42 U.S.C. § 280c–6 — Projects to improve maternal, infant, and child health
submitted 82 years ago by Pub. L. 102-321 to r/title-42-THE-PUBLIC-HEALTH-AND-WELFARE · 2,636 words · no verdicts yet
This law funds home visiting programs for at-risk pregnant women and young children. Trained visitors and case managers deliver health, safety, and family support services in the home. Grants can cover only 90 percent of costs and must last at least three years.
(a) In general.
(1) Establishing the program. The Secretary*, through the Administrator* of the Health Resources and Services Administration, must give grants to eligible entities. These grants pay the federal share of the cost of the services listed in subsection (b), for families that include:
(A) A pregnant woman at risk of having a baby with a health or developmental complication; or
(B) A child under age 3 who either (i) has, or is at risk of, a health or developmental complication, or of child abuse or neglect, or (ii) was exposed to the mother's substance abuse before birth.
(2) Grant length and consultation. (A) The Secretary must award these grants for periods of at least 3 years. (B) 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 the Secretary sets program guidelines and funding priorities.
(3) Medicaid provider status. (A) Except as (B) allows, the Secretary can only give a grant if, for any funded service* that is also covered under the State's Medicaid plan, either (i) the entity itself has signed a Medicaid participation agreement and can be paid under the state* plan, or (ii) the entity has arranged for another organization to provide the service, and that organization has signed such an agreement and can be paid. (B)(i) This Medicaid-agreement rule is waived for an organization if, in providing health or mental health services, it does not charge patients or accept reimbursement from any third party, including insurance or a federal or state health benefits program. (ii) In deciding whether an organization qualifies for this waiver, the Secretary ignores whether the organization accepts voluntary donations for its public services.
(b) Home visiting services for eligible families. Each project* funded under subsection (a) must make the following services available to the family, as applicable, either directly or by arrangement with other public or nonprofit groups:
(1) Prenatal and postnatal health care.
(2) Primary health care for children, including developmental checkups.
(3) Education for parents on caring for infants and child development, including help building and using networks of parents, teachers, and other family-support resources, where those networks exist.
(4) If a parent asks, giving that same education to other people who help care for the children.
(5) Education for parents about behaviors that hurt health.
(6) Help getting necessary health, mental health, developmental, social, housing, and nutrition services and other help — including help through maternal and child health programs; the WIC nutrition program; section 1786 of this title; title V of the Social Security Act; title XIX of the Social Security Act (including the early and periodic screening, diagnosis, and treatment* program); titles IV and XIX of the Social Security Act; housing programs; other food assistance programs; and appropriate alcohol and drug* treatment programs — depending on the family's needs.
(c) What the Secretary considers in awarding grants. The Secretary must weigh:
(1) Whether the entity can provide, directly or through connections with others, a broad range of preventive and primary health care and related social, family-support, and developmental services.
(2) Whether the mix of professional and lay home visitors used fits the needs and traits of the population being served.
(3) How limited the target population's access to health care and related services already is.
(4) Whether grants are fairly spread between urban and rural areas, and whether entities serving Native American communities are among the grantees.
(d) The federal share. A grant cannot pay for more than 90 percent of a project's costs. To get the grant, the applicant must promise to get at least 10 percent of the costs from non-federal funds, which can be cash or in-kind support such as facilities and staff.
(e) When a pregnancy counts as "at risk." For purposes of subsection (a)(1), a pregnant woman counts as at risk of having a baby with a health or developmental complication if, during the 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 related social services;
(4) Is afraid to use substance abuse services or child and family support services; or
(5) Is a minor with low income.
(f) Delivering services and managing cases.
(1) Case management model. Services must be delivered through a case management system. A registered nurse, licensed social worker, or other licensed health care professional experienced in home and community health and social services must be assigned as case manager for each family.
(2) The case manager's role. The case manager is mainly responsible for coordinating and overseeing a plan for each family getting home visiting services, and for coordinating the delivery of those services through the right personnel.
