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

**(a) In general** (1) **Establishment of program** — 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) a pregnant woman at risk of delivering an infant with a health or developmental complication; or (B) a child less than 3 years of age— (i) who is experiencing or is at risk of a health or developmental complication, or of child abuse or neglect; or (ii) who has been prenatally exposed to maternal substance abuse. (2) **Minimum period of awards; administrative consultations** (A) The Secretary shall award grants under paragraph (1) for periods of at least three years. (B) 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. (3) **Requirement of status as medicaid provider** (A) 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396&num=0&edition=prelim) et seq.] for the State involved— (i) 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 (ii) 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. (B) (i) 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. (ii) 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. **(b) Home visiting services for eligible families** 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): (1) Prenatal and postnatal health care. (2) Primary health care for the children, including developmental assessments. (3) 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. (4) Upon the request of a parent, providing the education described in paragraph (3) to other individuals who have responsibility for caring for the children. (5) Education for the parents concerning behaviors that adversely affect health. (6) 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1786&num=0&edition=prelim); title V of the Social Security Act [[42 U.S.C. 701](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section701&num=0&edition=prelim) et seq.]; title XIX of such Act [[42 U.S.C. 1396](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396&num=0&edition=prelim) 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)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396d/r&num=0&edition=prelim)]); titles IV and XIX of the Social Security Act [[42 U.S.C. 601](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section601&num=0&edition=prelim) et seq., 1396 et seq.]; housing programs; other food assistance programs; and appropriate alcohol and drug dependency treatment programs, according to need. **(c) Considerations in making grants** In awarding grants under subsection (a), the Secretary shall take into consideration— (1) 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; (2) different combinations of professional and lay home visitors utilized within programs that are reflective of the identified service needs and characteristics of target populations; (3) the extent to which the population to be targeted has limited access to health care, and related social, family support, and developmental services; and (4) whether such grants are equitably distributed among urban and rural settings and whether entities serving Native American communities are represented among the grantees. **(d) Federal share** 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). **(e) Rule of construction regarding at-risk births** 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— (1) lacks appropriate access to, or information concerning, early and routine prenatal care; (2) lacks the transportation necessary to gain access to the services described in subsection (b); (3) lacks appropriate child care assistance, which results in impeding the ability of such woman to utilize health and related social services; (4) is fearful of accessing substance abuse services or child and family support services; or (5) is a minor with a low income. **(f) Delivery of services and case management** (1) **Case management model** — 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. (2) **Case manager** — 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. (3) **Appropriate personnel** — In determining which personnel shall be utilized in the delivery of services, the case manager shall consider— (A) 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 (B) 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. (4) **Family service plan** — 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— (A) an assessment of the health and related social service needs of the family; (B) a structured plan for the delivery of home visiting services to meet the identified needs of the family; (C) the frequency with which such services are to be provided to the family; (D) ongoing revisions made as the needs of family members change; and (E) the continuing voluntary participation of the family in the plan. (5) **Home visiting services team** — 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. **(g) Outreach** 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. **(h) Confidentiality** 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. **(i) Certain assurances** The Secretary may award a grant under subsection (a) only if the entity involved provides assurances satisfactory to the Secretary that— (1) the entity will provide home visiting services with reasonable frequency— (A) 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 (B) to other eligible families, for at least 2 years; and (2) 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. **(j) Submission to Secretary of certain information** The Secretary may award a grant under subsection (a) only if the entity involved submits to the Secretary— (1) 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; (2) 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 (3) such other information as the Secretary determines to be appropriate. **(k) Limitation regarding administrative expenses** 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. **(l) Restrictions on use of grant** To be eligible to receive a grant under this section, an entity must agree that the grant will not be expended— (1) to provide inpatient hospital services; (2) to make cash payments to intended recipients of services; (3) to purchase or improve land, purchase, construct, or permanently improve (other than minor remodeling) any building or other facility, or purchase major medical equipment; (4) to satisfy any requirement for the expenditure of non-Federal funds as a condition for the receipt of Federal funds; or (5) to provide financial assistance to any entity other than a public or nonprofit private entity. **(m) Reports to Secretary** 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— (1) the characteristics of the families and children receiving services under this section; (2) the usage, nature, and location of the provider, of preventive health services, including prenatal, primary infant, and child health care; (3) the incidence of low birthweight and premature infants; (4) the length of hospital stays for pre- and post-partum women and their children; (5) the incidence of substantiated child abuse and neglect for all children within participating families; (6) the number of emergency room visits for routine health care; (7) 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396&num=0&edition=prelim) et seq.], and under other Federal, State, and local programs, is reduced; (8) 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 (9) the incidence of developmental disabilities. **(n) Requirement of application** The Secretary may make a grant under subsection (a) only if— (1) an application for the grant is submitted to the Secretary; (2) the application contains the agreements and assurances required in this section, and the information required in subsection (j); (3) 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title20-section1431&num=0&edition=prelim) et seq.]; and (4) 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. **(o) Peer review** (1) **Requirement** — 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). (2) **Composition** — The Secretary shall establish a review panel to make recommendations under paragraph (1) that shall be composed of— (A) national experts in the fields of maternal and child health, child abuse and neglect, and the provision of community-based primary health services; and (B) 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. **(p) Evaluations** (1) **In general** — The Secretary shall, directly or through contracts with public or private entities— (A) 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 (B) 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. (2) **Contents** — The evaluations conducted under paragraph (1) shall— (A) include a summary of the data contained in the annual reports submitted under subsection (m); (B) 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 (C) make further recommendations necessary or desirable to increase the effectiveness of such projects. **(q) Definitions** For purposes of this section: (1) 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. (2) The term “eligible family” means a family described in subsection (a). (3) The term “health or developmental complication”, with respect to a child, means— (A) being born in an unhealthy or potentially unhealthy condition, including premature birth, low birthweight, and prenatal exposure to maternal substance abuse; (B) a condition arising from a condition described in subparagraph (A); (C) a physical disability or delay; and (D) a developmental disability or delay. (4) 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). (5) The term “home visitors” means providers of home visiting services. **(r) Authorization of appropriations** 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.