+------------------------------------------------------+---+-------------+
| TITLE I - INDIAN HEALTH MANPOWER                     |   | P.L.102-573 |
|                                                      |   |             |
| PURPOSE                                              |   | P.L.102-573 |
|                                                      |   |             |
| ~~SEC. 101. The purpose of this title is to augment  |   | P.L.102-573 |
| the inadequate number of health professionals        |   |             |
| serving Indians and remove the multiple barriers to  |   | P.L.102-573 |
| the entrance of health professionals into the        |   |             |
| Service and private practice among Indians.~~        |   | P.L.102-573 |
|                                                      |   |             |
| SEC 101. The purpose of this title is to increase    |   | P.L.102-573 |
| the number of Indians entering the health            |   |             |
| professions and to assure an adequate supply of      |   | P.L.96-537  |
| health professionals to the Service, Indian tribes,  |   |             |
| tribal organizations, and urban Indian organizations |   | P.L.96-537  |
| involved in the provision of health care to Indian   |   |             |
| people.                                              |   | P.L.100-713 |
|                                                      |   |             |
| HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR INDIANS   |   | P.L.100-713 |
|                                                      |   |             |
| SEC. 102. (a) The Secretary, acting through the      |   | P.L.102-573 |
| Service, shall make grants to public or nonprofit    |   |             |
| private health or educational entities or Indian     |   | P.L.102-573 |
| tribes or tribal organizations to assist such        |   |             |
| entities in meeting the costs of\--                  |   | P.L.96-537  |
|                                                      |   |             |
| > \(1\) identifying Indians with a potential for     |   | P.L.102-573 |
| > education or training in the health professions    |   |             |
| > and encouraging and assisting them ~~(A) to enroll |   | P.L.102-573 |
| > in schools of medicine, osteopathy, podiatry,      |   |             |
| > pharmacy, public health, nursing, or allied health |   | P.L.102-573 |
| > professions; or (B) if they are not qualified to   |   |             |
| > enroll in any such school, to undertake such       |   | P.L.100-713 |
| > post-secondary education or training as may be     |   |             |
| > required to qualify them for enrollment;~~**\--**  |   | P.L.96-537  |
| >                                                    |   |             |
| > \(A\) to enroll in courses of study in such health |   | P.L.100-713 |
| > professions; or                                    |   |             |
| >                                                    |   | P.L.100-713 |
| > \(B\) if they are not qualified to enroll in any   |   |             |
| > such courses of study, to undertake such           |   | P.L.102-573 |
| > postsecondary education or training as may be      |   |             |
| > required to qualify them for enrollment;           |   | P.L.102-573 |
| >                                                    |   |             |
| > \(2\) publicizing existing sources of financial    |   | P.L.100-713 |
| > aid available to Indians enrolled in any           |   |             |
| > ~~school~~ courses of study referred to in         |   | P.L.100-713 |
| > ~~clause (1)(A)~~ paragraph (1) of this subsection |   |             |
| > or who are undertaking training necessary to       |   | P.L.102-573 |
| > qualify them to enroll in any such school; or      |   |             |
| >                                                    |   | P.L.102-573 |
| > \(3\) establishing other programs which the        |   |             |
| > Secretary determines will enhance and facilitate   |   | P.L.104-313 |
| > the enrollment of Indians in, and the subsequent   |   |             |
| > pursuit and completion by them of courses of       |   | P.L.102-573 |
| > study, ~~in any school~~ referred to in ~~clause   |   |             |
| > (1)(A)~~ paragraph (1) of this subsection.         |   | P.L.102-573 |
|                                                      |   |             |
| (b)(1) No grant may be made under this section       |   | P.L.102-573 |
| unless an application therefore has been submitted   |   |             |
| to, and approved by, the Secretary. Such application |   | P.L.102-573 |
| shall be in such form, submitted in such manner, and |   |             |
| contain such information, as the Secretary shall by  |   | P.L.104-313 |
| regulation prescribe~~: *Provided*, That the~~ The   |   |             |
| Secretary shall give a preference to applications    |   | P.L.104-313 |
| submitted by Indian tribes or tribal organizations.  |   |             |
|                                                      |   | P.L.102-573 |
| \(2\) The amount of any grant under this section     |   |             |
| shall be determined by the Secretary. Payments       |   | P.L.104-313 |
| pursuant to grants under this section may be made in |   |             |
| advance or by way of reimbursement, and at such      |   | P.L.104-313 |
| intervals and on such conditions as the Secretary    |   |             |
| finds necessary.                                     |   | P.L.104-313 |
|                                                      |   |             |
| ~~(c) For the purpose of making payments pursuant to |   | P.L.102-573 |
| grants under this section, there are authorized to   |   |             |
| be appropriated \$900,000 for fiscal year 1978,      |   | P.L.104-313 |
| \$1,500,000 for fiscal year 1979, and \$1,800,000    |   |             |
| for fiscal year 1980. For fiscal year 1981, 1982,    |   | P.L.104-313 |
| 1983, and 1984, there are authorized to be           |   |             |
| appropriated for such payments such sums as may be   |   | P.L.102-573 |
| specifically authorized by an Act enacted after this |   |             |
| Act.~~                                               |   | P.L.102-573 |
|                                                      |   |             |
| ~~There are authorized to be appropriated to carry   |   | P.L.104-313 |
| out this section \$2,300,000 for the fiscal year     |   |             |
| ending September 30, 1981, \$2,600,000 for the       |   | P.L.102-573 |
| fiscal year ending September 30, 1982, \$3,000,000   |   |             |
| for fiscal year ending September 30, 1983, and       |   | P.L.102-573 |
| \$3,500,000 for the fiscal year ending September 30, |   |             |
| 1984~~.                                              |   | P.L.102-573 |
|                                                      |   |             |
| ~~(c) There are authorized to be appropriated for    |   | P.L.102-573 |
| the purpose of carrying out the provisions of this   |   |             |
| section\--~~                                         |   | P.L.102-573 |
|                                                      |   |             |
| > ~~(1) \$600,000 for fiscal year 1989,~~            |   | P.L.96-537  |
| >                                                    |   |             |
| > ~~(2) \$650,000 for fiscal year 1990,~~            |   | P.L.96-537  |
| >                                                    |   |             |
| > ~~(3) \$700,000 for fiscal year 1991, and~~        |   | P.L.100-713 |
| >                                                    |   |             |
| > ~~(4) \$750,000 for fiscal year 1992.~~            |   | P.L.100-713 |
|                                                      |   |             |
| HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM   |   | P.L.102-573 |
| FOR INDIANS                                          |   |             |
|                                                      |   | P.L.102-573 |
| SEC. 103. (a) The Secretary, acting through the      |   |             |
| Service, shall make scholarship grants to Indians    |   | P.L.100-713 |
| who\--                                               |   |             |
|                                                      |   | P.L.100-713 |
| > \(1\) have successfully completed their high       |   |             |
| > school education or high school equivalency; and   |   | P.L.102-573 |
| >                                                    |   |             |
| > \(2\) have demonstrated the capability to          |   | P.L.102-573 |
| > successfully complete courses of study ~~in        |   |             |
| > schools of medicine, osteopathy, dentistry,        |   | P.L.100-713 |
| > veterinary medicine, optometry, podiatry,          |   |             |
| > pharmacy, public health, nursing, or allied health |   | P.L.102-573 |
| > professions~~ in the health professions.           |   |             |
|                                                      |   | P.L.102-573 |
| ~~(b) Each scholarship grant made under this section |   |             |
| shall be for a period not to exceed two academic     |   | P.L.102-573 |
| years, which years shall be for compensatory         |   |             |
| preprofessional education of any grantee.~~          |   | P.L.102-573 |
|                                                      |   |             |
| \(b\) Scholarship grants made pursuant to this       |   | P.L.102-573 |
| section shall be for the following purposes:         |   |             |
|                                                      |   | P.L.100-713 |
| > \(1\) compensatory preprofessional education of    |   |             |
| > any grantee, such scholarship not to exceed two    |   | P.L.102-573 |
| > years on a full‑time basis (or the part‑time       |   |             |
| > equivalent thereof, as determined by the           |   | P.L.102-573 |
| > Secretary).                                        |   |             |
| >                                                    |   | P.L.102-573 |
| > ~~(2) Pregraduate education of any grantee leading |   |             |
| > to a baccalaureate degree in an approved           |   | P.L.102-573 |
| > premedicine, pre dentistry, preosteopathy,         |   |             |
| > preventerinary medicine, preoptometry, or          |   | P.L.102-573 |
| > prepodiatry curriculum, such scholarship not to    |   |             |
| > exceed four years.~~                               |   | P.L.102-573 |
| >                                                    |   |             |
| > \(2\) Pregraduate education of any grantee leading |   | P.L.102-573 |
| > to a baccalaureate degree in an approved course of |   |             |
| > study preparatory to a field of study in a health  |   | P.L.102-573 |
| > profession, such scholarship not to exceed 4 years |   |             |
| > (or the part‑time equivalent thereof, as           |   | P.L.102-573 |
| > determined by the Secretary).                      |   |             |
|                                                      |   | P.L.102-573 |
| \(c\) Scholarship grants made under this section may |   |             |
| cover costs of tuition, books, transportation,       |   | P.L.102-573 |
| board, and other necessary related ~~expenses.~~     |   |             |
| expenses of a grantee while attending school ~~full  |   | P.L.102-573 |
| time~~.                                              |   |             |
|                                                      |   | P.L.102-573 |
| ~~(d) There are authorized to be appropriated for    |   |             |
| the purpose of this section \$800,000 for fiscal     |   | P.L.102-573 |
| year 1978, \$1,000,000 for fiscal year 1979, and     |   |             |
| \$1,300,000 for fiscal year 1980. For fiscal years   |   | P.L.102-573 |
| 1981, 1982, 1983, and 1984 there are authorized to   |   |             |
| be appropriated for the purpose of t his section     |   | P.L.102-573 |
| such sums as may be specifically authorized by an    |   |             |
| Act enacted after this Act.~~                        |   | P.L.102-573 |
|                                                      |   |             |
| ~~(d) There are authorized to be appropriated to     |   | P.L.102-573 |
| carry out this section \$3,510,000 for the fiscal    |   |             |
| year ending September 30, 1981, \$4,000,000 for      |   | P.L.102-573 |
| fiscal year ending September 30, 1982, \$4,620,000   |   |             |
| for the fiscal year ending September 30, 1983, and   |   | P.L.102-573 |
| \$5,300,000 for the fiscal year ending September 30, |   |             |
| 1984~~.                                              |   | P.L.102-573 |
|                                                      |   |             |
| \(d\) The Secretary shall not deny scholarship       |   | P.L.102-573 |
| assistance to an eligible applicant under this       |   |             |
| section solely on the basis of the applicant\'s      |   | P.L.102-573 |
| scholastic achievement if such applicant has been    |   |             |
| admitted to, or maintained good standing at, an      |   | P.L.102-573 |
| accredited institution.                              |   |             |
|                                                      |   | P.L.102-573 |
| ~~(e) There are authorized to be appropriated for    |   |             |
| the purpose of carrying out the provisions of this   |   | P.L.102-573 |
| section\--~~                                         |   |             |
|                                                      |   | P.L.102-573 |
| > ~~(1) \$3,000,000 for fiscal year 1989,~~          |   |             |
| >                                                    |   | P.L.102-573 |
| > ~~(2) \$3,700,000 for fiscal year 1990,~~          |   |             |
| >                                                    |   | P.L.102-573 |
| > ~~(3) \$4,400,000 for fiscal year 1991, and~~      |   |             |
| >                                                    |   | P.L.102-573 |
| > ~~(4) \$5,100,000 for fiscal year 1992.~~          |   |             |
|                                                      |   | P.L.102-573 |
| \(e\) The Secretary shall not deny scholarship       |   |             |
| assistance to an eligible applicant under this       |   | P.L.100-713 |
| section solely by reason of such applicant\'s        |   |             |
| eligibility for assistance or benefits under any     |   | P.L.102-573 |
| other Federal program.                               |   |             |
|                                                      |   | P.L.102-573 |
| ~~HEALTH PROFESSIONS SCHOLARSHIP PROGRAM~~           |   |             |
|                                                      |   | P.L.102-573 |
| ~~SEC. 104. Section 225(j) of the Public Health      |   |             |
| Service Act (42 U.S.C. 234(I)) is amended (1) by     |   | P.L.100-713 |
| inserting \"(1) after \"(I)\", and (2) by adding at  |   |             |
| the end the following:~~                             |   | P.L.102-573 |
|                                                      |   |             |
| > ~~(2)(A)In addition to the sums authorized to be   |   | P.L.100-713 |
| > appropriated under paragraph (1) to carry out the  |   |             |
| > Program, there are authorized to be appropriated   |   | P.L.102-573 |
| > for the fiscal year ending September 30, 1978,     |   |             |
| > \$5,450,000; for the fiscal year ending September  |   | P.L.102-573 |
| > 30, 1979, \$6,300,000; for the fiscal year ending  |   |             |
| > September 30, 1980, \$7,200,000; and for fiscal    |   | P.L.100-713 |
| > years 1981, 1982, 1983, and 1984 such sums as may  |   |             |
| > be specifically authorized by an act enacted after |   | P.L.102-573 |
| > the Indian Health Care Improvement Act, to provide |   |             |
| > scholarships under the Program to provide          |   | P.L.102-573 |
| > physicians, osteopaths,                            |   |             |
| > dentists,veterinarians,nurses, optometrists,       |   | P.L.102-573 |
| > podiatrists, pharmacists, public health personnel, |   |             |
| > and allied health professionals to provide         |   | P.L.102-573 |
| > services to Indians. Such scholarships shall be    |   |             |
| > designated Indian Health Scholarships and shall be |   | P.L.102-573 |
| > made in accordance with this section except as     |   |             |
| > provided in subparagraph (B)~~.                    |   | P.L.102-573 |
| >                                                    |   |             |
| > ~~(B)(I) The Secretary, acting through the Indian  |   | P.L.102-573 |
| > Health Service, shall determine the individuals    |   |             |
| > who receive the Indian Health Scholarships, shall  |   | P.L.100-713 |
| > accord priority to applicants who are Indians, and |   |             |
| > shall determine the distribution of the            |   | P.L.102-573 |
| > scholarships on the basis of the relative need of  |   |             |
| > Indians for additional service in specific health  |   | P.L.102-573 |
| > professions.~~                                     |   |             |
| >                                                    |   | P.L.100-713 |
| > ~~(ii)The active duty service obligation           |   |             |
| > prescribed by subsection (e) shall be met by the   |   | P.L.102-573 |
| > recipient of an Indian Health Scholarship by       |   |             |
| > service in the Indian Health Service, in a program |   | P.L.102-573 |
| > assisted under title V of the Indian Health Care   |   |             |
| > Improvement act, or in the private practice of his |   | P.L.100-713 |
| > profession if, as determined by the Secretary in   |   |             |
| > accordance with guidelines promulgated by him such |   | P.L.102-573 |
| > practice is situated in a physician or other       |   |             |
| > health professional shortage area and addresses    |   | P.L.100-713 |
| > the health care needs of a substantial number of   |   |             |
| > Indians~~.                                         |   | P.L.102-573 |
| >                                                    |   |             |
| > ~~(c) For purposes of this paragraph, the term     |   | P.L.102-573 |
| > \"Indians\" has the same meaning that the term by  |   |             |
| > subsection (c) of section 4 of the Indian Health   |   | P.L.100-713 |
| > Care Improvement Act and includes individuals      |   |             |
| > described in clauses (1) through (4) of that       |   | P.L.102-573 |
| > subsection~~.                                      |   |             |
|                                                      |   | P.L.102-573 |
| INDIAN HEALTH PROFESSIONS SCHOLARSHIP                |   |             |
|                                                      |   | P.L.102-573 |
| SEC. 104. (a) In order to provide health             |   |             |
| professionals to ~~Indian communities~~ Indians,     |   | P.L.102-573 |
| Indian tribes, tribal organizations, and urban       |   |             |
| Indian organizations, the Secretary, acting through  |   | P.L.102-573 |
| the Service and in accordance with this section,     |   |             |
| shall make scholarship grants to Indians who are     |   | P.L.102-573 |
| enrolled ~~full time~~ full or part time in          |   |             |
| appropriately accredited schools ~~of medicine,      |   | P.L.102-573 |
| osteopathy, podiatry, psychology, dentistry,         |   |             |
| environmental health and engineering, nursing,       |   | P.L.102-573 |
| optometry, public health, allied health professions, |   |             |
| and social work~~ and pursuing courses of study in   |   | P.L.102-573 |
| the health professions. Such scholarships shall be   |   |             |
| designated Indian Health Scholarships and shall be   |   | P.L.102-573 |
| made in accordance with section 338A of the Public   |   |             |
| Health Service Act (42 U.S.C. 2541), except as       |   | P.L.102-573 |
| provided in subsection (b) of this section.          |   |             |
|                                                      |   | P.L.102-573 |
| (b)(1) The Secretary, acting through the Service,    |   |             |
| shall determine who shall receive scholarships under |   | P.L.102-573 |
| subsection (a) and shall determine the distribution  |   |             |
| of such scholarships among such health professions   |   | P.L.102-573 |
| on the basis of the relative needs of Indians for    |   |             |
| additional service in such health professions.       |   | P.L.102-573 |
|                                                      |   |             |
| \(2\) An individual shall be eligible for a          |   |             |
| scholarship under subsection (a) in any year in      |   |             |
| which such individual is enrolled ~~full time~~ full |   |             |
| or part time in a ~~health profession school~~       |   |             |
| course of study referred to in subsection (a).       |   |             |
|                                                      |   |             |
| \(3\) ~~(A) The active duty service obligation       |   |             |
| prescribed under section 338C of the Public Health   |   |             |
| Service Act (42 U.S.C. 254m) shall be met by a       |   |             |
| recipient of an Indian Health Scholarship by         |   |             |
| service\--~~                                         |   |             |
|                                                      |   |             |
| \(3\) **[(A) The active duty service obligation      |   |             |
| under a written contract with the secretary under    |   |             |
| section 338A of the Public Health Service Act (42    |   |             |
| U.S.C.254*l*) that an individual has entered into    |   |             |
| under that section shall,if that individual is a     |   |             |
| recipient of an Indian Health Scholarship, be met in |   |             |
| full-time practice, by service\--;]{.underline}**    |   |             |
|                                                      |   |             |
| > ~~(A)~~ (i) in the Indian Health Service;          |   |             |
| >                                                    |   |             |
