I

103D CONGRESS

2D SESSION H. R. 3869

To amend the Public Health Service Act to revise and extend programs

relating to the health of individuals who are members of minority groups,

and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 11, 1994

Mr. WAXMAN (for himself, Mr. SYNAR, Mr. RICHARDSON, Mr. TOWNS, Mr.

WASHINGTON, Mr. UPTON, Mr. FRANKS of Connecticut, Mr. MINETA,

Mr. MATSUI, Mr. SERRANO, Mr. GUTIERREZ, Mr. PASTOR, Mr.

MENENDEZ, Mr. ROMERO-BARCELO ́, Ms. VELA ́ZQUEZ, and Mr.

UNDERWOOD) introduced the following bill; which was referred to the

Committee on Energy and Commerce

A BILL

To amend the Public Health Service Act to revise and extend

programs relating to the health of individuals who are

members of minority groups, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Minority Health Improvement Act of 1994’’.

6 (b) TABLE OF CONTENTS.—The table of contents for

7 this Act is as follows:
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Sec. 1. Short title; table of contents.

TITLE I—OFFICE OF MINORITY HEALTH

Sec. 101. Revision and extension of programs of Office of Minority Health.

Sec. 102. Establishment of individual offices of minority health within agencies

of Public Health Service.

TITLE II—PRIMARY HEALTH SERVICES

Sec. 201. Migrant health centers; community health centers.

Sec. 202. Health services for the homeless.

Sec. 203. Health services for residents of public housing.

Sec. 204. Grants to States for loan repayment programs regarding obligated

service of health professionals.

Sec. 205. Grants to States for operation of State offices of rural health.

Sec. 206. Demonstration grants to States for community scholarship programs

regarding obligated service of health professionals.

Sec. 207. Programs regarding birth defects.

Sec. 208. Healthy start for infants.

Sec. 209. Demonstration projects regarding diabetic-retinopathy.

TITLE III—HEALTH PROFESSIONS PROGRAMS

Sec. 301. Primary care scholarships for students from disadvantaged backgrounds.

Sec. 302. Scholarships generally; certain other purposes.

Sec. 303. Loan repayments and fellowships regarding faculty positions.

Sec. 304. Centers of Excellence.

Sec. 305. Educational assistance regarding undergraduates.

Sec. 306. Student loans regarding schools of nursing.

Sec. 307. Federally-supported student loans funds.

TITLE IV—RESEARCH

Sec. 401. Office of Research on Minority Health.

Sec. 402. Activities of Agency for Health Care Policy and Research.

Sec. 403. Data collection by National Center for Health Statistics.

TITLE V—NATIVE HAWAIIAN HEALTH CARE

Sec. 501. Clarification of 1992 amendments.

Sec. 502. Amendment of Native Hawaiian Health Care Improvement Act to reflect 1992 agreement.

Sec. 503. Repeal of Public Health Service Act provision.

TITLE VI—MISCELLANEOUS PROVISIONS

Sec. 601. Technical amendment to Indian Health Care Improvement Act.

Sec. 602. Health services for Pacific Islanders.

Sec. 603. Technical corrections regarding Public Law 103-183.

Sec. 604. Certain authorities of Centers for Disease Control and Prevention.

TITLE VII—GENERAL PROVISIONS

Sec. 701. Effective date.
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1 TITLE I—OFFICE OF MINORITY

2 HEALTH

3 SEC. 101. REVISION AND EXTENSION OF PROGRAMS OF OF4 FICE OF MINORITY HEALTH.

5 (a) IN GENERAL.—Section 1707 of the Public Health

6 Service Act (42 U.S.C. 300u–6) is amended by striking

7 subsection (b) and all that follows and inserting the follow8 ing:

9 ‘‘(b) DUTIES.—With respect to improving the health

10 of minority groups, the Secretary shall carry out the fol11 lowing:

12 ‘‘(1) In consultation with the advisory council

13 under subsection (c), establish goals and objectives

14 regarding disease prevention, health promotion, serv15 ice delivery, and research, and coordinate all activi16 ties within the Department of Health and Human

17 Services that relate to such goals and objectives.

18 ‘‘(2) In consultation with such council, enter

19 into interagency agreements with other agencies of

20 the Service, and under such agreements provide

21 amounts to such agencies, to carry out the following:

22 ‘‘(A) Support research, demonstrations and

23 evaluations to test new and innovative models

24 of delivering services.
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1 ‘‘(B) Increase knowledge and understand2 ing of health risk factors.

3 ‘‘(C) Ensure that the National Center for

4 Health Statistics collects data on the health

5 status of each minority group.

6 ‘‘(D) With respect to individuals who lack

7 proficiency in speaking the English language,

8 enter into contracts with public and nonprofit

9 private providers of primary health services for

10 the purpose of increasing the access of the indi11 viduals to such services by developing and car12 rying out programs to provide bilingual or in13 terpretive services.

14 ‘‘(3) Establish by contract a center to carry out

15 the following:

16 ‘‘(A) Facilitate the exchange of informa17 tion regarding matters relating to health infor18 mation and health promotion, preventive health

19 services, and education in the appropriate use

20 of health care.

21 ‘‘(B) Facilitate access to such information.

22 ‘‘(C) Assist in the analysis of issues and

23 problems relating to such matters.

24 ‘‘(D) Provide technical assistance with re25 spect to the exchange of such information (in-
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1 cluding facilitating the development of materials

2 for such technical assistance).

3 ‘‘(4)(A) Establish by contract a center for the

4 purpose of carrying out programs to improve access

5 to health care services for individuals who lack pro6 ficiency in speaking the English language by devel7 oping and carrying out programs to provide bilingual

8 or interpretive services.

9 ‘‘(B) In carrying out subparagraph (A), ensure

10 that—

11 ‘‘(i) the center under such subparagraph

12 conducts research, develops and evaluates model

13 projects, and provides technical assistance to

14 health care providers; and

15 ‘‘(ii) such center is not operated by the en16 tity that operates the center established under

17 paragraph (3).

18 ‘‘(c) ADVISORY COMMITTEE.—

19 ‘‘(1) IN GENERAL.—The Secretary shall estab20 lish an advisory committee to be known as the Advi21 sory Committee on Minority Health (in this sub22 section referred to as the ‘Committee’).

23 ‘‘(2) DUTIES.—The Committee shall provide

24 advice to the Secretary on carrying out this section,
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1 including advice on carrying out paragraphs (1) and

2 (2) of subsection (b) for each minority group.

3 ‘‘(3) COMPOSITION.—

4 ‘‘(A) The Committee shall be composed of

5 12 voting members appointed in accordance

6 with subparagraph (B) and the nonvoting, ex

7 officio members designated under subparagraph

8 (C).

9 ‘‘(B) The voting members of the Commit10 tee shall be appointed from among individuals

11 who have expertise regarding the health status

12 of minority groups and the access of such

13 groups to health services, which individuals are

14 not officers or employees of the Federal Gov15 ernment. The appointed membership of the

16 Committee shall be broadly representative of

17 the various minority groups.

18 ‘‘(C) The Secretary shall designate as ex

19 officio members of the Committee the heads of

20 the minority health offices referred to in section

21 1707A.

22 ‘‘(d) APPROPRIATE CONTEXT OF SERVICES.—The

23 Secretary shall ensure that information and services pro24 vided pursuant to subsection (b) are provided in the lan25 guage and cultural context that is most appropriate for
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1 the individuals for whom the information and services are

2 intended.

3 ‘‘(e) EQUITABLE ALLOCATION OF SERVICES.—The

4 Secretary shall ensure that services provided under sub5 section (b) are equitably allocated among the various mi6 nority groups.

7 ‘‘(f) CONSULTATION WITH INDIVIDUAL MINORITY

8 HEALTH OFFICES.—In carrying out subsection (b) re9 garding a specified agency, the Secretary shall consult

10 with the head of the minority health office of the agency.

11 For purposes of the preceding sentence, the terms ‘speci12 fied agency’ and ‘minority health office’ have the meaning

13 given such terms in section 1707A(f).

14 ‘‘(g) BIENNIAL REPORTS.—Not later than February

15 1 of fiscal year 1996 and of each second year thereafter,

16 the Secretary shall submit to the Committee on Energy

17 and Commerce of the House of Representatives, and to

18 the Committee on Labor and Human Resources of the

19 Senate, a report describing the activities carried out under

20 this section during the preceding 2 fiscal years and evalu21 ating the extent to which such activities have been effec22 tive in improving the health of minority groups. Each such

23 report shall include the biennial reports submitted to the

24 Secretary under section 1707A(e) for such years by the

25 heads of the minority health offices.
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1 ‘‘(h) DEFINITION.—For purposes of this section, the

2 term ‘minority groups’ means African Americans, Amer3 ican Indians, Asian Americans, Hispanics, and Pacific Is4 landers.

5 ‘‘(i) FUNDING.—

6 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

7 For the purpose of carrying out this section, there

8 is authorized to be appropriated $21,000,000 for

9 each of the fiscal years 1995 through 1997.

10 ‘‘(2) ALLOCATION OF FUNDS BY SECRETARY.—

11 Of the amounts appropriated under paragraph (1)

12 for a fiscal year, the Secretary shall make available

13 not less than $3,000,000 for carrying out subsection

14 (b)(2)(D).’’.

15 (b) MISCELLANEOUS AMENDMENT.—Section 1707 of

16 the Public Health Service Act (42 U.S.C. 300u–6) is

17 amended in the heading for the section by striking ‘‘ES18 TABLISHMENT OF’’.

19 SEC. 102. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MI20 NORITY HEALTH WITHIN AGENCIES OF PUB21 LIC HEALTH SERVICE.

22 Title XVII of the Public Health Service Act (42

23 U.S.C. 300u et seq.), as amended by section 302 of Public

24 Law 102–531 (106 Stat. 3483), is amended by inserting

25 after section 1707 the following section:
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1 ‘‘INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN

2 PUBLIC HEALTH SERVICE

3 ‘‘SEC. 1707A. (a) IN GENERAL.—The head of each

4 agency specified in subsection (b)(1) shall establish within

5 the agency an office to be known as the Office of Minority

6 Health. Each such Office shall be headed by a director,

7 who shall be appointed by the head of the agency within

8 which the Office is established, and who shall report di9 rectly to the head of the agency. The head of such agency

10 shall carry out this section (as this section relates to the

11 agency) acting through such Director.

12 ‘‘(b) SPECIFIED AGENCIES.—

13 ‘‘(1) IN GENERAL.—The agencies referred to in

14 subsection (a) are the following:

15 ‘‘(A) The Centers for Disease Control and

16 Prevention.

17 ‘‘(B) The Agency for Health Care Policy

18 and Research.

19 ‘‘(C) The Health Resources and Services

20 Administration.

21 ‘‘(D) The Substance Abuse and Mental

22 Health Services Administration.

23 ‘‘(2) NATIONAL INSTITUTES OF HEALTH.—For

24 purposes of subsection (c) and the subsequent provi25 sions of this section, the term ‘minority health office’
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1 includes the Office of Research on Minority Health

2 established within the National Institutes of Health.

3 The Director of the National Institutes of Health

4 shall carry out this section (as this section relates to

5 the agency) acting through the Director of such Of6 fice.

7 ‘‘(c) COMPOSITION.—The head of each specified

8 agency shall ensure that the officers and employees of the

9 minority health office of the agency are, collectively, expe10 rienced in carrying out community-based health programs

11 for each of the various minority groups that are present

12 in significant numbers in the United States. The head of

13 such agency shall ensure that, of such officers and employ14 ees who are members of minority groups, no such group

15 is disproportionately represented.

16 ‘‘(d) DUTIES.—Each Director of a minority health of17 fice shall monitor the programs of the specified agency of

18 such office in order to—

19 ‘‘(A) determine the extent to which the pur20 poses of the programs are being carried out with re21 spect to minority groups;

22 ‘‘(B) determine the extent to which members of

23 such groups are represented among the Federal offi24 cers and employees who administer the programs;

25 and
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1 ‘‘(C) make recommendations to the head of

2 such agency on carrying out the programs with re3 spect to such groups.

4 ‘‘(e) BIENNIAL REPORTS TO SECRETARY.—The head

5 of each specified agency shall submit to the Secretary for

6 inclusion in each biennial report under section 1707(g)

7 (without change) a biennial report describing—

8 ‘‘(1) the extent to which the minority health of9 fice of the agency employs individuals who are mem10 bers of minority groups, including a specification by

11 minority group of the number of such individuals

12 employed by such office; and

13 ‘‘(2) the manner in which the agency is comply14 ing with Public Law 94–311 (relating to data on

15 Americans of Spanish origin or descent).

16 ‘‘(f) DEFINITIONS.—For purposes of this section:

17 ‘‘(1) The term ‘minority health office’ means an

18 office established under subsection (a), subject to

19 subsection (b)(2).

20 ‘‘(2) The term ‘minority group’ has the mean21 ing given such term in section 1707(h).

22 ‘‘(3) The term ‘specified agency’ means—

23 ‘‘(A) an agency specified in subsection

24 (b)(1); and

25 ‘‘(B) the National Institutes of Health.
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1 ‘‘(g) FUNDING.—

2 (1) ALLOCATIONS.—Of the amounts appro3 priated for a specified agency for a fiscal year, the

4 Secretary may reserve not more than 0.5 percent for

5 the purpose of carrying out activities under this sec6 tion through the minority health office of the agen7 cy. In reserving an amount under the preceding sen8 tence for a minority health office for a fiscal year,

9 the Secretary shall reduce, by substantially the same

10 percentage, the amount that otherwise would be

11 available for each of the programs of the designated

12 agency involved.

13 ‘‘(2) AVAILABILITY OF FUNDS FOR STAFF14 ING.—The purposes for which amounts made avail15 able under paragraph (1) may be expended by a mi16 nority health office include the costs of employing

17 staff for such office.’’.

18 TITLE II—PRIMARY HEALTH

19 SERVICES

20 SEC. 201. MIGRANT HEALTH CENTERS; COMMUNITY

21 HEALTH CENTERS.

22 (a) MIGRANT HEALTH CENTERS.—

23 (1) TREATMENT OF PREGNANT WOMEN FOR

24 SUBSTANCE ABUSE.—Section 329(a) of the Public
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1 Health Service Act (42 U.S.C. 254b(a)) is amend2 ed—

3 (A) in paragraph (1)(C)—

4 (i) by inserting ‘‘(i)’’ after ‘‘(C)’’;

5 (ii) in clause (i) (as so designated), by

6 adding ‘‘and’’ after the comma at the end;

7 and

8 (iii) by adding at the end the follow9 ing clause:

10 ‘‘(ii) to the State official responsible for carry11 ing out programs under subpart II of part B of title

12 XIX, and in accordance with the provisions of sec13 tion 543 regarding the disclosure of information, a

14 notification if a pregnant women is provided a refer15 ral for the treatment of substance abuse but the en16 tity involved does not have the capacity to admit ad17 ditional individuals for treatment,’’; and

18 (B) in paragraph (7)—

19 (i) in subparagraph (L), by striking

20 ‘‘and’’ at the end;

21 (ii) by redesignating subparagraph

22 (M) as subparagraph (N); and

23 (iii) by inserting after subparagraph

24 (L) the following subparagraph:
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1 ‘‘(M) treatment of pregnant women for sub2 stance abuse; and’’.

3 (2) OVERLAP IN CATCHMENT AREAS.—Section

4 329(a) of the Public Health Service Act (42 U.S.C.

5 254b(a)) is amended by adding at the end the fol6 lowing paragraph:

7 ‘‘(8) In making grants under subsections (c)(1) and

8 (d)(1), the Secretary may provide for the development and

9 operation of more than one migrant health center in a

10 catchment area in any case in which the Secretary deter11 mines that in such area there are workers or other individ12 uals described in subsection (a)(1) (in the matter after

13 and below subparagraph (H)) who otherwise will have a

14 shortage of personal health services. The preceding sen15 tence may not be construed as requiring that, in such a

16 case, the catchment areas of the centers involved be iden17 tical.’’.

