I

103D CONGRESS

1ST SESSION H. R. 3699

To amend the Public Health Service Act to establish, reauthorize and revise

provisions to improve the health of individuals from disadvantaged backgrounds, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

NOVEMBER 22, 1993

Mr. STOKES (for himself, Mr. CLAY, Mrs. MEEK, Mr. LEWIS of Georgia, Mr.

DELLUMS, Mr. HILLIARD, Mr. MFUME, Mr. JEFFERSON, Mr. TOWNS,

Mr. BISHOP, Ms. NORTON, and Mr. THOMPSON of Mississippi) introduced the following bill; which was referred jointly to the Committees on

Education and Labor and Energy and Commerce

A BILL

To amend the Public Health Service Act to establish, reauthorize and revise provisions to improve the health of

individuals from disadvantaged backgrounds, 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; AMENDATORY REFERENCES;

4 TABLE OF CONTENTS.

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

6 ‘‘Minority Health Improvement Act of 1993’’.
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1 (b) AMENDATORY REFERENCES.—Any reference in

2 this Act to an amendment or repeal of a section or other

3 provision shall be considered to be an amendment or re4 peal, respectively, of that provision of the Public Health

5 Service Act, unless another public law is specified as being

6 the subject of the amendment or repeal.

7 (c) TABLE OF CONTENTS.—The table of contents of

8 this Act is as follows:

Sec. 1. Short title; amendatory references; table of contents.

Sec. 2. Findings.

TITLE I—HEALTH POLICY

Sec. 101. Office of Minority Health.

Sec. 102. Agency Offices of Minority Health.

Sec. 103. State Offices of Minority Health.

Sec. 104. Assistant Secretary of Health and Human Services for Civil Rights.

TITLE II—HEALTH SERVICES

Sec. 201. Community scholarship programs.

Sec. 202. Health services for residents of public housing.

Sec. 203. Health services for Pacific Islanders.

TITLE III—HEALTH PROFESSIONS

Sec. 301. Loans for disadvantaged students.

Sec. 302. Cesar Chavez scholarship program.

Sec. 303. Thurgood Marshall scholarship program.

Sec. 304. Loan repayments and fellowships regarding faculty positions at

health professions schools.

Sec. 305. Centers of excellence.

Sec. 306. Educational assistance regarding undergraduates.

Sec. 307. Area health education centers.

TITLE IV—RESEARCH AND DATA COLLECTION

Sec. 401. Office of Research on Minority Health.

Sec. 402. National Center for Health Statistics.

Sec. 403. Activities of Agency for Health Care Policy and Research.

TITLE V—MISCELLANEOUS

Sec. 501. Medically underserved area study.

Sec. 502. Federal and State offices regarding urban health.

Sec. 503. Grants regarding organ and bone marrow transplantation with respect to minority populations.

Sec. 504. Demonstration project grants to States for Alzheimer’s disease.
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Sec. 505. Waivers regarding obligated service in primary health care.

1 SEC. 2. FINDINGS.

2 Section 1(b) of the Disadvantaged Minority Health

3 Improvement Act of 1990 (42 U.S.C. 300u–6 note) is

4 amended to read as follows—

5 ‘‘(b) FINDINGS.—Congress finds that—

6 ‘‘(1) the health status of individuals from racial

7 and ethnic minorities in the United States is signifi8 cantly lower than the health status of the general

9 population and has not improved significantly since

10 the issuance of the 1985 report entitled ‘‘Report of

11 the Secretary’s Task Force on Black and Minority

12 Health’’;

13 ‘‘(2) racial and ethnic minorities are dispropor14 tionately represented among the poor;

15 ‘‘(3) racial and ethnic minorities suffer dis16 proportionately high rates of cancer, heart disease,

17 diabetes, substance abuse, acquired immune defi18 ciency syndrome, and other diseases and disorders;

19 ‘‘(4) the incidence of infant mortality among

20 African Americans is almost double that for the gen21 eral population;

22 ‘‘(5) Mexican-American and Puerto Rican

23 adults have diabetes rates twice that of non-His24 panic whites;
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1 ‘‘(6) a third of American Indian deaths occur

2 before the age of 45;

3 ‘‘(7) the crisis in minority health continues

4 while the United States has the most sophisticated

5 and elaborate medical system in the world; while

6 medical and technological breakthroughs are afford7 ing Americans a longer life expectancy; and while

8 the United States continues to witness unprece9 dented explosion in scientific knowledge and a phe10 nomenal capacity to treat and cure disease;

11 ‘‘(8) according to the 1990 Census, African

12 Americans, Hispanics, American Indians, Alaskan

13 Natives, and Asian/Pacific Islanders constitute ap14 proximately 12.1 percent, 9 percent, 0.08 percent,

15 and 2.9 percent, respectively, of the population of

16 the United States;

17 ‘‘(9) minority health professionals have histori18 cally tended to practice in low-income areas, medi19 cally underserved areas, and to serve racial and eth20 nic minorities;

21 ‘‘(10) minority health professionals have histori22 cally tended to engage in the general practice of

23 medicine and specialties providing primary care;

24 ‘‘(11) reports published in leading medical jour25 nals indicate that access to health care among mi-
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1 norities can be substantially improved by increasing

2 the number of minority professionals;

3 ‘‘(12) diversity in the faculty and student body

4 of health professions schools enhances the quality of

5 education for all students attending the schools; and

6 ‘‘(13) health professionals need greater access

7 to continuing medical education programs to enable

8 such professionals to upgrade their skills (including

9 linguistic and cultural competence skills) and im10 prove the quality of medical care rendered in minor11 ity communities.’’.

12 TITLE I—HEALTH POLICY

13 SEC. 101. OFFICE OF MINORITY HEALTH.

14 Section 1707 (42 U.S.C. 300u–6) is amended by

15 striking subsection (b) and all that follows and inserting

16 the following:

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

18 of racial and ethnic minority groups, the Secretary, acting

19 through the Deputy Assistant Secretary for Minority

20 Health, shall carry out the following:

21 ‘‘(1) Establish short-range and long-range goals

22 and objectives and coordinate all other activities

23 within the Department of Health and Human Serv24 ices that relate to disease prevention, health pro25 motion, service delivery, and research concerning
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1 such individuals. The heads of the operating divi2 sions of the Department of Health and Human

3 Services and the heads of Public Health Service

4 agencies shall consult with the Deputy Assistant

5 Secretary for Minority Health to assist in the coordi6 nation of all activities within the Department as

7 they relate to disease prevention, health promotion,

8 service delivery, and research concerning such indi9 viduals.

10 ‘‘(2) Carry out the following types of activities

11 by entering into interagency agreements with other

12 agencies of the public health service:

13 ‘‘(A) Support research, demonstrations and

14 evaluations to test new and innovative models.

15 ‘‘(B) Increase knowledge and understand16 ing of health risk factors.

17 ‘‘(C) Develop mechanisms that support

18 better information dissemination, education,

19 prevention, and service delivery to individuals

20 from disadvantaged backgrounds, including ra21 cial and ethnic minority groups.

22 ‘‘(3) Establish a national minority health re23 source center to carry out the following:

24 ‘‘(A) Facilitate the exchange of informa25 tion regarding matters relating to health infor-
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1 mation and health promotion, preventive health

2 services, and education in the appropriate use

3 of health care.

