ESTABLISHMENT OF GRANT PROGRAM.

SEC. 601. ESTABLISHMENT OF GRANT PROGRAM. Part D of title III of the Public Health Service Act (42 U.S.C. 254b et seq.) is amended by striking subpart IV and inserting the following new subpart: “Subpart IV— Health Services for the Homeless “grant program for certain health services for the homeless “Sec. 340. (a) Establishment.— (1) The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall make grants for the purpose of enabling grantees, directly or through contracts, to provide for the delivery of health services to homeless individuals. “(2) In carrying out the program established in paragraph (1), the Administrator shall consult with the Director of the National Institute on Alcohol Abuse and Alcoholism and with the Director of the National Institute of Mental Health. “(b) Minimum Qualifications of Grantees.— The Secretary may not make a grant under subsection (a) to an applicant unless— “(1) the applicant is a public or nonprofit private entity; “(2) the applicant has the capacity to effectively administer a grant under subsection (a); and “(3) with respect to health services that are covered in the appropriate State plan approved under title XIX of the Social Security Act— “(A) if the applicant will provide under the grant any such health services directly— “(i) the applicant has entered into a participation agreement under the appropriate State plan; and “(ii) the applicant is qualified to receive payments under the appropriate State plan; and “(B) if the applicant will provide under the grant any such health services through a contract with an organization— “(i) the organization has entered into a participation agreement under the appropriate State plan; and “(ii) the organization is qualified to receive payments under the appropriate State plan. “(c) Preferences in Making Grants.— The Secretary shall, in making grants under subsection (a), give preference to qualified applicants that— 101 STAT. 512 “(1) (A) are experienced in the direct delivery of primary health services to homeless individuals or medically underserved populations; or “(B) are experienced in the treatment of substance abuse in homeless individuals or medically underserved populations; and “(2) agree to provide for health services to homeless individuals through both public entities and private organizations. “(d) Requirement of Submission of Application Containing Certain Agreements.— (1) The Secretary may not make a grant under subsection (a) to an applicant unless the applicant has submitted to the Secretary an application for the grant containing agreements in accordance with— “(A) subsection (e)(1)(A)(ii), relating to the provision of matching funds; “(B) subsection (f), relating to the provision of certain health services; “(C) subsection (h), relating to restrictions on the use of funds; “(D) subsection (i), relating to a limitation on charges for services; “(E) subsection (j), relating to the administration of grants; and “(F) subsection (k), relating to a limitation on administrative expenses. “(2) An application required in paragraph (1) shall, with respect to agreements required to be contained in the application, provide assurances of compliance satisfactory to the Secretary and shall otherwise be in such form, be made in such manner, and contain such information in addition to information required in paragraph (1) as the Secretary determines to be necessary to carry out this section. “(e) Requirement of Provision of Matching Funds.— (1) (A) The Secretary may not make a grant under subsection (a) to an applicant— “(i) in an amount exceeding 75 percent of the costs of providing health services under the grant; and “(ii) unless the applicant agrees that the applicant will make available, directly or through donations to the applicant, non-Federal contributions toward such costs in an amount equal to not less than $1 (in cash or in kind under subparagraph (B)) for each $3 of Federal funds provided in such grant. “(B) (i) Non-Federal contributions required in subparagraph (A) may be in cash or in kind, fairly evaluated, including plant, equipment, or services. Amounts provided by the Federal Government, or services assisted or subsidized to any significant extent by the Federal Government, may not be included in determining the amount of such non-Federal contributions. “(ii) Such determination may not include any cash or in-kind contributions that, prior to February 26, 1987, were made available by any public or private entity for the purpose of assisting homeless individuals (including assistance other than the provision of health services). “(2) The Secretary may waive the requirement established in paragraph (1)(A) if— “(A) the applicant involved is a nonprofit private grantee under section 330; and “(B) the Secretary determines that it is not feasible for the applicant to comply with such requirement. 101 STAT. 513 “(f) Requirement of Provision of Certain Health Services.— The Secretary may not make a grant under subsection (a) to an applicant unless the applicant agrees that the applicant will, directly or through contract— “(1) provide health services at locations accessible to homeless individuals; “(2) provide to homeless individuals, at all hours, emergency health services; “(3) refer homeless individuals as appropriate to medical facilities for necessary hospital services; “(4) refer for mental health services homeless individuals who are mentally ill to entities that provide such services, unless the applicant will provide such services pursuant to subsection (g); “(5) provide outreach services to inform homeless individuals of the availability of health services; and “(6) aid homeless individuals in establishing eligibility for assistance, and in obtaining services, under entitlement programs. “(g) Optional Provision of Mental Health Services.— A grantee under subsection (a) may expend amounts received pursuant to such subsection for the purpose of providing mental health services to homeless individuals. “(h) Restrictions on Use of Grant Funds.