18 (3) OFFSITE ACTIVITIES.—Section 329(a) of

19 the Public Health Service Act, as amended by para20 graph (2) of this subsection, is amended by adding

21 at the end the following paragraph:

22 ‘‘(9) In making grants under this section, the Sec23 retary may, to the extent determined by the Secretary to

24 be appropriate, authorize migrant health centers to pro25 vide services at locations other than the center.’’.
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1 (4) AMOUNT OF GRANT; USE OF CERTAIN

2 FUNDS.—Section 329(d)(4) of the Public Health

3 Service Act (42 U.S.C. 254b(d)(4)), as amended by

4 section 309(a)(3) of Public Law 102–531 (106 Stat.

5 3500), is amended to read as follows:

6 ‘‘(4)(A) The amount of a grant under paragraph (1)

7 or under subsection (c) for a migrant health center shall

8 be determined by the Secretary, taking into account (for

9 the period for which the grant is made)—

10 ‘‘(i) the costs that the center may reasonably be

11 expected to incur in carrying out the plan approved

12 by the Secretary pursuant to subsection (f)(3)(H),

13 and

14 ‘‘(ii) the amounts that the center may reason15 ably be expected to receive as State, local, and other

16 operational funding (exclusive of amounts to be pro17 vided in the grant under this section) and as fees,

18 premiums, and third-party reimbursements.

19 ‘‘(B)(i) Subject to clause (ii), the Secretary may not

20 restrict the purposes for which a migrant health center

21 expends the amounts described in subparagraph (A)(ii)

22 (including restrictions imposed pursuant to Federal cost

23 principles).

24 ‘‘(ii) The Secretary may require that amounts de25 scribed in subparagraph (A)(ii) be expended for purposes
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1 that are consistent with the purposes specified in this sec2 tion.

3 ‘‘(C)(i) Payments under a grant under this section

4 shall be made in advance or by way of reimbursement and

5 in such installments as the Secretary finds necessary. Ad6 justments in such payments may be made for overpay7 ments or underpayments, subject to clause (ii).

8 ‘‘(ii) If, for the period for which a grant is made

9 under paragraph (1) to a migrant health center, the sum

10 of the amount of the grant and the amounts described in

11 subparagraph (A)(ii) that the center actually received ex12 ceeded the costs of the center in carrying out the plan

13 approved by the Secretary pursuant to subsection

14 (f)(3)(H), then the center is entitled to retain such excess

15 amount if the center agrees to expend such amount only

16 for the following purposes:

17 ‘‘(I) To expand and improve services.

18 ‘‘(II) To increase the number of persons served.

19 ‘‘(III) To acquire, modernize, or expand facili20 ties, or to construct facilities.

21 ‘‘(IV) To improve the administration of service

22 programs.

23 ‘‘(V) To establish financial reserves.

24 ‘‘(D) With respect to funds that are amounts de25 scribed in subparagraph (A)(ii) or excess amounts de-
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1 scribed in subparagraph (C)(ii), this paragraph may not

2 be construed as limiting the authority of the Secretary to

3 require the submission of such plans, budgets, and other

4 information as may be necessary to ensure that the funds

5 are expended in accordance with subparagraph (B)(ii), or

6 clauses (I) through (V) of subparagraph (C)(ii), respec7 tively.’’.

8 (5) AUTHORIZATION OF APPROPRIATIONS.—

9 Section 329(h) of the Public Health Service Act (42

10 U.S.C. 254b(h)) is amended—

11 (A) in paragraph (1)(A), by striking

12 ‘‘1994’’ and inserting ‘‘1998’’; and

13 (B) in paragraph (2)(A), by striking

14 ‘‘1994’’ and inserting ‘‘1998’’.

15 (b) COMMUNITY HEALTH CENTERS.—

16 (1) TREATMENT OF PREGNANT WOMEN FOR

17 SUBSTANCE ABUSE.—Section 330 of the Public

18 Health Service Act (42 U.S.C. 254c) is amended—

19 (A) in subsection (a)(3)—

20 (i) by inserting ‘‘(A)’’ after ‘‘(3)’’;

21 (ii) in subparagraph (A) (as so des22 ignated), by adding ‘‘and’’ after the

23 comma at the end; and

24 (iii) by adding at the end the follow25 ing subparagraph:
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1 ‘‘(B) to the State official responsible for carry2 ing out programs under subpart II of part B of title

3 XIX, and in accordance with the provisions of sec4 tion 543 regarding the disclosure of information, a

5 notification if a pregnant women is provided a refer6 ral for the treatment of substance abuse but the en7 tity involved does not have the capacity to admit ad8 ditional individuals for treatment,’’; and

9 (B) in subsection (b)(2)—

10 (i) in subparagraph (L), by striking

11 ‘‘and’’ at the end;

12 (ii) by redesignating subparagraph

13 (M) as subparagraph (N); and

14 (iii) by inserting after subparagraph

15 (L) the following subparagraph:

16 ‘‘(M) treatment of pregnant women for sub17 stance abuse; and’’.

18 (2) OVERLAP IN CATCHMENT AREAS.—Section

19 330(b) of the Public Health Service Act (42 U.S.C.

20 254c(b)) is amended by adding at the end the fol21 lowing paragraph:

22 ‘‘(7) In making grants under subsections (c)(1) and

23 (d)(1), the Secretary may provide for the development and

24 operation of more than one community health center in

25 a catchment area in any case in which the Secretary deter-
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1 mines that there is a population group in such area that

2 otherwise will have a shortage of personal health services.

3 The preceding sentence may not be construed as requiring

4 that, in such a case, the catchment areas of the centers

5 involved be identical.’’.

6 (3) OFFSITE ACTIVITIES.—Section 330(b) of

7 the Public Health Service Act, as amended by para8 graph (2) of this subsection, is amended by adding

9 at the end the following paragraph:

10 ‘‘(8) In making grants under this section, the Sec11 retary may, to the extent determined by the Secretary to

12 be appropriate, authorize community health centers to

13 provide services at locations other than the center.’’.

14 (4) AMOUNT OF GRANT; USE OF CERTAIN

15 FUNDS.—Section 330(d)(4) of the Public Health

16 Service Act (42 U.S.C. 254c(d)(4)), as amended by

17 section 309(b)(3) of Public Law 102–531 (106 Stat.

18 3501), is amended to read as follows:

19 ‘‘(4)(A) The amount of a grant under paragraph (1)

20 or under subsection (c) for a community health center

21 shall be determined by the Secretary, taking into account

22 (for the period for which the grant is made)—

23 ‘‘(i) the costs that the center may reasonably be

24 expected to incur in carrying out the plan approved
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1 by the Secretary pursuant to subsection (e)(3)(H),

2 and

3 ‘‘(ii) the amounts that the center may reason4 ably be expected to receive as State, local, and other

5 operational funding (exclusive of amounts to be pro6 vided in the grant under this section) and as fees,

7 premiums, and third-party reimbursements.

8 ‘‘(B)(i) Subject to clause (ii), the Secretary may not

9 restrict the purposes for which a community health center

10 expends the amounts described in subparagraph (A)(ii)

11 (including restrictions imposed pursuant to Federal cost

12 principles).

13 ‘‘(ii) The Secretary may require that amounts de14 scribed in subparagraph (A)(ii) be expended for purposes

15 that are consistent with the purposes specified in this sec16 tion.

17 ‘‘(C)(i) Payments under a grant under this section

18 shall be made in advance or by way of reimbursement and

19 in such installments as the Secretary finds necessary. Ad20 justments in such payments may be made for overpay21 ments or underpayments, subject to clause (ii).

22 ‘‘(ii) If, for the period for which a grant is made

23 under paragraph (1) to a community health center, the

24 sum of the amount of the grant and the amounts described

25 in subparagraph (A)(ii) that the center actually received
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1 exceeded the costs of the center in carrying out the plan

2 approved by the Secretary pursuant to subsection

3 (e)(3)(H), then the center is entitled to retain such excess

4 amount if the center agrees to expend such amount only

5 for the following purposes:

6 ‘‘(I) To expand and improve services.

7 ‘‘(II) To increase the number of persons served.

8 ‘‘(III) To acquire, modernize, or expand facili9 ties, or to construct facilities.

10 ‘‘(IV) To improve the administration of service

11 programs.

12 ‘‘(V) To establish financial reserves.

13 ‘‘(D) With respect to funds that are amounts de14 scribed in subparagraph (A)(ii) or excess amounts de15 scribed in subparagraph (C)(ii), this paragraph may not

16 be construed as limiting the authority of the Secretary to

17 require the submission of such plans, budgets, and other

18 information as may be necessary to ensure that the funds

19 are expended in accordance with subparagraph (B)(ii), or

20 clauses (I) through (V) of subparagraph (C)(ii), respec21 tively.’’.

22 (5) AUTHORIZATION OF APPROPRIATIONS.—

23 Section 330(g) of the Public Health Service Act (42

24 U.S.C. 254c(g)) is amended—
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1 (A) in paragraph (1)(A), by striking

2 ‘‘1994’’ and inserting ‘‘1998’’; and

3 (B) in paragraph (2)(A), by striking

4 ‘‘1994’’ and inserting ‘‘1998’’.

5 SEC. 202. HEALTH SERVICES FOR THE HOMELESS.

6 Section 340(q)(1) of the Public Health Service Act

7 (42 U.S.C. 256(q)(1)) is amended by striking ‘‘and 1994’’

8 and inserting ‘‘through 1998’’.

9 SEC. 203. HEALTH SERVICES FOR RESIDENTS OF PUBLIC

10 HOUSING.

11 Section 340A(p)(1) of the Public Health Service Act

12 (42 U.S.C. 256a(p)(1)) is amended by striking ‘‘and

13 1993’’ and inserting ‘‘through 1998’’.

14 SEC. 204. GRANTS TO STATES FOR LOAN REPAYMENT PRO15 GRAMS REGARDING OBLIGATED SERVICE OF

16 HEALTH PROFESSIONALS.

17 Section 338I(c) of the Public Health Service Act (42

18 U.S.C. 254q–1(c)) is amended by adding at the end the

19 following paragraph:

20 ‘‘(4) PRIVATE PRACTICE.—

21 ‘‘(A) In carrying out the program operated

22 with a grant under subsection (a), a State may

23 waive the requirement of paragraph (1) regard24 ing the assignment of a health professional if,

25 subject to subparagraph (B), the health profes-
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1 sional enters into an agreement with the State

2 to provide primary health services in a full-time

3 private clinical practice in a health professional

4 shortage area.

5 ‘‘(B) The Secretary may not make a grant

6 under subsection (a) unless the State involved

7 agrees that, if the State provides a waiver

8 under subparagraph (A) for a health profes9 sional, section 338D(b)(1) will apply to the

10 agreement under such subparagraph between

11 the State and the health professional to the

12 same extent and in the same manner as such

13 section applies to an agreement between the

14 Secretary and a health professional regarding a

15 full-time private clinical practice.’’.

16 SEC. 205. GRANTS TO STATES FOR OPERATION OF STATE

17 OFFICES OF RURAL HEALTH.

18 Section 338J of the Public Health Service Act (42

19 U.S.C. 254r) is amended—

20 (1) in subsection (b)(1), in the matter preced21 ing subparagraph (A), by striking ‘‘in cash’’; and

22 (2) in subsection (j)(1)—

23 (A) by striking ‘‘and’’ after ‘‘1992’’; and

24 (B) by inserting before the period the fol25 lowing: ‘‘, and such sums as may be necessary
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1 for each of the fiscal years 1995 through

2 1997’’.

3 SEC. 206. DEMONSTRATION GRANTS TO STATES FOR COM4 MUNITY SCHOLARSHIP PROGRAMS REGARD5 ING OBLIGATED SERVICE OF HEALTH PRO6 FESSIONALS.

7 Section 338L of the Public Health Service Act (42

8 U.S.C. 254t) is amended—

9 (1) by striking ‘‘health manpower shortage’’

10 each place such term appears and inserting ‘‘health

11 professional shortage’’;

12 (2) in subsection (e)—

13 (A) by striking paragraph (1);

14 (B) by redesignating paragraphs (2)

15 through (6) as paragraphs (1) through (5), re16 spectively; and

17 (C) in paragraph (1) (as so redesignated),

18 by inserting after ‘‘the individual’’ the follow19 ing: ‘‘who is to receive the scholarship under

20 the contract’’;

21 (3) in subsection (k)(2), by striking ‘‘internal

22 medicine, pediatrics,’’ and inserting ‘‘general inter23 nal medicine, general pediatrics,’’; and

24 (4) in subsection (l)(1)—

25 (A) by striking ‘‘and’’ after ‘‘1992,’’; and
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1 (B) by inserting before the period the fol2 lowing: ‘‘, and such sums as may be necessary

3 for each of the fiscal years 1995 through

4 1997’’.

5 SEC. 207. PROGRAMS REGARDING BIRTH DEFECTS.

6 Section 317C of the Public Health Service Act (42

7 U.S.C. 247b–4), as added by section 306 of Public Law

8 102–531 (106 Stat. 3494), is amended to read as follows:

9 ‘‘PROGRAMS REGARDING BIRTH DEFECTS

10 ‘‘SEC. 317C. (a) The Secretary, acting through the

11 Director of the Centers for Disease Control and Preven12 tion, shall carry out programs—

13 ‘‘(1) to collect, analyze, and make available data

14 on birth defects (in manner that facilitates compli15 ance with subsection (d)(2)), including data on the

16 causes of such defects and on the incidence and

17 prevalence of such defects;

18 ‘‘(2) to provide information and education to

19 the public on the prevention of such defects;

20 ‘‘(3) to improve the education, training, and

21 clinical skills of health professionals with respect to

22 the prevention of such defects;

23 ‘‘(4) to carry out demonstration projects for the

24 prevention of such defects; and

25 ‘‘(5) to operate regional centers for the conduct

26 of research on the prevention of such defects.
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1 ‘‘(b) ADDITIONAL PROVISIONS REGARDING COLLEC2 TION OF DATA.—

3 ‘‘(1) IN GENERAL.—In carrying out subsection

4 (a)(1), the Secretary—

5 ‘‘(A) shall collect and analyze data by gen6 der and by racial and ethnic group, including

7 Hispanics, non-Hispanic whites, African Ameri8 cans, Native Americans, Asian Americans, and

9 Pacific Islanders;

10 ‘‘(B) shall collect data under subparagraph

11 (A) from birth certificates, death certificates,

12 hospital records, and such other sources as the

13 Secretary determines to be appropriate; and

14 ‘‘(C) shall encourage States to establish or

15 improve programs for the collection and analy16 sis of epidemiological data on birth defects, and

17 to make the data available.

18 ‘‘(2) NATIONAL CLEARINGHOUSE.—In carrying

19 out subsection (a)(1), the Secretary shall establish

20 and maintain a National Information Clearinghouse

21 on Birth Defects to collect and disseminate to health

22 professionals and the general public information on

23 birth defects, including the prevention of such de24 fects.

25 ‘‘(c) GRANTS AND CONTRACTS.—
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1 ‘‘(1) IN GENERAL.—In carrying out subsection

2 (a), the Secretary may make grants to and enter

3 into contracts with public and nonprofit private enti4 ties.

5 ‘‘(2) SUPPLIES AND SERVICES IN LIEU OF

6 AWARD FUNDS.—

7 ‘‘(A) Upon the request of a recipient of an

8 award of a grant or contract under paragraph

9 (1), the Secretary may, subject to subparagraph

10 (B), provide supplies, equipment, and services

11 for the purpose of aiding the recipient in carry12 ing out the purposes for which the award is

13 made and, for such purposes, may detail to the

14 recipient any officer or employee of the Depart15 ment of Health and Human Services.

16 ‘‘(B) With respect to a request described

17 in subparagraph (A), the Secretary shall reduce

18 the amount of payments under the award in19 volved by an amount equal to the costs of de20 tailing personnel and the fair market value of

21 any supplies, equipment, or services provided by

22 the Secretary. The Secretary shall, for the pay23 ment of expenses incurred in complying with

24 such request, expend the amounts withheld.
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1 ‘‘(3) APPLICATION FOR AWARD.—The Secretary

2 may make an award of a grant or contract under

3 paragraph (1) only if an application for the award

4 is submitted to the Secretary and the application is

5 in such form, is made in such manner, and contains

6 such agreements, assurances, and information as the

7 Secretary determines to be necessary to carry out

8 the purposes for which the award is to be made.