(3) Choosing the right personnel. In deciding which staff to use, the case manager considers: (A) the project's stated goals, based on gaps found in the current service system; and (B) the family's needs, based on the case manager's first assessment and later contacts by other service providers.
(4) The family service plan. After the first home visit, the case manager — consulting the team described in paragraph (5) — must build a plan for the family. The plan must include: (A) an assessment of the family's health and social service needs; (B) a structured plan for delivering home visiting services to meet those needs; (C) how often services will be provided; (D) ongoing changes as the family's needs change; and (E) confirmation that the family keeps taking part in the plan voluntarily.
(5) The home visiting services team. This team, consulted for each family's plan, should 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 lines up with whatever doctor's care the mother or child needs.
(g) Outreach. Every grantee must do outreach and casefinding to let eligible families know these home visiting services exist.
(h) Confidentiality. Following state law, a grantee must keep confidential the services it gives to families under this section.
(i) Required assurances. The Secretary can only award a grant if the entity assures the Secretary that: (1) it will provide home visiting services often enough — (A) to families with pregnant women, starting as early in the pregnancy as practical and continuing until the infant is at least 2 years old, and (B) to other eligible families, for at least 2 years; and (2) it will coordinate with public health and social service agencies to avoid duplicating work and to improve delivery of full-range services.
(j) Required information. The Secretary can only award a grant if the entity submits: (1) a description of the population it will target, and how it will do outreach and find eligible families, including its use of lay home visitors where fitting; (2) a description of the types and qualifications of the home visitors it will use, and how it will keep training and supporting them; and (3) any other information the Secretary decides is appropriate.
(k) Limit on administrative costs. No more than 10 percent of a grant may be spent on administrative expenses. Costs to train people to work in the project are not counted against this 10 percent limit.
(l) What the grant cannot pay for. To be eligible, an entity must agree the grant will not be spent: (1) on inpatient hospital services; (2) as cash payments to the people meant to receive services; (3) to buy or improve land, to build, buy, or permanently improve (other than minor remodeling) a building or other facility, or to buy major medical equipment; (4) to meet some other program's requirement to spend non-federal money as a condition of getting federal funds; or (5) to give financial assistance to any entity that is not a public or nonprofit private group.
(m) Annual reports. To be eligible, an entity must agree to send the Secretary a yearly report on the services it provided, covering at least: (1) the traits of the families and children served; (2) how, where, and by whom preventive health services — prenatal care and primary care for infants and children — were used; (3) how often babies were born premature or with low birthweight; (4) how long mothers and children stayed in the hospital before and after birth; (5) how often confirmed child abuse or neglect happened among children in participating families; (6) how many emergency room visits were for routine care; (7) who paid for health care services, and how much the project reduced use of health care services (beyond routine screening and care) available under Medicaid and other federal, state, and local programs; (8) how many referrals were made for health and related social services, including alcohol and drug treatment, and how much families used those services; and (9) how often developmental disabilities occurred.
(n) Application requirements. The Secretary can only give a grant if: (1) the entity submits an application; (2) the application includes the required agreements and assurances, and the information required by subsection (j); (3) the application shows that it was prepared together with the state agencies responsible for maternal and child health and child welfare, and coordinated with services provided under Part C of the Individuals with Disabilities Education Act; and (4) the application is in whatever form, manner, and with whatever agreements, assurances, and information the Secretary decides are necessary.
(o) Peer review. (1) The Secretary must base grant decisions on the recommendations of a peer review panel. (2) That panel must include (A) national experts in maternal and child health, child abuse and neglect, and community-based primary health services, and (B) 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) The Secretary, directly or through contracts, must (A) evaluate how well projects under subsection (a) reduce the number of babies born with health or developmental complications, the number of children under 3 with such complications, and the amount of child abuse and neglect; and (B) at least once every 3 years, send Congress a report on the results. (2) These evaluations must (A) summarize the data from the annual reports required under subsection (m); (B) compare how well projects work in urban versus rural areas, and among programs that mix professional and community-trained home visitors differently, for their particular target populations; and (C) recommend ways to make the projects more effective.
