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Page:United States Statutes at Large Volume 89.djvu/377

 PUBLIC LAW 94-63—JULY 29, 1975

89 STAT. 317

contain such information as the Secretary may require. Except as provided in paragraph (3), an application for a grant under section 203, 204, or 205 shall contain or be supported by assurances satis- Ante, pp. 312, 314, 316. factory to the Secretary that— "(A) the community mental health center for which the application is submitted will provide, in accordance with regulations of the Secretary (i) an overall plan and budget that meets the requirements of section 1861(z) of the Social Security Act, 42 USC 1395x, and (ii) an effective procedure for developing, compiling, evaluating, and reporting to the Secretary statistics and other information (which the Secretary shall publish and disseminate on a periodic basis and which the center shall disclose at least annually to the general public) relating to (I) the cost of the center's operation, ( II) the patterns of use of its services, ( III) the availability, accessibility, and acceptability of its services, (IV) the impact of its services upon the mental health of the residents of its catchment area, and (V) such other matters as the Secretary may require; " (B) such community mental health center will, in consultation Review. with the residents of its catchment area, review its program of services and the statistics and other information referred to in subparagraph (A) to assure that its services are responsive to the needs of the residents of the catchment area; "(C) to the extent practicable, such community mental health center will enter into cooperative arrangements with health maintenance organizations serving residents of the center's catchment area for the provision through the center of mental health services for the members of such organizations under which arrangements the charges to the health maintenance organizations for such services shall be not less than the actual costs to the center of providing such services; " (D) in the case of a community mental health center serving Limited Englisha population including a substantial proportion of individuals speaking of limited English-speaking ability, the center has (i) developed individuals. a plan and made arrangements responsive to the needs of such population for providing services to the extent practicable in the language and cultural context most ajppropriate to such individuals, and (ii) identified an individual on its staff' who is fluent in both that language and English and whose responsibilities shall include providing guidance to such individuals and to appropriate staff members with respect to cultural sensitivities and bridging linguistic and cultural differences; " (E) such community mental health center has (i) established a requirement that the health care of every patient must be under the supervision of a member of the professional staff, and (ii) provided for having a member of the professional staff available to furnish necessary mental health care in case of an emergency; " (F) such community mental health center has provided appropriate methods and procedures for the dispensing and administering of drugs and biologicals; " (G) in the case of an application for a grant under section 203 for a community mental health center which will provide services to persons in an area designated by the Secretary as an urban or rural poverty area, the applicant will use the additional grant funds it receives, because it will provide services to persons in such an area, to provide services to persons in such area who are unable to pay therefor;

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Page:United States Statutes at Large Volume 89.djvu/378

 89 STAT. 318

Ante, p. 309.

42 USC 1396.

Reimbursements.

42 USC 1395.

Fee schedule.

Ante, p. 312.

PUBLIC LAW 94-63—JULY 29, 1975 " (H) such community mental health center will develop a plan for adequate financial support to be available, and will use its best efforts to insure that adequate financial support will be available, to it from Federal sources (other than this part) and nonFederal sources (including, to the maximum extent feasible, reimbursement from the recipients of consultation and education services and screening services provided in accordance with sections 201(b)(1)(D) and 201 (b)(1)(E)) so that the center will be able to continue to provide comprehensive mental health services when financial assistance provided under this part is reduced or terminated, as the case may be; " (I) such community mental health center (i) has or will have a contractual or other arrangement with the agency of the State, in which it provides services, which administers or supervises the administration of a State plan approved under title X IX of the Social Security Act for the payment of all or a part of the center's costs in providing health services to persons who are eligible for medical assistance under such a State plan, or (ii) has made or will make every reasonable effort to enter into such an arrangement; " (J) such community mental health center has made or will make and will continue to make every reasonable effort to collect appropriate reimbursement for its costs in providing health services to persons who are entitled to insurance benefits under title X VIII of the Social Security Act, to medical assistance under a State plan approved under title X IX of such Act, or to assistance for medical expenses under any other public assistance program or private health insurance program; " (K) such community mental health center (i) has prepared a schedule of fees or payments for the provision of its services designed to cover its reasonable costs of operation and a corresponding schedule of discounts to be applied to the payment of such fees or payments which discounts are adjusted on the basis of the patient's ability to pay; (ii) has made and will continue to make every reasonable effort (I) to secure from patients payment for services in accordance with such approved schedules, and (II) to collect reimbursement for health services to persons described in subparagraph (J) on the basis of the full amount of fees and payments for such services without application of any discount, and (iii) has submitted to the Secretary such reports as he may require to determine compliance with this subparagraph; and "(L) such community mental health center will adopt and enforce a policy (i) under which fees for the4)rovision of mental health services through the center will be paid to the center, and (ii) which prohibits health professionals who provide such services to patients through the center from providing such services to such patients except through the center. An application for a grant under section 203 shall also contain a long-range plan for the expansion of the program of the community mental health center for which the application is submitted for the purpose of meeting anticipated increases in demand by residents of the center's catchment area for the comprehensive mental health services described in section 201(b)(1). Such a plan shall include a description of planned growth in the programs of the center, estimates of increased costs arising from such growth, estimates of the portion of such increased costs to be paid from Federal funds, and anticipated

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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 89.djvu/379

 PUBLIC LAW 94-63—JULY 29, 1975

89 STAT. 319

sources of non-Federal funds to pay the portion of such increased costs not to be paid from Federal funds. "(2) The Secretary may approve an application for a ^ a n t under section 203, 204, or 205 only if the application is recommended for Ante, pp. 312, approval by the National Advisory Mental Health Council, the appli- 314, 316. cation meets the requirements of paragraph (1), and, except as provided in paragraph (3), the Secretary— "(A) determines that the facilities and equipment of the applicant under the application meet such requirements as the Secretary may prescribe; "(B) determines that— " (i) the application contains or is supported by satisfactory assurances that the comprehensive mental health services (in the case of an application for a grant under section 203 or 205) or the consultation and education services (in the case of an application for a grant under section 204) to be provided by the applicant will constitute an addition to, or a significant improvement in quality (as determined in accordance with criteria of the Secretary) of, services that would otherwise be provided in the catchment area of the applicant; "(ii) the application contains or is supported by satisfactory assurances that Federal funds made available under section 203, 204, or 205, as the case may be, will (I) be used to supplement and, to the extent practical, increase the level of State, local, and other non-Federal funds, including thirdparty health insurance payments, that would in the absence of such Federal funds be made available for the applicant's comprehensive mental health services, and (II) in no event supplant such State, local, and other non-Federal funds; "(iii) in the case of an applicant which received a grant from appropriations for the preceding fiscal year, during the year for which the grant was made the applicant met, in accordance with the section under which such grant was made, the requirements of section 201 and complied with the assur- Ante, p. 309. ances which were contained in or supported the applicant's application for such grant; and "(iv) in the case of an application for a grant the amount of which is or may be determined under section 203(c)(2)(B) or 204(b)(3)(B) or under a provision of a repealed section of this title referred to in section 203(e) which authorizes an increase in the ceiling on the amount of a grant to support services to persons in areas designated by the Secretary as urban or rural poverty areas, the application contains or is supported by assurances satisfactory to the Secretary that the services of the applicant will, to the extent feasible, be used by a significant number of persons residing in an area designated by the Secretary as an urban or rural poverty area and requiring such services. "(3) In the case of an application— "(A) for the first grant under section 203(a) for an entity described in section 203(a)(1)(B), or "(B) for the first grant the authority for which is provided by section 203(e), the Secretary may approve such application without regard to the assurances required by the second sentence of paragraph (1) of this subsection and without regard to the determinations required of the Secretary under paragraph (2) of this subsection if the application

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Page:United States Statutes at Large Volume 89.djvu/380

 89 STAT. 320

Evaluation and review. r\T PP; ' '

PUBLIC LAW 94-63—JULY 29, 1975 contains or is supported by assurances satisfactory to the Secretary that the applicant will undertake, during the period for which such first grant is to be made, such actions as may be necessary to enable the applicant, upon the expiration of such period, to make each of the assurances required by paragraph (1) and to enable the Secretary, upon the expiration of such period, to make each of the determinations required by paragraph (2). " (4) In each fiscal year for which a community mental health center receives a grant under section 203,204, or 205, such center shall obligate for a program of continuing evaluation of the effectiveness of its programs in serving the needs of the residents of its catchment area and for a review of the quality of the services provided by the center not less than an amount equal to 2 per centum of the amount obligated by the center in the preceding fiscal year for its operating expenses. " (5) The costs for which grants may be made under section 203(a), 204, or 205 shall be determined in the manner prescribed in regulations of the Secretary issued after consultation with the National Advisory Mental Health Council. "(6) If the Secretary determines under section 203, 204, or 205 that an applicant for a grant under such section— "(A) has not made reasonable efforts to secure payments or reimbursements in accordance with assurances provided under subparagraph (I), (J), or (K) of subsection (c)(1), or "(B) is capable of increasing the amount of payments or reimbursements described in any such subparagraph, the Secretary shall, in the case of a determination described in subparagraph (A), inform the applicant of the respects in which the applicant has not made such reasonable efforts and the manner in which the applicant's performance can be improved and, in the case of a determination described in subparagraph (B), inform the applicant of the manner in which the applicant can increase the amount of such payments. The Secretary shall give to an applicant a reasonble opportunity to respond, before the amount of the grant the applicant is applying for is determined, to a determination described in the preceding sentence. A determination of the Secretary referred to in the first sentence shall be referred to the National Advisory Mental Health Council for its review and recommendations. "(d) An application for a grant under this part which is submitted to the Secretary shall at the same time be submitted to the State mental health authority for the State in which the project or community mental health center for which the application is submitted is located. A State mental health authority which receives such an application under this subsection may review it and submit its comments to the Secretary within the forty-five-day period beginning on the date the application was received by it. The Secretary shall take action to require an applicant to revise his application or to approve or disapprove an application within the period beginning on the date the State mental health authority submits its comments or on the expiration of such forty-five-day period, whichever occurs first, and ending on the ninetieth day following the date the application was submitted to him. " (e) Not more than 2 per centum of the total amount appropriated under sections 203, 204, and 205 for any fiscal year shall be used by the Secretary to provide directly through the Department technical assistance for program management and for training in program management to community mental health centers which received grants under such sections or to entities which received grants under section 220 of