9 ‘‘(d) BIENNIAL REPORT.—Not later than February

10 1 of fiscal year 1995 and of every second such year there11 after, the Secretary shall submit to the Committee on En12 ergy and Commerce of the House of Representatives, and

13 the Committee on Labor and Human Resources of the

14 Senate, a report that, with respect to the preceding 2 fis15 cal years—

16 ‘‘(1) contains information regarding the inci17 dence and prevalence of birth defects and the extent

18 to which birth defects have contributed to the inci19 dence and prevalence of infant mortality;

20 ‘‘(2) contains information under paragraph (1)

21 that is specific to various racial and ethnic groups

22 (including Hispanics, non-Hispanic whites, African

23 Americans, Native Americans, and Asian Ameri24 cans);
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1 ‘‘(3) contains an assessment of the extent to

2 which various approaches of preventing birth defects

3 have been effective;

4 ‘‘(4) describes the activities carried out under

5 this section; and

6 ‘‘(5) contains any recommendations of the Sec7 retary regarding this section.

8 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the

9 purpose of carrying out this section, there are authorized

10 to be appropriated $5,000,000 for fiscal year 1995, and

11 such sums as may be necessary for each of the fiscal years

12 1996 and 1997.’’.

13 SEC. 208. HEALTHY START FOR INFANTS.

14 (a) IN GENERAL.—Part D of title III of the Public

15 Health Service Act (42 U.S.C. 254b et seq.) is amended

16 by inserting after section 330 the following section:

17 ‘‘HEALTHY START FOR INFANTS

18 ‘‘SEC. 330A. (a) GRANTS FOR COMPREHENSIVE

19 SERVICES.—

20 ‘‘(1) IN GENERAL.—The Secretary may make

21 grants for the operation of not more than 19 dem22 onstration projects to provide the services described

23 in subsection (b) for the purpose of reducing, in the

24 geographic areas in which the projects are carried

25 out—
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1 ‘‘(A) the incidence of infant mortality and

2 morbidity;

3 ‘‘(B) the incidence of fetal deaths;

4 ‘‘(C) the incidence of maternal mortality;

5 ‘‘(D) the incidence of fetal alcohol syn6 drome; and

7 ‘‘(E) the incidence of low-birthweight

8 births.

9 ‘‘(2) ACHIEVEMENT OF YEAR 2000 HEALTH STA10 TUS OBJECTIVES.—With respect to the objectives es11 tablished by the Secretary for the health status of

12 the population of the United States for the year

13 2000, the Secretary shall, in providing for a dem14 onstration project under paragraph (1) in a geo15 graphic area, seek to meet the objectives that are

16 applicable to the purpose described in such para17 graph and the populations served by the project.

18 ‘‘(b) AUTHORIZED SERVICES.—

19 ‘‘(1) IN GENERAL.—Subject to subsection (h),

20 the services referred to in this subsection are com21 prehensive services (including preventive and pri22 mary health services for pregnant women and in23 fants and childhood immunizations in accordance

24 with the schedule recommended by the Secretary)
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1 for carrying out the purpose described in subsection

2 (a), including services other than health services.

3 ‘‘(2) CERTAIN PROVIDERS.—The Secretary may

4 make a grant under subsection (a) only if the appli5 cant involved agrees that, in making any arrange6 ments under which other entities provide authorized

7 services in the demonstration project involved, the

8 applicant will include among the entities with which

9 the arrangements are made grantees under any of

10 sections 329, 330, 340, and 340A, if such grantees

11 are providing services in the service area of such

12 project and the grantees are willing to make such

13 arrangements with the applicant.

14 ‘‘(c) ELIGIBLE GEOGRAPHIC AREAS.—The Secretary

15 may make a grant under subsection (a) only if—

16 ‘‘(1) the applicant for the grant specifies the

17 geographic area in which the demonstration project

18 under such subsection is to be carried out and

19 agrees that the project will not be carried out in

20 other areas; and

21 ‘‘(2) for the fiscal year preceding the first fiscal

22 year for which the applicant is to receive such a

23 grant, the rate of infant mortality in the geographic

24 area equals or exceeds 150 percent of the national

25 average in the United States of such rates.
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1 ‘‘(d) MINIMUM QUALIFICATIONS OF GRANTEES.—

2 ‘‘(1) PUBLIC OR NONPROFIT PRIVATE ENTI3 TIES.—The Secretary may make a grant under sub4 section (a) only if the applicant for the grant is a

5 State or local department of health, or other public

6 or nonprofit private entity, or a consortium of public

7 or nonprofit private entities.

8 ‘‘(2) APPROVAL OF POLITICAL SUBDIVISIONS.—

9 With respect to a proposed demonstration project

10 under subsection (a), the Secretary may make a

11 grant under such subsection only if—

12 ‘‘(A) the chief executive officer of each po13 litical subdivision in the service area of such

14 project approves the applicant for the grant as

15 being qualified to carry out the project; and

16 ‘‘(B) the leadership of any Indian tribe or

17 tribal organization with jurisdiction over any

18 portion of such area so approves the applicant.

19 ‘‘(3) STATUS AS MEDICAID PROVIDER.—

20 ‘‘(A) In the case of any service described

21 in subsection (b) that is available pursuant to

22 the State plan approved under title XIX of the

23 Social Security Act for a State in which a dem24 onstration project under subsection (a) is car25 ried out, the Secretary may make a grant under
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1 such subsection for the project only if, subject

2 to subparagraph (B)—

3 ‘‘(i) the applicant for the grant will

4 provide the service directly, and the appli5 cant has entered into a participation agree6 ment under the State plan and is qualified

7 to receive payments under such plan; or

8 ‘‘(ii) the applicant will enter into an

9 agreement with a public or private entity

10 under which the entity will provide the

11 service, and the entity has entered into

12 such a participation agreement under the

13 State plan and is qualified to receive such

14 payments.

15 ‘‘(B)(i) In the case of an entity making an

16 agreement pursuant to subparagraph (A)(ii) re17 garding the provision of services, the require18 ment established in such subparagraph regard19 ing a participation agreement shall be waived

20 by the Secretary if the entity does not, in pro21 viding health care services, impose a charge or

22 accept reimbursement available from any third23 party payor, including reimbursement under

24 any insurance policy or under any Federal or

25 State health benefits plan.
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1 ‘‘(ii) A determination by the Secretary of

2 whether an entity referred to in clause (i) meets

3 the criteria for a waiver under such clause shall

4 be made without regard to whether the entity

5 accepts voluntary donations regarding the pro6 vision of services to the public.

7 ‘‘(e) STATE APPROVAL OF PROJECT.—With respect

8 to a proposed demonstration project under subsection (a),

9 the Secretary may make a grant under such subsection

10 to the applicant involved only if—

11 ‘‘(1) the chief executive officer of the State in

12 which the project is to be carried out approves the

13 proposal of the applicant for carrying out the

14 project; and

15 ‘‘(2) the leadership of any Indian tribe or tribal

16 organization with jurisdiction over any portion of the

17 service area of the project so approves the proposal.

18 ‘‘(f) ELIGIBILITY FOR SERVICES PROVIDED WITH

19 GRANT FUNDS.—The Secretary may make a grant under

20 subsection (a) only if the applicant involved agrees as fol21 lows:

22 ‘‘(1) With respect to any authorized service

23 under subsection (b), if the service is a service that

24 the State involved is required or has elected to pro25 vide under title XIX of the Social Security Act, the
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1 grant will not be expended to provide the service to

2 any individual to whom the State is required or has

3 elected under such title to provide the service.

4 ‘‘(2) The grant will not be expended to make

5 payment for any item or service to the extent that

6 payment has been made, or can reasonably be ex7 pected to be made, with respect to such item or serv8 ice—

9 ‘‘(A) under a health insurance policy or

10 plan (including a group health plan or a pre11 paid health plan);

12 ‘‘(B) under any Federal or State health

13 benefits program, including any program under

14 title V, XVIII, or XIX of the Social Security

15 Act; or

16 ‘‘(C) under subpart II of part B of title

17 XIX of this Act.

18 ‘‘(g) MAINTENANCE OF EFFORT.—

19 ‘‘(1) GRANTEE.—With respect to authorized

20 services under subsection (b), the Secretary may

21 make a grant under subsection (a) only if the appli22 cant involved agrees to maintain expenditures of

23 non-Federal amounts for such services at a level

24 that is not less than the level of such expenditures

25 maintained by the applicant for fiscal year 1991.
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1 ‘‘(2) RELEVANT POLITICAL SUBDIVISIONS.—

2 With respect to authorized services under subsection

3 (b), the Secretary may make a grant under sub4 section (a) only if each political subdivision in the

5 service area of the demonstration project involved

6 agrees to maintain expenditures of non-Federal

7 amounts for such services at a level that is not less

8 than the level of such expenditures maintained by

9 the political subdivision for fiscal year 1991.

10 ‘‘(h) RESTRICTIONS ON EXPENDITURE OF GRANT.—

11 ‘‘(1) IN GENERAL.—Except as provided in para12 graph (3), the Secretary may make a grant under

13 subsection (a) only if the applicant involved agrees

14 that the grant will not be expended—

15 ‘‘(A) to provide inpatient services, except

16 with respect to residential treatment for sub17 stance abuse provided in settings other than

18 hospitals;

19 ‘‘(B) to make cash payments to intended

20 recipients of health services or mental health

21 services; or

22 ‘‘(C) to purchase or improve real property

23 (other than minor remodeling of existing im24 provements to real property) or to purchase

25 major medical equipment (other than mobile
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1 medical units for providing ambulatory prenatal

2 services).

3 ‘‘(2) ADMINISTRATIVE EXPENSES; DATA COL4 LECTION.—The Secretary may make a grant under

5 subsection (a) only if the applicant involved agrees

6 that not more than an aggregate 10 percent of the

7 grant will be expended for administering the grant

8 and the collection and analysis of data.

9 ‘‘(3) WAIVER.—If the Secretary finds that the

10 purpose described in subsection (a) cannot otherwise

11 be carried out, the Secretary may, with respect to an

12 otherwise qualified applicant, waive the restriction

13 established in paragraph (1)(C).

14 ‘‘(i) DETERMINATION OF CAUSE OF INFANT

15 DEATHS.—The Secretary may make a grant under sub16 section (a) only if the applicant involved—

17 ‘‘(1) agrees to provide for a determination of

18 the cause of each infant death in the service area of

19 the demonstration project involved; and

20 ‘‘(2) the applicant has made such arrangements

21 with public entities as may be necessary to carry out

22 paragraph (1).

23 ‘‘(j) ANNUAL REPORTS TO SECRETARY.—The Sec24 retary may make a grant under subsection (a) only if the

25 applicant involved agrees that, for each fiscal year for
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1 which the applicant operates a demonstration project

2 under such subsection the applicant will, not later than

3 April 1 of the subsequent fiscal year, submit to the Sec4 retary a report providing the following information with

5 respect to the project:

6 ‘‘(1) The number of individuals that received

7 authorized services, and the demographic character8 istics of the population of such individuals.

9 ‘‘(2) The types of authorized services provided,

10 including the types of ambulatory prenatal services

11 provided and the trimester of the pregnancy in

12 which the services were provided.

13 ‘‘(3) The sources of payment for the authorized

14 services provided.

15 ‘‘(4) The extent to which children under age 2

16 receiving authorized services have received the ap17 propriate number and variety of immunizations

18 against vaccine-preventable diseases.

19 ‘‘(5) An analysis of the causes of death deter20 mined under subsection (i).

21 ‘‘(6) The extent of progress being made toward

22 meeting the health status objectives specified in sub23 section (a)(2).

24 ‘‘(7) The extent to which, in the service area in25 volved, progress is being made toward meeting the
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1 participation goals established for the State by the

2 Secretary under section 1905(r) of the Social Secu3 rity Act (relating to early periodic screening, diag4 nostic, and treatment services for children under the

5 age of 21).

6 ‘‘(k) COMMUNITY PARTICIPATION.—The Secretary

7 may make a grant under subsection (a) only if the appli8 cant involved agrees that, in preparing the proposal of the

9 applicant for the demonstration project involved, and in

10 the operation of the project, the applicant will consult with

11 the residents of the service area for the project and with

12 public and nonprofit private entities that provide author13 ized services to such residents.

14 ‘‘(l) APPLICATION FOR GRANT.—The Secretary may

15 make a grant under subsection (a) only if an application

16 for the grant is submitted to the Secretary and the appli17 cation is in such form, is made in such manner, and con18 tains such agreements, assurances, and information as the

19 Secretary determines to be necessary to carry out this sub20 section.

21 ‘‘(m) REPORT TO CONGRESS.—Not later than Feb22 ruary 1, 1998, the Secretary shall submit to the Commit23 tee on Energy and Commerce of the House of Representa24 tives, and the Committee on Labor and Human Resources

25 of the Senate, a report—
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1 ‘‘(1) summarizing the reports received by the

2 Secretary under subsection (j);

3 ‘‘(2) describing the extent to which the Sec4 retary has, in the service areas of such projects,

5 been successful in meeting the health status objec6 tives specified in subsection (a)(2); and

7 ‘‘(3) describing the extent to which demonstra8 tion projects under subsection (a) have been cost ef9 fective.

10 ‘‘(n) LIMITATION ON CERTAIN EXPENSES OF SEC11 RETARY.—Of the amounts appropriated under subsection

12 (p) for a fiscal year, the Secretary may not obligate more

13 than an aggregate 5 percent for the administrative costs

14 of the Secretary in carrying out this section, for the provi15 sion of technical assistance regarding demonstration

16 projects under subsection (a), and for evaluations of such

17 projects.

18 ‘‘(o) DEFINITIONS.—For purposes of this section:

19 ‘‘(1) The term ‘authorized services’ means the

20 services specified in subsection (b).

21 ‘‘(2) The terms ‘Indian tribe’ and ‘tribal organi22 zation’ have the meaning given such terms in section

23 4(b) and section 4(c) of the Indian Self-Determina24 tion and Education Assistance Act.
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1 ‘‘(3) The term ‘service area’, with respect to a

2 demonstration project under subsection (a), means

3 the geographic area specified in subsection (c).

4 ‘‘(p) AUTHORIZATION OF APPROPRIATIONS.—For the

5 purpose of carrying out this section, there are authorized

6 to be appropriated such sums as may be necessary for

7 each of the fiscal years 1995 through 1997.

8 ‘‘(q) SUNSET.—Effective October 1, 1997, this sec9 tion is repealed.’’.

10 (b) CERTAIN PROVISIONS REGARDING REPORTS.—

11 (1) FISCAL YEAR 1995.—With respect to grants

12 under section 330A of the Public Health Service Act

13 (as added by subsection (a) of this section), the Sec14 retary of Health and Human Services may make a

15 grant under such section for fiscal year 1995 only

16 if the applicant for the grant agrees to submit to the

17 Secretary, not later than April 1 of such year, a re18 port on any federally-supported project of the appli19 cant that is substantially similar to the demonstra20 tion projects authorized in such section 330A, which

21 report provides, to the extent practicable, the infor22 mation described in subsection (j) of such section.

23 (2) FISCAL YEAR 1997.—With respect to grants

24 for fiscal year 1997 under section 330A of the Pub25 lic Health Service Act (as added by subsection (a)
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1 of this section), the requirement under subsection (j)

2 of such section that a report be submitted not later

3 than April 1, 1998, remains in effect notwithstand4 ing the repeal of such section pursuant to subsection

5 (q) of such section.

6 (c) LAPSE OF FUNDS.—Effective October 1, 1997,

7 all unexpended portions of amounts appropriated for

8 grants under 330A of the Public Health Service Act (as

9 added by subsection (a) of this section) are unavailable

10 for obligation or expenditure, without regard to whether

11 the amounts have been received by the grantees involved.

12 (d) USE OF GENERAL AUTHORITY UNDER PUBLIC

13 HEALTH SERVICE ACT.—With respect to the program es14 tablished in section 330A of the Public Health Service Act

15 (as added by subsection (a) of this section), section 301

16 of such Act may not be construed as providing to the Sec17 retary of Health and Human Services any authority to

18 carry out, during any fiscal year in which such program

19 is in operation, any demonstration project to provide any

20 of the services specified in subsection (b) of such section

21 330A.

