I

103D CONGRESS

2D SESSION H. R. 3804

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 3, 1994

Mr. WAXMAN 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:

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.
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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.

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.

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 ‘‘(1) determine the extent to which the purposes

20 of the programs are being carried out with respect

21 to minority groups;

22 ‘‘(2) 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 ‘‘(3) 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) in the case of referrals of pregnant women

11 for the treatment of substance abuse, notification of

12 the referrals to the State official responsible for car13 rying out programs under subpart II of part B of

14 title XIX,’’; and

15 (B) in paragraph (7)—

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

17 ‘‘and’’ at the end;

18 (ii) by redesignating subparagraph

19 (M) as subparagraph (N); and

20 (iii) by inserting after subparagraph

21 (L) the following subparagraph:

22 ‘‘(M) treatment of pregnant women for sub23 stance abuse; and’’.

24 (2) OVERLAP IN CATCHMENT AREAS.—Section

25 329(a) of the Public Health Service Act (42 U.S.C.
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1 254b(a)) is amended by adding at the end the fol2 lowing paragraph:

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

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

5 operation of more than one migrant health center in a

6 catchment area in any case in which the Secretary deter7 mines that in such area there are workers or other individ8 uals described in subsection (a)(1) (in the matter after

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

10 shortage of personal health services. The preceding sen11 tence may not be construed as requiring that, in such a

12 case, the catchment areas of the centers involved be iden13 tical.’’.

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

15 the Public Health Service Act, as amended by para16 graph (2) of this subsection, is amended by adding

17 at the end the following paragraph:

18 ‘‘(9) In making grants under this section, the Sec19 retary may, to the extent determined by the Secretary to

20 be appropriate, authorize migrant health centers to pro21 vide services at locations other than the center.’’.

22 (4) AMOUNT OF GRANT; USE OF CERTAIN

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

24 Service Act (42 U.S.C. 254b(d)(4)), as amended by
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1 section 309(a)(3) of Public Law 102–531 (106 Stat.

2 3500), is amended to read as follows:

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

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

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

6 the period for which the grant is made)—

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

8 expected to incur in carrying out the plan approved

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

10 and

11 ‘‘(ii) the amounts that the center may reason12 ably be expected to receive as State, local, and other

13 operational funding (exclusive of amounts to be pro14 vided in the grant under this section) and as fees,

15 premiums, and third-party reimbursements.

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

17 restrict the purposes for which a migrant health center

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

19 (including restrictions imposed pursuant to Federal cost

20 principles).

21 ‘‘(ii) The Secretary may require that amounts de22 scribed in subparagraph (A)(ii) be expended for purposes

23 that are consistent with the purposes specified in this sec24 tion.
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1 ‘‘(C)(i) Payments under a grant under this section

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

3 in such installments as the Secretary finds necessary. Ad4 justments in such payments may be made for overpay5 ments or underpayments, subject to clause (ii).

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

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

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

9 subparagraph (A)(ii) that the center actually received ex10 ceeded the costs of the center in carrying out the plan

11 approved by the Secretary pursuant to subsection

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

13 amount if the center agrees to expend such amount only

14 for the following purposes:

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

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

17 ‘‘(III) To acquire, modernize, or expand facili18 ties, or to construct facilities.

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

20 programs.

21 ‘‘(V) To establish financial reserves.

22 ‘‘(D) With respect to funds that are amounts de23 scribed in subparagraph (A)(ii) or excess amounts de24 scribed in subparagraph (C)(ii), this paragraph may not

25 be construed as limiting the authority of the Secretary to
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1 require the submission of such plans, budgets, and other

2 information as may be necessary to ensure that the funds

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

4 clauses (I) through (V) of subparagraph (C)(ii), respec5 tively.’’.

6 (5) AUTHORIZATION OF APPROPRIATIONS.—

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

8 U.S.C. 254b(h)) is amended—

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

10 ‘‘1994’’ and inserting ‘‘1998’’; and

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

12 ‘‘1994’’ and inserting ‘‘1998’’.

13 (b) COMMUNITY HEALTH CENTERS.—

14 (1) TREATMENT OF PREGNANT WOMEN FOR

15 SUBSTANCE ABUSE.—Section 330 of the Public

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

17 (A) in subsection (a)(3)—

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

19 (ii) in subparagraph (A) (as so des20 ignated), by adding ‘‘and’’ after the

21 comma at the end; and

22 (iii) by adding at the end the follow23 ing subparagraph:

24 ‘‘(B) in the case of referrals of pregnant women

25 for the treatment of substance abuse, notification of
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1 the referrals to the State official responsible for car2 rying out programs under subpart II of part B of

3 title XIX,’’; and

4 (B) in subsection (b)(2)—

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

6 ‘‘and’’ at the end;

7 (ii) by redesignating subparagraph

8 (M) as subparagraph (N); and

9 (iii) by inserting after subparagraph

10 (L) the following subparagraph:

11 ‘‘(M) treatment of pregnant women for sub12 stance abuse; and’’.

13 (2) OVERLAP IN CATCHMENT AREAS.—Section

14 330(b) of the Public Health Service Act (42 U.S.C.

15 254c(b)) is amended by adding at the end the fol16 lowing paragraph:

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

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

19 operation of more than one community health center in

20 a catchment area in any case in which the Secretary deter21 mines that there is a population group in such area that

22 otherwise will have a shortage of personal health services.

23 The preceding sentence may not be construed as requiring

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

25 involved be identical.’’.
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1 (3) OFFSITE ACTIVITIES.—Section 330(b) of

2 the Public Health Service Act, as amended by para3 graph (2) of this subsection, is amended by adding

4 at the end the following paragraph:

5 ‘‘(8) In making grants under this section, the Sec6 retary may, to the extent determined by the Secretary to

7 be appropriate, authorize community health centers to

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

9 (4) AMOUNT OF GRANT; USE OF CERTAIN

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

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

12 section 309(b)(3) of Public Law 102-531 (106 Stat.

13 3501), is amended to read as follows:

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

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

16 shall be determined by the Secretary, taking into account

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

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

19 expected to incur in carrying out the plan approved

20 by the Secretary pursuant to subsection (e)(3)(H),

21 and

22 ‘‘(ii) the amounts that the center may reason23 ably be expected to receive as State, local, and other

24 operational funding (exclusive of amounts to be pro-
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1 vided in the grant under this section) and as fees,

2 premiums, and third-party reimbursements.

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

4 restrict the purposes for which a community health center

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

6 (including restrictions imposed pursuant to Federal cost

7 principles).

8 ‘‘(ii) The Secretary may require that amounts de9 scribed in subparagraph (A)(ii) be expended for purposes

10 that are consistent with the purposes specified in this sec11 tion.

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

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

14 in such installments as the Secretary finds necessary. Ad15 justments in such payments may be made for overpay16 ments or underpayments, subject to clause (ii).

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

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

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

20 in subparagraph (A)(ii) that the center actually received

21 exceeded the costs of the center in carrying out the plan

22 approved by the Secretary pursuant to subsection

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

24 amount if the center agrees to expend such amount only

25 for the following purposes:
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1 ‘‘(I) To expand and improve services.

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

3 ‘‘(III) To acquire, modernize, or expand facili4 ties, or to construct facilities.

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

6 programs.

7 ‘‘(V) To establish financial reserves.

8 ‘‘(D) With respect to funds that are amounts de9 scribed in subparagraph (A)(ii) or excess amounts de10 scribed in subparagraph (C)(ii), this paragraph may not

11 be construed as limiting the authority of the Secretary to

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

13 information as may be necessary to ensure that the funds

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

15 clauses (I) through (V) of subparagraph (C)(ii), respec16 tively.’’.

17 (5) AUTHORIZATION OF APPROPRIATIONS.—

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

19 U.S.C. 254c(g)) is amended—

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

21 ‘‘1994’’ and inserting ‘‘1998’’; and

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

23 ‘‘1994’’ and inserting ‘‘1998’’.
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1 SEC. 202. HEALTH SERVICES FOR THE HOMELESS.

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

3 (42 U.S.C. 256(q)(1)) is amended by striking ‘‘and 1994’’

4 and inserting ‘‘through 1998’’.

5 SEC. 203. HEALTH SERVICES FOR RESIDENTS OF PUBLIC

6 HOUSING.

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

8 (42 U.S.C. 256a(p)(1)) is amended by striking ‘‘and

9 1993’’ and inserting ‘‘through 1998’’.

10 SEC. 204. GRANTS TO STATES FOR LOAN REPAYMENT PRO11 GRAMS REGARDING OBLIGATED SERVICE OF

12 HEALTH PROFESSIONALS.

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

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

15 following paragraph:

16 ‘‘(4) PRIVATE PRACTICE.—

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

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

19 waive the requirement of paragraph (1) regard20 ing the assignment of a health professional if,

21 subject to subparagraph (B), the health profes22 sional enters into an agreement with the State

23 to provide primary health services in a full-time

24 private clinical practice in a health professional

25 shortage area.
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1 ‘‘(B) The Secretary may not make a grant

2 under subsection (a) unless the State involved

3 agrees that, if the State provides a waiver

4 under subparagraph (A) for a health profes5 sional, section 338D(b)(1) will apply to the

6 agreement under such subparagraph between

7 the State and the health professional to the

8 same extent and in the same manner as such

9 section applies to an agreement between the

10 Secretary and a health professional regarding a

11 full-time private clinical practice.’’.

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

13 OFFICES OF RURAL HEALTH.

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

15 U.S.C. 254r) is amended—

16 (1) in subsection (b)(1), in the matter preced17 ing subparagraph (A), by striking ‘‘in cash’’; and

18 (2) in subsection (j)(1)—

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

20 (B) by inserting before the period the fol21 lowing: ‘‘, and such sums as may be necessary

22 for each of the fiscal years 1995 through

23 1997’’.
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1 SEC. 206. DEMONSTRATION GRANTS TO STATES FOR COM2 MUNITY SCHOLARSHIP PROGRAMS REGARD3 ING OBLIGATED SERVICE OF HEALTH PRO4 FESSIONALS.

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

6 U.S.C. 254t) is amended—

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

8 each place such term appears and inserting ‘‘health

9 professional shortage’’;

10 (2) in subsection (e)—

11 (A) by striking paragraph (1);

12 (B) by redesignating paragraphs (2)

13 through (6) as paragraphs (1) through (5), re14 spectively; and

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

16 by inserting after ‘‘the individual’’ the follow17 ing: ‘‘who is to receive the scholarship under

18 the contract’’;

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

20 medicine, pediatrics,’’ and inserting ‘‘general inter21 nal medicine, general pediatrics,’’; and

22 (4) in subsection (l)(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. 207. PROGRAMS REGARDING BIRTH DEFECTS.

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

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

6 102-531 (106 Stat. 3494), is amended to read as follows:

7 ‘‘PROGRAMS REGARDING BIRTH DEFECTS

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

9 Director of the Centers for Disease Control and Preven10 tion, shall carry out programs—

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

12 on birth defects (in manner that facilitates compli13 ance with subsection (d)(2)), including data on the

14 causes of such defects and on the incidence and

15 prevalence of such defects;

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

17 the public on the prevention of such defects;

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

19 clinical skills of health professionals with respect to

20 the prevention of such defects;

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

22 prevention of such defects; and

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

24 of research on the prevention of such defects.

25 ‘‘(b) ADDITIONAL PROVISIONS REGARDING COLLEC26 TION OF DATA.—
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1 ‘‘(1) IN GENERAL.—In carrying out subsection

2 (a)(1), the Secretary—

3 ‘‘(A) shall collect and analyze data by gen4 der and by racial and ethnic group, including

5 Hispanics, non-Hispanic whites, African Ameri6 cans, Native Americans, Asian Americans, and

7 Pacific Islanders;

8 ‘‘(B) shall collect data under subparagraph

9 (A) from birth certificates, death certificates,

10 hospital records, and such other sources as the

11 Secretary determines to be appropriate; and

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

13 improve programs for the collection and analy14 sis of epidemiological data on birth defects, and

15 to make the data available.