4 ‘‘(B) Target the most prevalent morbidity

5 and mortality concerns of the various racial and

6 ethnic minorities.

7 ‘‘(C) Facilitate access to such information.

8 ‘‘(D) Assist in the analysis of issues and

9 problems relating to such matters.

10 ‘‘(E) Provide technical assistance with re11 spect to the exchange of such information (in12 cluding facilitating the development of materials

13 for such technical assistance).

14 ‘‘(F) Improve access to health care services

15 for racial and ethnic minorities, including those

16 with limited English proficiency, by facilitating

17 the removal of impediments to the receipt of

18 health care.

19 ‘‘(4) With respect to awards of grants and con20 tracts that are available under certain minority

21 health programs, establish a program—

22 ‘‘(A) to inform entities, as appropriate,

23 that the entities may be eligible for the awards;

24 ‘‘(B) to provide technical assistance to

25 such entities in the process of preparing and
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1 submitting applications for the awards in ac2 cordance with the policies of the Secretary re3 garding such application; and

4 ‘‘(C) to inform populations, as appropriate,

5 that members of the populations may be eligible

6 to receive services or otherwise participate in

7 the activities carried out with such awards.

8 ‘‘(c) ADVISORY COMMITTEE.—

9 ‘‘(1) IN GENERAL.—The Secretary shall estab10 lish an advisory committee to be known as the Advi11 sory Committee on Minority Health (in this sub12 section referred to as the ‘Committee’).

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

14 advice to the Secretary on carrying out this section,

15 including advice on the development of goals and

16 specific program activities under subsection (b)(1)

17 for each racial and ethnic minority group.

18 ‘‘(3) CHAIRPERSON.—The Deputy Assistant

19 Secretary for Minority Health shall serve as the

20 Chairperson of the Committee.

21 ‘‘(4) COMPOSITION.—The Committee shall be

22 composed of no fewer than 12, and not more than

23 18 individuals, who are not officers or employees of

24 the Federal Government. The Secretary shall ap25 point the members of the Committee from among in-
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1 dividuals with expertise regarding issues of minority

2 health. The membership of the Committee shall be

3 equitably representative of the various racial and

4 ethnic minority groups. The Secretary may appoint

5 representatives from selected Federal agencies to

6 serve as ex officio, non-voting members of the Com7 mittee.

8 ‘‘(5) TERMS.—Each member of the Committee

9 shall serve for a term of 4 years, except that the

10 Secretary shall initially appoint a portion of the

11 members to terms of 1 year, 2 years, and 3 years.

12 ‘‘(6) VACANCIES.—If a vacancy occurs on the

13 Committee, a new member shall be appointed by the

14 Secretary within 90 days from the date that the va15 cancy occurs, and serve for the remainder of the

16 term for which the predecessor of such member was

17 appointed. The vacancy shall not affect the power of

18 the remaining members to execute the duties of the

19 Committee.

20 ‘‘(7) COMPENSATION.—Members of the Com21 mittee who are officers or employees of the United

22 States shall serve without compensation. Members of

23 the Committee who are not officers or employees of

24 the United States shall receive, for each day (includ25 ing travel time) they are engaged in the performance
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1 of the functions of the Committee, compensation at

2 rates that do not exceed the daily equivalent of the

3 annual rate in effect for grade GS–18 of the General

4 Schedule under title 5, United States Code.

5 ‘‘(d) CERTAIN REQUIREMENTS REGARDING DU6 TIES.—

7 ‘‘(1) EQUITABLE ALLOCATION REGARDING AC8 TIVITIES.—In awarding grants or contracts or coop9 erative agreements under section 340A, 724, 737,

10 738, or 1707, the Secretary shall ensure that such

11 awards are allocated to address the most prevalent

12 morbidity and mortality concerns of the various ra13 cial and ethnic minority groups.

14 ‘‘(2) CULTURAL COMPETENCY OF SERVICES.—

15 The Secretary shall ensure that information and

16 services provided pursuant to subsection (b) are pro17 vided in the language and cultural context that is

18 most appropriate for the individuals for whom the

19 information and services are intended.

20 ‘‘(3) PEER REVIEW.—The Secretary shall en21 sure that each application for a grant, contract or

22 cooperative agreement under section 340A, 724,

23 737, or 1707 undergoes appropriate peer review.

24 ‘‘(e) REPORTS.—Not later than January 31 of fiscal

25 year 1995 and of each second year thereafter, the Sec-
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1 retary shall submit to the Congress a report describing

2 the activities carried out under this section during the pre3 ceding 2 fiscal years and evaluating the extent to which

4 such activities have been effective in improving the health

5 of racial and ethnic minority groups.

6 ‘‘(f) GRANTS AND CONTRACTS AND COOPERATIVE

7 AGREEMENTS REGARDING DUTIES.—

8 ‘‘(1) AUTHORITY.—In carrying out subsection

9 (b), the Secretary may make grants to and enter

10 into contracts and cooperative agreements with pub11 lic and nonprofit private entities for activities de12 scribed in paragraphs (3) of subsection (b).

13 ‘‘(2) EVALUATION AND DISSEMINATION.—The

14 Secretary shall, directly or through contracts with

15 public and private entities, provide for evaluations of

16 projects carried out with financial assistance pro17 vided under paragraph (1) during the preceding 2

18 fiscal years. The report shall be included in the re19 port required under subsection (e) for the fiscal year

20 involved.

21 ‘‘(g) DEFINITION.—As used in this section, the term

22 ‘racial and ethnic minority group’ means Hispanics,

23 Blacks, Asian Americans, Pacific Islanders, Native Ameri24 cans, and Alaskan Natives.
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1 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the

2 purpose of carrying out this section, there is authorized

3 to be appropriated such sums as may be necessary for

4 each of the fiscal years 1994 through 1998.’’.

5 SEC. 102. AGENCY OFFICES OF MINORITY HEALTH.

6 Title XVII (42 U.S.C. 300u et seq.) is amended by

7 adding at the end the following new section:

8 ‘‘SEC. 1709. AGENCY OFFICES OF MINORITY HEALTH.

9 ‘‘(a) IN GENERAL.—The Secretary, acting through

10 the Deputy Assistant Secretary for Minority Health, shall

11 ensure that an Office of Minority Health is established

12 and operating at the Centers for Disease Control and Pre13 vention, the Health Resources and Services Administra14 tion, the Substance Abuse and Mental Health Administra15 tion, and the Agency for Health Care Policy and Research.

16 Such Offices shall be established to ensure that services

17 and programs carried out within each such respective

18 agency or office—

19 ‘‘(1) address the most prevalent morbidity and

20 mortality concerns of racial and ethnic minority

21 groups;

22 ‘‘(2) provide culturally competent services; and

23 ‘‘(3) utilize racial and ethnic minority commu24 nity-based organizations to deliver services.
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1 ‘‘(b) REPORTS.—Each Office of Minority Health

2 within the Department of Health and Human Services

3 shall submit a report, not later than May 1 of each year,

4 to the Deputy Assistant Secretary for Minority Health (as

5 provided for in section 1707(a)) describing the accom6 plishments or programs of the plan, the budget allocation

7 and expenditures for, and the development and implemen8 tation of, such health programs targeting racial and ethnic

9 minority populations. The Secretary shall ensure the par10 ticipation and cooperation of each Agency in the develop11 ment of the annual report.

