migrant health centers

migrant health centers Sec. 401. (a) Section 319 of the Public Health Service Act is amended to read as follows: “migrant health “Sec. 319. (a) For purposes of this section: “(1) The term ‘migrant health center’ means an entity which either through its staff and supporting resources or through contracts or cooperative arrangements with other public or private entities provides— “(A) primary health services, “(B) as may be appropriate for particular centers, supple-mental health services necessary for the adequate support of primary health services, 89 STAT. 335 “(C) referral to providers of supplemental health services and payment, as appropriate and feasible, for their provision of such services, “(D) environmental health services, including, as may be appropriate for particular centers, the detection and alleviation of unhealthful conditions associated with water supply, sewage treatment, solid waste disposal, rodent and parasitic infestation, field sanitation, housing, and other environmental factors related to health, “(E) as may be appropriate for particular centers, infectious and parasitic disease screening and control, “(F) as may be appropriate for particular centers, accident prevention programs, including prevention of excessive pesticide exposure, and “(G) information on the availability and proper use of health services, for migratory agricultural workers, seasonal agricultural workers, and the members of the families of such migratory and seasonal workers, within the area it serves (referred to in this section as a ‘catchment area’). “(2) The term ‘migratory agricultural worker’ means an individual whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last twenty-four months, and who establishes for the purposes of such employment a temporary abode. “(3) The term ‘seasonal agricultural workers’ means an individual whose principal employment is in agriculture on a seasonal basis and who is not a migratory agricultural worker. “(4) The term ‘agriculture’ means farming in all its branches, including— “(A) cultivation and tillage of the soil, “(B) the production, cultivation, growing, and harvesting of any commodity grown on, in or as an adjunct to or part of a commodity grown in or on, the land, and “(C) any practice (including preparation and processing for market and delivery to storage or to market or to carriers for transportation to market) performed by a farmer or on a farm incident to or in conjunction with an activity described in subparagraph (B). “(5) The term ‘high impact area’ means a health service area or other area which has not less than six thousand migratory agricultural workers and seasonal agricultural workers residing within its boundaries for more than two months in any calendar year. In computing the number of workers residing in an area, there shall be included as workers the members of the families of such workers. “(6) The term ‘primary health services means— “(A) services of physicians and, where feasible, services of physicians’ assistants and nurse clinicians; “(B) diagnostic laboratory and radiologic services; “(C) preventive health services (including children’s eye and ear examinations to determine the need for vision and hearing correction, perinatal services, well child services, and family planning services); “(D) emergency medical services; “(E) transportation services as required for adequate patient care; and “(F) preventive dental services. 89 STAT. 336 “(7) The term ‘supplemental health services’ means services which are not included as primary health services and which are—- “(A) hospital services; “(B) home health services; “(C) extended care facility services; “(D) rehabilitative services (including physical therapy) and long-term physical medicine; “(E) mental health services; “(F) dental services; “(G) vision services; “(H) allied health services; “(I) pharmaceutical services; “(J) therapeutic radiologic services; “(K) public health services (including nutrition education and social services); “(L) health education services; and “(M) services which promote and facilitate optimal use of primary health services and the services referred to in the preceding subparagraphs of this paragraph, including, if a substantial number of the individuals in the population served by a migrant health center are of limited English-speaking ability, the services of outreach workers fluent in the language spoken by a predominant number of such individuals. “(b) (1) The Secretary shall assign to high impact areas and any other areas (where appropriate) priorities for the provision of assistance under this section to projects and programs 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 applications under such subsections for projects in areas with migratory agricultural workers. “(c) (1) (A) The Secretary may, in accordance with the priorities , assigned under subsection (b)(1), make grants to public and non-profit private, entities for projects to plan and develop migrant health centers which will serve migratory agricultural workers, seasonal agricultural workers, and the members of the families of such migratory and seasonal workers, in high impact areas. A project, for which a grant may be made under this subparagraph may include the cost of the acquisition and modernization of existing buildings (including the costs of amortizing the principal of, and paying the interest on, loans) and the costs of providing training related to the management of migrant health center programs, and shall include— “(i) an assessment of the need that the workers (and the members of the