42 U.S.C. § 256 — Grants to strengthen the effectiveness, efficiency, and coordination of services for the uninsured and underinsured

(a) In general The Secretary may award grants to eligible groups to help build integrated health care systems for communities of uninsured and underinsured people. The goals are: (1) making providers in these systems more efficient and better coordinated; (2) helping communities build programs to prevent and manage chronic disease; and (3) expanding and improving the services these systems provide. (b) Eligible entities To qualify for a grant, an applicant must represent a consortium whose main purpose is providing coordinated health care to a defined community, and that consortium must include (unless a provider doesn't exist locally, refuses to join, or sets unreasonable conditions): (i) a federally qualified health center; (ii) a hospital that serves a high share of low-income patients (over 25 percent); (iii) a public health department; and (iv) another interested public or private health care provider that has traditionally served uninsured patients. The applicant must also submit an application that: (A) defines the community or area of uninsured and underinsured people it will serve; (B) identifies the participating providers and each one's contribution, including how much care they give to Medicare, Medicaid, and CHIP patients versus private-pay patients; (C) describes the planned grant activities; (D) shows the consortium can build on the community's current system for serving these patients; (E) shows the consortium can coordinate a full range of high-quality services — including substance abuse treatment and mental health care — with continuity of care; (F) shows evidence the community was involved in designing and directing the program; (G) shows the consortium can help enroll eligible people in public insurance or make them aware of private options; (H) presents a plan for other funding sources so the program can last; (I) describes how the program will be evaluated and improved; (J) shows financial responsibility through proper accounting; (K) shows commitment to serve everyone regardless of ability to pay, including free or reduced-cost care for the poor; and (L) includes anything else the Secretary requires. (c) Limitations (1) Number of awards: (A) For fiscal years 2003 through 2006, the Secretary can make no more than 35 new awards per year (not counting renewals). (B) This does not affect awards made before fiscal year 2003. (2) In general: A grantee generally cannot receive this grant for more than 3 straight fiscal years (even counting pre-2003 grants). It may get one extra year if: (A) it requests one; (B) the Secretary finds "extraordinary circumstances" justify it; and (C) the Secretary finds the extra year is needed to meet the program's goals. (3) Extraordinary circumstances: (A) This means events outside the grantee's control that stopped it from meeting the goals in its application. (B) Examples include (i) natural disasters or major disruptions to the community's health or security, or (ii) a serious local economic downturn that directly hurts the grantee. (d) Priorities In choosing grantees, the Secretary (1) must favor applicants that show the greatest unmet need for coordinated care in their community, and (2) may also favor applicants whose application best shows: (A) a community with a high or growing uninsured rate; (B) a consortium of providers with a track record serving the uninsured; (C) evidence the program would expand preventive and primary care, including behavioral health, oral health, or substance abuse services; (D) better coordination between health and social service providers; (E) collaboration with state and local government; (F) heavy use of non-federal funding; or (G) a good chance the program continues after the grant ends. (e) Use of funds (1) Use by grantees: (A) Except as allowed in (2) and (3), grant money may only pay for (i) direct costs of integrating the health care system so it provides or ensures a broad range of culturally appropriate services, including substance abuse and mental health care, and (ii) direct patient care and service expansion to fill documented gaps. (B) Examples of allowed uses include: (i) more outreach and closing service gaps; (ii) better case management; (iii) better transportation coordination to appointments; (iv) building provider networks to engage doctors in serving underserved patients; (v) hiring, training, and paying needed staff; (vi) technology to coordinate care; (vii) better provider communication, including shared information or clinical systems; (viii) common eligibility processes, like shared ID cards and sliding-scale discounts; (ix) prevention and disease-management tools; (x) translation services; and (xi) other activities that boost uninsured people's access to care, including projects where private partners chip in non-federal funds. (2) Direct patient care limitation: No more than 15 percent of grant funds can go to direct patient care and services. (3) Reservation of funds for national program purposes: The Secretary can use up to 3 percent of the appropriated funds for technical assistance, expert consultants, meetings, tool development, information sharing, evaluation, and spreading program benefits to other communities. (f) Grantee requirements (1) Evaluation of effectiveness: A grantee must (A) report to the Secretary each year on progress toward its application's goals, and on whether its work (I) improved effectiveness, efficiency, and coordination of care for uninsured and underinsured people, (II) led to better-quality care, and (III) delivered that care at lower cost than without the program; and (B) get an independent annual financial audit of grant-related records. (2) Progress: The Secretary can't renew a grant unless satisfied the consortium made real, demonstrated progress on its prior year's goals. (g) Maintenance of effort The Secretary can only give a grant if the applicant and each participating provider agree to keep spending non-federal money on these activities at least at the level they spent the year before applying. (h) Technical assistance The Secretary may provide, directly or through a grant or contract, technical and other non-financial help to grantees so they can meet this section's requirements. (i) Evaluation of program By September 30, 2005, the Secretary had to report to Congress on how well funded projects improved effectiveness, efficiency, and coordination of care for uninsured and underinsured people — including whether care quality improved and costs were lower than without the projects. (j) Demonstration authority The Secretary may give demonstration awards to historically Black health professions schools to: (1) build patient-based research infrastructure at schools affiliated with the providers described in (b)(1)(B); (2) set up joint medical research and data-collection programs between those schools and such providers, aimed at improving health for medically underserved people; or (3) support the research-related costs of patient care, data collection, and academic training from those affiliations. (k) Authorization of appropriations Congress authorized whatever funding is necessary for fiscal years 2002 through 2006. (l) Date certain for termination of program No funds may be appropriated for this program after September 30, 2006.