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

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

18 and maintain a National Information Clearinghouse

19 on Birth Defects to collect and disseminate to health

20 professionals and the general public information on

21 birth defects, including the prevention of such de22 fects.

23 ‘‘(c) GRANTS AND CONTRACTS.—

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

25 (a), the Secretary may make grants to and enter
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1 into contracts with public and nonprofit private enti2 ties.

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

4 AWARD FUNDS.—

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

6 award of a grant or contract under paragraph

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

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

9 for the purpose of aiding the recipient in carry10 ing out the purposes for which the award is

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

12 recipient any officer or employee of the Depart13 ment of Health and Human Services.

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

15 in subparagraph (A), the Secretary shall reduce

16 the amount of payments under the award in17 volved by an amount equal to the costs of de18 tailing personnel and the fair market value of

19 any supplies, equipment, or services provided by

20 the Secretary. The Secretary shall, for the pay21 ment of expenses incurred in complying with

22 such request, expend the amounts withheld.

23 ‘‘(3) APPLICATION FOR AWARD.—The Secretary

24 may make an award of a grant or contract under

25 paragraph (1) only if an application for the award
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1 is submitted to the Secretary and the application is

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

3 such agreements, assurances, and information as the

4 Secretary determines to be necessary to carry out

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

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

7 1 of fiscal year 1995 and of every second such year there8 after, the Secretary shall submit to the Committee on En9 ergy and Commerce of the House of Representatives, and

10 the Committee on Labor and Human Resources of the

11 Senate, a report that, with respect to the preceding 2 fis12 cal years—

13 ‘‘(1) contains information regarding the inci14 dence and prevalence of birth defects and the extent

15 to which birth defects have contributed to the inci16 dence and prevalence of infant mortality;

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

18 that is specific to various racial and ethnic groups

19 (including Hispanics, non-Hispanic whites, African

20 Americans, Native Americans, and Asian Ameri21 cans);

22 ‘‘(3) contains an assessment of the extent to

23 which various approaches of preventing birth defects

24 have been effective;
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1 ‘‘(4) describes the activities carried out under

2 this section; and

3 ‘‘(5) contains any recommendations of the Sec4 retary regarding this section.

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

6 purpose of carrying out this section, there are authorized

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

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

9 1996 and 1997.’’.

10 SEC. 208. HEALTHY START FOR INFANTS.

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

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

13 by inserting after section 330 the following section:

14 ‘‘HEALTHY START FOR INFANTS

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

16 SERVICES.—

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

18 grants for the operation of not more than 19 dem19 onstration projects to provide the services described

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

21 geographic areas in which the projects are carried

22 out—

23 ‘‘(A) the incidence of infant mortality and

24 morbidity;

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

26 ‘‘(C) the incidence of maternal mortality;
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1 ‘‘(D) the incidence of fetal alcohol syn2 drome; and

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

4 births.

5 ‘‘(2) ACHIEVEMENT OF YEAR 2000 HEALTH STA6 TUS OBJECTIVES.—With respect to the objectives es7 tablished by the Secretary for the health status of

8 the population of the United States for the year

9 2000, the Secretary shall, in providing for a dem10 onstration project under paragraph (1) in a geo11 graphic area, seek to meet the objectives that are

12 applicable to the purpose described in such para13 graph and the populations served by the project.

14 ‘‘(b) AUTHORIZED SERVICES.—

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

16 the services referred to in this subsection are com17 prehensive services (including preventive and pri18 mary health services for pregnant women and in19 fants and childhood immunizations in accordance

20 with the schedule recommended by the Secretary)

21 for carrying out the purpose described in subsection

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

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

24 make a grant under subsection (a) only if the appli25 cant involved agrees that, in making any arrange-
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1 ments under which other entities provide authorized

2 services in the demonstration project involved, the

3 applicant will include among the entities with which

4 the arrangements are made grantees under any of

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

6 are providing services in the service area of such

7 project and the grantees are willing to make such

8 arrangements with the applicant.

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

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

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

12 geographic area in which the demonstration project

13 under such subsection is to be carried out and

14 agrees that the project will not be carried out in

15 other areas; and

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

17 year for which the applicant is to receive such a

18 grant, the rate of infant mortality in the geographic

19 area equals or exceeds 150 percent of the national

20 average in the United States of such rates.

21 ‘‘(d) MINIMUM QUALIFICATIONS OF GRANTEES.—

22 ‘‘(1) PUBLIC OR NONPROFIT PRIVATE ENTI23 TIES.—The Secretary may make a grant under sub24 section (a) only if the applicant for the grant is a

25 State or local department of health, or other public
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1 or nonprofit private entity, or a consortium of public

2 or nonprofit private entities.

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

4 With respect to a proposed demonstration project

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

6 grant under such subsection only if—

7 ‘‘(A) the chief executive officer of each po8 litical subdivision in the service area of such

9 project approves the applicant for the grant as

10 being qualified to carry out the project; and

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

12 tribal organization with jurisdiction over any

13 portion of such area so approves the applicant.

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

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

16 in subsection (b) that is available pursuant to

17 the State plan approved under title XIX of the

18 Social Security Act for a State in which a dem19 onstration project under subsection (a) is car20 ried out, the Secretary may make a grant under

21 such subsection for the project only if, subject

22 to subparagraph (B)—

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

24 provide the service directly, and the appli25 cant has entered into a participation agree-
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1 ment under the State plan and is qualified

2 to receive payments under such plan; or

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

4 agreement with a public or private entity

5 under which the entity will provide the

6 service, and the entity has entered into

7 such a participation agreement under the

8 State plan and is qualified to receive such

9 payments.

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

11 agreement pursuant to subparagraph (A)(ii) re12 garding the provision of services, the require13 ment established in such subparagraph regard14 ing a participation agreement shall be waived

15 by the Secretary if the entity does not, in pro16 viding health care services, impose a charge or

17 accept reimbursement available from any third18 party payor, including reimbursement under

19 any insurance policy or under any Federal or

20 State health benefits plan.

21 ‘‘(ii) A determination by the Secretary of

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

23 the criteria for a waiver under such clause shall

24 be made without regard to whether the entity
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1 accepts voluntary donations regarding the pro2 vision of services to the public.

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

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

5 the Secretary may make a grant under such subsection

6 to the applicant involved only if—

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

8 which the project is to be carried out approves the

9 proposal of the applicant for carrying out the

10 project; and

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

12 organization with jurisdiction over any portion of the

13 service area of the project so approves the proposal.

14 ‘‘(f) ELIGIBILITY FOR SERVICES PROVIDED WITH

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

16 subsection (a) only if the applicant involved agrees as fol17 lows:

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

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

20 the State involved is required or has elected to pro21 vide under title XIX of the Social Security Act, the

22 grant will not be expended to provide the service to

23 any individual to whom the State is required or has

24 elected under such title to provide the service.
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1 ‘‘(2) The grant will not be expended to make

2 payment for any item or service to the extent that

3 payment has been made, or can reasonably be ex4 pected to be made, with respect to such item or serv5 ice—

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

7 plan (including a group health plan or a pre8 paid health plan);

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

10 benefits program, including any program under

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

12 Act; or

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

14 XIX of this Act.

15 ‘‘(g) MAINTENANCE OF EFFORT.—

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

17 services under subsection (b), the Secretary may

18 make a grant under subsection (a) only if the appli19 cant involved agrees to maintain expenditures of

20 non-Federal amounts for such services at a level

21 that is not less than the level of such expenditures

22 maintained by the applicant for fiscal year 1991.

23 ‘‘(2) RELEVANT POLITICAL SUBDIVISIONS.—

24 With respect to authorized services under subsection

25 (b), the Secretary may make a grant under sub-
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1 section (a) only if each political subdivision in the

2 service area of the demonstration project involved

3 agrees to maintain expenditures of non-Federal

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

5 than the level of such expenditures maintained by

6 the political subdivision for fiscal year 1991.

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

8 ‘‘(1) IN GENERAL.—Except as provided in para9 graph (3), the Secretary may make a grant under

10 subsection (a) only if the applicant involved agrees

11 that the grant will not be expended—

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

13 with respect to residential treatment for sub14 stance abuse provided in settings other than

15 hospitals;

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

17 recipients of health services or mental health

18 services; or

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

20 (other than minor remodeling of existing im21 provements to real property) or to purchase

22 major medical equipment (other than mobile

23 medical units for providing ambulatory prenatal

24 services).
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1 ‘‘(2) ADMINISTRATIVE EXPENSES; DATA COL2 LECTION.—The Secretary may make a grant under

3 subsection (a) only if the applicant involved agrees

4 that not more than an aggregate 10 percent of the

5 grant will be expended for administering the grant

6 and the collection and analysis of data.

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

8 purpose described in subsection (a) cannot otherwise

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

10 otherwise qualified applicant, waive the restriction

11 established in paragraph (1)(C).

12 ‘‘(i) DETERMINATION OF CAUSE OF INFANT

13 DEATHS.—The Secretary may make a grant under sub14 section (a) only if the applicant involved—

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

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

17 the demonstration project involved; and

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

19 with public entities as may be necessary to carry out

20 paragraph (1).

21 ‘‘(j) ANNUAL REPORTS TO SECRETARY.—The Sec22 retary may make a grant under subsection (a) only if the

23 applicant involved agrees that, for each fiscal year for

24 which the applicant operates a demonstration project

25 under such subsection the applicant will, not later than
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1 April 1 of the subsequent fiscal year, submit to the Sec2 retary a report providing the following information with

3 respect to the project:

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

5 authorized services, and the demographic character6 istics of the population of such individuals.

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

8 including the types of ambulatory prenatal services

9 provided and the trimester of the pregnancy in

10 which the services were provided.

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

12 services provided.

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

14 receiving authorized services have received the ap15 propriate number and variety of immunizations

16 against vaccine-preventable diseases.

17 ‘‘(5) An analysis of the causes of death deter18 mined under subsection (i).

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

20 meeting the health status objectives specified in sub21 section (a)(2).

22 ‘‘(7) The extent to which, in the service area in23 volved, progress is being made toward meeting the

24 participation goals established for the State by the

25 Secretary under section 1905(r) of the Social Secu-
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1 rity Act (relating to early periodic screening, diag2 nostic, and treatment services for children under the

3 age of 21).

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

5 may make a grant under subsection (a) only if the appli6 cant involved agrees that, in preparing the proposal of the

7 applicant for the demonstration project involved, and in

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

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

10 public and nonprofit private entities that provide author11 ized services to such residents.

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

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

14 for the grant is submitted to the Secretary and the appli15 cation is in such form, is made in such manner, and con16 tains such agreements, assurances, and information as the

17 Secretary determines to be necessary to carry out this sub18 section.

19 ‘‘(m) REPORT TO CONGRESS.—Not later than Feb20 ruary 1, 1998, the Secretary shall submit to the Commit21 tee on Energy and Commerce of the House of Representa22 tives, and the Committee on Labor and Human Resources

23 of the Senate, a report—

24 ‘‘(1) summarizing the reports received by the

25 Secretary under subsection (j);
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1 ‘‘(2) describing the extent to which the Sec2 retary has, in the service areas of such projects,

3 been successful in meeting the health status objec4 tives specified in subsection (a)(2); and

5 ‘‘(3) describing the extent to which demonstra6 tion projects under subsection (a) have been cost ef7 fective.

