42 U.S.C. § 280c–6 — Projects to improve maternal, infant, and child health

(a) In general: (1) Establishment of program: The Secretary, through the Administrator of the Health Resources and Services Administration, must give grants to eligible entities to pay the federal share of providing the services listed in subsection (b). These services go to families where a member is either a pregnant woman at risk of having a baby with a health or developmental problem, or a child under age 3 who is experiencing or at risk of a health or developmental problem, child abuse, or neglect, or who was exposed to a mother's substance abuse before birth. (2) Minimum period of awards; administrative consultations: The Secretary must award these grants for at least three years. The Administrator of the Administration for Children, Youth, and Families and the Director of the National Commission to Prevent Infant Mortality must be consulted when setting program guidelines and funding priorities. (3) Requirement of status as Medicaid provider: (A) Except as described below, the Secretary can give a grant only if — for any service covered under the state's Medicaid plan — either the entity itself has signed a Medicaid participation agreement and can receive Medicaid payments, or the entity has an agreement with an organization that has done so. (B) This Medicaid participation requirement is waived if the organization does not charge patients or accept third-party payment (including insurance or federal or state health benefits) for the health or mental health services it provides. Whether an organization qualifies for this waiver does not depend on whether it accepts voluntary donations for services it gives the public. (b) Home visiting services for eligible families: Each project funded under subsection (a) must make these services available, directly or through arrangements with other public or nonprofit groups, as applicable to each family member: (1) Prenatal and postnatal health care. (2) Primary health care for children, including developmental checkups. (3) Education for parents on infant care and child development, including building and using parent and teacher resource networks where they exist. (4) If a parent asks, giving that same education to other people who help care for the children. (5) Education for parents on behaviors that harm health. (6) Help getting necessary health, mental health, developmental, social, housing, and nutrition services and other help — including through maternal and child health programs, the special supplemental nutrition program for women, infants, and children, section 1786 of this title, titles IV, V, and XIX of the Social Security Act (including early and periodic screening, diagnosis, and treatment services), housing programs, other food assistance programs, and alcohol and drug treatment programs, based on need. (c) Considerations in making grants: When awarding grants, the Secretary must consider: (1) Whether the entity can provide, directly or through connections, a broad range of preventive and primary health care and related social, family support, and developmental services. (2) Whether the program uses different mixes of professional and lay home visitors suited to its target population's needs. (3) How limited the target population's access is to health care and related services. (4) Whether grants are fairly spread between urban and rural areas, and whether groups serving Native American communities are represented among grantees. (d) Federal share: A grant cannot cover more than 90 percent of a project's costs. To get the grant, the applicant must show it will get at least 10 percent of the costs from non-federal funds (cash or in-kind, including facilities and staff). (e) Rule of construction regarding at-risk births: For subsection (a)(1), a pregnant woman is considered at risk of having a baby with a health or developmental problem if, during pregnancy, she: (1) Lacks proper access to, or information about, early and routine prenatal care. (2) Lacks the transportation needed to reach the services in subsection (b). (3) Lacks proper child care help, which stops her from using health and social services. (4) Is afraid to use substance abuse or child and family support services. (5) Is a minor with low income. (f) Delivery of services and case management: (1) Case management model: Home visiting services must be delivered through a case management model. A registered nurse, licensed social worker, or other licensed health care professional experienced in home and community health and social services must be the case manager for each family. (2) Case manager: The case manager is mainly responsible for coordinating and overseeing a plan for each family receiving home visiting services, and for coordinating the delivery of services through the right staff. (3) Appropriate personnel: In deciding which staff to use, the case manager must consider the project's stated goals — after considering gaps in the current service system — and the family's needs, based on the case manager's initial assessment and follow-up contact by other service providers. (4) Family service plan: After the first home visit, the case manager, consulting with the team under paragraph (5), must develop a plan for the family that reflects: an assessment of the family's health and social service needs; a structured plan for delivering home visiting services to meet those needs; how often services will be given; ongoing updates as the family's needs change; and the family's continued voluntary participation. (5) Home visiting services team: The team consulted under paragraph (4) must include, as appropriate, nursing professionals, physician assistants, social workers, child welfare professionals, infant and early childhood specialists, nutritionists, and trained lay home visitors. The case manager must make sure the plan is coordinated with any physician services the mother or child needs. (g) Outreach: Each grantee must do outreach and casefinding to let eligible families know home visiting services are available. (h) Confidentiality: Following state law, a grantee must keep confidential the services it provides to families under this section. (i) Certain assurances: The Secretary can award a grant only if the entity assures the Secretary that: (1) It will provide home visiting services reasonably often — to families with pregnant women, starting as early in pregnancy as practical and continuing until the infant turns at least 2, and to other eligible families for at least 2 years; and (2) It will coordinate with public health and social service agencies to avoid duplicating effort and to improve comprehensive health and social services. (j) Submission to Secretary of certain information: The Secretary can award a grant only if the entity submits: (1) A description of the target population and how it will do outreach and casefinding, including using lay home visitors where appropriate. (2) A description of the types and qualifications of its home visitors and how it will keep training and supporting them. (3) Other information the Secretary decides is appropriate. (k) Limitation regarding administrative expenses: No more than 10 percent of a grant may go to administrative expenses. The cost of training people to work in the project does not count as an administrative expense. (l) Restrictions on use of grant: To qualify for a grant, an entity must agree not to spend the grant to: (1) Provide inpatient hospital services. (2) Give cash payments to people who receive services. (3) Buy or improve land, build or substantially improve any building or facility, or buy major medical equipment. (4) Meet a requirement to spend non-federal funds as a condition of getting federal funds. (5) Give financial help to any entity other than a public or nonprofit private one. (m) Reports to Secretary: To qualify for a grant, an entity must agree to send the Secretary an annual report, in the form the Secretary requires, on services provided. At minimum, it must report on: (1) Characteristics of the families and children served. (2) How, and where, preventive health services (prenatal, primary infant, and child health care) were used. (3) How often low-birthweight and premature babies occurred. (4) How long mothers and children stayed in the hospital before and after birth. (5) How often confirmed child abuse and neglect occurred among participating families. (6) The number of emergency room visits for routine care. (7) Who paid for health care services, and how much using this program reduced use of other health care services (besides routine screening) under Medicaid and other federal, state, and local programs. (8) The number and type of referrals made for health and social services, including alcohol and drug treatment, and how much of those services families actually used. (9) How often developmental disabilities occurred. (n) Requirement of application: The Secretary can award a grant only if: (1) The entity submits an application; (2) The application includes the agreements and assurances this section requires, plus the information required in subsection (j); (3) The application shows the entity coordinated preparing the application with state maternal, child health, and child welfare agencies, and with services under Part C of the Individuals with Disabilities Education Act; and (4) The application is in whatever form, manner, and content the Secretary decides is necessary. (o) Peer review: (1) Requirement: The Secretary must rely on the recommendations of a peer review panel when deciding which grants to award. (2) Composition: This panel must include national experts in maternal and child health, child abuse and neglect, and community-based primary health services, plus representatives from relevant federal agencies — including the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Administration for Children, Youth, and Families, the U.S. Advisory Board on Child Abuse and Neglect, and the National Commission to Prevent Infant Mortality. (p) Evaluations: (1) In general: The Secretary must, directly or through contracts, evaluate how effective the funded projects are at reducing babies born with health or developmental problems, such problems among children under 3, and child abuse and neglect. At least once every 3 years, the Secretary must send Congress a report on these evaluation results. (2) Contents: These evaluations must include a summary of the data from the annual reports in subsection (m); assess how effective the projects are in urban versus rural areas and among programs using different mixes of professional and trained lay home visitors; and make recommendations to make the projects more effective. (q) Definitions: In this section: (1) "Eligible entity" includes public and nonprofit groups that provide health or related social services — community-based organizations, visiting nurse organizations, hospitals, local health departments, community health centers, Native Hawaiian health centers, nurse-managed clinics, family service agencies, child welfare agencies, developmental service providers, family resource programs, and resource mothers projects. (2) "Eligible family" means a family described in subsection (a). (3) "Health or developmental complication," for a child, means: being born unhealthy or in a potentially unhealthy state, including premature birth, low birthweight, and prenatal exposure to a mother's substance abuse; a condition that results from that; a physical disability or delay; or a developmental disability or delay. (4) "Home visiting services" means the services in subsection (b), given at the family's home or through arrangements made for the family, including in community settings. (5) "Home visitors" means people who provide home visiting services. (r) Authorization of appropriations: Congress may spend $30,000,000 in each of fiscal years 1993 and 1994 to carry out this section.