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1974/12/23 HR14214 Health Revenue Sharing and Health Services Act of 1974 (vetoed) (3)
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1974/12/23 HR14214 Health Revenue Sharing and Health Services Act of 1974 (vetoed) (3)
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The original documents are located in Box 16, folder "1974/12/23 HR14214 Health Revenue
Sharing and Health Services Act of 1974 (vetoed) (3)" of the White House Records Office:
Legislation Case Files at the Gerald R. Ford Presidential Library.
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. Gerald R. Ford donated to the United
States of America his copyrights in all of his unpublished writings in National Archives collections.
Works prepared by U.S. Government employees as part of their official duties are in the public
domain. The copyrights to materials written by other individuals or organizations are presumed to
remain with them. If you think any of the information displayed in the PDF is subject to a valid
copyright claim, please contact the Gerald R. Ford Presidential Library.
Exact duplicates within this folder were not digitized.
Digitized from Box 16 of the White House Records Office Legislation Case Files at the Gerald R. Ford Presidential Library
LIBRARY
FORD
H. R. 14214
to/
Ninety-third Congress of the United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Monday, the twenty-first day of January,
one thousand nine hundred and seventy-four
An Act
To amend the Public Health Service Act and related laws, to revise and extend
programs of health revenue sharing and health services, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SHORT TITLE
SECTION 1. This Act may be cited as the "Health Revenue Sharing
and Health Services Act of 1974".
TITLE I-HEALTH REVENUE SHARING
SEC. 101. This title may be cited as the "Special Health Revenue
Sharing Act of 1974".
SEC. 102. Section 314(d) of the Public Health Service Act is
amended to read as follows:
"Comprehensive Public Health Services
(d) (1) From allotments made pursuant to paragraph (4), the Sec-
retary may make grants to State health and mental health authorities
to assist in meeting the costs of providing comprehensive public health
services under State plans approved under paragraph (3).
"(2) No grant may be made under paragraph (1) to the State health
or mental health authority of any State unless an application therefor
has been submitted to and approved by the Secretary and unless-
"(A) the State has submitted to the Secretary a State plan for
the provision of comprehensive public health services and has
had the plan intially approved by him under paragraph (3); or
"(B) in the case of a State which has had a State plan intially
approved under such, paragraph, the Secretary, upon his annual
review of the State plan of the State, determines that the plan
and the activities undertaken under it continue to meet the require-
ments of such paragraph.
An application for a grant under paragraph (1) shall be submitted
in such form and manner and shall contain such information as the
Secretary may require.
(3) A State plan for the provision of comprehensive public health
services shall include such information and assurances as the Secretary
may find necessary for approval of the plan and shall be comprised of
the following three parts:
"(A) An administrative part setting out a program for the per-
formance of the activities prescribed by the public health service
and mental health service parts of the State plan, which program
shall-
"(i) provide for administration, or supervision of admin-
istration, of such activities by the State health authority or,
with respect to mental health activities, by the State mental
health authority;
"(ii) set forth policies and procedures to be followed in the
expenditure of funds received from grants made under
paragraph (1);
(iii) contain or be supported by assurances satisfactory
to the Secretary that (I) the funds paid to the State public
and mental health authorities under grants made under para-
graph (1) will be used to make a significant contribution
H. R. 14214-2
toward providing and strengthening public health services
in the various political subdivisions of the State; (II) such
funds will be made available to other public or nonprofit
private agencies, institutions, and organizations, in accord-
ance with criteria which the Secretary determines are designed
to secure maximum participation of local, regional, or metro-
politan agencies and groups in the provision of such services;
(III) such funds will be used to supplement and, to the extent
practical, to increase the level of non-Federal funds that
would otherwise be made available for the purposes for which
the grant funds are provided and not to supplant such non-
Federal funds; and (IV) the plan is compatible with the
total health program of the State;
"(iv) provide that the State health authority or, with
respect to mental health activities, the State mental health
authority, will, from time to time, but not less often than
annually, (I) review and evaluate its State plan and submit
to the Secretary appropriate modifications thereof, (II)
report to the Secretary (by such categories as the Secretary
may prescribe) a description of the services provided pur-
suant to the public health service and mental health service
parts of the State plan in the preceding fiscal year and the
amount of funds spent by such categories for the provision of
such services, and (III) report to the Secretary the extent to
which services provided under the State plan for persons with
developmental disabilities and for the prevention and treat-
ment of alcohol and drug abuse are integrated with services
provided under the plan through community mental health
centers;
"(v) provide that the State health authority or, with
respect to mental health activities, the State mental health
authority will make such reports, in such form and con-
taining 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 finds necessary to assure
the correctness and verification of such reports;
(vi) provide for such fiscal control and fund accounting
procedures as may be necessary to assure the proper disburse-
ment of and accounting for funds paid under grants under
paragraph (1) and
(vii) 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;
"(viii) contain such additional provisions as the Secretary
may find necessary for the proper and efficient operation of
the State plan.
(B) A public health service part setting out a plan for the
provision within the State of public health services (other than
mental health services). Such plan shall be prepared by the State
health authority and shall-
"(i) require that such services provided within the State
be provided in conformity with the applicable provisions
and requirements of any comprehensive State health plan
developed with assistance provided under subsection (a) of
this section:
((ii) include an assessment of the most serious public
health problems that exist within the State, based upon data
pertaining to mortality and morbidity within the State and
H. R. 14214-3
to the economic impact of public health problems within the
State and upon other appropriate information; and
"(iii) provide for programs relating to environmental
health, health education, preventive medicine, health man-
power and facilities licensure, and, commensurate with the
extent of the problem, services for the prevention and treat-
ment of hypertension, drug abuse, drug dependence, alcohol
abuse, and alcoholism.
(C) A mental health service part setting out a plan for the
provision within the State of mental health services. Such plan
shall be prepared by the State mental health authority and shall-
" (i) require that such services provided within the State
be provided in conformity with the applicable provisions
and requirements of any comprehensive State health plan
developed with assistance provided under subsection (a) of
this section;
"(ii) include an assessment of the most serious mental
health problems that exist within the State, based upon data
pertaining to mortality and morbidity within the State and
to the economic impact of mental health problems within
the State and upon other appropriate information;
'(iii) include a detailed plan designed to eliminate inap-
propriate placement of persons with mental health problems
in institutions and to improve the quality of care for those
with mental health problems for whom institutional care is
appropriate;
(iv) prescribe minimum standards for the maintenance
and operation of mental health programs and facilities
(including community mental health centers) within the
State and for the enforcement of such standards; and
"(v) provide for assistance to courts and other public
agencies and to appropriate private agencies to facilitate (I)
screening by community mental health centers (or, if there
are no such centers, other appropriate entities) of residents
of the State who are being considered for inpatient care in a
mental health facility to determine if such care is necessary,
and (II) provision of followup care by community mental
health centers (or, if there are no such centers, by other
appropriate entities) for residents of the State who have been
discharged from mental health facilities.
The Secretary shall approve a State plan submitted to him which
meets the requirements of subparagraphs (A), (B), and (C) of this
paragraph and such other requirements as he is authorized to pre-
scribe under this paragraph. The Secretary shall review annually
each State plan which has been initially approved by him and the
activities undertaken under the plan to determine if the plan and such
activities continue to meet the requirements of such subparagraphs.
"(4) In each fiscal year the Secretary shall, in accordance with reg-
ulations, allot the sums appropriated for such year under paragraph
(7) among the States on the basis of the population and the financial
need of the respective States. The populations of the States shall be
determined on the basis of the latest figures for the population of the
States available from the Department of Commerce.
"(5) The Secretary shall determine the amount of any grant under
paragraph (1) ; but the amount of grants made in any fiscal year to
the public and mental health authorities of any State may not exceed
the amount of the State's allotment available for obligation in such
fiscal year. Payments under such grants may be made in advance or
H. R. 14214-4
by way of reimbursement, and at such intervals and on such conditions,
as the Secretary finds necessary.
"(6) In any fiscal year-
(A) not less than 15 per centum of a State's allotment under
paragraph (4) shall be made available only for grants under para-
graph (1) to the State's mental health authority for the provision
of mental health services pursuant to its State plan, and not less
than 22 per centum of a State's allotment under paragraph (4)
shall be available only for establishing and maintaining under the
State plan programs for the screening, detection, diagnosis, pre-
vention, and detection of hypertension; and
((B) not less than-
"(i) 70 per centum of the amount of a State's allotment
which is made available for grants to the mental health
authority, and
"(ii) 70 per centum of the remainder of the State's
allotment,
shall be available only for the provision under the State plan of
services in communities of the State.
(7) For the purpose of making grants under paragraph (1) there
are authorized to be appropriated $160,000,000 for the fiscal year
ending June 30, 1975, and $160,000,000 for the fiscal year ending
June 30, 1976."
TITLE II-FAMILY PLANNING PROGRAMS
SEC. 201. This title may be cited as the "Family Planning and Popu-
lation Research Act of 1974".
SEC. 202. (a) Section 1001 (c) of the Public Health Service Act is
amended (1) by striking out "and" after "1973;" and (2) by inserting
after "1974" the following: "; $150,000,000 for the fiscal year ending
June 30, 1975; and $175,000,000 for the fiscal year ending June 30,
1976".
(b) Section 1003(b) of such Act is amended (1) by striking out
"and" after "1973; and (2) by inserting after "1974" the following:
"; $4,000,000 for the fiscal year ending June 30, 1975; and $5,000,000
for the fiscal year ending June 30, 1976".