8 ‘‘(n) LIMITATION ON CERTAIN EXPENSES OF SEC9 RETARY.—Of the amounts appropriated under subsection

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

11 than an aggregate 5 percent for the administrative costs

12 of the Secretary in carrying out this section, for the provi13 sion of technical assistance regarding demonstration

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

15 projects.

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

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

18 services specified in subsection (b).

19 ‘‘(2) The terms ‘Indian tribe’ and ‘tribal organi20 zation’ have the meaning given such terms in section

21 4(b) and section 4(c) of the Indian Self-Determina22 tion and Education Assistance Act.

23 ‘‘(3) The term ‘service area’, with respect to a

24 demonstration project under subsection (a), means

25 the geographic area specified in subsection (c).
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1 ‘‘(p) AUTHORIZATION OF APPROPRIATIONS.—For the

2 purpose of carrying out this section, there are authorized

3 to be appropriated such sums as may be necessary for

4 each of the fiscal years 1995 through 1997.

5 ‘‘(q) SUNSET.—Effective October 1, 1997, this sec6 tion is repealed.’’.

7 (b) CERTAIN PROVISIONS REGARDING REPORTS.—

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

9 under section 330A of the Public Health Service Act

10 (as added by subsection (a) of this section), the Sec11 retary of Health and Human Services may make a

12 grant under such section for fiscal year 1995 only

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

14 Secretary, not later than April 1 of such year, a re15 port on any federally-supported project of the appli16 cant that is substantially similar to the demonstra17 tion projects authorized in such section 330A, which

18 report provides, to the extent practicable, the infor19 mation described in subsection (j) of such section.

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

21 for fiscal year 1997 under section 330A of the Pub22 lic Health Service Act (as added by subsection (a)

23 of this section), the requirement under subsection (j)

24 of such section that a report be submitted not later

25 than April 1, 1998, remains in effect notwithstand-
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1 ing the repeal of such section pursuant to subsection

2 (q) of such section.

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

4 all unexpended portions of amounts appropriated for

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

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

7 for obligation or expenditure, without regard to whether

8 the amounts have been received by the grantees involved.

9 (d) USE OF GENERAL AUTHORITY UNDER PUBLIC

10 HEALTH SERVICE ACT.—With respect to the program es11 tablished in section 330A of the Public Health Service Act

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

13 of such Act may not be construed as providing to the Sec14 retary of Health and Human Services any authority to

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

16 is in operation, any demonstration project to provide any

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

18 330A.

19 TITLE III—HEALTH

20 PROFESSIONS PROGRAMS

21 SEC. 301. PRIMARY CARE SCHOLARSHIPS FOR STUDENTS

22 FROM DISADVANTAGED BACKGROUNDS.

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

24 Service Act (42 U.S.C. 293) is amended to read as follows:
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1 ‘‘SEC. 736. PRIMARY CARE SCHOLARSHIPS FOR STUDENTS

2 FROM DISADVANTAGED BACKGROUNDS.

3 ‘‘(a) IN GENERAL.—The Secretary may in accord4 ance with this section award scholarships to individuals

5 described in subsection (b) for the purpose of assisting the

6 individuals with the costs of attending schools of medicine

7 or osteopathic medicine, schools of dentistry, schools of

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

9 in mental health practice, and programs for the training

10 of physician assistants.

11 ‘‘(b) ELIGIBLE INDIVIDUALS.—An individual re12 ferred to in subsection (a) is any individual meeting the

13 following conditions:

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

15 background.

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

17 enrollment) at an eligible school as a full-time stu18 dent in a program leading to a degree in a health

19 profession.

20 ‘‘(3) The costs of attending such school would

21 constitute a severe financial hardship for the individ22 ual.

23 ‘‘(4) The individual enters into the contract re24 quired pursuant to (d) as a condition of receiving

25 the scholarship (relating to an agreement to provide
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1 primary health services in a health professional

2 shortage area designated under section 332).

3 ‘‘(c) SPECIAL CONSIDERATION REGARDING CERTAIN

4 AWARDS.—In awarding scholarships under subsection (a),

5 the Secretary shall give special consideration to eligible in6 dividuals who received scholarships pursuant to this sec7 tion or section 737 for fiscal year 1993 or 1994 and are

8 seeking scholarships for attendance at eligible schools that

9 received a grant under either of such sections for either

10 of such fiscal 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) FUNDING.—Section 737(h) of the Public Health

15 Service Act (42 U.S.C. 293a(h)) is amended—

16 (1) in paragraph (1), by inserting before the pe17 riod the following: ‘‘, and $6,000,000 for each of the

18 fiscal years 1994 through 1997’’; and

19 (2) in paragraph (2)(A), by striking ‘‘30 per20 cent’’ and all that follows and inserting the follow21 ing: ‘‘50 percent for such grants to schools of allied

22 health; and’’.
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1 SEC. 303. LOAN REPAYMENTS AND FELLOWSHIPS REGARD2 ING FACULTY POSITIONS.

3 (a) LOAN REPAYMENTS.—Section 738(a) of the Pub4 lic Health Service Act (42 U.S.C. 293b(a)) is amended—

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

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

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

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

9 amending subparagraph (B) to read as follows:

10 ‘‘(B) the contract referred to in subpara11 graph (A) provides that the school, in making

12 a determination of the amount of compensation

13 to be provided by the school to the individual

14 for serving as a member of the faculty, will

15 make the determination without regard to the

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

17 the individual by the Federal Government under

18 paragraph (1).’’.

19 (b) AUTHORIZATION OF APPROPRIATIONS REGARD20 ING LOAN REPAYMENTS AND FELLOWSHIPS.—Section

21 738(c) of the Public Health Service Act (42 U.S.C.

22 293b(c)) is amended by striking ‘‘there is’’ and all that

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

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

25 1995 through 1997.’’.
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1 SEC. 304. CENTERS OF EXCELLENCE.

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

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

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

5 each place such term appears and inserting ‘‘des6 ignated health professions schools’’; and

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

8 place such term appears and inserting ‘‘designated

9 health professions school’’.

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

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

12 amended by subsection (a), is amended—

13 (1) by striking paragraph (2);

14 (2) by redesignating paragraph (1) as para15 graph (2);

16 (3) by inserting before paragraph (2) (as so re17 designated) the following paragraph:

18 ‘‘(1) to collaborate with public and nonprofit

19 private entities to carry out community-based pro20 grams to recruit students of secondary schools and

21 institutions of higher education and to prepare the

22 students academically for attendance at the des23 ignated health professions school;’’;

24 (4) in paragraph (5)—

25 (A) by striking ‘‘faculty and student re26 search’’ and inserting ‘‘student research’’; and
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1 (B) by inserting before the period the fol2 lowing: ‘‘, including research on issues relating

3 to the delivery of health care’’; and

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

5 after the semicolon at the end;

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

7 the end and inserting ‘‘; and’’; and

8 (C) by adding at the end the following para9 graph:

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

11 of the school in providing health services to minority

12 individuals, which program includes training pro13 vided at community-based health facilities that pro14 vide such services to a significant number of minor15 ity individuals and that are located at a site remote

16 from the main site of the teaching facilities of the

17 school.’’.

18 (c) REQUIREMENTS REGARDING CONSORTIA.—

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

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

21 amended by subsection (a), is amended—

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

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

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

25 subparagraphs (B) and (C)’’;
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1 (B) by redesignating subparagraph (C) as

2 subparagraph (D); and

3 (C) by inserting after subparagraph (B)

4 the following subparagraph:

5 ‘‘(C) The condition specified in this sub6 paragraph is that, in accordance with sub7 section (e)(1), the designated health professions

8 school involved has with other health profession

9 schools (designated or otherwise) formed a con10 sortium to carry out the purposes described in

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

12 The grant involved may be expended with re13 spect to the other schools without regard to

14 whether such schools meet the conditions speci15 fied in subparagraph (B).’’.

16 (2) CERTAIN REQUIREMENTS.—Section 739(e)

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

18 293c(e)), as amended by subsection (a), is amended

19 to read as follows:

20 ‘‘(e) PROVISIONS REGARDING CONSORTIA.—

21 ‘‘(1) REQUIREMENTS.—For purposes of sub22 section (c)(1)(C), a consortium of schools has been

23 formed in accordance with this subsection if—

24 ‘‘(A) the consortium consists of—
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1 ‘‘(i) the designated health professions

2 school seeking the grant under subsection

3 (a); and

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

5 osteopathic medicine, dentistry, pharmacy,

6 nursing, allied health, or public health, or

7 graduate programs in mental health prac8 tice;

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

10 entered into an agreement for the allocation of

11 such grant among the schools; and

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

13 the grant in accordance with this section.

14 ‘‘(2) AUTHORITY REGARDING NATIVE AMERI15 CANS CENTERS OF EXCELLENCE.—With respect to

16 meeting the conditions specified in subsection (c)(4),

17 the Secretary may make a grant under subsection

18 (a) to a designated health professions school that

19 does not meet such conditions if—

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

21 in accordance with paragraph (1); and

22 ‘‘(B) the schools of the consortium collec23 tively meet such conditions, without regard to

24 whether the schools individually meet such con25 ditions.’’.
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1 (3) CONFORMING AMENDMENTS.—Section 739

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

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

4 (A) in subsection (b), in the matter preced5 ing paragraph (1), by inserting ‘‘, subject to

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

7 (B) in subsection (d)—

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

9 and inserting ‘‘(e)(2)’’; and

10 (ii) by adding at the end the following

11 paragraph:

12 ‘‘(4) RULE OF CONSTRUCTION.—Except as pro13 vided in paragraph (3) regarding a consortium

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

15 that does not meet the conditions specified in sub16 section (c)(1)(B) may not be designated as a center

17 of excellence for purposes of this section. The pre18 ceding sentence applies without regard to whether a

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

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

21 school.’’.

22 (d) MODIFICATIONS REGARDING HISTORICALLY

23 BLACK COLLEGES AND UNIVERSITIES.—Section

24 739(c)(2) of the Public Health Service Act (42 U.S.C.
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1 293c(c)(2), as amended by subsection (a), is amended to

2 read as follows:

3 ‘‘(2) AFRICAN-AMERICAN CENTERS OF EXCEL4 LENCE.—

5 ‘‘(A) The conditions specified in this para6 graph are that—

7 ‘‘(i) with respect to African American

8 individuals, each of clauses (i) through (iv)

9 of paragraph (1)(B) applies to the des10 ignated health professions school involved;

11 and

12 ‘‘(ii) the school agree, as a condition

13 of receiving a grant under subsection (a),

14 that the school will, in carrying out the du15 ties described in subsection (b), give prior16 ity to carrying out the duties with respect

17 to African American individuals.

18 ‘‘(B) The following historically black col19 leges or universities shall be considered to meet

20 the conditions specified in subparagraph (A):

21 Meharry Medical College School of Medicine.

22 Meharry Medical College School of Dentistry.

23 Morehouse School of Medicine. Tuskegee Uni24 versity School of Veterinary Medicine. Florida

25 A&M University College of Pharmacy. Texas
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1 Southern University College of Pharmacy. Xa2 vier University College of Pharmacy. Howard

3 Medical College. Charles R. Drew University of

4 Medicine and Science.’’.

5 (e) DEFINITION OF HEALTH PROFESSIONS

6 SCHOOL.—

7 (1) GRADUATE PROGRAMS IN MENTAL HEALTH

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

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

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

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

12 (B) by inserting before the period the fol13 lowing: ‘‘, or a graduate program in mental

14 health practice’’.

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

16 through 1997, the Secretary of Health and Human

17 Services may not make more than one grant under

18 section 739 of the Public Health Service Act directly

19 to a graduate program in mental health practice (as

20 defined in section 799 of such Act).

