 902. (a) Sections 401 and 402 of the Health Services and Centers Amendments of 1978 are repealed. (b) Sections 314(d) and subpart III of part D of title III of the Public Health Service Act are repealed. (c)(1) The second sentence of section 311(a) of the Public Health Service Act is amended— (A) by inserting "and with respect to other public health matters" after "diseases", and

42 USC 247b-i, ^^'^''"^ 42 USC 246, 255. 42 USC 243.

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Page:United States Statutes at Large Volume 95.djvu/586

 95 STAT. 560 42 USC 243. 42 USC 246. Repeals.

42 USC

300d-300d-9, 300d-21.

PUBLIC LAW 97-35—AUG. 13, 1981 (B) by striking out "and in carrying out the purposes of section 314". (2) The first sentence of section 311(b) of such Act is amended by striking out "the purposes of section 314" and inserting in lieu thereof "public health activities". (d)(1) Sections 1201, 1202, 1203, 1204, 1205(d), 1206, 1207(a), 1208, 1209, and 1210, and part B of title XII of the Public Health Service Act are repealed. (2) Title XII of such Act is amended by striking out— "PART A—ASSISTANCE FOR EMERGENCY MEDICAL SERVICES SYSTEMS".

42 USC 300d-4. 42 USC 300d-6. 42 USC 201. Repeals 94 Stat. 1564.

42 USC 9411. 42 USC 9421. 42 USC 9431. 42 USC 9451. 42 USC 9502. 42 USC 9512. 42 USC 9521. 42 USC 9523. 42 USC 229d, 2689m. Repeal.

42 USC 2689 note. 9411. 42 USC 9412. 42 USC

(3) Section 1205 of such Act is redesignated as section 1201. (4) Section 1207(b) of such Act is redesignated as section 1202. (5) Section 2(f) of such Act is amended by striking out "1201(2),". (e)(1) Section 101, part B of title I, titles II and III, and sections 502, 602, 801, and 806 of the Mental Health Systems Act are repealed. (2)(A) Section 225 of the Community Mental Health Centers Act is transferred to title V of the Public Health Service Act, inserted after section 514, redesignated as section 515, and amended (A) by striking out "this title" and inserting in lieu thereof "the Community Mental Health Centers Act" and (B) by inserting "of the Community Mental Health Centers Act" after "section 222". (B) The (Community Mental Health Centers Act is repealed. (f)(1) Title I of the Mental Health Systems Act is amended— (A) by striking out "PART A—DEFINITIONS";

(B) by striking out "OTHER" in the section heading for section 102; and (C)) by striking out paragraphs (3), (4), (6), and (7) of section 102, and by redesignating paragraph (5) of such section as paragraph (3). (2) The table of contents in the first section of such Act is amended by striking out the items relating to sections 101, 105, 106, 107, 201 through 208, 301 through 303, 305 through 309, 315 through 317, 321, 325 through 328,502,602,801, and 806, parts A and B of title I, title II, title III, and parts A, B, C, D, and E of title III. (3) The table of section 102 in such table of contents is amended to read as follows: "Sec. 102. Definitions.".

94 Stat. 1602. 42 USC 9511.

(20) Section 601(a) of such Act is amended— (A) by striking out "community mental health centers and other" in paragraph (5); and (B) by striking out paragraph (6). (g)(1) The second sentence of section 455(a) of the Public Health 94 Stat. 1608. Service Act is amended by striking out ", the Mental Retardation 42 USC 289k-l. Facilities and Community Mental Health Centers Construction Act of 1963 (other than part C of title II), and the Mental Health Systems Act". 42 USC 225a. (2) Section 507 of such Act is amended by striking out ", appropriations available under the Community Mental Health Centers Act for construction and staffing of community mental health centers and alcoholism and narcotic addiction, drug abuse, and drug dependence facilities,". 42 USC 229b. (3) Section 513 of such Act is amended by striking out "the Mental Retardation Facilities Construction Act, the Community Mental Health Centers Act,".

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Page:United States Statutes at Large Volume 95.djvu/587

 PUBLIC LAW 97-35—AUG. 13, 1981

95 STAT. 561

(4) Section 1513(e)(l)(A)(i) of such Act is amended by striking out ", 9| Stat. 1608.^ the Community Mental Health Centers Act, the Mental Health Systems Act, sections 409 and 410 of the Drug Abuse Prevention, Treatment, and Rehabilitation Act, or the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970". 42 USC 300m. (5) Section 1521(d)(2)(A) of such Act is amended— (A) by striking out ", the Community Mental Health Centers Act," and inserting in lieu thereof "or"; and (B) by striking out", and the Drug Abuse Office and Treatment Act of 1972". (6) Section 1524(c)(6)(A) of such Act is amended by striking out "the 94 Stat. 3191. Community Mental Health Centers Act, section 409 or 410 of the 42 USC 300m-3. Drug Abuse Office and Treatment Act of 1972, or the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970,". (h) The amendments made by this section sheill take effect October 1, Effective date. 42 USC 229d 1981. note. ONE-YEAR EXTENSION OF COMMUNITY HEALTH CENTERS AND PRIMARY CARE RESEARCH AND DEMONSTRATIONS

SEC. 903. (a) The first sentence of section 330(g)(2) (42 U.S.C. 254c(g)(2)) of the Public Health Service Act is amended by striking out "and" after "1980," and by striking out the period and inserting in lieu thereof the following: "and $280,000,000 for the fiscal year ending September 30, 1982. For authorizations for appropriations for fiscal years 1983 and 1984, see section 1922.", Ante, p. 552. (b)(1) Section 340(g)(2) of the Public Health Service Act (42 U.S.C. 256(g)(2)) is amended by striking out "and" after "1980," and by striking out the period and inserting in lieu thereof the following: "and $3,000,000 for the fiscal year ending September 30, 1982. No funds may be appropriated under this paragraph or paragraph (1) for a fiscal year beginning after September 30, 1982.". (c) Effective October 1, 1982, section 340 of such Act is repealed. Repeal. SERVICES TO MIGRANTS BY COMMUNITY HEALTH CENTERS

SEC. 904. The Secretary of Health and Human Services shall review the performance of community health centers which have received grants under section 329 of the Public Health Service Act (relating to 42 USC 254b. migrant health centers) to determine if the community health centers have provided services to migrants in a manner which is consistent with the needs of the migrants. In determining if the services have been provided in such a manner, the Secretary shall consider the hours of operation of a center, the bilingual capabilities of a center's staff, and the ability of the center's staff to detect, report, and treat adverse health effects resulting from exposure to pesticides. The Secretary shall report the results of the review conducted under Report to this section to the Congress not later than six months after the date of Congress. the enactment of this section and shall include in the report actions taken by the Secretary to assure that community health centers receiving grants under such section 329 will provide services to migrants in a manner consistent with their needs.

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Page:United States Statutes at Large Volume 95.djvu/588

 95 STAT. 562

PUBLIC LAW 97-35—AUG. 13, 1981 CRITERIA FOR DETERMINING AREAS AND POPULATION GROUPS IN NEED OF SERVICES OF COMMUNITY HEALTH CENTERS

Ante, p. 535.

SEC. 905. (a) Section 330(b)(3) of the Public Health Service Act (42 U.S.C. 254c(b)(3)) is amended by adding at the end the following: "After the date of the enactment of part A of title XIX, the Secretary may not designate a medically underserved population or remove the designation of such a population unless the Secretary provides reasonable notice and opportunity for comment and consults with the chief executive officer of the State in which the population is located and appropriate local officials. The Secretary shall prescribe criteria for determining the specific shortages of personal health services of an area or population group. Such criteria shall 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.". G)) Section 330(e)(2) of such Act is amended by inserting before the second sentence the following: "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) 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.". AUDITS OF GRANTS TO COMMUNITY HEALTH CENTERS

Recordkeeping.