12 ‘‘(c) FUNDING.—Of the amounts appropriated for fis13 cal year 1995 or any subsequent fiscal year for an agency

14 for which an Office of Minority Health is established

15 under subsection (a), the Secretary shall reserve not less

16 than 10 percent for the purpose of such Office to carry

17 out minority health program activities.

18 SEC. 103. STATE OFFICES OF MINORITY HEALTH.

19 Title XVII (42 U.S.C. 300u et seq.), as amended by

20 section 102, is further amended by adding at the end the

21 following new section:

22 ‘‘SEC. 1710. GRANTS TO STATES FOR OPERATION OF OF23 FICES OF MINORITY HEALTH.

24 ‘‘(a) IN GENERAL.—The Secretary, acting through

25 the Deputy Assistant Secretary for Minority Health (as
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1 provided for in section 1707), may make grants to States

2 for the purpose of improving the health status in minority

3 communities, through the operation of State offices of mi4 nority health established to monitor and facilitate the

5 achievement of the Health Objectives for the Year 2000

6 as they affect minority populations.

7 ‘‘(b) ADMINISTRATION OF PROGRAM.—The Secretary

8 may not make a grant to a State under subsection (a)

9 unless such State agrees that the program carried out by

10 the State with amounts received under the grant will be

11 administered directly by a single State agency.

12 ‘‘(c) CERTAIN REQUIRED ACTIVITIES.—The Sec13 retary may not make a grant to a State under subsection

14 (a) unless such State agrees that activities carried out by

15 an office operated under the grant received pursuant to

16 such subsection will—

17 ‘‘(1) establish and maintain within the State a

18 clearinghouse for collecting and disseminating infor19 mation on—

20 ‘‘(A) minority health issues, including

21 health care issues;

22 ‘‘(B) research findings relating to minority

23 health, including findings relating to health

24 care; and
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1 ‘‘(C) innovative approaches to the delivery

2 of health care and social services in minority

3 communities;

4 ‘‘(2) coordinate the activities carried out in the

5 State that relate to minority health, including activi6 ties relating to health care, which activities include

7 providing coordination for the purpose of avoiding

8 redundancy in such activities;

9 ‘‘(3) identify Federal and State programs re10 garding minority health, and providing technical as11 sistance to public and nonprofit entities regarding

12 participation in such program; and

13 ‘‘(4) develop additional Healthy People 2000

14 objectives for the State that are necessary to address

15 the most prevalent morbidity and mortality concerns

16 of racial and ethnic minority groups in the State.

17 ‘‘(d) REQUIREMENT REGARDING ANNUAL BUDGET

18 OFFICE.—The Secretary may not make a grant to a State

19 under subsection (a) unless such State agrees that, for any

20 fiscal year for which the State receives such a grant, the

21 office operated under such grant will be provided with an

22 annual budget of not less than $75,000.

23 ‘‘(e) CERTAIN USES OF FUNDS.—
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1 ‘‘(1) RESTRICTIONS.—The Secretary may not

2 make a grant to a State under subsection (a) unless

3 such State agrees that—

4 ‘‘(A) if research with respect to minority

5 health is conducted pursuant to the grant, not

6 more than 10 percent of the amount received

7 under the grant will be expended for such re8 search; and

9 ‘‘(B) amounts provided under the grant

10 will not be expended—

11 ‘‘(i) to provide health care (including

12 providing cash payments regarding such

13 care);

14 ‘‘(ii) to conduct activities for which

15 Federal funds are expended—

16 ‘‘(I) within the State to provide

17 technical and other nonfinancial as18 sistance under subsection (m) of sec19 tion 340A;

20 ‘‘(II) under a memorandum of

21 agreement entered into with the State

22 under subsection (h) of such section;

23 or

24 ‘‘(III) under a grant under sec25 tion 388I;
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1 ‘‘(iii) to purchase medical equipment,

2 to purchase ambulances, aircraft, or other

3 vehicles, or to purchase major communica4 tions equipment;

5 ‘‘(iv) to purchase or improve real

6 property; or

7 ‘‘(v) to carry out any activity regard8 ing a certificate of need.

9 ‘‘(2) AUTHORITIES.—Activities for which a

10 State may expend amounts received under a grant

11 under subsection (a) include—

12 ‘‘(A) paying the costs of establishing an of13 fice of minority health for purposes of sub14 section (a);

15 ‘‘(B) subject to paragraph (1)(B)(ii)(III),

16 paying the costs of any activity carried out with

17 respect to recruiting and retaining health pro18 fessionals to serve in minority communities or

19 underserved areas in the State; and

20 ‘‘(C) providing grants and contracts to

21 public and nonprofit entities to carry out activi22 ties authorized in this section.

23 ‘‘(f) REPORTS.—The Secretary may not make a

24 grant to a State under subsection (a) unless such State

25 agrees—
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1 ‘‘(1) to submit to the Secretary reports contain2 ing such information as the Secretary may require

3 regarding activities carried out under this section by

4 the State; and

5 ‘‘(2) to submit a report not later than January

6 10 of each fiscal year immediately following any fis7 cal year for which the State has received such a

8 grant.

9 ‘‘(g) APPLICATION FOR GRANT.—The Secretary may

10 not make a grant to a State under subsection (a) unless

11 an application for the grant is submitted to the Secretary

12 and the application in such form, is made in such manner,

13 and contains such agreements, assurances, and informa14 tion as the Secretary determines to be necessary to carry

15 out such subsection.

16 ‘‘(h) NONCOMPLIANCE.—The Secretary may not

17 make payments under subsection (a) to a State for any

18 fiscal year subsequent to the first fiscal year of such pay19 ments unless the Secretary determines that, for the imme20 diately preceding fiscal year, the State has complied with

21 each of the agreements made by the State under this sec22 tion.

23 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—

24 ‘‘(1) IN GENERAL.—For purposes of making

25 grants under subsection (a) there are authorized to
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1 be appropriated $3,000,000 for fiscal year 1995,

2 $4,000,000 for fiscal year 1996, and $3,000,000 for

3 fiscal year 1997.

4 ‘‘(2) AVAILABILITY.—Amounts appropriated

5 under paragraph (1) shall remain available until ex6 pended.

7 ‘‘(j) TERMINATION OF PROGRAM.—No grant may be

8 made under this section after the aggregate amounts ap9 propriated under subsection (i)(1) are equal to

10 $10,000,000.’’.

11 SEC. 104. ASSISTANT SECRETARY OF HEALTH AND HUMAN

12 SERVICES FOR CIVIL RIGHTS.

13 (a) IN GENERAL.—Part A of title II (42 U.S.C. 202

14 et seq.), as amended by section 2010 of Public Law 103–

15 43, is amended by adding at the end the following new

16 section:

17 ‘‘SEC. 229. ASSISTANT SECRETARY FOR CIVIL RIGHTS.

18 ‘‘(a) ESTABLISHMENT OF POSITION.—There shall be

19 in the Department of Health and Human Services an As20 sistant Secretary for Civil Rights, who shall be appointed

21 by the President, by and with the advice and consent of

22 the Senate.