families of such workers) proposed to be served by the migrant health center for which the project is undertaken have for primary health services, supplemental health services, and environmental health services; “(ii) the design of a migrant health center program for such workers and the members of their families, based on such assessment : “(iii) efforts to secure, within the proposed catchment area of such center, financial and professional assistance and support for the project; and 89 STAT. 337 “(iv) initiation and encouragement of continuing community involvement in the development and operation of the project. “(B) The Secretary may make grants to or enter into contracts with public and nonprofit private entities for projects to plan and develop programs in areas in which no migrant health center exists and in which not more than six thousand migratory agricultural workers and their families reside for more than two months— “(i) for the provision of emergency care to migratory agricultural workers, seasonal agricultural workers, and the members of families of such migratory and seasonal workers; “(ii) for the provision of primary care (as defined in regulations of the Secretary) for such workers and the members of their families; “(iii) for the development of arrangements with existing facilities to provide primary health services (not included as primary care as defined under regulations under clause (ii)) to such workers and the members of their families; or “(iv) which otherwise improve the health of such workers and their families. Any such program may include the acquisition and modernization of existing buildings and providing training related to the management of programs assisted under this subparagraph. “(2) Not more than two grants may be made under paragraph (1) (A) for the same project, and if a grant or contract is made or entered into under paragraph (1) (B) for a project, no other grant or contract under that paragraph may be made or entered into for the project. “(3) The amount of any grant made under paragraph (1) for any project shall be determined by the Secretary. “(d) (1) (A) The Secretary may, in accordance with priorities assigned under subsection (b)(1), make grants for the costs of operation of public and nonprofit private migrant health centers in high impact areas. “(B) The Secretary may, in accordance with priorities assigned under subsection (b) fl), 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 migratory agricultural workers, seasonal agricultural workers, and the members of the families of such migratory and seasonal workers, but with respect to which he is unable to make each of the determinations required by subsection (f)(2). Not more than two grants may be made under this subparagraph for any entity. “(C) The Secretary may make grants to and enter into contracts with public and nonprofit private entities for projects for the operation of programs in areas in which no migrant health center exists and in which not more than six thousand migratory agricultural workers and their families reside for more than two months— “(i) for the provision of emergency care to migratory agricultural workers, seasonal agricultural workers, and the members of the families of such migratory and seasonal workers; “(ii) for the provision of primary care (as defined in regulations of the Secretary) for such workers and the members of their families; “(iii) for the development of arrangements with existing facilities to provide primary health services (not included as primary care as defined under regulations under clause (ii)) to such workers and the members of their families; or 89 STAT. 338 “(iv) which otherwise improve the health of such workers and the members of their families. Any such program may include the acquisition and modernization of existing buildings and providing training related to the management of programs assisted under this subparagraph. “(2) The costs for which a grant may be made under paragraph (1) (A) or (1) (B) may include the costs of acquiring and modernizing existing buildings (including the costs of amortizing the principal of, and paying the interest on, loans); and the costs for which a grant or contract may be made under paragraph (1) may include the costs of providing training related to the provision of primary health services, supplemental health services, and environmental health services, and to the management of migrant health center programs. “(3) The amount of any grant made under paragraph (1) shall be determined by the Secretary. “(e) The Secretary may enter into contracts with, public and private entities to— “(1) assist the States in the implementation and enforcement of acceptable environmental health standards, including enforcement of standards for sanitation in migrant labor camps and applicable Federal and State pesticide control standards; and “(2) conduct projects and studies to assist the several States and entities which have, received grants or contracts under this section in the assessment of problems related to camp and 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 (e)(1)(B), (d)(1) (C), or (e) unless an application therefore is submitted to, and approved by, the Secretary. Such an application shall be submitted in such form and manner and shall contain such information as the Secretary shall prescribe. An application for a grant or contract which will cover the costs of modernizing a building shall include, in addition to other information required by the Secretary— “(A) a description of the site of the building, “(B) plans and specifications for