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Page:United States Statutes at Large Volume 89.djvu/381

 PUBLIC LAW 94-63—JULY 29, 1975 this title in a j&scal year beginning before the date of the enactment of the Community Mental Health Centers Amendments of 1975. "(f) For purposes of subsections (b), (c), (d), and (e) of this section, the term 'community mental health center' includes an entity which applies for or has received a grant under section 203 or 204 (a)(2). "PART B—FINANCIAL DISTRESS GRANTS

89 STAT. 321 42 USC 268B "Community mental health center." Ante, pp. 312, 314.

a GRANT AUTHORITY

"SEC. 211, The Secretary may make grants for the operation of 42 USC 2689f. any community mental health center which— "(1)(A) received a grant under section 220 of this title (as in eifect before the date of enactment of the Community Mental Health Centers Amendments of 1975) and, because of limitations in such section 220 respecting the period for which the center may receive grants under such section 220, is not eligible for further grants under that section for a fiscal year beginning after June 30, 1975; or "(B) received a grant or grants under section 203(a) of this title and, because of limitations respecting the period for which grants under such section may be made, is not eligible for further grants under that section; and "(2) demonstrates that without a grant under this section there will be a significant reduction in the types or quality of services provided or there will be an inability to provide the services described in section 201(b). Ante, p. 309. GRANT REQUIREMENTS

"SEC. 212. (a) No grant may be made under section 211 to an^ community mental health center in any State unless a State plan for the provision of comprehensive mental health services within such State has been submitted to, and approved by, the Secretary under section 237. Any grant under section 211 may be made upon such terms and conditions as the Secretary determines to be reasonable and necessary, including requirements that the community mental health center agree (1) to disclose any financial information or data deemed by the Secretary to be necessary to determine the sources or causes of that center's financial distress, (2) to conduct a comprehensive cost analysis study in cooperation with the Secretary, (3) to carry out appropriate operational and financial reforms on the basis of information obtained in the course of the comprehensive cost analysis study or on the basis of other relevant information, and (4) to use a grant received under section 211 to enable it to provide (within such period as the Secretary may prescribe) the comprehensive mental health services described in section 201(b) and to revise its organization to meet the requirements of sections 201(c) and 201Cd). "(b) An application for a grant under section 211 must contain or be supported by the assurances prescribed by subparagrjiphs (A), (B), (C), (D), (E), (F), (G), (I), (J), (K),and (L) of section 206(c)(1) and assurances satisfactory to the Secretary that the applicant will expend for its operation as a community mental health center, during the year for which such grant is sought, an amount of funds (other than funds for construction, as determined by the Secretary) from non-Federal sources which is at least as great as the average annual

42 USC 2689g. Supra. Post, p. 330.

Ante, p. 316.

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Page:United States Statutes at Large Volume 89.djvu/382

 89 STAT. 322

Ante, p. 316. Ante, p. 321. Ante, p. 309.

42 USC 2688. Ante, p. 313.

PUBLIC LAW 94-63—JULY 29, 1975 amount of funds expended by such applicant for such purpose (excluding expenditures of a nonrecurring nature) in the three years immediately preceding the year for which such grant is sought. The Secretary may not approve such an application unless it has been recommended for approval by the National Advisory Mental Health Council. The requirements of section 206(d) respecting opportunity for review of applications by State mental health authorities and time limitations on actions by the Secretary on applications shall apply with respect to applications submitted for grants under section 211. " (c) Each grant under this section to a grantee shall be made for the projected costs of operation (except the costs of providing the consultation and education services described in section 201(b)(1) (D)) of such grantee for the one-year period beginning on the first day of the first month in which such grant is made. No community mental health center may receive more than three grants under section 211. " (d) The amount of a grant for a community mental health center under section 211 for any year shall be the lesser of the amounts computed under paragraph (1) or (2) as follows: " (1) An amount equal to the amount by which the center's projected costs of operation for that year exceed the total of State, local, and other funds and of the fees, premiums, and third-party reimbursements which the center may reasonably be expected to collect in that year. " (2) An amount equal to the product of— " (A) 90 per centum of the percentage of costs— " (i) which was the ceiling on the grant last made to the center in the first series of grants it received under section 220 of this title (as in effect before the date of the enactment of the Community Mental Health Centers Amendments of 1975),or " (ii) prescribed by subsection (c)(2) of section 203 for computation of the last grant to the center under such section, whichever grant was made last, and "(B) the center's projected costs of operation in the year for which the grant is to be made under section 211. ((AUTHORIZATION

42 USC 2689h.

OF APPROPRIATIONS

"SEC. 213. There are authorized to be appropriated $15,000,000 for fiscal year 1976, and $15,000,000 for fiscal year 1977 for payments under grants under section 211. "PART C—^FACILITIES ASSISTANCE

42 USC 26891. Post, p. 327.
 * ASSISTANCE

AUTHORITY

"SEC. 221. (a) From allotments made under section 227 the Secretary shall pav, in accordance with this part, the Federal share of projects for (1) the acquisition or remodeling, or both, of facilities for community mental health centers, (2) the leasing (for not more than twenty-five years) of facilities for such centers, (3) the construction of new facilities or expansion of existing facilities for community mental health centers if not less than 25 per centum of the residents of the centers' catchment areas are members of low-income groups (as determined under regulations prescribed by the Secretary), and (4) the initial equipment of a facility acquired, remodeled, leased, con-

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 PUBLIC LAW 94-63—JULY 29, X975

89 STAT. 323

structed, or expanded with financial assistance provided under payments under this part. Payments shall not be made for the construction of a new facility or the expansion of an existing one unless the Secretary determines that it is not feasible for the recipient to acquire or remodel an existing facility. "(b)(1) For purposes of this part, the term 'Federal share' with "Federal share, respect to any project described in subsection (a) means the portion of the cost of such project to be paid by the Federal Government under this part. "(2) The Federal share with respect to any project described in subsection (a) in a State shall be the amount determined by the State agency of the State, but, except as provided in paragraph (3), the Federal share for any such project may not exceed 66% per centum of the costs of such project or the State's Federal percentage, whichever is the lower. Prior to the approval of the first such project in a State during any fiscal year, the State agency shall give the Secretary written notification of (A) the maximum Federal share, established pursuant to this paragraph, for such projects in such State which the Secretary approves during such fiscal year, and (B) the method for determining the specific Federal share to be paid with respect to any such project; and such maximum Federal share and such method of Federal share determination for such projects in such State during such fiscal year shall not be changed after the approval of the first such project in the State during such fiscal year. "(3) In the case of any community mental health center which provides or will, upon completion of the project for which application has been made under this part, provide services for persons in an area designated by the Secretary as an urban or rural poverty area, the maximum Federal share determined under paragraph (2) may not exceed 90 per centum of the costs of the project. "(4)(A) For purposes of paragraph (2), the Federal percentage for (i) Puerto Kico, Guam, American Samoa, and the Virgin Tslands shall be 66% per centum, and (ii) any other State shall be 100 per centum less that percentage which bears the same ratio to 50 per centum as the per capita income of such State bears to the average per capita income of all such other States. "(B) The Federal percentages under clause (ii) of subparagraph (A) shall be promulgated by the Secretary, between October 1 and December 31 of each even-numbered year, on the basis of the average of the per capita incomes of each of the States subject to such Federal percentages and of all the States subject to such percentages for the three most recent consecutive years for which satisfactory data are available from the Department of Commerce. Such promulgation shall be conclusive for each of the two fiscal years in the period beginning July 1 next succeeding such promulgation. ii

APPROVAL, o r

PROJECTS

"SEC. 222. (a) For each project for a community mental health Application. center facility pursuant to a State plan approved under section 237, 42 USC 2689J. there shall be submitted to the Secretary, through the State agency of Post, p. 330. the State, an application by the State or a political subdivision thereof or by a public or other nonprofit agency. If two or more such agencies join in the project, the application may be filed by one or more of such agencies. Such application shall set forth— " (1) a description of the site for such project;

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Page:United States Statutes at Large Volume 89.djvu/384

 89 STAT. 324

Post, p. 329.

5 USC app. II.

Ante, p. 319. Hearing. "Title."

Post, p. 330.

Hearing.

