[House Report 109-509]
[From the U.S. Government Publishing Office]
109th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 109-509
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HEALTH CENTERS RENEWAL ACT OF 2006
_______
June 20, 2006.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Barton of Texas, from the Committee on Energy and Commerce,
submitted the following
R E P O R T
[To accompany H.R. 5573]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 5573) to amend the Public Health Service Act to
provide additional authorizations of appropriations for the
health centers program under section 330 of such Act, having
considered the same, report favorably thereon without amendment
and recommend that the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 1
Background and Need for Legislation.............................. 2
Hearings......................................................... 3
Committee Consideration.......................................... 3
Committee Votes.................................................. 3
Committee Oversight Findings..................................... 3
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Committee Cost Estimate.......................................... 4
Congressional Budget Office Cost Estimate........................ 4
Federal Mandates Statement....................................... 5
Advisory Committee Statement..................................... 5
Constitutional Authority Statement............................... 5
Applicability to Legislative Branch.............................. 5
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill, as Reported............ 6
Purpose and Summary
The purpose of H.R. 5573, the Health Centers Renewal Act of
2006, is to reauthorize the existing Community Health Center
Program for fiscal years 2007 through 2011. The Health Centers
Renewal Act will ensure that community health centers can
continue to offer health care services to millions of medically
underserved and uninsured people.
Background and Need for Legislation
Community Health Centers (CHCs) have been in existence
since the 1960s to provide health services in underserved
communities. In 1996, the Health Centers Consolidation Act
combined the various federally qualified health centers
(FQHCs)--community, migrant, homeless, and health centers for
residents of public housing--under Section 330 of the Public
Health Service Act (PHSA) and created the Consolidated Health
Centers Program. The program was later reauthorized through
FY2006 as part of the Health Care Safety Net Amendments of
2002. The CHC program is administered by the Health Resources
and Services Administration's (HRSA) Bureau of Primary Health
Care.
CHCs have in common several specific features, as provided
by subsection 330(k)(3) of the PHSA. CHCs (1) serve either a
federally designated, medically underserved area or a
population; (2) have nonprofit, public, or tax exempt status;
(3) provide comprehensive primary health care services,
referrals, and other services needed to facilitate access to
care, such as care management, translation, and transportation;
(4) have a governing board in which the majority of members are
patients of the health center; and (5) provide services to all
in the service area, regardless of ability to pay, and offer a
sliding fee schedule that adjusts according to family income.
Once designated, an FQHC is eligible for cost-based
reimbursement from Medicaid, access to physicians through the
National Health Service Corps and J-1 Visa Waiver Program, and
medical malpractice coverage under the Federal Tort Claims Act.
Presently, there are over 900 CHCs operating 3,600 urban
and rural sites in every State and territory. Primary health
services delivered at CHCs also include pre-natal care, mental
health services, blood pressure and cholesterol checks, and
care of chronic diseases such as diabetes. According to the
Health Resources and Services Administration's (HRSA) Bureau of
Primary Health Care, CHCs in 2003 treated over 12 million
people in medically underserved areas, including 4.8 million
uninsured patients. In 2003, CHCs delivered mammograms to over
200,000 women, gave check-ups and other health services to 1.6
million children, and administered over 2.2 million
immunizations. By the end of 2007, 15.8 million patients will
be receiving affordable primary and preventative health care at
4,015 sites across the country. Notably, nearly 90 percent of
the CHC patient population lives under 200 percent of the
Federal poverty level.
The Secretary may make grants, for a period of not to
exceed two years, 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 the
Secretary is unable to make each of the determinations required
by subsection (k)(3).
In the May 4, 2006, hearing, witnesses differed in their
interpretation of HRSAs current authority to provide waivers of
the community governance board requirement. The Committee
intends that the waiver authority of subsection (e)(1)(B) apply
to all requirements set forth in subsection (k), including the
ability to waive the majority patient board requirement.
The Committee notes that look-alike centers, as outlined in
the Social Security Act, must meet the same standards as FQHCs
receiving grants under Section 330 of the PHSA. It is the
intent of the Committee to clarify that the authority of the
Secretary under existing law to provide waivers to entities
receiving grants under Section 330 of the PHSA for particular
requirements under subsection 330(k) also be available to the
Secretary when making the determination that an entity applying
for look-alike status meets the requirements set forth under
Section 330. This bill does not expand the scope of the
Secretary's waiver authority under existing law but rather
clarifies the current waiver authority of the Secretary.
Hearings
On May 4, 2006, the Subcommittee on Health held a hearing
entitled ``The Critical Role of Community Health Centers in
Ensuring Access to Care.'' The Subcommittee received testimony
from: Elisabeth Handley, Division Director for Policy and
Development, Bureau of Primary Health Care, Health Resources
and Services Administration, U.S. Department of Health and
Human Services; Roy C. Brooks, Commissioner of Tarrant County,
Texas; Kathy Grant-Davis, Executive Director, New Jersey
Primary Care Association; and Dan Hawkins, Vice President for
Federal, State and Public Affairs, National Association of
Community Health Centers, Inc.