22 SEC. 209. DEMONSTRATION PROJECTS REGARDING DIA23 BETIC-RETINOPATHY.

24 (a) IN GENERAL.—The Secretary of Health and

25 Human Services, acting through the Director of the Cen-
43

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1 ters for Disease Control and Prevention and in consulta2 tion with the Director of the National Eye Institute, may

3 make grants to public and nonprofit private entities for

4 demonstration projects to serve the populations specified

5 in subsection (b) by carrying out, with respect to the eye

6 disorder known as diabetic retinopathy, activities regard7 ing information, identification, dissemination, education,

8 and prevention.

9 (b) RELEVANT POPULATIONS.—The populations re10 ferred to in subsection (a) are minority populations that

11 are at significant risk of contracting diabetes mellitus.

12 (c) AUTHORIZATION OF APPROPRIATIONS.—For the

13 purpose of carrying out this section, there is authorized

14 to be appropriated $1,000,000 for each of the fiscal years

15 1995 through 1997.

16 TITLE III—HEALTH

17 PROFESSIONS PROGRAMS

18 SEC. 301. PRIMARY CARE SCHOLARSHIPS FOR STUDENTS

19 FROM DISADVANTAGED BACKGROUNDS.

20 (a) IN GENERAL.—Section 736 of the Public Health

21 Service Act (42 U.S.C. 293) is amended to read as follows:

22 ‘‘SEC. 736. PRIMARY CARE SCHOLARSHIPS FOR STUDENTS

23 FROM DISADVANTAGED BACKGROUNDS.

24 ‘‘(a) IN GENERAL.—The Secretary may in accord25 ance with this section award scholarships to individuals
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1 described in subsection (b) for the purpose of assisting the

2 individuals with the costs of attending schools of medicine

3 or osteopathic medicine, schools of dentistry, schools of

4 nursing (as defined in section 853), graduate programs

5 in mental health practice, and programs for the training

6 of physician assistants.

7 ‘‘(b) ELIGIBLE INDIVIDUALS.—An individual re8 ferred to in subsection (a) is any individual meeting the

9 following conditions:

10 ‘‘(1) The individual is from a disadvantaged

11 background.

12 ‘‘(2) The individual is enrolled (or accepted for

13 enrollment) at an eligible school as a full-time stu14 dent in a program leading to a degree in a health

15 profession.

16 ‘‘(3) The individual enters into the contract re17 quired pursuant to subsection (d) as a condition of

18 receiving the scholarship (relating to an agreement

19 to provide primary health services in a health profes20 sional shortage area designated under section 332).

21 ‘‘(c) PREFERENCES REGARDING AWARDS; SPECIAL

22 CONSIDERATION.—In awarding scholarships under sub23 section (a), the Secretary shall—
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1 ‘‘(1) give preference to eligible individuals for

2 whom the costs of attending the school involved

3 would constitute a severe financial hardship; and

4 ‘‘(2) give special consideration to eligible indi5 viduals who received scholarships pursuant to this

6 section, section 737, or section 740(d)(2) for fiscal

7 year 1993 or 1994 and are seeking scholarships for

8 attendance at eligible schools that received a grant

9 under any of such sections for any of such fiscal

10 years.

11 ‘‘(d) APPLICABILITY OF CERTAIN PROVISIONS.—Ex12 cept as inconsistent with this section, the provisions of

13 subpart III of part D of title III apply to an award of

14 a scholarship under subsection (a) to the same extent and

15 in the same manner as such provisions apply to an award

16 of a scholarship under section 338A. This section shall be

17 carried out by the bureau that administers such subpart

18 III.

19 ‘‘(e) DEFINITIONS.—For purposes of this section:

20 ‘‘(1) The term ‘eligible individual’ means an in21 dividual described in subsection (b).

22 ‘‘(2) The term ‘eligible school’ means a school

23 or program specified in subsection (a).

24 ‘‘(f) FUNDING.—
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1 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

2 For the purpose of carrying out this section, there

3 are authorized to be appropriated $34,000,000 for

4 fiscal year 1995, $50,000,000 for fiscal year 1996,

5 and $65,000,000 for fiscal year 1997.

6 ‘‘(2) ALLOCATIONS BY SECRETARY.—Of the

7 amounts appropriated for a fiscal year under para8 graph (1), the Secretary shall make available—

9 ‘‘(A) 20 percent for scholarships under

10 subsection (a) for attendance at schools of

11 nursing; and

12 ‘‘(B) 15 percent for scholarships under

13 such subsection for attendance at graduate pro14 grams in mental health practice.’’.

15 (b) CERTAIN PROGRAMS OF OBLIGATED SERVICE.—

16 (1) REPEAL.—Section 795 of the Public Health

17 Service Act (42 U.S.C. 295n) is repealed.

18 (2) RULE OF CONSTRUCTION.—Paragraph (1)

19 does not terminate agreements in effect on the day

20 before the date of the enactment of this Act pursu21 ant to section 795 of the Public Health Service Act.

22 Such agreements continue in effect in accordance

23 with the terms of the agreements. With respect to

24 compliance with such agreements, any period of

25 practice as a provider of primary health services
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1 (whether provided pursuant to other agreements

2 with the Federal Government or whether provided

3 otherwise) counts toward satisfaction of the require4 ment of practice pursuant to such section 795.

5 SEC. 302. SCHOLARSHIPS GENERALLY; CERTAIN OTHER

6 PURPOSES.

7 (a) RELEVANT HEALTH PROFESSIONS SCHOOLS.—

8 Section 737(a)(3) of the Public Health Service Act (42

9 U.S.C. 293a(a)(3)) is amended—

10 (1) by striking ‘‘medicine,’’ and all that follows

11 through ‘‘dentistry,’’; and

12 (2) by striking ‘‘allied health,’’ and all that fol13 lows and inserting ‘‘allied health.’’.

14 (b) ELIGIBLE INDIVIDUALS.—

15 (1) IN GENERAL.—Section 737(a)(2) of the

16 Public Health Service Act (42 U.S.C. 293a(a)(2)) is

17 amended to read as follows:

18 ‘‘(2) ELIGIBLE INDIVIDUALS.—An individual

19 referred to in paragraph (1) is any individual meet20 ing the following conditions:

21 ‘‘(A) The individual is from a disadvan22 taged background.

23 ‘‘(B) The individual is enrolled (or accept24 ed for enrollment) as a full-time student in a
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1 health professions school specified in paragraph

2 (3).

3 ‘‘(C) The individual enters into the con4 tract required pursuant to subsection (e) as a

5 condition of receiving the scholarship under

6 paragraph (1) (relating to an agreement to pro7 vide services).’’.

8 (2) CERTAIN REQUIREMENT.—Section 737 of

9 the Public Health Service Act (42 U.S.C. 293a) is

10 amended—

11 (A) in subsection (a)(1), by striking ‘‘sub12 section (e)’’ and inserting ‘‘subsection (f)’’;

13 (B) by redesignating subsections (e)

14 through (h) as subsections (f) through (i), re15 spectively; and

16 (C) by inserting after subsection (d) the

17 following subsection:

18 ‘‘(e) APPLICABILITY OF CERTAIN PROVISIONS.—

19 ‘‘(1) IN GENERAL.—Except as inconsistent with

20 this section, and subject to paragraph (2), the provi21 sions of subpart III of part D of title III apply to

22 an award of a scholarship under subsection (a) to

23 the same extent and in the same manner as such

24 provisions apply to an award of a scholarship under
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1 section 338A. This section shall be carried out by

2 the bureau that administers such subpart III.

3 ‘‘(2) CERTAIN INDIVIDUALS.—

4 ‘‘(A) In the case of an individual who re5 ceives a scholarship under subsection (a) for at6 tendance at a school of veterinary medicine, the

7 contract referred to in subsection (a)(2)(C) is a

8 contract under which the individual agrees that,

9 after completing training in such medicine, the

10 individual will, in accordance with requirements

11 established under subparagraph (B), conduct or

12 assist in the conduct of research regarding

13 human health or safety. Except as inconsistent

14 with this section, the provisions specified in

15 paragraph (1) with respect to title III apply to

16 such a scholarship to the same extent and in

17 the same manner as such provisions apply to an

18 award of a scholarship under section 338A.

19 ‘‘(B) The Secretary shall establish require20 ments regarding contracts under subparagraph

21 (A).’’.

22 (c) FUNDING.—Section 737(i) of the Public Health

23 Service Act, as redesignated by subsection (b)(2) of this

24 section, is amended—
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1 (1) in paragraph (1), by inserting before the pe2 riod the following: ‘‘, and $6,000,000 for each of the

3 fiscal years 1994 through 1997’’; and

4 (2) in paragraph (2)(A), by striking ‘‘30 per5 cent’’ and all that follows and inserting the follow6 ing: ‘‘50 percent for such grants to schools of allied

7 health; and’’.

8 SEC. 303. LOAN REPAYMENTS AND FELLOWSHIPS REGARD9 ING FACULTY POSITIONS.

10 (a) LOAN REPAYMENTS.—Section 738(a) of the Pub11 lic Health Service Act (42 U.S.C. 293b(a)) is amended—

12 (1) by striking paragraphs (4) and (6);

13 (2) by redesignating paragraphs (5) and (7) as

14 paragraphs (4) and (5), respectively; and

15 (3) in paragraph (4) (as so redesignated), by

16 amending subparagraph (B) to read as follows:

17 ‘‘(B) the contract referred to in subpara18 graph (A) provides that the school, in making

19 a determination of the amount of compensation

20 to be provided by the school to the individual

21 for serving as a member of the faculty, will

22 make the determination without regard to the

23 amount of payments made (or to be made) to

24 the individual by the Federal Government under

25 paragraph (1).’’.
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1 (b) AUTHORIZATION OF APPROPRIATIONS REGARD2 ING LOAN REPAYMENTS AND FELLOWSHIPS.—Section

3 738(c) of the Public Health Service Act (42 U.S.C.

4 293b(c)) is amended by striking ‘‘there is’’ and all that

5 follows and inserting the following: ‘‘there is authorized

6 to be appropriated $1,000,000 for each of the fiscal years

7 1995 through 1997.’’.

8 SEC. 304. CENTERS OF EXCELLENCE.

9 (a) REFERENCES TO SCHOOLS.—Section 739 of the

10 Public Health Service Act (42 U.S.C. 293c) is amended—

11 (1) by striking ‘‘health professions schools’’

12 each place such term appears and inserting ‘‘des13 ignated health professions schools’’; and

14 (2) by striking ‘‘health professions school’’ each

15 place such term appears and inserting ‘‘designated

16 health professions school’’.

17 (b) REQUIRED USES OF FUNDS.—Section 739(b) of

18 the Public Health Service Act (42 U.S.C. 293c(b)), as

19 amended by subsection (a), is amended—

20 (1) by striking paragraph (2);

21 (2) by redesignating paragraph (1) as para22 graph (2);

23 (3) by inserting before paragraph (2) (as so re24 designated) the following paragraph:
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1 ‘‘(1) to collaborate with public and nonprofit

2 private entities to carry out community-based pro3 grams to recruit students of secondary schools and

4 institutions of higher education and to prepare the

5 students academically for attendance at the des6 ignated health professions school;’’;

7 (4) in paragraph (5)—

8 (A) by striking ‘‘faculty and student re9 search’’ and inserting ‘‘student research’’; and

10 (B) by inserting before the period the fol11 lowing: ‘‘, including research on issues relating

12 to the delivery of health care’’; and

13 (5)(A) in paragraph (4), by striking ‘‘and’’

14 after the semicolon at the end;

15 (B) in paragraph (5), by striking the period at

16 the end and inserting ‘‘; and’’; and

17 (C) by adding at the end the following para18 graph:

19 ‘‘(6) to carry out a program to train students

20 of the school in providing health services to minority

21 individuals, which program includes training pro22 vided at community-based health facilities that pro23 vide such services to a significant number of minor24 ity individuals and that are located at a site remote
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1 from the main site of the teaching facilities of the

2 school.’’.

3 (c) REQUIREMENTS REGARDING CONSORTIA.—

4 (1) IN GENERAL.—Section 739(c)(1) of the

5 Public Health Service Act (42 U.S.C. 293c(c)(1)), as

6 amended by subsection (a), is amended—

7 (A) in subparagraph (A), in the matter

8 preceding clause (i), by striking ‘‘specified in

9 subparagraph (B)’’ and inserting ‘‘specified in

10 subparagraphs (B) and (C)’’;

11 (B) by redesignating subparagraph (C) as

12 subparagraph (D); and

13 (C) by inserting after subparagraph (B)

14 the following subparagraph:

15 ‘‘(C) The condition specified in this sub16 paragraph is that, in accordance with sub17 section (e)(1), the designated health professions

18 school involved has with other health profession

19 schools (designated or otherwise) formed a con20 sortium to carry out the purposes described in

21 subsection (b) at the schools of the consortium.

22 The grant involved may be expended with re23 spect to the other schools without regard to

24 whether such schools meet the conditions speci25 fied in subparagraph (B).’’.
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1 (2) CERTAIN REQUIREMENTS.—Section 739(e)

2 of the Public Health Service Act (42 U.S.C.

3 293c(e)), as amended by subsection (a), is amended

4 to read as follows:

5 ‘‘(e) PROVISIONS REGARDING CONSORTIA.—

6 ‘‘(1) REQUIREMENTS.—For purposes of sub7 section (c)(1)(C), a consortium of schools has been

8 formed in accordance with this subsection if—

9 ‘‘(A) the consortium consists of—

10 ‘‘(i) the designated health professions

11 school seeking the grant under subsection

12 (a); and

13 ‘‘(ii) 1 or more schools of medicine,

14 osteopathic medicine, dentistry, pharmacy,

15 nursing, allied health, or public health, or

16 graduate programs in mental health prac17 tice;

18 ‘‘(B) the schools of the consortium have

19 entered into an agreement for the allocation of

20 such grant among the schools; and

21 ‘‘(C) each of the schools agrees to expend

22 the grant in accordance with this section.

23 ‘‘(2) AUTHORITY REGARDING NATIVE AMERI24 CANS CENTERS OF EXCELLENCE.—With respect to

25 meeting the conditions specified in subsection (c)(4),
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1 the Secretary may make a grant under subsection

2 (a) to a designated health professions school that

3 does not meet such conditions if—

4 ‘‘(A) the school has formed a consortium

5 in accordance with paragraph (1); and

6 ‘‘(B) the schools of the consortium collec7 tively meet such conditions, without regard to

8 whether the schools individually meet such con9 ditions.’’.

10 (3) CONFORMING AMENDMENTS.—Section 739

11 of the Public Health Service Act (42 U.S.C. 293c),

12 as amended by subsection (a), is amended—

13 (A) in subsection (b), in the matter preced14 ing paragraph (1), by inserting ‘‘, subject to

15 subsection (c)(1)(C),’’ after ‘‘agrees’’; and

16 (B) in subsection (d)—

17 (i) in paragraph (3), by striking ‘‘(e)’’

18 and inserting ‘‘(e)(2)’’; and

19 (ii) by adding at the end the following

20 paragraph:

21 ‘‘(4) RULE OF CONSTRUCTION.—Except as pro22 vided in paragraph (3) regarding a consortium

23 under subsection (e)(2), a health professions school

24 that does not meet the conditions specified in sub25 section (c)(1)(B) may not be designated as a center
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1 of excellence for purposes of this section. The pre2 ceding sentence applies without regard to whether a

3 grant under subsection (a) is, pursuant to subsection

4 (c)(1)(C), being expended with respect to the

5 school.’’.

6 (d) DEFINITION OF HEALTH PROFESSIONS

7 SCHOOL.—

8 (1) GRADUATE PROGRAMS IN MENTAL HEALTH

9 PRACTICE.—Section 739(h)(1)(A) of the Public

10 Health Service Act (42 U.S.C. 293c(h)(1)(A)), as

11 amended by subsection (a), is amended by—

12 (A) by striking ‘‘or’’ after ‘‘dentistry’’; and

13 (B) by inserting before the period the fol14 lowing: ‘‘, or a graduate program in mental

15 health practice’’.

16 (2) LIMITATION.—During the fiscal years 1995

17 through 1997, the Secretary of Health and Human

18 Services may not make more than one grant under

19 section 739 of the Public Health Service Act directly

20 to a graduate program in mental health practice (as

21 defined in section 799 of such Act).