(c) Section 1004 of such Act is amended to read as follows:
"RESEARCH
"SEC. 1004. (a) The Secretary may-
"(1) conduct, and
(2) make grants to public or nonprofit private entities and
enter into contracts with public or private entities and individuals
for projects for,
research in the biomedical, contraceptive development, behavioral, and
program implementation fields related to family planning and
population.
(b) (1) To carry out subsection (a) there are authorized to be
appropriated $60,000,000 for the fiscal year ending June 30, 1975, and
$75,000,000 for the fiscal year ending June 30, 1976.
(2) No funds appropriated under any provision of this Act (other
than this subsection) may be used to conduct or support the research
described in subsection (a).
(d) Section 1005(b) of such Act is amended (1) by striking out
"and" after "1973; and (2) by inserting after "1974" the following:
"; $1,500,000 for the fiscal year ending June 30, 1975; and $2,000,000
for the fiscal year ending June 30, 1976".
H. R. 14214-5
(e) The last sentence of section 1006(c) of such Act is amended by
inserting immediately before the period the following: "so as to
insure that economic status shall not be a deterrent to participation in
the programs assisted under this title".
SEC. 203. (a) Title X of such Act is amended by inserting after
section 1008 the following new section:
"PLANS AND REPORTS
"SEC. 1009. (a) Not later than four months after the close of each
fiscal year, the Secretary shall make a report to the Congress setting
forth a plan to be carried out over the next five fiscal years for-
"(1) extension of family planning services to all persons
desiring such services,
"(2) family planning and population research programs,
"(3) training of necessary manpower for the programs author-
ized by this title and other Federal laws for which the Secre-
tary has responsibility and which pertain to family planning
programs, and
"(4) carrying out the other purposes set forth in this title and
the Family Planning Services and Population Research Act
of 1970.
"(b) Such a plan shall, at a minimum, indicate on a phased basis-
"(1) the number of individuals to be served by family plan-
ning programs under this title and other Federal laws for which
the Secretary has responsibility, the types of family planning
and population growth information and educational materials
to be developed under such laws and how they will be made
available, the research goals to be reached under such laws, and
the manpower to be trained under such laws;
(2) an estimate of the costs and personnel requirements
needed to meet the purposes of this title and other Federal laws
for which the Secretary has responsibility and which pertain
to family planning programs; and
'(3) the steps to be taken to maintain a systematic reporting
system capable of yielding comprehensive data on which serv-
ice figures and program evaluations for the Department of
Health, Education, and Welfare shall be based.
(c) Each report submitted under subsection (a) shall-
"(1) compare results achieved during the preceding fiscal year
with the objectives established for such year under the plan con-
tained in such report;
(2) indicate steps being taken to achieve the objectives during
the remaining fiscal years of the plan contained in such report and
any " revisions necessary to meet these objectives; and
(3) make recommendations with respect to any additional
legislative or administrative action necessary or desirable in carry-
ing out the plan contained in such report."
(b) Section 5 of the Family Planning Services and Population
Research Act of 1970 is repealed.
TITLE IHI-COMMUNITY MENTAL HEALTH CENTERS
SEC. 301. This title may be cited as the "Community Mental Health
Centers Amendments of 1974".
SEC. 302. (a) The Congress finds that-
(1) community mental health care is the most effective and
humane form of care for a majority of mentally ill individuals;
H. R. 14214-6
(2) the federally funded community mental health centers have
had a major impact on the improvement of mental health care by-
(A) fostering coordination and cooperation between vari-
ous agencies responsible for mental health care which in turn
has resulted in a decrease in overlapping services and more
efficient utilization of available resources,
(B) bringing comprehensive community mental health care
to all in need within a specific geographic area regardless of
ability to pay, and
(C) developing a system of care which insures continuity
of care for all patients,
and thus are a national resource to which all Americans should
enjoy access; and
(3) there is currently a shortage and maldistribution of quality
community mental health care resources in the United States.
(b) The Congress further declares that Federal funds should con-
tinue to be made available for the purposes of initiating new and
continuing existing community mental health centers and initiating
new services within existing centers, and for the monitoring of the
performance of all federally funded centers to insure their responsive-
ness to community needs and national goals relating to community
mental health care.
SEC. 303. The Community Mental Health Centers Act is amended
to read as follows:
"TITLE I-COMMUNITY MENTAL HEALTH CENTERS
"PART A-PLANNING AND OPERATIONS ASSISTANCE
"REQUIREMENTS FOR COMMUNITY MENTAL HEALTH CENTERS
"SEC. 201. (a) For purposes of this title (other than part B
thereof), the term 'community mental health center' means a legal
entity (1) through which comprehensive mental health services are
provided-
(A) principally to individuals residing in a defined geo-
graphic area (referred to in this title as a 'catchment area'),
(B) within the limits of its capacity, to any individual resid-
ing or employed in such area regardless of his ability to pay for
such services, his current or past health condition, or any other
factor, and
(C) in the manner prescribed by subsection (b),
and (2) which is organized in the manner prescribed by subsection (c).
(b) (1) The comprehensive mental health services which shall be
provided through a community mental health center shall include-
"(A) inpatient services, outpatient services, day care and other
partial hospitalization services, and emergency services;
'(B) a program of specialized services for the mental health
of children, including a full range of diagnostic, treatment, liaison,
and followup services (as prescribed by the Secretary) ;
(C) a program of specialized services for the mental health of
the elderly, including a full range of diagnostic, treatment, liaison,
and followup services (as prescribed by the Secretary);
'(D) consultation and education services which—
" (i) are for a wide range of individuals and entities
involved with mental health services, including health pro-
fessionals, schools, courts, State and local law enforcement
and correctional agencies, members of the clergy, public wel-
fare agencies, health services delivery agencies, and other
appropriate entities; and
H. R. 14214-7
"(ii) include a wide range of activities (other than the
provision of direct clinical services) designed to (I) develop
effective mental health programs in the center's catchment
area, (II) promote the coordination of the provision of men-
tal health services among various entities serving the center's
catchment area, (III) increase the awareness of the residents
of the center's catchment area with respect to the nature of
mental health problems and the type of mental health serv-
ices available, and (IV) promote the prevention and control
of rape and the proper treatment of the victims of rape;
(E) assistance to courts and other public agencies in screening
residents of the center's catchment area who are being considered
for referral to a State mental health facility for inpatient treat-
ment to determine if they should be SO referred and provision,
where appropriate, of treatment for such persons through the
center as an alternative to inpatient treatment at such a facility;
"(F) provision of followup care for residents of its catchment
area who have been discharged from a mental health facility;
"(G) a program of transitional halfway-house services for
mentally ill individuals who are residents of its catchment area
and who have been discharged from a mental health facility;
and
'(H) provision of each of the following service programs
(other than a service program for which there is not sufficient
need (as determined by the Secretary) in the center's catchment
area, or the need for which in the center's catchment area the
Secretary determines is currently being met)
"(i) A program for the prevention and treatment of alco-
holism and alcohol abuse and for the rehabilitation of alcohol
abusers and alcoholics.
"(ii) A program for the prevention and treatment of drug
addiction and abuse and for the rehabilitation of drug
addicts, drug abusers, and other persons with drug depend-
ency problems.
"(2) The provision of comprehensive mental health services through
a center shall be coordinated with the provision of services by other
health and social service agencies in the center's catchment area to
insure that persons receiving services through the center have access
to all such health and social services as they may require. The center's
services (A) may be provided at the center or satellite centers through
the staff of the center or through appropriate arrangements with
health professionals and others in the center's catchment area, (B)
shall be available and accessible to the residents of the area promptly,
as appropriate, and in a manner which preserves human dignity and
assures continuity and high quality care and which overcomes geo-
graphic, cultural, linguistic, and economic barriers to the receipt of
services, and (C) when medically necessary, shall be available and
accessible twenty-four hours a day and seven days a week.
"(c) (1) (A) The governing body of a community mental health
center (other than a center described in subparagraph (B)) shall (i)
be composed, where practicable, of individuals who reside in the
center's catchment area and who, as a group, represent the residents of
that area taking into consideration their employment, age, sex, and
place of residence, and other demographic characteristics of the area,
and (ii) meet at least once a month, establish general policies for the
center (including a schedule of hours during which services will be
provided), approve the center's annual budget, and approve the selec-
tion of a director for the center. At least one-half of the members of
such body shall be individuals who are not providers of health care
services.
H. R. 14214-8
(B) In the case of a community mental health center which before
the date of enactment of the Community Mental Health Centers
Amendments of 1974 was operated by a governmental agency and
received a grant under section 220 (as in effect before such date), the
requirements of subparagraph (A) shall not apply with respect to
such center, but the governmental agency operating the center shall
appoint a committee to advise it with respect to the operations of
the center, which committee shall be composed of individuals who
reside in the center's catchment area, who are representative of the
residents of the area as to employment, age, sex, place of residence,
and other demographic characteristics, and at least one-half of whom
are not providers of health care services.
"(C) For purposes of subparagraphs (A) and (B), the term
'provider of health care services' means an individual who receives
(either directly or through his spouse) more than one-tenth of his
gross annual income from fees or other compensation for the pro-
vision of health care services or from financial interests in entities
engaged in the provision of health care services or in producing or
supplying drugs or other articles for use in the provision of such
services, or from both such compensation and such interests.