(q) Definitions used in this section: (1) "Eligible entity" includes public and nonprofit private groups that provide health or related social services — such as 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 and support programs, and resource mothers projects. (2) "Eligible family" means a family described in subsection (a). (3) "Health or developmental complication," for a child, means (A) being born in an unhealthy or possibly unhealthy condition, including premature birth, low birthweight, or exposure to the mother's substance abuse before birth; (B) a condition that grows out of (A); (C) a physical disability or delay; or (D) a developmental disability or delay. (4) "Home visiting services" means the services listed in subsection (b), given at the eligible family's home or under arrangements made for the family, including in community settings. (5) "Home visitors" means the people who provide home visiting services.
(r) Money authorized. Congress authorized $30,000,000 for each of fiscal years 1993 and 1994 to carry out this section.
The Secretary*, acting through the Administrator* of the Health Resources and Services Administration, shall make grants to eligible entities to pay the Federal share of the cost of providing the services specified in subsection (b) to families in which a member is—
a pregnant woman at risk of delivering an infant with a health or developmental complication; or
a child less than 3 years of age—
who is experiencing or is at risk of a health or developmental complication, or of child abuse or neglect; or
who has been prenatally exposed to maternal substance abuse.
The Secretary shall award grants under paragraph (1) for periods of 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 shall be consulted regarding the promulgation of program guidelines and funding priorities under this section.
Subject to subparagraph (B), the Secretary may make a grant under paragraph (1) only if, in the case of any service* under such paragraph that is covered in the State* plan approved under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] for the State involved—
the entity involved will provide the service directly, and the entity has entered into a participation agreement under the State plan and is qualified to receive payments under such plan; or
the entity will enter into an agreement with an organization under which the organization will provide the service, and the organization has entered into such a participation agreement and is qualified to receive such payments.
In the case of an organization making an agreement under subparagraph (A)(ii) regarding the provision of services under paragraph (1), the requirement established in such subparagraph regarding a participation agreement shall be waived by the Secretary if the organization does not, in providing health or mental health services, impose a charge or accept reimbursement available from any third-party payor, including reimbursement under any insurance policy or under any Federal or State health benefits program.
A determination by the Secretary of whether an organization referred to in clause (i) meets the criteria for a waiver under such clause shall be made without regard to whether the organization accepts voluntary donations regarding the provision of services to the public.
With respect to an eligible family, each of the following services shall, directly or through arrangement with other public or nonprofit private entities, be available (as applicable to the family member involved) in each project* operated with a grant under subsection (a):
Prenatal and postnatal health care.
Primary health care for the children, including developmental assessments.
Education for the parents concerning infant care and child development, including the development and utilization of parent and teacher resource networks and other family resource and support networks where such networks are available.
Upon the request of a parent, providing the education described in paragraph (3) to other individuals who have responsibility for caring for the children.
Education for the parents concerning behaviors that adversely affect health.
Assistance in obtaining necessary health, mental health, developmental, social, housing, and nutrition services and other assistance, including services and other assistance under maternal and child health programs; the special supplemental nutrition program for women, infants, and children; section 1786 of this title; title V of the Social Security Act [42 U.S.C. 701 et seq.]; title XIX of such Act [42 U.S.C. 1396 et seq.] (including the program for early and periodic screening, diagnostic, and treatment* services described in section 1905(r) of such Act [42 U.S.C. 1396d(r)]); titles IV and XIX of the Social Security Act [42 U.S.C. 601 et seq., 1396 et seq.]; housing programs; other food assistance programs; and appropriate alcohol and drug* dependency treatment programs, according to need.
In awarding grants under subsection (a), the Secretary shall take into consideration—
the ability of the entity involved to provide, either directly or through linkages, a broad range of preventive and primary health care services and related social, family support, and developmental services;
different combinations of professional and lay home visitors utilized within programs that are reflective of the identified service needs and characteristics of target populations;
the extent to which the population to be targeted has limited access to health care, and related social, family support, and developmental services; and
whether such grants are equitably distributed among urban and rural settings and whether entities serving Native American communities are represented among the grantees.