23 ‘‘(b) RESPONSIBILITIES.—The Assistant Secretary

24 shall perform such functions relating to civil rights as the

25 Secretary may assign.’’.
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1 (b) CONFORMING AMENDMENT.—Section 5315 of

2 title 5, United States Code, is amended, in the item relat3 ing to Assistant Secretaries of Health and Human Serv4 ices, by striking ‘‘(5)’’ and inserting ‘‘(6)’’.

5 TITLE II—HEALTH SERVICES

6 SEC. 201. COMMUNITY SCHOLARSHIP PROGRAMS.

7 Section 338L (42 U.S.C. 254t) is amended—

8 (1) in subsection (a), by striking ‘‘health man9 power shortage areas’’ and inserting ‘‘Federally-des10 ignated health professional shortage areas’’;

11 (2) in subsection (c)—

12 (A) by striking ‘‘health manpower shortage

13 areas’’ and inserting ‘‘Federally-designated

14 health professional shortage areas’’ in the mat15 ter preceding paragraph (1); and

16 (B) by striking ‘‘in the health manpower

17 shortage areas in which the community organi18 zations are located,’’ and inserting ‘‘in a Feder19 ally-designated health professional shortage

20 area that is served by the community organiza21 tion awarding the scholarship,’’ in paragraph

22 (2);

23 (3) in subsection (e)(1)—
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1 (A) by striking ‘‘health manpower shortage

2 area’’ and inserting ‘‘Federally-designated

3 health professional shortage area’’; and

4 (B) by striking ‘‘in which the community’’

5 and all that follows through ‘‘located’’; and

6 (4) in subsection (l)(1), by striking

7 ‘‘$5,000,000’’ and all that follows through ‘‘1993’’

8 and inserting such sums as may be necessary for

9 each of the fiscal years 1994, 1995, and 1996’’.

10 SEC. 202. HEALTH SERVICES FOR RESIDENTS OF PUBLIC

11 HOUSING.

12 Section 340A(p)(1) (42 U.S.C. 256a(p)(1)) is amend13 ed—

14 (1) by inserting ‘‘for fiscal years 1994, 1995,

15 and 1996 such sums as necessary’’; and

16 (2) by striking ‘‘1992 and 1993’’.

17 SEC. 203. HEALTH SERVICES FOR PACIFIC ISLANDERS.

18 Section 10 of the Disadvantaged Minority Health Im19 provement Act of 1990 (42 U.S.C. 254c–1) is amended—

20 (1) in subsection (b)—

21 (A) in paragraph (2)—

22 (i) by inserting ‘‘, substance abuse’’

23 after ‘‘availability of health’’; and

24 (ii) by striking ‘‘, including improved

25 health data systems’’;
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1 (B) in paragraph (3)—

2 (i) by striking ‘‘manpower’’ and in3 serting ‘‘care providers’’; and

4 (ii) by striking ‘‘by—’’ and all that

5 follows through the end thereof and insert6 ing a semicolon;

7 (C) by striking paragraphs (5) and (6);

8 (D) by redesignating paragraphs (7), and

9 (8) as paragraphs (5) and (6), respectively;

10 (E) in paragraph (5) (as so redesignated),

11 by striking ‘‘and’’ at the end thereof;

12 (F) in paragraph (6) (as so redesignated),

13 by striking the period and inserting a semi14 colon; and

15 (G) by inserting after paragraph (6) (as so

16 redesignated), the following new paragraphs:

17 ‘‘(7) to provide primary health care, preventive

18 health care, and related training to American Sa19 moan health care professionals; and

20 ‘‘(8) to improve access to health promotion and

21 disease prevention services for rural American

22 Samoa.’’;

23 (2) in subsection (f)—

24 (A) by striking ‘‘there is’’ and inserting

25 ‘‘there are’’; and
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1 (B) by striking ‘‘$10,000,000’’ and all that

2 follows through ‘‘1993’’ and inserting ‘‘such

3 sums as may be necessary for each of the fiscal

4 years 1994 through 1996’’; and

5 (3) by adding at the end thereof the following

6 new subsection:

7 ‘‘(g) STUDY AND REPORT.—

8 ‘‘(1) STUDY.—Not later than 180 days after

9 the date of enactment of this subsection, the Sec10 retary, acting through the Administrator of the

11 Health Resources and Services Administration, shall

12 enter into a contract with a public or nonprofit pri13 vate entity for the conduct of a study to determine

14 the effectiveness of projects funded under this sec15 tion.

16 ‘‘(2) REPORT.—Not later than July 1, 1995,

17 the Secretary shall prepare and submit to the Com18 mittee on Energy and Commerce and the Committee

19 on Appropriations of the House of Representatives,

20 and to the Committee on Labor and Human Re21 sources and the Committee on Appropriations of the

22 Senate, a report describing the findings made with

23 respect to the study conducted under paragraph

24 (1).’’.
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1 TITLE III—HEALTH

2 PROFESSIONS

3 SEC. 301. LOANS FOR DISADVANTAGED STUDENTS.

4 Subpart II of part A of title VII (42 U.S.C. 292q)

5 is amended—

6 (1) in section 723—

7 (A) in subsection (a)(2), by adding at the

8 end the following subparagraph:

9 ‘‘(C) The requirement established in para10 graph (1) regarding a a student does not apply

11 to students from disadvantaged backgrounds

12 who are underrepresented in the health profes13 sions.’’; and

14 (B) in subsection (b), by adding at the end

15 the following paragraph:

16 ‘‘(7) INAPPLICABILITY TO CERTAIN SCHOOLS.—

17 The requirement established in paragraph (1) re18 garding a school does not apply if the school is a

19 historically black college or university.’’; and

20 (2) in section 724(f)(1)—

21 (A) by striking ‘‘there is’’ and inserting

22 ‘‘there are’’; and

23 (B) by striking ‘‘$15,000,000 for fiscal

24 year 1993’’ and inserting ‘‘such sums as may
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1 be necessary for each of the fiscal years 1994,

2 1995, and 1996’’.

3 SEC. 302. CESAR CHAVEZ SCHOLARSHIP PROGRAM.

4 Section 736 (42 U.S.C. 293) is amended—

5 (1) by striking the section heading and insert6 ing the following:

7 ‘‘SEC. 736. CESAR CHAVEZ SCHOLARSHIP PROGRAM.’’;

8 (2) in subsection (a), by striking ‘‘need, subject

9 to’’ and all that follows and inserting ‘‘need.’’; and

10 (3) in subsection (c)—

11 (A) by striking ‘‘there is’’ and inserting

12 ‘‘there are’’; and

13 (B) by striking ‘‘$11,000,000 for fiscal

14 year 1993’’ and inserting ‘‘such sums as may

15 be necessary for each fiscal year 1994, 1995,

16 and 1996’’.

17 SEC. 303. THURGOOD MARSHALL SCHOLARSHIP PROGRAM.

18 Section 737 (42 U.S.C. 293a) is amended—

19 (1) by striking the section heading and insert20 ing the following:

21 ‘‘SEC. 737. THURGOOD MARSHALL SCHOLARSHIP PRO22 GRAM.’’;

23 (2) in subsection (a)—
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1 (A) in paragraph (1), by inserting ‘‘(to be

2 known as Thurgood Marshall Scholars)’’ after

3 ‘‘providing scholarships to individuals’’; and

4 (B) by adding at the end the following

5 paragraph:

6 ‘‘(4) INAPPLICABILITY OF CERTAIN REQUIRE7 MENTS.—Any obligation under this section regard8 ing practicing in primary health care is waived for

9 students from disadvantaged backgrounds who are

10 underrepresented in the health professions.’’; and

11 (3) in subsection (h), by striking paragraph (1)

12 and inserting the following new paragraph:

13 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

14 For the purpose of carrying out this section, there

15 are authorized to be appropriated such sums as may

16 be necessary for each of the fiscal years 1994, 1995,

17 and 1996.’’.