42 USC 2688, 2688g, 2688h, 2688k, 2688n-l, 2688r, 2688u.

PUBLIC LAW 94-63—JULY 29, 1975 " (2) plans and specifications therefor in accordance with the regulations prescribed by the Secretary under section 236; " (3) except in the case of a leasing project, reasonable assurance that title to such site is or will be vested in one or more of the agencies filing the application or in a public or nonprofit private agency which is to operate the community mental health center; " (4) reasonable assurance that adequate financial support will be available for the project and for its maintenance and operation when completed; " (5) reasonable assurance that all laborers and mechanics employed by contractors or subcontractors in the performance of work on a construction or remodeling project will be paid wages at rates not less than those prevailing on similar construction in the locality as determined by the Secretary of Labor in accordance with the Act of March 3, 1931 (40 U.S.C. 276a—276a-5, known as the Davis-Bacon Act), and the Secretary of Labor shall have with respect to such labor standards the authority and functions set forth in Reorganization P l a n Numbered 14 of 1950 (15 F. R. 3176; 5 U.S.C. A p p e n d i x) and section 2 of the Act of June 13, 1934 (40 U.S.C. 276c); " (6) a certification by the State agency of the Federal share for the project; and " (7) the assurances described in section 206(c)(2). E a c h applicant shall be afforded an opportunity for a hearing before the State agency respecting its application. For purposes of paragraph (3), the term 'title' means a fee simple or such other estate or interest (including a leasehold on which the rental does not exceed 4 per centum of the value of the land) as the Secretary finds sufficient to assure for a period of not less than fifty years undisturbed use and possession for the purposes of acquisition, remodeling, construction, or expansion of a facility and its operation. " (b) The Secretary shall approve an application submitted in accordance wnth subsection (a) if— " (1) sufficient funds to pay the Federal share for the project for which the application was submitted are available from the allotment to the State; " (2) the Secretary finds that the application meets the applicable requirements of subsection (a) and the community mental health center for which the application was submitted will meet the requirements of the State plan (under section 237) of the State in which the project is located; and " (3) the Secretary finds that the application has been approved and recommended by the State agency and is entitled to priority over other projects within the State, as determined under the State plan. No application shall be disapproved by the Secretary until he has afforded the State agency an opportunity for a hearing. The Secretary may not approve an application under this part for a project for a facility for a community mental health center or other entity which received a g r a n t under section 220, 242, 243, 251, 256, 264, or 271 of this title (as in effect before the date of the enactment of the Community Mental Health Centers Amendments of 1975) from appropriations for a fiscal year ending before July 1, 1975, unless the Secretary determines that the application is for a project for a center or entity which upon completion of such project will be able to significantly expand its services and which demonstrates exceptional financial need

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 PUBLIC LAW 94-63—JULY 29, 1975

89 STAT. 325

for assistance under this p a i t for such project. Amendment of any approved application shall be subject to approval in the same manner as an original application. "PAYMENTS

" SEC. 223. (a)(1) Upon certiHcation to the Secretary by the State agency, based upon inspection by it, that work has been performed upon a remodeling, construction, or expansion project, or purchases for such a project have been made, in accordance with the approved plans and specifications, and that payment of an installment is due to the applicant, such installment shall be paid to the State, from the applicable allotment of such State, except that (1) if the State is not authorized by law to make payments to the applicant, the payment shall be made directly to the applicant, (2) if the Secretary, after investigation or otherwise, has reason to believe that any act (or failure to act) has occurred requiring action pursuant to subsection (c) of this section, payment may, after he has given the State agency notice of opportunity for hearing pursuant to such section, be withheld in whole or in part, pending corrective action or action based on such hearing, and (3) the total payments with respect to such project may not exceed an amount equal to the Federal share of the cost of such project. " (2) If an amendment to an approved application is approved or the estimated cost of a remodeling, construction, or expansion project is revised upward, any additional payment with respect thereto may be made from the applicable allotment of the State for the fiscal year in which such amendment or revision is approved. " (b) Payments from a State allotment for acquisition and leasing projects shall be made in accordance with regulations which the Secretary shall promulgate. " (c)(1) If the Secretary finds that— " (A) a State agency is not substantially complying with the provisions required by section 237 to be in a State plan or with regulations issued under section 236; " (B) any assurance required to be in an application filed under section 222 is not being carried o u t; " (C) there is substantial failure to carry out plans and specifications approved by the Secretary under section 222; or " (D) adequate State funds are not being provided annually for the direct administration of a State plan approved under section 237, the Secretary may take the action authorized under paragraph (2) of this subsection if the finding was made after reasonable notice and opportunity for hearing to the involved State agency. " (2) If the Secretary makes a finding described in paragraph (1), he may notify the involved State agency, which is the subject of the finding or which is connected with a project or State plan which is the subject of the finding, that— " (A) no f u r the r payments will be made to the State from allotments under section 227; or " (B) no further payments will be made from allotments under section 227 for any project or projects designated by the Secretary as being affected by the action or inaction referred to in subparagraph (A), (B), (C), o r (D) of paragraph (1), as the Secretary may determine to be appropriate under the circumstances; and, except with regard to any project for which the application has already been approved and which is not directly affected, further payments from such allotments may be withheld, in whole or

57-194 O - 77 - 25

42 USC 2689k.

Notice and hearing,

Regulations,

Post, p. 330. Post, p. 329. ^"•^^> P- 323,.

Notice and hearing,

Post, ^.327.

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Page:United States Statutes at Large Volume 89.djvu/386

 89 STAT. 326

PUBLIC LAW 94-63—JULY 29, 1975 in part, until there is no longer any failure to comply (or to carry out the assurance or plans and specifications or to provide adequate State funds, as the case may be) or, if such compliance (or other action) is impossible, until the State repays or arranges for the repayment of Federal moneys to which the recipient was not entitled. JUDICIAL REVIEW

42 USC 2689/. Ante, p. 323. Ante, p. 325. Post, p. 330.

224. If— "(1) the Secretary refuses to approve an application for a project submitted under section 222, the State agency through which such application was submitted, or "(2) any State is dissatisfied with the Secretary's action under section 223(c) or 237 (c), such State, may appeal to the United States court of appeals for the circuit in which such State agency or State is located, by filing a petition with such court within sixty days after such action. A copy of the petition shall be forthwith transmitted by the clerk of the court to the Secretary, or any officer designated by him for that purpose. The Secretary thereupon shall file in the court the record of the proceedings on which he based his action, as provided in section 2112 of title 28, United States Code. Upon the filing of such petition, the court shall have jurisdiction to affirm the action of the Secretary or to set it aside, in whole or in part, temporarily or permanently, laut, until the filing of the record, the Secretary may modify or set aside his order. The findings of the Secretary as to the facts, if supported by substantial evidence, shall be conclusive, but the court, for good cause shown, may remand the case to the Secretary to take further evidence, and the Secretary may thereupon make new or modified findings of facts and may modify his previous action, and shall file in the court the record of the further proceedings. Such new or modified findings of fact shall likewise be conclusive if supported by substantial evidence. The judgment of the court affirming or setting aside, in whole or in part, any action of the Secretary shall be final, subject to review by the Supreme Court of the United States upon certiorari or certification as provided in section 1254 of title 28, United States Code. The commencement of proceedings under this section shall not, unless so specifically ordered by the court, operate as a stay of the Secretary's action. "SEC.

ii

42 USC 2689m.

RECOVERY

"SEC. 225. If any facility of a community mental health center acquired, remodeled, constructed, or expanded with funds provided under this part is, at any time within twenty years after the completion of such remodeling, construction, or expansion or after the date of its acquisition with such funds— "(1) sold or transferred to any person or entity (A) which is not qualified to file an application under section 222, or (B) which is not approved as a transferee by the State agency of the State in which such facility is located, or its successor; or " (2) not used by a community mental health center in the provision of comprehensive mental health services, and the Secretary has not determined that there is good cause for termination of such use, the United States shall be entitled to recover from either the transferor or the transferee in the case of a sale or transfer or from the owner in the case of termination of use an amount bearing the same ratio to the

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 PUBLIC LAW 94-63—JULY 29, 1975

89 STAT. 327

then value (as determined by the agreement of the parties or by action brought in the United States district court for the district in which the center is situated) of so much of such facility or center as constituted an approved project or projects, as the amount of the Federal participation bore to the acquisition, remodeling, construction, or expansion cost of such project or projects. Such right of recovery shall not constitute a lien upon such facility or center prior to judgment. ' NONDUPLICATION

" SEC. 226. No g r a n t may be made under the Public Health Service 42 USC 2689n. Act for the remodeling, construction, or expansion of a facility for a 42 USC 201 mote. community mental health center unless the Secretary determines that there are no funds available under t h i s part for the remodeling, construction, or expansion of such facility. 'ALLOTMENTS TO STATES

" S E C 227. (a) I n each fiscal year, the Secretary shall, in accordance 42 USC 2689o. with regulations, make allotments, from the sums appropriated under section 228, to the States (with State plans approved under section Infra. 237) on the basis of (1) the population, (2) the extent of the need for Post, p. 330. community mental health centers, and (3) the financial need, of the respective States; except that no such allotment to any State, other than the Virgin Islands, American Samoa, Guam, and the T r u s t Territory of the Pacific Islands, in any fiscal year may be less than $100,000. Sums so allotted to a State other than the Virgin Islands, American Samoa, Guam, and the T r u s t T e r r i to r y of the Pacific Islands, in a fiscal year and remaining unobligated at the end of such year shall remain available to such State for such purpose in the next fiscal year (and in such year o n l y), in addition to the sums allotted for such State in such next fiscal year. Sums so allotted to the V i r g i n Islands, American Samoa, Guam, or the T r u s t Territory of the Pacific Islands i n a fiscal year and remaining unobligated at the end of such year shall remain available to such State for such purpose in the next two fiscal years (and in such years o n l y), in addition to the sums allotted to such State for such purpose in each of such next two fiscal years. " (b) The amount of an allotment under subsection (a) to a State in a fiscal year which the Secretary determines will not be required by the State during the period for which it is available for the purpose for which allotted shall be available for reallotment by the Secretary from time to time, on such date or dates as he may fix, to other States with respect to which such a determination has not been made, in proportion to the original allotments of such States for such fiscal year, but with such proportionate amount for any of such other States being reduced to the extent it exceeds the sum the Secretary estimates such State needs and will be able to use during such period; and the total of such reductions shall be similarly reallotted among the States whose proportionate amounts were not so reduced. Any amount so reallotted to a State in a fiscal year shall be deemed to be a part of its allotment under subsection (a) in such fiscal year. a AUTHORIZATION OF APPROPRIATIONS

" SEC. 228. There are authorized to be appropriated $5,000,000 for fiscal year 1976, and $5,000,000 for fiscal year 1977, for allotments under section 227.