its modernization, and “(C) reasonable assurance that all laborers and mechanics employed by contractors or subcontractors in the performance of work on the modernization of the building will be paid wages at rates not less than those prevailing on similar work in the locality as determined by the Secretary of Labor in accordance with the Act of March 3, 1931 (40 U.S.C. 276a–276a–5, known as the Davis-Bacon Act). The Secretary of Labor shall have with respect to the labor standards referred to in subparagraph (C) the authority and functions set forth in 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 appropriate, and in a manner which assures continuity; 89 STAT. 339 “(B) the center will have organizational arrangements, established in accordance with regulations of the Secretary, for (i) an ongoing quality assurance program (including utilization and peer review systems) respecting the center’s services, and (ii) maintaining the confidentiality of patient records; “(C) the center will demonstrate its financial responsibility by the use of such accounting procedures and other requirements as may be prescribed by the Secretary; “(D) the center (i) has or will have a contractual or other arrangement with the agency of the State, in which it provides services, which administers or supervises the administration of a State plan approved under title XIX of the Social Security Act 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 tinder 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; “(F) the center (i) has prepared a schedule of fees or payments for the provision of its services designed to cover its reasonable costs of operation and a corresponding schedule of discounts to be applied to the payment of such fees or payments, which discounts are adjusted on the basis of the patient’s ability to pay, (ii) has made and will continue to make every reasonable effort (I) to secure from patients payment for services in accordance with such schedules, and (II) to collect reimbursement for health services to persons described in subparagraph (E) on the basis of the full amount of fees and payments for such services without application of any discount, and (iii) has submitted to the Secretary such reports as he may require to determine compliance with this subparagraph; “(G) the center has established a governing board which (i) is composed of individuals a majority of whom are being served by the center and who, as a group, represent the individuals being served by the center, and (ii) establishes general policies for the center (including the selection of services to be provided by the center and a schedule of hours during which services will be provided), approves the center’s annual budget, and approves the selection of a director for the center; “(H) the center has developed, in accordance with regulations of the Secretary, (i) an overall plan and budget that meets the requirements of section 1861 (z) of the Social Security Act, and (ii) an effective procedure for compiling and reporting to the Secretary such statistics and other information as the Secretary may require relating to (I) the costs of its operations, (II) the patterns of use of its services, (III) the availability, accessibility, and acceptability of its services, and (IV) such other matters relating to operations of the applicant as the Secretary may, by regulation, require; 89 STAT. 340 “(I) the center will review periodically its catchment area to (i) insure that the size of such area is such that the services to be provided through the center (including any satellite) are available and accessible to the migratory agricultural workers, seasonal agricultural workers, and the members of the families of such migratory and seasonal workers, in the area promptly and as appropriate, (ii) insure that the boundaries of such area conform, to the extent practicable, to relevant boundaries of political subdivisions, school districts, and Federal and State health and social service programs, and (iii) insure that the boundaries of such area eliminate, to the extent possible, barriers to access to the services of the center, including barriers resulting from the area’s physical characteristics, its residential patterns, its economic and social groupings, and available transportation; and “(J) in the case of a center which serves a population including a substantial proportion of individuals of limited English-speaking ability, the center has (i) developed a plan and made arrangements responsive to the needs of such population for providing services to the extent practicable in the language and cultural context most appropriate to such individuals, and (ii) identified an individual on its staff who is fluent in both that language and English and whose responsibilities shall include providing guidance to such individuals and to appropriate staff members with respect to cultural sensitivities and bridging linguistic and cultural differences. “(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 peculations to be served through the projects, programs, or centers to be assisted by such grants or contracts. “(4) Contracts may be entered into under this section without regard to sections 3648 and 3709 of the Revised Statutes (31 U.S.C. 529; 41 U.S.C. 5). “(g) The Secretary may provide (either through the Department of Health, Education, and Welfare or by grant or contract) all necessary technical and other nonfinancial assistance (including fiscal and program management assistance and training in such management) to any migrant health center or to any public or private nonprofit