SEC. 906. Section 330 of the Public Health Service Act (42 U.S.C. 254c) is amended by adding at the end the following: "(h)(1) Each entity which receives a grant under subsection (d) 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) 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.

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Page:United States Statutes at Large Volume 95.djvu/589

 PUBLIC LAW 97-35—AUG. 13, 1981

95 STAT. 563

"(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.".

Subtitle B—Developmental Disabilities EXTENSION OF PROGRAMS

SEC. 911. (a) The first sentence of section 113(b)(2) of the Developmental Disabilities Assistance and Bill of Rights Act (hereinafter in this subtitle referred to as the "Act") (42 U.S.C 6012(b)(2)) is amended by striking out "and" after "1980," and by inserting before the period a comma and the following: "$8,000,000 for the fiscal year ending September 30, 1982, $8,000,000 for the fiscal year ending September 30, 1983, and $8,000,000 for the fiscal year ending September 30, 1984". (b) Section 123(a) of the Act (42 U.S.C. 6033(a)) is amended by striking out "and" after "1980," and by inserting before the period a comma and the following: "$7,500,000 for the fiscal year ending September 30, 1982, $7,500,000 for the fiscal year ending September 30, 1983, and $7,500,000 for the fiscal year ending September 30, 1984". (c) Section 131 of the Act (42 U.S.C. 6061) is amended by striking out "and" after "1980," and by inserting before the period a comma and the following: "$43,180,000 for the fiscal year ending September 30, 1982, $43,180,000 for the fiscal year ending September 30, 1983, and $43,180,000 for thefiscalyear ending September 30, 1984". EVALUATION SYSTEM

SEC. 912. (a) Section 110 of the Act (42 U.S.C. 6009) is repealed. Repeal. SPECIAL PROJECT GRANTS

SEC. 913. Section 145 of the Act (42 U.S.C. 6081) is amended to read as follows: " G R A N T AUTHORITY

"SEC. 145. (a) The Secretary may make grants to public or nonprofit private entities for— "(1) demonstration projects— "(A) which are conducted in more than one State, "(B) which involve the participation of two or more Federal departments or agencies, or "(C) which are otherwise of national significance, and which hold promise of expanding or otherwise improving services to persons with developmental disabilities (especially those who are disadvantaged or multihandicapped); and

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Page:United States Statutes at Large Volume 95.djvu/590

 95 STAT. 564

42 USC 6012.

42 USC 6063. 42 USC 6067.

Appropriation authorization.

PUBLIC LAW 97-35—AUG. 13, 1981 "(2) demonstration projects (including research, training, and evaluation in connection with such projects) which hold promise of expanding or otherwise improving protection and advocacy services relating to the State protection and advocacy system described in section 113. Projects for the evaluation and assessment of the quality of services provided persons with developmental disabilities which meet the requirements of subparagraphs (A), (B), and (C) of paragraph (1) may be included as projects for which grants are authorized under such paragraph. "(b) No grant may be made under subsection (a) unless an application therefor has been submitted to, and approved by, the Secretary. Such application shall be in such form, submitted in such manner, and contain such information as the Secretary shall by regulation prescribe. The Secretary may not approve such an application unless each State in which the applicant's project will be conducted has a State plan approved under section 133. The Secretary shall provide to the State Planning C!ouncil (established under section 137) for each State in which an applicant's project will be conducted an opportunity to review the application for such project and to submit its comments on the application. "(c) Payments under grants under subsection (a) may be made in advance or by way of reimbursement, and at such intervals and on such conditions, as the Secretary finds necessary. The amount of any grant under subsection (a) shall be determined by the Secretary. "(d) For the purpose of grants under subsection (a), there are authorized to the appropriated $2,500,000 for the fiscal year ending September 30, 1982, $2,500,000 for the fiscal year ending September 30, 1983, and $2,500,000 for the fiscal year ending September 30, 1984.".

Subtitle C—Health Services Research, Statistics, and Technology; Medical Libraries; and National Research Service Awards REFERENCES IN SUBTITLE

42 USC 201 note.

SEC. 916. Whenever in this subtitle an amendment or repeal is expressed in terms of an amendment to, or a repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of the Public Health Service Act. AUTHORIZATIONS FOR HEALTH SERVICES RESEARCH, STATISTICS, AND TECHNOLOGY

SEC. 917. (a) The first sentence of section 308(i)(l) (42 U.S.C. 242m(i)(l)) is amended by striking out "and" after "1980," and by inserting before the period a comma and the following: "$20,000,000 for the fiscal year ending September 30, 1982, $22,000,000 for the fiscal year ending September 30, 1983, and $24,000,000 for the fiscal year ending September 30, 1984". (b) Section 308(i)(2) is amended by striking out "and" after "1980," and by inserting before the period a comma and the following: "$39,000,000 for the fiscal year ending September 30, 1982, $39,000,000 for the fiscal year ending September 30, 1983, and $39,000,000 for the fiscal year ending September 30, 1984".

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Page:United States Statutes at Large Volume 95.djvu/591

 PUBLIC LAW 97-35—AUG. 13, 1981

95 STAT. 565

(c)(1) The first sentence of section 309(i) (42 U.S.C. 242n(i)) is amended by striking out "and" after "1980," and by inserting before the period a comma and the following: "$3,000,000 for the fiscal year ending September 30, 1982, $4,000,000 for the fiscal year ending September 30, 1983, and $5,000,000 for the fiscal year ending September 30, 1984". (2) The second sentence of such section is amended by striking out "the fiscal year ending September 30, 1981," and inserting in lieu thereof "for each of the fiscal years ending September 30, 1982, September 30, 1983, and September 30, 1984,". GENERAL AUTHORITIES

SEC. 918. (a) Section 304(a)(3) (42 U.S.C. 242b(a)(3)) is amended— (1) by striking out "shall" and inserting in lieu thereof "may", and (2) by striking out "and" the first three places it occurs and inserting in lieu thereof "or". (b)(1) The first sentence of section 304(d)(1) is amended by striking out "and the National Academy of Sciences (acting through the Institute of Medicine and other appropriate units) shall, jointly and" and inserting in lieu thereof ", with the advice and assistance of the National Academy of Sciences (acting through the Institute of Medicine and other appropriate units), shall,". (2) The second sentence of such section is amended by striking out "and the National Academy of Sciences (hereinafter in this subsection referred to as the 'Academy')". (3) Section 304(d)(3) is amended by striking out "and the Academy" each place it appears. (c) Section 304(d)(3) is amended by striking out "every two years" and inserting in lieu thereof "every three years". (d)(1) Subsections (b)(1) and (c)(1) of section 304 are each amended by striking out "Health, Education, and Welfare" and inserting in lieu thereof "Health and Human Services". (2) Subsection (d)(3) of such section is amended by striking out "Committee on Interstate and Foreign Commerce" and inserting in lieu thereof "Committee on Energy and Commerce". NATIONAL CENTER FOR HEALTH SERVICES RESEARCH

SEC. 919. (a)(1) The first sentence of section 305(d)(1) (42 U.S.C. 242c(d)(l)) is amended by striking out "health services, research, evaluations" and inserting in lieu thereof "health services research, evaluations, training, policy analysis,". (2)(A) The second sentence of such section is amended (i) by striking out "six of such centers" and inserting in lieu thereof "three of such centers", and (ii) by striking out "three national special emphasis centers" and all that follows through "health care delivery;" and inserting in lieu thereof "two national special emphasis centers,". (B) Section 308(i)(l) (42 U.S.C. 242m(i)(l)) (as amended by section 917(a) of this Act) is further amended by adding at the end thereof the following new sentence: "Of the amounts appropriated under this paragraph for each of the fiscal years ending September 30, 1982, September 30, 1983, and September 30, 1984, not more than $1,500,000 may be used for grants and contracts for all the costs of planning, establishing, and operating centers under section 305(d)."