22 (e) FUNDING.—Section 739(i) of the Public Health

23 Service Act (42 U.S.C. 293c(i)), as amended by subsection

24 (a), is amended to read as follows:

25 ‘‘(i) FUNDING.—
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1 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

2 For the purpose of making grants under subsection

3 (a), there are authorized to be appropriated

4 $28,000,000 for fiscal year 1995, $30,000,000 for

5 fiscal year 1996, and $32,000,000 for fiscal year

6 1997.

7 ‘‘(2) ALLOCATIONS BY SECRETARY.—

8 ‘‘(A) Of the amounts appropriated under

9 paragraph (1) for a fiscal year, the Secretary

10 shall make available $12,000,000 for grants

11 under subsection (a) to health professions

12 schools that are eligible for such grants pursu13 ant to meeting the conditions described in para14 graph (2)(A) of subsection (c).

15 ‘‘(B) Of the amounts appropriated under

16 paragraph (1) for a fiscal year and available

17 after compliance with subparagraph (A), the

18 Secretary shall make available 65 percent for

19 grants under subsection (a) to health profes20 sions schools that are eligible for such grants

21 pursuant to meeting the conditions described in

22 paragraph (3) or (4) of subsection (c) (includ23 ing meeting conditions pursuant to subsection

24 (e)(2)).
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1 ‘‘(C)(i) Of the amounts appropriated under

2 paragraph (1) for a fiscal year and available

3 after compliance with subparagraph (A), the

4 Secretary shall make available 35 percent for

5 grants under subsection (a) to health profes6 sions schools that are eligible for such grants

7 pursuant to meeting the conditions described in

8 paragraph (5) of subsection (c).

9 ‘‘(ii) With respect to a fiscal year, a grant

10 under subsection (a) that includes amounts

11 available under subparagraph (A) may not in12 clude amounts available under clause (i) unless

13 each of the following conditions is met:

14 ‘‘(I) In the case of amounts available

15 under subparagraph (B) or clause (i) and

16 included in grants made pursuant to sub17 section (c)(3), the aggregate number of

18 such grants is not less than such aggregate

19 number for the preceding fiscal year, and

20 one or more of such grants is made in an

21 amount that is not less than the lowest

22 amount among grants made from amounts

23 available under subparagraph (A).

24 ‘‘(II) In the case of amounts available

25 under subparagraph (B) or clause (i) and
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1 included in grants made pursuant to sub2 section (c)(4), the aggregate number of

3 such grants is not less than such aggregate

4 number for the preceding fiscal year, and

5 one or more of such grants is made in an

6 amount that is not less than the lowest

7 amount among grants made from amounts

8 available under subparagraph (A).

9 ‘‘(III) In the case of amounts avail10 able under clause (i) and included in

11 grants made pursuant to subsection (c)(5)

12 (exclusive of grants that include amounts

13 available under subparagraph (A) or (B)),

14 the aggregate number of such grants is not

15 less than such aggregate number for the

16 preceding fiscal year, and one or more of

17 such grants is made in an amount that is

18 not less than the lowest amount among

19 grants made from amounts available under

20 subparagraph (A).

21 ‘‘(IV) The aggregate amount of

22 grants under subsection (a) made from

23 amounts available under subparagraph (B)

24 and clause (i) (other than grants that in25 clude amounts available under subpara-
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1 graph (A)) is not less than such aggregate

2 amount for the preceding fiscal year.’’.

3 (f) CONFORMING AMENDMENTS.—Section 739(b) of

4 the Public Health Service Act (42 U.S.C. 293c(b)), as

5 amended by subsection (a), is amended—

6 (1) in paragraph (3)(B), by striking ‘‘the des7 ignated health professions school’’ and inserting

8 ‘‘the school’’; and

9 (2) in paragraph (4), in each of subparagraphs

10 (B) and (C), by striking ‘‘the designated health pro11 fessions school’’ and inserting ‘‘the school’’.

12 (g) TRANSITIONAL AND SAVINGS PROVISIONS.—

13 (1) IN GENERAL.—In the case of any entity re14 ceiving a grant under section 739 of the Public

15 Health Service Act for fiscal year 1994, the Sec16 retary of Health and Human Services may, during

17 the period specified in paragraph (2), waive any or

18 all of the additional requirements established pursu19 ant to this section for the receipt or expenditure of

20 such a grant, subject to the entity providing assur21 ances satisfactory to the Secretary that the entity is

22 making progress toward meeting such requirements.

23 (2) RELEVANT PERIOD.—In the case of any en24 tity receiving a grant under section 739 of the Pub25 lic Health Service Act for fiscal year 1994, the pe-
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1 riod referred to in paragraph (1) is the period that,

2 in first approving the grant, the Secretary specified

3 as the duration of the grant.

4 SEC. 305. EDUCATIONAL ASSISTANCE REGARDING UNDER5 GRADUATES.

6 (a) IN GENERAL.—Section 740 of the Public Health

7 Service Act (42 U.S.C. 293d) is amended to read as fol8 lows:

9 ‘‘SEC. 740. ASSISTANCE REGARDING HEALTH PROFESSIONS

10 AS CAREER CHOICE.

11 ‘‘(a) IN GENERAL.—

12 ‘‘(1) ACADEMIC PREPARATION OF STUDENTS.—

13 Subject to the provisions of this section, the Sec14 retary may make grants and enter into contracts for

15 purposes of—

16 ‘‘(A) identifying individuals who—

17 ‘‘(i) are students of elementary

18 schools, or students or graduates of sec19 ondary schools or of institutions of higher

20 education;

21 ‘‘(ii) are from disadvantaged back22 grounds; and

23 ‘‘(iii) are interested in a career in the

24 health professions; and
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1 ‘‘(B) providing to such individuals aca2 demic assistance, counseling, and other services

3 to prepare the students to meet the academic

4 requirements for entry into health professions

5 schools.

6 ‘‘(2) RECIPIENTS OF GRANTS AND CON7 TRACTS.—The Secretary may make an award of a

8 grant or contract under paragraph (1) only if the

9 applicant for the award is a nonprofit private com10 munity-based organization or other public or non11 profit private entity. Such other entities include

12 schools of medicine, osteopathic medicine, public

13 health, dentistry, veterinary medicine, optometry,

14 pharmacy, allied health, chiropractic, and podiatric

15 medicine, and include graduate programs in mental

16 health practice.

17 ‘‘(3) CERTAIN USES OF AWARDS.—The pur18 poses for which the Secretary may authorize an

19 award under paragraph (1) to be expended include

20 the following:

21 ‘‘(A) Assisting elementary and secondary

22 schools and institutions of higher education in

23 developing or improving programs to prepare

24 students to meet the academic requirements for

25 entry into health professions schools.
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1 ‘‘(B) Establishing arrangements with non2 profit private community-based providers of pri3 mary health services under which students are

4 provided with opportunities to visit or work at

5 facilities of such providers and gain experience

6 regarding a career in a field of primary health

7 care.

8 ‘‘(C) Developing or improving programs to

9 enhance the academic preparation of advanced,

10 prehealth professions students or

11 postbaccalaureate individuals to successfully

12 enter a health professions school.

13 ‘‘(D) In the case of an award under para14 graph (1) that the Secretary has authorized to

15 be expended for the purpose described in sub16 paragraph (B) or (C), paying such stipends as

17 the Secretary may approve for individuals from

18 disadvantaged backgrounds for any period of

19 education in student-enhancement programs

20 (other than regular courses), except that such a

21 stipend may not be provided to an individual

22 for more than 12 months, and such a stipend

23 shall be in an amount of $25 per day (notwith24 standing any other provision of law regarding

25 the amount of stipends).
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1 ‘‘(b) MINIMUM REQUIREMENTS FOR AWARDS.—

2 ‘‘(1) ASSURANCES REGARDING FINANCIAL CA3 PACITY.—The Secretary may make an award of a

4 grant or contract under subsection (a) only if the

5 applicant provides assurances satisfactory to the

6 Secretary that, with respect to the activities for

7 which the award is to be made, the applicant has or

8 will have the financial capacity to continue the ac9 tivities after the eligibility of the applicant for such

10 awards for such activities is terminated pursuant to

11 subsection (e).

12 ‘‘(2) COLLABORATION AMONG VARIOUS ENTI13 TIES.—The Secretary may make an award of a

14 grant or contract under subsection (a) only if the

15 applicant for the award has entered into an agree16 ment with any schools, institutions, community17 based organizations, or other entities with which the

18 applicant will collaborate in carrying out activities

19 under the award, and the agreement specifies wheth20 er and to what extent the award will be allocated

21 among the applicant and the entities.

22 ‘‘(3) MATCHING FUNDS.—

23 ‘‘(A) With respect to the costs of the ac24 tivities to be carried out under subsection (a)

25 by an applicant, the Secretary may make an
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1 award of a grant or contract under such sub2 section only if the applicant agrees to make

3 available (directly or through donations from

4 public or private entities), in cash, non-Federal

5 contributions toward such costs in an amount

6 that—

7 ‘‘(i) for any second fiscal year for

8 which the applicant receives such a grant,

9 is not less than 20 percent of such costs;

10 ‘‘(ii) for any third such fiscal year, is

11 not less than 20 percent of such costs;

12 ‘‘(iii) for any fourth such fiscal year,

13 is not less than 40 percent of such costs;

14 ‘‘(iv) for any fifth such fiscal year, is

15 not less than 60 percent of such costs; and

16 ‘‘(v) for any sixth or subsequent such

17 fiscal year, is not less than 80 percent of

18 such costs.

19 ‘‘(B) Amounts provided by the Federal

20 Government may not be included in determin21 ing the amount of non-Federal contributions re22 quired in subparagraph (A).

23 ‘‘(C) The Secretary may not require non24 Federal contributions for the first fiscal year
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1 for which an applicant receives a grant under

2 subsection (a).

3 ‘‘(c) PREFERENCE IN MAKING AWARDS.—

4 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

5 in making awards of grants and contracts under

6 subsection (a), the Secretary shall give preference to

7 any applicant that has made an arrangement with 1

8 or more elementary schools, an arrangement with 1

9 or more secondary schools, an arrangement with 1

10 or more institutions of higher education, an arrange11 ment with 1 or more health professions schools, and

12 an arrangement with 1 or more community-based or13 ganizations, the purpose of which arrangements is to

14 establish a program as follows:

15 ‘‘(A) With respect to the elementary

16 schools involved, the program carries out the

17 purposes described in subsection (a)(1).

18 ‘‘(B) After a student identified pursuant to

19 paragraph (1) enters the secondary school in20 volved, the program continues to carry out such

21 purposes with respect to the student.

22 ‘‘(C) After graduating from the secondary

23 school, the student enters the institution of

24 higher education involved, subject to meeting

25 reasonable academic requirements, and the pro-
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1 gram continues to carry out such purposes with

2 respect to the student.

3 ‘‘(D) After graduating from the institution

4 of higher education, the student enters the

5 health professions school involved, subject to

6 meeting reasonable academic requirements.

7 ‘‘(2) REQUIREMENT REGARDING SCHOOLS AND

8 INSTITUTIONS.—For purposes of paragraph (1), an

9 applicant may not receive preference unless the

10 schools or institutions with which arrangements have

11 been made are schools or institutions whose enroll12 ment of students includes a significant number of

13 individuals from disadvantaged backgrounds.

14 ‘‘(d) LIMITATION ON YEARS OF FUNDING FOR PAR15 TICULAR ACTIVITIES.—With respect to a particular activ16 ity carried out under paragraph (1) or (3) of subsection

17 (a) by an entity, the Secretary may not, for the activity

18 involved, provide more than 6 years of financial assistance

19 under such subsection to the entity.

20 ‘‘(e) FUNDING.—

21 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

22 For the purpose of carrying out this section and sec23 tion 736, there are authorized to be appropriated

24 $32,000,000 for fiscal year 1995, $36,000,000 for
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1 fiscal year 1996, and $38,000,000 for fiscal year

2 1997.

3 ‘‘(2) ALLOCATIONS.—Of the amounts appro4 priated under paragraph (1) for a fiscal year, the

5 Secretary shall obligate not less than 20 percent for

6 carrying out subsection (a)(3)(B) and not less than

7 20 percent for providing scholarships under section

8 736.’’.

9 (b) TRANSITIONAL AND SAVINGS PROVISION.—In the

10 case of an entity that received an award of a grant or

11 contract for fiscal year 1994 under section 740 of the Pub12 lic Health Service Act, the Secretary of Health and

13 Human Services may continue in effect the award in ac14 cordance with the terms of the award, subject to the dura15 tion of the award not exceeding the period determined by

16 the Secretary in first approving the award. The preceding

17 sentence applies notwithstanding the amendment made by

18 subsection (a) of this section.

19 SEC. 306. STUDENT LOANS REGARDING SCHOOLS OF NURS20 ING.

21 Section 836(b) of the Public Health Service Act (42

22 U.S.C. 297b(b)) is amended—

23 (1) in paragraph (1), by striking the period at

24 the end and inserting a semicolon;

25 (2) in paragraph (2)—
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1 (A) in subparagraph (A), by striking

2 ‘‘and’’ at the end; and

3 (B) by inserting before the semicolon at

4 the end the following: ‘‘, and (C) such addi5 tional periods under the terms of paragraph (8)

6 of this subsection’’;

7 (3) in paragraph (7), by striking the period at

8 the end and inserting ‘‘; and’’; and

9 (4) by adding at the end the following para10 graph:

11 ‘‘(8) pursuant to uniform criteria established by

12 the Secretary, the repayment period established

13 under paragraph (2) for any student borrower who

14 during the repayment period failed to make consecu15 tive payments and who, during the last 12 months

16 of the repayment period, has made at least 12 con17 secutive payments may be extended for a period not

18 to exceed 10 years.’’.

19 SEC. 307. FEDERALLY-SUPPORTED STUDENT LOAN FUNDS.

20 (a) AUTHORIZATION OF APPROPRIATIONS REGARD21 ING CERTAIN MEDICAL SCHOOLS.—

22 (1) IN GENERAL.—Subpart II of part A of title

23 VII of the Public Health Service Act (42 U.S.C.

24 292q et seq.) is amended—
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1 (A) by transferring subsection (f) of sec2 tion 735 from the current placement of the sub3 section;

4 (B) by adding the subsection at the end of

5 section 723;

6 (C) by redesignating the subsection as sub7 section (e); and

8 (D) in subsection (e)(1) of section 723 (as

9 so redesignated), by striking ‘‘1996’’ and in10 serting ‘‘1997’’.

11 (2) CONFORMING AMENDMENTS.—Section 723

12 of the Public Health Service Act (42 U.S.C. 292s),

13 as amended by paragraph (1) of this subsection, is

14 amended in subsection (e)(2)(A)—

15 (A) by striking ‘‘section 723(b)(2)’’ and in16 serting ‘‘subsection (b)(2)’’; and

17 (B) by striking ‘‘such section’’ and insert18 ing ‘‘such subsection’’.

19 (b) AUTHORIZATION OF APPROPRIATIONS REGARD20 ING INDIVIDUALS FROM DISADVANTAGED BACK21 GROUNDS.—Section 724(f)(1) of the Public Health Serv22 ice Act (42 U.S.C. 292t(f)(1)) is amended to read as fol23 lows:

24 ‘‘(1) IN GENERAL.—With respect to making

25 Federal capital contributions to student loan funds
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1 for purposes of subsection (a), other than the stu2 dent loan fund of any school of medicine or osteo3 pathic medicine, there is authorized to be appro4 priated $5,000,000 for each of the fiscal years 1995

5 through 1997.’’.

6 TITLE IV—RESEARCH

7 SEC. 401. OFFICE OF RESEARCH ON MINORITY HEALTH.

8 Section 404 of the Public Health Service Act, as

9 added by section 151 of Public Law 103–43, is amended

10 by adding at the end the following subsections:

11 ‘‘(c) PLAN.—Subject to applicable law, the Director

12 of the Office, in consultation with the advisory committee

13 established under subsection (d), shall develop and imple14 ment a plan for carrying out the duties established in sub15 section (b). The Director shall review the plan not less

16 than annually, and revise the plan as appropriate.

17 ‘‘(d) ADVISORY COMMITTEE.—

18 ‘‘(1) In carrying out subsection (b), the Direc19 tor of the Office shall establish an advisory commit20 tee to be known as the Advisory Committee on Re21 search on Minority Health (in this subsection re22 ferred to as the ‘Committee’).