"(2) A center shall have established, in accordance with regulations
prescribed by the Secretary, (A) an ongoing quality assurance pro-
gram (including utilization and peer review systems) respecting the
center's services, (B) an integrated medical records system (including
a drug use profile) which, in accordance with applicable Federal and
State laws respecting confidentiality, is designed to provide access to
all past and current information regarding the health status of each
patient and to maintain safeguards to preserve confidentiality and to
protect the rights of the patient, (C) a professional advisory board,
which is composed of members of the center's professional staff, to
advise the governing board in establishing policies governing medical
and other services provided by such staff on behalf of the center, and
(D) an identifiable administrative unit which shall be responsible
for providing the consultation and education services described in
subsection (b) (1) (D). The Secretary may waive the requirements of
clause (D) with respect to any center if he determines that because of
the size of such center or because of other relevant factors the estab-
lishment of the administrative unit described in such clause is not
warranted.
"GRANTS FOR PLANNING COMMUNITY MENTAL HEALTH CENTER
PROGRAMS
"SEC. 202. (a) The Secretary may make grants to public and non-
profit private entities to carry out projects to plan community mental
health center programs. In connection with a project to plan a com-
munity mental health center program for an area the grant recipient
shall (1) assess the needs of the area for mental health services, (2)
design a community mental health center program for the area based
on such assessment, (3) obtain within the area financial and profes-
sional assistance and support for the program, and (4) initiate and
encourage continuing community involvement in the development and
operation of the program. The amount of any grant under this sub-
section may not exceed $75,000.
(b) A grant under subsection (a) may be made for not more than
one year, and, if a grant is made under such subsection for a project,
no other grant may be made for such project under such subsection.
(c) The Secretary shall give special consideration to applications
submitted for grants under subsection (a) for projects for community
H. R. 14214-9
mental health centers programs for areas designated by the Secretary
as urban or rural poverty areas. No applications for a grant under
subsection (a) may be approved unless the application is recommended
for approval by the National Advisory Mental Health Council.
(d) There are authorized to be appropriated for payments under
grants under subsection (a) $5,000,000 for the fiscal year ending
June 30, 1975, and $5,000,000 for the fiscal year ending June 30, 1976.
"GRANTS FOR INITIAL OPERATION
"SEC. 203. (a) (1) The Secretary may make grants to-
(A) public and nonprofit private community mental health
centers, and
(B) any public or nonprofit private entity which-
(i) is providing mental health services,
(ii) meets the requirements of section 201 except that it is
not providing all of the comprehensive mental health services
described in subsection (b) (1) of such section, and
(iii) has a plan satisfactory to the Secretary for the provi-
sion of all such services within two years after the date of the
receipt of the first grant under this subsection,
to assist them in meeting their costs of operation (other than costs
related to construction).
(2) Grants under subsection (a) may only be made for a grantee's
costs of operation during the first eight years after its establishment.
In the case of a community mental health center or other entity which
received a grant under section 220 (as in effect before the date of enact-
ment of the Community Mental Health Centers Amendments of 1974),
such center or other entity shall, for purposes of grants under subsec-
tion (a), be considered as being in operation for a number of years
equal to the sum of the number of grants in the first series of grants
it received under such section and the number of grants it received
under this subsection.
"(b) (1) Each grant under subsection (a) to a community mental
health center or other entity shall be made for the costs of its opera-
tion for the one-year period beginning on the first day of the month
in which such grant is made.
"(2) No community mental health center may receive more than
eight grants under subsection (a). No entity described in subsection
(a) (1) (B) may receive more than two grants under subsection (a).
In determining the number of grants that a community mental health
center has received under subsection (a), there shall be included any
grants which the center received under such subsection as an entity
described in paragraph (1) (B) of such subsection.
"(c) The amount of a grant for any year made under subsection (a)
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 grantee'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 grantee may reasonably be expected to
collect in that year.
(2) (A) Except as provided in subparagraph (B), an amount
equal to the following percentages of the grantee's projected costs
of operation: 80 per centum of such costs for the first year of its
operation, 65 per centum of such costs for the second year of its
operation, 40 per centum of such costs for the third year of its
operation, 35 per centum of such costs for the fourth year of its
operation, 30 per centum of such costs for the fifth and sixth
H. R. 14214-10
years of its operation, and 25 per centum of such costs for the
seventh and eighth years of its operation.
"(B) In the case of a grantee providing services for persons
in an area designated by the Secretary as an urban or rural pov-
erty area, an amount equal to the following percentages of the
grantee's projected costs of operation: 90 per centum of such
costs for the first two years of its operation, 80 per centum of
such costs for the third year of its operation, 70 per centum of
such costs for the fourth year of its operation, 60 per centum of
such costs for the fifth year of its operation; 50 per centum of such
costs for the sixth year of its operation, 40 per centum of such costs
for the seventh year of its operation, and 30 per centum of such
costs for the eighth year of its operation.
In any year in which a grantee receives a grant under section 204 for
consultation and education services, the costs of the grantee's opera-
tion for that year attributable to the provision of such services and
its collections in that year for such services shall be disregarded in
making a computation under paragraph (1) or (2) respecting a
grant under subsection (a) for that year.
(d) (1) There are authorized to be appropriated for payments
under initial grants under subsection (a) $85,000,000 for the fiscal
year ending June 30, 1975, and $100,000,000 for the fiscal year ending
June 30, 1976.
(2) For the fiscal year ending June 30, 1976, and for each of the
succeeding seven fiscal years, there are authorized to be appropriated
such sums as may be necessary to make payments under continuation
grants under subsection (a) to community mental health centers and
other entities which first received an initial grant under this section
for the fiscal year ending June 30, 1975, or the next fiscal year and
which are eligible for a grant under this section in a fiscal year for
which sums are authorized to be appropriated under this paragraph.
(e) (1) Any entity which has not received a grant under sub-
section (a), which received a grant under section 220, 242, 243, 251,
256, 264, or 271 of this title (as in effect before the date of enactment
of the Community Mental Health Centers Amendments of 1974) from
appropriations under this title for a fiscal year ending before July 1,
1974, and which would be eligible for another grant under such section
from an appropriation for a succeeding fiscal year if such section were
not repealed by the Community Mental Health Centers Amendments
of 1974 may, in lieu of receiving a grant under subsection (a) of this
section, continue to receive a grant under each such repealed section
under which it would be SO eligible for another grant—
(A) for the number of years and in the amount prescribed for
the grant under each such repealed section, except that-
"(i) the entity may not receive under this subsection more
than two grants under any such repealed- section unless it
meets the requirements of section 201, and
(ii) the total amount received for any year (as determined
under regulations of the Secretary) under the total of the
grants made to the entity under this subsection may not
exceed the amount by which the entity's projected costs of
operation for that year exceed the total collections of State,
local, and other funds and of the fees, premiums, and third-
party reimbursements, which the entity may reasonably be
expected to make in that year; and
(B) in accordance with any other terms and conditions appli-
cable to such grant.
In any year in which a grantee under this subsection receives a grant
under section 204 for consultation and education services, the staffing
H. R. 14214-11
costs of the grantee for that year which are attributable to the provi-
sion of such services and the grantee's collections in that year for such
services shall be disregarded in applying subparagraph (A) and the
provision of the repealed section applicable to the amount of the
grant the grantee may receive under this subsection for that year.
'(2) An entity which receives a grant under this subsection may
not receive any grant under subsection (a).
"(3) There are authorized to be appropriated for the fiscal year
ending June 30, 1975, and for each of the next six fiscal years such
sums as may be necessary to make grants in accordance with
paragraph (1).
"GRANTS FOR CONSULTATION AND EDUCATION SERVICES
"SEC. 204. (a) (1) The Secretary may make annual grants to any
community mental health center for the costs of providing the con-
sultation and education services described in section 201 (b) (1) (D)
if the center-
(A) received from appropriations for a fiscal year ending
before July 1, 1974, a staffing grant under section 220 of this title
(as in effect before the date of enactment of the Community
Mental Centers Amendments of 1974) and may not because of
limitations respecting the period for which grants under that
section may be made receive under section 203(e) an additional
grant under such section 220; or
"(B) has received or is receiving a grant under subsection (a)
or (e) of section 203 and the number of years in which the center
has been in operation (as determined in accordance with section
203 (a) (2) is not less than four (or is not less than two if the
Secretary determines that the center will be unable to adequately
provide the consultation and education services described in
section 201 (b) (1) (D) during the third or fourth years of its
operation without a grant under this subsection).
(2) The Secretary may also make annual grants to a public or non-
profit private entity-
"(A) which has not received any grant under this title (other
than a grant under this section as amended by the Community
Mental Health Centers Amendments of 1974),
'(B) which meets the requirements of section 201 except, in the
case of an entity which has not received a grant under this section,
the requirement for the provision of consultation and education
services described in section 201 (b) (1) (D), and
"(C) the catchment area of which is not within (in whole or
in part) the catchment area of a community mental health center,
for the costs of providing such consultation and education services.