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Page:United States Statutes at Large Volume 95.djvu/592

 95 STAT. 566 42 USC 242c.

42 USC 242c ^°^-

PUBLIC LAW 97-35—AUG. 13, 1981 (3) Section 305(d)(2)(B)(iv) is amended by striking out "demonstrations, and evaluations" and inserting in lieu thereof "evaluations, policy analysis, and demonstrations". (b)(1) Paragraph (4) of section 305(b) is amended to read as follows: "(4) the role of market forces in the health care system and the appropriate role they may play in restraining cost increases and improving the availability and quality of care.". (2) The amendment made by paragraph (1) shall apply with respect to grants made under section 305(b) of the Public Health Service Act for fiscal years beginning after September 30, 1981, except that if an entity received a grant under paragraph (4) of such section, as in effect before the date of the enactment of this Act, for the fiscal year ending September 30, 1981, the Secretary may, until the fiscal year be^nning October 1, 1983, make an additional grant or grants to such entity for the purposes prescribed by such paragraph as so in effect. (c) Section 305(b) is amended by adding after and below paragraph (4) the following: "No grant or contract shall be made under this subsection for the purpose of funding clinical research that is directly related to determining the cause of any disease or disorder or clinical research that is directly and principally designed to evaluate the efficacy of any therapeutic, diagnostic, or preventive health measure.". (d) Subsections (a) and (c) of section 305 are each amended by striking out "Health, Education, and Welfare" and inserting in lieu thereof "Health and Human Services". NATIONAL CENTER FOR HEALTH STATISTICS

SEC. 920. (a) Section 306(e)(3) (42 U.S.C. 242k(e)(3)) is amended by inserting "and other activities" after "data collection". (b) The first sentence of section 306(1)(2)(A) is amended by striking out "the Center" and inserting in lieu thereof "the Center and in cooperation with the Office of Federal Statistical Policy and Standards". (c) Section 306(1)(2)(D) is amended by striking out all after "subparagraph (A)" and inserting in lieu thereof a period. (d)(1) Subsections (a), (e)(4), (j), (k)(4)(C), (k)(4)(D), and (l)(2)(B)(v) of section 306 are each amended by striking out "Health, Education, and Welfare" and inserting in lieu thereof "Health and Human Services". (2) Subsection (c) of such section is amended by striking out "Committee on Interstate and Foreign Commerce" and inserting in lieu thereof "Committee on Energy and Commerce". INTERNATIONAL COOPERATION

42 USC 242/.

SEC. 921. (a) Section 307(a) (42 U.S.C. 2421(a)) is amended (1) by striking out "and the" and inserting in lieu thereof ", health care technology, and the", and (2) by striking out "and 306" and inserting in lieu thereof "306, and 309". (b) Section 307(b) is amended— (1) in paragraph (5), by striking out "or health statistics" and inserting in lieu thereof ", health statistics, or health care technology", and (2) in paragraph (6), by striking out "and programs of biomedical research, health services research, and health statistical activities" and inserting in lieu thereof "or programs of biomedi-

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Page:United States Statutes at Large Volume 95.djvu/593

 PUBLIC LAW 97-35—AUG. 13, 1981 cal research, health services research, health statistical activities, or health care technology activities". GENERAL PROVISIONS

SEC. 922. (a) Section 308(a)(2) (42 U.S.C. 242m(a)(2)) is amended by striking out "September 1" and inserting in lieu thereof "December 1". (b) Section 308(b)(2) is amended by striking out "$35,000" and inserting in lieu thereof "$50,000". (c) Section 308(d)(2) is amended by inserting "or in the course of health care technology activities under section 309" after "305". NATIONAL CENTER FOR HEALTH CARE TECHNOLOGY

SEC. 923. (a) Section 309(b)(l) (42 U.S.C. 242n(b)(l)) is amended by adding at the end thereof the following new sentence: "In carrying out this section, the Center shall not unreasonably inhibit the innovation of new technologies." (b) Section 309(b)(5) is amended by striking out "may" and inserting in lieu thereof "shall" and by adding at the end thereof the following new sentence: "The making of such recommendations shall be a priority of the Center." (c) Section 309(e) is amended by adding at the end thereof the following new sentence: "In carrying out this section, the Secretary shall ensure that the Center does not duplicate the activities of other units of the Department of Health and Human Services or, to the extent practicable, the activities of other Federal departments and agencies. To ensure necessary coordination, all assessments, research, evaluations, and demonstrations conducted by the Center shall take into consideration relevant studies and activities undertaken by the National Institutes of Health, the Food and Drug Administration, the Center for Disease Control, the Alcohol, Drug Abuse, and Mental Health Administration, and other Federal departments and agencies." (d) Sections 309(d) and 309(f)(l)(B) are each amended by striking out "$35,000" and inserting in lieu thereof "$50,000". (e) Section 309(fKlXB) is amended by striking out "in excess o f and inserting in lieu thereof "the direct costs of which will exceed". (f)(1) Subparagraph (D) of section 309(fKl) is amended by striking out "exemplary standards, norms, and criteria" and inserting in lieu thereof "information". (2) Subparagraph (E) of such section is amended by striking out "standards, norms, and criteria" and inserting in lieu thereof "information". (g) Section 309(fK2XA) is amended by striking out "and the head of the Health Care Financing Administration (or the successor to such entity) who (or their designees) shall be ex officio members" and inserting in lieu thereof "the head of the Health Care Financing Administration (or the successor to such entity), and such other Federal officials as the Secretary may specify, who (or their designees) shall be nonvoting ex officio members". (h) The third sentence in the matter following section 309(f)(2)(B) is amended by striking out "two" and inserting in lieu thereof "three". (i)(1) Clauses (1) and (2) of section 309(f)(6) are redesignated as clauses (A) and (B), respectively.

89-194 O—82

38:QL3

95 STAT. 567

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Page:United States Statutes at Large Volume 95.djvu/594

 95 STAT. 568 42 USC 242n.

PUBLIC LAW 97-35—AUG. 13, 1981 (2) Subsections (a) and (g) of section 309 are each amended by striking out "Health, Education, and Welfare" and inserting in lieu thereof "Health and Human Services". (j) Section 309(fK7) is amended by striking out "1981" and inserting in lieu thereof "1984". (k) Subsection (g) of section 309 is repealed and subsections (h) and (i) are redesignated as subsections (g) and (h), respectively. NATIONAL RESEARCH SERVICE AWARDS