23 ‘‘(2)(A) The Committee shall be composed of

24 nonvoting, ex offico members designated in accord-
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1 ance with subparagraph (B) and voting members ap2 pointed in accordance with subparagraph (C).

3 ‘‘(B) The Secretary shall designate as ex officio

4 members of the Committee the Directors of each of

5 the national research institutes and the Deputy As6 sistant Secretary for Minority Health (except that

7 any of such officials may designate another officer

8 or employee of the office or agency involved to serve

9 as a member of the Committee in lieu of the offi10 cial).

11 ‘‘(C) The Director of the Office shall appoint as

12 voting members of the Committee not fewer than 12

13 and not more than 18 individuals who are not offi14 cers or employees of the Federal Government. The

15 appointments shall be made from among scientists

16 and health professionals whose clinical practice, re17 search specialization, or professional expertise in18 cludes significant expertise in research on minority

19 health. The appointed membership of the Advisory

20 Committee shall be broadly representative of the

21 various minority groups.

22 ‘‘(3) The Director of the Office shall serve as

23 the chair of the Committee.

24 ‘‘(4) The Committee shall—
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1 ‘‘(A) advise the Director of the Office on

2 appropriate research activities to be undertaken

3 by the national research institutes with respect

4 to—

5 ‘‘(i) research on minority health;

6 ‘‘(ii) research on racial and ethnic dif7 ferences in clinical drug trials, including

8 responses to pharmacological drugs;

9 ‘‘(iii) research on racial and ethnic

10 differences in disease etiology, course, and

11 treatment; and

12 ‘‘(iv) research on minority health con13 ditions which require a multidisciplinary

14 approach;

15 ‘‘(B) report to the Director of the Office

16 on such research;

17 ‘‘(C) provide recommendations to such Di18 rector regarding activities of the Office (includ19 ing recommendations on priorities in carrying

20 out research described in subparagraph (A));

21 and

22 ‘‘(D) assist in monitoring compliance with

23 section 492B regarding the inclusion of minori24 ties in clinical research.
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1 ‘‘(5)(A) The Advisory Committee shall prepare

2 biennial reports describing the activities of the Com3 mittee, including findings made by the Committee

4 regarding—

5 ‘‘(i) compliance with section 492B;

6 ‘‘(ii) the extent of expenditures made for

7 research on minority health by the agencies of

8 the National Institutes of Health; and

9 ‘‘(iii) the level of funding needed for such

10 research.

11 ‘‘(B) Each report under subparagraph (A) shall

12 be submitted to the Director of NIH for inclusion in

13 the report required in section 403 for the period in14 volved.

15 ‘‘(e) REPRESENTATION OF MINORITIES AMONG RE16 SEARCHERS.—The Secretary, acting through the Assist17 ant Secretary for Personnel and in collaboration with the

18 Director of the Office, shall determine the extent to which

19 the various minority groups are represented among admin20 istrators, senior physicians, and scientists of the national

21 research institutes and among physicians and scientists

22 conducting research with funds provided by such insti23 tutes, and as appropriate, carry out activities to increase

24 the extent of such representation.
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1 ‘‘(f) REQUIREMENT REGARDING GRANTS AND CON2 TRACTS.—Any award of a grant, cooperative agreement,

3 or contract that the Director of the Office is authorized

4 to make shall be made only on a competitive basis.

5 ‘‘(g) DEFINITIONS.—For purposes of this section:

6 ‘‘(1) The term ‘minority health conditions’, with

7 respect to individuals who are members of minority

8 groups, means all diseases, disorders, and conditions

9 (including with respect to mental health)—

10 ‘‘(A) unique to, more serious, or more

11 prevalent in such individuals;

12 ‘‘(B) for which the factors of medical risk

13 or types of medical intervention are different

14 for such individuals, or for which it is unknown

15 whether such factors or types are different for

16 such individuals; or

17 ‘‘(C) with respect to which there has been

18 insufficient clinical research involving such indi19 viduals as subjects or insufficient clinical data

20 on such individuals.

21 ‘‘(2) The term ‘research on minority health’

22 means research on minority health conditions, in23 cluding research on preventing such conditions.

24 ‘‘(3) The term ‘minority groups’ has the mean25 ing given such term in section 1707(h).’’.
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1 SEC. 402. ACTIVITIES OF AGENCY FOR HEALTH CARE POL2 ICY AND RESEARCH.

3 Title IX of the Public Health Service Act (42 U.S.C.

4 299 et seq.) is amended—

5 (1) in section 902, by amending subsection (b)

6 to read as follows:

7 ‘‘(b) REQUIREMENTS WITH RESPECT TO CERTAIN

8 POPULATIONS.—In carrying out subsection (a), the Ad9 ministrator shall undertake and support research, dem10 onstration projects, and evaluations with respect to the

11 health status of, and the delivery of health care to—

12 ‘‘(1) the populations of medically underserved

13 urban or rural areas (including frontier areas); and

14 ‘‘(2) low-income groups, minority groups, and

15 the elderly.’’; and

16 (2) in section 926(a), by adding at the end the

17 following sentence: ‘‘Of the amounts appropriated

18 under the preceding sentence for a fiscal year, the

19 Administrator shall reserve not less than 8 percent

20 for carrying out section 902(b)(2).’’.

21 SEC. 403. DATA COLLECTION BY NATIONAL CENTER FOR

22 HEALTH STATISTICS.

23 Section 306(n) of the Public Health Service Act (42

24 U.S.C. 242k(n)), as redesignated by section 501(a)(5)(B)

25 of Public Law 103–183 (107 Stat. 2237), is amended to

26 read as follows:
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1 ‘‘(n)(1) For health statistical and epidemiological ac2 tivities undertaken or supported under this section, there

3 are authorized to be appropriated such sums as may be

4 necessary for each of the fiscal years 1995 through 1998.

5 ‘‘(2) Of the amounts appropriated under paragraph

6 (1) for a fiscal year, the Secretary shall obligate not less

7 than an aggregate $5,000,000 for carrying out subsections

8 (h), (l), and (m) with respect to particular racial and eth9 nic population groups, except that not more than

10 $100,000 may be expended in the aggregate for the ad11 ministration of activities under subsection (m) and for ac12 tivities described in paragraph (2) of such subsection.’’.

13 TITLE V—NATIVE HAWAIIAN

14 HEALTH CARE

15 SEC. 501. CLARIFICATION OF 1992 AMENDMENTS.

16 (a) CLARIFICATION OF DATE OF PASSAGE.—Section

17 9168 of the Department of Defense Appropriations Act,

18 1993 (106 Stat. 1948) is amended by striking ‘‘September

19 12, 1992,’’ and inserting ‘‘August 7, 1992,’’.

20 (b) EFFECTIVE DATE.—The amendment made by

21 subsection (a) shall take effect as of October 6, 1992.
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1 SEC. 502. AMENDMENT OF NATIVE HAWAIIAN HEALTH

2 CARE IMPROVEMENT ACT TO REFLECT 1992

3 AGREEMENT.

4 Effective on the date of enactment of this Act, the

5 Native Hawaiian Health Care Improvement Act (42

6 U.S.C. 11701 et seq.) is amended to read as follows:

7 ‘‘SECTION 1. SHORT TITLE.

8 ‘‘This Act may be cited as the ‘Native Hawaiian

9 Health Care Improvement Act’.

10 ‘‘SEC. 2. FINDINGS; DECLARATION OF POLICY; INTENT OF

11 CONGRESS.

12 ‘‘(a) FINDINGS.—The Congress finds that—

13 ‘‘(1) the United States retains the legal respon14 sibility to enforce the administration of the public

15 trust responsibility of the State of Hawaii for the

16 betterment of the conditions of Native Hawaiians

17 under section 5(f) of Public Law 86–3 (73 Stat. 6;

18 commonly referred to as the ‘Hawaii Statehood Ad19 missions Act’);

20 ‘‘(2) in furtherance of the State of Hawaii’s

21 public trust responsibility for the betterment of the

22 conditions of Native Hawaiians, contributions by the

23 United States to the provision of comprehensive

24 health promotion and disease prevention services to

25 maintain and improve the health status of Native

26 Hawaiians are consistent with the historical and
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1 unique legal relationship of the United States with

2 the government that represented the indigenous na3 tive people of Hawaii; and

4 ‘‘(3) it is the policy of the United States to

5 raise the health status of Native Hawaiians to the

6 highest possible level and to encourage the maximum

7 participation of Native Hawaiians in order to

8 achieve this objective.

9 ‘‘(b) DECLARATION OF POLICY.—The Congress here10 by declares that it is the policy of the United States in

11 fulfillment of its special responsibilities and legal obliga12 tions to the indigenous people of Hawaii resulting from

13 the unique and historical relationship between the United

14 States and the Government of the indigenous people of

15 Hawaii—

16 ‘‘(1) to raise the health status of Native Hawai17 ians to the highest possible health level; and

18 ‘‘(2) to provide existing Native Hawaiian health

19 care programs with all resources necessary to effec20 tuate this policy.

21 ‘‘(c) INTENT OF CONGRESS.—It is the intent of the

22 Congress that the Nation meet the following health objec23 tives with respect to Native Hawaiians by the year 2000:

24 ‘‘(1) Reduce coronary heart disease deaths to

25 no more than 100 per 100,000.
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1 ‘‘(2) Reduce stroke deaths to no more than 20

2 per 100,000.

3 ‘‘(3) Increase control of high blood pressure to

4 at least 50 percent of people with high blood pres5 sure.

6 ‘‘(4) Reduce blood cholesterol to an average of

7 no more than 200 mg/dl.

8 ‘‘(5) Slow the rise in lung cancer deaths to

9 achieve a rate of no more than 42 per 100,000.

10 ‘‘(6) Reduce breast cancer deaths to no more

11 than 20.6 per 100,000 women.

12 ‘‘(7) Increase Pap tests every 1 to 3 years to

13 at least 85 percent of women age 18 and older.

14 ‘‘(8) Increase fecal occult blood testing every 1

15 to 2 years to at least 50 percent of people age 50

16 and older.

17 ‘‘(9) Reduce diabetes-related deaths to no more

18 than 34 per 100,000.

19 ‘‘(10) Reduce the most severe complications of

20 diabetes as follows:

21 ‘‘(A) End-stage renal disease to no more

22 than 1.4 in 1,000;

23 ‘‘(B) Blindness to no more than 1.4 in

24 1,000;
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1 ‘‘(C) Lower extremity amputation to no

2 more than 4.9 in 1,000;

3 ‘‘(D) Perinatal mortality to no more than

4 2 percent; and

5 ‘‘(E) Major congenital malformations to no

6 more than 4 percent.

7 ‘‘(11) Reduce infant mortality to no more than

8 7 deaths per 1,000 live births.

9 ‘‘(12) Reduce low birth weight to no more than

10 5 percent of live births.

11 ‘‘(13) Increase first trimester prenatal care to

12 at least 90 percent of live births.

13 ‘‘(14) Reduce teenage pregnancies to no more

14 than 50 per 1,000 girls age 17 and younger.

15 ‘‘(15) Reduce unintended pregnancies to no

16 more than 30 percent of pregnancies.

17 ‘‘(16) Increase to at least 60 percent the pro18 portion of primary care providers who provide age19 appropriate preconception care and counseling.

20 ‘‘(17) Increase years of healthy life to at least

21 65 years.

22 ‘‘(18) Eliminate financial barriers to clinical

23 preventive services.

24 ‘‘(19) Increase childhood immunization levels to

25 at least 90 percent of 2-year-olds.
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1 ‘‘(20) Reduce the prevalence of dental caries to

2 no more than 35 percent of children by age 8.

3 ‘‘(21) Reduce untreated dental caries so that

4 the proportion of children with untreated caries (in

5 permanent or primary teeth) is no more than 20

6 percent among children age 6 through 8 and no

7 more than 15 percent among adolescents age 15.

8 ‘‘(22) Reduce edentulism to no more than 20

9 percent in people age 65 and older.

10 ‘‘(23) Increase moderate daily physical activity

11 to at least 30 percent of the population.

12 ‘‘(24) Reduce sedentary lifestyles to no more

13 than 15 percent of the population.

14 ‘‘(25) Reduce overweight to a prevalence of no

15 more than 20 percent of the population.

16 ‘‘(26) Reduce dietary fat intake to an average

17 of 30 percent of calories or less.

18 ‘‘(27) Increase to at least 75 percent the pro19 portion of primary care providers who provide nutri20 tion assessment and counseling or referral to quali21 fied nutritionists or dieticians.

22 ‘‘(28) Reduce cigarette smoking prevalence to

23 no more than 15 percent of adults.

24 ‘‘(29) Reduce initiation of smoking to no more

25 than 15 percent by age 20.
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1 ‘‘(30) Reduce alcohol-related motor vehicle

2 crash deaths to no more than 8.5 per 100,000 ad3 justed for age.

4 ‘‘(31) Reduce alcohol use by school children age

5 12 to 17 to less than 13 percent.

6 ‘‘(32) Reduce marijuana use by youth age 18 to

7 25 to less than 8 percent.

8 ‘‘(33) Reduce cocaine use by youth age 18 to

9 25 to less than 3 percent.

10 ‘‘(34) Confine HIV infection to no more than

11 800 per 100,000.

12 ‘‘(35) Reduce gonorrhea infections to no more

13 than 225 per 100,000.

14 ‘‘(36) Reduce syphilis infections to no more

15 that 10 per 100,000.

16 ‘‘(37) Reduce significant hearing impairment to

17 a prevalance of no more than 82 per 1,000.

18 ‘‘(38) Reduce acute middle ear infections

19 among children age 4 and younger, as measured by

20 days of restricted activity or school absenteeism, to

21 no more than 105 days per 100 children.

22 ‘‘(39) Reduce indigenous cases of vaccine-pre23 ventable diseases as follows:

24 ‘‘(A) Diphtheria among individuals age 25

25 and younger to 0;
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1 ‘‘(B) Tetanus among individuals age 25

2 and younger to 0;

3 ‘‘(C) Polio (wild-type virus) to 0;

4 ‘‘(D) Measles to 0;

5 ‘‘(E) Rubella to 0;

6 ‘‘(F) Congenital Rubella Syndrome to 0;

7 ‘‘(G) Mumps to 500; and

8 ‘‘(H) Pertussis to 1,000; and

9 ‘‘(40) Reduce significant visual impairment to a

10 prevalence of no more than 30 per 1,000.

11 ‘‘(d) REPORT.—The Secretary shall submit to the

12 President, for inclusion in each report required to be

13 transmitted to the Congress under section 9, a report on

14 the progress made toward meeting each of the objectives

15 described in subsection (c).

16 ‘‘SEC. 3. COMPREHENSIVE HEALTH CARE MASTER PLAN

17 FOR NATIVE HAWAIIANS.

18 ‘‘The Secretary may make a grant to, or enter into

19 a contract with, Papa Ola Lokahi for the purpose of co20 ordinating, implementing, and updating a Native Hawai21 ian comprehensive health care master plan designed to

22 promote comprehensive health promotion and disease pre23 vention services and to maintain and improve the health

24 status of Native Hawaiians. The master plan shall be

25 based upon an assessment of the health care status and
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1 health care needs of Native Hawaiians. To the extent

2 practicable, assessments made as of the date of such grant

3 or contract shall be used by Papa Ola Lokahi, except that

4 any such assessment shall be updated as appropriate.

5 ‘‘SEC. 4. NATIVE HAWAIIAN HEALTH CARE SYSTEMS.

6 ‘‘(a) COMPREHENSIVE HEALTH PROMOTION, DIS7 EASE PREVENTION, AND PRIMARY HEALTH SERVICES.—

8 (1)(A) The Secretary, in consultation with Papa Ola

9 Lokahi, may make grants to, or enter into contracts with,

10 any qualified entity for the purpose of providing com11 prehensive health promotion and disease prevention serv12 ices as well as primary health services to Native Hawai13 ians.

14 ‘‘(B) In making grants and entering into contracts

15 under this paragraph, the Secretary shall give preference

16 to Native Hawaiian health care systems and Native Ha17 waiian organizations, and, to the extent feasible, health

18 promotion and disease prevention services shall be per19 formed through Native Hawaiian health care systems.