'(b) The amount of any grant made under subsection (a) shall be
determined by the Secretary, but no such grant to a center may exceed
the lesser of 100 per centum of such center's costs of providing such
consultation and education services during the year for which the
grant is made or-
"(1) in the case of each of the first two years for which
a center receives such grant, the sum of (A) an amount equal
to the product of $0.50 and the population of the center's catch-
ment area, and (B) the lesser of (i) one-half the amount deter-
mined under clause (A), or (ii) one-half of the amount received
by the center in such year from charges for the provision of such
services;
"(2) in the case of the third year for which a center receives
such a grant, the sum of (A) an amount equal to the product of
H. R. 14214-12
$0.50 and the population of the center's catchment area, and (B)
the lesser of (i) one-half the amount determined under clause
(A), or (ii) one-fourth of the amount received by the center in
such year from charges for the provision of such services; and
"(3) (A) except as provided in subparagraph (B), in the
case of the fourth year and each subsequent year thereafter for
which a center receives such a grant, the lesser of (i) the sum
of (I) an amount equal to the product of $0.125 and the popu-
lation of the center's catchment area, and (II) one-eighth of
the amount received by the center in such year from charges for
the provision of such services, or (ii) $50,000; or
(B) in the case of the fourth year and each subsequent year
for which a center receives such a grant, the sum of (i) an
amount equal to the product of $0.25 and the population of the
center's catchment area, and (ii) the lesser of (I) the amount
determined under clause (i) of this subparagraph, or (II) one-
fourth of the amount received by the center in such year from
charges for the provision for such services if the amount of the
last grant received by the center under section 220 of this title
(as in effect before the date of the enactment of the Community
Mental Health Amendments of 1974) or section 203 of this title,
as the case may be, was determined on the basis of the center pro-
viding services to persons in an area designated by the Secretary
as an urban or rural poverty area.
For purposes of this subsection, the term 'center' includes an entity
which receives a grant under subsection (a) (2).
"(c) There are authorized to be appropriated for payments under
grants under this section $4,000,000 for the fiscal year ending June 30,
1975, and $9,000,000 for the fiscal year ending June 30, 1976.
"CONVERSION GRANTS
"SEC. 205. (a) The Secretary may make not more than two grants
to any public or nonprofit entity which—
(1) has an approved application for a grant under section
203 or 211, and
"(2) can reasonably be expected to have an operating deficit,
for the period for which a grant is or will be made under such
application, which is greater than the amount of the grant the
entity is receiving or will receive under such application,
for the entity's reasonable costs in providing mental health services
which are described in section 201 (b) (1) but which the entity did not
provide before the date of the enactment of the Community Mental
Health Centers Amendments of 1974. For purposes of this section,
the term 'projected operating deficit' with respect to an entity described
in the preceding sentence means the excess of its projected costs of
operation (including the costs of operation related to the provision
of services for which a grant may be made under this subsection)
for a particular period over the total of the amount of State, local,
and other funds (including funds under a grant under section 203,
204, or 211) received by the entity in that period and the fees, pre-
miums, and third-party reimbursements to be collected by the entity
during that period.
(b) (1) Each grant under subsection (a) to an entity shall be made
for the same period as the period for which the grant under section 203
or 211 for which the entity had an approved application is or will be
made.
(2) The amount of any grant under subsection (a) to any entity
shall be determined by the Secretary, but no such grant may exceed
H. R. 14214-13
that part of the entity's projected operating deficit for the year for
which the grant is made which is reasonably attributable to its costs of
providing in such year the services with respect to which the grant is
made.
"(c) There are authorized to be appropriated for payments under
grants under subsection (a) $20,000,000 for the fiscal year ending
June 30, 1975, and $20,000,000 for the fiscal year ending June 30, 1976.
"GENERAL PROVISIONS RESPECTING GRANTS UNDER THIS PART
"SEC. 206. (a) (1) No grant may be made under this part to any
entity or 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.
(b) No grant may be made under this part unless-
"(1) an application (meeting the requirements of subsection
(c) for such grant has been submitted to, and approved by, the
Secretary; and
(2) the proposed use of grant funds in any area under the
jurisdiction of a State or area health planning agency established
under the Public Health Service Act has been reviewed to the
extent provided by law by such agencies to determine whether
such use is consistent with any plans which such agencies have
developed for such area, and with respect to-
" (A) the need for a community mental health center in
such area;
"(B) the definition of the catchment area to be served,
which shall be determined after consideration of any such
area previously designated;
"(C) the need for the services to be offered;
(D) in the case of an applicant described in section 203 (a)
(1) (B), the applicant's plans for developing comprehensive
mental health services;
'(E) the adequacy of the resources of the applicant for the
direct provision of mental health services and the adequacy
of agreements with the applicant for the indirect provision
of such services;
(F) the adequacy of the applicant's arrangements for the
appropriate use of and integration with existing health deliv-
ery services and facilities to assure optimum utilization of
and nonduplication of such services and facilities and to
assure continuity of patient care, including arrangements
of the applicant with health maintenance organizations and
community health centers serving individuals who reside in
or are employed in the area served by the applicant for the
provision by the applicant of mental health services for the
members and patients of such organizations and centers;
"(G) the adequacy of arrangements of the applicant for
the coordination of its services with those of other health and
social service agencies including, where appropriate, exchange
of staff resources; and
(H) any other factor which the State or area health plan-
ning agency determines to be significant for purposes of plan-
ning and coordination of health services for the area within
the jurisdiction of such planning agency.
"(c) (1) An application for a grant under this part shall be sub-
mitted in such form and manner as the Secretary shall prescribe and
shall contain such information as the Secretary may require. Except
H. R. 14214-14
as provided in paragraph (3), an application for a grant under sec-
tion 203, 204, or 205 shall contain or be supported by assurances
satisfactory to the Secretary that-
"(A) the community mental health center for which the appli-
cation 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, 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 utilization of its services, (III) the avail-
ability, 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
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 main-
tenance 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 of the center in
providing such services;
"(D) in the case of a community mental health center serving
a population including a substantial proportion of individuals of
limited English-speaking ability, the center has (i) developed a
plan and made arrangements responsive to the needs of such popu-
lation for providing services to the extent practicable in the
language and cultural context most appropriate to such indi-
viduals, and (ii) identified an individual on its staff who is
bilingual and whose responsibilities shall include providing guid-
ance to such individuals and to appropriate staff members with
respect to cultural sensitivities and bridging linguistic and cul-
tural 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 emergency;
'(F) such community mental health center has provided appro-
priate methods and procedures for the dispensing and adminis-
tering 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;
(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
H. R. 14214-15
available, to it from Federal sources (other than this part) and
non-Federal sources (including, to the maximum extent feasible,
reimbursement from the recipients of consultation and educa-
tion 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 agency administers or super-
vises the administration of a State plan approved under title XIX
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 XVIII of the Social Security Act, to medical assistance
under a State plan approved under title XIX 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 corre-
sponding 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 the provision of mental
health services through the center will be paid to the center, and
(ii) which prohibits health professionals who provide such serv-
ices 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
sources of non-Federal funds to pay such increased costs.
"(2) The Secretary may approve an application for a grant under
section 203, 204, or 205 only if the application is recommended for
approval by the National Advisory Mental Health Council, the appli-
cation meets the requirements of paragraph (1), and, except as pro-
vided in paragraph (3), the Secretary-
H. R. 14214-16
((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 pro-
vided by the applicant will constitute an addition to, or a
significant improvement in quality (as determined in accord-
ance 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 satis-
factory 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 third-
party 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, determines
that during the year for which the grant was made the appli-
cant met, in accordance with the section under which such
grant was made, the requirements of section 201 and complied
with the assurances 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, that the application contains or
is supported by assurances satisfactory to the Secretary that
the services of the applicant will, to the extent feasible, be
utilized 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 under 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
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 obli-
gate for a program of continuing evaluation of the effectiveness of
its programs in serving the needs of the residents of its catchment
H. R. 14214-17
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,
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) An application for a grant under section 203, 204, or 205-
(A) may not be disapproved, and
((B) may not be approved for a grant which is less than the
amount of the grant received by the applicant under such section
in the preceding fiscal year,
on the ground that the applicant has not made reasonable efforts to
secure payments or reimbursements in accordance with assurances
provided under subparagraphs (I), (J), and (K) of subsection (c) (1)
unless the Secretary first informs such applicant of the respects in
which he has not made such reasonable efforts and the manner in
which his performance can be improved and gives the applicant a
reasonable opportunity to respond. Applications disapproved, and
applications approved for reduced amounts, on such grounds shall be
referred to the National Advisory Mental Health Council for its
review and recommendations respecting such approval or disapproval.
"(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 dis-
approve an application within the period beginning on the date the
State mental health authority submitted its comments or on the expira-
tion 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 this title in a fiscal year beginning before the date of
the enactment of the Community Mental Health Centers Amendments
of 1974.
"(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 (a), 203 (e),
or 204(a) (2).
"PART B-FINANCIAL DISTRESS GRANTS
"GRANT AUTHORITY
"SEC. 211. The Secretary may make grants for the operation of
any community mental health center which-
"(1) (A) received a grant under section 220 of this title (as
in effect before the date of enactment of the Community Mental
Health Centers Amendments of 1974) and, because of limitations
H. R. 14214-18
in such section 220 respecting the period for which the center
may receive grants under such section 220, is not eligible for fur-
ther grants under that section; 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).
"GRANT REQUIREMENTS
"SEC. 212. (a) No grant may be made under section 211 to any
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 compre-
hensive 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 analy-
sis 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 organiza-
tion to meet the requirements of section 201 (c).
(b) An application for a grant under section 211 must contain or
be supported by the assurances prescribed by subparagraphs (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 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 com-
puted under paragraph (1) or (2) as follows:
H. R. 14214-19
"(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 1974), 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 OF APPROPRIATIONS
"SEC. 213. There are authorized to be appropriated $10,000,000 for
the fiscal year ending June 30, 1975, and $15,000,000 for the fiscal year
ending June 30, 1976, for payments under grants under section 211.