| > ~~(B)~~ (ii) in a program conducted under a        |   |             |
| > contract entered into under the Indian             |   |             |
| > Self-Determination Act.;                           |   |             |
| >                                                    |   |             |
| > ~~(C)~~ (iii) in a program assisted under title V  |   |             |
| > of this Act; ~~or~~                                |   |             |
| >                                                    |   |             |
| > ~~(D)~~ (iv) in the private practice of the        |   |             |
| > applicable profession if, as determined by the     |   |             |
| > Secretary, such practice is situated in a          |   |             |
| > physician or other health professional shortage    |   |             |
| > area and addresses the health care needs of a      |   |             |
| > substantial number of Indians,                     |   |             |
| > **[OR]{.underline}**                               |   |             |
|                                                      |   |             |
| **[(B) At the request of any individual who has      |   |             |
| entered into a contract referred to in subparagraph  |   |             |
| (A) and who receives a degree in medicine (including |   |             |
| osteopathic or allopathic medicine), dentistry,      |   |             |
| optometry, podiatry, or pharmacy, the Secretary      |   |             |
| shall defer the active duty service obligation of    |   |             |
| that individual under that contract, in order that   |   |             |
| such individual may complete any internship,         |   |             |
| residency, or other advanced clinical training that  |   |             |
| is required for the practice of that health          |   |             |
| profession, for any appropriate period (in years, as |   |             |
| determined by the Secretary), subject to the         |   |             |
| following conditions:]{.underline}**                 |   |             |
|                                                      |   |             |
| **[(i)No period of internship, residency, or other   |   |             |
| advanced clinical training shall be counted as       |   |             |
| satisfying any period of obligated service that is   |   |             |
| required under this section.]{.underline}**          |   |             |
|                                                      |   |             |
| **[(ii)The active duty service obligation of that    |   |             |
| individual shall commence not later that 90 days     |   |             |
| after the completion of that advanced clinical       |   |             |
| training (or by a date specified by the              |   |             |
| Secretary).]{.underline}**                           |   |             |
|                                                      |   |             |
| **[(iii)The active duty service obligation will be   |   |             |
| served in the health profession of that individual,  |   |             |
| in a manner consistent with clauses (i) through (v)  |   |             |
| of subparagraph (A).;]{.underline}**                 |   |             |
|                                                      |   |             |
| ~~(B)~~**[(C)]{.underline}** A recipient of an       |   |             |
| Indian Health Scholarship may, at the election of    |   |             |
| the recipient**,** meet the active duty service      |   |             |
| obligation ~~prescribed under section 338C of the    |   |             |
| Public Health Service Act (42 U.S.C. 254m) by        |   |             |
| service in a program specified in subparagraph (A)   |   |             |
| that~~‑‑**[described in subparagraph by service in a |   |             |
| program specified in that                            |   |             |
| subparagraph.]{.underline}**                         |   |             |
|                                                      |   |             |
| > \(i\) is located on the reservation of the tribe   |   |             |
| > in which the recipient is enrolled; or             |   |             |
| >                                                    |   |             |
| > \(ii\) serves the tribe in which the recipient is  |   |             |
| > enrolled.                                          |   |             |
|                                                      |   |             |
| ~~(C)~~**[(D)]{.underline}** Subject to subparagraph |   |             |
| ~~(B)~~**[(C),]{.underline}** the Secretary, in      |   |             |
| making assignments of Indian Health Scholarship      |   |             |
| recipients required to meet the active duty service  |   |             |
| obligation ~~prescribed under section~~ ~~338C of    |   |             |
| the Public Health Service Act (42 U.S.C.~~           |   |             |
| ~~254m)~~,**[described in subparagraph               |   |             |
| (A)]{.underline}**, shall give priority to assigning |   |             |
| individuals to service in those programs specified   |   |             |
| in subparagraph (A) that have a need for health      |   |             |
| professionals to provide health care services as a   |   |             |
| result of individuals having breached contracts      |   |             |
| entered into under this section.                     |   |             |
|                                                      |   |             |
| \(4\) In the case of an individual receiving a       |   |             |
| scholarship under this section who is enrolled part  |   |             |
| time in an approved course of study‑‑                |   |             |
|                                                      |   |             |
| > \(A\) such scholarship shall be for a period of    |   |             |
| > years not to exceed the part‑time equivalent of 4  |   |             |
| > years, as determined by the Secretary;             |   |             |
| >                                                    |   |             |
| > \(B\) the period of obligated service ~~specified  |   |             |
| > in section 338A(f)(1)(B)(iv) of the Public Health  |   |             |
| > Service Act (42 U.S.C.~~ ~~254m(f)(1)(B)(iv))~~    |   |             |
| > **[described in]{.underline}** **[paragraph (3)    |   |             |
| > (A),]{.underline}** shall be equal to the greater  |   |             |
| > of‑‑                                               |   |             |
| >                                                    |   |             |
| > \(i\) the part‑time equivalent of one year for     |   |             |
| > each year for which the individual was provided a  |   |             |
| > scholarship (as determined by the Secretary); or   |   |             |
| >                                                    |   |             |
| > \(ii\) two years; and                              |   |             |
| >                                                    |   |             |
| > \(C\) the amount of the monthly stipend specified  |   |             |
| > in section 338A(g)(1)(B) of the Public Health      |   |             |
| > Service Act ~~(42~~                                |   |             |
| > ~~U.S.C.254m(g)(1)(B))~~**[(42U.S.C.               |   |             |
| > 2541(g)(1)(B))]{.underline}** shall be reduced pro |   |             |
| > rata (as determined by the Secretary) based on the |   |             |
| > number of hours such student is enrolled.          |   |             |
|                                                      |   |             |
| (5)(A) An individual who has, on or after the date   |   |             |
| of the enactment of this paragraph, entered into a   |   |             |
| written contract with the Secretary under this       |   |             |
| section and who‑‑                                    |   |             |
|                                                      |   |             |
| > \(i\) fails to maintain an acceptable level of     |   |             |
| > academic standing in the educational institution   |   |             |
| > in which he is enrolled (such level determined by  |   |             |
| > the educational institution under regulations of   |   |             |
| > the Secretary),                                    |   |             |
| >                                                    |   |             |
| > \(ii\) is dismissed from such educational          |   |             |
| > institution for disciplinary reasons,              |   |             |
| >                                                    |   |             |
| > \(iii\) voluntarily terminates the training in     |   |             |
| > such an educational institution for which he is    |   |             |
| > provided a scholarship under such contract before  |   |             |
| > the completion of such training, or                |   |             |
| >                                                    |   |             |
| > \(iv\) fails to accept payment, or instructs the   |   |             |
| > educational institution in which he is enrolled    |   |             |
| > not to accept payment, in whole or in part, of a   |   |             |
| > scholarship under such contract, in lieu of any    |   |             |
| > service obligation arising under such contract,    |   |             |
| > shall be liable to the United States for the       |   |             |
| > amount which has been paid to him, or on his       |   |             |
| > behalf, under the contract.                        |   |             |
| >                                                    |   |             |
| > \(B\) If for any reason not specified in           |   |             |
| > subparagraph (A) an individual breaches his        |   |             |
| > written contract by failing either to begin such   |   |             |
| > individual\'s service obligation under this        |   |             |
| > section or to complete such service obligation,    |   |             |
| > the United States shall be entitled to recover     |   |             |
| > from the individual an amount determined in        |   |             |
| > accordance with the formula specified in           |   |             |
| > subsection (l) of section 108 in the manner        |   |             |
| > provided for in such subsection.                   |   |             |
|                                                      |   |             |
| ~~(c) For purposes of this section, the term         |   |             |
| \"Indian\" has the same meaning given that term by   |   |             |
| subsection (c) of section 4 of this Act, including   |   |             |
| all individuals described in clauses (a) through (4) |   |             |
| of that subsection.~~                                |   |             |
|                                                      |   |             |
| **[(C)Upon the death of an individual who receives   |   |             |
| an Indian Health Scholarship, any obligation of that |   |             |
| individual for service or payment that relates to    |   |             |
| that scholarship shall be canceled]{.underline}**    |   |             |
|                                                      |   |             |
| **[(D)The secretary shall provide for the partial or |   |             |
| total waiver or suspension of any obligation of      |   |             |
| service or payment of a recipient of an Indian       |   |             |
| Health Scholarship if the Secretary determines       |   |             |
| that\--]{.underline}**                               |   |             |
|                                                      |   |             |
| **[(i)it is not possible for the recipient to meet   |   |             |
| that obligation or make that payment;]{.underline}** |   |             |
|                                                      |   |             |
| **[(ii)requiring that recipient to meet that         |   |             |
| obligation or make that payment would result in      |   |             |
| extreme hardship to the recipient; or]{.underline}** |   |             |
|                                                      |   |             |
| **[(iii)the enforcement of the requirement to meet   |   |             |
| the obligation or make the payment would be          |   |             |
| unconscionable.]{.underline}**                       |   |             |
|                                                      |   |             |
| **[(E)Notwithstanding any other provision of law, in |   |             |
| any case of extreme hardship or for other good cause |   |             |
| shown, the Secretary may waive, in whole or in part, |   |             |
| the right of the United States to recover funds made |   |             |
| available under this section.]{.underline}**         |   |             |
|                                                      |   |             |
| **[(F)Notwithstanding any other provision of law,    |   |             |
| with respect to a recipient of an Indian Health      |   |             |
| Scholarship, no obligation for payment may b         |   |             |
| released by a discharge in bankruptcy under title    |   |             |
| 11, United States Code, unless that discharge is     |   |             |
| granted after the expiration of the 5-year period    |   |             |
| beginning on the initial date on which that payment  |   |             |
| is due, and only if the bankruptcy court finds that  |   |             |
| the nondischarge of the obligation would be          |   |             |
| unconscionable.]{.underline}**                       |   |             |
|                                                      |   |             |
| \(c\) The Secretary shall, acting through the        |   |             |
| Service, establish a Placement Office to develop and |   |             |
| implement a national policy for the placement, to    |   |             |
| available vacancies within the Service, of Indian    |   |             |
| Health Scholarship recipients required to meet the   |   |             |
| active duty service obligation prescribed under      |   |             |
| section 338C of the Public Health Service Act (42    |   |             |
| U.S.C. 254m) without regard to any competitive       |   |             |
| personnel system, agency personnel limitation, or    |   |             |
| Indian preference policy.                            |   |             |
|                                                      |   |             |
| ~~(d) There are authorized to be appropriated for    |   |             |
| the purpose of carrying out the provisions of this   |   |             |
| section\--~~                                         |   |             |
|                                                      |   |             |
| > ~~(1) \$5,100,000 for fiscal year 1989,~~          |   |             |
| >                                                    |   |             |
| > ~~(2) \$6,000,000 for fiscal year 1990,~~          |   |             |
| >                                                    |   |             |
| > ~~(3) \$7,100,000 for fiscal year 1991, and~~      |   |             |
| >                                                    |   |             |
| > ~~(4) \$8,234,000 for fiscal year 1992.~~          |   |             |
|                                                      |   |             |
| \[Note: Sec. 102(d) of P.L. 102-573 reads:           |   |             |
| \"EFFECTIVE DATE.‑‑The amendments made by subsection |   |             |
| (c)(1)(C) \[Sec 104(a) of P.L. 94-437 above\] and    |   |             |
| subsection (c)(2)(B) \[Sec 104(b)(3) of P.L. 94-437  |   |             |
| above\] shall apply with respect to scholarships     |   |             |
| granted under section 104 of the Indian Health Care  |   |             |
| Improvement Act after the date of the enactment of   |   |             |
| this Act \[October 29, 1992\]\".\]                   |   |             |
|                                                      |   |             |
| > **\[NOTE: Section 104 of P.L. 100-713 contained a  |   |             |
| > free-standing provision relevant to section 104 of |   |             |
| > the Indian Health Care Improvement Act. For easy   |   |             |
| > reference, this language has been provided         |   |             |
| > below.\]**                                         |   |             |
| >                                                    |   |             |
| > **{(b)(1) Section 338I of the Public Health        |   |             |
| > Service Act (42 U.S.C. 254r) is repealed.**        |   |             |
| >                                                    |   |             |
| > **{(2) Scholarships that have been provided under  |   |             |
| > section 338I of the Public Health Service Act (42  |   |             |
| > U.S.C. 254r) on or before the date of enactment of |   |             |
| > this Act\--\[November 23, 1988\]**                 |   |             |
| >                                                    |   |             |
| > **(A) shall continue to be provided under the      |   |             |
| > provisions of such section that were in effect on  |   |             |
| > the day before the date of enactment of this       |   |             |
| > Act,**                                             |   |             |
| >                                                    |   |             |
| > **(B) shall be subject to the same terms and       |   |             |
| > conditions to which such scholarships were subject |   |             |
| > on the day before the date of enactment of this    |   |             |
| > Act, and**                                         |   |             |
| >                                                    |   |             |
| > **(C) shall be funded from funds appropriated to   |   |             |
| > carry out section 104 of the Indian Health Care    |   |             |
| > Improvement Act, as amended by this Act.}**        |   |             |
|                                                      |   |             |
| INDIAN HEALTH SERVICE EXTERN PROGRAMS                |   |             |
|                                                      |   |             |
| SEC. 105. (a) Any individual who receives a          |   |             |
| scholarship grant pursuant to section 104 shall be   |   |             |
| entitled to employment in the Service during any     |   |             |
| nonacademic period of the year. Periods of           |   |             |
| employment pursuant to this subsection shall not be  |   |             |
| counted in determining fulfillment of the service    |   |             |
| obligation incurred as a condition of the            |   |             |
| scholarship grant.                                   |   |             |
|                                                      |   |             |
| \(b\) Any individual enrolled in a ~~school of       |   |             |
| medicine, osteopathy, dentistry, veterinary          |   |             |
| medicine, optometry, podiatry, pharmacy, public      |   |             |
| health, nursing, or allied health professions~~      |   |             |
| course of study may be employed by the Service       |   |             |
| during any nonacademic period of the year. Any such  |   |             |
| employment shall not exceed one hundred and twenty   |   |             |
| days during any calendar year.                       |   |             |
|                                                      |   |             |
| \(c\) Any employment pursuant to this section shall  |   |             |
| be made without regard to any competitive personnel  |   |             |
| system or agency personnel limitation and to a       |   |             |
| position which will enable the individual so         |   |             |
| employed to receive practical experience in the      |   |             |
| health profession in which he or she is engaged in   |   |             |
| study. Any individual so employed shall receive      |   |             |
| payment for his or her services comparable to the    |   |             |
| salary he or she would receive if he or she were     |   |             |
| employed in the competitive system. Any individual   |   |             |
| so employed shall not be countered against any       |   |             |
| employment ceiling affecting the Service or the      |   |             |
| ~~Department of Health, Education, and Welfare~~     |   |             |
| Department of Health and Human Services.             |   |             |
|                                                      |   |             |
| ~~(d) There are authorized to be appropriated for    |   |             |
| the purpose of this section, \$600,000 for fiscal    |   |             |
| year 1978; \$800,000 for fiscal year 1979, and       |   |             |
| \$1,000,000 for fiscal year 1980. For fiscal years   |   |             |
| 1981, 1982, 1983 and 1984, here are authorized to be |   |             |
| appropriated for the purpose of this section such    |   |             |
| sums as may be specifically authorized by an Act     |   |             |
| enacted after this section.~~                        |   |             |
|                                                      |   |             |
| ~~(d) there are authorized to be appropriated to     |   |             |
| carry out this section \$990,000 for the fiscal year |   |             |
| ending September 30, 1981; \$1,140,00 for the fiscal |   |             |
| year ending September 30, 1982; \$1,310,000 for the  |   |             |
| fiscal year ending September 30, 1983; and           |   |             |
| \$1,510,000 for the fiscal year ending September 30, |   |             |
| 1984.~~                                              |   |             |
|                                                      |   |             |
| ~~(d) There are authorized to be appropriated for    |   |             |
| the purpose of carrying out the provisions of this   |   |             |
| section\--~~                                         |   |             |