20 ‘‘(2) In addition to paragraph (1), the Secretary may

21 make a grant to, or enter into a contract with, Papa Ola

22 Lokahi for the purpose of planning Native Hawaiian

23 health care systems to serve the health needs of Native

24 Hawaiian communities on the islands of O’ahu, Moloka’i,
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1 Maui, Hawai’i, Lana’i, Kaua’i, and Ni’ihau in the State

2 of Hawaii.

3 ‘‘(b) QUALIFIED ENTITY.—An entity is a qualified

4 entity for purposes of subsection (a)(1) if the entity is a

5 Native Hawaiian health care system.

6 ‘‘(c) SERVICES TO BE PROVIDED.—(1) Each recipi7 ent of funds under subsection (a)(1) shall provide the fol8 lowing services:

9 ‘‘(A) Outreach services to inform Native Hawai10 ians of the availability of health services.

11 ‘‘(B) Education in health promotion and disease

12 prevention of the Native Hawaiian population by

13 (wherever possible) Native Hawaiian health care

14 practitioners, community outreach workers, coun15 selors, and cultural educators.

16 ‘‘(C) Services of physicians, physicians’ assist17 ants, or nurse practitioners.

18 ‘‘(D) Immunizations.

19 ‘‘(E) Prevention and control of diabetes, high

20 blood pressure, and otitis media.

21 ‘‘(F) Pregnancy and infant care.

22 ‘‘(G) Improvement of nutrition.

23 ‘‘(2) In addition to the mandatory services under

24 paragraph (1), the following services may be provided pur25 suant to subsection (a)(1):
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1 ‘‘(A) Identification, treatment, control, and re2 duction of the incidence of preventable illnesses and

3 conditions endemic to Native Hawaiians.

4 ‘‘(B) Collection of data related to the preven5 tion of diseases and illnesses among Native Hawai6 ians.

7 ‘‘(C) Services within the meaning of the terms

8 ‘health promotion’, ‘disease prevention’, and ‘pri9 mary health services’, as such terms are defined in

10 section 10, which are not specifically referred to in

11 paragraph (1) of this subsection.

12 ‘‘(3) The health care services referred to in para13 graphs (1) and (2) which are provided under grants or

14 contracts under subsection (a)(1) may be provided by tra15 ditional Native Hawaiian healers.

16 ‘‘(d) LIMITATION ON NUMBER OF ENTITIES.—Dur17 ing a fiscal year, the Secretary under this Act may make

18 a grant to, or hold a contract with, not more than 5 Native

19 Hawaiian health care systems.

20 ‘‘(e) MATCHING FUNDS.—(1) The Secretary may not

21 make a grant or provide funds pursuant to a contract

22 under subsection (a)(1) to an entity—

23 ‘‘(A) in an amount exceeding 75 percent of the

24 costs of providing health services under the grant or

25 contract; and
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1 ‘‘(B) unless the entity agrees that the entity

2 will make available, directly or through donations to

3 the entity, non-Federal contributions toward such

4 costs in an amount equal to not less than $1 (in

5 cash or in kind under paragraph (2)) for each $3 of

6 Federal funds provided in such grant or contract.

7 ‘‘(2) Non-Federal contributions required in para8 graph (1) may be in cash or in kind, fairly evaluated, in9 cluding plant, equipment, or services. Amounts provided

10 by the Federal Government or services assisted or sub11 sidized to any significant extent by the Federal Govern12 ment may not be included in determining the amount of

13 such non-Federal contributions.

14 ‘‘(3) The Secretary may waive the requirement estab15 lished in paragraph (1) if—

16 ‘‘(A) the entity involved is a nonprofit private

17 entity described in subsection (b); and

18 ‘‘(B) the Secretary, in consultation with Papa

19 Ola Lokahi, determines that it is not feasible for the

20 entity to comply with such requirement.

21 ‘‘(f) RESTRICTION ON USE OF GRANT AND CON22 TRACT FUNDS.—The Secretary may not make a grant to,

23 or enter into a contract with, an entity under subsection

24 (a)(1) unless the entity agrees that amounts received pur-
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1 suant to such subsection will not, directly or through con2 tract, be expended—

3 ‘‘(1) for any purpose other than the purposes

4 described in subsection (c);

5 ‘‘(2) to provide inpatient services;

6 ‘‘(3) to make cash payments to intended recipi7 ents of health services; or

8 ‘‘(4) to purchase or improve real property

9 (other than minor remodeling of existing improve10 ments to real property) or to purchase major medi11 cal equipment.

12 ‘‘(g) LIMITATION ON CHARGES FOR SERVICES.—The

13 Secretary may not make a grant, or enter into a contract

14 with, an entity under subsection (a)(1) unless the entity

15 agrees that, whether health services are provided directly

16 or through contract—

17 ‘‘(1) health services under the grant or contract

18 will be provided without regard to ability to pay for

19 the health services; and

20 ‘‘(2) the entity will impose a charge for the de21 livery of health services, and such charge—

22 ‘‘(A) will be made according to a schedule

23 of charges that is made available to the public,

24 and
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1 ‘‘(B) will be adjusted to reflect the income

2 of the individual involved.

3 ‘‘SEC. 5. FUNCTIONS OF, AND GRANTS TO, PAPA OLA

4 LOKAHI.

5 ‘‘(a) FUNCTIONS.—Papa Ola Lokahi shall—

6 ‘‘(1) coordinate, implement, and update, as ap7 propriate, the comprehensive health care master

8 plan developed pursuant to section 3;

9 ‘‘(2) to the maximum extent possible, coordi10 nate and assist the health care programs and serv11 ices provided to Native Hawaiians;

12 ‘‘(3) provide for the training of the persons de13 scribed in section 4(c)(1)(B);

14 ‘‘(4) develop an action plan outlining the con15 tributions that each member organization of Papa

16 Ola Lokahi will make in carrying out this Act;

17 ‘‘(5) serve as a clearinghouse for—

18 ‘‘(A) the collection and maintenance of

19 data associated with the health status of Native

20 Hawaiians;

21 ‘‘(B) the identification of and research into

22 diseases affecting Native Hawaiians;

23 ‘‘(C) the availability of Native Hawaiian

24 project funds, research projects, and publica25 tions; and
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1 ‘‘(D) the timely dissemination of informa2 tion relating to Native Hawaiian health care

3 systems;

4 ‘‘(6) perform the recognition and certification

5 functions specified in sections 10(6)(F) and

6 10(6)(G); and

7 ‘‘(7) provide technical support and coordination

8 of training and technical assistance to Native Ha9 waiian health care systems.

10 ‘‘(b) SPECIAL PROJECT FUNDS.—Papa Ola Lokahi

11 may receive project funds that may be appropriated for

12 the purpose of research on the health status of Native Ha13 waiians or for the purpose of addressing the health care

14 needs of Native Hawaiians.

15 ‘‘(c) GRANTS.—In addition to any other grant or con16 tract under this Act, the Secretary may make grants to,

17 or enter into contracts with, Papa Ola Lokahi for—

18 ‘‘(1) carrying out the functions described in

19 subsection (a); and

20 ‘‘(2) administering any special project funds re21 ceived under the authority of subsection (b).

22 ‘‘(d) RELATIONSHIPS WITH OTHER AGENCIES.—

23 Papa Ola Lokahi may enter into agreements or memo24 randa of understanding with relevant agencies or organi-
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1 zations that are capable of providing resources or services

2 to Native Hawaiian health care systems.

3 ‘‘SEC. 6. ADMINISTRATION OF GRANTS AND CONTRACTS.

4 ‘‘(a) TERMS AND CONDITIONS.—The Secretary shall

5 include in any grant made or contract entered into under

6 this Act such terms and conditions as the Secretary con7 siders necessary or appropriate to ensure that the objec8 tives of such grant or contract are achieved.

9 ‘‘(b) PERIODIC REVIEW.—The Secretary shall peri10 odically evaluate the performance of, and compliance with,

11 grants and contracts under this Act.

12 ‘‘(c) ADMINISTRATIVE REQUIREMENTS.—The Sec13 retary may not make a grant or enter into a contract

14 under this Act with an entity unless the entity—

15 ‘‘(1) agrees to establish such procedures for fis16 cal control and fund accounting as may be necessary

17 to ensure proper disbursement and accounting with

18 respect to the grant or contract;

19 ‘‘(2) agrees to ensure the confidentiality of

20 records maintained on individuals receiving health

21 services under the grant or contract;

22 ‘‘(3) with respect to providing health services to

23 any population of Native Hawaiians a substantial

24 portion of which has a limited ability to speak the

25 English language—
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1 ‘‘(A) has developed and has the ability to

2 carry out a reasonable plan to provide health

3 services under the grant or contract through in4 dividuals who are able to communicate with the

5 population involved in the language and cultural

6 context that is most appropriate; and

7 ‘‘(B) has designated at least one individ8 ual, fluent in both English and the appropriate

9 language, to assist in carrying out the plan;

10 ‘‘(4) with respect to health services that are

11 covered in the plan of the State of Hawaii approved

12 under title XIX of the Social Security Act—

13 ‘‘(A) if the entity will provide under the

14 grant or contract any such health services di15 rectly—

16 ‘‘(i) the entity has entered into a par17 ticipation agreement under such plan; and

18 ‘‘(ii) the entity is qualified to receive

19 payments under such plan; and

20 ‘‘(B) if the entity will provide under the

21 grant or contract any such health services

22 through a contract with an organization—

23 ‘‘(i) the organization has entered into

24 a participation agreement under such plan;

25 and
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1 ‘‘(ii) the organization is qualified to

2 receive payments under such plan; and

3 ‘‘(5) agrees to submit to the Secretary and to

4 Papa Ola Lokahi an annual report that describes

5 the utilization and costs of health services provided

6 under the grant or contract (including the average

7 cost of health services per user) and that provides

8 such other information as the Secretary determines

9 to be appropriate.

10 ‘‘(d) CONTRACT EVALUATION.—(1) If, as a result of

11 evaluations conducted by the Secretary, the Secretary de12 termines that an entity has not complied with or satisfac13 torily performed a contract entered into under section 4,

14 the Secretary shall, prior to renewing such contract, at15 tempt to resolve the areas of noncompliance or unsatisfac16 tory performance and modify such contract to prevent fu17 ture occurrences of such noncompliance or unsatisfactory

18 performance. If the Secretary determines that such non19 compliance or unsatisfactory performance cannot be re20 solved and prevented in the future, the Secretary shall not

21 renew such contract with such entity and is authorized

22 to enter into a contract under section 4 with another en23 tity referred to in section 4(b) that provides services to

24 the same population of Native Hawaiians which is served
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1 by the entity whose contract is not renewed by reason of

2 this subsection.

3 ‘‘(2) In determining whether to renew a contract en4 tered into with an entity under this Act, the Secretary

5 shall consider the results of evaluation under this section.

6 ‘‘(3) All contracts entered into by the Secretary under

7 this Act shall be in accordance with all Federal contract8 ing laws and regulations except that, in the discretion of

9 the Secretary, such contracts may be negotiated without

10 advertising and may be exempted from the provisions of

11 the Act of August 24, 1935 (40 U.S.C. 270a et seq.).

12 ‘‘(4) Payments made under any contract entered into

13 under this Act may be made in advance, by means of reim14 bursement, or in installments and shall be made on such

15 conditions as the Secretary deems necessary to carry out

16 the purposes of this Act.

17 ‘‘(e) LIMITATION ON USE OF FUNDS FOR ADMINIS18 TRATIVE EXPENSES.—Except for grants and contracts

19 under section 5(c), the Secretary may not make a grant

20 to, or enter into a contract with, an entity under this Act

21 unless the entity agrees that the entity will not expend

22 more than 10 percent of amounts received pursuant to this

23 Act for the purpose of administering the grant or contract.

24 ‘‘(f) REPORT.—(1) For each fiscal year during which

25 an entity receives or expends funds pursuant to a grant
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1 or contract under this Act, such entity shall submit to the

2 Secretary and to Papa Ola Lokahi a quarterly report on—

3 ‘‘(A) activities conducted by the entity under

4 the grant or contract;

5 ‘‘(B) the amounts and purposes for which Fed6 eral funds were expended; and

7 ‘‘(C) such other information as the Secretary

8 may request.

9 ‘‘(2) The reports and records of any entity which con10 cern any grant or contract under this Act shall be subject

11 to audit by the Secretary, the Inspector General of Health

12 and Human Services, and the Comptroller General of the

13 United States.

14 ‘‘(g) ANNUAL PRIVATE AUDIT.—The Secretary shall

15 allow as a cost of any grant made or contract entered into

16 under this Act the cost of an annual private audit con17 ducted by a certified public accountant.

18 ‘‘SEC. 7. ASSIGNMENT OF PERSONNEL.

19 ‘‘(a) IN GENERAL.—The Secretary is authorized to

20 enter into an agreement with any entity under which the

21 Secretary is authorized to assign personnel of the Depart22 ment of Health and Human Services with expertise identi23 fied by such entity to such entity on detail for the purposes

24 of providing comprehensive health promotion and disease

25 prevention services to Native Hawaiians.
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1 ‘‘(b) APPLICABLE FEDERAL PERSONNEL PROVI2 SIONS.—Any assignment of personnel made by the Sec3 retary under any agreement entered into under the au4 thority of subsection (a) shall be treated as an assignment

5 of Federal personnel to a local government that is made

6 in accordance with subchapter VI of chapter 33 of title

7 5, United States Code.

8 ‘‘SEC. 8. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.

9 ‘‘(a) ELIGIBILITY.—The Secretary is authorized to

10 make scholarship grants to students who—

11 ‘‘(1) meet the requirements of section 338A(b)

12 of the Public Health Service Act (42 U.S.C.

13 254l(b)); and

14 ‘‘(2) are Native Hawaiians.

15 ‘‘(b) TERMS AND CONDITIONS.—(1) Scholarship

16 grants provided under subsection (a) shall be provided

17 under the same terms and subject to the same conditions,

18 regulations, and rules that apply to scholarship grants

19 provided under section 338A of the Public Health Service

20 Act (42 U.S.C. 254l), except that—

21 ‘‘(A) the provision of scholarships in each type

22 of health care profession training shall correspond to

23 the need for each type of health care professional to

24 serve Native Hawaiian health care systems, as iden25 tified by Papa Ola Lokahi;
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1 ‘‘(B) in selecting scholarship recipients, the

2 Secretary shall give priority to individuals included

3 on a list of eligible applicants submitted by the Ka4 mehameha Schools/Bishop Estate;

5 ‘‘(C) the obligated service requirement for each

6 scholarship recipient shall be fulfilled through serv7 ice, in order of priority, in—

8 ‘‘(i) any one of the five Native Hawaiian

9 health care systems which, during the fiscal

10 year in which the obligated service requirement

11 is assigned, has received a grant or entered into

12 a contract pursuant to section 4; or

13 ‘‘(ii) health professions shortage areas,

14 medically underserved areas, or geographic

15 areas or facilities similarly designated by the

16 United States Public Health Service in the

17 State of Hawaii.

18 ‘‘(2) The Secretary shall enter into a cooperative

19 agreement with the Kamehameha Schools/Bishop Estate

20 under which such organization shall provide recruitment,

21 retention, counseling, and other support services intended

22 to improve the operation of the scholarship program estab23 lished under this section.
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1 ‘‘(3) The Native Hawaiian Health Scholarship pro2 gram shall not be administered by or through the Indian

3 Health Service.

4 ‘‘SEC. 9. REPORT.

5 ‘‘The President shall, at the time the budget is sub6 mitted under section 1105 of title 31, United States Code,

7 for each fiscal year transmit to the Congress the report

8 required pursuant to section 2(d).

9 ‘‘SEC. 10. DEFINITIONS.

10 ‘‘For purposes of this Act:

11 ‘‘(1) DISEASE PREVENTION.—The term ‘disease

12 prevention’ includes—

13 ‘‘(A) immunizations,

14 ‘‘(B) control of high blood pressure,

15 ‘‘(C) control of sexually transmittable dis16 eases,

17 ‘‘(D) prevention and control of diabetes,

18 ‘‘(E) control of toxic agents,

19 ‘‘(F) occupational safety and health,

20 ‘‘(G) accident prevention,

21 ‘‘(H) fluoridation of water,

22 ‘‘(I) control of infectious agents, and

23 ‘‘(J) provision of mental health care.