42 USC 2689p.

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Page:United States Statutes at Large Volume 89.djvu/388

 89 STAT. 328

PUBLIC LAW 94-63—JULY 29, 1975 "PART D — R A P E PREVENTION AND CONTROL "RAPE PREVENTION AND CONTROL

National Center for the Prevention and Control of Rape. Establishment. 42 USC 2689q. Grants for study and investigation.

Summary, submittal to Congress. Information clearinghouse.

"SEC. 231. (a) The Secretary shall establish within the National Institute of Mental Health an identifiable administrative unit to be known as the National Center for the Prevention and Control of Rape (hereinafter in this section referred to as the 'Center'). "(b)(1) The Secretary, acting through the Center, may, directly or by grant, carry out the following: " (A) A continuing study of rape, including a study and investigation of— " (i) the effectiveness of existing Federal, State, and local laws dealing with rape; "(ii) the relationship, if any, between traditional legal and social attitudes toward sexual roles, the act of rape, and the formulation of laws dealing with rape; " (iii) the treatment of the victims of rape by law enforcement agencies, hospitals or other medical institutions, prosecutors, and the courts; " (iv) the causes of rape, identifying to the degree possible— " (I) social conditions which encourage sexual attacks, and " (II) the motives of offenders, and "(v) the impact of rape on the victim and the family of the victim; " (vi) sexual assaults in correctional institutions; "(vii) the actual incidence of forcible rape as compared to the reported incidence of forcible rape and the reasons for any difference in such incidences; and "(viii) the effectiveness of existing private and local and State government educational, counseling, and other programs designed to prevent and control rape. "(B) The compilation, analysis, and publication of summaries of the continuing study conducted under subparagraph (A) and the research and demonstration projects conducted under subparagraph (E). The Secretary shall annually submit to the Congress a summary of such study and projects together with recommendations where appropriate. "(C) The development and maintenance of an information clearinghouse with regard to— " (i) the prevention and control of rape; "(ii) the treatment and counseling of the victims of rape and their families; and " (iii) the rehabilitation of offenders. "(D) The compilation and publication of training materials for personnel who are engaged or intend to engage in programs designed to prevent and control rape. " (E) Assistance to community mental health centers and other qualified public and nonprofit private entities in conducting research and demonstration projects concerning the prevention and control of rape, including projects (i) for the planning, developing, implementing, and evaluating of alternative methods used in the prevention and control of rape, the treatment and counseling of the victims of rape and their families, and the rehabilitation of offenders; (ii) for the application of such alternative

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Page:Hockey, Canada's Royal Winter Game.djvu/95

 "He should attempt an individual rush only when an exceptional opportunity offers itself. In the early part of a match the cover-point should not leave his position more than is absolutely necessary, but towards the end, when his opposing forwards are played out he may assume, to great advantage, a decidedly offensive position.

"The stick of a cover-point player should be somewhat heavier than a forward's. It should belong in the handle, in order to increase a man`s reach, and the blade should taper, becoming thinner towards the end, which aids in raising the puck. His dress and skates are the same as used by the forwards."

Mr. Harry Trihey, captain of the Shamrock Hockey Team, holders of the Stanley Cup, and perhaps the most effective forward player in the game, gives the following as his opinion regarding forward playing:

"The essentials of a forward are science, speed, coolness, endurance and stick-handling, which embraces shooting, and the success of a forward line is combination play. Science and speed are exercised at all times during the game; coolness is essential, especially when a forward is near his opponents' goals; endurance


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Page:United States Statutes at Large Volume 89.djvu/389

 PUBLIC LAW 94-63—JULY 29, 1975 methods; and (iii) for the promotion of community awareness of the specific locations in which, and the specific social and other conditions under which, sexual attacks are most likely to occur. " (F) Assistance to community mental health centers in meeting the costs of providing consultation and education services respecting rape. " (2) For purposes of this subsection, the term 'rape' includes statutory and attempted rape and any other criminal sexual assault (whether homosexual or heterosexual) which involves force or the threat of force. "(c) The Secretary shall appoint an advisory committee to advise, consult with, and make recommendations to him on the implementation of subsection (b). The Secretary shall appoint to such committee persons who are particularly qualified to assist in carrying out the functions of the committee. A majority of the members of the committee shall be women. Members of the advisory committee shall receive compensation at rates, not to exceed the daily equivalent of the annual rate in effect for grade GS-18 of the General Schedule, for each day (including traveltime) they are engaged in the performance of their duties as members of the advisory committee and, while so serving away from their homes or regular places of business, each member shall be allowed travel expenses, including per diem in lieu of subsistence, in the same manner as authorized by section 5703 of title 5, United States Code, for persons in Government service employed intermittently. "(d) For the purpose of carrying out subsection (b), there are authorized to be appropriated $7,000,000 for fiscal year 1976, dnd $10,000,000 for fiscal year 1977.

89 STAT. 329

'Rape.'

Advisory committee, appointment.

Compensation and travel expenses. 5 USC 5332 note.

Appropriation authorization.

"PART E—GENERAL PROVISIONS "DEFINITIONS 42 USC 2689r. "SEC. 235. For purposes of this title— "(1) The term 'State' includes the Commonwealth of Puerto Rico, Guam, American Samoa, the Virgin Islands, the Trust Territory of the Pacific Islands, and the District of Columbia. " (2) The term 'State agency' means the State mental health authority for which grants are authorized under section 314(d) of the Public 42 USC 24e.. Health Service Act. "(3) The term 'Secretary' means the Secretary of Health, Education, and Welfare. "(4) The term 'National Advisory Mental Health Council' means the National Advisory Mental Health Council established under sec42 USC 218. tion 217 of the Public Health Service Act. a. REGULATIONS

"SEC. 236. Regulations issued by the Secretary for the administration 42 USC 26898. of this title shall include provisions applicable uniformly to all the States which— "(1) prescribe the general manner in which the State agency of a State shall determine the priority of projects for community mental health centers on the basis of the relative need of the different areas of the State for such centers and their services and require special consideration for projects on the basis of the extent to which a center to be assisted or established upon completion of a

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Page:United States Statutes at Large Volume 89.djvu/390

 89 STAT. 330

Consultation.

PUBLIC LAW 94-63—JULY 29, 1975 project (A) will, alone or in conjunction with other centers owned or operated by the applicant for the project or affiliated or associated with such applicant, provide comprehensive mental health services for residents of a particular community or communities, or (B) will be part of or closely associated with a general hospital; "(2) prescribe general standards for facilities and equipment for centers of different classes and in different types of location; and " (3) require that the State plan of a State submitted under section 237 provide for adequate community mental health centers for people residing in the State, and provide for adequate community mental health centers to furnish needed services for persons unable to pay therefor. The National Advisory Mental Health Council shall be consulted by the Secretary before the issuance of regulations under this section. uSTATE PLAN

Contents. 42 USC 2689t. Administration.