18 SEC. 304. LOAN REPAYMENTS AND FELLOWSHIPS REGARD19 ING FACULTY POSITIONS AT HEALTH PRO20 FESSIONS SCHOOLS.

21 Section 738 (42 U.S.C. 293b) is amended—

22 (1) in subsection (a)—

23 (A) in paragraph (2), by striking ‘‘dis24 advantaged backgrounds who—’’ and inserting

25 ‘‘racial or ethnic groups that are
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1 underrepresented in the health professions

2 who—’’

3 (B) in paragraph (5)—

4 (i) by striking ‘‘; and’’ in subpara5 graph (A) and inserting a period;

6 (ii) by striking ‘‘unless—’’ and all

7 that follows through ‘‘the individual in8 volved’’ in subparagraph (A) and inserting

9 ‘‘unless the individual involved’’; and

10 (iii) striking subparagraph (B);

11 (C) by striking paragraph (6); and

12 (D) by redesignating paragraph (7) as

13 paragraph (6); and

14 (2) in subsection (b)(2)(B), by striking

15 ‘‘$30,000’’ and inserting ‘‘$50,000’’;

16 (3) in subsection (c)—

17 (A) by striking ‘‘there is’’ and inserting

18 ‘‘there are’’; and

19 (B) by striking ‘‘$4,000,000 for fiscal year

20 1993’’ and inserting ‘‘such sums as may be nec21 essary for each of the fiscal years 1994, 1995,

22 and 1996’’.

23 SEC. 305. CENTERS OF EXCELLENCE.

24 Section 739 (42 U.S.C. 293c) is amended—

25 (1) in subsection (b)—
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1 (A) in paragraph (2), by inserting before

2 the semicolon the following: ‘‘through collabora3 tion with public and nonprofit private entities

4 to carry out community-based programs to pre5 pare students in secondary schools and institu6 tions of higher education for attendance at the

7 health professions school’’;

8 (B) in paragraph (4), by striking ‘‘and’’ at

9 the end thereof;

10 (C) in paragraph (5), by striking the pe11 riod and inserting ‘‘; and’’; and

12 (D) by adding at the end thereof the fol13 lowing new paragraph:

14 ‘‘(6) to carry out a program to provide training

15 to the students of the school to enable such students

16 to provide health services to minority individuals at

17 community-based health facilities that provide such

18 services to a significant number of minority individ19 uals and that are located at a site remote from the

20 main site of the teaching facilities of the school.’’;

21 (2) in subsection (c)—

22 (A) in paragraph (1)(B), by amending

23 clause (i) to read as follows:

24 ‘‘(i) whose most recent graduating

25 class included a significant number of mi-
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1 nority individuals, which number con2 stituted (except as provided in paragraph

3 (4)(A)) not less than 25 percent of such

4 class;’’; and

5 (B) in paragraph (4)(A), by inserting be6 fore the semicolon the following: ‘‘(except that

7 the requirement in paragraph (1)(B)(i) regard8 ing 25 percent does not apply for purposes of

9 this subparagraph)’’;

10 (3) in subsection (e)—

11 (A) by striking the subsection heading and

12 inserting ‘‘AUTHORITY REGARDING CONSOR13 TIA.—’’;

14 (B) by striking paragraph (1) and insert15 ing the following new paragraph:

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

17 grant under subsection (a) to a school of medicine,

18 a school of osteopathic medicine, a school of den19 tistry, or a school or pharmacy, that has in accord20 ance with paragraph (2) formed a consortium of

21 schools.’’;

22 (C) in paragraph (2), by striking subpara23 graphs (A) through (D) and inserting the fol24 lowing new subparagraphs:

25 ‘‘(A) the consortium consists of—
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1 ‘‘(i) the health professions school

2 seeking the grant under subsection (a);

3 and

4 ‘‘(ii) one or more schools of medicine

5 or osteopathic medicine, schools of nursing

6 (as defined in section 853), schools of den7 tistry, schools of pharmacy, schools of

8 podiatric medicine, schools of optometry,

9 schools of veterinary medicine, schools of

10 public health, schools of allied health, or

11 graduate programs in mental health prac12 tice;

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

14 entered into an agreement for the allocation of

15 such grant among the schools; and

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

17 the grant in accordance with this section.’’; and

18 (D) by adding at the end the following

19 paragraph:

20 ‘‘(3) AUTHORITY FOR COLLECTIVELY MEETING

21 RELEVANT REQUIREMENTS IN CERTAIN CASES.—

22 With respect to meeting the conditions specified in

23 subsection (c)(4) for Native American Centers of

24 Excellence, the Secretary may make a grant to any

25 school that has in accordance with paragraphs (1)
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1 and (2) formed a consortium of schools that meets

2 such conditions (without regard to whether the

3 schools of the consortium individually meet such

4 conditions).’’;

5 (4)(A) by redesignating subsections (h) and (i)

6 as subsections (i) and (j), respectively; and

7 (B) by inserting after subsection (g) the follow8 ing subsection:

9 ‘‘(h) COLLABORATION WITH NATIONAL INSTITUTES

10 OF HEALTH.—The Director of the National Institutes of

11 Health, acting through the Director of the Office of Re12 search on Minority Health (or as appropriate through

13 other officials of such Institutes), may enter into collabo14 rative grant programs and other program initiatives with

15 Centers of Excellence under this section for the purposes

16 of collaborative research efforts, research program activ17 ity, training, and supplemental biomedical and health serv18 ices research linkages between the National Institutes of

19 Health and the Health Resources and Services Adminis20 tration.’’; and

21 (5) in subsection (j) (as redesignated by para22 graph (4) of this subsection)—

23 (A) in paragraph (1), by striking ‘‘such

24 sums as may be necessary for fiscal year 1993’’

25 and inserting ‘‘such sums as may be necessary
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1 for each of the fiscal years 1994, 1995, and

2 1996’’; and

3 (B) in paragraph (2)(C) by adding at the

4 end the following: ‘‘Health professions schools

5 described in subsection (c)(2)(A) shall be eligi6 ble for grants under this subparagraph in a fis7 cal year if the amount appropriated for the fis8 cal year under paragraph (1) is greater than

9 $23,500,000. Such schools shall be eligible to

10 apply only for grants made from the portion of

11 such amount that exceeds $23,500,000.’’.