"PART C-FACILITIES ASSISTANCE
"ASSISTANCE AUTHORITY
"SEC. 221. (a) From allotments made under section 227 the Secretary
shall pay, in accordance with this part, the Federal share of projects
for (1) the acquisition or remodeling, or both, of facilities for com-
munity 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 deter-
mined under regulations prescribed by the Secretary), and (4) the
initial equipment of a facility acquired, remodeled, leased, or con-
structed 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
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 sub-
section (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 662/3 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 such project; and
such maximum Federal share and such method of Federal share deter-
H. R. 14214-20
mination 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 pro-
vides 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 Rico, Guam, American Samoa, and the Virgin Islands
shall be 662/3 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 the fifty States and the District of Columbia.
(B) The Federal percentages under clause (ii) of subparagraph
(A) shall be promulgated by the Secretary between July 1 and Sep-
tember 30 of each even-numbered year, on the basis of the average of
the per capita incomes of the States subject to such Federal percentages
and of the fifty States and the District of Columbia 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.
"APPROVAL OF PROJECTS
"SEC. 222. (a) For each project for a community mental health
center facility pursuant to a State plan approved under section 237,
there shall be submitted to the Secretary, through the State agency of
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;
(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 other nonprofit
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 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)
"(6) a certification by the State agency of the Federal share for
the project; and
"(7) the assurances described in section 206 (c) (2).
Each applicant shall be afforded an opportunity for a hearing before
the State agency respecting its application.
H. R. 14214-21
(b) The Secretary shall approve an application submitted in
accordance with subsection (a) if-
(1) sufficient funds to pay the Federal share for the project for
which the application was submitted are available from the allot-
ment to the State;
'(2) the Secretary finds that the application meets the appli-
cable 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 Secre-
tary 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 grant under section 220, 242, 243, 251, 256, 264, or
274 of this title (as in effect before the date of the enactment of the
Community Mental Health Centers Amendments of 1974) from appro-
priations for a fiscal year ending before July 1, 1974, 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 sig-
nificantly expand its services and which demonstrates exceptional
financial need for assistance under this part for such project. Amend-
ment of any approved application shall be subject to approval in
the same manner as an original application.
"PAYMENTS
"SEC. 223. (a) (1) Upon certification to the Secretary by the State
agency, based upon inspection by it, that work has been performed
upon a construction or remodeling 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 appli-
cant, 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 oppor-
tunity 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 of payments with respect to such project may not
exceed an amount equal to the Federal share of the cost of such project.
"(2) In case an amendment to an approved application is approved
or the estimated cost of a construction or remodeling 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 Sec-
retary 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;
H. R. 14214-22
"(B) any assurance required to be in an application filed under
section 222 is not being carried out;
"(C) there is substantial failure to carry out plans and specifi-
cations 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 sec-
tion 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 further payments will be made to the State from allot-
ments 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), or (D) of paragraph (1),
as the Secretary may determine to be appropriate under the circum-
stances; and, except with regard to any project for which the appli-
cation has already been approved and which is not directly affected,
further payments from such allotments may be withheld, in whole or
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 repay-
ment of Federal moneys to which the recipient was not entitled.
"JUDICIAL REVIEW
"SEC. 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 there-
upon 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, but 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 sup-
ported by substantial evidence. The judgment of the court affirm-
ing 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
H. R. 14214-23
United States upon certiorari or certification as provided in sec-
tion 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.
"RECOVERY
"SEC. 225. If any facility of a community mental health center
remodeled, constructed, or acquired with funds provided under this
part is, at any time within twenty years after the completion of such
remodeling or construction 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 Secre-
tary 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 then value (as determined by the agreement of the parties or by
action brought in the district court of the United States 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 cost of the construction 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 grant may be made under the Public Health Service
Act for the construction or modernization of a facility for a com-
munity mental health center unless the Secretary determines that
there are no funds available under this part for the construction or
modernization of such facility.
"ALLOTMENTS TO STATES
"SEC. 227. (a) In each fiscal year, the Secretary shall, in accordance
with regulations, make allotments from the sums appropriated under
section 228 to the several States (with State plans approved under
section 237) on the basis of (1) the population, (2) the extent of the
need for 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 Trust
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 Trust Territory 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 only), in addition to the sums allotted
for such State in such next fiscal year. Sums SO allotted to the Virgin
Islands, American Samoa, Guam, or the Trust Territory of the Pacific
Islands in a fiscal year and remaining unobligated at the end of such
year shall remain available to it for such purpose in the next two
H. R. 14214-24
fiscal years (and in such years only), in addition to the sums allotted to
it 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.
"AUTHORIZATION OF APPROPRIATIONS
"SEC. 228. There are authorized to be appropriated $15,000,000 for
the fiscal year ending June 30, 1975, and $15,000,000 for the fiscal year
ending June 30, 1976, for allotments under section 227.
"PART D-RAPE PREVENTION AND CONTROL
"RAPE PREVENTION AND CONTROL
"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 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 enforce-
ment agencies, hospitals or other medical institutions, prose-
cutors, and the courts;
"(iv) the causes of rape, identifying to the degree possible-
(I) social conditions which encourage sexual attacks,
(II) motivations of offenders, and
" (III) the impact of the offense on the victim and the
family of the victim;
(v) sexual assaults in correctional institutions;
"(vi) the actual incidence of forcible rape as compared to
the reported cases and the reasons therefor; and
"(vii) the effectiveness of existing private and local and
State government education and counseling 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 sub-
paragraph (E). The Secretary shall annually submit to the Con-
gress a summary of such study and projects together with
recommendations where appropriate.
H. R. 14214-25
'(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) Assist community mental health centers and other quali-
fied public and nonprofit private entities in conducting research
and demonstration projects concerning the control and prevention
of rape, including projects (i) to research and demonstrate alter-
native methods of planning, developing, implementing, and evalu-
ating programs used in the prevention and control of rape, the
treatment and counseling of victims of rape and their families,
and the rehabilitation of offenders; and (ii) involving the appli-
cation of such methods.
"(F) Assist 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 forci-
ble, statutory, and attempted rape, homosexual assaults, and other
criminal assaults.
"(c) The Secretary shall appoint an advisory committee to advise,
consult with, and make recommendations to him on the implementa-
tion 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 com-
mittee 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 is 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 $10,000,000 for the fiscal year ending
June 30, 1975, and $10,000,000 for the fiscal year ending June 30, 1976.
"PART E-GENERAL PROVISIONS
"DEFINITIONS
"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 responsible for the mental health service part of a
State's plan under section 314 (d) of the Public Health Service
Act.
(3) The term 'Secretary' means the Secretary of Health, Edu-
cation, and Welfare.
"(4) The term 'National Advisory Mental Health Council'
means the National Advisory Mental Health Council established
under section 217 of the Public Health Service Act.
H. R. 14214-26
"REGULATIONS
"SEc. 236. Regulations issued by the Secretary for the administration
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 dif-
ferent areas of the State for such centers and their services and
requiring special consideration for projects on the basis of the
extent to which a center to be assisted or established upon com-
pletion of a 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 sec-
tion 237 provide for adequate community mental health centers
for people residing in the State, and provide for adequate com-
munity mental health centers to furnish needed services for
persons unable to pay therefor.
The Federal Hospital Council (established by section 641 of the Public
Health Service Act) and the National Advisory Mental Health
Council shall be consulted by the Secretary before the issuance of
regulations under this section.
"STATE PLAN
"SEC. 237. (a) A State plan for the provision of comprehensive
mental health services within a State shall be comprised of the fol-
lowing 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 planning, operation, or utilization
of community mental health centers or other mental health
facilities, and (ii) representatives of consumers and pro-
viders of the services provided by 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 Secre-
tary 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 estab-
lishment and maintenance of personnel standards on a merit
basis.
H. R. 14214-27
(2) A services and facilities part containing provisions respect-
ing 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 mental health services part of
the State's plan under section 314(d) of the Public Health
Service Act;
(B) set forth a program for community mental health cen-
ters within the State (i) which is based on a statewide inventory
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 sec-
tion 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 com-
munity 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 Sec-
retary under this title.
(b) The State agency shall administer or supervise the adminis-
tration 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 com-
plies 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 construction projects 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 shall be paid on condition that there shall be expended from
State sources for such year for administration of such provisions of
the State plan approved under this section not less than the total
amount expended for such purposes from such sources during the
fiscal year ending June 30, 1968.
H. R. 14214-28
"CATCHMENT AREA REVIEW
"SEC. 238. Each agency of a State which administers or supervises
the administration of a State's health planning functions under a State
plan approved under section 314(a) of the Public Health Service Act
shall, in consultation with that State's mental health authority, peri-
odically review the catchment areas of the community mental health
centers located in that State to (1) insure that the sizes of such areas
are such that the services to be provided through the centers (includ-
ing 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, includ-
ing barriers resulting from an area's physical characteristics, its resi-
dential patterns, its economic and social groupings, and available
transportation.
"STATE CONTROL OF OPERATIONS
"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.
"RECORDS AND AUDIT
"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 sup-
plied 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, docu-
ments, papers, and records of the recipients that are pertinent to the
assistance received under this title.
"NONDUPLICATION
"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
"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—
H. R. 14214-29
"(1) such area contains one or more subareas which are charac-
terized 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
"(3) the project, facility, or activity, in connection with which
such determination is made, does, or (when completed or put into
operation) will, serve the needs of the residents of such subarea
or subareas.
"PROTECTION OF PERSONAL RIGHTS
"SEC. 243. In making grants under parts A and B, the Secretary
shall take such steps as may be necessary to assure that no individual
shall be made the subject of any research involving surgery which is
carried out (in whole or in part) with funds under such grants unless
such individual explicity agrees to become a subject of such research.
"REIMBURSEMENT
"SEC. 244. The Secretary shall, to the extent permitted by law,
work with States, private insurers, community mental health centers,
and other appropriate 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.