Services and facilities,

42 USC 300m-3. 42 USC 246.

"SEC. 237. (a) A State plan for the provision of comprehensive mental health services within a State shall be comprised of the following two parts: "(1) An administrative part containing provisions respecting the administration of the plan and related matters. Such part shall— " (A) provide for the designation of a State advisory council to consult with the State agency in administering such plan, which council shall include (i) representatives of nongovernment organizations or groups, and of State agencies, concerned with the planning, operation, or use of community mental health centers or other mental health facilities, and (ii) representatives of consumers and providers of the services of such centers and facilities who are familiar with the need for such services; "(B) provide that the State agency will make such reports in such form and containing such information as the Secretary may from time to time reasonably require, and will keep such records and afford such access thereto as the Secretary may find necessary to assure the correctness and verification of such reports; "(C) provide that the State agency will from time to time, but not less often than annually, review the State plan and submit to the Secretary appropriate modifications thereof which it considers necessary; and "(D) include provisions, meeting such requirements as the Civil Service Commission may prescribe, relating to the establishment and maintenance of personnel standards on a merit basis. " (2) A services and facilities part containing provisions respecting services to be offered within the State by community mental health centers and provisions respecting facilities for such centers. Such part shall— "(A) be consistent with the provisions of the State plan prepared in accordance with section 1524(c)(2) of the Public Health Service Act or the State plan approved under section 314(a) of such Act. whichever is applicable, relating to the provision of mental health services; "(B) set forth a program for community mental health centers within the State (i) which is based on a statewide inven-

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Page:United States Statutes at Large Volume 89.djvu/391

 PUBLIC LAW 94-63—JULY 29, 1975 tory of existing facilities and a survey of need for the comprehensive mental health services described in section 201(b); (ii) which conforms with regulations prescribed by the Secretary under section 236; and (iii) which shall provide for adequate community mental health centers to furnish needed services for persons unable to pay therefor; "(C) set forth the relative need, determined in accordance with the regulations prescribed under section 236, for the projects included in the program described in subparagraph (B), and, in the case of projects under part C, provide for the completion of such projects in the order of such relative need; "(D) emphasize the provision of outpatient services by community mental health centers as a preferable alternative to inpatient hospital services; and " (E) provide minimum standards (to be fixed in the discretion of the State) for the maintenance and operation of centers which receive Federal aid under this title and provide for enforcement of such standards with respect to projects approved by the Secretary under this title. " (b) The State agency shall administer or supervise the administration of the State plan. "(c) A State shall submit a State plan in such form and manner as the Secretary shall by regulation prescribe. The Secretary shall approve any State plan (and any modification thereof) which complies with the requirements of subsection (a). The Secretary shall not finally disapprove a State plan except after reasonable notice and opportunity for a hearing to the State. "(d)(1) At the request of any State, a portion of any allotment or allotments of such State under section 227 for any fiscal year shall be available to pay one-half (or such smaller share as the State may request) of the expenditures found necessary by the Secretary for the proper and efficient administration of the provisions of the State plan approved under this section which relate to projects under part C for facilities for community mental health centers; except that not more than 5 per centum of the total of the allotments of such State for any fiscal year, or $50,000, whichever is less, shall be available for such purpose. Amounts made available to any State under this paragraph from its allotment or allotments under section 227 for any fiscal year shall be available only for such expenditures (referred to in the preceding sentence) during such fiscal year or the following fiscal year. Payments of amounts due under this paragraph may be made in advance or by way of reimbursement, and in such installments, as the Secretary may determine. "(2) Any amount paid under paragraph (1) to any State for any fiscal year for administration of the provisions of an approved State plan shall be paid on condition that there shall be expended from State sources for each year for administration of such provisions not less than the total amount expended for such purposes from such sources during the fiscal year ending June 30, 1968.

89 STAT. 331

Ante, p. 309. Ante, p. 329.

Submission and approval,

Ante, p. 327.

Ante, p. 322.

'CATCHMENT AREA REVIEW

"SEC. 238. Each State health planning and development agency 42 USC 2689u. designated for a State under section 1521 of the Public Health Service Act shall, in consultation with that State's mental health authority, 42 USC 300m. periodically review the catchment areas of the community mental health centers located in that State to (1) insure that the sizes of

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 89 STAT. 332

PUBLIC LAW 94-63—JULY 29, 1975 such areas are such that the services to be provided through the centers (including their satellites) serving the areas are available and accessible to the residents of the areas promptly, as appropriate, (2) insure that the boundaries of such areas conform, to the extent practicable, with relevant boundaries of political subdivisions, school districts, and Federal and State health and social service programs, and (3) insure that the boundaries of such areas eliminate, to the extent possible, barriers to access to the services of the centers serving the areas, including barriers resulting from an area's physical characteristics, its residential patterns, its economic and social groupings, and available transportation. "STATE CONTROL OF OPERATIONS

42 USC 2689v.

"SEC. 239. Except as otherwise specifically provided, nothing in this title shall be construed as conferring on any Federal officer or employee the right to exercise any supervision or control over the administration, personnel, maintenance, or operation of any community mental health center with respect to which any funds have been or may be expended under this title. uRECORDS AND AUDIT

42 USC 2689w.

"SEC. 240. (a) Each recipient of assistance under this title shall keep such records as the Secretary shall prescribe, including records which fully disclose the amount and disposition by such recipient of the proceeds of such assistance, the total cost of the project or undertaking in connection with which such assistance is given or used, and the amount of that portion of the cost of the project or undertaking supplied by other sources, and such other records as will facilitate an effective audit. "(b) The Secretary and the Comptroller General of the United States, or any of their duly authorized representatives, shall have access for the purpose of audit and examination to any books, documents, papers, and records of the recipients that are pertinent to the assistance received under this title. ' NONDITPLICATION

42 USC 2689x.

"SEC. 241. In determining the amount of any grant under part A, B, or C for the costs of any project there shall be excluded from such costs an amount equal to the sum of (1) the amount of any other Federal grant which the applicant for such grant has obtained, or is assured of obtaining, with respect to such project, and (2) the amount of any non-Federal funds required to be expended as a condition of such other Federal grant. "DETERMINATION OF POVERTY AREA

42 USC 2689y.

"SEC. 242. For purposes of any determination by the Secretary under this title as to whether any urban or rural area is a poverty area, the Secretary may not determine that an area is an urban or rural poverty area unless— " (1) such area contains one or more subareas which are characterized as subareas of poverty; "(2) the population of such subarea or subareas constitutes a substantial portion of the population of such rural or urban area; and

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Page:United States Statutes at Large Volume 89.djvu/393

 PUBLIC LAW 94-63—JULY 29, 1975

89 STAT. 333

" (3) the ]pro]ect, facility, or activity, in connection with which such determination is made, does, or (when completed or p u t into operation) will, serve the needs of the residents of such subarea or subareas. uPROTECTION o r PERSONAL RIGHTS " SEC. 243. I n making g r a n t s under part s A and B, the Secretary 42 USC 26892. shall take such steps as may be necessary to assure that no individual Ante, pp. 309, shall be made the subject of any research involving surgery which is 321. carried out (in whole or in part) with funds under such g r a n t s unless such individual explicitly agrees to become a subject of such research. REIMBURSEMENT

" SEC. 244. The Secretary shall, to the extent permitted by law, work 42 USC 268!?aa. with States, private insurers, community mental health centers, and other a p p r o p r i a t e entities to assure that community mental health centers shall be eligible for reimbursement for their mental health services to the same extent as general hospitals and other licensed providers. a SHORT TITLE

" SEC. 245. T h i s title may be cited as the 'Community Mental Health 42 USC 2689 Centers Act'.". noteREPORT

SEC. 304. (a) Not later than one year after the date of the enactment 42 USC 2689 of this Act the Secretary of Health, Education, and Welfare shall note. make a report to the Committee on Interstate and Foreign Commerce of the House of Representatives and the Committee on Labor and P u b lic Welfare of the Senate setting forth a plan, to be carried out in a period of five years, for the extension of comprehensive mental health services through community mental health centers to persons in all areas in which there is a demonstrated need for such services. Such plan shall, at a minimum, indicate on a phased basis the number of persons to be served by such services and an estimate of the cost and personnel requirements needed to provide such services. (b) Not later than eighteen months after the date of the enactment of this Act the Secretary of Health, Education, and Welfare shall submit to the Committee on Interstate and Foreign Commerce of the House of Representatives and the Committee on Labor and Public Welfare of the Senate a report setting forth (1) national standards for care provided by community mental health centers, and (2) criteria for evaluation of community mental health centers and the quality of the services provided by the centers. CONFORMING

AMENDMENTS

SEC. 305. (a) Section 401 of the Mental Retardation Facility and Community Mental Health Centers Construction Act of 1963 is 42 USC 2691. amended— (1) by striking out paragraph (c); Definitions. (2) by amending paragraph (d) to read as follows: " (d) The terms 'nonprofit facility for persons with developmental disabilities' and 'nonprofit private institution of higher learning' mean, respectively, a facility for persons with developmental disabilities and an institution of higher learning which is owned and operated by one or more nonprofit corporations or associations no part of the net

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Page:United States Statutes at Large Volume 89.djvu/394

 89 STAT. 334

42 USC 2691.

42 USC 2693.

42 USC 2694. 42 USC 2695.

42 USC 2696.

PUBLIC LAW 94-63—JULY 29, 1975 earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual; and the term 'nonprofit private agency or organization' means an agency or organization which is such a corporation or association or which is owned and operated by one or more of such corporations or associations."; and (3) by (A) striking out "or part A of title II " in paragraph (li)(l), (B) by striking out in paragraph (h)(2) " (A) " and "; and (B) for any project under part A of title II may not exceed 66% per centum of the costs of construction of such project or the State's Federal percentage, whichever is the lower", and (C) by striking out "or under part A of title II " in paragraph (h)(3). (b) Section 403 of such Act is amended— (1) by striking out ", or section 204 in the case of a community mental health center," in subsection (a), (2) by striking out "or section 206, as the case may be," in such subsection, (3) by striking out "or 205" in subsection (b), and (4) by striking out the second sentence of subsection (c)(1). (c) Section 404 is amended by striking out "or 205", "or 204(b)", and "or 206". (d) Section 405 is amended— (1) by striking out "or 205" in paragraph (1)(A), (2) by striking out "or section 204 (in case of a community mental health center)" in such paragraph, (3) by striking out "or community mental health center, as the case may be," in paragraph (2), (4) by striking out "or such center as a community mental health center" in such paragraph, (5) by striking out "or center" each place it occurs in the matter following paragraph (2), and (6) by striking out "or community mental health center" in such matter. (e) Section 406 is amended by striking out "or community mental health center". TITLE IV—MIGEANT H E A L T H CENTEKS MIGRANT H E A L T H CENTERS

42USe247d.