21 (f) FUNDING.—Section 739(i) of the Public Health

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

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

24 ‘‘(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 $24,000,000 for fiscal year 1995, $26,000,000 for

5 fiscal year 1996, and $28,000,000 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 reserve an amount equal to the amount

11 appropriated for carrying out this section for

12 fiscal year 1994, and shall make the amount so

13 reserved available as follows:

14 ‘‘(i) The Secretary shall make avail15 able $13,700,000 for grants under sub16 section (a) to designated health professions

17 schools that are eligible for such grants

18 pursuant to meeting the conditions de19 scribed in paragraph (2) of subsection (c).

20 ‘‘(ii) Of the amounts so reserved and

21 available after compliance with clause (i),

22 the Secretary shall make available

23 $7,200,000 for grants under subsection (a)

24 to designated health professions schools

25 that are eligible for such grants pursuant
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1 to meeting the conditions described in

2 paragraph (3) or (4) of subsection (c) (in3 cluding meeting conditions pursuant to

4 subsection (e)(2)).

5 ‘‘(iii)(I) Of the amounts so reserved

6 and available after compliance with clause

7 (i), the Secretary shall, subject to

8 subclause (II), make available $2,500,000

9 for grants under subsection (a) to des10 ignated health professions schools that are

11 eligible for such grants pursuant to meet12 ing the conditions described in paragraph

13 (5) of subsection (c).

14 ‘‘(II) A grant under subsection (a)

15 that includes amounts available under

16 clause (i) or (ii) may not include amounts

17 available under this clause.

18 ‘‘(B) In the case of amounts appropriated

19 under paragraph (1) for a fiscal year and avail20 able after the Secretary reserves the amount re21 quired in subparagraph (A), the following ap22 plies: Grants under subsection (a) from such

23 amounts may be made to a designated health

24 professions school only if—
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1 ‘‘(i) the school has not previously re2 ceived any grant under such subsection (or

3 under section 782 as in effect on the day

4 before the date of the enactment of Public

5 Law 102–408); or

6 ‘‘(ii) the amount of the most recent

7 grant under subsection (a) (or under such

8 section 782, as the case may be) that the

9 school received before such year is below

10 the mean average amount of the grants

11 that were made under such subsection for

12 the fiscal year involved.’’.

13 (g) CONFORMING AMENDMENTS.—Section 739(b) of

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

15 amended by subsection (a), is amended—

16 (1) in paragraph (3)(B), by striking ‘‘the des17 ignated health professions school’’ and inserting

18 ‘‘the school’’; and

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

20 (B) and (C), by striking ‘‘the designated health pro21 fessions school’’ and inserting ‘‘the school’’.

22 (h) TRANSITIONAL AND SAVINGS PROVISIONS.—

23 (1) IN GENERAL.—In the case of any entity re24 ceiving a grant under section 739 of the Public

25 Health Service Act for fiscal year 1994, the Sec-
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1 retary of Health and Human Services may, during

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

3 all of the additional requirements established pursu4 ant to this section for the receipt or expenditure of

5 such a grant, subject to the entity providing assur6 ances satisfactory to the Secretary that the entity is

7 making progress toward meeting such requirements.

8 (2) RELEVANT PERIOD.—In the case of any en9 tity receiving a grant under section 739 of the Pub10 lic Health Service Act for fiscal year 1994, the pe11 riod referred to in paragraph (1) is the period that,

12 in first approving the grant, the Secretary specified

13 as the duration of the grant.

14 SEC. 305. EDUCATIONAL ASSISTANCE REGARDING UNDER15 GRADUATES.

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

17 Service Act (42 U.S.C. 293d) is amended to read as fol18 lows:

19 ‘‘SEC. 740. ASSISTANCE REGARDING HEALTH PROFESSIONS

20 AS CAREER CHOICE.

21 ‘‘(a) IN GENERAL.—

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

23 Subject to the provisions of this section, the Sec24 retary may make grants and enter into contracts for

25 purposes of—
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1 ‘‘(A) identifying individuals who—

2 ‘‘(i) are students of elementary

3 schools, or students or graduates of sec4 ondary schools or of institutions of higher

5 education;

6 ‘‘(ii) are from disadvantaged back7 grounds; and

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

9 health professions; and

10 ‘‘(B) providing to such individuals aca11 demic assistance, counseling, and other services

12 to prepare the students to meet the academic

13 requirements for entry into health professions

14 schools.

15 ‘‘(2) RECIPIENTS OF GRANTS AND CON16 TRACTS.—The Secretary may make an award of a

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

18 applicant for the award is a nonprofit private com19 munity-based organization or other public or non20 profit private entity. Such other entities include

21 schools of medicine, osteopathic medicine, public

22 health, dentistry, veterinary medicine, optometry,

23 pharmacy, allied health, chiropractic, and podiatric

24 medicine, and include graduate programs in mental

25 health practice.
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1 ‘‘(3) CERTAIN USES OF AWARDS.—The pur2 poses for which the Secretary may authorize an

3 award under paragraph (1) to be expended include

4 the following:

5 ‘‘(A) Assisting elementary and secondary

6 schools and institutions of higher education in

7 developing or improving programs to prepare

8 students to meet the academic requirements for

9 entry into health professions schools.

10 ‘‘(B) Establishing arrangements with non11 profit private community-based providers of pri12 mary health services under which students are

13 provided with opportunities to visit or work at

14 facilities of such providers and gain experience

15 regarding a career in a field of primary health

16 care.

17 ‘‘(C) Developing or improving programs to

18 enhance the academic preparation of advanced,

19 prehealth professions students or

20 postbaccalaureate individuals to successfully

21 enter a health professions school.

22 ‘‘(D) In the case of an award under para23 graph (1) that the Secretary has authorized to

24 be expended for the purpose described in sub25 paragraph (B) or (C), paying such stipends as
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1 the Secretary may approve for individuals from

2 disadvantaged backgrounds for any period of

3 education in student-enhancement programs

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

5 stipend may not be provided to an individual

6 for more than 12 months, and such a stipend

7 shall be in an amount of $25 per day (notwith8 standing any other provision of law regarding

9 the amount of stipends).

10 ‘‘(b) MINIMUM REQUIREMENTS FOR AWARDS.—

11 ‘‘(1) ASSURANCES REGARDING FINANCIAL CA12 PACITY.—The Secretary may make an award of a

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

14 applicant provides assurances satisfactory to the

15 Secretary that, with respect to the activities for

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

17 will have the financial capacity to continue the ac18 tivities after the eligibility of the applicant for such

19 awards for such activities is terminated pursuant to

20 subsection (e).

21 ‘‘(2) COLLABORATION AMONG VARIOUS ENTI22 TIES.—The Secretary may make an award of a

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

24 applicant for the award has entered into an agree25 ment with any schools, institutions, community-
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1 based organizations, or other entities with which the

2 applicant will collaborate in carrying out activities

3 under the award, and the agreement specifies wheth4 er and to what extent the award will be allocated

5 among the applicant and the entities.

6 ‘‘(3) MATCHING FUNDS.—

7 ‘‘(A) With respect to the costs of the ac8 tivities to be carried out under subsection (a)

9 by an applicant, the Secretary may make an

10 award of a grant or contract under such sub11 section only if the applicant agrees to make

12 available (directly or through donations from

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

14 contributions toward such costs in an amount

15 that—

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

17 which the applicant receives such a grant,

18 is not less than 20 percent of such costs;

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

20 not less than 20 percent of such costs;

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

22 is not less than 40 percent of such costs;

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

24 not less than 60 percent of such costs; and
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•HR 3804 IH

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

2 fiscal year, is not less than 80 percent of

3 such costs.

4 ‘‘(B) Amounts provided by the Federal

5 Government may not be included in determin6 ing the amount of non-Federal contributions re7 quired in subparagraph (A).

8 ‘‘(C) The Secretary may not require non9 Federal contributions for the first fiscal year

10 for which an applicant receives a grant under

11 subsection (a).

12 ‘‘(c) PREFERENCE IN MAKING AWARDS.—

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

14 in making awards of grants and contracts under

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

16 any applicant that has made an arrangement with 1

17 or more elementary schools, an arrangement with 1

18 or more secondary schools, an arrangement with 1

19 or more institutions of higher education, an arrange20 ment with 1 or more health professions schools, and

21 an arrangement with 1 or more community-based or22 ganizations, the purpose of which arrangements is to

23 establish a program as follows:
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1 ‘‘(A) With respect to the elementary

2 schools involved, the program carries out the

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

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

5 paragraph (1) enters the secondary school in6 volved, the program continues to carry out such

7 purposes with respect to the student.

8 ‘‘(C) After graduating from the secondary

9 school, the student enters the institution of

10 higher education involved, subject to meeting

11 reasonable academic requirements, and the pro12 gram continues to carry out such purposes with

13 respect to the student.

14 ‘‘(D) After graduating from the institution

15 of higher education, the student enters the

16 health professions school involved, subject to

17 meeting reasonable academic requirements.

18 ‘‘(2) REQUIREMENT REGARDING SCHOOLS AND

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

20 applicant may not receive preference unless the

21 schools or institutions with which arrangements have

22 been made are schools or institutions whose enroll23 ment of students includes a significant number of

24 individuals from disadvantaged backgrounds.
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1 ‘‘(d) LIMITATION ON YEARS OF FUNDING FOR PAR2 TICULAR ACTIVITIES.—With respect to a particular activ3 ity carried out under paragraph (1) or (3) of subsection

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

5 involved, provide more than 6 years of financial assistance

6 under such subsection to the entity.

7 ‘‘(e) FUNDING.—

8 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

9 For the purpose of carrying out this section and sec10 tion 736, there are authorized to be appropriated

11 $32,000,000 for fiscal year 1995, $36,000,000 for

12 fiscal year 1996, and $38,000,000 for fiscal year

13 1997.

14 ‘‘(2) ALLOCATIONS.—Of the amounts appro15 priated under paragraph (1) for a fiscal year, the

16 Secretary shall obligate not less than 20 percent for

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

18 20 percent for providing scholarships under section

19 736.’’.

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

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

22 contract for fiscal year 1994 under section 740 of the Pub23 lic Health Service Act, the Secretary of Health and

24 Human Services may continue in effect the award in ac25 cordance with the terms of the award, subject to the dura-
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1 tion of the award not exceeding the period determined by

2 the Secretary in first approving the award. The preceding

3 sentence applies notwithstanding the amendment made by

4 subsection (a) of this section.

5 SEC. 306. STUDENT LOANS REGARDING SCHOOLS OF NURS6 ING.

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

8 U.S.C. 297b(b)) is amended—

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

10 the end and inserting a semicolon;

11 (2) in paragraph (2)—

12 (A) in subparagraph (A), by striking

13 ‘‘and’’ at the end; and

14 (B) by inserting before the semicolon at

15 the end the following: ‘‘, and (C) such addi16 tional periods under the terms of paragraph (8)

17 of this subsection’’;

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

19 the end and inserting ‘‘; and’’; and

20 (4) by adding at the end the following para21 graph:

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

23 the Secretary, the repayment period established

24 under paragraph (2) for any student borrower who

25 during the repayment period failed to make consecu-
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1 tive payments and who, during the last 12 months

2 of the repayment period, has made at least 12 con3 secutive payments may be extended for a period not

4 to exceed 10 years.’’.

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

6 (a) AUTHORIZATION OF APPROPRIATIONS REGARD7 ING CERTAIN MEDICAL SCHOOLS.—

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

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

10 292q et seq.) is amended—

11 (A) by transferring subsection (f) of sec12 tion 735 from the current placement of the sub13 section;

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

15 section 723;

16 (C) by redesignating the subsection as sub17 section (e); and

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

19 so redesignated), by striking ‘‘1996’’ and in20 serting ‘‘1997’’.