"SHORT TITLE
"SEC. 245. This title may be cited as the "Community Mental Health
Centers Act'.'
SEC. 304. The amendment made by section 303 shall take effect as of
July 1, 1974.
SEC. 305. (a) Section 513 of the Public Health Service Act is
amended by striking out "or by grants or contracts" and inserting in
lieu thereof "or, except in the case of evaluations of programs under
the Community Mental Health Centers Act, by grants or contracts".
(b) The amendment made by subsection (a) shall apply with respect
to evaluations of programs under the Community Mental Health
Centers Act made under such section 513 with appropriations for fiscal
years ending after June 30, 1974.
Sec. 306. (a) Not later than one year after the date of the enactment
of this Act the Secretary of Health, Education, and Welfare shall
make a report to the Committee on Interstate and Foreign Commerce
of the House of Representatives and the Committee on Labor and
Public 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 sub-
mit 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.
H. R. 14214-30
TITLE IV-MIGRANT HEALTH CENTERS
MIGRANT HEALTH CENTERS
SEC. 401. (a) Section 310 of the Public Health Service Act is
amended to read as follows:
"MIGRANT HEALTH
"SEC. 310. (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-
mental health services necessary for the adequate support of pri-
mary health services,
"(C) referral to providers of supplemental health services and
payment, as appropriate and feasible, for their provision of such
services,
"(D) environmental health services, including, as may be appro-
priate for particular centers, the detection and alleviation of
unhealthful conditions associated with water supply, sewage treat-
ment, 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, 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 work-
ers, within the area it serves (referred to in this section as a 'catch-
ment 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 worker' 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 sub-
paragraph (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 bound-
H. R. 14214-31
aries 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.
(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 pre-
ceding subparagraphs of this paragraph, including, if a sub-
stantial 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 assist-
ance under this section to projects and programs in 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 appli-
cations 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 cen-
ters which will serve migratory agricultural workers, seasonal agri-
cultural 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,
H. R. 14214-32
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 assess-
ment;
"(iii) efforts to secure, within the proposed catchment area
of such center, financial and professional assistance and support
for the project; and
"(iv) initiation and encouragement of continuing commu-
nity 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 agri-
cultural workers, seasonal agricultural workers, and the mem-
bers of the families of such migratory and seasonal workers;
(ii) for the provision of primary care (as defined in regu-
lations 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 pri-
mary 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 buildings and the cost of 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 opera-
tion 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 entities which intend to become migrant health
centers, which provide health services in high impact areas to migra-
tory 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 opera-
tion of programs in areas in which no migrant health center exists
H. R. 14214-33
and in which not more than six thousand migratory agricultural work-
ers and their families reside for more than two months-
(i) for the provision of emergency care to migratory agricul-
tural 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 regula-
tions of the Secretary) for such workers and the members of their
families;
(iii) for the development of arrangements with existing facili-
ties to provide primary health services (not included as primary
care as defined under regulations under clause (ii)) to such
workers and the members of their families; or
'(iv) which otherwise improve the health of such workers and
the members of their families.
Any such program may include the acquisition and modernization of
existing buildings and the cost of 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 enforce-
ment of standards for sanitation in migrant labor camps and
applicable Federal and State pesticide control standards; and
" (2) conduct projects and studies to assist the several States and
entities which have received grants or contracts under this section
in the assessment of problems related to camp and field sanitation,
pesticide hazards, and other environmental health hazards to
which migratory agricultural workers, seasonal agricultural
workers, and members of their families are exposed.
(f) (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 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 pre-
scribe. An application for a grant or contract which will cover the costs
of modernizing a building shall include, in addition to other infor-
mation 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
H. R. 14214-34
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) 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 appro-
priate, and in a manner which assures continuity;
"(B) the center will have organizational arrangements, estab-
lished in accordance with regulations of the Secretary, for (i)
an ongoing quality assurance program (including utilization and
peer review systems) respecting the center's services, and (ii)
maintaining the confidentiality of patient records;
(C) the center will demonstrate its financial responsibility by
the use of such accounting procedures and other requirements as
may be prescribed by the Secretary;
(D) the center (i) has or will have a contractual or other
arrangement with the agency of the State in which it provides
services which agency administers or supervises the administra-
tion of a State plan approved under title XIX 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 XVIII of the Social
Security Act, to medical assistance under a State plan approved
under title XIX of such Act, or to assistance for medical expenses
under any other public assistance program or private health insur-
ance 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 dis-
counts 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 Sec-
retary 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) 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
H. R. 14214-35
may require relating to (I) the costs of its operations, (II) the
patterns of utilization of its services, (III) the availability, acces-
sibility, 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 avail-
able 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, with 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 includ-
ing a substantial proportion of individuals of limited English-
speaking ability, the center has (i) developed a plan and made
arrangements responsive to the needs of such population for pro-
viding services to the extent practicable in the language and cul-
tural context most appropriate to such individuals, and (ii)
identified an individual on its staff who is bilingual and whose
responsibilities shall include providing guidance to such indi-
viduals 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 neces-
sary technical and other nonfinancial assistance (including fiscal and
program management 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) $5,000,000
for the fiscal year ending June 30, 1975, and $5,000,000 for the fiscal
year ending June 30, 1976. Of the funds appropriated under this
paragraph for the fiscal year ending June 30, 1975, not more than 30
per centum of such funds may be made available for grants and con-
tracts 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 such subsection.
"(2) There are authorized to be appropriated for payments pur-
suant 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) $60,000,000 for the fiscal year ending
June 30, 1975, and $65,000,000 for the fiscal year ending June 30, 1976.
H. R. 14214-36
Of the funds appropriated under the first sentence for the fiscal year
ending June 30, 1975, there shall be made available for grants and
contracts under subsection (d) (1) (C) an amount equal to 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 pro-
grams described in subsection (d) (1) (C). Of the funds appropriated
under the first sentence for the fiscal year ending June 30, 1976, there
shall be made available for grants and contracts under subsection
(d) (1) (C) an amount equal to the greater of 25 per centum of such
funds or 90 per centum of the amount of grants made under this sec-
tion 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, 1974. 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 $10,000,000 for the fiscal
year ending June 30, 1975, and $10,000,000 for the fiscal year ending
June 30, 1976."
(b) Section 217 of the Public Health Service Act is amended by
adding after subsection (f) the following new subsection:
(g) (1) Within one hundred and twenty days after the date of
the enactment of this subsection, the Secretary shall appoint and
organize a National Advisory Council on Migrant Health (herein-
after 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 fund-
ing of migrant health centers and other entities under grants and
contracts under section 310.
"(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 310. 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 mem-
bers 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 prede-
cessor 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 (here-
inafter in this subsection referred to as the "Secretary") shall con-
duct 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;
H. R. 14214-37
(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 this first Act making appropriations for such study.
TITLE V-COMMUNITY HEALTH CENTERS
COMMUNITY HEALTH 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 HEALTH CENTERS
"SEC. 330. (a) For purposes of this section, the term 'community
health center' means an entity which either through its staff and sup-
porting resources or through contracts or cooperative arrangements
with other public or private entities provides-
"(1) primary 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, environ-
mental 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.
"(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;
H. R. 14214-38
" (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 pre-
ceding subparagraphs of this paragraph, including, if a substan-
tial 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 pop-
ulation 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
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 (includ-
ing 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 oper-
ation 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).
(2) The costs for which a grant may be made under paragraph
(1) may include the costs of acquiring and modernizing existing
buildings (including the costs of amortizing the principal of, and pay-
ing interest on, loans) and the costs of providing training related to
the provision of primary health services, supplemental health serv-
H. R. 14214-39
ices, 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 (c) or (d) unless
an application therefor is submitted to, and approved by, the Secre-
tary. Such an application shall be submitted in such form and manner
and shall contain such information as the Secretary shall prescribe.
An application for a grant which will cover the costs of modernizing a
building shall include, in addition to other information required by
the Secretary-
"(A) a description of the site of the building,
(B) plans and specifications for its modernization, and
"(C) reasonable assurance that all laborers and mechanics
employed by contractors or subcontractors in the performance of
work on the modernization of the building will be paid wages at
rates not less than those prevailing on similar work in the locality
as determined by the Secretary of Labor in accordance with the
Act of March 3, 1931 (40 U.S.C. 276a-276a-5, known as the
Davis-Bacon Act).
The Secretary of Labor shall have with respect to the labor standards
referred to in subparagraph (C) the authority and functions set forth
in Reorganization Plan Numbered 14 of 1950 (15 F.R. 3176, 5 U.S.C.
Appendix) and section 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 applica-
tion 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 appro-
priate, and in a manner which assures continuity;
"(B) the center will have organizational arrangements, estab-
lished in accordance with regulations prescribed by the Secretary,
for (i) an ongoing quality assurance program (including utiliza-
tion and peer review systems) respecting the center's services, and
(ii) maintaining the confidentiality of patient records;
'(C) the center will demonstrate its financial responsibility by
the use of such accounting procedures and other requirements as
may be prescribed by the Secretary;
"(D) the center (i) has or will have a contractual or other
arrangement with the agency of the State in which it provides
services which agency administers or supervises the administra-
tion of a State plan approved under title XIX 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 medi-
cal assistance under such a State plan, or (ii) has made or will
make every reasonable effort to enter into such an arrangement;
"(E) the center has made or will make and will continue to
make every reasonable effort to collect appropriate reimbursement
for its costs in providing health services to persons who are
entitled to insurance benefits under title XVIII of the Social
Security Act, to medical assistance under a State plan approved
under title XIX of such Act, or to assistance for medical expenses
under any other public assistance program or private health
insurance program;
H. R. 14214-40
"(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 Sec-
retary 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, estab-
lishes 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 utilization 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 Sec-
retary 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 avail-
able 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, with 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 includ-
ing a substantial proportion of individuals of limited English-
speaking ability, the center has (i) developed a plan and made
arrangements responsive to the needs of such population for
providing services to the extent practicable in the language and
cultural context most appropriate to such individuals, and (ii)
identified an individual on its staff who is bilingual and whose
responsibilities shall include providing guidance to such individ-
uals and to appropriate staff members with respect to cultural
sensitivities and bridging linguistic and cultural differences.