|                                                      |   |             |
| > ~~(1) \$300,000 for fiscal year 1989,~~            |   |             |
| >                                                    |   |             |
| > ~~(2) \$350,000 for fiscal year 1990,~~            |   |             |
| >                                                    |   |             |
| > ~~(3) \$400,000 for fiscal year 1991, and~~        |   |             |
| >                                                    |   |             |
| > ~~(4) \$450,000 for fiscal year 1992.~~            |   |             |
|                                                      |   |             |
| CONTINUING EDUCATION ALLOWANCES                      |   |             |
|                                                      |   |             |
| SEC. 106. (a) In order to encourage physicians,      |   |             |
| dentists, nurses, and other health professionals to  |   |             |
| join or continue in the Service and to provide their |   |             |
| services in the rural and remote areas where a       |   |             |
| significant portion of the Indian people reside, the |   |             |
| Secretary, acting through the Service, may provide   |   |             |
| allowances to health professionals employed in the   |   |             |
| Service to enable them for a period of time each     |   |             |
| year prescribed by regulation of the Secretary to    |   |             |
| take leave of their duty stations for professional   |   |             |
| consultation and refresher training courses.         |   |             |
|                                                      |   |             |
| ~~(b) There are authorized to be appropriated for    |   |             |
| the purpose of this section: \$100,000 for fiscal    |   |             |
| year 1978, \$200,000 for fiscal year 1979, and       |   |             |
| \$250,000 for fiscal year 1980. For fiscal years     |   |             |
| 1981, 1982, and 1983, and 1984 there are authorized  |   |             |
| to be appropriated for the purpose of this section   |   |             |
| such sums as may be specifically authorized by an    |   |             |
| Act enacted after this Act~~.                        |   |             |
|                                                      |   |             |
| ~~(b) There are authorized to be appropriated for    |   |             |
| the purpose of carrying out the provisions of this   |   |             |
| section\--~~                                         |   |             |
|                                                      |   |             |
| > ~~(1) \$500,000 for fiscal year 1989,~~            |   |             |
| >                                                    |   |             |
| > ~~(2) \$526,300 for fiscal year 1990,~~            |   |             |
| >                                                    |   |             |
| > ~~(3) \$553,800 for fiscal years 1991, and~~       |   |             |
| >                                                    |   |             |
| > ~~(4) \$582,500 for fiscal year 1992.~~            |   |             |
|                                                      |   |             |
| \(b\) Of amounts appropriated under the authority of |   |             |
| this title for each fiscal year to be used to carry  |   |             |
| out this section, not more than \$1,000,000 may be   |   |             |
| used to establish postdoctoral training programs for |   |             |
| health professionals.                                |   |             |
|                                                      |   |             |
| COMMUNITY HEALTH REPRESENTATIVE PROGRAM              |   |             |
|                                                      |   |             |
| SEC. 107. (a) Under the authority of the Act of      |   |             |
| November 2, 1921 (25 U.S.C. 13), popularly known as  |   |             |
| the Snyder Act, the Secretary shall maintain a       |   |             |
| Community Health Representative Program under which  |   |             |
| the Service\--                                       |   |             |
|                                                      |   |             |
| > \(1\) provides for the training of Indians as      |   |             |
| > health paraprofessionals, and                      |   |             |
| >                                                    |   |             |
| > \(2\) uses such paraprofessionals in the provision |   |             |
| > of health care, health promotion, and disease      |   |             |
| > prevention services to Indian communities.         |   |             |
|                                                      |   |             |
| \(b\) The Secretary, acting through the Community    |   |             |
| Health Representative Program of the Service,        |   |             |
| shall\--                                             |   |             |
|                                                      |   |             |
| > \(1\) provide a high standard of training for      |   |             |
| > paraprofessionals to Community Health              |   |             |
| > Representatives to ensure that the Community       |   |             |
| > Health Representatives provide quality health      |   |             |
| > care, health promotion, and disease prevention     |   |             |
| > services to the Indian communities, served by such |   |             |
| > Program.                                           |   |             |
| >                                                    |   |             |
| > \(2\) in order to provide such training, develop   |   |             |
| > and maintain a curriculum that\--                  |   |             |
| >                                                    |   |             |
| > \(A\) combines education in the theory of health   |   |             |
| > care with supervised practical experience in the   |   |             |
| > provision of health care, and                      |   |             |
| >                                                    |   |             |
| > \(B\) provides instruction and practical           |   |             |
| > experience in health promotion and disease         |   |             |
| > prevention activities with appropriate             |   |             |
| > consideration given to lifestyle factors that have |   |             |
| > an impact on Indian health status, such as         |   |             |
| > alcoholism, family dysfunction, and poverty.       |   |             |
| >                                                    |   |             |
| > \(3\) ~~develop~~ maintain a system which          |   |             |
| > identifies the needs of Community Health           |   |             |
| > Representatives for continuing education in health |   |             |
| > care, health promotion, and disease prevention and |   |             |
| > develop programs that meet the needs for           |   |             |
| > continuing education,                              |   |             |
| >                                                    |   |             |
| > \(4\) ~~develop and~~ maintain a system that       |   |             |
| > provides close supervision of Community Health     |   |             |
| > Representatives,                                   |   |             |
| >                                                    |   |             |
| > \(5\) ~~develop~~ maintain a system under which    |   |             |
| > the work of the Community Health Representatives   |   |             |
| > is reviewed and evaluated, and                     |   |             |
| >                                                    |   |             |
| > \(6\) promote traditional health care practices of |   |             |
| > the Indian tribes served consistent with the       |   |             |
| > Service standards for the provision of health      |   |             |
| > care, health promotion, and disease prevention.    |   |             |
|                                                      |   |             |
| INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM         |   |             |
|                                                      |   |             |
| SEC. 108. (a)(1) the Secretary, acting through the   |   |             |
| Service, shall establish a program to be known as    |   |             |
| the Indian Health Service Loan Repayment Program     |   |             |
| (hereinafter referred to as the \"Loan Repayment     |   |             |
| Program\") in order to assure an adequate supply of  |   |             |
| trained ~~physicians, dentists, nurses, nurse        |   |             |
| practitioners, physician assistants, clinical and    |   |             |
| counseling psychologists, graduates of schools of    |   |             |
| public health, graduates of schools of social work,  |   |             |
| and other health professionals~~ health              |   |             |
| professionals necessary to maintain accreditation    |   |             |
| of, and provide health care services to Indians      |   |             |
| through, Indian health programs.                     |   |             |
|                                                      |   |             |
| \(2\) For the purposes of this section\--            |   |             |
|                                                      |   |             |
| > \(A\) the term \"Indian health program\" means any |   |             |
| > health program or facility funded, in whole or     |   |             |
| > part, by the Service for the benefit of Indians    |   |             |
| > and administered\--                                |   |             |
| >                                                    |   |             |
| > \(i\) directly by the Service;                     |   |             |
| >                                                    |   |             |
| > \(ii\) by any Indian tribe or tribal or Indian     |   |             |
| > organization pursuant to a contract under\--       |   |             |
| >                                                    |   |             |
| > \(I\) The Indian Self-Determination Act, or        |   |             |
| >                                                    |   |             |
| > \(II\) section 23 of the Act of April 30, 1908 (25 |   |             |
| > U.S.C. 47), popularly known as the \"Buy 2Indian\" |   |             |
| > Act; or                                            |   |             |
| >                                                    |   |             |
| > \(iii\) by an urban Indian organization pursuant   |   |             |
| > to title V of this Act; and                        |   |             |
| >                                                    |   |             |
| > \(B\) the term \"State\" has the same meaning      |   |             |
| > given such term in section 331(i)(4) of the Public |   |             |
| > Health Service Act.                                |   |             |
|                                                      |   |             |
| \(b\) To be eligible to participate in the Loan      |   |             |
| Repayment Program, an individual must\--             |   |             |
|                                                      |   |             |
| > (1)(A) be enrolled\--                              |   |             |
| >                                                    |   |             |
| > ~~(i) as a full-time student in the final year of  |   |             |
| > a course of study or program in an accredited      |   |             |
| > institution, as determined by the Secretary,       |   |             |
| > within any state; or~~                             |   |             |
| >                                                    |   |             |
| > (i)in a course of study or program in an           |   |             |
| > accredited institution, as determined by the       |   |             |
| > Secretary, within any State and be scheduled to    |   |             |
| > complete such course of study in the same year     |   |             |
| > such individual applies to participate in such     |   |             |
| > program; or                                        |   |             |
| >                                                    |   |             |
| > (ii)in an approved graduate training program in    |   |             |
| > ~~medicine, osteopathy, dentistry, or other health |   |             |
| > profession;~~ a health profession or               |   |             |
| >                                                    |   |             |
| > \(B\) have\--                                      |   |             |
| >                                                    |   |             |
| > \(i\) a degree in ~~medicine, osteopathy,          |   |             |
| > dentistry, or other health profession~~ a health   |   |             |
| > profession; and                                    |   |             |
| >                                                    |   |             |
| > ~~(ii) completed an approved graduate training     |   |             |
| > program in medicine, osteopathy, dentistry, or     |   |             |
| > other health profession in a State, except that    |   |             |
| > the Secretary may waive the completion requirement |   |             |
| > of this clause for good cause; and~~               |   |             |
| >                                                    |   |             |
| > ~~(iii)~~ (ii) a license to practice ~~medicine,   |   |             |
| > osteopathy, dentistry, or other health profession  |   |             |
| > in a State~~ a health profession;                  |   |             |
| >                                                    |   |             |
| > (2)(A) be eligible for, or hold, an appointment as |   |             |
| > a commissioned officer in the Regular or Reserve   |   |             |
| > Corps of the Public Health Service;                |   |             |
| >                                                    |   |             |
| > \(B\) be eligible for selection for civilian       |   |             |
| > service in the Regular or Reserve Corps of the     |   |             |
| > Public Health Service;                             |   |             |
| >                                                    |   |             |
| > \(C\) meet the professional standards for civil    |   |             |
| > service employment in the Indian Health Service;   |   |             |
| > or                                                 |   |             |
| >                                                    |   |             |
| > \(D\) be employed in an Indian Health program      |   |             |
| > without service obligation and;                    |   |             |
| >                                                    |   |             |
| > ~~(3)submit an application to participate in the   |   |             |
| > Loan Repayment Program; and~~                      |   |             |
| >                                                    |   |             |
| > (3)submit to the Secretary an appplication for a   |   |             |
| > contract described in subsection (f).              |   |             |
| >                                                    |   |             |
| > ~~(4) sign and submit to the Secretary, at the     |   |             |
| > time of submission of such application, a written  |   |             |
| > contract (described in subsection (f) to accept    |   |             |
| > repayment of education loans and to serve (in      |   |             |
| > accordance with this section) for the applicable   |   |             |
| > period of obligated service in an Indian health    |   |             |
| > program.~~                                         |   |             |
|                                                      |   |             |
| (c)(1) In disseminating application forms and        |   |             |
| contract forms to individuals desiring to            |   |             |
| participate in the Loan Repayment Program, the       |   |             |
| Secretary shall include with such forms a fair       |   |             |
| summary of the rights and liabilities of an          |   |             |
| individual whose application is approved (and whose  |   |             |
| contract is accepted) by the Secretary, including in |   |             |
| the summary a clear explanation of the damages to    |   |             |
| which the United States is entitled under subsection |   |             |
| (l) in the case of the individual\'s breach of       |   |             |
| contract. The Secretary shall provide such           |   |             |
| individuals with sufficient information regarding    |   |             |
| the advantages and disadvantages of service as a     |   |             |
| commissioned officer in the Regular or Reserve Corps |   |             |
| of the Public Health Service or a civilian employee  |   |             |
| of the Indian Health Service to enable the           |   |             |
| individual to make a decision on an informed basis.  |   |             |
|                                                      |   |             |
| \(2\) The application form, contract form, and all   |   |             |
| other information furnished by the Secretary under   |   |             |
| this section shall be written in a manner calculated |   |             |
| to be understood by the average individual applying  |   |             |
| to participate in the Loan Repayment Program.        |   |             |
|                                                      |   |             |
| \(3\) The Secretary shall make such application      |   |             |
| forms, contract forms, and other information         |   |             |
| available to individuals desiring to participate in  |   |             |
| the Loan Repayment Program on a date sufficiently    |   |             |
| early to ensure that such individuals have adequate  |   |             |
| time to carefully review and evaluate such forms and |   |             |
| information.                                         |   |             |
|                                                      |   |             |
| (d)(1) ~~The~~ Consistent with paragraph (3), the    |   |             |
| Secretary, acting through the Service and in         |   |             |
| accordance with subsection (k), shall annually\--    |   |             |
|                                                      |   |             |
| > \(A\) identify the positions in each ~~Indian      |   |             |
| > Health program~~ Indian health and program for     |   |             |
| > which there is a need or a vacancy, and            |   |             |
| >                                                    |   |             |
| > \(B\) rank those positions in order of priority.   |   |             |
|                                                      |   |             |
| \(2\) Consistent with the priority determined under  |   |             |
| paragraph (1), the Secretary, in determining which   |   |             |
| applications under the Loan Repayment Program to     |   |             |
| approve (and which contracts to accept), shall give  |   |             |
| priority to applications made by\--                  |   |             |
|                                                      |   |             |
| > \(A\) Indians; and                                 |   |             |
| >                                                    |   |             |
| > \(B\) individuals recruited through the efforts of |   |             |
| > Indian tribes or tribal or Indian organizations.   |   |             |
|                                                      |   |             |
| (3)(A) Subject to subparagraph (B), of the total     |   |             |
| amounts appropriated for each of the fiscal years    |   |             |
| 1993, 1994, and 1995 for loan repayment contracts    |   |             |
| under this section, the Secretary shall provide      |   |             |
| that‑‑                                               |   |             |
|                                                      |   |             |
| > \(i\) not less than 25 percent be provided to      |   |             |
| > applicants who are nurses, nurse practitioners, or |   |             |
| > nurse midwives; and                                |   |             |
| >                                                    |   |             |
| > \(ii\) not less than 10 percent be provided to     |   |             |
| > applicants who are mental health professionals     |   |             |
| > (other than applicants described in clause (i)).   |   |             |
|                                                      |   |             |
| \(B\) The requirements specified in clause (i) or    |   |             |
| clause (ii) of subparagraph (A) shall not apply if   |   |             |
| the Secretary does not receive the number of         |   |             |
| applications from the individuals described in       |   |             |
| clause (i) or clause (ii), respectively, necessary   |   |             |
| to meet such requirements.                           |   |             |
|                                                      |   |             |
| ~~(e)(1) An individual becomes a participant in the  |   |             |
| Loan Repayment Program only on the Secretary\'s      |   |             |
| approval of the individual\'s application submitted  |   |             |
| under subsection (b)(3) and the Secretary\'s         |   |             |
| acceptance of the contract submitted by the          |   |             |
| individual under subsection (b)(4).~~                |   |             |
|                                                      |   |             |
| (e)(1) An individual becomes a participant in the    |   |             |
| Loan Repayment Program only upon the Secretary and   |   |             |
| the individual entering into a written contract      |   |             |
| described in subsection (f).                         |   |             |