entity to assist it in developing plans for, and in operating as, a migrant health center, and in meeting the requirements of subsection (f) (2). “(h) (1) There are authorized to be appropriated for payments pursuant to grants and contracts under subsection (c) (1) $4,000,000 for fiscal year 1976, and $4,000,000 for fiscal year 1977, Of the funds appropriated under this paragraph for fiscal year 1976, not more than 30 per centum of such funds may be made available for grants and contracts under subsection (c) (1) (B), and of the funds appropriated under this paragraph for the next fiscal year, not more than 25 per centum of such funds may be made available for grants and contracts under such subsection. “(2) There are authorized to be appropriated for payments pursuant to grants and contracts under subsection (d)(1) (other than for payments under such grants and contracts for the provision of inpatient and outpatient hospital services) and for payments pursuant to contracts under subsection (e) $30,000,000 for fiscal year 1976, and $35,000,000 for fiscal year 1977. Of the funds appropriated under the 89 STAT. 341first sentence for fiscal year 1976, there shall be made available for grants and contracts under subsection (d)(1)(C) an amount not exceeding the greater of 30 per centum of such funds or 90 per centum of the amount of grants made under this section for the preceding fiscal year for programs described in subsection (d)(1)(C). Of the funds appropriated under the first sentence for fiscal year 1977, there shall be made available for grants and contracts under subsection (d) (1) (C) an amount not exceeding the greater of 25 per centum of such funds or 90 per centum of the amount of grants made under this section for the preceding fiscal year for programs described in subsection (d)(1)(C) which received grants under this section for tile fiscal year ending June 30, 1975. Of the funds appropriated under this paragraph for any fiscal year, not more than 10 per centum of such funds may be made available for contracts under subsection (e). “(3) There are authorized to be appropriated for payments under grants and contracts under Subsection (d)(1) for the provision of inpatient and outpatient hospital services $5,000,000 for fiscal year 1976, and $5,000,000 for fiscal year 1977.”. (b) Section 217 of the Public Health Service. Act is amended by adding after the subsection (f) added by Public Law 93–248 the fol-lowing new subsection: “(g) (1) Within 120 days of the date of the enactment of this sub-section, the Secretary shall appoint and organize a National Advisory Council on Migrant Health (hereinafter in this subsection referred to as the ‘Council’) which shall advise, consult with, and make recommendations to, the Secretary on matters concerning the organization, operation, selection, and funding of migrant health centers and other entities under grants and contracts under section 319. “(2) The Council shall consist of fifteen members, at least twelve of whom shall be members of the governing boards of migrant health center’s or other entities assisted under section 319. Of such twelve members who are members of such governing boards, at least nine shall be chosen from among those members of such governing boards who are being served by such centers or grantees and who are familiar with the delivery of health care to migratory agricultural worker’s and seasonal agricultural workers. The remaining three Council members shall be individuals qualified by training and experience in the medical sciences or in the administration of health programs. “(3) Each member of the Council shall hold office for a term of four years, except that (A) any member appointed to fill a vacancy occurring prior to the expiration of the term for which his predecessor was appointed shall be appointed for the remainder of such term; and (B) the terms of the members first taking office after the date of enactment of this subsection shall expire, as follows: four shall expire four years after such date, four shall expire three years after such date, four shall expire two years after such date, and three shall expire one year after such date, as designated by the Secretary at the time of appointment. “(4) Section 14(a) of the Federal Advisory Committee Act shall not apply to the Council.”. (c) (1) The Secretary of Health, Education, and Welfare (herein-after in this subsection referred to as the “Secretary”) shall conduct or arrange for the conduct of a study of— (A) the quality of housing which is available to agricultural migratory workers in the United States during the period of their employment in seasonal agricultural activities while away from their permanent abodes; 89 STAT. 342 (B) the effect on the health of such workers of deficiencies in their housing conditions during such period; and (C) Federal, State, and local government standards respecting housing conditions for such workers during such period and the adequacy of the enforcement of such standards. In conducting or arranging for the conduct of such study, the Secretary shall consult with the Secretary of Housing and Urban. Development. (2) Such study shall be completed and a report, detailing the findings of the study and the recommendations of the Secretary for Federal action (including legislation) respecting such housing conditions shall be submitted to the Committee on Interstate and Foreign Commerce of the House of Representatives and the Committee on Labor and Public Welfare of the Senate within eighteen months of the date of the enactment of the first Act making appropriations for such study.