— (1) The Secretary may not, except as provided in paragraph (2), make a grant under subsection (a) to an applicant unless the applicant agrees that amounts received pursuant to such subsection will not, directly or through contract, be expended— “(A) for any purpose other than the purposes described in subsections (a) and (g); “(B) to provide inpatient services, except with respect to residential treatment for substance abuse provided in settings other than hospitals; “(C) to make cash payments to intended recipients of health services or mental health services; or “(D) to purchase or improve real property (other than minor remodeling of existing improvements to real property) or to purchase major medical equipment. “(2) If the Secretary finds that the purpose described in subsection (a) cannot otherwise be carried out, the Secretary may, with respect to an otherwise qualified applicant, waive the restriction established in paragraph (1)(D). “(i) Limitation on Charges for Services.— The Secretary may not make a grant under subsection (a) to an applicant unless the applicant agrees that, whether health services are provided directly or through contract— “(1) health services under the grant will be provided without regard to ability to pay for the health services; and “(2) if a charge is imposed for the delivery of health services, such charge— “(A) will be made according to a schedule of charges that is made available to the public; “(B) will not be imposed on any homeless individual with an income less than the official poverty level; and “(C) will be adjusted to reflect the income and resources of the homeless individual involved. 101 STAT. 514 “(j) Requirements With Respect to Administration.— The Secretary may not make a grant under subsection (a) to an applicant unless the applicant— “(1) agrees to establish such procedures for fiscal control and fund accounting as may be necessary to ensure proper disbursement and accounting with respect to the grant; “(2) agrees to establish an ongoing program of quality assurance with respect to the health services provided under the grant; “(3) agrees to ensure the confidentiality of records maintained on homeless individuals receiving health services under the grant; “(4) with respect to providing health services to any population of homeless individuals a substantial portion of which has a limited ability to speak the English language— “(A) has developed and has the ability to carry out a reasonable plan to provide health services under the grant through individuals who are able to communicate with the population involved in the language and cultural context that is most appropriate; and “(B) has designated at least one individual, fluent in both English and the appropriate language, to assist in carrying out the plan; and “(5) agrees to submit to the Secretary an annual report that describes the utilization and costs of health services provided under the grant and that provides such other information as the Secretary determines to be appropriate. “(k) Limitation on Administrative Expenses of Grantee.— The Secretary may not make a grant under subsection (a) to an applicant unless the applicant agrees that the applicant will not expend more than 10 percent of amounts received pursuant to such subsection for the purpose of administering the grant. “(l) Use of Grant Funds for Referrals to Certain Advocacy Systems—A grantee under subsection (a) may, with respect to title I of the Protection and Advocacy for Mentally Ill Individuals Act of 1986, expend amounts received under subsection (a) for the purpose of referring homeless individuals who are chronically mentally ill, and who are eligible under such Act, to systems that provide advocacy services under such Act. “(m) Use of Self-Help Organizations.— Any grantee under subsection (a) may provide health services through contracts with nonprofit self-help organizations that— “(1) are established and managed by current and former recipients of mental health services, or substance abuse services, who have been homeless individuals; and “(2) with respect to the provision of health services described in subsection (b)(3), are organizations qualified under subparagraph (B) of such subsection. “(n) Technical Assistance.— (1) The Secretary may, without charge to any grantee under subsection (a), provide technical assistance to any such grantee with respect to the planning, development, and operation of programs to carry out the purpose described in such subsection. The Secretary may provide such technical assistance directly, through contract, or through grants. “(2) Of the amounts appropriated pursuant to subsection (p)(1), the Secretary may expend not more than $2,000,000 for the purpose of carrying out paragraph (1). 101 STAT. 515 “(o) Annual Reports by Secretary.— Not later than January 10 of each year, the Secretary shall submit to the Congress a report describing the utilization and costs of health services provided under subsection (a) during the immediately preceding fiscal year. “(p) Funding.— (1) There are authorized to be appropriated to carry out this section $50,000,000 for fiscal year 1987 and $30,000,000 for fiscal year 1988. “(2) Amounts received by a grantee pursuant to subsection (a) remaining unobligated at the end of the fiscal year in which the amounts were received shall remain available to the grantee during the succeeding fiscal year for the purpose described in such subsection. “(q) Definitions.— For purposes of this section: “(1) The term ‘health services’ means primary health services and substance abuse services. “(2) The term ‘homeless individual’ means an individual who lacks housing (without regard to whether the individual is a member of a family), including an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations. “(3) The term ‘medically underserved population’ has the meaning given such term in section 330(b)(3). “(4) The term ‘official poverty level’ means the nonfarm income official poverty line defined by the Office of Management and Budget and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981. “(5) The term ‘organization’ includes individuals, corporations, partnerships, companies, and associations. “(6) The term ‘primary health services’ has the meaning given such term in section 330(b)(1). “(7) The term ‘substance abuse’ has the meaning given such term in section 536(4). “(8) The term ‘substance abuse services’ includes detoxification and residential treatment for substance abuse provided in settings other than hospitals.”.