|                                                      |   |             |
| \(2\) The Secretary shall provide written notice to  |   |             |
| an individual promptly on\--                         |   |             |
|                                                      |   |             |
| > \(A\) The Secretary\'s approving, under paragraph  |   |             |
| > (1), of the individual\'s participation in the     |   |             |
| > Loan Repayment Program including extensions        |   |             |
| > resulting in an aggregate period of obligated      |   |             |
| > service in excess of 4 years; or                   |   |             |
| >                                                    |   |             |
| > \(B\) The Secretary\'s disapproving an             |   |             |
| > individual\'s participation in such program.       |   |             |
|                                                      |   |             |
| \(f\) The written contract referred to in this       |   |             |
| section between the Secretary and an individual      |   |             |
| shall contain\--                                     |   |             |
|                                                      |   |             |
| > \(1\) an agreement under which\--                  |   |             |
| >                                                    |   |             |
| > \(A\) subject to paragraph (3), the Secretary      |   |             |
| > agrees\--                                          |   |             |
| >                                                    |   |             |
| > \(i\) to pay loans on behalf of the individual in  |   |             |
| > accordance with the provisions of this section,    |   |             |
| > and                                                |   |             |
| >                                                    |   |             |
| > \(ii\) to accept (subject to the availability of   |   |             |
| > appropriated funds for carrying out this section)  |   |             |
| > the individual into the Service or place the       |   |             |
| > individual with a tribe or Indian organization as  |   |             |
| > provided in subparagraph (B)(iii), and             |   |             |
| >                                                    |   |             |
| > \(B\) subject to paragraph (3), the individual     |   |             |
| > agrees\--                                          |   |             |
| >                                                    |   |             |
| > \(i\) to accept loan payments on behalf of the     |   |             |
| > individual;                                        |   |             |
| >                                                    |   |             |
| > \(ii\) in the case of an individual described in   |   |             |
| > subsection (b)(1)\--                               |   |             |
| >                                                    |   |             |
| > \(I\) to maintain enrollment in a course of study  |   |             |
| > or training described in subsection (b)(1)A) until |   |             |
| > the individual completes the course of study or    |   |             |
| > training, and                                      |   |             |
| >                                                    |   |             |
| > \(II\) while enrolled in such course of study or   |   |             |
| > training, to maintain an acceptable level of       |   |             |
| > academic standing (as determined under regulations |   |             |
| > of the Secretary by the education institution      |   |             |
| > offering such course of study or training);        |   |             |
| >                                                    |   |             |
| > \(iii\) to serve for a time period (hereinafter in |   |             |
| > this section referred to as the \"period of        |   |             |
| > obligated service\") equal to 2 years or such      |   |             |
| > longer period as the individual may agree to serve |   |             |
| > in the full-time clinical practice of such         |   |             |
| > individual\'s profession in an Indian health       |   |             |
| > program to which the individual may be assigned by |   |             |
| > the Secretary.                                     |   |             |
| >                                                    |   |             |
| > \(2\) a provision permitting the Secretary to      |   |             |
| > extend for such longer additional periods, as the  |   |             |
| > individual may agree to, the period of obligated   |   |             |
| > service agreed to by the individual under          |   |             |
| > paragraph (1)(B)(iii);                             |   |             |
| >                                                    |   |             |
| > \(3\) a provision that any financial obligation of |   |             |
| > the United States arising out of a contract        |   |             |
| > entered into under this section and any obligation |   |             |
| > of the individual which is conditioned thereon is  |   |             |
| > contingent upon funds being appropriated for loan  |   |             |
| > repayments under this section;                     |   |             |
| >                                                    |   |             |
| > \(4\) a statement of the damages to which the      |   |             |
| > United States is entitled under subsection (l) for |   |             |
| > the individual\'s breach of the contract; and      |   |             |
| >                                                    |   |             |
| > \(5\) such other statements of the rights and      |   |             |
| > liabilities of the Secretary and of the            |   |             |
| > individual, not inconsistent with this section.    |   |             |
|                                                      |   |             |
| (g)(1) A loan repayment provided for an individual   |   |             |
| under a written contract under the Loan Repayment    |   |             |
| Program shall consist of a payment, in accordance    |   |             |
| with paragraph (2), on behalf of the individual of   |   |             |
| the principal, interest and related expenses on      |   |             |
| government and commercial ~~loans received by the    |   |             |
| individual for~~ loans received by the individual    |   |             |
| regarding the undergraduate or graduate education of |   |             |
| the individual (or both), which loans were made      |   |             |
| for\--                                               |   |             |
|                                                      |   |             |
| > \(A\) tuition expenses;                            |   |             |
| >                                                    |   |             |
| > \(B\) all other reasonable educational expenses,   |   |             |
| > including fees, books, and laboratory expenses,    |   |             |
| > incurred by the individual; and                    |   |             |
| >                                                    |   |             |
| > \(C\) reasonable living expenses as determined by  |   |             |
| > the Secretary.                                     |   |             |
|                                                      |   |             |
| ~~(2)(A) Except as provided in subparagraph (B) and  |   |             |
| paragraph (3) for each year of obligated service for |   |             |
| which an individual contracts to serve under         |   |             |
| subsection (f), the Secretary may pay up to \$25,000 |   |             |
| on behalf of the individual for loans described in   |   |             |
| paragraph (1).~~                                     |   |             |
|                                                      |   |             |
| (2)(A) For each year of obligated service that an    |   |             |
| individual contracts to serve under subsection (f)   |   |             |
| the Secretary may pay up to \$35,000 (or an amount   |   |             |
| equal to the amount specified in section             |   |             |
| 338B(g)(2)(A) of the Public Health Service Act) on   |   |             |
| behalf of the individual for loans described in      |   |             |
| paragraph (1). In making a determination of the      |   |             |
| amount to pay for a year of such service by an       |   |             |
| individual, the Secretary shall consider the extent  |   |             |
| to which each such determination‑‑                   |   |             |
|                                                      |   |             |
| > \(i\) affects the ability of the Secretary to      |   |             |
| > maximize the number of contracts that can be       |   |             |
| > provided under the Loan Repayment Program from the |   |             |
| > amounts appropriated for such contracts;           |   |             |
| >                                                    |   |             |
| > \(ii\) provides an incentive to serve in Indian    |   |             |
| > health programs with the greatest shortages of     |   |             |
| > health professionals; and                          |   |             |
| >                                                    |   |             |
| > \(iii\) provides an incentive with respect to the  |   |             |
| > health professional involved remaining in an       |   |             |
| > Indian health program with such a health           |   |             |
| > professional shortage, and continuing to provide   |   |             |
| > primary health services, after the completion of   |   |             |
| > the period of obligated service under the Loan     |   |             |
| > Repayment Program.                                 |   |             |
|                                                      |   |             |
| \(B\) Any arrangement made by the Secretary for the  |   |             |
| making of loan repayments in accordance with this    |   |             |
| subsection shall provide that any repayments for a   |   |             |
| year of obligated service shall be made no later     |   |             |
| than the end of the fiscal year in which the         |   |             |
| individual completes such year of service.           |   |             |
|                                                      |   |             |
| ~~(3) In addition to payments made under paragraph   |   |             |
| (2), in any casein which payments on behalf of an    |   |             |
| individual under the Loan Repayment Program result   |   |             |
| in an increase in Federal, State, or local income    |   |             |
| tax liability for such individual, the Secretary     |   |             |
| may, on the request of such individual, make         |   |             |
| payments to such individual in a reasonable amount,  |   |             |
| as determined by the Secretary, to reimburse such    |   |             |
| individual for all or part of the increased tax      |   |             |
| liability of the individual.~~                       |   |             |
|                                                      |   |             |
| \(3\) For the purpose of providing reimbursements    |   |             |
| for tax liability resulting from payments under      |   |             |
| paragraph (2) on behalf of an individual, the        |   |             |
| Secretary‑‑                                          |   |             |
|                                                      |   |             |
| > \(A\) in addition to such payments, may make       |   |             |
| > payments to the individual in an amount not less   |   |             |
| > than 20 percent and not more than 39 percent of    |   |             |
| > the total amount of loan repayments made for the   |   |             |
| > taxable year involved; and                         |   |             |
| >                                                    |   |             |
| > \(B\) may make such additional payments as the     |   |             |
| > Secretary determines to be appropriate with        |   |             |
| > respect to such purpose.                           |   |             |
| >                                                    |   |             |
| > [\[Note]{.underline}: Sec. 106(g)(2) of P.L.       |   |             |
| > 102-573 states: \"The amendment made by paragraph  |   |             |
| > (1) \[Sec. 108 g (3) of P.L. 94-437, above\] shall |   |             |
| > apply only with respect to contracts under section |   |             |
| > 108 of the Indian Health Care Improvement Act      |   |             |
| > entered into on or after the date of enactmet of   |   |             |
| > the Act \[October 29, 1992\].\"\]                  |   |             |
|                                                      |   |             |
| \(4\) The Secretary may enter into an agreement with |   |             |
| the holder of any loan for which payments are made   |   |             |
| under the Loan Repayment Program to establish a      |   |             |
| schedule for the making of such payments.            |   |             |
|                                                      |   |             |
| \(h\) Notwithstanding any other provision of law,    |   |             |
| individuals who have entered into written contracts  |   |             |
| with the Secretary under this section, while         |   |             |
| undergoing academic training, shall not be countered |   |             |
| against any employment ceiling affecting the         |   |             |
| Department of Health and Human Services.             |   |             |
|                                                      |   |             |
| \(i\) The Secretary shall conduct recruiting         |   |             |
| programs for the Loan Repayment Program and other    |   |             |
| Service manpower programs at educational             |   |             |
| institutions training health professionals or        |   |             |
| specialists identified in subsection (a).            |   |             |
|                                                      |   |             |
| \(j\) Section 214 of the Public Health Service Act   |   |             |
| (42 U.S.C. 215) shall not apply to individuals       |   |             |
| during their period of obligated service under the   |   |             |
| Loan Repayment Program.                              |   |             |
|                                                      |   |             |
| ~~(k) The Secretary shall ensure that the staffing   |   |             |
| needs of Indian health programs administered by any  |   |             |
| Indian tribe or tribal or Indian organizations       |   |             |
| receive consideration on an equal basis with         |   |             |
| programs that are administered directly by the       |   |             |
| Service.~~                                           |   |             |
|                                                      |   |             |
| \(k\) The Secretary, in assigning individuals to     |   |             |
| serve in Indian health programs pursuant to          |   |             |
| contracts entered into under this section, shall‑‑   |   |             |
|                                                      |   |             |
| > (1)ensure that the staffing needs of Indian health |   |             |
| > programs administered by an Indian tribe or tribal |   |             |
| > or health organization receive consideration on an |   |             |
| > equal basis with programs that are administered    |   |             |
| > directly by the Service; and                       |   |             |
| >                                                    |   |             |
| > (2)give priority to assigning individuals to       |   |             |
| > Indian health programs that have a need for health |   |             |
| > professionals to provide health care services as a |   |             |
| > result of individuals having breached contracts    |   |             |
| > entered into under this section.                   |   |             |
|                                                      |   |             |
| (l)(1) An individual who has entered into a written  |   |             |
| contract with the Secretary under this section and   |   |             |
| who\--                                               |   |             |
|                                                      |   |             |
| > \(A\) is enrolled in the final year of a course of |   |             |
| > study and who\--                                   |   |             |
| >                                                    |   |             |
| > (i)fails to maintain an acceptable level of        |   |             |
| > academic standing in the educational institution   |   |             |
| > in which he is enrolled (such level determined by  |   |             |
| > the educational institution under regulations of   |   |             |
| > the Secretary);                                    |   |             |
| >                                                    |   |             |
| > (ii)voluntarily terminates such enrollment; or     |   |             |
| >                                                    |   |             |
| > (iii)is dismissed from such educational            |   |             |
| > institution before completion of such course of    |   |             |
| > study; or                                          |   |             |
| >                                                    |   |             |
| > \(B\) is enrolled in a graduate training program,  |   |             |
| > fails to complete such training program, and does  |   |             |
| > not receive a waiver from the Secretary under      |   |             |
| > subsection (b)(1)(B)(ii),                          |   |             |
|                                                      |   |             |
| shall be liable, in lieu of any service obligation   |   |             |
| arising under such contract, to the United States    |   |             |
| for the amount which has been paid on such           |   |             |
| individual\'s behalf under the contract.             |   |             |
|                                                      |   |             |
| (2)If, for any reason not specified in paragraph     |   |             |
| (1), an individual breaches his written contract     |   |             |
| under this section by failing either to begin, or    |   |             |
| complete, such individual\'s period of obligated     |   |             |
| service in accordance with subsection (f), the       |   |             |
| United States shall be entitled to recover from such |   |             |
| individual an amount to be determined in accordance  |   |             |
| with the following formula:                          |   |             |
|                                                      |   |             |
| A=3Z(t-s/t)                                          |   |             |
|                                                      |   |             |
| in which\--                                          |   |             |
|                                                      |   |             |
| > \(A\) \"A\" is the amount the United States is     |   |             |
| > entitled to recover,                               |   |             |
| >                                                    |   |             |
| > \(B\) \"Z\" is the sum of the amounts paid under   |   |             |
| > this section 50, or on behalf of, the individual   |   |             |
| > and the interest on such amounts which would be    |   |             |
| > payable if, at the time the amounts were paid,     |   |             |
| > they were loans bearing interest at the maximum    |   |             |
| > legal prevailing rate, as determined by the        |   |             |
| > Treasurer of the United States;                    |   |             |
| >                                                    |   |             |
| > \(C\) \"t\" is the total number of months in the   |   |             |
| > individual\'s period of obligated service in       |   |             |
| > accordance with subsection (f); and                |   |             |
| >                                                    |   |             |
| > \(D\) \"s\" is the number of months of such period |   |             |
| > served by such individual in accordance with this  |   |             |
| > section.                                           |   |             |
|                                                      |   |             |
| Amounts not paid within such period shall be subject |   |             |
| to collection through deductions in Medicare         |   |             |
| payments pursuant to section 1892 of the Social      |   |             |
| Security Act.                                        |   |             |
|                                                      |   |             |
| (3)(A) Any amount of damages which the United States |   |             |
| is entitled to recover under this subsection shall   |   |             |
| be paid to the United States within the 1-year       |   |             |
| period beginning on the date of the breach or such   |   |             |
| longer period beginning on such date as shall be     |   |             |
| specified by the Secretary.                          |   |             |
|                                                      |   |             |
| \(B\) If damages described in subparagraph (A) are   |   |             |
| delinquent for 3 months, the Secretary shall, for    |   |             |
| the purpose of recovering such damages\--            |   |             |
|                                                      |   |             |
| > (i)utilize collection agencies contracted with by  |   |             |
| > the Administrator of the General Services          |   |             |
| > Administration; or                                 |   |             |