21 (2) CONFORMING AMENDMENTS.—Section 723

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

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

24 amended in subsection (e)(2)(A)—
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1 (A) by striking ‘‘section 723(b)(2)’’ and in2 serting ‘‘subsection (b)(2)’’; and

3 (B) by striking ‘‘such section’’ and insert4 ing ‘‘such subsection’’.

5 (b) AUTHORIZATION OF APPROPRIATIONS REGARD6 ING INDIVIDUALS FROM DISADVANTAGED BACK7 GROUNDS.—Section 724(f)(1) of the Public Health Serv8 ice Act (42 U.S.C. 292t(f)(1)) is amended to read as fol9 lows:

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

11 Federal capital contributions to student loan funds

12 for purposes of subsection (a), other than the stu13 dent loan fund of any school of medicine or osteo14 pathic medicine, there is authorized to be appro15 priated $5,000,000 for each of the fiscal years 1995

16 through 1997.’’.

17 TITLE IV—RESEARCH

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

19 Section 404 of the Public Health Service Act, as

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

21 by adding at the end the following subsections:

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

23 of the Office, in consultation with the advisory committee

24 established under subsection (d), shall develop and imple25 ment a plan for carrying out the duties established in sub-
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1 section (b). The Director shall review the plan not less

2 than annually, and revise the plan as appropriate.

3 ‘‘(d) ADVISORY COMMITTEE.—

4 ‘‘(1) In carrying out subsection (b), the Direc5 tor of the Office shall establish an advisory commit6 tee to be known as the Advisory Committee on Re7 search on Minority Health (in this subsection re8 ferred to as the ‘Committee’).

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

10 nonvoting, ex offico members designated in accord11 ance with subparagraph (B) and voting members ap12 pointed in accordance with subparagraph (C).

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

14 members of the Committee the Directors of each of

15 the national research institutes and the Deputy As16 sistant Secretary for Minority Health (except that

17 any of such officials may designate another officer

18 or employee of the office or agency involved to serve

19 as a member of the Committee in lieu of the offi20 cial).

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

22 voting members of the Committee not fewer than 12

23 and not more than 18 individuals who are not offi24 cers or employees of the Federal Government. The

25 appointments shall be made from among scientists
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1 and health professionals whose clinical practice, re2 search specialization, or professional expertise in3 cludes significant expertise in research on minority

4 health. The appointed membership of the Advisory

5 Committee shall be broadly representative of the

6 various minority groups.

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

8 the chair of the Committee.

9 ‘‘(4) The Committee shall—

10 ‘‘(A) advise the Director of the Office on

11 appropriate research activities to be undertaken

12 by the national research institutes with respect

13 to—

14 ‘‘(i) research on minority health;

15 ‘‘(ii) research on racial and ethnic dif16 ferences in clinical drug trials, including

17 responses to pharmacological drugs;

18 ‘‘(iii) research on racial and ethnic

19 differences in disease etiology, course, and

20 treatment; and

21 ‘‘(iv) research on minority health con22 ditions which require a multidisciplinary

23 approach;

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

25 on such research;
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1 ‘‘(C) provide recommendations to such Di2 rector regarding activities of the Office (includ3 ing recommendations on priorities in carrying

4 out research described in subparagraph (A));

5 and

6 ‘‘(D) assist in monitoring compliance with

7 section 492B regarding the inclusion of minori8 ties in clinical research.

9 ‘‘(5)(A) The Advisory Committee shall prepare

10 biennial reports describing the activities of the Com11 mittee, including findings made by the Committee

12 regarding—

13 ‘‘(i) compliance with section 492B;

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

15 research on minority health by the agencies of

16 the National Institutes of Health; and

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

18 research.

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

20 be submitted to the Director of NIH for inclusion in

21 the report required in section 403 for the period in22 volved.

23 ‘‘(e) REPRESENTATION OF MINORITIES AMONG RE24 SEARCHERS.—The Secretary, acting through the Assist25 ant Secretary for Personnel and in collaboration with the
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1 Director of the Office, shall determine the extent to which

2 the various minority groups are represented among admin3 istrators, senior physicians, and scientists of the national

4 research institutes and among physicians and scientists

5 conducting research with funds provided by such insti6 tutes, and as appropriate, carry out activities to increase

7 the extent of such representation.

8 ‘‘(f) REQUIREMENT REGARDING GRANTS AND CON9 TRACTS.—Any award of a grant, cooperative agreement,

10 or contract that the Director of the Office is authorized

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

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

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

14 respect to individuals who are members of minority

15 groups, means all diseases, disorders, and conditions

16 (including with respect to mental health)—

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

18 prevalent in such individuals;

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

20 or types of medical intervention are different

21 for such individuals, or for which it is unknown

22 whether such factors or types are different for

23 such individuals; or

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

25 insufficient clinical research involving such indi-
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1 viduals as subjects or insufficient clinical data

2 on such individuals.

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

4 means research on minority health conditions, in5 cluding research on preventing such conditions.

6 ‘‘(3) The term ‘minority groups’ has the mean7 ing given such term in section 1707(h).’’.

8 SEC. 402. ACTIVITIES OF AGENCY FOR HEALTH CARE POL9 ICY AND RESEARCH.

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

11 299 et seq.) is amended—

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

13 to read as follows:

14 ‘‘(b) REQUIREMENTS WITH RESPECT TO CERTAIN

15 POPULATIONS.—In carrying out subsection (a), the Ad16 ministrator shall undertake and support research, dem17 onstration projects, and evaluations with respect to the

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

19 ‘‘(1) the populations of medically underserved

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

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

22 the elderly.’’; and

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

24 following sentence: ‘‘Of the amounts appropriated

25 under the preceding sentence for a fiscal year, the
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1 Administrator shall reserve not less than 8 percent

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

3 TITLE V—NATIVE HAWAIIAN

4 HEALTH CARE

5 SEC. 501. CLARIFICATION OF 1992 AMENDMENTS.

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

7 9168 of the Department of Defense Appropriations Act,

8 1993 (106 Stat. 1948) is amended by striking ‘‘September

9 12, 1992,’’ and inserting ‘‘August 7, 1992,’’.

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

11 subsection (a) shall take effect as of October 6, 1992.

12 SEC. 502. AMENDMENT OF NATIVE HAWAIIAN HEALTH

13 CARE IMPROVEMENT ACT TO REFLECT 1992

14 AGREEMENT.

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

16 Native Hawaiian Health Care Improvement Act (42

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

18 ‘‘SECTION 1. SHORT TITLE.

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

20 Health Care Improvement Act’.

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

22 CONGRESS.

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

24 ‘‘(1) the United States retains the legal respon25 sibility to enforce the administration of the public
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1 trust responsibility of the State of Hawaii for the

2 betterment of the conditions of Native Hawaiians

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

4 commonly referred to as the ‘Hawaii Statehood Ad5 missions Act’);

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

7 public trust responsibility for the betterment of the

8 conditions of Native Hawaiians, contributions by the

9 United States to the provision of comprehensive

10 health promotion and disease prevention services to

11 maintain and improve the health status of Native

12 Hawaiians are consistent with the historical and

13 unique legal relationship of the United States with

14 the government that represented the indigenous na15 tive people of Hawaii; and

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

17 raise the health status of Native Hawaiians to the

18 highest possible level and to encourage the maximum

19 participation of Native Hawaiians in order to

20 achieve this objective.

21 ‘‘(b) DECLARATION OF POLICY.—The Congress here22 by declares that it is the policy of the United States in

23 fulfillment of its special responsibilities and legal obliga24 tions to the indigenous people of Hawaii resulting from

25 the unique and historical relationship between the United
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1 States and the Government of the indigenous people of

2 Hawaii—

3 ‘‘(1) to raise the health status of Native Hawai4 ians to the highest possible health level; and

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

6 care programs with all resources necessary to effec7 tuate this policy.

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

9 Congress that the Nation meet the following health objec10 tives with respect to Native Hawaiians by the year 2000:

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

12 no more than 100 per 100,000.

13 ‘‘(2) Reduce stroke deaths to no more than 20

14 per 100,000.

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

16 at least 50 percent of people with high blood pres17 sure.

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

19 no more than 200 mg/dl.

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

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

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

23 than 20.6 per 100,000 women.

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

25 at least 85 percent of women age 18 and older.
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1 ‘‘(8) Increase fecal occult blood testing every 1

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

3 and older.

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

5 than 34 per 100,000.

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

7 diabetes as follows:

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

9 than 1.4 in 1,000.

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

11 1,000.

12 ‘‘(C) Lower extremity amputation to no

13 more than 4.9 in 1,000.

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

15 2 percent.

16 ‘‘(E) Major congenital malformations to no

17 more than 4 percent.

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

19 7 deaths per 1,000 live births.

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

21 5 percent of live births.

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

23 at least 90 percent of live births.

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

25 than 50 per 1,000 girls age 17 and younger.
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1 ‘‘(15) Reduce unintended pregnancies to no

2 more than 30 percent of pregnancies.

3 ‘‘(16) Increase to at least 60 percent the pro4 portion of primary care providers who provide age5 appropriate preconception care and counseling.

6 ‘‘(17) Increase years of healthy life to at least

7 65 years.

8 ‘‘(18) Eliminate financial barriers to clinical

9 preventive services.

10 ‘‘(19) Increase childhood immunization levels to

11 at least 90 percent of 2-year-olds.

12 ‘‘(20) Reduce the prevalence of dental caries to

13 no more than 35 percent of children by age 8.

14 ‘‘(21) Reduce untreated dental caries so that

15 the proportion of children with untreated caries (in

16 permanent or primary teeth) is no more than 20

17 percent among children age 6 through 8 and no

18 more than 15 percent among adolescents age 15.

19 ‘‘(22) Reduce edentulism to no more than 20

20 percent in people age 65 and older.

21 ‘‘(23) Increase moderate daily physical activity

22 to at least 30 percent of the population.

23 ‘‘(24) Reduce sedentary lifestyles to no more

24 than 15 percent of the population.
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1 ‘‘(25) Reduce overweight to a prevalence of no

2 more than 20 percent of the population.

3 ‘‘(26) Reduce dietary fat intake to an average

4 of 30 percent of calories or less.

5 ‘‘(27) Increase to at least 75 percent the pro6 portion of primary care providers who provide nutri7 tion assessment and counseling or referral to quali8 fied nutritionists or dieticians.

9 ‘‘(28) Reduce cigarette smoking prevalence to

10 no more than 15 percent of adults.

11 ‘‘(29) Reduce initiation of smoking to no more

12 than 15 percent by age 20.

13 ‘‘(30) Reduce alcohol-related motor vehicle

14 crash deaths to no more than 8.5 per 100,000 ad15 justed for age.

16 ‘‘(31) Reduce alcohol use by school children age

17 12 to 17 to less than 13 percent.

18 ‘‘(32) Reduce marijuana use by youth age 18 to

19 25 to less than 8 percent.

20 ‘‘(33) Reduce cocaine use by youth age 18 to

21 25 to less than 3 percent.

22 ‘‘(34) Confine HIV infection to no more than

23 800 per 100,000.

24 ‘‘(35) Reduce gonorrhea infections to no more

25 than 225 per 100,000.
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1 ‘‘(36) Reduce syphilis infections to no more

2 that 10 per 100,000.

3 ‘‘(37) Reduce significant hearing impairment to

4 a prevalance of no more than 82 per 1,000.

5 ‘‘(38) Reduce acute middle ear infections

6 among children age 4 and younger, as measured by

7 days of restricted activity or school absenteeism, to

8 no more than 105 days per 100 children.