"(f) The Secretary may provide (either through the Department
of Health, Education, and Welfare or by grant or contract) all neces-
sary technical and other nonfinancial assistance (including fiscal and
program management and training in such management) to any
public or private nonprofit entity to assist it in developing plans for,
H.R. 14214-41
and in operating as, a community health center, and in meeting the
requirements of subsection (e) (2).
" (g) (1) There are authorized to be appropriated for payments
pursuant to grants under subsection (c) $20,000,000 for the fiscal year
ending June 30, 1975, and $20,000,000 for the fiscal year ending
June 30, 1976.
"(2) There are authorized to be appropriated for payments pur-
suant to grants under subsection (d) $240,000,000 for the fiscal year
ending June 30, 1975, and $260,000,000 for the fiscal year ending
June 30, 1976."
(b) Section 314(e) of the Public Health Service Act is repealed.
TITLE VI-MISCELLANEOUS
DISEASES BORNE BY RODENTS
SEC. 601. (a) Section 317 (h) (1) of the Public Health Service Act
is amended by striking out "and RH disease" and inserting in lieu
thereof ", RH disease, and diseases borne by rodents".
(b) Section 317 (d) (3) of such Act is amended by striking out
"$23,000,000 for the fiscal year ending June 30, 1975" and inserting
in lieu thereof "$38,000,000 for the fiscal year ending June 30, 1975".
HOME HEALTH SERVICES
SEC. 602. (a) (1) For the purpose of demonstrating the establish-
ment and initial operation of public and nonprofit private agencies
(as defined in section 1861 (o) of the Social Security Act) which will
provide home health services (as defined in section 1861 (m) of the
Social Security Act) in areas in which such services are not other-
wise available, the Secretary of Health, Education, and Welfare may,
in accordance with the provisions of this section, make grants to meet
the initial costs of establishing and operating such agencies and
expanding the services available through existing agencies, and to
meet the costs of compensating professional and paraprofessional
personnel during the initial operation of such agencies or the expan-
sion of services of existing agencies.
(2) In making grants under this subsection, the Secretary shall
consider the relative needs of the several States for home health
services and preference shall be given to areas within a State in
which a high percentage of the population proposed to be served
is composed of individuals who are elderly, medically indigent, or
both.
(3) Applications for grants under this subsection shall be in such
form and contain such information as the Secretary shall prescribe
by regulation.
(4) Payment of grants under this subsection may be made in
advance or by way of reimbursement or in installments as the Secre-
tary may determine.
(5) There are authorized to be appropriated $12,000,000 for the
fiscal year ending June 30, 1976, for payments under grants under
this subsection.
(b) (1) The Secretary of Health, Education, and Welfare may
make grants to public and nonprofit private entities to assist them in
demonstrating the training of professional and paraprofessional per-
sonnel to provide home health services (as defined in section 1861 (m)
of the Social Security Act).
(2) Applications for grants under this subsection shall be in such
form and contain such information as the Secretary shall by regula-
tions prescribe.
H. R. 14214-42
(3) Payment of grants under this section may be made in advance
or by way of reimbursement, or in installments, as the Secretary
shall determine.
(4) There is authorized to be appropriated $3,000,000 for the fiscal
year ending June 30, 1976, for payments under grants under this
subsection.
COMMITTEE ON MENTAL HEALTH AND ILLNESS OF THE ELDERLY
SEC. 603. (a) The Secretary of Health, Education, and Welfare shall
appoint a Committee on Mental Health and Illness of the Elderly
(hereinafter in this section referred to as the "Committee") to make
a study of and recommendations respecting-
(1) the future needs for mental health facilities, manpower,
research, and training to meet the mental health care needs of
elderly persons,
(2) the appropriate care of elderly persons who are in mental
institutions or who have been discharged from such institutions,
and
(3) proposals for implementing the recommendations of the
1971 White House Conference on Aging respecting the mental
health of the elderly.
(b) Within one year from the date of enactment of this Act the
Secretary shall report to the Committee on Labor and Public Welfare
of the Senate and the Committee on Interstate and Foreign Commerce
of the House of Representatives the findings of the Committee under
the study under subsection (a) and the Committee's recommendations
under such subsection.
(c) (1) The Committee shall be composed of nine members appointed
by the Secretary of Health, Education, and Welfare. The Committee
shall include at least one member from each of the fields of psychology,
psychiatry, social science, social work, and nursing. Each member
of the Committee shall by training, experience, or attainments be
exceptionally qualified to assist in carrying out the function of the
Committee.
(2) Members of the Committee shall receive compensation at a rate
to be fixed by the Secretary, but not exceeding the daily equivalent of
the annual rate of basic pay in effect for grade GS-18 of the General
Schedule, for each day (including traveltime) during which they are
engaged in the actual performance of duties vested in the Committee.
While away from their homes or regular places of business in the
performance of services for the Committee, members of the Committee
shall be allowed travel expenses, including per diem in lieu of sub-
sistence, in the same manner as persons employed intermittently in the
Government service are allowed expenses under section 5703 (b) of
title 5 of the United States Code.
(d) The Committee shall cease to exist thirty days after the sub-
mission of the report pursuant to subsection (b).
COMMISSION FOR CONTROL OF EPILEPSY
SEC. 604. (a) The Secretary of Health, Education, and Welfare shall
establish a temporary commission to be known as the Commission for
the Control of Epilepsy and Its Consequences (hereinafter referred to
in this section as the "Commission").
(b) It shall be the duty of the Commission to-
(1) make a comprehensive study of the state of the art of
medical and social management of the epilepsies in the United
States;
H. R. 14214-43
(2) investigate and make recommendations concerning the
proper roles of Federal and State governments and national and
local public and private agencies in research, prevention, identi-
fication, treatment, and rehabilitation of persons with epilepsy;
(3) develop a comprehensive national plan for the control of
epilepsy and its consequences based on the most thorough, com-
plete, and accurate data and information available on the
disorder; and
(4) transmit to the President and the Committee on Labor and
Public Welfare of the Senate and the Committee on Interstate and
Foreign Commerce of the House of Representatives, not later than
one year a fter the date of enactment of this Act, a report detailing
the findings and conclusions of the Commission, together with
recommendations for legislation and appropriations, as it deems
advisable.
(c) (1) The Commission shall be composed of nine members to be
appointed by the Secretary of Health, Education, and Welfare. Such
members shall be persons, including consumers of health services,
who, by reason of experience or training in the medical, social, or
educational aspects of the epilepsies, are especially qualified to serve
on such Commission.
(2) The Secretary shall designate one of the members of the Com-
mission to serve as Chairman and one to serve as Vice Chairman.
Vacancies shall be filled in the same manner in which the original
appointments were made. Any vacancy in the Commission shall not
affect its powers.
(3) Any member of the Commission who is otherwise employed by
the Federal Government shall serve without compensation in addi-
tion to that received in his regular employment, but shall be entitled
to reimbursement for travel, subsistence, and other necessary expenses
incurred by him in the performance of his duties on the Commission.
(4) Members of the Commission, other than those referred to in
paragraph (3), 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 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 sub-
sistence in the same manner as is authorized by section 5703 of title 5,
United States Code, for persons in Government service employed
intermittently.
(d) The Commission shall cease to exist thirty days after the sub-
mission of the final report required by subsection (b) (4).
COMMISSION FOR CONTROL OF HUNTINGTON'S DISEASE
SEC. 605. (a) The Secretary of Health, Education, and Welfare shall
establish a temporary commission to be known as the Commission for
the Control of Huntington's Disease and Its Consequences (herein-
after referred to in this section as the "Commission").
(b) It shall be the duty of the Commission to-
(1) make a comprehensive study of the state of the art of
medical and social management of Huntington's disease in the
United States;
(2) investigate and make recommendations concerning the
proper roles of Federal and State governments and national and
local public and private agencies in research, prevention, identifi-
cation, treatment, and rehabilitation of persons with Huntington's
disease;
H. R. 14214-44
(3) develop a comprehensive national plan for the control of
Huntington's disease and its consequences based on the most
thorough, complete, and accurate data and information available
on the disorder; and
(4) transmit to the President and the Committee on Labor and
Public Welfare of the Senate and the Committee on Interstate
and Foreign Commerce of the House of Representatives, not later
than one year after the date of enactment of this Act, a report
detailing the findings and conclusions of the Commission, together
with recommendations for legislation and appropriations, as it
deems advisable.
(c) (1) The Commission shall be composed of nine members to be
appointed by the Secretary of Health, Education, and Welfare. Such
members shall be persons, including consumers of health services,
who, by reason of experience or training in the medical, social, or edu-
cational aspects of Huntington's disease, are especially qualified to
serve on such Commission.
(2) The Secretary shall designate one of the members of the Com-
mission to serve as Chairman and one to serve as Vice Chairman.
Vacancies shall be filled in the same manner in which the original
appointments were made. Any vacancy in the Commission shall not
affect its powers.