With respect to the costs of carrying out a project under subsection (a), a grant under such subsection for the project may not exceed 90 percent of such costs. To be eligible to receive such a grant, an applicant must provide assurances that the applicant will obtain at least 10 percent of such costs from non-Federal funds (and such contributions to such costs may be in cash or in-kind, including facilities and personnel).
For purposes of subsection (a)(1), a pregnant woman shall be considered to be at risk of delivering an infant with a health or developmental complication if during the pregnancy the woman—
lacks appropriate access to, or information concerning, early and routine prenatal care;
lacks the transportation necessary to gain access to the services described in subsection (b);
lacks appropriate child care assistance, which results in impeding the ability of such woman to utilize health and related social services;
is fearful of accessing substance abuse services or child and family support services; or
is a minor with a low income.
Home visiting services provided under this section shall be delivered according to a case management model, and a registered nurse, licensed social worker, or other licensed health care professional with experience and expertise in providing health and related social services in home and community settings shall be assigned as the case manager for individual cases under such model.
A case manager assigned under paragraph (1) shall have primary responsibility for coordinating and overseeing the development of a plan for each family that is to receive home visiting services under this section, and for coordinating the delivery of such services provided through appropriate personnel.
In determining which personnel shall be utilized in the delivery of services, the case manager shall consider—
the stated objective of the project to be operated with the grant, as determined after considering identified gaps in the current service delivery system; and
the nature of the needs of the family to be served, as determined at the initial assessment of the family that is conducted by the case manager, and through follow-up contacts by other providers of home visiting services.
A case manager, in consultation with a team established in accordance with paragraph (5) for the family involved, shall develop a plan for the family following the initial visit to the home of the family. Such plan shall reflect—
an assessment of the health and related social service needs of the family;
a structured plan for the delivery of home visiting services to meet the identified needs of the family;
the frequency with which such services are to be provided to the family;
ongoing revisions made as the needs of family members change; and
the continuing voluntary participation of the family in the plan.
The team to be consulted under paragraph (4) on behalf of a family shall include, as appropriate, other nursing professionals, physician assistants, social workers, child welfare professionals, infant and early childhood specialists, nutritionists, and laypersons trained as home visitors. The case manager shall ensure that the plan is coordinated with those physician services that may be required by the mother or child.
Each grantee under subsection (a) shall provide outreach and casefinding services to inform eligible families of the availability of home visiting services from the project.
In accordance with applicable State law, an entity receiving a grant under subsection (a) shall maintain confidentiality with respect to services provided to families under this section.
The Secretary may award a grant under subsection (a) only if the entity involved provides assurances satisfactory to the Secretary that—
the entity will provide home visiting services with reasonable frequency—
to families with pregnant women, as early in the pregnancy as is practicable, and until the infant reaches at least 2 years of age; and
to other eligible families, for at least 2 years; and
the entity will coordinate with public health and related social service agencies to prevent duplication of effort and improve the delivery of comprehensive health and related social services.
The Secretary may award a grant under subsection (a) only if the entity involved submits to the Secretary—
a description of the population to be targeted for home visiting services and methods of outreach and casefinding for identifying eligible families, including the use of lay home visitors where appropriate;
a description of the types and qualifications of home visitors used by the entity and the process by which the entity will provide continuing training and sufficient support to the home visitors; and
such other information as the Secretary determines to be appropriate.
Not more than 10 percent of a grant under subsection (a) may be expended for administrative expenses with respect to the grant. The costs of training individuals to serve in the project involved are not subject to the preceding sentence.
To be eligible to receive a grant under this section, an entity must agree that the grant will not be expended—
to provide inpatient hospital services;
to make cash payments to intended recipients of services;
to purchase or improve land, purchase, construct, or permanently improve (other than minor remodeling) any building or other facility, or purchase major medical equipment;
to satisfy any requirement for the expenditure of non-Federal funds as a condition for the receipt of Federal funds; or
to provide financial assistance to any entity other than a public or nonprofit private entity.