SEC. 924. (a)(1) Section 472(a)(l)(A) (42 U.S.C. 2891-l(a)(l)(A)) is amended— (A) by inserting "and" after the comma in clause (iii); (B) by striking out clauses (iv), (v), and (vi); (C) by redesignating clause (vii) as clause (iv); and (D) by striking out "and the research described in clause (vi)" in clause (iv) (as redesignated by subparagraph (C) of this paragraph). (2) Section 472(a)(3) is amended to read as follows: "(3) In awarding National Research Service Awards under this section, the Secretary shall take account of the Nation's overall need for biomedical research personnel by giving special consideration to physicians who agree to undertake a minimum of two years of bioiTifidicdl. rGSfiS-rch (b)(1) Section 472(b)(l)(C) is amended by striking out "or (a)(l)(A)(iv)". (2) Section 472(b)(2) is amended by striking out "Health, Education, jand Welfare" and inserting in lieu thereof "Health and Human Services". (3) The first sentence of section 472(b)(5) is amended by inserting a comma and "tuition, fees," after "stipends". (c)(1) Section 472(c)(l) is amended to read as follows: "(c)(1) Each individual who is awarded a National Research Service Award (other than an individual who is a prebaccalaureate student who is awarded a National Research Service Award for research training) shall, in accordance with paragraph (3), engage in health research or teaching or any combination thereof which is in accordance with the usual patterns of academic employment, for a period computed in accordance with paragraph (2).". (2) Section 472(c)(2) is amended to read as follows: "(2) For each month for which an individual receives a National Research Service Award which is made for a period in excess of twelve months, such individual shall engage in one month of health research or teaching or any combination thereof which is in accordance with the usual patterns of academic employment.". (3) The second sentence of section 472(c)(3) is amended to read as follows: "The Secretary shall by regulation prescribe the type of research and teaching in which an individual may engage to comply with such requirement and such other requirements respecting research and teaching as the Secretary considers appropriate.. (d) The first sentence of section 472(d) is amended by striking out "and" after "1980," and by inserting before the period a comma and "$182,000,000 for the fiscal year ending September 30, 1982, and $195,000,000 for thefiscalyear ending September 30, 1983". (e) Section 473(c) (42 U.S.C. 2891-2(c)) is amended (1) by striking out "Interstate and Foreign Commerce" and inserting in lieu thereof "Energy and Commerce", and (2) by striking out Public Welfare" and inserting in lieu thereof "Human Resources".

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Page:United States Statutes at Large Volume 95.djvu/595

 PUBLIC LAW 97-35—AUG. 13, 1981

95 STAT. 569

EXTENSION OF ASSISTANCE FOR LIBRARIES; MISCELLANEOUS

SEC. 925. (a) Section 890(c) (42 U.S.C. 280b(c)) is amended by striking out "and" after "1980," and by inserting before the period a comma and the following: "and $7,500,000 for the fiscal year ending September 30, 1982". (b) Section 434(d)(1) (42 U.S.C. 289c-l(d)(l)) is amended by inserting 94 Stat. 3184. "musculoskeletal and skin diseases," after "arthritis,".

Subtitle D—Categorical Programs PREVENTIVE HEALTH SERVICE PROGRAMS

SEC. 928. (a) Subsection (a) of section 317(a) of the Public Health Service Act (42 U.S.C. 247b) is amended to read as follows: "(a) The Secretary may make grants to States, and in consultation with State health authorities, to political subdivisions of States and to other public entities to assist them in meeting the costs of establishing and maintaining preventive health service programs.". (b) Subsection (j) of such section (42 U.S.C. 247b(j)(l)(A)) is amended to read as follows: "(j)(l) For grants under subsection (a) for preventive health service programs to immunize children against immunizable diseases there are authorized to be appropriated $29,500,000 for the fiscal year ending September 30, 1982, $32,000,000 for the fiscal year ending September 30, 1983, and $34,500,000 for the fiscal year ending September 30, 1984. "(2) For grants under subsection (a) for preventive health service programs for tuberculosis there are authorized to be appropriated $9,000,000 for the fiscal year ending September 30, 1982, $10,000,000 for the fiscal year ending September 30, 1983, and $11,000,000 for the fiscal year ending September 30, 1984.". PREVENTION AND CONTROL OF VENEREAL DISEASES

SEC. 929. The first sentence of section 318(d)(1) of the Public Health Service Act (42 U.S.C. 247c(d)(l)) is amended by striking out "and" after "1980," and by inserting before the period a comma and the following: "$40,000,000 for the fiscal year ending September 30, 1982, $46,500,000 for the fiscal year ending September 30, 1983, and $50,000,000 for the fiscal year ending September 30, 1984". EXTENSION OF PROGRAM FOR MIGRANT HEALTH CENTERS

SEC. 930. (a) Section 329(h) of the Public Health Service Act (42 U.S.C. 247d(h)) is amended by striking out paragraphs (1), (2), and (3) 42 USC 254b. and inserting in lieu thereof the following: "(h)(1) For the purposes of subsections (c), (d), and (e), 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, and $51,000,000 for the fiscal year ending September 30, 1984. The Secretary may not obligate for grants and contracts under subsection (c)(1) 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) in any fiscal year an amount which exceeds 5 per centum of such funds, and the Secretary may not obligate for contracts under

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Page:United States Statutes at Large Volume 95.djvu/596

 95 STAT. 570

42 USC 254b.

PUBLIC LAW 97-35—AUG. 13, 1981 subsection (e) in any fiscal year an amount which exceeds 10 per centum of such funds.". (b) Paragraph (4) of section 329(h) is redesignated as paragraph (2). FAMILY PLANNING PROGRAMS

SEC. 931. (a)(1) Section 1001(c) of the Public Health Service Act (42 U.S.C. 300(c)) is amended by striking out "and" after "1980," and by inserting before the period a comma and the following: "$126,510,000 for the fiscal year ending September 30, 1982; $139,200,000 for the fiscal year ending September 30, 1983; and $150,830,000 for the fiscal year ending September 30, 1984". (2) Section 1003(b) of such Act (42 U.S.C. 300a-l(b)) is amended by striking out "and" after "1980," and by inserting before the period a comma and the following: "$2,920,000 for the fiscal year ending September 30, 1982; $3,200,000 for the fiscal year ending September 30, 1983; and $3,500,000 for the fiscal year ending September 30, 1984". (3) Section 1005(b) of Such Act (42 U.S.C. 300a-3(b)) is amended by striking out "and" after "1980," and by inserting before the period a comma and the following: "$570,000 for the fiscal year ending September 30, 1982; $600,000 for the fiscal year ending September 30, 1983; and $670,000 for the fiscal year ending September 30, 1984". (b)(1) Section 1001(a) of such Act is amended by adding at the end the following: "To the extent practiced, entities which receive grants or contracts under this subsection shall encourage familiy participation in projects assisted under this subsection.". 42 USC 300a-2. (2) Section 1004 is amended by striking out "(a)" after "SEC. 1004." and by striking out subsection (b). ^tudy. (c) The Secretary of Health and Human Services shall conduct a note study of the possible ways of State delivery of the services for which 42 USC 300. assistance is authorized by title X of the Public Health Service Act and the willingness and ability of the States to assume the adminisReport to tration of activities assisted under such title X. The Secretary shall Congress. report to the Congress on the results of such study 18 months after the date of the enactment of this Act.

Subtitle E—Health Planning AUTHORIZATIONS

SEC. 933. (a)(1) Section 1516(d)(1) of the Public Health Service Act (42 U.S.C. 3001-5(d)(l)) is amended by inserting "and" after "1980," and by inserting a period after "1981' and striking out the remainder of such section. (2) Section 1525(c) of such Act (42 U.S.C. 300m-4(c)) is amended by inserting "and" after "1980," and by inserting a period after "1981^' and striking out the remainder of such section. (3) Section 1534(d) of such Act (42 U.S.C. 300n-3(d)) is amended by inserting "and" after "1980," and by inserting a period after "198r' and striking out the remainder of such section. (b) Part D of the Public Health Service Act is amended by adding at the end the following: "AUTHORIZATIONS FOR FISCAL YEAR 1982

42 USC 300n-6

"SEC. 1537. For grants and contracts under sections 1516(a), 1525(a), and 1534(a) there is authorized to be appropriated $102,000,000 for

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Page:United States Statutes at Large Volume 95.djvu/597

 PUBLIC LAW 97-35—AUG. 13, 1981

95 STAT. 571

fiscal year 1982. Of the amount appropriated under this section, not more than $65,000,000 may be used for grants under section 1516(a).". MINIMUM G R A N T; WAIVER OF REQUIREMENTS

SEC. 934. (a) Section 1516(c)(l)(C)(iv) of the Public Health Service Act is amended by striking out "$260,000" and inserting in lieu thereof "$100,000". (b) The Secretary of Health and Human Services may— (1) upon application waive the application of the requirements of subsection (e), (g), or (h) of section 1513 of the Public Health Service Act, or any combination of such subsections, to a health systems agency if the Secretary determines that the Federal funds made available to the agency are not sufficient to enable it to meet such requirements or (2) by regulation waive the application of the requirements of subsection (e), (g), or (h) of section 1513 of the Public Health Service Act, or any combination of such subsections, to all health systems agencies if the Secretary determines that the Federal funds made available to all the agencies are not sufficient to enable them to meet such requirements.