| >                                                    |   |             |
| > (ii)enter into contracts for the recovery of such  |   |             |
| > damages with collection agencies selected by the   |   |             |
| > Secretary.                                         |   |             |
|                                                      |   |             |
| \(C\) Each contract for recovering damages pursuant  |   |             |
| to this subsection shall provide that the contractor |   |             |
| will, not less than once each 6 months, submit to    |   |             |
| the Secretary a status report on the success of the  |   |             |
| contractor in collecting such damages. Section 3718  |   |             |
| of title 31, United States Code, shall apply to any  |   |             |
| such contract to the extent not inconsistent with    |   |             |
| this subsection.                                     |   |             |
|                                                      |   |             |
| (m)(1) Any obligation of an individual under the     |   |             |
| Loan Repayment Program for service or payment of     |   |             |
| damages shall be canceled upon the death of the      |   |             |
| individual.                                          |   |             |
|                                                      |   |             |
| \(2\) The Secretary shall by regulation provide for  |   |             |
| the partial or total waiver or suspension of any     |   |             |
| obligation of service or payment by an individual    |   |             |
| under the Loan Repayment Program whenever compliance |   |             |
| by the individual is impossible or would involve     |   |             |
| extreme hardship to the individual and if            |   |             |
| enforcement of such obligation with respect to any   |   |             |
| individual would be unconscionable.                  |   |             |
|                                                      |   |             |
| \(3\) The Secretary may waive, in whole or in part,  |   |             |
| the rights of the United States to recover amounts   |   |             |
| under this section in any case of extreme hardship   |   |             |
| or other good cause shown, as determined by the      |   |             |
| Secretary.                                           |   |             |
|                                                      |   |             |
| \(4\) Any obligation of an individual under the Loan |   |             |
| Repayment Program for payment of damages may be      |   |             |
| released by a discharge in bankruptcy under title 11 |   |             |
| of the United States Code only if such discharge is  |   |             |
| granted after the expiration of the 5-year period    |   |             |
| beginning on the first date that payment of such     |   |             |
| damages is required, and only if the bankruptcy      |   |             |
| court finds that nondischarge of the obligation      |   |             |
| would be unconscionable.                             |   |             |
|                                                      |   |             |
| ~~(n)(1) By not later than the first of March of     |   |             |
| each year, the Secretary shall, beginning with the   |   |             |
| fiscal year 1990, submit to the Congress an annual   |   |             |
| report for the preceding fiscal year setting         |   |             |
| out\--~~                                             |   |             |
|                                                      |   |             |
| > ~~(A) the number of such applications filed with   |   |             |
| > respect to each type of health profession;~~       |   |             |
| >                                                    |   |             |
| > ~~(B) the health professional positions maintained |   |             |
| > by the Service or by tribal or Indian              |   |             |
| > organizations for which recruitment or retention   |   |             |
| > is difficult;~~                                    |   |             |
| >                                                    |   |             |
| > ~~(C) the number of contracts described in         |   |             |
| > subsection (f) that are entered into with respect  |   |             |
| > to each health profession; and~~                   |   |             |
| >                                                    |   |             |
| > ~~(D) the amount of loan payments made in total    |   |             |
| > and by health professions.~~                       |   |             |
|                                                      |   |             |
| ~~(2) Not later than the first of July of each year, |   |             |
| beginning in 1989, the Secretary shall submit to     |   |             |
| Congress a report on\--~~                            |   |             |
|                                                      |   |             |
| > ~~(A) the number of providers of health care that  |   |             |
| > will be needed by Indian health programs by        |   |             |
| > location and profession, during the three fiscal   |   |             |
| > years beginning after the date the report is       |   |             |
| > filed; and~~                                       |   |             |
| >                                                    |   |             |
| > ~~(B) the measures the Secretary plans to take to  |   |             |
| > fill the health professional positions maintained  |   |             |
| > by the Service or by tribes or tribal or Indian    |   |             |
| > organizations for which recruitment or retention   |   |             |
| > is difficult.~~                                    |   |             |
|                                                      |   |             |
| \(n\) The Secretary shall submit to the President,   |   |             |
| for inclusion in each report required to be          |   |             |
| submitted to the Congress under section 801, a       |   |             |
| report concerning the previous fiscal year which     |   |             |
| sets forth‑‑                                         |   |             |
|                                                      |   |             |
| > \(1\) the health professional positions maintained |   |             |
| > by the Service or by tribal or Indian              |   |             |
| > organizations for which recruitment or retention   |   |             |
| > is difficult;                                      |   |             |
| >                                                    |   |             |
| > \(2\) the number of Loan Repayment Program         |   |             |
| > applications filed with respect to each type of    |   |             |
| > health profession;                                 |   |             |
| >                                                    |   |             |
| > \(3\) the number of contracts described in         |   |             |
| > subsection (f) that are entered into with respect  |   |             |
| > to each health profession;                         |   |             |
| >                                                    |   |             |
| > \(4\) the amount of loan payments made under this  |   |             |
| > section, in total and by health profession;        |   |             |
| >                                                    |   |             |
| > \(5\) the number of scholarship grants that are    |   |             |
| > provided under section 104 with respect to each    |   |             |
| > health profession;                                 |   |             |
| >                                                    |   |             |
| > \(6\) the amount of scholarship grants provided    |   |             |
| > under section 104, in total and by health          |   |             |
| > profession;                                        |   |             |
| >                                                    |   |             |
| > \(7\) the number of providers of health care that  |   |             |
| > will be needed by Indian health programs, by       |   |             |
| > location and profession, during the three fiscal   |   |             |
| > years beginning after the date the report is       |   |             |
| > filed; and                                         |   |             |
| >                                                    |   |             |
| > \(8\) the measures the Secretary plans to take to  |   |             |
| > fill the health professional positions maintained  |   |             |
| > by the Service or by tribes or tribal or Indian    |   |             |
| > organizations for which recruitment or retention   |   |             |
| > is difficult.                                      |   |             |
|                                                      |   |             |
| ~~(o) There are authorized to be appropriated such   |   |             |
| sums as may be necessary for each fiscal year to     |   |             |
| carry out the provisions of this section.~~          |   |             |
|                                                      |   |             |
| SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND         |   |             |
|                                                      |   |             |
| > SEC. 108A. (a) There is established in the         |   |             |
| > Treasury of the United States a fund to be known   |   |             |
| > as the Indian Health Scholarship and Loan          |   |             |
| > Repayment Recovery Fund (hereafter in this section |   |             |
| > referred to as the \`Fund\'). The Fund shall       |   |             |
| > consist of such amounts as may be appropriated to  |   |             |
| > the Fund under subsection (b). Amounts             |   |             |
| > appropriated for the Fund shall remain available   |   |             |
| > until expended.                                    |   |             |
| >                                                    |   |             |
| > \(b\) For each fiscal year, there is authorized to |   |             |
| > be appropriated to the Fund an amount equal to the |   |             |
| > sum of‑‑                                           |   |             |
| >                                                    |   |             |
| > \(1\) the amount collected during the preceding    |   |             |
| > fiscal year by the Federal Government pursuant     |   |             |
| > to‑‑                                               |   |             |
| >                                                    |   |             |
| > \(A\) the liability of individuals under           |   |             |
| > subparagraph (A) or (B) of section 104(b)(5) for   |   |             |
| > the breach of contracts entered into under section |   |             |
| > 104; and                                           |   |             |
| >                                                    |   |             |
| > \(B\) the liability of individuals under section   |   |             |
| > 108(l)for the breach of contracts entered into     |   |             |
| > under section 108; and                             |   |             |
| >                                                    |   |             |
| > \(2\) the aggregate amount of interest accruing    |   |             |
| > during the preceding fiscal year on obligations    |   |             |
| > held in the Fund pursuant to subsection (d) and    |   |             |
| > the amount of proceeds from the sale or redemption |   |             |
| > of such obligations during such fiscal year.       |   |             |
| >                                                    |   |             |
| > (c)(1) Amounts in the Fund and available pursuant  |   |             |
| > to appropriation Acts may be expended by the       |   |             |
| > Secretary, acting through the Service, to make     |   |             |
| > payments to an Indian tribe or tribal organization |   |             |
| > administering a health care program pursuant to a  |   |             |
| > contract entered into under the Indian             |   |             |
| > Self‑Determination Act‑‑                           |   |             |
| >                                                    |   |             |
| > \(A\) to which a scholarship recipient under       |   |             |
| > section 104 or a loan repayment program            |   |             |
| > participant under section 108 has been assigned to |   |             |
| > meet the obligated service requirements pursuant   |   |             |
| > to sections; and                                   |   |             |
| >                                                    |   |             |
| > \(B\) that has a need for a health professional to |   |             |
| > provide health care services as a result of such   |   |             |
| > recipient or participant having breached the       |   |             |
| > contract entered into under section 104 or section |   |             |
| > 108.                                               |   |             |
| >                                                    |   |             |
| > \(2\) An Indian tribe or tribal organization       |   |             |
| > receiving payments pursuant to paragraph (1) may   |   |             |
| > expend the payments to recruit and employ,         |   |             |
| > directly or by contract, health professionals to   |   |             |
| > provide health care services.                      |   |             |
| >                                                    |   |             |
| > (d)(1) The Secretary of the Treasury shall invest  |   |             |
| > such amounts of the Fund as such Secretary         |   |             |
| > determines are not required to meet current        |   |             |
| > withdrawals from the Fund. Such investments may be |   |             |
| > made only in interest‑bearing obligations of the   |   |             |
| > United States. For such purpose, such obligations  |   |             |
| > may be acquired on original issue at the issue     |   |             |
| > price, or by purchase of outstanding obligations   |   |             |
| > at the market price.                               |   |             |
| >                                                    |   |             |
| > \(2\) Any obligation acquired by the Fund may be   |   |             |
| > sold by the Secretary of the Treasury at the       |   |             |
| > market price.                                      |   |             |
|                                                      |   |             |
| ~~TRAVEL EXPENSES FOR RECRUITMENT~~                  |   |             |
|                                                      |   |             |
| RECRUITMENT ACTIVITIES                               |   |             |
|                                                      |   |             |
| SEC. 109. (a) The Secretary may reimburse health     |   |             |
| professionals seeking positions with the Service,    |   |             |
| including individuals considering entering into a    |   |             |
| contract under section 108, and their spouses, for   |   |             |
| actual and reasonable expenses incurred in traveling |   |             |
| to and from their places of residence to an area in  |   |             |
| which they may be assigned for the purpose of        |   |             |
| evaluating such area with respect to such            |   |             |
| assignment.                                          |   |             |
|                                                      |   |             |
| ~~(b) There are authorized to be appropriated        |   |             |
| \$100,000 for each of the fiscal years 1990,1991,    |   |             |
| and 1992, for the purpose of carrying out the        |   |             |
| provisions of this section.~~                        |   |             |
|                                                      |   |             |
| \(b\) The Secretary, acting through the Service,     |   |             |
| shall assign one individual in each area office to   |   |             |
| be responsible on a full-time basis for recruitment  |   |             |
| activites.                                           |   |             |
|                                                      |   |             |
| TRIBAL RECRUITMENT AND RETENTION PROGRAM             |   |             |
|                                                      |   |             |
| SEC. 110. (a) The Secretary, acting through the      |   |             |
| Service, shall fund, on a competitive basis,projects |   |             |
| to enable Indian tribes and tribal and Indian        |   |             |
| organizations to recruit, place, and retain health   |   |             |
| professionals to meet the staffing needs of Indian   |   |             |
| health programs (as defined in section 108(a)(2)).   |   |             |
|                                                      |   |             |
| (b)(1) Any Indian tribe or tribal or Indian          |   |             |
| organization may submit an application for funding   |   |             |
| of a project pursuant to this section.               |   |             |
|                                                      |   |             |
| \(2\) Indian tribes and tribal and Indian            |   |             |
| organizations under the authority of the Indian      |   |             |
| Self-Determination Act shall be given an equal       |   |             |
| opportunity with programs that are administered      |   |             |
| directly by the Service to compete for, and receive, |   |             |
| grants under subsection (a) for such projects.       |   |             |
|                                                      |   |             |
| ~~(c) There are authorized to be appropriated        |   |             |
| \$1,000,000 for each of the fiscal years 1990, 1991, |   |             |
| and 1992, for the purpose of carrying out the        |   |             |
| provisions of this section.~~                        |   |             |
|                                                      |   |             |
| > \[NOTE: P.L. 100-713 established a free-standing   |   |             |
| > provision affecting sections 109 and 110 of the    |   |             |
| > Indian Health Care Improvement Act. For easy       |   |             |
| > reference, this language has been provided         |   |             |
| > below.\]                                           |   |             |
|                                                      |   |             |
| **{REPORT ON RECRUITMENT AND RETENTION**             |   |             |
|                                                      |   |             |
| > **{SEC. 110. (a) The Secretary of Health and Human |   |             |
| > Services shall establish an advisory panel         |   |             |
| > composed of\--**                                   |   |             |
| >                                                    |   |             |
| > **(1) 10 physicians or other health professionals  |   |             |
| > who are employees of, or assigned to, the Indian   |   |             |
| > Health Service,**                                  |   |             |
| >                                                    |   |             |
| > **(2) 3 representatives of tribal health boards,   |   |             |
| > and**                                              |   |             |
| >                                                    |   |             |
| > **(3) 1 representative of an urban health care     |   |             |
| > organization.**                                    |   |             |
| >                                                    |   |             |
| > **{(b) The advisory panel established under        |   |             |
| > subsection (a) shall conduct an investigation      |   |             |
| > of\--**                                            |   |             |
| >                                                    |   |             |
| > **(1) the administrative policies and regulatory   |   |             |
| > procedures which impede the recruitment or         |   |             |
| > retention of physicians and other health           |   |             |
| > professionals by the Indian Health Service, and**  |   |             |
| >                                                    |   |             |
| > **(2) the regulatory changes necessary to          |   |             |
| > establish pay grades for health professionals      |   |             |
| > employed by, or assigned to, the Service that      |   |             |
| > correspond to the pay grades established for       |   |             |
| > positions provided under sections 4103 and 4104 of |   |             |
| > title 38, United States Code, and the costs        |   |             |
| > associated with establishing such pay grades.**    |   |             |
| >                                                    |   |             |
| > **{(c) By no later than the date that is 18 months |   |             |
| > after the date of enactment of this Act, the       |   |             |
| > advisory panel established under subsection (a)    |   |             |
| > shall submit to the Congress a report on the       |   |             |
| > investigation conducted under subsection (b),      |   |             |
| > together with any recommendations for              |   |             |
| > administrative or legislative changes in existing  |   |             |
| > law, practices or procedures.}**                   |   |             |
|                                                      |   |             |
| ADVANCED TRAINING AND RESEARCH                       |   |             |
|                                                      |   |             |
| SEC. 111. (a) The Secretary, acting through the      |   |             |
| Service, shall establish a program to enable health  |   |             |