24 ‘‘(2) HEALTH PROMOTION.—The term ‘health

25 promotion’ includes—
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1 ‘‘(A) pregnancy and infant care, including

2 prevention of fetal alcohol syndrome,

3 ‘‘(B) cessation of tobacco smoking,

4 ‘‘(C) reduction in the misuse of alcohol and

5 drugs,

6 ‘‘(D) improvement of nutrition,

7 ‘‘(E) improvement in physical fitness,

8 ‘‘(F) family planning, and

9 ‘‘(G) control of stress.

10 ‘‘(3) NATIVE HAWAIIAN.—The term ‘Native

11 Hawaiian’ means any individual who is—

12 ‘‘(A) a citizen of the United States; and

13 ‘‘(B) a descendant of the aboriginal people,

14 who prior to 1778, occupied and exercised sov15 ereignty in the area that now constitutes the

16 State of Hawaii, as evidenced by—

17 ‘‘(i) genealogical records;

18 ‘‘(ii) Kupuna (elders) or Kama’aina

19 (long-term community residents) verifica20 tion; or

21 ‘‘(iii) birth records of the State of Ha22 waii.

23 ‘‘(4) NATIVE HAWAIIAN HEALTH CENTER.—The

24 term ‘Native Hawaiian health center’ means an en25 tity—
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1 ‘‘(A) which is organized under the laws of

2 the State of Hawaii,

3 ‘‘(B) which provides or arranges for health

4 care services through practitioners licensed by

5 the State of Hawaii, where licensure require6 ments are applicable,

7 ‘‘(C) which is a public or nonprofit private

8 entity, and

9 ‘‘(D) in which Native Hawaiian health

10 practitioners significantly participate in the

11 planning, management, monitoring, and evalua12 tion of health services.

13 ‘‘(5) NATIVE HAWAIIAN ORGANIZATION.—The

14 term ‘Native Hawaiian organization’ means any or15 ganization—

16 ‘‘(A) which serves the interests of Native

17 Hawaiians,

18 ‘‘(B) which is—

19 ‘‘(i) recognized by Papa Ola Lokahi

20 for the purpose of planning, conducting, or

21 administering programs (or portions of

22 programs) authorized under this Act for

23 the benefit of Native Hawaiians, and

24 ‘‘(ii) certified by Papa Ola Lokahi as

25 having the qualifications and capacity to
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1 provide the services, and meet the require2 ments, under the contract the organization

3 enters into with, or grant the organization

4 receives from, the Secretary under this

5 Act,

6 ‘‘(C) in which Native Hawaiian health

7 practitioners significantly participate in the

8 planning, management, monitoring, and evalua9 tion of health services, and

10 ‘‘(D) which is a public or nonprofit private

11 entity.

12 ‘‘(6) NATIVE HAWAIIAN HEALTH CARE SYS13 TEM.—The term ‘Native Hawaiian health care sys14 tem’ means an entity—

15 ‘‘(A) which is organized under the laws of

16 the State of Hawaii;

17 ‘‘(B) which provides or arranges for health

18 care services through practitioners licensed by

19 the State of Hawaii, where licensure require20 ments are applicable;

21 ‘‘(C) which is a public or nonprofit private

22 entity;

23 ‘‘(D) in which Native Hawaiian health

24 practitioners significantly participate in the
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1 planning, management, monitoring, and evalua2 tion of health care services;

3 ‘‘(E) which may be composed of as many

4 Native Hawaiian health centers as necessary to

5 meet the health care needs of Native Hawaiians

6 residing on the island or islands served by such

7 entity;

8 ‘‘(F) which is recognized by Papa Ola

9 Lokahi for the purpose of providing comprehen10 sive health promotion and disease prevention

11 services as well as primary health services to

12 Native Hawaiians under this Act; and

13 ‘‘(G) which is certified by Papa Ola Lokahi

14 as having the qualifications and the capacity to

15 provide the services and meet the requirements

16 of a contract entered into, or a grant received,

17 under section 4.

18 ‘‘(7) PAPA OLA LOKAHI.—(A) Subject to sub19 paragraph (B), the term ‘Papa Ola Lokahi’ means

20 an organization composed of—

21 ‘‘(i) E Ola Mau;

22 ‘‘(ii) the Office of Hawaiian Affairs of the

23 State of Hawaii;

24 ‘‘(iii) Alu Like Inc.;

25 ‘‘(iv) the University of Hawaii;
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1 ‘‘(v) the Office of Hawaiian Health of the

2 Hawaii State Department of Health;

3 ‘‘(vi) Ho’ola Lahui Hawaii, or a health

4 care system serving the islands of Kaua’i and

5 Ni’ihau;

6 ‘‘(vii) Ke Ola Mamo, or a health care sys7 tem serving the island of O’ahu;

8 ‘‘(viii) Na Pu’uwai or a health care system

9 serving the islands of Moloka’i and Lana’i;

10 ‘‘(ix) Hui No Ke Ola Pono, or a health

11 care system serving the island of Maui;

12 ‘‘(x) Hui Malama Ola Ha’Oiwi or a health

13 care system serving the island of Hawaii; and

14 ‘‘(xi) such other member organizations as

15 the Board of Papa Ola Lokahi may admit from

16 time to time, based upon satisfactory dem17 onstration of a record of contribution to the

18 health and well-being of Native Hawaiians, and

19 upon satisfactory development of a mission

20 statement in relation to this Act, including

21 clearly defined goals and objectives, a 5-year ac22 tion plan outlining the contributions that each

23 organization will make in carrying out the pol24 icy of this Act, and an estimated budget.
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1 ‘‘(B) Such term does not include any organiza2 tion identified in subparagraph (A) if the Secretary

3 determines that such organization does not have a

4 mission statement with clearly defined goals and ob5 jectives for the contributions the organization will

6 make to Native Hawaiian health care systems and

7 an action plan for carrying out such goals and objec8 tives.

9 ‘‘(8) PRIMARY HEALTH SERVICES.—The term

10 ‘primary health services’ means—

11 ‘‘(A) services of physicians, physicians’ as12 sistants and nurse practitioners;

13 ‘‘(B) diagnostic laboratory and radiologic

14 services;

15 ‘‘(C) preventive health services (including

16 children’s eye and ear examinations to deter17 mine the need for vision and hearing correction,

18 perinatal services, well child services, and family

19 planning services);

20 ‘‘(D) emergency medical services;

21 ‘‘(E) transportation services as required

22 for adequate patient care;

23 ‘‘(F) preventive dental services; and

24 ‘‘(G) pharmaceutical services, as may be

25 appropriate for particular health centers.
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1 ‘‘(9) SECRETARY.—The term ‘Secretary’ means

2 the Secretary of Health and Human Services.

3 ‘‘(10) TRADITIONAL NATIVE HAWAIIAN HEAL4 ER.—The term ‘traditional Native Hawaiian healer’

5 means a practitioner—

6 ‘‘(A) who—

7 ‘‘(i) is of Hawaiian ancestry, and

8 ‘‘(ii) has the knowledge, skills, and ex9 perience in direct personal health care of

10 individuals, and

11 ‘‘(B) whose knowledge, skills, and experi12 ence are based on a demonstrated learning of

13 Native Hawaiian healing practices acquired

14 by—

15 ‘‘(i) direct practical association with

16 Native Hawaiian elders, and

17 ‘‘(ii) oral traditions transmitted from

18 generation to generation.

19 ‘‘SEC. 11. RULE OF CONSTRUCTION.

20 ‘‘Nothing in this Act shall be construed to restrict

21 the authority of the State of Hawaii to license health prac22 titioners.

23 ‘‘SEC. 12. COMPLIANCE WITH BUDGET ACT.

24 ‘‘Any new spending authority (described in subsection

25 (c)(2) (A) or (B) of section 401 of the Congressional
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1 Budget Act of 1974) which is provided under this Act

2 shall be effective for any fiscal year only to such extent

3 or in such amounts as are provided in appropriation Acts.

4 ‘‘SEC. 13. SEVERABILITY.

5 ‘‘If any provision of this Act, or the application of

6 any such provision to any person or circumstances is held

7 to be invalid, the remainder of this Act, and the applica8 tion of such provision or amendment to persons or cir9 cumstances other than those to which it is held invalid,

10 shall not be affected thereby.

11 ‘‘SEC. 14. AUTHORIZATION OF APPROPRIATIONS.

12 ‘‘There is authorized to be appropriated for each of

13 the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and

14 2000 such sums as may be necessary to carry out the pur15 poses of this Act.

16 ‘‘SEC. 15. PROHIBITION AGAINST EXCLUSION FROM PAR17 TICIPATION.

18 ‘‘Notwithstanding any other provision of this Act, no

19 person shall, on the basis of race, color, or national origin,

20 be excluded from participation in, or be denied the benefits

21 of, or be subjected to discrimination under, any program

22 or activity receiving Federal financial assistance under

23 this Act.’’.
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1 SEC. 503. REPEAL OF PUBLIC HEALTH SERVICE ACT PROVI2 SION.

3 The Public Health Service Act (42 U.S.C. 201 et

4 seq.), as amended by section 206 of this Act, is amended

5 by repealing section 338K and redesignating section 338L

6 as section 338K. Such repeal shall not be construed to

7 terminate contracts in effect under such section on the

8 date of the enactment of this Act. Any such contracts shall

9 continue according to the terms and conditions of such

10 contracts.

11 TITLE VI—MISCELLANEOUS

12 PROVISIONS

13 SEC. 601. TECHNICAL AMENDMENT TO INDIAN HEALTH

14 CARE IMPROVEMENT ACT.

15 The last sentence of section 818(e)(3) of the Indian

16 Health Care Improvement Act (25 U.S.C. 1680h(e)(3))

17 is amended—

18 (1) by striking ‘‘services,’’ and inserting ‘‘serv19 ices’’; and

20 (2) by striking ‘‘, shall be recoverable.’’ and in21 serting a period.

22 SEC. 602. HEALTH SERVICES FOR PACIFIC ISLANDERS.

23 Section 10 of the Disadvantaged Minority Health Im24 provement Act of 1990 (42 U.S.C. 254c–1) is amended—

25 (1) in subsection (b)—

26 (A) by striking paragraphs (5) and (6);
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1 (B) by redesignating paragraphs (7) and

2 (8) as paragraphs (5) and (6), respectively;

3 (C) in paragraph (1) (as so redesig4 nated)—

5 (i) by inserting ‘‘substance abuse’’

6 after ‘‘availability of health’’; and

7 (ii) by striking ‘‘, including improved

8 health data systems’’; and

9 (D) in paragraph (2) (as so redesig10 nated)—

11 (i) by striking ‘‘manpower’’ and in12 serting ‘‘care providers’’; and

13 (ii) by striking ‘‘by—’’ and all that

14 follows through the end thereof and insert15 ing a semicolon; and

16 (2) in subsection (f)—

17 (A) by striking ‘‘there is’’ and inserting

18 ‘‘there are’’; and

19 (B) by striking ‘‘$10,000,000’’ and all that

20 follows through ‘‘1993’’ and inserting

21 ‘‘$3,000,000 for each of the fiscal years 1995

22 through 1997’’.
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1 SEC. 603. TECHNICAL CORRECTIONS REGARDING PUBLIC

2 LAW 103–183.

3 (a) AMENDATORY INSTRUCTIONS.—Public Law 103–

4 183 is amended—

5 (1) in section 301(a), by striking ‘‘(42 U.S.C.

6 242 et seq.)’’ and inserting ‘‘(42 U.S.C. 243 et

7 seq.)’’;

8 (2) in section 601—

9 (A) in subsection (b), in the matter preced10 ing paragraph (1), by striking ‘‘Section 1201 of

11 the Public Health Service Act (42 U.S.C.

12 300d)’’ and inserting ‘‘Title XII of the Public

13 Health Service Act (42 U.S.C. 300d et seq.)’’;

14 and

15 (B) in subsection (f)(1), by striking ‘‘in

16 section 1204(c)’’ and inserting ‘‘in section

17 1203(c) (as redesignated by subsection (b)(2) of

18 this section)’’;

19 (3) in section 602, by striking ‘‘‘for the pur20 pose’’ and inserting ‘‘‘For the purpose’’; and

21 (4) in section 705(b), by striking ‘‘317D((l)(1)’’

22 and inserting ‘‘317D(l)(1)’’.

23 (b) PUBLIC HEALTH SERVICE ACT.—The Public

24 Health Service Act, as amended by Public Law 103–183

25 and by subsection (a) of this section, is amended—
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1 (1) in section 317E(g)(2), by striking ‘‘making

2 grants under subsection (b)’’ and inserting ‘‘carrying

3 out subsection (b)’’;

4 (2) in section 318, in subsection (e) as in effect

5 on the day before the date of the enactment of Pub6 lic Law 103–183, by redesignating the subsection as

7 subsection (f);

8 (3) in part D of title III, by inserting before

9 section 340D the following subpart heading:

10 ‘‘Subpart IX—Miscellaneous Provisions Regarding

11 Primary Health Care’’;

12 (4) in subpart 6 of part C of title IV—

13 (A) by transferring the first section 447

14 (added by section 302 of Public Law 103–183)

15 from the current placement of the section;

16 (B) by redesignating the section as section

17 447A; and

18 (C) by inserting the section after section

19 447;

20 (5) in section 1213(a)(8), by striking ‘‘provides

21 for for’’ and inserting ‘‘provides for’’;

22 (6) in section 1501, by redesignating the second

23 subsection (c) (added by section 101(f) of Public

24 Law 103–183) as subsection (d); and

25 (7) in section 1505(3), by striking ‘‘nonprofit’’.
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1 (c) MISCELLANEOUS CORRECTION.—Section

2 401(c)(3) of Public Law 103–183 is amended in the mat3 ter preceding subparagraph (A) by striking ‘‘(d)(5)’’ and

4 inserting ‘‘(e)(5)’’.

5 SEC. 604. CERTAIN AUTHORITIES OF CENTERS FOR DIS6 EASE CONTROL AND PREVENTION.

7 Part B of title III of the Public Health Service Act

8 (42 U.S.C. 243 et seq.), as amended pursuant to section

9 603(a)(1) of this Act and as amended by section 703 of

10 Public Law 103–183, is amended by inserting after sec11 tion 317F the following section:

12 ‘‘MISCELLANEOUS AUTHORITIES REGARDING CENTERS

13 FOR DISEASE CONTROL AND PREVENTION

14 ‘‘SEC. 317G. (a) TECHNICAL AND SCIENTIFIC PEER

15 REVIEW GROUPS.—The Secretary, acting through the Di16 rector of the Centers for Disease Control and Prevention,

17 may, without regard to the provisions of title 5, United

18 States Code, governing appointments in the competitive

19 service, and without regard to the provisions of chapter

20 51 and subchapter III of chapter 53 of such title relating

21 to classification and General Schedule pay rates, establish

22 such technical and scientific peer review groups and sci23 entific program advisory committees as are needed to

24 carry out the functions of such Centers and appoint and

25 pay the members of such groups, except that officers and

26 employees of the United States shall not receive additional
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1 compensation for service as members of such groups. The

2 Federal Advisory Committee Act shall not apply to the

3 duration of such peer review groups. Not more than one4 fourth of the members of any such group shall be officers

5 or employees of the United States.

6 ‘‘(b) FELLOWSHIP AND TRAINING PROGRAMS.—The

7 Secretary, acting through the Director of the Centers for

8 Disease Control and Prevention, shall establish fellowship

9 and training programs to be conducted by such Centers

10 to train individuals to develop skills in epidemiology, sur11 veillance, laboratory analysis, and other disease detection

12 and prevention methods. Such programs shall be designed

13 to enable health professionals and health personnel trained

14 under such programs to work, after receiving such train15 ing, in local State, national, and international efforts to16 ward the prevention and control of diseases, injuries, and

17 disabilities. Such fellowships and training may be adminis18 tered through the use of either appointment or

19 nonappointment procedures.’’.

20 TITLE VII—GENERAL

21 PROVISIONS

22 SEC. 701. EFFECTIVE DATE.

23 Except as otherwise provided in this Act, this Act

24 takes effect October 1, 1994, or upon the date of the en25 actment of this Act, whichever occurs later.
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