42 USC 300/-5. 42 USC 300Z-2 "°*® 42 USC 300/-2.

STATES WITHOUT HEALTH SYSTEMS AGENCIES

SEC. 935. (a)(1) Section 1536 of the Public Health Service Act (42 U.S.C. 300n-5) is amended— (1) by striking out subsection (a), (2) by amending the matter in subsection (b) preceding paragraph (1) to read as follows: "Upon application of the chief executive officer of a State or the Commonwealth of Puerto Rico, the Virgin Islands, Guam, the Trust Territory of the Pacific Islands, the Northern Mariana Islands, or AmericEm Samoa, it shall, upon approval of the application, be considered to be a State for purposes of this title and", (3) by striking out "sections 1516 and 1640" and inserting in lieu thereof "section 1640", and (4) by adding after and below paragraph (4) the following: "An application made under this section for a fiscal year shall be made not later than November 1 in that fiscal year and shall contain the certification of the chief executive officer that the State is willing and able to meet the purposes of this title in such fiscal year without any health systems agency in the State.". (b) A State which— (1) because of section 1536(b) of the Public Health Service Act (as in effect on September 30, 1981) received a grant under section 1516 of such Act for fiscal year 1981, and (2) had an application under section 1536 of such Act (as amended by subsection (a)) approved, shall be eligible to receive a grant under section 1516 of such Act for fiscal year 1982. (c) If a State which on the date of the enactment of this Act has a population of less than 600,000 and has only one health service area has an application approved under this section, such State shall be eligible to receive a grant under section 1516 of the Public Health Service Act for fiscal year 1982. (d) The last sentence of section 1512(b)(5) of the Public Health Service Act (42 U.S.C. 3001-l(b)(5)) is amended by inserting before the period the following: "or health insurance".

42 USC 300Z-5 '^"^

42 USC 300/-5 "°*®

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Page:United States Statutes at Large Volume 95.djvu/598

 95 STAT. 572

PUBLIC LAW 97-35—AUG. 13, 1981 CERTIFICATE OF NEED REVIEW

SEC. 936. (a) Section 1531 of the Public Health Service Act (42 U.S.C. 300n) is amended— (1) by striking out "$75,000" each place it occurs in paragraph (5) and inserting in lieu thereof "$250,000"; (2) by striking out "$150,000" each place it occurs in paragraph (6) and inserting in lieu thereof "$600,000"; and (3) by striking out "$150,000" each place it occurs in paragraph (7) and inserting in lieu thereof "$400,000". QoXD Section 1521(d)(1)(B) of the Public Health Service Act (42 U.S.C. 300m(d)(l)(B)(ii)) is amended— (A) by strUdng out "twelve months" the second time it appears in clause (i) and inserting in lieu thereof "twenty-four months", and (B) by striking out "twelve months" the second time it appears in clause (ii) and inserting in lieu thereof "twenty-four months". (2) The first sentence of section 1521(b)(2)(B) of such Act is amended to read as follows: "The period of an agreement described in subparagraph (A) shall not extend beyond the period set forth in subsection (d)(1)(B).". EFFECTIVE DATE 42 USC 300Z-1 note.

SEC. 937. The amendments made by this subtitle shall take effect October 1, 1981.

Health Maintenance Organization Amendments of 1981.

Subtitle F—Health Maintenance Organizations CHAPTER 10—HEALTH MAINTENANCE ORGANIZATIONS SHORT TITLE; REFERENCE TO ACT

42 USC 201 note.

42 USC 201 note.

SEC. 940. (a) This subtitle may be cited as the "Health Maintenance Organization Amendments of 1981". (b) Whenever in this subtitle an amendment or repeal is expressed in terms of an amendment to, or repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of the Public Health Service Act. EXTENSIONS

42 USC 300e-2, 300e-3.

42 USC 242a, 242b. 42 USC 300e-16.

42 USC 300e-7.

SEC. 941. (a) Subsection (a) of section 1309 (42 U.S.C. 300e-8(a)) is amended to read as follows: "(a)(1) For grants and contracts under sections 1303 and 1304 there is authorized to be appropriated $20,000,000 for the fiscal years 1982, 1983, and 1984, No funds appropriated under this paragraph may be expended or obligated for a grant or contract unless the entity received a grant or contract under section 303 or 304 during or before the fiscal year 1981. "(2) For grants under section 1317 there is authorized to be appropriated $1,000,000 for each of the fiscal years 1982, 1983, and 1984.'^ O> Subsection (b) of section 1309 is amended to read as follows: t) "(b) To maintain in the loan fund established under section 1308(e) for the purpose of making new loans a balance of at least $5,000,000 at the end of each fiscal year and to meet the obligations of the loan fund resulting from defaults on loans made from the fund and to meet the other obligations of the fund, there is authorized to be appropriated to

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Page:United States Statutes at Large Volume 95.djvu/599

 PUBLIC LAW 97-35—AUG. 13, 1981

95 STAT. 573

the loan fund for fiscal years 1982, 1983, and 1984, such sums as may be necessary to assure such balance and meet such obligations.'. (c) Section 1304(j) (42 U.S.C. 300e-3(j)) is amended by striking out "1981" and inserting in lieu thereof "1984". REVISION OF REQUIREMENTS FOR HEALTH MAINTENANCE ORGANIZATIONS

SEC. 942. (a)(1) Section 1301(b)(3) is amended (A) by striking out 42 USC 300e. subparagraph (C), and (B) by redesignating subparagraphs (D) and (E) as subparagraphs (C) and (D), respectively. (2) Section 1301(b)(3)(A)(iv) is amended by striking out "subject to subparagraph (C),". (3)(A) Section 1310(b)(1) (42 U.S.C. 300e-9(b)(l)) is amended by striking out "provides basic health services" and inserting in lieu thereof "provides more than one-half of its basic health services which are provided by physicians". (B) Section 1310(b)(2) is amended by striking out "basic health services" and inserting in lieu thereof "its basic health services which are provided by physicians". (4) Section 1310(b)(2) (42 U.S.C. 300e-9(b)(2)) is amended by striking out "or (B)" and inserting in lieu thereof "(B) individual physicians and other health professionals under contract with the organization, or(C)". (5) The amendment made by paragraph (3)(A) shall apply with ^^ use 300e-9 respect to the offering of a health maintenance organization in note. accordance with section 13100t>Xl) of the Public Health Service Act after four years after the date the organization becomes a qualified health maintenance organization for purposes of section 1310 of such Act if the health maintenance organization provides assurances satisfactory to the Secretary that upon the expiration of such four years it will provide more than one half of its basic health services which are provided by physicians through physicians or other health professionals who are members of the staff of the organization or a medical group (or groups). (b)(1) Section 1301(b)(3)(B) is amended by striking out "(i)", by striking out clause (ii), and by redesignating subclauses (I) and (II) as clauses (i) and (ii), respectively. (2) Subparagraph (D) of section 1301(b)(3) is amended to read as follows: "(D) Contracts between a health maintenance organization and health professionals for the provision of basic and supplemental health services shall include such provisions as the Secretary may require, but only to the extent that such requirements are designed to insure the delivery of quality health care services and sound fiscal management.". (c)(1) The first sentence of section 1301(b)(4) (42 U.S.C. 300e(b)(4)) is amended by inserting before the period a comma and the following: "except that a health maintenance organization which has a service area located wholly in a nonmetropolitan area may make a basic health service avauable outside its service area if that basic health service is not a primary care or emergency health care service and if there is an insufficient number of providers of that basic health service within the service area who will provide such service to members of the health maintenance organization". (2) The first sentence of section 1301(b)(4) is amended by striking out "promptly as appropriate" and inserting in lieu thereof "with reasonable promptness".