| professionals who have worked in an Indian health    |   |             |
| program (as defined in section 108(a)(2)) for a      |   |             |
| substantial period of time to pursue advanced        |   |             |
| training or research areas of study for which the    |   |             |
| Secretary determines a need exists.                  |   |             |
|                                                      |   |             |
| \(b\) An individual who participates in a program    |   |             |
| under subsection (a) where the educational costs are |   |             |
| borne by the Service, shall incur an obligation to   |   |             |
| serve in an Indian health program for a period of    |   |             |
| obligated service equal to at least the period of    |   |             |
| time during which the individual participates in     |   |             |
| such program. In the event that the individual fails |   |             |
| to complete such obligated service, the individual   |   |             |
| shall be liable to the United States for the period  |   |             |
| of servie remaining. ~~The Secretary shall develop   |   |             |
| standards for appropriate recoupment for such        |   |             |
| remaining service.~~ In such event, with respect to  |   |             |
| individuals entering the program after the date of   |   |             |
| enactment of the Indian Health Amendments of 1992,   |   |             |
| the United States shall be entitled to recoer from   |   |             |
| such individual an amount to be determined in        |   |             |
| accordance with the formula specified in subsection  |   |             |
| (l) of section 108 in the manner provided for in     |   |             |
| such subsection.                                     |   |             |
|                                                      |   |             |
| \(c\) Health professionals from Indian tribes and    |   |             |
| tribal and Indian organizations under the authority  |   |             |
| of the Indian Self-Determination Act shall be given  |   |             |
| an equal opportunity to participate in the program   |   |             |
| under subsection (a).                                |   |             |
|                                                      |   |             |
| ~~(d) REGULATIONS.-The Secretary shall prescribe     |   |             |
| such regulations as may be necessary to carry out    |   |             |
| the provisions of this section.~~                    |   |             |
|                                                      |   |             |
| NURSING PROGRAM                                      |   |             |
|                                                      |   |             |
| **QUENTIN N. BURDICK AMERICAN INDIANS INTO NURSING   |   |             |
| PROGRAM\"**                                          |   |             |
|                                                      |   |             |
| SEC. 112. (a) The Secretary, acting through the      |   |             |
| Service, shall provide grants to\--                  |   |             |
|                                                      |   |             |
| > (1)public or private schools of nursing,           |   |             |
| >                                                    |   |             |
| > (2)tribally-controlled community colleges and      |   |             |
| > tribally controlled postsecondary vocational       |   |             |
| > institutions (as defined in section 390(2) of the  |   |             |
| > Tribally Controlled Vocational Institutions        |   |             |
| > Support Act of 1990 (20 U.S.C. 2397h(2)), and      |   |             |
| >                                                    |   |             |
| > \(3\) nurse midwife programs, and nurse            |   |             |
| > practitioner programs,that are provided by any     |   |             |
| > public or private institutions,                    |   |             |
|                                                      |   |             |
| for the purpose of increasing the number of nurses,  |   |             |
| nurse midwives, and nurse practitioners who deliver  |   |             |
| health care services to Indians.                     |   |             |
|                                                      |   |             |
| \(b\) Grants provided under subsection (a) may be    |   |             |
| used to\--                                           |   |             |
|                                                      |   |             |
| > (1)recruit individuals for programs which train    |   |             |
| > individuals to be nurses, nurse midwives, or nurse |   |             |
| > practitioners,                                     |   |             |
| >                                                    |   |             |
| > (2)provide scholarships to individuals enrolled in |   |             |
| > such programs that may pay the tuition charged for |   |             |
| > such program and other expenses incurred in        |   |             |
| > connection with such program, including books,     |   |             |
| > fees, room and board, and stipends for living      |   |             |
| > expenses,                                          |   |             |
| >                                                    |   |             |
| > (3)provide a program that encourages nurses,nurse  |   |             |
| > midwives, and nurse practitioners to provide, or   |   |             |
| > continue to provide, health care services to       |   |             |
| > Indians,                                           |   |             |
| >                                                    |   |             |
| > (4)provide a program that increases the skills of, |   |             |
| > and provides continuing education to, nurses,      |   |             |
| > nurse midwives, and nurse practitioners, or        |   |             |
| >                                                    |   |             |
| > (5)provide any program that is designed to achieve |   |             |
| > the purpose described in subsection (a).           |   |             |
|                                                      |   |             |
| (c)Each applicant for a grant under subsection       |   |             |
| (a)shall include such information as the Secretary   |   |             |
| may require to establish the connection between the  |   |             |
| program of the applicant and a health care facility  |   |             |
| that primarily serves Indians.                       |   |             |
|                                                      |   |             |
| \(d\) In providing grants under subsection (a), the  |   |             |
| Secretary shall extend a preference to\--            |   |             |
|                                                      |   |             |
| > \(1\) programs that provide a preference to        |   |             |
| > Indians,                                           |   |             |
| >                                                    |   |             |
| > \(2\) programs that train nurse midwives or nurse  |   |             |
| > practitioners,                                     |   |             |
| >                                                    |   |             |
| > (3)programs that are interdisciplinary and         |   |             |
| >                                                    |   |             |
| > (4)programs that are conducted in cooperation with |   |             |
| > a center for gifted and talented Indian students   |   |             |
| > established under section 5324(a) of the Indian    |   |             |
| > Education Act of 1988.                             |   |             |
|                                                      |   |             |
| \(e\) The Secretary shall provide one of the grants  |   |             |
| authorized under subsection (a) to establish and     |   |             |
| maintain a program at the University of North Dakota |   |             |
| to be known as the \"Quentin N. Burdick American     |   |             |
| Indians Into Nursing Program\". Such program shall,  |   |             |
| to the maximum extent feasible, coordinate with the  |   |             |
| Quentin N. Burdick Indian Health Programs            |   |             |
| established under section 114(b) and the Quentin N.  |   |             |
| Burdick American Indians Into Psychology Program     |   |             |
| established under section 217(b).                    |   |             |
|                                                      |   |             |
| ~~(e)~~ (f) The active duty service obligation       |   |             |
| prescribed under section 338C of the Public Health   |   |             |
| Service Act (42 U.S.C. 254m) shall be met by each    |   |             |
| individual who receives training or assistance       |   |             |
| described in paragraph (1) or (2) of subsection (b)  |   |             |
| that is funded by a grant provided under subsection  |   |             |
| (a). Such obligation shall be met by service\--      |   |             |
|                                                      |   |             |
| > (A)in the Indian Health Service;                   |   |             |
| >                                                    |   |             |
| > (B)in a program conducted under a contract entered |   |             |
| > into under the Indian Self-Determination Act;      |   |             |
| >                                                    |   |             |
| > (C)in a program assisted under title V of this     |   |             |
| > Act; or                                            |   |             |
| >                                                    |   |             |
| > (D)in the private practice of nursing if, as       |   |             |
| > determined by the Secretary, in accordance with    |   |             |
| > guidelines promulgated by the Secretary, such      |   |             |
| > practice is situated in a physician or other       |   |             |
| > health professional shortage area and addresses    |   |             |
| > the health care needs of a substantial number of   |   |             |
| > Indians.                                           |   |             |
|                                                      |   |             |
| ~~(f)(1) There are authorized to be appropriated for |   |             |
| each of the fiscal years 1990, 1991, and 1992,       |   |             |
| \$5,000,000 for the purpose of carrying out the      |   |             |
| provisions of this section.~~                        |   |             |
|                                                      |   |             |
| ~~(2) Of the amounts appropriated under the          |   |             |
| authority of paragraph (1) for each fiscal year, the |   |             |
| Secretary shall use at least \$1,000,000 to provide  |   |             |
| grants under subsection (a) for the training of      |   |             |
| nurse midwives.~~                                    |   |             |
|                                                      |   |             |
| \(g\) Beginning with fiscal year 1993, of the        |   |             |
| amounts appropriated under the authority of this     |   |             |
| title for each fiscal year to be used to carry out   |   |             |
| this section, not less than \$1,000,000 shall be     |   |             |
| used to provide grants under subsection (a) for the  |   |             |
| training of nurse midwives, nurse anesthetists, and  |   |             |
| nurse practitioners.                                 |   |             |
|                                                      |   |             |
| NURSING SCHOOL CLINICS                               |   |             |
|                                                      |   |             |
| > SEC. 112A. (a) GRANTS.‑‑In addition to the         |   |             |
| > authority of the Secretary under section           |   |             |
| > 112(a)(1), the Secretary, acting through the       |   |             |
| > Service, is authorized to provide grants to public |   |             |
| > or private schools of nursing for the purpose of   |   |             |
| > establishing, developing, operating, and           |   |             |
| > administering clinics to address the health care   |   |             |
| > needs of Indians, and to provide primary health    |   |             |
| > care services to Indians who reside on or within   |   |             |
| > 50 miles of Indian country, as defined in section  |   |             |
| > 1151 of title 18, United States Code.              |   |             |
| >                                                    |   |             |
| > \(b\) PURPOSES.‑‑Grants provided under subsection  |   |             |
| > (a) may be used to‑‑                               |   |             |
| >                                                    |   |             |
| > (1)establish clinics, to be run and staffed by the |   |             |
| > faculty and students of a grantee school, to       |   |             |
| > provide primary care services in areas in or       |   |             |
| > within 50 miles of Indian country (as defined in   |   |             |
| > section 1151 of title 18, United States Code)      |   |             |
| >                                                    |   |             |
| > (2)provide clinical training, program              |   |             |
| > development,faculty enhancement, and student       |   |             |
| > scholarships in a manner that would benefit such   |   |             |
| > clinics; and                                       |   |             |
| >                                                    |   |             |
| > (3)carry out any other activities determined       |   |             |
| > appropriate by the Secretary.                      |   |             |
| >                                                    |   |             |
| > (c)AMOUNT AND CONDITIONS.‑‑The Secretary may award |   |             |
| > grants under this section in such amounts and      |   |             |
| > subject to such conditions as the Secretary deems  |   |             |
| > appropriate.                                       |   |             |
| >                                                    |   |             |
| > \(d\) DESIGN.‑‑The clinics established under this  |   |             |
| > section shall be designed to provide nursing       |   |             |
| > students with a structured clinical experience     |   |             |
| > that is similar in nature to that provided by      |   |             |
| > residency training programs for physicians.        |   |             |
| >                                                    |   |             |
| > \(e\) REGULATIONS.‑‑The Secretary shall prescribe  |   |             |
| > such regulations as may be necessary to carry out  |   |             |
| > the provisions of this section.                    |   |             |
| >                                                    |   |             |
| > \(f\) AUTHORIZATION TO USE AMOUNTS.‑‑Out of        |   |             |
| > amounts appropriated to carry out this title for   |   |             |
| > each of the fiscal years 1993 through 2000 not     |   |             |
| > more than \$5,000,000 may be used to carry out     |   |             |
| > this section.                                      |   |             |
|                                                      |   |             |
| TRIBAL CULTURE AND HISTORY                           |   |             |
|                                                      |   |             |
| SEC 113. (a) The Secretary, acting through the       |   |             |
| Service, shall establish a program under which       |   |             |
| appropriate employees of the Service who serve       |   |             |
| particular Indian tribes shall receive educational   |   |             |
| instruction in the history and culture of such       |   |             |
| tribes and in the history of the Service.            |   |             |
|                                                      |   |             |
| (b)To the extent feasible, the program established   |   |             |
| under subsection (a) shall\--                        |   |             |
|                                                      |   |             |
| > \(1\) be carried out through tribally-controlled   |   |             |
| > community colleges (within the meaning of section  |   |             |
| > 2(4) of the Tribally Controlled Community College  |   |             |
| > Assistance Act of 1978)and tribally controlled     |   |             |
| > postsecondary vocational institutions (as defined  |   |             |
| > in section 390(2) of the tribally Controlled       |   |             |
| > Vocational Institutions Support Act of 1990 (20    |   |             |
| > U.S.C. 2397 h(2)), and                             |   |             |
| >                                                    |   |             |
| > \(2\) be developed in consultation with the        |   |             |
| > affected tribal government, and                    |   |             |
| >                                                    |   |             |
| > \(3\) include instruction in Native American       |   |             |
| > studies.                                           |   |             |
|                                                      |   |             |
| ~~(c) There are authorized to be appropriated for    |   |             |
| each of the fiscal years 1990, 1991, and 1992,       |   |             |
| \$1,000,000 to carry out the provisions of this      |   |             |
| section.~~                                           |   |             |
|                                                      |   |             |
| INMED PROGRAM                                        |   |             |
|                                                      |   |             |
| SEC. 114. (a) The Secretary is authorized to provide |   |             |
| grants to at least 3 colleges and universities for   |   |             |
| the purpose of maintaining and expanding the Native  |   |             |
| American health careers recruitment program known as |   |             |
| the \"Indians into Medicine Program\" (hereinafter   |   |             |
| in this section referred to as \"INMED\") as a means |   |             |
| of encouraging Indians to enter the health           |   |             |
| professions.                                         |   |             |
|                                                      |   |             |
| \(b\) The Secretary shall provide one of the grants  |   |             |
| authorized under subsection (a) to maintain the      |   |             |
| INMED program at the University of North Dakota to   |   |             |
| be known as the Quentin N. Burdick Indian Health     |   |             |
| Programs, unless the Secretary makes a               |   |             |
| determination, based upon program reviews, that the  |   |             |
| program is not meeting the purposes of this section  |   |             |
| such program shall, to the maximum extent feasible,  |   |             |
| coordinate with the Quentin N. Burdick American      |   |             |
| Indians Into Psychology Program established under    |   |             |
| section 217(b) and the Quentin N. Burdick American   |   |             |
| Indians Into Nursing Program established under       |   |             |
| section 112(e).                                      |   |             |
|                                                      |   |             |
| (c)(1)The Secretary shall develop regulations for    |   |             |
| the competitive awarding of the grants provided      |   |             |
| under this section.                                  |   |             |
|                                                      |   |             |
| \(2\) Applicants for grants provided under this      |   |             |
| section shall agree to provide a program which\--    |   |             |
|                                                      |   |             |
| > (A)provides outreach and recruitment for health    |   |             |
| > professions to Indian communities including        |   |             |
| > elementary, secondary and community colleges       |   |             |
| > located on Indian reservations which will be       |   |             |
| > served by the program,                             |   |             |
| >                                                    |   |             |
| > (B)incorporates a program advisory board comprised |   |             |
| > of representatives from the tribes and communities |   |             |
| > which will be served by the program,               |   |             |
| >                                                    |   |             |
| > (C)provides summer preparatory programs for Indian |   |             |
| > students who need enrichment in the subjects of    |   |             |
| > math and science in order to pursue training in    |   |             |
| > the health professions,                            |   |             |
| >                                                    |   |             |
| > (D)provides tutoring, counseling and support to    |   |             |
| > students who are enrolled in a health career       |   |             |
| > program of study at the respective college or      |   |             |
| > university, and                                    |   |             |
| >                                                    |   |             |
| > (E)to the maximum extent feasible, employs         |   |             |
| > qualified Indians in the program.                  |   |             |
|                                                      |   |             |
| \(d\) By no later than the date that is 3 years      |   |             |
| after the date of enactment of the Indian Health     |   |             |