SEC. 401. (a) Section 319 of the Public Health Service Act is amended to read as follows: ((MIGRANT

Definitions.

HEALTH

"SEC. 319. (a) For purposes of this Section: "(1) The term 'migrant health center' means an entity which either through its staff and supporting resources or through contracts or cooperative arrangements with other public or private entities provides— " (A) primary health services, [B) as may be appropriate for particular centers, supple"(r mental health services necessary for the adequate support of primary health services.

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Page:United States Statutes at Large Volume 89.djvu/395

 PUBLIC LAW 94-63—JULY 29, 1975 "(C) referral to providers of supplemental health services and payment, as appropriate and feasible, for their provision of such services, "(D) environmental health services, including, as may be appropriate for particular centers, the detection and alleviation of unhealthful conditions associated with water supply, sewage treatment, solid waste disposal, rodent and parasitic infestation, field sanitation, housing, and other environmental factors related to health, " (E) as may be appropriate for particular centers, infectious and parasitic disease screening and control, " (F) as may be appropriate for particular centers, accident prevention programs, including prevention of excessive pesticide exposure, and "(G) information on the availability and proper use of health services, for migratory agricultural workers, seasonal agricultural workers, and the members of the families of such migratory and seasonal workers, within the area it serves (referred to in this section as a 'catchment area'). "(2) The term 'migratory agricultural worker' means an individual whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last twenty-four months, and who establishes for the purposes of such employment a temporary abode. "(3) The term 'seasonal agricultural workers' means an individual whose principal employment is in agriculture on a seasonal basis and who is not a migratory agricultural worker. "(4) The term 'agriculture' means farming in all its branches, including— " (A) cultivation and tillage of the soil, "(B) the production, cultivation, growing, and harvesting of any commodity grown on, in, or as an adjunct to or part of a commodity grown in or on, the land, and "(C) any practice (including preparation and processing for market and delivery to storage or to market or to carriers for transportation to market) performed by a farmer or on a farm incident to or in conjunction with an activity described in subparagraph (B). "(5) The term 'high impact area' means a health service area or other area which has not less than six thousand migratory agricultural workers and seasonal agricultural workers residing within its boundaries for more than two months in any calendar year. In computing the number of workers residing in an area, there shall be included as workers the members of the families of such workers. " (6) The term 'primary health services' means— "(A) services of physicians and, where feasible, services of physicians' assistants and nurse clinicians; "(B) diagnostic laboratory and radiologic services; "(C) preventive health services (including children's eye and ear examinations to determine the need for vision and hearing correction, perinatal services, well child services, and family planning services); "(D) emergency medical services; " (E) transportation services as required for adequate patient care; and " (F) preventive dental services.

89 STAT. 335

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Page:United States Statutes at Large Volume 89.djvu/396

 89 STAT. 336

Priority areas.

Grants.

PUBLIC LAW 94-63—JULY 29, 1975 "(7) The term 'supplemental health services' means services which are not included as primary health services and which are— " (A) hospital services; "(B) home health services; "(C) extended care facility services; "(D) rehabilitative services (including physical therapy) and long-term physical medicine; " (E) mental health services; " (F) dental services; "(G) vision services; " (H) allied health services; " (I) pharmaceutical services; " (J) therapeutic radiologic services; " (K) public health services (including nutrition education and social services); " (L) health education services; and " (M) services which promote and facilitate optimal use of primary health services and the services referred to in the preceding subparagraphs of this paragraph, including, if a substantial number of the individuals in the population served by a migrant health center are of limited English-speaking ability, the services of outreach workers fluent in the language spoken by a predominant number of such individuals. "(b)(1) The Secretary shall assign to high impact areas and any other areas (where appropriate) priorities for the provision of assistance under this section to projects and programs m such areas. The highest priorities for such assistance shall be assigned to areas in which reside the greatest number of migratory agricultural workers and the members of their families for the longest period of time. "(2) No application for a grant under subsection (c) or (d) for a project in an area which has no migratory agricultural workers may be approved unless grants have been provided for all approved applications under such subsections for projects in areas with migratory agricultural workers. "(c)(1)(A) The Secretary may, in accordance with the priorities, assigned under subsection (b)(1), make grants to public and nonprofit private entities for projects to plan and develop migrant health centers which will serve migratory agricultural workers, seasonal agricultural workers, and the members of the families of such migratory and seasonal workers, in high impact areas. A project for which a grant may be made under this subparagraph may include the cost of the acquisition and modernization of existing buildings (including the costs of amortizing the principal of, and paying the interest on, loans) and the costs of providing training related to the management of migrant health center programs, and shall include— "(i) an assessment of the need that the workers (and the members of the families of such workers) proposed to be served by the migrant health center for which the project is undertaken have for primary health services, supplemental health services, and environmental health services; "(ii) the design of a migrant health center program for such workers and the members of their families, based on such assessment; " (iii) efforts to secure, within the proposed catchment area of such center, financial and professional assistance and support for the project; and

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Page:United States Statutes at Large Volume 89.djvu/397

 PUBLIC LAW 94-63—JULY.29, 1975 "(iv) initiation and encouragement of continuing community involvement in the development and operation of the project. "(B) The Secretary may make grants to or enter into contracts with public and nonprofit private entities for projects to plan and develop programs in areas in which no migrant health center exists and in which not more than six thousand migratory agricultural workers and their families reside for more than two months— "(i) for the provision of emergency care to migratory agricultural workers, seasonal agricultural workers, and the members of families of such migratory and seasonal workers; "(ii) for the provision of primary care (as defined in regulations of the Secretary) for such workers and the members of their families; "(iii) for the development of arrangements with existing facilities to provide primary health services (not included as primary care as defined under regulations under clause (ii)) to such workers and the members of their families; or "(iv) which otherwise improve the health of such workers and their families. Any such program may include the acquisition and modernization of existing bufldings and providing training related to the management of programs assisted under this subparagraph. "(2) Not more than two grants may be made under paragraph (1)(A) for the same project, and if a grant or contract is made or entered into under paragraph (1)(B) for a project, no other grant or contract under that paragraph may be made or entered into for the project. "(3) The amount of any grant made under paragraph (1) for any project shall be determined by the Secretary. " (d)(1)(A) The Secretary may, in accordance with priorities assigned under subsection (b)(1), make grants for the costs of operation of public and nonprofit private migrant health centers in high impact areas. "(B) The Secretary may, in accordance with priorities assigned under subsection (b)(1), make grants for the costs of the operation of public and nonprofit enti|;ies which intend to become migrant health centers, which provide health services in high impact areas to migratory agricultural workers, seasonal agricultural workers, and the members of the families of such migratory and seasonal workers, but with respect to which he is unable to make each of the determinations required by subsection (f)(2). Not more than two grants may be made under this subparagraph for any entity. "(C) The Secretary may make grants to and enter into contracts with public and nonprofit private entities for projects for the operation of programs in areas in which no migrant health center exists and in which not more than six thousand migratory agricultural workers and their families reside for more than two months— "(i) for the provision of emergency care to migratory agricultural workers, seasonal agricultural workers, and the members of the families of such migratory and seasonal workers; "(ii) for the provision of primary care (as defined in regulations of the Secretary) for such workers and the members of their families; "(iii) for the development of arrangements with existing facilities to provide primary health services (not included as primary care as defined under regulations under clause (ii)) to such workers and the members of their families; or

89 STAT. 337

Grants.

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 89 STAT. 338

Contracts.

Application.

5 USC app. II.

PUBLIC LAW 94-63—JULY 29, 1975 "(iv) which otherwise improve the health of such workers and the members of their families. Any such program may include the acquisition and modernization of existing buildings and providing training related to the management of programs assisted under this subparagraph. "(2) The costs for which a grant may be made under paragraph (1)(A) or (1)(B) may include the costs of acquiring and modernizing existing buildings (including the costs of amortizing the principal of, and paying the interest on, loans); and the costs for which a grant or contract may be made under paragraph (1) may include the costs of providing training related to the provision of primary health services, supplemental health services, and environmental health services, and to the management of migrant health center programs. "(3) The amount of any grant made under paragraph (1) shall be determined by the Secretary. "(e) The Secretary may enter into contracts with public and private entities to— "(1) assist the States in the implementation and enforcement of acceptable environmental health standards, including enforcement of standards for sanitation in migrant labor camps and applicable Federal and State pesticide control standards; and "(2) conduct projects and studies to assist the several States and entities which have received grants or contracts under this section in the assessment of problems related to camp and j&eld sanitation, pesticide hazards, and other environmental health hazards to which migratory agricultural workers, seasonal agricultural workers, and members of their families are exposed. "(f)(1) No grant may be made under subsection (c) or (d) and no contract may be entered into under subsection (c)(1)(B), (d)(1) (C), or (e) 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. An application for a grant or contract which will cover the costs of modernizing a building shall include, in addition to other information required by the Secretary— "(A) a description of the site of the building, "(B) plans and specifications for its modernization, and "(C) reasonable assurance that all laborers and mechanics employed by contractors or subcontractors in the performance of work on the modernization of the building will be paid wages at rates not less than those prevailing on similar work in the locality as determined by the Secretary of Labor in accordance with the Act of March 3, 1931 (40 U.S.C. 276a—276a-5, known as the Davis-Bacon Act). The Secretary of Labor shall have with respect to the labor standards referred to in subparagraph (C) the authority and functions set forth in Keorganization Plan Numbered 14 of 1950 (15 F.E. 3176; 5 U.S.C. Appendix) and section 2 of the Act of June 13, 1934 (40 U.S.C. 276c). "(2) The Secretary may not approve an application for a grant under subsection (d)(1)(A) unless the Secretary determines that the entity for which the application is submitted is a migrant health center (within the meaning of subsection (a)(1)) and that— "(A) the primary health services of the center will be available and accessible in the center's catchment area promptly, as appropriate, and in a manner which assures continuity;