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Page:United States Statutes at Large Volume 95.djvu/600

 95 STAT. 574 42 USC 300e.

42 USC 300e-9.

PUBLIC LAW 97-35—AUG. 13, 1981 (d)(1) Section 1301(c) is amended by striking out paragraphs (4), (9), and (10), by redesignating paragraphs (5) through (8) as paragraphs (4) through (7), by redesignating paragraph (11) as paragraph (9), and by adding after paragraph (7) (as so redesignated) the following new paragraph: "(8) adopt at least one of the following arrangements to protect its members from incurring liability for payment of any fees which are the legal obligation of such organization— "(A) a contractual arrangement with any hospital that is regularly used by the members of such organization prohibiting such hospital from holding any such member liable for payment of any fees which are the legal obligation of such organization; (B) insolvency insurance, acceptable to the Secretary; "(C) adequate financial reserve, acceptable to the Secretary; and . (D) other arrangements, acceptable to the Secretary, to protect members, except that the requirements of this paragraph shall not apply to a health maintenance organization if applicable State law provides the members of such organization with protection from liability for payment of any fees which are the legal obligation of such organization; and". (2) Subsection (d) of section 1301 is repealed. (e) Section 1301(c)(2) (42 U.S.C. 300e(c)(2)) is amended— (1) by striking out "obtain insurance or make other arrangements", (2) by inserting "obtain insurance or make other arrangements'^^after "(A)^, "(B)", and "(C)", (3) by striking out "and (C)" and inserting in lieu thereof "(C)", and (4) by inserting before the semicolon a comma and the following: "and (D) make arrangements with physicians or other health professionals, health care institutions, or any combination of such individuals or institutions to assume all or part of the financial risk on a prospective basis for the provision of basic health services by the physicians or other health professionals or through the institutions". (f) The last sentence of section 1302(1) (42 U.S.C. 300e-l(l)) is repealed. (g)(1) The first sentence of section 1302(2) (42 U.S.C. 300e-l(2)) is amended to read as follows: "The term 'supplemental health services' means any health service which is not included as a basic health service under paragraph (1) of this section.". (2) The second sentence of such section is amended by striking out "If a service of a physician described in the preceding sentence' and inserting in lieu thereof "If a health service provided by a physician". (3) The last sentence of such section is repealed. (h) Section 1302(4)(C) is amended by inserting before the semicolon at the end of clause (i) the following:, except that this clause does not apply before the end of the forty-eight month period beginning after the month in which the health maintenance oranization becomes a qualified health maintenance organization as defined in section 1310(d), or as authorized by the Secretary in accordance with regulations that take into consideration the unusual circumstances of the group". (i) Section 1302(5)(B) is amended by striking out "feasible (1)" and inserting in lieu thereof "feasible," and by striking out "administra-

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Page:United States Statutes at Large Volume 95.djvu/601

 PUBLIC LAW 97-35—AUG. 13, 1981 tive staff and all that follows in such section and inserting in lieu thereof "administrative staff.". 0) Section 1302(8) (42 U.S.C. 300e-l(8)) is amended to read as follows: "(8)(A) The term 'community rating system' means the systems, described in subparagraphs (B) and (C), of fixing rates of payments for health services. A health maintenance organization may fix its rates of payments under the system described in subparagraph (B) or (C) or under both such systems, but a health maintenance organization may use only one such system for fixing its rates of payments for any one group. "(B) A system of fixing rates of payment for health services may provide that the rates shall be fixed on a per-person or per-family basis and may authorize the rates to vary with the number of persons in a family, but, except as authorized in subparagraph (D), such rates must be equivalent for all individuals and for all families of similar composition. "(C) A system of fixing rates of payment for health services may provide that the rates shall be fixed for individuals and families by groups. Except as authorized in subparagraph (D), such rates must be equivalent for all individuals in the same group and for all families of similar composition in the same group. If a health maintenance organization is to fix rates of payment for individuals and families by groups, it shall— "(i) classify all of the members of the organization into classes based on factors which the health maintenance organization determines predict the differences in the use of health services by the individuals or families in each class and which have not been disapproved by the Secretary, "(ii) determine its revenue requirements for providing services to the members of each class established under clause (i), and "(iii) fix the rates of payment for the individuals and families of a group on the basis of a composite of the organization's revenue requirements determined under clause (ii) for providing services to them as members of the classes established under clause (i). The Secretary shall review the factors used by each health maintenance organization to establish classes under clause (i). If the Secretary determines that any such factor may not reasonably be used to predict the use of the health services by individuals and families, the Secretary shall disapprove such factor for such purpose. "(D) The following differentials in rates of payments may be established under the systems described in subparagraphs (B) and (C): "(i) Nominal differentials in such rates may be established to reflect differences in marketing costs and the different administrative costs of collecting payments from the following categories of members: "(I) Individual members (including their families). "(II) Small groups of members (as determined under regulations of the Secretary). "(Ill) Large groups of members (as determined under regulations of the Secretary). "(ii) Nominal differentials in such rates may be established to reflect the compositing of the rates of payment in a systematic manner to accommodate group purchasing practices of the various employers. "(iii) Differentials in such rates may be established for members enrolled in a health maintenance organization pursuant to a contract with a governmental authority under section 1079 or

95 STAT. 575

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Page:United States Statutes at Large Volume 95.djvu/602

 95 STAT. 576

5 USC 8901 et

PUBLIC LAW 97-35—AUG. 13, 1981 1086 of title 10, United States Code, or under any other governmental program (other than the health benefits program authorized by chapter 89 of title 5, United States Code) or any health benefits program for employees of States, political subdivision of States, and other public entities.". INITIAL OPERATION COSTS

SEC. 943. (a) Section 1805(a) (42 U.S.C. 300e-4) is amended— (1) by striking out "nonprofit" in paragraphs (1) and (2), and (2) by amending paragraph (3) to read as follows: "(3) guarantee to non-Federal lenders payment of the principal of and the interest on loans made to private health maintenance organizations for the amounts referred to in paragraphs (1) and (2).". (b) Section 1305(b)(l) is amended to read as follows: "(b)(1) Except as provided in paragraph (2), the aggregate amount of principal of loans made or guaranteed, or both, under subsection (a) for a health maintenance organization may not exceed $7,000,000. In any twelve-month period the amount disbursed to a health maintenance organization under this section (either directly by the Secretary, by an escrow agent under the terms of an escrow agreement, or by a lender under a guaranteed loan) may not exceed $3,000,000.". (c) Section 1305(d) is amended by striking out "1981" and inserting in lieu thereof "1986". (d) Subsection (e) of section 1307 (42 U.S.C. 300e-6) is repealed. AMBULATORY FACILITIES

SEC. 944. (a) Section 1305A(a) (42 U.S.C. 300e-4a(a)) is amended— (1) by striking out "nonprofit" in paragraph (1), and (2) by amending paragraph (2) to read as follows: "(2) guarantee to non-Federal lenders for their loans to private health maintenance organizations for projects described in paragraph (1) the payment of principal and interest on such loans.", (b) Subsections (b) and (c) of section 1305A are redesignated as subsections (c) and (d), respectively, and the following is inserted after subsection (a): "(b) No loan may be made to a health maintenance organization and no loan to a health maintenance organization may be guaranteed under subsection (a) unless the application of the health maintenance organization for such loan or loan guarantee contains assurances satisfactory to the Secretary that— "(1) at the time the application is made the health maintenance organization isfiscallysound; "(2) if the application is for a loan, the health maintenance organization is unable to secure a loan, at the rate of interest prevailing in the area in which the organization is located, from non-Federal lenders for the project with respect to which the application is submitted, or, if the application is for a loan guarantee, the health maintenance organization would be unable to secure a loan from such lenders for such project without the loan guarantee; and "(3) during the period of the loan or loan guarantee, the health maintenance organization will remain fiscally sound.".