(3) Any member of the Commission who is otherwise employed by
the Federal Government shall serve without compensation in addition
to that received in his regular employment, but shall be entitled to
reimbursement for travel, subsistence, and other necessary expenses
incurred by him in the performance of his duties on the Commission.
(4) Members of the Commission, other than those referred to in
paragraph (3), 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 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 subsist-
ence in the same manner as is authorized by section 5703 of title 5,
United States Code, for persons in Government service employed
intermittently.
(d) The Commission shall cease to exist thirty days after the sub-
mission of the final report required by subsection (b) (4).
HEMOPHILIA PROGRAMS
SEC. 606. Title XI of the Public Health Service Act is amended by
adding after part C the following new part:
"PART D-HEMOPHILIA PROGRAMS
"TREATMENT CENTERS
"SEC. 1131. (a) The Secretary may make grants to and enter into
contracts with public and nonprofit private entities for projects for
the establishment of comprehensive hemophilia diagnostic and treat-
ment centers. A center established under this subsection shall provide-
"(1) access to the services of the center for all individuals suf-
fering from hemophilia who reside within the geographic area
served by the center;
"(2) programs for the training of professional and parapro-
fessional personnel in hemophilia research, diagnosis, and treat-
ment;
H. R. 14214-45
"(3) a program for the diagnosis and treatment of individuals
suffering from hemophilia who are being treated on an outpatient
basis;
"(4) a program for association with providers of health care
who are treating individuals suffering from hemophilia in areas
not conveniently served directly by such center but who are more
conveniently (as determined by the Secretary) served by it than
by the next geographically closest center;
"(5) programs of social and vocational counseling for indi-
viduals suffering from hemophilia; and
"(6) individualized written comprehensive care programs for
each individual treated by or in association with such center.
"(b) No grant or contract may be made under subsection (a) unless
an application therefor has been submitted to and approved by the
Secretary. Such application shall be in such form, submitted in such.
manner, and contain such information, as the Secretary shall by regu-
lation prescribe.
"(c) An application for a grant or contract under subsection (a)
shall contain assurances satisfactory to the Secretary that the appli-
cant will serve the maximum number of individuals that its available
and potential resources will enable it to effectively serve.
(d) In considering applications for grants and contracts under
subsection (a) for projects to establish hemophilia diagnostic and
treatment centers, the Secretary shall-
"(1) take into account the number of persons to be served by
the programs to be supported by such centers and the extent to
which rapid and effective use will be made by such centers of
funds under such grants and contracts, and
"(2) give priority to projects for centers which will operate
in areas which the Secretary determines have the greatest number
of persons in need of the services provided by such centers.
" (e) Contracts may be entered into under subsection (a) without
regard to sections 3648 and 3709 of the Revised Statutes (31 U.S.C.
529; 41 U.S.C. 5).
"(f) There are authorized to be appropriated to make payments
under grants and contracts under subsection (a) $3,000,000 for the
fiscal year ending June 30, 1975, $5,000,000 for the fiscal year ending
June 30, 1976.
"BLOOD SEPARATION CENTERS
"SEC. 1132. (a) The Secretary may make grants to and enter into
contracts with public and nonprofit private entities for projects to
develop and expand, within existing facilities, blood-separation cen-
ters to separate and make available for distribution blood components
to providers of blood services and manufacturers of blood fractions.
For purposes of this section-
"(1) the term 'blood components means those constituents of
whole blood which are used for therapy and which are obtained
by physical separation processes which result in licensed products
such as red blood cells, platelets, white blood cells, AHF-rich
plasma, fresh-frozen plasma, cryoprecipitate, and single unit
plasma for infusion; and
"(2) the term 'blood fractions' means those constituents of
plasma which are used for therapy and which are obtained by
licensed fractionation processes presently used in manufacturing
which result in licensed products such as normal serum albumin,
plasma, protein fraction, prothrombin complex, fibrinogen, AHF
concentrate, immune serum globulin, and hyperimmune globulins.
H. R. 14214-46
"(b) In the event the Secretary finds that there is an insufficient
supply of blood fractions available to meet the needs for treatment
of persons suffering from hemophilia, and that public and other non-
profit private centers already engaged in the production of blood
fractions could alleviate such insufficiency with assistance under this
subsection, he may make grants not to exceed $500,000 to such centers
for the purposes of alleviating the insufficiency.
(c) No grant or contract may be made under subsection (a) or
(b) unless an application therefor has been submitted to and approved
by the Secretary. Such an application shall be in such form, sub-
mitted in such manner, and contain such information as the Secretary
shall by regulation prescribe.
"(d) Contracts may be entered into under subsection (a) without
regard to sections 3648 and 3709 of the Revised Statutes (31 U.S.C.
529 41 U.S.C. 5).
(e) For the purpose of making payments under grants and con-
tracts under subsections (a) and (b), there are authorized to be appro-
priated $5,000,000 for the fiscal year ending June 30, 1975, and
$5,000,000 for the fiscal year ending June 30, 1976."
TECHNICAL AMENDMENTS
SEC. 607. (a) Section 399c of the Public Health Service Act (added
by Public Law 93-222) is redesignated as section 399A.
(b) The section 472 of the Public Health Service Act (entitled
"Peer Review of Grant Applications and Control Projects") is
redesignated as section 475.
(c) Section 317 (d) of the Public Health Service is amended (1)
by striking out "communicable and other disease" in paragraphs (1)
and (2), and (2) by striking out "communicable and other disease"
the second time it occurs in paragraph (3).
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.
MEMORANDUM OF DISAPPROVAL
I have withheld my approval from H.R. 14214, the
"Health Revenue Sharing and Health Services Act of 1974."
H.R. 14214 conflicts with my strong commitment to
the American taxpayers to hold Federal spending to essen-
tial purposes. The bill authorizes appropriations of
more than $1 billion over my recommendations and I can-
not, in good conscience, approve it. These appropriation
authorizations are almost double the funding levels I
have recommended for Fiscal Year 1975 and almost triple
the levels I believe would be appropriate for 1976.
As part of my effort to see that the burden upon our
taxpayers does not increase, I requested the Congress last
month to exercise restraint in expanding existing Federal
responsibilities, and to resist adding new Federal programs
to our already overloaded and limited Federal resources.
These recommendations reflect my concern with both the need
to hold down the Federal budget and the need to limit the
Federal role to those activities which can make the most
necessary and significant contributions.
In H.R. 14214, the Congress not only excessively
increased authorizations for existing programs but also
created several new ones that would result in an unjusti-
fied expenditure of Federal taxpayers' funds. Although
the purposes of many of the programs authorized in this
bill are certainly worthy, I just cannot approve this
legislation because of its effect upon the economy through
increased unwarranted Federal spending.
2
Finally, it should be pointed out that the Federal
Government will spend almost $20 billion in 1975 through
Medicare and Medicaid for the financing of health services
for priority recipients - aged and low-income persons.
These services are provided on the basis of national eli-
gibility standards in Medicare and State eligibility
standards in Medicaid and therefore are available to
individuals in a more equitable and less restrictive manner
than many of the programs authorized in H.R. 14214.
Merchd R. 7nd
THE WHITE HOUSE,
December 21, 1974
FOR IMMEDIATE RELEASE
DECEMBER 23, 1974
Office of the White House Press Secretary
THE WHITE HOUSE
MEMORANDUM OF DISAPPROVAL
I have withheld my approval from H.R. 14214, the
"Health Revenue Sharing and Health Services Act of 1974."
H.R. 14214 conflicts with my strong commitment to
the American taxpayers to hold Federal spending to essen-
tial purposes. The bill authorizes appropriations of
more than $1 billion over my recommendations and I can-
not, in good conscience, approve it. These appropriation
authorizations are almost double the funding levels I
have recommended for Fiscal Year 1975 and almost triple
the levels I believe would be appropriate for 1976.
As part of my effort to see that the burden upon our
taxpayers does not increase, I requested the Congress last
month to exercise restraint in expanding existing Federal
responsibilities, and to resist adding new Federal programs
to our already overloaded and limited Federal resources.
These recommendations reflect my concern with both the need
to hold down the Federal budget and the need to limit the
Federal role to those activities which can make the most
necessary and significant contributions.
In H.R. 14214, the Congress not only excessively
increased authorizations for existing programs but also
created several new ones that would result in an unjusti-
fied expenditure of Federal taxpayers' funds. Although
the purposes of many of the programs authorized in this
bill are certainly worthy, I just cannot approve this
legislation because of its effect upon the economy through
increased unwarranted Federal spending.
Finally, it should be pointed out that the Federal
Government will spend almost $20 billion in 1975 through
Medicare and Medicaid for the financing of health services
for priority recipients -- aged and low-income persons.
These services are provided on the basis of national eli-
gibility standards in Medicare and State eligibility
standards in Medicaid and therefore are available to
individuals in a more equitable and less restrictive manner
than many of the programs authorized in H.R. 14214.
GERALD R. FORD
THE WHITE HOUSE,
December 21, 1974.
#####
December 11, 1974
Dear Mr. Director:
The following bills were received at the White
House on December 11th:
8. 2193
H.R. 7730
S. 2363
H.R. 8352
S. 3906
H.R. 8824
8. 4040
H.R. 11929
H.R. 6274
N.R. 14214
H.R. 6925
H.R. 17026
Please let the President have reports and
recommendations as to the approval of these
bills as soon as possible.
Sincerely,
Robert D. Linder
Chief Executive Clerk
The Honorable Roy L. Ash
Director
FORD is LIBRARY
Office of Management and Budget
Washington, D.C.