| Care Amendments of 1988, the Secretary shall submit  |   |             |
| a report to the Congress on the program established  |   |             |
| under this section including recommendations for     |   |             |
| expansion or changes to the program.                 |   |             |
|                                                      |   |             |
| ~~(e) There are authorized to be appropriated for    |   |             |
| each of the fiscal years 1990, 1991, and 1992,       |   |             |
| \$1,000,000 to carry out the provisions of this      |   |             |
| section.~~                                           |   |             |
|                                                      |   |             |
| HEALTH TRAINING PROGRAMS OF COMMUNITY COLLEGES       |   |             |
|                                                      |   |             |
| SEC. 115. (a)(1) The Secretary, acting through the   |   |             |
| Service, shall award grants to community colleges    |   |             |
| for the purpose of assisting the community college   |   |             |
| in the establishment of programs which provide       |   |             |
| education in a health profession leading to a degree |   |             |
| or diploma in a health profession for individuals    |   |             |
| who desire to practice such profession on an Indian  |   |             |
| reservation or in a tribal clinic.                   |   |             |
|                                                      |   |             |
| (2)The amount of any grant awarded to a community    |   |             |
| college under paragraph (1) for the first year in    |   |             |
| which such a grant is provided to the community      |   |             |
| college shall not exceed \$100,000.                  |   |             |
|                                                      |   |             |
| (b)(1)The Secretary, acting through the Service,     |   |             |
| shall award grants to community colleges that have   |   |             |
| established a program described in subsection (a)(1) |   |             |
| for the purpose of maintaining the program and       |   |             |
| recruiting students for the program.                 |   |             |
|                                                      |   |             |
| (2)Grants may only be made under this section to a   |   |             |
| community college which\--                           |   |             |
|                                                      |   |             |
| > (A)is accredited,                                  |   |             |
| >                                                    |   |             |
| > (B)has access to a hospital facility, Service      |   |             |
| > facility, or hospital that could provide training  |   |             |
| > of nurses or health professionals.                 |   |             |
| >                                                    |   |             |
| > (C)has entered into an agreement with an           |   |             |
| > accredited college or university medical school,   |   |             |
| > the terms of which\--                              |   |             |
| >                                                    |   |             |
| > (i)provide a program that enhances the transition  |   |             |
| > and recruitment of students into advanced          |   |             |
| > baccalaureate or graduate programs which train     |   |             |
| > health professionals, and                          |   |             |
| >                                                    |   |             |
| > (iii)stipulate certifications necessary to approve |   |             |
| > internship and field placement opportunities at    |   |             |
| > service unit facilities of the Service or at       |   |             |
| > tribal health facilities,                          |   |             |
| >                                                    |   |             |
| > (D)has a qualified staff which has the appropriate |   |             |
| > certifications, and                                |   |             |
| >                                                    |   |             |
| > (E)is capable of obtaining State or regional       |   |             |
| > accreditation of the program described in          |   |             |
| > subsection (a)(1).                                 |   |             |
|                                                      |   |             |
| \(c\) The Secretary shall encourage community        |   |             |
| colleges described in subsection (b)(2) to establish |   |             |
| and maintain programs described in subsection (a)(1) |   |             |
| by\--                                                |   |             |
|                                                      |   |             |
| > (1)entering into agreements with such colleges for |   |             |
| > the provision of qualified personnel of the        |   |             |
| > service to teach courses of study in such          |   |             |
| > programs, and                                      |   |             |
| >                                                    |   |             |
| > (2)providing technical assistance and support to   |   |             |
| > such colleges.                                     |   |             |
|                                                      |   |             |
| \(d\) Any program receiving assistance under this    |   |             |
| section that is conducted with respect to a health   |   |             |
| profession shall also offer courses of study which   |   |             |
| provide advanced training for any health             |   |             |
| professional who\--                                  |   |             |
|                                                      |   |             |
| > (1)has already received a degree or diploma in     |   |             |
| > such health profession, and                        |   |             |
| >                                                    |   |             |
| > (2)provides clinical services on an Indian         |   |             |
| > reservation, at a Service facility, or at a tribal |   |             |
| > clinic.                                            |   |             |
|                                                      |   |             |
| Such courses of study may be offered in conjunction  |   |             |
| with the college or university with which the        |   |             |
| community college has entered into the agreement     |   |             |
| required under subsection (b)(2)(C).                 |   |             |
|                                                      |   |             |
| (e)For purposes of this section\--                   |   |             |
|                                                      |   |             |
| > (1)The term \"community college\" means-           |   |             |
| >                                                    |   |             |
| > (A)a tribally controlled community college, or     |   |             |
| >                                                    |   |             |
| > (B)a junior or community college.                  |   |             |
| >                                                    |   |             |
| > (2)the term \"tribally controlled community        |   |             |
| > college\" has the meaning given to such term by    |   |             |
| > section 2(4) of the Tribally Controlled Community  |   |             |
| > College Assistance Act of 1978.                    |   |             |
| >                                                    |   |             |
| > (3)The term \"junior or community college\" has    |   |             |
| > the meaning given to such term by section 312(e)   |   |             |
| > of the Higher Education Act of 1965 (20 U.S.C.     |   |             |
| > 1058(e)).                                          |   |             |
|                                                      |   |             |
| ~~(f) There are authorized to be appropriated for    |   |             |
| each of the fiscal years 1990, 1991, and 1992,       |   |             |
| \$1,500,000 to carry out the provisions of this      |   |             |
| section.~~                                           |   |             |
|                                                      |   |             |
| ADDITIONAL INCENTIVES FOR HEALTH PROFESSIONALS       |   |             |
|                                                      |   |             |
| SEC. 116. (a) The Secretary may provide the          |   |             |
| incentive special pay authorized under section       |   |             |
| 302(b) of title 37, United States Code, to civilian  |   |             |
| medical officers of the Indian Health Service who    |   |             |
| are assigned to, and serving in, positions included  |   |             |
| in the list established under subsection (b)(1) for  |   |             |
| which recruitment or retention of personnel is       |   |             |
| difficult.                                           |   |             |
|                                                      |   |             |
| (b)(1) The Secretary shall establish and update on   |   |             |
| an annual basis a list of positions of health care   |   |             |
| professionals employed by, or assigned to, the       |   |             |
| Service for which recruitment or retention is        |   |             |
| difficult.                                           |   |             |
|                                                      |   |             |
| (2)(A) The Secretary may pay a bonus to any          |   |             |
| commissioned officer or civil service employee,      |   |             |
| other than a commissioned medical officer, dental    |   |             |
| officer, optometrist, and veterinarian, who is       |   |             |
| employed in or assigned to, and serving in, a        |   |             |
| position in the Service included in the list         |   |             |
| established by the Secretary under paragraph (1).    |   |             |
|                                                      |   |             |
| \(B\) The total amount of bonus payments made by the |   |             |
| Secretary under this paragraph to any employee       |   |             |
| during any 1-year period shall not exceed \$2,000.   |   |             |
|                                                      |   |             |
| \(c\) The Secretary may establish programs to allow  |   |             |
| the use of flexible work schedules, and compressed   |   |             |
| work schedules, in accordance with the provisions of |   |             |
| subchapter II of chapter 61, title 5, United States  |   |             |
| Code, for health professionals employed by, or       |   |             |
| assigned to, the Service.                            |   |             |
|                                                      |   |             |
| ~~(d) By no later than the date that is 6 months     |   |             |
| after the date of enactment of the Indian Health     |   |             |
| Care Amendments of 1988, the Secretary shall submit  |   |             |
| a report to the Congress on the limitation imposed   |   |             |
| on amounts of premium pay for overtime to any        |   |             |
| individual employed by, or assigned to, the Service. |   |             |
| The report shall include an explanation of existing  |   |             |
| overtime pay policy, an estimate of the budget       |   |             |
| impact of removing limitations on overtime pay, a    |   |             |
| summary of problems associated with overtime pay     |   |             |
| limitations, and recommendations for changes to the  |   |             |
| overtime pay policy~~.                               |   |             |
|                                                      |   |             |
| ~~(e) There are authorized to be appropriated        |   |             |
| \$600,000 for each of the fiscal years 1990, 1991,   |   |             |
| and 1992 to carry out the provisions of this         |   |             |
| section.~~                                           |   |             |
|                                                      |   |             |
| RETENTION BONUS                                      |   |             |
|                                                      |   |             |
| SEC. 117. (a) The Secretary may pay a retention      |   |             |
| bonus to any physician or nurse employed by, or      |   |             |
| assigned to, and serving in, the Service either as a |   |             |
| civilian employee or as a commissioned officer in    |   |             |
| the Regular or Reserve Corps of the Public Health    |   |             |
| Service who\--                                       |   |             |
|                                                      |   |             |
| > \(1\) is assigned to, and serving in, a position   |   |             |
| > included in the list established under section     |   |             |
| > 116(b)(1) for which recruitment or retention of    |   |             |
| > personnel is difficult,                            |   |             |
| >                                                    |   |             |
| > \(2\) the Secretary determines is needed by the    |   |             |
| > Service,                                           |   |             |
| >                                                    |   |             |
| > \(3\) has\--                                       |   |             |
| >                                                    |   |             |
| > \(A\) completed 3 years of employment with the     |   |             |
| > Service, or                                        |   |             |
| >                                                    |   |             |
| > \(B\) completed any service obligations incurred   |   |             |
| > as a requirement of\--                             |   |             |
| >                                                    |   |             |
| > (i)any Federal scholarship program, or             |   |             |
| >                                                    |   |             |
| > (ii)any Federal education loan repayment program,  |   |             |
| > and                                                |   |             |
| >                                                    |   |             |
| > \(4\) enters into an agreement with the Service    |   |             |
| > for continued employment for a period of not less  |   |             |
| > than 1 year.                                       |   |             |
|                                                      |   |             |
| \(b\) Beginning with fiscal year 1993, not less than |   |             |
| 25 percent of the retention bonuses awarded each     |   |             |
| year under subsection (a) shall be awarded to        |   |             |
| nurses.                                              |   |             |
|                                                      |   |             |
| ~~(b)~~ (c) The Secretary may establish rates for    |   |             |
| the retention bonus which shall provide a for a      |   |             |
| higher annual rate for multiyear agreements than for |   |             |
| single year agreements referred to in subsection     |   |             |
| (a)(4), but in no event shall the annual rate be     |   |             |
| more than \$25,000 per annum.                        |   |             |
|                                                      |   |             |
| ~~(c)~~ (d) The retention bonus for the entire       |   |             |
| period covered by the agreement described in         |   |             |
| subsection (a)(4) shall be paid at the beginning of  |   |             |
| the agreed upon term of service.                     |   |             |
|                                                      |   |             |
| ~~(d)~~ (e) Any physician or nurse failing to        |   |             |
| complete the agreed upon term of service, except     |   |             |
| where such failure is through no fault of the        |   |             |
| individual, shall be obligated to refund to the      |   |             |
| government the full amount of the retention bonus    |   |             |
| for the period covered by the agreement, plus        |   |             |
| interest as determined by the Secretary in           |   |             |
| accordance with section 108(l)(2)(B).                |   |             |
|                                                      |   |             |
| \(f\) The Secretary may pay a retention bonus to any |   |             |
| physician or nurse employed by an organization       |   |             |
| providing health care services to Indians pursuant   |   |             |
| to a contract under the Indian Self‑ Determination   |   |             |
| Act if such physician or nurse is serving in a       |   |             |
| position which the Secretary determines is‑‑         |   |             |
|                                                      |   |             |
| > \(1\) a position for which recruitment or          |   |             |
| > retention is difficult; and                        |   |             |
| >                                                    |   |             |
| > \(2\) necessary for providing health care services |   |             |
| > to Indians.                                        |   |             |
|                                                      |   |             |
| NURSING RESIDENCY PROGRAM                            |   |             |
|                                                      |   |             |
| SEC. 118. (a) The Secretary, acting through the      |   |             |
| Service, shall establish a program to enable         |   |             |
| licensed practical nurses, licensed vocational       |   |             |
| nurses, and registered nurses who are working in an  |   |             |
| Indian health program (as defined in section         |   |             |
| 108(a)(2)(A)), and have done so for a period of not  |   |             |
| less than one year, to pursue advanced training.     |   |             |
|                                                      |   |             |
| \(b\) Such program shall include a combination of    |   |             |
| education and work study in an Indian health program |   |             |
| (as defined in section 108(a)(2)(A)) leading to an   |   |             |
| associate or bachelor\'s degree (in the case of a    |   |             |
| licensed practical nurse or licensed vocational      |   |             |
| nurse) or a bachelor\'s degree (in the case of a     |   |             |
| registered nurse).                                   |   |             |
|                                                      |   |             |
| \(c\) An individual who participates in a program    |   |             |
| under subsection (a), where the educational costs    |   |             |
| are paid by the Service, shall incur an obligation   |   |             |
| to serve in an Indian health program for a period of |   |             |
| obligated service equal to at least three times the  |   |             |
| period of time during which the individual           |   |             |
| participates in such program. In the event that the  |   |             |
| individual fails to complete such obligated service, |   |             |
| the United States shall be entitled to recover from  |   |             |
| such individual an amount determined in accordance   |   |             |
| with the formula specified in subsection (l) of      |   |             |
| section 108 in the manner provided for in such       |   |             |
| subsection.                                          |   |             |
|                                                      |   |             |
| COMMUNITY HEALTH AIDE PROGRAM FOR ALASKA             |   |             |
|                                                      |   |             |
| SEC. 119. (a) Under the authority of the Act of      |   |             |
| November 2, 1921 (25 U.S.C. 13; popularly known as   |   |             |
| the Snyder Act), the Secretary shall maintain a      |   |             |
| Community Health Aide Program in Alaska under which  |   |             |
| the Service‑‑                                        |   |             |
|                                                      |   |             |
| > \(1\) provides for the training of Alaska Natives  |   |             |
| > as health aides or community health practitioners; |   |             |
| >                                                    |   |             |
| > \(2\) uses such aides or practitioners in the      |   |             |
| > provision of health care, health promotion, and    |   |             |
| > disease prevention services to Alaska Natives      |   |             |
| > living in villages in rural Alaska; and            |   |             |
| >                                                    |   |             |
| > \(3\) provides for the establishment of            |   |             |
| > teleconferencing capacity in health clinics        |   |             |
| > located in or near such villages for use by        |   |             |
| > community health aides or community health         |   |             |
| > practitioners.                                     |   |             |
|                                                      |   |             |
| \(b\) The Secretary, acting through the Community    |   |             |
| Health Aide Program of the Service, shall‑‑          |   |             |
|                                                      |   |             |
| > \(1\) using trainers accredited by the Program,    |   |             |
| > provide a high standard of training to community   |   |             |
| > health aides and community health practitioners to |   |             |