9 ‘‘(39) Reduce indigenous cases of vaccine-pre10 ventable diseases as follows:

11 ‘‘(A) Diphtheria among individuals age 25

12 and younger to 0.

13 ‘‘(B) Tetanus among individuals age 25

14 and younger to 0.

15 ‘‘(C) Polio (wild-type virus) to 0.

16 ‘‘(D) Measles to 0.

17 ‘‘(E) Rubella to 0.

18 ‘‘(F) Congenital Rubella Syndrome to 0.

19 ‘‘(G) Mumps to 500.

20 ‘‘(H) Pertussis to 1,000.

21 ‘‘(40) Reduce significant visual impairment to a

22 prevalence of no more than 30 per 1,000.

23 ‘‘(d) REPORT.—The Secretary shall submit to the

24 President, for inclusion in each report required to be

25 transmitted to the Congress under section 9, a report on
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1 the progress made toward meeting each of the objectives

2 described in subsection (c).

3 ‘‘SEC. 3. COMPREHENSIVE HEALTH CARE MASTER PLAN

4 FOR NATIVE HAWAIIANS.

5 ‘‘The Secretary may make a grant to, or enter into

6 a contract with, Papa Ola Lokahi for the purpose of co7 ordinating, implementing, and updating a Native Hawai8 ian comprehensive health care master plan designed to

9 promote comprehensive health promotion and disease pre10 vention services and to maintain and improve the health

11 status of Native Hawaiians. The master plan shall be

12 based upon an assessment of the health care status and

13 health care needs of Native Hawaiians. To the extent

14 practicable, assessments made as of the date of such grant

15 or contract shall be used by Papa Ola Lokahi, except that

16 any such assessment shall be updated as appropriate.

17 ‘‘SEC. 4. NATIVE HAWAIIAN HEALTH CARE SYSTEMS.

18 ‘‘(a) COMPREHENSIVE HEALTH PROMOTION, DIS19 EASE PREVENTION, AND PRIMARY HEALTH SERVICES.—

20 (1)(A) The Secretary, in consultation with Papa Ola

21 Lokahi, may make grants to, or enter into contracts with,

22 any qualified entity for the purpose of providing com23 prehensive health promotion and disease prevention serv24 ices as well as primary health services to Native Hawai25 ians.
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1 ‘‘(B) In making grants and entering into contracts

2 under this paragraph, the Secretary shall give preference

3 to Native Hawaiian health care systems and Native Ha4 waiian organizations, and, to the extent feasible, health

5 promotion and disease prevention services shall be per6 formed through Native Hawaiian health care systems.

7 ‘‘(2) In addition to paragraph (1), the Secretary may

8 make a grant to, or enter into a contract with, Papa Ola

9 Lokahi for the purpose of planning Native Hawaiian

10 health care systems to serve the health needs of Native

11 Hawaiian communities on the islands of O’ahu, Moloka’i,

12 Maui, Hawai’i, Lana’i, Kaua’i, and Ni’ihau in the State

13 of Hawaii.

14 ‘‘(b) QUALIFIED ENTITY.—An entity is a qualified

15 entity for purposes of subsection (a)(1) if the entity is a

16 Native Hawaiian health care system.

17 ‘‘(c) SERVICES TO BE PROVIDED.—(1) Each recipi18 ent of funds under subsection (a)(1) shall provide the fol19 lowing services:

20 ‘‘(A) Outreach services to inform Native Hawai21 ians of the availability of health services.

22 ‘‘(B) Education in health promotion and disease

23 prevention of the Native Hawaiian population by

24 (wherever possible) Native Hawaiian health care
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1 practitioners, community outreach workers, coun2 selors, and cultural educators.

3 ‘‘(C) Services of physicians, physicians’ assist4 ants, or nurse practitioners.

5 ‘‘(D) Immunizations.

6 ‘‘(E) Prevention and control of diabetes, high

7 blood pressure, and otitis media.

8 ‘‘(F) Pregnancy and infant care.

9 ‘‘(G) Improvement of nutrition.

10 ‘‘(2) In addition to the mandatory services under

11 paragraph (1), the following services may be provided pur12 suant to subsection (a)(1):

13 ‘‘(A) Identification, treatment, control, and re14 duction of the incidence of preventable illnesses and

15 conditions endemic to Native Hawaiians.

16 ‘‘(B) Collection of data related to the preven17 tion of diseases and illnesses among Native Hawai18 ians.

19 ‘‘(C) Services within the meaning of the terms

20 ‘health promotion’, ‘disease prevention’, and ‘pri21 mary health services’, as such terms are defined in

22 section 10, which are not specifically referred to in

23 paragraph (1) of this subsection.

24 ‘‘(3) The health care services referred to in para25 graphs (1) and (2) which are provided under grants or
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1 contracts under subsection (a)(1) may be provided by tra2 ditional Native Hawaiian healers.

3 ‘‘(d) LIMITATION ON NUMBER OF ENTITIES.—Dur4 ing a fiscal year, the Secretary under this Act may make

5 a grant to, or hold a contract with, not more than 5 Native

6 Hawaiian health care systems.

7 ‘‘(e) MATCHING FUNDS.—(1) The Secretary may not

8 make a grant or provide funds pursuant to a contract

9 under subsection (a)(1) to an entity—

10 ‘‘(A) in an amount exceeding 75 percent of the

11 costs of providing health services under the grant or

12 contract; and

13 ‘‘(B) unless the entity agrees that the entity

14 will make available, directly or through donations to

15 the entity, non-Federal contributions toward such

16 costs in an amount equal to not less than $1 (in

17 cash or in kind under paragraph (2)) for each $3 of

18 Federal funds provided in such grant or contract.

19 ‘‘(2) Non-Federal contributions required in para20 graph (1) may be in cash or in kind, fairly evaluated, in21 cluding plant, equipment, or services. Amounts provided

22 by the Federal Government or services assisted or sub23 sidized to any significant extent by the Federal Govern24 ment may not be included in determining the amount of

25 such non-Federal contributions.
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1 ‘‘(3) The Secretary may waive the requirement estab2 lished in paragraph (1) if—

3 ‘‘(A) the entity involved is a nonprofit private

4 entity described in subsection (b); and

5 ‘‘(B) the Secretary, in consultation with Papa

6 Ola Lokahi, determines that it is not feasible for the

7 entity to comply with such requirement.

8 ‘‘(f) RESTRICTION ON USE OF GRANT AND CON9 TRACT FUNDS.—The Secretary may not make a grant to,

10 or enter into a contract with, an entity under subsection

11 (a)(1) unless the entity agrees that amounts received pur12 suant to such subsection will not, directly or through con13 tract, be expended—

14 ‘‘(1) for any purpose other than the purposes

15 described in subsection (c);

16 ‘‘(2) to provide inpatient services;

17 ‘‘(3) to make cash payments to intended recipi18 ents of health services; or

19 ‘‘(4) to purchase or improve real property

20 (other than minor remodeling of existing improve21 ments to real property) or to purchase major medi22 cal equipment.

23 ‘‘(g) LIMITATION ON CHARGES FOR SERVICES.—The

24 Secretary may not make a grant, or enter into a contract

25 with, an entity under subsection (a)(1) unless the entity
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1 agrees that, whether health services are provided directly

2 or through contract—

3 ‘‘(1) health services under the grant or contract

4 will be provided without regard to ability to pay for

5 the health services; and

6 ‘‘(2) the entity will impose a charge for the de7 livery of health services, and such charge—

8 ‘‘(A) will be made according to a schedule

9 of charges that is made available to the public,

10 and

11 ‘‘(B) will be adjusted to reflect the income

12 of the individual involved.

13 ‘‘SEC. 5. FUNCTIONS OF, AND GRANTS TO, PAPA OLA

14 LOKAHI.

15 ‘‘(a) FUNCTIONS.—Papa Ola Lokahi shall—

16 ‘‘(1) coordinate, implement, and update, as ap17 propriate, the comprehensive health care master

18 plan developed pursuant to section 3;

19 ‘‘(2) to the maximum extent possible, coordi20 nate and assist the health care programs and serv21 ices provided to Native Hawaiians;

22 ‘‘(3) provide for the training of the persons de23 scribed in section 4(c)(1)(B);
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1 ‘‘(4) develop an action plan outlining the con2 tributions that each member organization of Papa

3 Ola Lokahi will make in carrying out this Act;

4 ‘‘(5) serve as a clearinghouse for—

5 ‘‘(A) the collection and maintenance of

6 data associated with the health status of Native

7 Hawaiians;

8 ‘‘(B) the identification of and research into

9 diseases affecting Native Hawaiians;

10 ‘‘(C) the availability of Native Hawaiian

11 project funds, research projects, and publica12 tions;

13 ‘‘(D) the timely dissemination of informa14 tion relating to Native Hawaiian health care

15 systems;

16 ‘‘(6) perform the recognition and certification

17 functions specified in sections 10(6)(F) and

18 10(6)(G); and

19 ‘‘(7) provide technical support and coordination

20 of training and technical assistance to Native Ha21 waiian health care systems.

22 ‘‘(b) SPECIAL PROJECT FUNDS.—Papa Ola Lokahi

23 may receive project funds that may be appropriated for

24 the purpose of research on the health status of Native Ha-
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1 waiians or for the purpose of addressing the health care

2 needs of Native Hawaiians.

3 ‘‘(c) GRANTS.—In addition to any other grant or con4 tract under this Act, the Secretary may make grants to,

5 or enter into contracts with, Papa Ola Lokahi for—

6 ‘‘(1) carrying out the functions described in

7 subsection (a); and

8 ‘‘(2) administering any special project funds re9 ceived under the authority of subsection (b).

10 ‘‘(d) RELATIONSHIPS WITH OTHER AGENCIES.—

11 Papa Ola Lokahi may enter into agreements or memo12 randa of understanding with relevant agencies or organi13 zations that are capable of providing resources or services

14 to Native Hawaiian health care systems.

15 ‘‘SEC. 6. ADMINISTRATION OF GRANTS AND CONTRACTS.

16 ‘‘(a) TERMS AND CONDITIONS.—The Secretary shall

17 include in any grant made or contract entered into under

18 this Act such terms and conditions as the Secretary con19 siders necessary or appropriate to ensure that the objec20 tives of such grant or contract are achieved.

21 ‘‘(b) PERIODIC REVIEW.—The Secretary shall peri22 odically evaluate the performance of, and compliance with,

23 grants and contracts under this Act.
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1 ‘‘(c) ADMINISTRATIVE REQUIREMENTS.—The Sec2 retary may not make a grant or enter into a contract

3 under this Act with an entity unless the entity—

4 ‘‘(1) agrees to establish such procedures for fis5 cal control and fund accounting as may be necessary

6 to ensure proper disbursement and accounting with

7 respect to the grant or contract;

8 ‘‘(2) agrees to ensure the confidentiality of

9 records maintained on individuals receiving health

10 services under the grant or contract;

11 ‘‘(3) with respect to providing health services to

12 any population of Native Hawaiians a substantial

13 portion of which has a limited ability to speak the

14 English language—

15 ‘‘(A) has developed and has the ability to

16 carry out a reasonable plan to provide health

17 services under the grant or contract through in18 dividuals who are able to communicate with the

19 population involved in the language and cultural

20 context that is most appropriate; and

21 ‘‘(B) has designated at least one individ22 ual, fluent in both English and the appropriate

23 language, to assist in carrying out the plan;
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1 ‘‘(4) with respect to health services that are

2 covered in the plan of the State of Hawaii approved

3 under title XIX of the Social Security Act—

4 ‘‘(A) if the entity will provide under the

5 grant or contract any such health services di6 rectly—

7 ‘‘(i) the entity has entered into a par8 ticipation agreement under such plan; and

9 ‘‘(ii) the entity is qualified to receive

10 payments under such plan; and

11 ‘‘(B) if the entity will provide under the

12 grant or contract any such health services

13 through a contract with an organization—

14 ‘‘(i) the organization has entered into

15 a participation agreement under such plan;

16 and

17 ‘‘(ii) the organization is qualified to

18 receive payments under such plan; and

19 ‘‘(5) agrees to submit to the Secretary and to

20 Papa Ola Lokahi an annual report that describes

21 the utilization and costs of health services provided

22 under the grant or contract (including the average

23 cost of health services per user) and that provides

24 such other information as the Secretary determines

25 to be appropriate.
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1 ‘‘(d) CONTRACT EVALUATION.—(1) If, as a result of

2 evaluations conducted by the Secretary, the Secretary de3 termines that an entity has not complied with or satisfac4 torily performed a contract entered into under section 4,

5 the Secretary shall, prior to renewing such contract, at6 tempt to resolve the areas of noncompliance or unsatisfac7 tory performance and modify such contract to prevent fu8 ture occurrences of such noncompliance or unsatisfactory

9 performance. If the Secretary determines that such non10 compliance or unsatisfactory performance cannot be re11 solved and prevented in the future, the Secretary shall not

12 renew such contract with such entity and is authorized

13 to enter into a contract under section 4 with another en14 tity referred to in section 4(b) that provides services to

15 the same population of Native Hawaiians which is served

16 by the entity whose contract is not renewed by reason of

17 this subsection.