12 SEC. 306. EDUCATIONAL ASSISTANCE REGARDING UNDER13 GRADUATES.

14 Section 740 (42 U.S.C. 293d) is amended—

15 (1) in subsection (a)(1), by adding at the end

16 the following new sentence: ‘‘To be eligible for such

17 a grant, a school shall have in place a program

18 which with supplemental support may assist individ19 uals from disadvantaged backgrounds in gaining

20 entry into a health professions school or completing

21 the course of study at such a school.’’; and

22 (2) in subsection (d)—

23 (A) in paragraph (1)—

24 (i) by striking ‘‘there is’’ and inserting

25 ‘‘there are’’; and
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1 (ii) by striking ‘‘1993’’ and inserting

2 ‘‘such sums as may be necessary for each

3 of the fiscal years 1994, 1995, and 1996’’;

4 and

5 (B) in paragraph (2)(B), by striking ‘‘The

6 provision of’’ and all that follows through

7 ‘‘health care).’’.

8 SEC. 307. AREA HEALTH EDUCATION CENTERS.

9 Section 746(d)(2)(D) (42 U.S.C. 293j(d)(2)(D)) is

10 amended by inserting ‘‘and minority health’’ after ‘‘dis11 ease prevention’’.

12 TITLE IV—RESEARCH AND DATA

13 COLLECTION

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

15 Section 404 (42 U.S.C. 283b), as added by section

16 151 of Public Law 103–43, is amended by adding at the

17 end the following subsections:

18 ‘‘(c) PLAN.—The Director of the Office, shall collabo19 rate with the Deputy Assistant Secretary for Minority

20 Health (as provided for in section 1707), to develop and

21 implement a plan for carrying out the duties required by

22 subsection (b).

23 ‘‘(d) EQUITY REGARDING VARIOUS GROUPS.—The

24 Director of the Office shall ensure that activities under

25 subsection (b) address health research and research train-
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1 ing needs of minorities with respect to the most prevalent

2 morbidity and mortality concerns of the various racial and

3 ethnic minority groups.

4 ‘‘(e) ADVISORY SUBCOMMITTEE.—

5 ‘‘(1) ESTABLISHMENT.—In carrying out sub6 section (b), the Secretary shall establish a sub7 committee of the Advisory Committee to the Direc8 tor of the National Institutes of Health, an advisory

9 subcommittee to be known as the Advisory Sub10 committee on Research on Minority Health (in this

11 subsection referred to as the ‘Advisory Subcommit12 tee’).

13 ‘‘(2) COMPOSITION.—

14 ‘‘(A) VOTING AND NONVOTING MEM15 BERS.—The Advisory Subcommittee shall be

16 composed of voting members appointed in ac17 cordance with subparagraph (B) and the ex

18 officio nonvoting members described in subpara19 graph (C).

20 ‘‘(B) VOTING MEMBERS.—The Advisory

21 Subcommittee shall include not fewer than 12,

22 and not more than 18, voting members who are

23 not officers or employees of the Federal Gov24 ernment. The Director of the Office shall ap25 point such members to the Advisory Sub-
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1 committee from among physicians, practition2 ers, scientists, consumers and other health pro3 fessionals, whose clinical practices, research

4 specialization, or professional expertise includes

5 a significant focus on research on minority

6 health or on the barriers that minorities must

7 overcome to participate in clinical trials. The

8 membership of the Advisory Subcommittee shall

9 be equitably representative of the minority

10 groups served by the Office.

11 ‘‘(C) EX OFFICIO NONVOTING MEMBERS.—

12 The Deputy Assistant Secretary for Minority

13 Health and the Directors of each of the na14 tional research entities shall serve as ex officio

15 nonvoting members of the Advisory Subcommit16 tee (except that any of such Directors may des17 ignate an official of the institute involved to

18 serve as such member of the Subcommittee in

19 lieu of the Director).

20 ‘‘(3) CHAIRPERSON.—The Director of the Of21 fice shall serve as the chairperson of the Advisory

22 Subcommittee.

23 ‘‘(4) DUTIES.—The Advisory Subcommittee

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

2 appropriate research activities to be

3 undertaken by the national research institutes

4 with respect to—

5 ‘‘(i) research on minority health;

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

8 responses to pharmacological drugs;

9 ‘‘(iii) research on racial and ethnic

10 differences in d isease etiology, course, and

11 treatment; and

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

14 approach;

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

16 on such research;

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

20 out research described in subparagraph (A));

21 and

22 ‘‘(D) assist in monitoring compliance with

23 section 492B regarding the inclusion of minori24 ties in clinical research.

25 ‘‘(5) BIENNIAL REPORT.—
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1 ‘‘(A) PREPARATION.—The Advisory Sub2 committee shall prepare a biennial report de3 scribing the activities of the Subcommittee, in4 cluding findings made by the Subcommittee re5 garding—

6 ‘‘(i) compliance with section 492B;

7 ‘‘(ii) the extent of expenditures made

8 for research on minority health by the

9 agencies of the National Institutes of

10 Health; and

11 ‘‘(iii) the level of funding needed for

12 such research.

13 ‘‘(B) SUBMISSION.—The report required in

14 subparagraph (A) shall be submitted to the Di15 rector of the National Institutes of Health for

16 inclusion in the report required in section 403.

17 ‘‘(f) REPRESENTATIVES OF MINORITIES AMONG RE18 SEARCHERS.—The Secretary, acting through the Assist19 ant Secretary for Personnel Administration and in collabo20 ration with the Director of the Office, shall determine the

21 extent to which minorities are represented among senior

22 physicians and scientists employed by the national re23 search institutes and among physicians and scientists em24 ployed by and conducting research with funds provided by

25 such institutes, and as appropriate, carry out activities to
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1 increase the extent of such representation and the number

2 of minorities receiving doctorates in the biomedical

3 sciences, including targeting minorities at all points in the

4 education pipeline to increase minority participation in

5 general in biomedical research.

6 ‘‘(g) DEFINITIONS.—For purposes of this part:

7 ‘‘(1) MINORITY HEALTH CONDITIONS.—The

8 term ‘minority health conditions’, with respect to in9 dividuals who are members of minority groups,

10 means all diseases, disorders, and conditions (includ11 ing with respect to mental health and substance

12 abuse)—

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

14 prevalent in such individuals;

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

16 or types of medical intervention are different

17 for such individuals, or for which it is unknown

18 whether such factors or types are different for

19 such individuals; or

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

21 insufficient research involving such individuals

22 as subjects or insufficient data on such individ23 uals.

24 ‘‘(2) RESEARCH ON MINORITY HEALTH.—The

25 term ‘research on minority health’ means research
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1 on minority health conditions, including research on

2 preventing such conditions.

3 ‘‘(3) MINORITY GROUPS.—The term ‘minority

4 groups’ means Blacks, American Indians, Alaskan

5 Natives, Asian/Pacific Islanders, and Hispanics.’’.

6 SEC. 402. NATIONAL CENTER FOR HEALTH STATISTICS.

7 (a) IN GENERAL.—Section 306 (42 U.S.C. 242k) is

8 amended—

9 (1) in subsection (c), by striking ‘‘Committee on

10 Human Resources’’ and inserting ‘‘Committee on

11 Labor and Human Resources’’;

12 (2) in subsection (g), by striking ‘‘data which

13 shall be published’’ and all that follows and inserting

14 ‘‘data.’’;

15 (3) in subsection (k)(2)—

16 (A) in subparagraph (A)—

17 (i) by striking the subparagraph des18 ignation; and

19 (ii) by striking ‘‘Except as provided in

20 subparagraph (B), members’’ and inserting

21 ‘‘Members’’; and

22 (B) by striking subparagraph (B);

23 (4) in subsection (l)—

24 (A) by striking paragraph (3);
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1 (B) by redesignating paragraph (4) as

2 paragraph (3); and

3 (C) in paragraph (3) (as so redesignated),

4 by striking ‘‘paragraphs (1), (2), and (3),’’ and

5 inserting ‘‘paragraphs (1) and (2),’’; and

6 (5) in subsection (o)—

7 (A) in paragraph (1), by striking ‘‘1991

8 through 1993’’ and inserting ‘‘1994 through

9 1997’’; and

10 (B) in paragraph (2), by striking

11 ‘‘$5,000,000’’ and all that follows through

12 ‘‘1993’’ and inserting ‘‘such sums as may be

13 necessary for each of the fiscal years 1994

14 through 1997’’.