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Page:United States Statutes at Large Volume 89.djvu/399

 PUBLIC LAW 94-63—JULY 29, 1975 "(B) the center will have organizational arrangements, established in accordance with regulations of the Secretary, for (i) an ongoing quality assurance program (including utilization and peer review systems) respecting the center'services, and (ii) maintaining the confidentiality of patient records; " (C) the center will demonstrate its financial responsibility by the use of such accounting procedures and other requirements as may be prescribed by the Secretary; "(D) the center (i) has or will have a contractual or other arrangement with the agency of the State, in which it provides services, which administers or supervises the administration of a State plan approved under title X IX of the Social Security Act for the payment of all or a part of the center's costs in providing health services to persons who are eligible for medical assistance under such a State plan, or (ii) has made or will make every reasonable effort to enter into such an arrangement; " (E) the center has made or will make and will continue to make every reasonable effort to collect appropriate reimbursement for its costs in providing health services to persons who are entitled to insurance benefits under title X VIII of the Social Security Act, to medical assistance under a State plan approved under title X IX of such Act, or to assistance for medical expenses under any other public assistance program or private health insurance program; " (F) the center (i) has prepared a schedule of fees or payments for the provision of its services designed to cover its reasonable costs of operation and a corresponding schedule of discounts to be applied to the payment of such fees or payments, which discounts are adjusted on the basis of the patient's ability to pay, ^ii) has made and will continue to make every reasonable effort (I) to secure from patients payment for services in accordance with such schedules, and (II) to collect reimbursement for health services to persons described in subparagraph (E) on the basis of the full amount of fees and payments tor such services without application of any discount, and (iii) has submitted to the Secretary such reports as he may require to determine compliance with this subparagraph; "(G) the center has established a governing board which (i) is composed of individuals a majority of whom are bei^ig served by the center and who, as a group, represent the individuals being served by the center, and (ii) establishes general policies for the center (including the selection of services to be provided by the center and a schedule of hours during which services will be provided), approves the center's annual budget, and approves the selection of a director for the center; " (H) the center has developed, in accordance with regulations of the Secretary, (i) an overall plan and budget that meets the requirements of section 1861(z) of the Social Security Act, and (ii) an effective procedure for compiling and reporting to the Secretary such statistics and other information as the Secretary may require relating to (I) the costs of its operations, (II) the patterns of use of its services, (III) the availability, accessibility, and acceptability of its services, and (IV) such other matters relating to operations of the applicant as the Secretary may, by regulation, require;

89 STAT. 339

42 USC 1396.

42 USC 1395.

Fee schedule.

Governing board,

42 USC 1395x.

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Page:United States Statutes at Large Volume 89.djvu/400

 89 STAT. 340 Review.

Limited Englishspeaking individuals.

Application priorities.

Appropriation authorization.

Appropriation authorization.

PUBLIC LAW 94-63—JULY 29, 1975 " (I) the center will review periodically its catchment area to (i) insure that the size of such area is such that the services to be provided through the center (including any satellite) are available and accessible to the migratory agricultural workers, seasonal agricultural workers, and the members of the families of such migratory and seasonal workers, in the area promptly and as appropriate, (ii) insure that the boundaries of such area conform, to the extent practicable, to relevant boundaries of political subdivisions, school districts, and Federal and State health and social service programs, and (iii) insure that the boundaries of such area eliminate, to the extent possible, barriers to access to the services of the center, including barriers resulting from the area's physical characteristics, its residential patterns, its economic and social groupings, and available transportation; and " (J) in the case of a center which serves a population including a substantial proportion of individuals of limited Englishspeaking ability, the center has (i) developed a plan and made arrangements responsive to the needs of such population for providing services to the extent practicable in the language and cultural context most appropriate to such individuals, and (ii) identified an individual on its staff who is fluent in both that language and English and whose responsibilities shall include providing guidance to such individuals and to appropriate staff members with respect to cultural sensitivities and bridging linguistic and cultural differences. "(3) In considering applications for grants and contracts under subsection (c) or (d)(1)(C), the Secretary shall give priority to applications submitted by community-based organizations which are representative of the populations to be served through the projects, programs, or centers to be assisted by such grants or contracts. "(4) Contracts may be entered into under this section without regard to sections 3648 and 3709 of the Revised Statutes (31 U.S.C. 529; 41 U.S.C. 5). "(g) The Secretary may provide (either through the Department of Health, Education, and Welfare or by grant or contract) all necessary technical and other nonfinancial assistance (including fiscal and program management assistance and training in such management) to any migrant health center or to any public or private nonprofit entity to assist it in developing plans for, and in operating as, a migrant health center, and in meeting the requirements of subsection (f)(2). " (h)(1) There are authorized to be appropriated for payments pursuant to grants and contracts under subsection (c)(1) $4,000,000 for fiscal year 1976, and $4,000,000 for fiscal year 1977. Of the funds appropriated under this paragraph for fiscal year 1976, not more than 30 per centum of such funds may be made available for grants and contracts under subsection (c)(1)(B), and of the funds appropriated under this paragraph for the next fiscal year, not more than 25 per centum of such funds may be made available for grants and contracts under STich subsection. "(2) There are authorized to be appropriated for payments pursuant to grants and contracts under subsection (d)(1) (other than for payments under such grants and contracts for the provision of inpatient and outpatient hospital services) and for payments pursuant to contracts under subsection (e) $30,000,000 for fiscal year 1976, and $35,000,000 for fiscal year 1977. Of the funds appropriated under the

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Page:United States Statutes at Large Volume 89.djvu/401

 PUBLIC LAW 94-63—JULY 29, 1975 first sentence for fiscal year 1976, there shall be made available for grants and contracts under subsection (d)(1)(C) an amount not exceeding the greater of 30 per centum of such funds or 90 per centum of the amount of grants made under this section for the preceding fiscal year for programs described in subsection (d)(1)(C). Of the funds appropriated under the first sentence for fiscal year 1977, there shall be made available for grants and contracts under subsection (d)(1)(C) an amount not exceeding the greater of 25 per centum of such funds or 90 per centum of the amount of grants made under this section for the preceding fiscal year for programs described in subsection (d)(1)(C) which received grants under this section for the fiscal year ending June 30, 1975. Of the funds appropriated under this paragraph for any fiscal year, not more than 10 per centum of such funds may be made available for contracts under subsection (e). "(3) There are authorized to be appropriated for payments under grants and contracts under subsection (d)(1) for the provision of inpatient and outpatient hospital services $5,000,000 for fiscal year 1976, and $5,000,000 for fiscal year 1977.". (b) Section 217 of the Public Health Service Act is amended by adding after the subsection (f) added by Public Law 93-248 the following new subsection: "(g)(1) Within 120 days of the date of the enactment of this subsection, the Secretary shall appoint and organize a National Advisory Council on Migrant Health (hereinafter in this subsection referred to as the 'Council') which shall advise, consult with, and make recommendations to, the Secretary on matters concerning the organization, operation, selection, and funding of migrant health centers and other entities under grants and contracts under section 319. "(2) The Council shall consist of fifteen members, at least twelve of whom shall be members of the governing boards of migrant health centers or other entities assisted under section 319. Of such twelve members who are members of such governing boards, at least nine shall be chosen from among those members of such governing boards who are being served by such centers or grantees and who are familiar with the delivery of health care to migratory agricultural workers and seasonal agricultural workers. The remaining three Council members shall be individuals qualified by training and experience in the medical sciences or in the administration of health programs. "(3) Each member of the Council shall hold office for a term of four years, except that (A) any member appointed to fill a vacancy occurring prior to the expiration of the term for which his predecessor was appointed shall be appointed for the remainder of such term; and (B) the terms of the members first taking office after the date of enactment of this subsection shall expire as follows: four shall expire four years after such date, four shall expire three years after such date, four shall expire two years after such date, and three shall expire one year after such date, as designated by the Secretary at the time of appointment. "(4) Section 14(a) of the Federal Advisory Committee Act shall not apply to the Council.". (c)(1) The Secretary of Health, Education, and Welfare (hereinafter in this subsection referred to as the "Secretary") shall conduct or arrange for the conduct of a study of— (A) the quality of housing which is available to agricultural migratory workers in the United States during the period of their employment in seasonal agricultural activities while away from their permanent abodes;

89 STAT. 341

Appropriation authorization. National Advisory Council on Migrant Health. Appointment. 42 USC 218.

Ante, p. 334. Membership.

Term.

5 USC app. I. Study. 42 USC 247d note.

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Page:United States Statutes at Large Volume 89.djvu/402

 89 STAT. 342

Consultation.

Report to cong committees.