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 PUBLIC LAW 97-35—AUG. 13, 1981

95 STAT. 577

LOANS

SEC. 945. Section 1308(b)(2) (42 U.S.C. 300e-7(b)(2)) is amended— (1) by amending clause (D) to read as follows: "(D) on the date the loan is made, bear interest at a rate comparable to the rate of interest prevailing on such date with respect to marketable obligations of the United States of comparable maturities, adjusted to provide for appropriate administrative charges, and"; and (2) by adding at the end the following: "On the date disbursements are made under a loan after the initial disbursement under the loan, the Secretary may change the rate of interest on the amount of the loan disbursed on that date to a rate which is comparable to the rate of interest prevailing on the date the subsequent disbursement is made with respect to marketable obligations of the United States of comparable maturities, adjusted to provide for appropriate administrative charges.". DUAL CHOICE

SEC. 946. (a) Section 1310(d) (42 U.S.C. 300e-9(d)) is amended by adding at the end the following: "Every two years (or such longer period as the Secretary may by regulation prescribe) after the date a health maintenance organization becomes a qualified health maintenance organization under this subsection, the health maintenance organization must demonstrate to the Secretary that it is qualified within the meaning of this subsection.". (b) Section 1310(f)(1) is amended by inserting before the semicolon a comma and the following: "except that such term includes nonappropriated fund instrumentalities of the Government of the United States". REPEAL OF SPECIAL CONSIDERATIONS

SEC. 947. (a) Section 1303 (42 U.S.C. 300e-2) is amended by striking out subsection (i). (b) Section 1304 (42 U.S.C. 300e-3) is amended by striking out subsection (k). (c) Section 1305 (42 U.S.C. 300e-4) is amended by striking out subsection (e). FINANCIAL DISCLOSURE

SEC. 948. (a) Subsection (a)(2) of section 1318 (42 U.S.C. 300e-17) is amended to read as follows: "(2) A copy of the report, if any, filed with the Health Care Financing Administration containing the information required to be reported under section 1124 of the Social Security Act by 42 USC i320a-3. disclosing entities and the information required to be supplied under section 1902(a)(38) of such Act.". 42 USC I396a. (b) Subsection (a)(3)(B) of such section is amended to read as follows: "(B) any furnishing for consideration of goods, services (including management services), or facilities between the health maintenance organization and a party in interest, but not including salaries paid to employees for services provided in the normal course of their employment and health services provided to members by hospitals and other providers and by staff, medical group (or groups), individual practice association (or associations), or any combination thereof: and".

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Page:United States Statutes at Large Volume 95.djvu/604

 95 STAT. 578

PUBLIC LAW 97-35—AUG. 13, 1981

42 USC 300e-i7.

(Q) Subsection (b)(1) of such section is amended by striking out "employee" and inserting in lieu thereof "employee responsible for management or administration". (d) Subsection (b)(4) of such section is amended to read as follows: "(4) any spouse, child, or parent of an individual described in paragraph (1).". MISCELLANEOUS

Repeals.

Effective date. 42 USC 300m-6

SEC. 949. (a) The third sentence of section 1312(b)(1) (42 U.S.C. 300e-l 1(b)(1)) is amended by inserting after "Secretary prescribes" the following: ", then after the Secretary provides the entity a reasonable opportunity for reconsideration of his determination, including, at the entity s election, a fair hearing". (b) Sections 1314 and 1316 (42 U.S.C. 300e-13,300e-15) are repealed, (c) Section 1527(b)(l) (42 U.S.C. 300m-6(b)(l)) is amended— (1) by striking out clause (i) in subparagraph (A) and by redesignating clauses (ii) and (iii) as clauses (i) and (ii), respectively, (2) by striking out "such enrolled individuals" in subparagraph (A) and inserting in lieu thereof "individuals enrolled in such organization or organizations", (3) by striking out "which has, in the service area of the organization or service areas of the organizations in the combination, an enrollment of at least 50,000 individuals" in subparagraph (B)(ii), (4) by striking out "such enrolled individuals" in subparagraph (B)(iii) and inserting in lieu thereof "individuals enrolled in such organization or organizations", (5) by striking out "which has, in the service area or the organization or service areas of the organizations in the combination, an enrollment of at least 50,000 individuals" in subparagraph (C)(i), and (6) by striking out "such enrolled individuals" in subparagraph (C)(ii) and inserting in lieu thereof "individuals enrolled in such organization or organizations". (d) The amendments made by subsection (c) shall take effect October 1, 1982.

note.

Subtitle G—Adolescent Family Life SEC. 955. (a) The Public Health Service Act is amended by adding at the end thereof the following new title: "TITLE XX—ADOLESCENT FAMILY LIFE DEMONSTRATION PROJECTS "FINDINGS AND PURPOSES

42 USC 300z.

"SEC. 2001. (a) The Congress finds that— "(1) in 1978, an estimated one million one hundred thousand teenagers became pregnant, more than five hundred thousand teenagers carried their babies to term, and over one-half of the babies born to such teenagers were born out of wedlock; "(2) adolescents aged seventeen and younger accounted for more than one-half of the out of wedlock births to teenagers; "(3) in a high proportion of cases, the pregnant adolescent is herself the product of an unmarried parenthood during adolescence and is continuing the pattern in her own lifestyle;

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Page:United States Statutes at Large Volume 95.djvu/605

 PUBLIC LAW 97-35—AUG. 13, 1981 "(4) it is estimated that approximately 80 per centum of unmarried teenagers who carry their pregnancies to term live with their families before and during their pregnancy and remain with their families after the birth of the child; "(5) pregnancy and childbirth among unmarried adolescents, particularly young adolescents, often results in severe adverse health, social, and economic consequences, including: a higher percentage of pregnancy and childbirth complications; a higher incidence of low birth weight babies; a higher frequency of developmental disabilities; higher infant mortality and morbidity; a decreased likelihood of completing schooling; a greater likelihood that an adolescent marriage will end in divorce; and higher risks of unemployment and welfare dependency; (6)(A) adoption is a positive option for unmarried pregnant adolescents who are unwilling or unable to care for their children since adoption is a means of providing permanent families for such children from available approved couples who are unable or have difficulty in conceiving or carrying children of their own to term; and "(B) at present, only 4 per centum of unmarried pregnant adolescents who carry their babies to term enter into an adoption plan or arrange for their babies to be cared for by relatives or friends; "(7) an unmarried adolescent who becomes pregnant once is likely to experience recurrent pregnancies and childbearing, with increased risks; "(8)(A) the problems of adolescent premarital sexual relations, pregnancy, and parenthood are multiple and complex and are frequently associated with or are a cause of other troublesome situations in the family; and "(B) such problems are best approached through a variety of integrated and essential services provided to adolescents and their families by other family members, religious and charitable organizations, voluntary associations, and other groups in the private sector as well as services provided by publicly sponsored initiatives; "(9) a wide array of educational, health, and supportive services are not available to adolescents with such problems or to their families, or when available frequently are fragmented and thus are of limited effectiveness in discouraging adolescent premarital sexual relations and the consequences of such relations; "(10)(A) prevention of adolescent sexual activity and adolescent pregnancy depends primarily upon developing strong family values and close family ties, and since the family is the basic social unit in which the values and attitudes of adolescents concerning sexuality and pregnancy are formed, programs designed to deal with issues of sexuality and pregnancy will be successful to the extent that such programs encourage and sustain the role of the family in dealing with adolescent sexual activity and adolescent pregnancy; "(B) Federal policy therefore should encourage the development of appropriate health, educational, and social services where such services are now lacking or inadequate, and the better coordination of existing services where they are available; and "(C) services encouraged by the Federal Government should promote the involvement of parents with their adolescent chil-