To be eligible to receive a grant under this section, an entity must agree to submit an annual report on the services provided under this section to the Secretary in such manner and containing such information as the Secretary by regulation requires. At a minimum, the entity shall report information concerning eligible families, including—
the characteristics of the families and children receiving services under this section;
the usage, nature, and location of the provider, of preventive health services, including prenatal, primary infant, and child health care;
the incidence of low birthweight and premature infants;
the length of hospital stays for pre- and post-partum women and their children;
the incidence of substantiated child abuse and neglect for all children within participating families;
the number of emergency room visits for routine health care;
the source of payment for health care services and the extent to which the utilization of health care services, other than routine screening and medical care, available to the individuals under the program established under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.], and under other Federal, State, and local programs, is reduced;
the number and type of referrals made for health and related social services, including alcohol and drug treatment services, and the utilization of such services provided by the grantee; and
the incidence of developmental disabilities.
The Secretary may make a grant under subsection (a) only if—
an application for the grant is submitted to the Secretary;
the application contains the agreements and assurances required in this section, and the information required in subsection (j);
the application contains evidence that the preparation of the application has been coordinated with the State agencies responsible for maternal and child health and child welfare, and coordinated with services provided under part C of the Individuals with Disabilities Education Act [20 U.S.C. 1431 et seq.]; and
the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section.
In making determinations for awarding grants under subsection (a), the Secretary shall rely on the recommendations of the peer review panel established under paragraph (2).
The Secretary shall establish a review panel to make recommendations under paragraph (1) that shall be composed of—
national experts in the fields of maternal and child health, child abuse and neglect, and the provision of community-based primary health services; and
representatives of 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.
The Secretary shall, directly or through contracts with public or private entities—
conduct evaluations to determine the effectiveness of projects under subsection (a) in reducing the incidence of children born with health or developmental complications, the incidence among children less than 3 years of age of such complications, and the incidence of child abuse and neglect; and
not less than once during each 3-year period, prepare and submit to the appropriate committees of Congress a report concerning the results of such evaluations.
The evaluations conducted under paragraph (1) shall—
include a summary of the data contained in the annual reports submitted under subsection (m);
assess the relative effectiveness of projects under subsection (a) in urban and rural areas, and among programs utilizing differing combinations of professionals and trained home visitors recruited from the community to meet the needs of defined target service populations; and
make further recommendations necessary or desirable to increase the effectiveness of such projects.
For purposes of this section:
The term “eligible entity” includes public and nonprofit private entities that provide health or related social services, including 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 and support programs, and resource mothers projects.
The term “eligible family” means a family described in subsection (a).
The term “health or developmental complication”, with respect to a child, means—
being born in an unhealthy or potentially unhealthy condition, including premature birth, low birthweight, and prenatal exposure to maternal substance abuse;
a condition arising from a condition described in subparagraph (A);
a physical disability or delay; and
a developmental disability or delay.
The term “home visiting services” means the services specified in subsection (b), provided at the residence of the eligible family involved or provided pursuant to arrangements made for the family (including arrangements for services in community settings).
The term “home visitors” means providers of home visiting services.
For the purpose of carrying out this section, there is authorized to be appropriated $30,000,000 for each of the fiscal years 1993 and 1994.
Source credit: (July 1, 1944, ch. 373, title III, § 399, as added Pub. L. 102–321, title V, § 502(2), July 10, 1992, 106 Stat. 427; amended Pub. L. 103–448, title II, § 204(w)(2)(D), Nov. 2, 1994, 108 Stat. 4746; Pub. L. 108–446, title III, § 305(i)(2), Dec. 3, 2004, 118 Stat. 2806.)
- 1944Enacted · Pub. L. 102-321 · 106 Stat. 427
- 1994Amended · Pub. L. 103-448 · 108 Stat. 4746
- 2004Amended · Pub. L. 108-446 · 118 Stat. 2806
A history note hasn’t been published yet. The record shows enactment by Pub. L. 102-321 on 1944-07-01.
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