18 ‘‘(2) In determining whether to renew a contract en19 tered into with an entity under this Act, the Secretary

20 shall consider the results of evaluation under this section.

21 ‘‘(3) All contracts entered into by the Secretary under

22 this Act shall be in accordance with all Federal contract23 ing laws and regulations except that, in the discretion of

24 the Secretary, such contracts may be negotiated without
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1 advertising and may be exempted from the provisions of

2 the Act of August 24, 1935 (40 U.S.C. 270a et seq.).

3 ‘‘(4) Payments made under any contract entered into

4 under this Act may be made in advance, by means of reim5 bursement, or in installments and shall be made on such

6 conditions as the Secretary deems necessary to carry out

7 the purposes of this Act.

8 ‘‘(e) LIMITATION ON USE OF FUNDS FOR ADMINIS9 TRATIVE EXPENSES.—Except for grants and contracts

10 under section 5(c), the Secretary may not make a grant

11 to, or enter into a contract with, an entity under this Act

12 unless the entity agrees that the entity will not expend

13 more than 10 percent of amounts received pursuant to this

14 Act for the purpose of administering the grant or contract.

15 ‘‘(f) REPORT.—(1) For each fiscal year during which

16 an entity receives or expends funds pursuant to a grant

17 or contract under this Act, such entity shall submit to the

18 Secretary and to Papa Ola Lokahi a quarterly report on—

19 ‘‘(A) activities conducted by the entity under

20 the grant or contract;

21 ‘‘(B) the amounts and purposes for which Fed22 eral funds were expended; and

23 ‘‘(C) such other information as the Secretary

24 may request.
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1 ‘‘(2) The reports and records of any entity which con2 cern any grant or contract under this Act shall be subject

3 to audit by the Secretary, the Inspector General of Health

4 and Human Services, and the Comptroller General of the

5 United States.

6 ‘‘(g) ANNUAL PRIVATE AUDIT.—The Secretary shall

7 allow as a cost of any grant made or contract entered into

8 under this Act the cost of an annual private audit con9 ducted by a certified public accountant.

10 ‘‘SEC. 7. ASSIGNMENT OF PERSONNEL.

11 ‘‘(a) IN GENERAL.—The Secretary is authorized to

12 enter into an agreement with any entity under which the

13 Secretary is authorized to assign personnel of the Depart14 ment of Health and Human Services with expertise identi15 fied by such entity to such entity on detail for the purposes

16 of providing comprehensive health promotion and disease

17 prevention services to Native Hawaiians.

18 ‘‘(b) APPLICABLE FEDERAL PERSONNEL PROVI19 SIONS.—Any assignment of personnel made by the Sec20 retary under any agreement entered into under the au21 thority of subsection (a) shall be treated as an assignment

22 of Federal personnel to a local government that is made

23 in accordance with subchapter VI of chapter 33 of title

24 5, United States Code.
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1 ‘‘SEC. 8. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.

2 ‘‘(a) ELIGIBILITY.—The Secretary is authorized to

3 make scholarship grants to students who—

4 ‘‘(1) meet the requirements of section 338A(b)

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

6 254l(b)); and

7 ‘‘(2) are Native Hawaiians.

8 ‘‘(b) TERMS AND CONDITIONS.—(1) Scholarship

9 grants provided under subsection (a) shall be provided

10 under the same terms and subject to the same conditions,

11 regulations, and rules that apply to scholarship grants

12 provided under section 338A of the Public Health Service

13 Act (42 U.S.C. 254l), except that—

14 ‘‘(A) the provision of scholarships in each type

15 of health care profession training shall correspond to

16 the need for each type of health care professional to

17 serve Native Hawaiian health care systems, as iden18 tified by Papa Ola Lokahi;

19 ‘‘(B) in selecting scholarship recipients, the

20 Secretary shall give priority to individuals included

21 on a list of eligible applicants submitted by the Ka22 mehameha Schools/Bishop Estate;

23 ‘‘(C) the obligated service requirement for each

24 scholarship recipient shall be fulfilled through serv25 ice, in order of priority, in—
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1 ‘‘(i) any one of the five Native Hawaiian

2 health care systems which, during the fiscal

3 year in which the obligated service requirement

4 is assigned, has received a grant or entered into

5 a contract pursuant to section 4; or

6 ‘‘(ii) health professions shortage areas,

7 medically underserved areas, or geographic

8 areas or facilities similarly designated by the

9 United States Public Health Service in the

10 State of Hawaii.

11 ‘‘(2) The Secretary shall enter into a cooperative

12 agreement with the Kamehameha Schools/Bishop Estate

13 under which such organization shall provide recruitment,

14 retention, counseling, and other support services intended

15 to improve the operation of the scholarship program estab16 lished under this section.

17 ‘‘(3) The Native Hawaiian Health Scholarship pro18 gram shall not be administered by or through the Indian

19 Health Service.

20 ‘‘SEC. 9. REPORT.

21 ‘‘The President shall, at the time the budget is sub22 mitted under section 1105 of title 31, United States Code,

23 for each fiscal year transmit to the Congress the report

24 required pursuant to section 2(d).
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1 ‘‘SEC. 10. DEFINITIONS.

2 ‘‘For purposes of this Act:

3 ‘‘(1) DISEASE PREVENTION.—The term ‘disease

4 prevention’ includes—

5 ‘‘(A) immunizations,

6 ‘‘(B) control of high blood pressure,

7 ‘‘(C) control of sexually transmittable dis8 eases,

9 ‘‘(D) prevention and control of diabetes,

10 ‘‘(E) control of toxic agents,

11 ‘‘(F) occupational safety and health,

12 ‘‘(G) accident prevention,

13 ‘‘(H) fluoridation of water,

14 ‘‘(I) control of infectious agents, and

15 ‘‘(J) provision of mental health care.

16 ‘‘(2) HEALTH PROMOTION.—The term ‘health

17 promotion’ includes—

18 ‘‘(A) pregnancy and infant care, including

19 prevention of fetal alcohol syndrome,

20 ‘‘(B) cessation of tobacco smoking,

21 ‘‘(C) reduction in the misuse of alcohol and

22 drugs,

23 ‘‘(D) improvement of nutrition,

24 ‘‘(E) improvement in physical fitness,

25 ‘‘(F) family planning, and

26 ‘‘(G) control of stress.
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1 ‘‘(3) NATIVE HAWAIIAN.—The term ‘Native

2 Hawaiian’ means any individual who is—

3 ‘‘(A) a citizen of the United States; and

4 ‘‘(B) a descendant of the aboriginal people,

5 who prior to 1778, occupied and exercised sov6 ereignty in the area that now constitutes the

7 State of Hawaii, as evidenced by—

8 ‘‘(i) genealogical records;

9 ‘‘(ii) Kupuna (elders) or Kama’aina

10 (long-term community residents) verifica11 tion; or

12 ‘‘(iii) birth records of the State of Ha13 waii.

14 ‘‘(4) NATIVE HAWAIIAN HEALTH CENTER.—The

15 term ‘Native Hawaiian health center’ means an en16 tity—

17 ‘‘(A) which is organized under the laws of

18 the State of Hawaii,

19 ‘‘(B) which provides or arranges for health

20 care services through practitioners licensed by

21 the State of Hawaii, where licensure require22 ments are applicable,

23 ‘‘(C) which is a public or nonprofit private

24 entity, and
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1 ‘‘(D) in which Native Hawaiian health

2 practitioners significantly participate in the

3 planning, management, monitoring, and evalua4 tion of health services.

5 ‘‘(5) NATIVE HAWAIIAN ORGANIZATION.—The

6 term ‘Native Hawaiian organization’ means any or7 ganization—

8 ‘‘(A) which serves the interests of Native

9 Hawaiians,

10 ‘‘(B) which is—

11 ‘‘(i) recognized by Papa Ola Lokahi

12 for the purpose of planning, conducting, or

13 administering programs (or portions of

14 programs) authorized under this Act for

15 the benefit of Native Hawaiians, and

16 ‘‘(ii) certified by Papa Ola Lokahi as

17 having the qualifications and capacity to

18 provide the services, and meet the require19 ments, under the contract the organization

20 enters into with, or grant the organization

21 receives from, the Secretary under this

22 Act,

23 ‘‘(C) in which Native Hawaiian health

24 practitioners significantly participate in the
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1 planning, management, monitoring, and evalua2 tion of health services, and

3 ‘‘(D) which is a public or nonprofit private

4 entity.

5 ‘‘(6) NATIVE HAWAIIAN HEALTH CARE SYS6 TEM.—The term ‘Native Hawaiian health care sys7 tem’ means an entity—

8 ‘‘(A) which is organized under the laws of

9 the State of Hawaii;

10 ‘‘(B) which provides or arranges for health

11 care services through practitioners licensed by

12 the State of Hawaii, where licensure require13 ments are applicable;

14 ‘‘(C) which is a public or nonprofit private

15 entity;

16 ‘‘(D) in which Native Hawaiian health

17 practitioners significantly participate in the

18 planning, management, monitoring, and evalua19 tion of health care services;

20 ‘‘(E) which may be composed of as many

21 Native Hawaiian health centers as necessary to

22 meet the health care needs of Native Hawaiians

23 residing on the island or islands served by such

24 entity;
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1 ‘‘(F) which is recognized by Papa Ola

2 Lokahi for the purpose of providing comprehen3 sive health promotion and disease prevention

4 services as well as primary health services to

5 Native Hawaiians under this Act; and

6 ‘‘(G) which is certified by Papa Ola Lokahi

7 as having the qualifications and the capacity to

8 provide the services and meet the requirements

9 of a contract entered into, or a grant received,

10 under section 4.