PUBLIC LAW 94-63—JULY 29, 1975 (B) the effect on the health of such workers of deficiencies in their housing conditions during such period; and (C) Federal, State, and local government standards respecting housing conditions for such workers during such period and the adequacy of the enforcement of such standards. In conducting or arranging for the conduct of such study, the Secretary shall consult with the Secretary of Housing and Urban Development. (2) Such study shall be completed and a report detailing the findings of the study and the recommendations of the Secretary for Federal action (including legislation) respecting such housing conditions shall be submitted to the Committee on Interstate and Foreign Commerce of the House of Representatives and the Committee on Labor and Public Welfare of the Senate within eighteen months of the date of the enactment of the first Act making appropriations for such study. TITLE V—COMMUNITY H E A L T H CENTERS COMMUNITY H E A L T H CENTERS

SEC. 501. (a) Part C of title III of the Public Health Service Act is amended by adding after section 329 the following new section:
 * COMMUNITY H E A L T H CENTERS

Definitions. 42 USC 254c.

"SEC. 330. (a) For purposes of this section, the term 'community health center' means an entity which either through its staff and supporting resources or through contracts or cooperative arrangements with other public or private entities provides— " (1) primarily health services, "(2) as may be appropriate for particular centers, supplemental health services necessary for the adequate support of primary health services, "(3) referral to providers of supplemental health services and payment, as appropriate and feasible, for their provision of such services, "(4) as may be appropriate for particular centers, environmental health services, and "(5) information on the availability and proper use of health services, for all residents of the area it serves (referred to in this section as a 'catchment area'). "(b) For purposes of this section: " (1) The term 'primary health services' means— " (A) services of physicians and, where feasible, services of physicians' assistants and nurse clinicians; "(B) diagnostic laboratory and radiologic services; "(C) preventive health services (including children's eye and ear examinations to determine the need for vision and hearing correction, perinatal services, well child services, and family planning services); " (D) emergency medical services; " (E) transportation services as required for adequate patient care; and " (F) preventive dental services.

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Page:United States Statutes at Large Volume 89.djvu/403

 PUBLIC LAW 94-63—JULY 29, 1975

89 STAT. 343

"(2) The term 'supplemental health services' means services Which are not included as primary health services and which are— "(A) hospital services; "(B) home health services; "(C) extended care facility services; "(D) rehabilitative services (including physical therapy) and long-term physical medicine; " (E) mental health services; " (F) dental services; " (G) vision services; " (H) allied health services; " (I) pharmaceutical services; " (J) therapeutic radiologic services; " (K) public health services (including nutrition education and social services); " (L) health education services; and "(M) services which promote and facilitate optimal use of primary health services and the services referred to in the preceding subparagraphs of this paragraph, including, if a substantial number of the individuals in the population served by a community health center are of limited English-speaking ability, the services of outreach workers fluent in the language spoken by a predominant number of such individuals. "(3) The term 'medically underserved population' means the population of an urban or rural area designated by the Secretary as an area with a shortage of personal health services or a population group designated by the Secretary as having a shortage of such services. "(c)(1) The Secretary may make grants to public and nonprofit Grants, private entities for projects to plan and develop community health centers which will serve medically underserved populations. A project for which a grant may be made under this subsection may include the cost of the acquisition and modernization of existing buildings (including the costs of amortizing the principal of, and paying the interest on, loans) and shall include— "(A) an assessment of the need that the population proposed to be served by the community health center for which the project is undertaken has for primary health services, supplemental health services, and environmental health services; "(B) the design of a community health center program for such population based on such assessment; "(C) efforts to secure, within the proposed catchment area of such center, financial and professional assistance and support for the project; and "(D) initiation and encouragement of continuing community involvement in the development and operation of the project. "(2) Not more than two grants may be made under this subsection for the same project. "(3) the amount of any grant made under this subsection for any project shall be determined by the Secretary. " (d)(1)(A) The Secretary may make grants for the costs of opera- Grants, tion of public and nonprofit private community health centers which serve medically underserved populations. "(B) The Secretary may make grants for the costs of the operation of public and nonprofit private entities which provide health services to medically underserved populations but with respect to which he is unable to make each of the determinations required by subsection (e)(2).

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Page:United States Statutes at Large Volume 89.djvu/404

 89 STAT. 344

Application.

42 USC 1396.

PUBLIC LAW 94-63—JULY 29, 1975 "(2) The costs for which a grant may be made under jjaragraph (1) may include the costs of acquiring and modernizing existing buildings (including the costs of amortizing the principal of, and paying interest on, loans) and the costs of providing training related to the provision of primary health services, supplemental health services and environmental health services, and to the management of community health center programs, "(3) Not more than two grants may be made under paragraph (1)(B) for the same entity. "(4) The amount of any grant made under paragraph (1) shall be determined by the Secretary. "(e)(1) No grant may be made under subsection (e) or (d) unless an application therefor is submitted to, and approved by, the Secretary. Such an application shall be submitted in such form and manner and shall contain such information as the Secretary shall prescribe. An application for a grant which will cover the costs of modernizing a building shall include, in addition to other information required by the Secretary— "^A) a description of the site of the building, "(B) plans and specifications for its modernization, and "(C) reasonable assurance that all laborers and mechanics employed by contractors or subcontractors in the performance of work on the modernization of the building will be paid wages at rates not less than those prevailing on similar work in the locality as determined by the Secretary of Labor in accordance with the Act of March 3, 1931 (40 U.S.C. 2r6a—276a-5, known as the Davis-Bacon Act). The Secretary of Labor shall have with respect to the labor standards referred to in subparagraph (C) the authority and functions set forth in Reorganization Plan Numbered 14 of 1950 (15 F.R. 3176, 5 U.S.C. Appendix) and section 2 of the Act of June 13, 1934 (40 U.S.C.276C). "(2) Except as provided in subsection (d)(1)(B), the Secretary may not approve an application for a grant under subsection (d) unless the Secretary determines that the entity for which the application is submitted is a community health center (within the meaning of subsection (a)) and that— "(A) the primary health services of the center will be available and accessible in the center's catchment area promptly, as appropriate, and in a manner which assures continuity; "(B) the center will have organizational arrangements, established in accordance with regulations prescribed by the Secretary, or (i) an ongoing quality assurance program (including utilization and peer review systems) respecting the center'services, and (ii) maintaining the confidentiality of patient records; "(C) the center will demonstrate its financial responsibility by the use of such accounting procedures and other requirements as may be prescribed by the Secretary; "(D) the center (i) has or will have a contractual or other arrangement with the agency of the State, in which it provides services, which administers or supervises the administration of a State plan approved under title X IX of the Social Security Act for the payment of all or a part of the center's costs in providing health services to persons who are eligible for medical assistance under such a State plan, or (ii) has made or will make every reasonable effort to enter into such an arrangement;

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Page:United States Statutes at Large Volume 89.djvu/405

 PUBLIC LAW 94-63—JULY 29, 1975 " (E) the center has made or will make and Avill continue to make every reasonable effort to collect appropriate reimbursement for its costs in providing health services to pereons who are entitled to insurance benefits under title X VIII of the Social Security Act, to medical assistance under a State plan approved under title X IX of such Act, or to assistance for medical expenses under any other public assistance program or private health insurance program; "(F) the center (i) has prepared a schedule of fees or payments for the provision of its services designed to cover its reasonable costs of operation and a corresponding schedule of discounts to be applied to the payment of such fees or payments, which discounts are adjusted on the basis of the patient's ability to pay, (ii) has made and will continue to make every reasonable effort (I) to secure from patients payment for services in accordance with such schedules, and (II) to collect reimbursement for health services to persons described in subparagraph (E) on the basis of the full amount of fees and payments for such services without application of any discount, and (iii) has submitted to the Secretary such reports as he may require to determine compliance with this subparagraph; "(G) the center has established a governing board which (i) is composed of individuals a majority of whom are being served by the center and who, as a group, represent the individuals being served by the center, and (ii) meets at least once a month, establishes general policies for the center (including the selection of services to be provided by the center and a schedule of hours during which services will be provided), approves the center's annual budget, and approves the selection of a director for the center; " (H) the center has developed, in accordance with regulations of the Secretary, (i) an overall plan and budget that meets the requirements of section 1861(z) of the Social Security Act, and (ii) an effective procedure for compiling and reporting to the Secretary such statistics and other information as the Secretary may require relating to (I) the costs of its operations, (II) the patterns of use of its services, (III) the availability, accessibility, and acceptability of its services, and (IV) such other matters relating to operations of the applicant as the Secretary may, by regulation, require; " (I) the center will review periodically its catchment area to (i) insure that the size of such area is such that the services to be provided through the center (including any satellite) are available and accessible to the residents of the area promptly and as appropriate, (ii) insure that the boundaries of such area conform, to the extent practicable, to relevant boundaries of political subdivisions, school districts, and Federal and State health and social service programs, and (iii) insure that the boundaries of such area eliminate, to the extent possible, barriers to access to the services of the center, including barriers resulting from the area's physical characteristics, its residential patterns, its economic and social groupings, and available transportation; and " (J) in the case of a center which serves a population including a substantial proportion of individuals of limited Englishspeaking ability, the center has (i) developed a plan and made arrangements responsive to the needs of such population for

89 STAT. 345

42 USC 1395. 42 USC 1396. Fee schedule.

Governing board

42 USC 1395x.

Review.

Limited Englishspeaking individuals.

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