15 (b) GENERAL AUTHORITY RESPECTING RESEARCH,

16 EVALUATIONS, AND DEMONSTRATIONS.—Section 304 (42

17 U.S.C. 242b) is amended by striking subsection (d).

18 (c) GENERAL PROVISIONS RESPECTING EFFECTIVE19 NESS, EFFICIENCY, AND QUALITY OF HEALTH SERV20 ICES.—Section 308 (42 U.S.C. 242m) is amended—

21 (1) in subsection (a)—

22 (A) in paragraph (1)—

23 (i) by striking subparagraph (A); and
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1 (ii) by redesignating subparagraphs

2 (B) through (E) as subparagraphs (A)

3 through (D), respectively; and

4 (B) in paragraph (2), by striking ‘‘reports

5 required by subparagraphs’’ and all that follows

6 through ‘‘Center’’ and inserting the following:

7 ‘‘reports required in paragraph (1) shall be pre8 pared through the National Center’’;

9 (2)(A) by striking subsection (c);

10 (B) by transferring paragraph (2) of subsection

11 (g) from the current location of the paragraph;

12 (C) by redesignating such paragraph as sub13 section (c);

14 (D) by inserting subsection (c) (as so redesig15 nated) after subsection (b); and

16 (E) by striking the remainder of subsection (g);

17 (3) in subsection (c) (as so redesignated)—

18 (A) by striking ‘‘shall (A) take’’ and in19 serting ‘‘shall take’’; and

20 (B) by striking ‘‘and (B) publish’’ and in21 serting ‘‘and shall publish’’;

22 (4) in subsection (f), by striking ‘‘sections

23 3648’’ and all that follows and inserting ‘‘section

24 3324 of title 31, United States Code, and section

25 3709 of the Revised Statutes (41 U.S.C. 5).’’; and
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1 (5) by striking subsection (h).

2 SEC. 403. ACTIVITIES OF AGENCY FOR HEALTH CARE POL3 ICY AND RESEARCH.

4 Section 902(b) (42 U.S.C. 299a(b)) is amended to

5 read as follows:

6 ‘‘(b) REQUIREMENTS WITH RESPECT TO CERTAIN

7 POPULATIONS.—In carrying out subsection (a), the Ad8 ministrator shall undertake and support research, dem9 onstration projects, and evaluations with respect to the

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

11 ‘‘(1) racial and ethnic minority groups residing

12 in medically underserved urban or rural areas (in13 cluding frontier areas); and

14 ‘‘(2) low-income groups, including the elderly,

15 women, and children with low incomes.’’.

16 TITLE V—MISCELLANEOUS

17 SEC. 501. MEDICALLY UNDERSERVED AREA STUDY.

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

19 Human Services shall conduct a study concerning the fea20 sibility and desirability of, and the criteria to be used for,

21 combining the designations of ‘‘health professional short22 age area’’ and ‘‘medically underserved area’’ into a single

23 health professional shortage area designation.

24 (b) REQUIREMENTS.—As part of the study conducted

25 under subsection (a), the Secretary of Health and Human
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1 Services, in considering the statutory and regulatory re2 quirements necessary for the creation of a single health

3 professional shortage area designation, shall—

4 (1) review and report on the application of cur5 rent statutory and regulatory criteria used—

6 (A) in designating an area as a health pro7 fessional shortage area;

8 (B) in designating an area as a medically

9 underserved area; and

10 (C) by a State in the determination of the

11 health professional shortage area designations

12 of such State; and

13 (2) review the suggestions of public health and

14 primary care experts.

15 (c) REPORT.—Not later than 1 year after the date

16 of enactment of this Act, the Secretary of Health and

17 Human Services shall prepare and submit to the appro18 priate committees of Congress a report concerning the

19 findings of the study conducted under subsection (a) to20 gether with the recommendations of the Secretary.

21 (d) RECOMMENDATIONS.—In making recommenda22 tions under subsection (c), the Secretary of Health and

23 Human Services shall give special consideration to (and

24 describe in the report) the unique impact of designation
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1 criteria on different rural and urban populations, and eth2 nic and racial minorities, including—

3 (1) rational service areas, and their application

4 to frontier areas and inner-city communities;

5 (2) indicators of high medical need, including

6 fertility rates, infant mortality rates, pediatric popu7 lation, elderly population, poverty rates, and physi8 cian to population ratios; and

9 (3) indicators of insufficient service capacity,

10 including language proficiency criteria for ethnic

11 populations, annual patient visits per physician,

12 waiting times for appointments, waiting times in a

13 primary care physician office, excessive use of emer14 gency facilities, low annual office visit rate, and de15 mand on physicians in contiguous rural or urban

16 areas.

17 SEC. 502. FEDERAL AND STATE OFFICES REGARDING

18 URBAN HEALTH.

19 (a) FEDERAL OFFICE OF URBAN HEALTH POLICY.—

20 Title XVII, as amended by section 103 of this Act, is

21 amended by adding at the end the following section:

22 ‘‘SEC. 1711. OFFICE OF URBAN HEALTH POLICY.

23 ‘‘(a) IN GENERAL.—There is established in the De24 partment of Health and Human Services an office to be

25 known as the Office of Urban Health Policy (in this sec-
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1 tion referred to as the ‘Office’). The Office shall be headed

2 by a director, who shall be appointed by the Secretary.

3 The Secretary shall carry out this section acting through

4 the Director of the Office.

5 ‘‘(b) ADVICE REGARDING PROGRAMS POLICIES AND

6 CHANGES.—With respect to current policies on and pro7 posed statutory, regulatory, administrative, and budgetary

8 changes in Federal health programs, the Director of the

9 Office shall advise the Secretary on the effects of such

10 policies and changes on the ability of underserved urban

11 areas to attract and retain physicians and other health

12 professionals, and access to (and the quality of) health

13 care in such areas.

14 ‘‘(c) CLEARINGHOUSE.—The Director of the Office

15 shall, with respect to underserved urban areas, establish

16 and maintain a clearinghouse for collecting and dissemi17 nating information on—

18 ‘‘(1) health care issues relating to such areas;

19 ‘‘(2) research findings relating to the health

20 care needs of such areas; and

21 ‘‘(3) innovative approaches to the delivery of

22 health care in such areas.

23 ‘‘(d) OTHER DUTIES.—The Director of the Office

24 shall—
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1 ‘‘(1) coordinate activities within the Depart2 ment of Health and Human Services that relate to

3 health care for residents of underserved urban areas;

4 and

5 ‘‘(2) provide information to the Secretary and

6 others in such Department with respect to the activi7 ties of other Federal departments and agencies that

8 relate to health care for such residents (including ac9 tivities relating to mental health, infant mortality,

10 occupational safety, and the promotion of preventive

11 health services).’’.