11 ‘‘(7) PAPA OLA LOKAHI.—(A) Subject to sub12 paragraph (B), the term ‘Papa Ola Lokahi’ means

13 an organization composed of—

14 ‘‘(i) E Ola Mau;

15 ‘‘(ii) the Office of Hawaiian Affairs of the

16 State of Hawaii;

17 ‘‘(iii) Alu Like Inc.;

18 ‘‘(iv) the University of Hawaii;

19 ‘‘(v) the Office of Hawaiian Health of the

20 Hawaii State Department of Health;

21 ‘‘(vi) Ho’ola Lahui Hawaii, or a health

22 care system serving the islands of Kaua’i and

23 Ni’ihau;

24 ‘‘(vii) Ke Ola Mamo, or a health care sys25 tem serving the island of O’ahu;
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1 ‘‘(viii) Na Pu’uwai or a health care system

2 serving the islands of Moloka’i and Lana’i;

3 ‘‘(ix) Hui No Ke Ola Pono, or a health

4 care system serving the island of Maui;

5 ‘‘(x) Hui Malama Ola Ha’Oiwi or a health

6 care system serving the island of Hawaii; and

7 ‘‘(xi) such other member organizations as

8 the Board of Papa Ola Lokahi may admit from

9 time to time, based upon satisfactory dem10 onstration of a record of contribution to the

11 health and well-being of Native Hawaiians, and

12 upon satisfactory development of a mission

13 statement in relation to this Act, including

14 clearly defined goals and objectives, a 5-year ac15 tion plan outlining the contributions that each

16 organization will make in carrying out the pol17 icy of this Act, and an estimated budget.

18 ‘‘(B) Such term does not include any organiza19 tion identified in subparagraph (A) if the Secretary

20 determines that such organization does not have a

21 mission statement with clearly defined goals and ob22 jectives for the contributions the organization will

23 make to Native Hawaiian health care systems and

24 an action plan for carrying out such goals and objec25 tives.
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1 ‘‘(8) PRIMARY HEALTH SERVICES.—The term

2 ‘primary health services’ means—

3 ‘‘(A) services of physicians, physicians’ as4 sistants and nurse practitioners;

5 ‘‘(B) diagnostic laboratory and radiologic

6 services;

7 ‘‘(C) preventive health services (including

8 children’s eye and ear examinations to deter9 mine the need for vision and hearing correction,

10 perinatal services, well child services, and family

11 planning services);

12 ‘‘(D) emergency medical services;

13 ‘‘(E) transportation services as required

14 for adequate patient care;

15 ‘‘(F) preventive dental services; and

16 ‘‘(G) pharmaceutical services, as may be

17 appropriate for particular health centers.

18 ‘‘(9) SECRETARY.—The term ‘Secretary’ means

19 the Secretary of Health and Human Services.

20 ‘‘(10) TRADITIONAL NATIVE HAWAIIAN HEAL21 ER.—The term ‘traditional Native Hawaiian healer’

22 means a practitioner—

23 ‘‘(A) who—

24 ‘‘(i) is of Hawaiian ancestry, and
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1 ‘‘(ii) has the knowledge, skills, and ex2 perience in direct personal health care of

3 individuals, and

4 ‘‘(B) whose knowledge, skills, and experi5 ence are based on a demonstrated learning of

6 Native Hawaiian healing practices acquired

7 by—

8 ‘‘(i) direct practical association with

9 Native Hawaiian elders, and

10 ‘‘(ii) oral traditions transmitted from

11 generation to generation.

12 ‘‘SEC. 11. RULE OF CONSTRUCTION.

13 ‘‘Nothing in this Act shall be construed to restrict

14 the authority of the State of Hawaii to license health prac15 titioners.

16 ‘‘SEC. 12. COMPLIANCE WITH BUDGET ACT.

17 ‘‘Any new spending authority (described in subsection

18 (c)(2) (A) or (B) of section 401 of the Congressional

19 Budget Act of 1974) which is provided under this Act

20 shall be effective for any fiscal year only to such extent

21 or in such amounts as are provided in appropriation Acts.

22 ‘‘SEC. 13. SEVERABILITY.

23 ‘‘If any provision of this Act, or the application of

24 any such provision to any person or circumstances is held

25 to be invalid, the remainder of this Act, and the applica-
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1 tion of such provision or amendment to persons or cir2 cumstances other than those to which it is held invalid,

3 shall not be affected thereby.

4 ‘‘SEC. 14. AUTHORIZATION OF APPROPRIATIONS.

5 ‘‘There is authorized to be appropriated for each of

6 the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and

7 2000 such sums as may be necessary to carry out the pur8 poses of this Act.

9 ‘‘SEC. 15. PROHIBITION AGAINST EXCLUSION FROM PAR10 TICIPATION.

11 ‘‘Notwithstanding any other provision of this Act, no

12 person shall, on the basis of race, color, or national origin,

13 be excluded from participation in, or be denied the benefits

14 of, or be subjected to discrimination under, any program

15 or activity receiving Federal financial assistance under

16 this Act.’’.

17 SEC. 503. REPEAL OF PUBLIC HEALTH SERVICE ACT PROVI18 SION.

19 The Public Health Service Act (42 U.S.C. 201 et

20 seq.), as amended by section 206 of this Act, is amended

21 by repealing section 338K and redesignating section 338L

22 as section 338K. Such repeal shall not be construed to

23 terminate contracts in effect under such section on the

24 date of the enactment of this Act. Any such contracts shall
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1 continue according to the terms and conditions of such

2 contracts.

3 TITLE VI—MISCELLANEOUS

4 PROVISIONS

5 SEC. 601. TECHNICAL AMENDMENT TO INDIAN HEALTH

6 CARE IMPROVEMENT ACT.

7 The last sentence of section 818(e)(3) of the Indian

8 Health Care Improvement Act (25 U.S.C. 1680h(e)(3))

9 is amended—

10 (1) by striking ‘‘services,’’ and inserting ‘‘serv11 ices’’; and

12 (2) by striking ‘‘, shall be recoverable.’’ and in13 serting a period.

14 SEC. 602. HEALTH SERVICES FOR PACIFIC ISLANDERS.

15 Section 10 of the Disadvantaged Minority Health Im16 provement Act of 1990 (42 U.S.C. 254c–1) is amended—

17 (1) in subsection (b)—

18 (A) by striking paragraphs (5) and (6);

19 (B) by redesignating paragraphs (7) and

20 (8) as paragraphs (5) and (6), respectively;

21 (C) in paragraph (1) (as so redesig22 nated)—

23 (i) by inserting ‘‘substance abuse’’

24 after ‘‘availability of health’’; and
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1 (ii) by striking ‘‘, including improved

2 health data systems’’; and

3 (D) in paragraph (2) (as so redesig4 nated)—

5 (i) by striking ‘‘manpower’’ and in6 serting ‘‘care providers’’; and

7 (ii) by striking ‘‘by—’’ and all that

8 follows through the end thereof and insert9 ing a semicolon; and

10 (2) in subsection (f)—

11 (A) by striking ‘‘there is’’ and inserting

12 ‘‘there are’’; and

13 (B) by striking ‘‘$10,000,000’’ and all that

14 follows through ‘‘1993’’ and inserting

15 ‘‘$3,000,000 for each of the fiscal years 1995

16 through 1997’’.

17 SEC. 603. TECHNICAL CORRECTIONS REGARDING PUBLIC

18 LAW 103–183.

19 (a) AMENDATORY INSTRUCTIONS.—Public Law 103–

20 183 is amended—

21 (1) in section 301(a), by striking ‘‘(42 U.S.C.

22 242 et seq.)’’ and inserting ‘‘(42 U.S.C. 243 et

23 seq.)’’;

24 (2) in section 601—
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1 (A) in subsection (b), in the matter preced2 ing paragraph (1), by striking ‘‘Section 1201 of

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

4 300d)’’ and inserting ‘‘Title XII of the Public

5 Health Service Act (42 U.S.C. 300d et seq.)’’;

6 and

7 (B) in subsection (f)(1), by striking ‘‘in

8 section 1204(c)’’ and inserting ‘‘in section

9 1203(c) (as redesignated by subsection (b)(2) of

10 this section)’’;

11 (3) in section 602, by striking ‘‘ ‘for the pur12 pose’’ and inserting ‘‘ ‘For the purpose’’; and

13 (4) in section 705(b), by striking ‘‘317D((l)(1)’’

14 and inserting ‘‘317D(l)(1)’’.

15 (b) PUBLIC HEALTH SERVICE ACT.—The Public

16 Health Service Act, as amended by Public Law 103–183

17 and by subsection (a) of this section, is amended—

18 (1) in section 317E(g)(2), by striking ‘‘making

19 grants under subsection (b)’’ and inserting ‘‘carrying

20 out subsection (b)’’;

21 (2) in section 318, in subsection (e) as in effect

22 on the day before the date of the enactment of Pub23 lic Law 103–183, by redesignating the subsection as

24 subsection (f);
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1 (3) in part D of title III, by inserting before

2 section 340D the following subpart heading:

3 ‘‘Subpart IX—Miscellaneous Provisions Regarding

4 Primary Health Care’’;

5 (4) in subpart 6 of part C of title IV—

6 (A) by transferring the first section 447

7 (added by section 302 of Public Law 103–183)

8 from the current placement of the section;

9 (B) by redesignating the section as section

10 447A; and

11 (C) by inserting the section after section

12 447;

13 (5) in section 1213(a)(8), by striking ‘‘provides

14 for for’’ and inserting ‘‘provides for’’;

15 (6) in section 1501, by redesignating the second

16 subsection (c) (added by section 101(f) of Public

17 Law 103–183) as subsection (d); and

18 (7) in section 1505(3), by striking ‘‘nonprofit’’.

19 (c) MISCELLANEOUS CORRECTION.—Section

20 401(c)(3) of Public Law 103–183 is amended in the mat21 ter preceding subparagraph (A) by striking ‘‘(d)(5)’’ and

22 inserting ‘‘(e)(5)’’.
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1 SEC. 604. CERTAIN AUTHORITIES OF CENTERS FOR DIS2 EASE CONTROL AND PREVENTION.

3 Part B of title III of the Public Health Service Act

4 (42 U.S.C. 243 et seq.), as amended pursuant to section

5 603(a)(1) of this Act and as amended by section 703 of

6 Public Law 103-183, is amended by inserting after section

7 317F the following section:

8 ‘‘MISCELLANEOUS AUTHORITIES REGARDING CENTERS

9 FOR DISEASE CONTROL AND PREVENTION

10 ‘‘SEC. 317G. (a) TECHNICAL AND SCIENTIFIC PEER

11 REVIEW GROUPS.—The Secretary, acting through the Di12 rector of the Centers for Disease Control and Prevention,

13 may, without regard to the provisions of title 5, United

14 States Code, governing appointments in the competitive

15 service, and without regard to the provisions of chapter

16 51 and subchapter III of chapter 53 of such title relating

17 to classification and General Schedule pay rates, establish

18 such technical and scientific peer review groups and sci19 entific program advisory committees as are needed to

20 carry out the functions of such Centers and appoint and

21 pay the members of such groups, except that officers and

22 employees of the United States shall not receive additional

23 compensation for service as members of such groups. The

24 Federal Advisory Committee Act shall not apply to the

25 duration of such peer review groups. Not more than one-
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1 fourth of the members of any such group shall be officers

2 or employees of the United States.

3 ‘‘(b) FELLOWSHIP AND TRAINING PROGRAMS.—The

4 Secretary, acting through the Director of the Centers for

5 Disease Control and Prevention, shall establish fellowship

6 and training programs to be conducted by such Centers

7 to train individuals to develop skills in epidemiology, sur8 veillance, laboratory analysis, and other disease detection

9 and prevention methods. Such programs shall be designed

10 to enable health professionals and health personnel trained

11 under such programs to work, after receiving such train12 ing, in local State, national, and international efforts to13 ward the prevention and control of diseases, injuries, and

14 disabilities. Such fellowships and training may be adminis15 tered through the use of either appointment or

16 nonappointment procedures.’’.

17 TITLE VII—GENERAL

18 PROVISIONS

19 SEC. 701. EFFECTIVE DATE.

20 Except as otherwise provided in this Act, this Act

21 takes effect October 1, 1994, or upon the date of the en22 actment of this Act, whichever occurs later.

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