95 STAT. 579

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Page:United States Statutes at Large Volume 95.djvu/606

 95 STAT. 580

PUBLIC LAW 97-35—AUG. 13, 1981 dren, and should emphasize the provision of support by other family members, religious and charitable organizations, voluntary associations, and other groups in the private sector in order to help adolescents and their families deal with complex issues of adolescent premarital sexual relations and the consequences of such relations; and "(11)(A) there has been limited research concerning the societal causes and consequences of adolescent pregnancy; "(B) there is limited knowledge concerning which means of intervention are effective in mediating or eliminating adolescent premarital sexual relations and adolescent pregnancy; and "(C) it is necessary to expand and strengthen such knowledge in order to develop an array of approaches to solving the problems of adolescent premarital sexual relations and adolescent pregnancy in both urban and rural settings. "(b) Therefore, the purposes of this title are— "(1) to find effective means, within the context of the family, of reaching adolescents before they become sexually active in order to maximize the guidance and support available to adolescents from parents and other family members, and to promote self discipline and other prudent approaches to the problem of adolescent premarital sexual relations, including adolescent pregnancy; "(2) to promote adoption as an alternative for adolescent parents; "(3) to establish innovative, comprehensive, and integrated approaches to the delivery of care services for pregnant adolescents, with primary emphasis on unmarried adolescents who are seventeen years of age or under, and for adolescent parents, which shall be based upon an assessment of existing programs and, where appropriate, upon efforts to establish better coordination, integration, and linkages among such existing programs in order to— "(A) enable pregnant adolescents to obtain proper care and assist pregnant adolescents and adolescent parents to become productive independent contributors to family and community life; and "(B) assist families of adolescents to understand and resolve the societal causes which are associated with adolescent pregnancy; "(4) to encourage and support research projects and demonstration projects concerning the societal causes and consequences of adolescent premarital sexual relations, contraceptive use, pregnancy, and child rearing; "(5) to support evaluative research to identify effective services which alleviate, eliminate, or resolve any negative consequences of adolescent premarital sexual relations and adolescent childbearing for the parents, the child, and their families; and "(6) to encourage and provide for the dissemination of results, findings, and information from programs and research projects relating to adolescent premarital sexual relations, pregnancy, and parenthood. "DEFINITIONS

42 USC 300Z-1.

"SEC. 2002. (a) For the purposes of this title, the term— "(1) 'Secretary' means the Secretary of Health and Human Services; "(2) 'eligible person' means—

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 PUBLIC LAW 97-35—AUG. 13, 1981 "(A) with regard to the provision of care services, a pregnant adolescent, an adolescent parent, or the family of a pregnant adolescent or an adolescent parent; or "(B) with regard to the provision of prevention services and referral to such other services which may be appropriate, a nonpregnant adolescent; "(3) 'eligible grant recipient' means a public or nonprofit private organization or agency which demonstrates, to the satisfaction of the Secretary— "(A) in the case of an organization which will provide care services, the capability of providing all core services in a single setting or the capability of creating a network through which all core services would be provided; or "(B) in the case of an organization which will provide prevention services, the capability of providing such services; "(4) 'necessary services' means services which may be provided by grantees which are— "(A) pregnancy testing and maternity counseling; "(B) adoption counseling and referral services which present adoption as an option for pregnant adolescents, including referral to licensed adoption agencies in the community if the eligible grant recipient is not a licensed adoption agency; "(C) primary and preventive health services including prenatal and postnatal care; "(D) nutrition information and counseling; "(E) referral for screening and treatment of venereal disease; "(F) referral to appropriate pediatric care; "(G) educational services relating to family life and problems associated with adolescent premarital sexual relations, including— "(i) information about adoption; "(ii) education on the responsibilities of sexuality and parenting; "(iii) the development of material to support the role of parents as the provider of sex education; and "(iv) assistance to parents, schools, youth agencies, and health providers to educate adolescents and preadolescents concerning self-discipline and responsibility in human sexuality; "(H) appropriate educational and vocational services and referral to such services; "(I) referral to licensed residential care or maternity home services; and "(J) mental health services and referral to mental health services and to other appropriate physical health services; "(K) child care sufficient to enable the adolescent parent to continue education or to enter into employment; "(L) consumer education and homemaking; "(M) counseling for the immediate and extended family members of the eligible person; "(N) transportation; "(O) outreach services to families of adolescents to discourage sexual relations among unemancipated minors; "(P) family planning services; and

95 STAT. 581

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 95 STAT. 582

PUBLIC LAW 97-35—AUG. 13, 1981

"(Q) such other services consistent with the purposes of this title as the Secretary may approve in accordance with regulations promulgated by the Secretary; "(5) 'core services' means those services which shall be provided by a grantee, as determined by the Secretary by regulation; "(6) 'supplemental services' means those services which may be provided by a grantee, as determined by the Secretary by regulation; "(7) 'care services' means necessary services for the provision of care to pregnant adolescents and adolescent parents and includes all core services with respect to the provision of such care prescribed by the Secretary by regulation; "(8) 'prevention services' means necessary services to prevent adolescent sexual relations, including the services described in subparagraphs (A), (D), (E), (G), (H), (M), (N), (O), and (Q) of paragraph (4); "(9) 'adolescent' means an individual under the age of nineteen; and "(10) 'unemancipated minor' means a minor who is subject to the control, authority, and supervision of his or her parents or guardians, as determined under State law. "(b) Until such time as the Secretary promulgates regulations pursuant to the second sentence of this subsection, the Secretary shall use the regulations promulgated under title VI of the Health 42 USC 300a-2i. Services and Centers Amendments of 1978 which were in effect on the date of enactment of this title, to determine which necessary services are core services for purposes of this title. The Secretary may promulgate regulations to determine which necessary services are core services for purposes of this title based upon an evaluation of and information concerning which necessary services are essential to carry out the purposes of this title and taking into account (1) factors such as whether services are to be provided in urban or rural areas, the ethnic groups to be served, and the nature of the populations to be served, and (2) the results of the evaluations required under section 2006(b). The Secretary may from time to time revise such regulations. "AUTHORITY TO MAKE GRANTS FOR DEMONSTRATION PROJECTS

42 USC 300Z-2.

"SEC. 2008. (a) The Secretary may make grants to further the purposes of this title to eligible grant recipients which have submitted an application which the Secretary finds meets the requirements of section 2006 for demonstration projects which the Secretary determines will help communities provide appropriate care and prevention services in easily accessible locations. Demonstration projects shall, as appropriate, provide, supplement, or improve the quality of such services. Demonstration projects shall use such methods as will strengthen the capacity of families to deal with the sexual behavior, pregnancy, or parenthood of adolescents and to make use of support systems such as other family members, friends, religious and charitable organizations, and voluntary associations. "(b) Grants under this title for demonstration projects may be for the provision of— "(1) care services; "(2) prevention services; or "(3) a combination of care services and prevention services.

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