Committee Consideration
On Thursday, June 8, 2006, the Subcommittee on Health met
in open markup session and approved H.R. 5573 for Full
Committee consideration, without amendment, by a voice vote, a
quorum being present. On Thursday, June 15, 2006, the Committee
on Energy and Commerce met in open markup session and ordered
H.R. 5573 reported to the House, without amendment, by a voice
vote, a quorum being present.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto.
There were no record votes taken in connection with ordering
H.R. 5573 reported. A motion by Mr. Deal to order H.R. 5573
reported to the House, without amendment, was agreed to by a
voice vote.
Committee Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the Committee held an oversight
hearing and made findings that are reflected in this report.
Statement of General Performance Goals and Objectives
The goal of H.R. 5573 is to allow Community Health Centers
to continue providing health care services to the Nation's
medically underserved.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee finds that H.R.
5573, the Health Centers Renewal Act of 2006, would result in
no new or increased budget authority, entitlement authority, or
tax expenditures or revenues.
Committee Cost Estimate
The Committee adopts as its own the cost estimate prepared
by the Director of the Congressional Budget Office pursuant to
section 402 of the Congressional Budget Act of 1974.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
provided by the Congressional Budget Office pursuant to section
402 of the Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 19, 2006.
Hon. Joe Barton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 5573, the Health
Centers Renewal Act of 2006.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Camile
Williams.
Sincerely,
Donald B. Marron,
Acting Director.
Enclosure.
H.R. 5573--Health Centers Renewal Act of 2006
Summary: H.R. 5573 would amend section 330 of the Public
Health Service Act to authorize through 2011 a program that
provides grants to community health centers (CHCs). Assuming
appropriation of the authorized amounts, CBO estimates that
implementing the bill would cost $1.0 billion in 2007 and $8.9
billion over the 2007-2011 period.
H.R. 5573 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would impose no costs on state, local, or tribal
governments.
Estimated Cost to the Federal Government: The estimated
budgetary impact of H.R. 5573 is shown in the following table.
The costs of this legislation fall within budget function 550
(health).
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By fiscal year, in millions of dollars
-----------------------------------------------
2006 2007 2008 2009 2010 2011
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SPENDING SUBJECT TO APPROPRIATION
Spending Under Current Law:
Budget Authority\1\......................................... 1,690 0 0 0 0 0
Estimated Outlays........................................... 896 710 0 0 0 0
Proposed Changes:
Authorization Level......................................... 0 1,963 1,999 2,015 2,041 2,041
Estimated Outlays........................................... 0 1,040 1,884 1,966 1,988 1,999
Spending Under H.R. 5573:
Authorization Level\1\...................................... 1,690 1,963 1,999 2,015 2,041 2,041
Estimated Outlays........................................... 896 1,750 1,884 1,966 1,988 1,999
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\1\The 2006 level is the amount appropriated for that year for grants to community health centers.
Basis of Estimate: The Health Resources and Services
Administration administers a program that provides grants to
community organizations for the development and operation of
community health centers. Those health centers provide medical
care to poor and underserved populations. Authorization for
that grant program expires in 2006.
H.R. 5573 would renew funding for that program by
authorizing appropriation of about $2 billion a year in 2007
through 2011.
Based on historical patterns of spending for community
health centers, CBO estimates that implementing the bill would
cost $1.0 billion in 2007 and $8.9 billion over the 2007-2011
period, assuming appropriation of authorized amounts.
Intergovernmental and Private-Sector Impact: H.R. 5573
contains no intergovernmental or private-sector mandates as
defined in UMRA and would impose no costs on state, local, or
tribal governments.
Estimate prepared by: Federal Costs: Camile Williams.
Impact on State, Local, and Tribal Governments: Leo Lex. Impact
on the Private Sector: Paige Shevlin.
Estimate approved by: Peter H. Fontaine, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for this legislation is provided in
Article I, section 8, clause 3, which grants Congress the power
to regulate commerce with foreign nations, among the several
States, and with the Indian tribes.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 1. Short Title.
Section 1 designates the title of the bill as the ``Health
Centers Renewal Act of 2006.''
Section 2. Findings.
Section 2 establishes the findings for the legislation.
Section 3. Additional Authorization of Appropriations for Health
Centers Program of Public Health Service Act.
Section 3 authorizes to be appropriated to the Department
of Health and Human Services to carry out the Act $1.963
billion for fiscal year 2007, $1.999 billion for fiscal year
2008, $2.015 billion for fiscal year 2009, $2.041 billion for
fiscal year 2010, and $2.041 billion for fiscal year 2011.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
SECTION 330 OF THE PUBLIC HEALTH SERVICE ACT
SEC. 330. HEALTH CENTERS.
(a) * * *
* * * * * * *
(r) Authorization of Appropriations.--
[(1) In general.--For the purpose of carrying out
this section, in addition to the amounts authorized to
be appropriated under subsection (d), there are
authorized to be appropriated $1,340,000,000 for fiscal
year 2002 and such sums as may be necessary for each of
the fiscal years 2003 through 2006.]
(1) In general.--For the purpose of carrying out this
section, in addition to the amounts authorized to be
appropriated under subsection (d), there are authorized
to be appropriated $1,963,000,000 for fiscal year 2007,
$1,999,000,000 for fiscal year 2008, $2,015,000,000 for
fiscal year 2009, $2,041,000,000 for fiscal year 2010,
and $2,041,000,000 for fiscal year 2011.
* * * * * * *