| > ensure that such aides and practitioners provide   |   |             |
| > quality health care, health promotion, and disease |   |             |
| > prevention services to the villages served by the  |   |             |
| > Program;                                           |   |             |
| >                                                    |   |             |
| > \(2\) in order to provide such training, develop a |   |             |
| > curriculum that‑‑                                  |   |             |
| >                                                    |   |             |
| > \(A\) combines education in the theory of health   |   |             |
| > care with supervised practical experience in the   |   |             |
| > provision of health care;                          |   |             |
| >                                                    |   |             |
| > \(B\) provides instruction and practical           |   |             |
| > experience in the provision of acute care,         |   |             |
| > emergency care, health promotion, disease          |   |             |
| > prevention, and the efficient and effective        |   |             |
| > management of clinic pharmacies, supplies,         |   |             |
| > equipment, and facilities; and                     |   |             |
| >                                                    |   |             |
| > \(C\) promotes the achievement of the health       |   |             |
| > status objectives specified in section 3(b);       |   |             |
| >                                                    |   |             |
| > \(3\) establish and maintain a Community Health    |   |             |
| > Aide Certification Board to certify as community   |   |             |
| > health aides or community health practitioners     |   |             |
| > individuals who have successfully completed the    |   |             |
| > training described in paragraph (1) or can         |   |             |
| > demonstrate equivalent experience;                 |   |             |
| >                                                    |   |             |
| > \(4\) develop and maintain a system which          |   |             |
| > identifies the needs of community health aides and |   |             |
| > community health practitioners for continuing      |   |             |
| > education in the provision of health care,         |   |             |
| > including the areas described in paragraph (2)(B), |   |             |
| > and develop programs that meet the needs for such  |   |             |
| > continuing education;                              |   |             |
| >                                                    |   |             |
| > \(5\) develop and maintain a system that provides  |   |             |
| > close supervision of community health aides and    |   |             |
| > community health practitioners; and                |   |             |
| >                                                    |   |             |
| > \(6\) develop a system under which the work of     |   |             |
| > community health aides and community health        |   |             |
| > practitioners is reviewed and evaluated to assure  |   |             |
| > the provision of quality health care, health       |   |             |
| > promotion, and disease prevention services.        |   |             |
|                                                      |   |             |
| MATCHING GRANTS TO TRIBES FOR SCHOLARSHIP PROGRAMS   |   |             |
|                                                      |   |             |
| SEC. 120. (a)(1) The Secretary shall make grants to  |   |             |
| Indian tribes and tribal organizations for the       |   |             |
| purpose of assisting such tribes and tribal          |   |             |
| organizations in educating Indians to serve as       |   |             |
| health professionals in Indian communities.          |   |             |
|                                                      |   |             |
| \(2\) Amounts available for grants under paragraph   |   |             |
| (1) for any fiscal year shall not exceed 5 percent   |   |             |
| of amounts available for such fiscal year for Indian |   |             |
| Health Scholarships under section 104.               |   |             |
|                                                      |   |             |
| \(3\) An application for a grant under paragraph (1) |   |             |
| shall be in such form and contain such agreements,   |   |             |
| assurances, and information as the Secretary         |   |             |
| determines are necessary to carry out this section.  |   |             |
|                                                      |   |             |
| (b)(1) An Indian tribe or tribal organization        |   |             |
| receiving a grant under subsection (a) shall agree   |   |             |
| to provide scholarships to Indians pursuing          |   |             |
| education in the health professions in accordance    |   |             |
| with the requirements of this section.               |   |             |
|                                                      |   |             |
| \(2\) With respect to the costs of providing any     |   |             |
| scholarship pursuant to paragraph (1)‑‑              |   |             |
|                                                      |   |             |
| > \(A\) 80 percent of the costs of the scholarship   |   |             |
| > shall be paid from the grant made under subsection |   |             |
| > (a) to the Indian tribe or tribal organization;    |   |             |
| > and                                                |   |             |
| >                                                    |   |             |
| > \(B\) 20 percent of such costs shall be paid from  |   |             |
| > non‑ Federal contributions by the Indian tribe or  |   |             |
| > tribal organization through which the scholarship  |   |             |
| > is provided.                                       |   |             |
|                                                      |   |             |
| \(3\) In determining the amount of non‑Federal       |   |             |
| contributions that have been provided for purposes   |   |             |
| of subparagraph (B) of paragraph (2), any amounts    |   |             |
| provided by the Federal Government to the Indian     |   |             |
| tribe or tribal organization involved or to any      |   |             |
| other entity shall not be included.                  |   |             |
|                                                      |   |             |
| \(4\) Non‑Federal contributions required by          |   |             |
| subparagraph (B) of paragraph (2) may be provided    |   |             |
| directly by the Indian tribe or tribal organization  |   |             |
| involved or through donations from public and        |   |             |
| private entities.                                    |   |             |
|                                                      |   |             |
| \(c\) An Indian tribe or tribal organization shall   |   |             |
| provide scholarships under subsection (b) only to    |   |             |
| Indians enrolled or accepted for enrollment in a     |   |             |
| course of study (approved by the Secretary) in one   |   |             |
| of the health professions described in section       |   |             |
| 104(a).                                              |   |             |
|                                                      |   |             |
| \(d\) In providing scholarships under subsection     |   |             |
| (b), the Secretary and the Indian tribe or tribal    |   |             |
| organization shall enter into a written contract     |   |             |
| with each recipient of such scholarship. Such        |   |             |
| contract shall‑‑                                     |   |             |
|                                                      |   |             |
| > \(1\) obligate such recipient to provide service   |   |             |
| > in an Indian health program (as defined in section |   |             |
| > 108(a)(2)(A)), in the same service area where the  |   |             |
| > Indian tribe or tribal organization providing the  |   |             |
| > scholarship is located, for‑‑                      |   |             |
| >                                                    |   |             |
| > \(A\) a number of years equal to the number of     |   |             |
| > years for which the scholarship is provided (or    |   |             |
| > the part‑time equivalent thereof, as determined by |   |             |
| > the Secretary), or for a period of 2 years,        |   |             |
| > whichever period is greater; or                    |   |             |
| >                                                    |   |             |
| > \(B\) such greater period of time as the recipient |   |             |
| > and the Indian tribe or tribal organization may    |   |             |
| > agree;                                             |   |             |
| >                                                    |   |             |
| > \(2\) provide that the amount of such              |   |             |
| > scholarship‑‑                                      |   |             |
| >                                                    |   |             |
| > \(A\) may be expended only for‑‑                   |   |             |
| >                                                    |   |             |
| > (i)tuition expenses,other reasonable educational   |   |             |
| > expenses, and reasonable living expenses incurred  |   |             |
| > in attendance at the educational institution; and  |   |             |
| >                                                    |   |             |
| > \(ii\) payment to the recipient of a monthly       |   |             |
| > stipend of not more than the amount authorized by  |   |             |
| > section 338A(g)(1)(B) of the Public Health Service |   |             |
| > Act(42 U.S.C. 254m(g)(1)(B)), such amount to be    |   |             |
| > reduced pro rata (as determined by the Secretary)  |   |             |
| > based on the number of hours such student is       |   |             |
| > enrolled; and                                      |   |             |
| >                                                    |   |             |
| > \(B\) may not exceed, for any year of attendance   |   |             |
| > which the scholarship is provided, the total       |   |             |
| > amount required for the year for the purposes      |   |             |
| > authorized in subparagraph (A);                    |   |             |
| >                                                    |   |             |
| > \(3\) require the recipient of such scholarship to |   |             |
| > maintain an acceptable level of academic standing  |   |             |
| > (as determined by the educational institution in   |   |             |
| > accordance with regulations issued by the          |   |             |
| > Secretary); and                                    |   |             |
| >                                                    |   |             |
| > \(4\) require the recipient of such scholarship to |   |             |
| > meet the educational and licensure requirements    |   |             |
| > necessary to be a physician, certified nurse       |   |             |
| > practitioner, certified nurse midwife, or          |   |             |
| > physician assistant.                               |   |             |
|                                                      |   |             |
| (e)(1) An individual who has entered into a written  |   |             |
| contract with the Secretary and an Indian tribe or   |   |             |
| tribal organization under subsection (d) and who‑‑   |   |             |
|                                                      |   |             |
| > (A)fails to maintain an acceptable level of        |   |             |
| > academic standing in the educational institution   |   |             |
| > in which he is enrolled (such level determined by  |   |             |
| > the educational institution under regulations of   |   |             |
| > the Secretary),                                    |   |             |
| >                                                    |   |             |
| > (B)is dismissed from such educational institution  |   |             |
| > for disciplinary reasons,                          |   |             |
| >                                                    |   |             |
| > (C)voluntarily terminates the training in such an  |   |             |
| > educational institution for which he is provided a |   |             |
| > scholarship under such contract before the         |   |             |
| > completion of such training, or                    |   |             |
| >                                                    |   |             |
| > (D)fails to accept payment, or instructs the       |   |             |
| > educational institution in which he is enrolled    |   |             |
| > not to accept payment, in whole or in part, of a   |   |             |
| > scholarship under such contract, in lieu of any    |   |             |
| > service obligation arising under such contract,    |   |             |
| > shall be liable to the United States for the       |   |             |
| > Federal share of the amount which has been paid to |   |             |
| > him, or on his behalf, under the contract.         |   |             |
|                                                      |   |             |
| \(2\) If for any reason not specified in paragraph   |   |             |
| (1), an individual breaches his written contract by  |   |             |
| failing either to begin such individual\'s service   |   |             |
| obligation required under such contract or to        |   |             |
| complete such service obligation, the United States  |   |             |
| shall be entitled to recover from the individual an  |   |             |
| amount determined in accordance with the formula     |   |             |
| specified in subsection (l) of section 108 in the    |   |             |
| manner provided for in such subsection.              |   |             |
|                                                      |   |             |
| \(3\) The Secretary may carry out this subsection on |   |             |
| the basis of information submitted by the tribes or  |   |             |
| tribal organizations involved, or on the basis of    |   |             |
| information collected through such other means as    |   |             |
| the Secretary determines to be appropriate.          |   |             |
|                                                      |   |             |
| \(f\) The recipient of a scholarship under           |   |             |
| subsection (b) shall agree, in providing health care |   |             |
| pursuant to the requirements of subsection (d)(1)‑‑  |   |             |
|                                                      |   |             |
| > \(1\) not to discriminate against an individual    |   |             |
| > seeking such care on the basis of the ability of   |   |             |
| > the individual to pay for such care or on the      |   |             |
| > basis that payment for such care will be made      |   |             |
| > pursuant to the program established in title XVIII |   |             |
| > of the Social Security Act or pursuant to the      |   |             |
| > program established in title XIX of such Act; and  |   |             |
| >                                                    |   |             |
| > \(2\) to accept assignment under section           |   |             |
| > 1842(b)(3)(B)(ii) of the Social Security Act for   |   |             |
| > all services for which payment may be made under   |   |             |
| > part B of title XVIII of such Act, and to enter    |   |             |
| > into an appropriate agreement with the State       |   |             |
| > agency that administers the State plan for medical |   |             |
| > assistance under title XIX of such Act to provide  |   |             |
| > service to individuals entitled to medical         |   |             |
| > assistance under the plan.                         |   |             |
|                                                      |   |             |
| \(g\) The Secretary may not make any payments under  |   |             |
| subsection (a) to an Indian tribe or tribal          |   |             |
| organization for any fiscal year subsequent to the   |   |             |
| first fiscal year of such payments unless the        |   |             |
| Secretary determines that, for the immediately       |   |             |
| preceding fiscal year, the Indian tribe or tribal    |   |             |
| organization has complied with requirements of this  |   |             |
| section.                                             |   |             |
|                                                      |   |             |
| TRIBAL HEALTH PROGRAM ADMINISTRATION                 |   |             |
|                                                      |   |             |
| SEC. 121. The Secretary shall, by contract or        |   |             |
| otherwise, provide training for individuals in the   |   |             |
| administration and planning of tribal health         |   |             |
| programs.                                            |   |             |
|                                                      |   |             |
| UNIVERSITY OF SOUTH DAKOTA PILOT PROGRAM             |   |             |
|                                                      |   |             |
| SEC. 122. (a) The Secretary may make a grant to the  |   |             |
| School of Medicine of the University of South Dakota |   |             |
| (hereafter in this section referred to as \"USDSM\") |   |             |
| to establish a pilot program on an Indian            |   |             |
| reservation at one or more service units in South    |   |             |
| Dakota to address the chronic manpower shortage in   |   |             |
| the Aberdeen Area of the Service.                    |   |             |
|                                                      |   |             |
| \(b\) The purposes of the program established        |   |             |
| pursuant to a grant provided under subsection (a)    |   |             |
| are‑‑                                                |   |             |
|                                                      |   |             |
| > \(1\) to provide direct clinical and practical     |   |             |
| > experience at a service unit to medical students   |   |             |
| > and residents from USDSM and other medical         |   |             |
| > schools;                                           |   |             |
| >                                                    |   |             |
| > \(2\) to improve the quality of health care for    |   |             |
| > Indians by assuring access to qualified health     |   |             |
| > care professionals; and                            |   |             |
| >                                                    |   |             |
| > \(3\) to provide academic and scholarly            |   |             |
| > opportunities for physicians, physician            |   |             |
| > assistants, nurse practitioners, nurses, and other |   |             |
| > allied health professionals serving Indian people  |   |             |
| > by identifying and utilizing all academic and      |   |             |
| > scholarly resources of the region.                 |   |             |
|                                                      |   |             |
| \(c\) The pilot program established pursuant to a    |   |             |
| grant provided under subsection (a) shall‑‑          |   |             |
|                                                      |   |             |
| > \(1\) incorporate a program advisory board         |   |             |
| > composed of representatives from the tribes and    |   |             |
| > communities in the area which will be served by    |   |             |
| > the program; and                                   |   |             |
| >                                                    |   |             |
| > \(2\) shall be designated as an extension of the   |   |             |
| > USDSM campus and program participants shall be     |   |             |
| > under the direct supervision and instruction of    |   |             |
| > qualified medical staff serving at the service     |   |             |
| > unit who shall be members of the USDSM faculty.    |   |             |
|                                                      |   |             |
| \(d\) The USDSM shall coordinate the program         |   |             |
| established pursuant to a grant provided under       |   |             |
| subsection (a) with other medical schools in the     |   |             |
| region, nursing schools, tribal community colleges,  |   |             |
| and other health professional schools.               |   |             |
|                                                      |   |             |
| \(e\) The USDSM, in cooperation with the Service,    |   |             |
| shall develop additional professional opportunities  |   |             |
| for program participants on Indian reservations in   |   |             |
| order to improve the recruitment and retention of    |   |             |
| qualified health professionals in the Aberdeen Area  |   |             |
| of the Service.                                      |   |             |
|                                                      |   |             |
| AUTHORIZATION OF APPROPRIATIONS                      |   |             |
|                                                      |   |             |
| SEC. 123. There are authorized to be appropriated    |   |             |
| such sums as may be necessary for each fiscal year   |   |             |
| through fiscal year 2000 to carry out this title.    |   |             |
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