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1 sums as are necessary to carry out the provisions of this 2 section."

3 (f) Subsection (e) of section 794C of such Act is 4 amended to read as follows:

5 "(e) There are authorized to be appropriated such sums

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as are necessary to carry out the provisions of this section." (g) Subsection (c) of section 794D of such Act is

8 amended to read as follows:

9 "(c) There are authorized to be appropriated to the 10 Secretary for Federal capital contributions to student loan 11 funds pursuant to subsection (a) (2) (B) (i) such sums as 12 are necessary, and there are also authorized to be appro13 priated such sums as may be necessary to enable students 14 who have received a loan from any academic year to con15 tinue or complete their education. Sums appropriated pur16 suant to this subsection for any fiscal year shall be available 17 to the Secretary (1) for payments into the funds established 18 by subsection (f) (4), and (2) in accordance with agree19 ments under this section, for Federal capital contributions to 20 schools with which such agreements have been made, to be 21 used together with deposits in such funds pursuant to subsec22 tion (a) (2) (B) (ii), for establishment and maintenance of 23 student loans funds."

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COMMUNITY MENTAL HEALTH CENTERS

SEC. 520. (a) Section 201 of the Community Mental

6 Health Centers Act is amended to read as follows:

7 "SEC. 201. There are authorized to be appropriated for 8 grants for construction of public and other nonprofit com9 munity mental health centers such sums as may be 10 necessary."

11 (b) Section 207 of such Act is amended to read as 12 follows:

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"SEC. 207. No grant may be made under any provision 14 of the Public Health Service Act for any fiscal year, for 15 construction of any facility described in this title, unless the 16 Secretary determines that funds are not available, under this 17 title to make a grant for the construction of such facility.". 18 (c) Section 224 of such Act is amended to read as 19 follows: "There are hereby authorized to be appropriated to 20 enable the Secretary to make initial grants to community 21 mental health centers, under the provisions of this part, such

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sums as may be necessary. For the fiscal year ending

23 June 30, 1973, and each succeeding fiscal year there are

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1 hereby authorized to be appropriated such sums as may be 2 necessary to make grants to such centers which have previ3 ously received a grant under this part and are eligible for 4 such a grant by the year for which sums are being appropri5 ated under this sentence.".

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PART C-AVAILABILITY OF APPROPRIATIONS

SEC. 530. Notwithstanding any other provision of law, 8 unless enacted after the enactment of this Act expressly in 9 limitation of the provisions of this section, funds appropriated 10 for any fiscal year, to carry out any program for which 11 appropriations are authorized by the Public Health Service

12 Act or the Mental Retardation Facilities and Community

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Mental Health Centers Construction Act of 1963 shall re14 main available for obligation and expenditure until the end of 15 such fiscal year.

SECTION-BY-SECTION ANALYSIS OF THE HEALTH MAINTENANCE ORGANIZATION AND RESOURCES DEVELOPMENT ACT OF 1972

(Section 2) States the finding of Congress that:

a. A shortage and maldistribution of health care resources in the United States has limited access to medical care;

b. the present health care system is not organized to promote efficient and economical health care;

c. the health care system is oriented toward the provision of acute health care rather than preventive health care;

d. health maintenance organizations, health service organizations, and area health education and service centers will help to alleviate such circumstances by providing efficient and economical health care, oriented toward the provision of preventive health services;

e. technical and resource assistance is needed for those planning to establish health maintenance organizations, health service organizations, and area health education and service centers;

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f. the system of medical education in the United States has a shortof health science educational facilities, and presently over emphasizes the practice of medicine within a hospital setting and the treatment of rare and exotic diseases;

g.

the quality of health care and that of the health service provided varies excessively throughout the United States.

The section also indicates that the purpose of this Act is to improve the health care delivery system by supporting the creation of health maintenance organizations, health service organizations, and area health education and service centers, particularly in medically under

served areas.

TITLE I-HEALTH MAINTENANCE ORGANIZATIONS

(Section 101) Amends the Public Health Service Act by adding new title XI entitled, "Health Maintenance Organizations and Health Service Organizations," and part A of new title XI entitled, "Support of Health Maintenance Organizations."

(Section 101-new section 1101) Defines the terms "health maintenance organization;" "comprehensive health services;" "medical group;""enrolled;" "medically underserved area;" "construction" and "costs of construction;" "university health center;" area health education and service center;" and "non-metropolitan area."

(New section 1101 (1)) "Health maintenance organization" means an entity which

a. Provides uniform comprehensive health services for all its enrollees (or subscribers), in return for fixed and uniform payments which are made on a periodic basis (without regard to the frequency, extent, or kind of service actually furnished). A basic range of serv

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ices is to be delivered directly through the staff and supporting r sources of the health maintenance organization or through a medica group (or groups). Additional services, if required, may be delivere by other health delivery entities;

b. satisfactorily demonstrates its ability to provide prompt and ap propriate health services that are accessible and available to all e rollees and that assure continuity of care;

C. satisfactorily demonstrates its financial responsibility by ad quately providing against the risk of insolvency;

d. is organized to assure enrollees (including representation of per sons from medically underserved areas) a substantial policymakin role in the health maintenance organization; and provides for meaning ful hearing and grievance procedures between enrollees and the healt maintenance organization, and between individuals providing service and the health maintenance organizations;

e. encourages and actively provides for its enrollees health educatio services and education in the appropriate use of health services;

f. has organizational arrangements for an ongoing quality assur ance program that stresses the outcomes of health services provide and assures that quality standards are met which are in complianc with the standards established by the Commission on Quality Healt Care (created under new title XII of the Public Health Service Act) g. provides effective procedures for developing, compiling, evaluat ing and reporting to the Secretary (without jeopardizing physician patient confidentiality) information on the costs, utilization, avail ability, accessibility, and acceptance of its health services and on othe matters as may be required. Discloses such information (at least an nually) to health maintenance organization enrollees and to the gen eral public;

h. assumes fully (without the benefit of insurance) financial respon sibility for comprehensive health services provided. Is not expected to assume direct liability for expenses incurred in association with out of-area emergency health care, or health care that can be reasonably valued in excess of $5,000 per enrollee per year;

i. has an unrestricted open enrollment period (of not less than 30 days) at least once during a 12-month period;

j. assumes responsibility for the health care of enrollees twenty four hours a day, seven days a week, and for the prompt availability of such care in emergency situations;

k. may not enroll more than 50 percent of its enrollees from the medically underserved areas, except in rural areas as designated by the Secretary;

1. provides ongoing education for its staff;

m. emphasizes the use of physicians' assistants, dental therapists. nurse practitioners, and other allied health personnel;

n. meets other criteria as prescribed by regulation which are consistent with the provisions of this title;

o. does not expell (or refuse to enroll) any enrollee from reasons of medical condition or adverse utilization experience.

(New section 1101 (2)) "Comprehensive health services" mean: a minimum range of health services that are provided by the health maintenance organization or health service organization (as defined

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