12 (b) STATE OFFICES OF URBAN HEALTH.—Subpart

13 III of part D of title III (42 U.S.C. 254 et seq.) is amend14 ed by adding at the end the following section:

15 ‘‘SEC. 338M. GRANTS TO STATES FOR OPERATION OF OF16 FICES OF URBAN HEALTH.

17 ‘‘(a) IN GENERAL.—The Secretary, acting through

18 the Director of the Office of Urban Health Policy, may

19 make grants to States for the purpose of improving health

20 care in underserved urban areas through the operation of

21 State offices of urban health.

22 ‘‘(b) REQUIREMENT OF MATCHING FUNDS.—

23 ‘‘(1) IN GENERAL.—With respect to the costs to

24 be incurred by a State in carrying out the purpose

25 described in subsection (a), the Secretary may not
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1 make a grant under such subsection unless the State

2 agrees to provide non-Federal contributions toward

3 such costs in an amount equal to—

4 ‘‘(A) for the first fiscal year of payments

5 under the grant, not less than $1 for each $3

6 of Federal funds provided in the grant;

7 ‘‘(B) for any second fiscal year of such

8 payments, not less than $1 for each $1 of Fed9 eral funds provided in the grant; and

10 ‘‘(C) for any third fiscal year of such pay11 ments, not less than $3 for each $1 of Federal

12 funds provided in the grant.

13 ‘‘(2) DETERMINATION OF AMOUNT OF NON14 FEDERAL CONTRIBUTION.—

15 ‘‘(A) Subject to subparagraph (B), non16 Federal contributions required in paragraph (1)

17 may be in cash or in kind, fairly evaluated, in18 cluding plant, equipment, or services. Amounts

19 provided by the Federal Government, or serv20 ices assisted or subsidized to any significant ex21 tent by the Federal Government, may not be in22 cluded in determining the amount of such non23 Federal contributions.
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1 ‘‘(B) The Secretary may not make a grant

2 under subsection (a) unless the State involved

3 agrees that—

4 ‘‘(i) for the first fiscal year of pay5 ments under the grant, 100 percent or less

6 of the non-Federal contributions required

7 in paragraph (1) will be provided in the

8 form of in-kind contributions;

9 ‘‘(ii) for any second fiscal year of such

10 payments, not more than 50 percent of

11 such non-Federal contributions will be pro12 vided in the form of in-kind contributions;

13 and

14 ‘‘(iii) for any third fiscal year of such

15 payments, such non-Federal contributions

16 will be provided solely in the form of cash.

17 ‘‘(c) CERTAIN REQUIRED ACTIVITIES.—The Sec18 retary may not make a grant under subsection (a) unless

19 the State involved agrees that activities carried out by an

20 office operated pursuant to such subsection will, with re21 spect to underserved urban areas, include—

22 ‘‘(1) establishing and maintaining within the

23 State a clearinghouse for collecting and disseminat24 ing information on—
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1 ‘‘(A) health care issues relating to such

2 areas;

3 ‘‘(B) research findings relating to the

4 health care needs of such areas; and

5 ‘‘(C) innovative approaches to the delivery

6 of health care in such areas;

7 ‘‘(2) coordinating the activities carried out in

8 the State that relate to the health care needs in such

9 areas, including providing coordination for the pur10 pose of avoiding redundancy in such activities; and

11 ‘‘(3) identifying Federal and State programs re12 lating to the health care needs of residents of such

13 areas, and providing technical assistance to public

14 and nonprofit private entities regarding participation

15 in such programs.

16 ‘‘(d) REQUIREMENT REGARDING ANNUAL BUDGET

17 FOR OFFICE.—The Secretary may not make a grant

18 under subsection (a) unless the State involved agrees that,

19 for any fiscal year for which the State receives such a

20 grant, the office operated pursuant to subsection (a) will

21 be provided with an annual budget of not less than

22 $75,000.

23 ‘‘(e) CERTAIN USES OF FUNDS.—
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1 ‘‘(1) RESTRICTIONS.—The Secretary may not

2 make a grant under subsection (a) unless the State

3 involved agrees that—

4 ‘‘(A) if research with respect to the health

5 of residents of underserved urban areas is con6 ducted pursuant to the grant, not more than 10

7 percent of the grant will be expended for such

8 research; and

9 ‘‘(B) the grant will not be expended—

10 ‘‘(i) to provide health care (including

11 providing cash payments regarding such

12 care);

13 ‘‘(ii) to conduct activities for which

14 Federal funds are expended—

15 ‘‘(I) within the State to provide

16 technical and other nonfinancial as17 sistance under subsection (f) of sec18 tion 330;

19 ‘‘(II) under a memorandum of

20 agreement entered into with the State

21 under subsection (h) of such section;

22 or

23 ‘‘(III) under a grant under sec24 tion 338I;
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1 ‘‘(iii) to purchase medical equipment,

2 to purchase ambulances, aircraft, or other

3 vehicles, or to purchase major communica4 tions equipment;

5 ‘‘(iv) to purchase or improve real

6 property; or

7 ‘‘(v) to carry out any activity regard8 ing a certificate of need.

9 ‘‘(2) AUTHORITIES.—Activities for which a

10 State may expend a grant under subsection (a) in11 clude—

12 ‘‘(A) paying the costs of establishing an of13 fice of urban health for purposes of subsection

14 (a);

15 ‘‘(B) subject to paragraph (1)(B)(ii)(III),

16 paying the costs of any activity carried out with

17 respect to recruiting and retaining health pro18 fessionals to serve in underserved urban areas

19 of the State; and

20 ‘‘(C) providing grants and contracts to

21 public and nonprofit private entities to carry

22 out activities authorized in this section.

23 ‘‘(f) REPORTS.—The Secretary may not make a

24 grant under subsection (a) unless the State involved

25 agrees—
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1 ‘‘(1) to submit to the Secretary reports contain2 ing such information as the Secretary may require

3 regarding activities carried out under this section by

4 the State; and

5 ‘‘(2) to submit such a report not later than

6 January 10 of each fiscal year immediately following

7 any fiscal year for which the State has received such

8 a grant.

9 ‘‘(g) REQUIREMENT OF APPLICATION.—The Sec10 retary may not make a grant under subsection (a) unless

11 an application for the grant is submitted to the Secretary

12 and the application is in such form, is made in such man13 ner, and contains such agreements, assurances, and infor14 mation as the Secretary determines to be necessary to

15 carry out such subsection.

16 ‘‘(h) NONCOMPLIANCE.—The Secretary may not

17 make payments under subsection (a) to a State for any

18 fiscal year subsequent to the first fiscal year of such pay19 ments unless the Secretary determines that, for the imme20 diately preceding fiscal year, the State has complied with

21 each of the agreements made by the State under this

22 section.

23 ‘‘(i) DEFINITIONS.—For purposes of this section, the

24 term ‘State’ means each of the several States.

25 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—
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1 ‘‘(1) IN GENERAL.—For the purpose of making

2 grants under subsection (a), there are authorized to

3 be appropriated $3,000,000 for fiscal year 1994,

4 $4,000,000 for fiscal year 1995, and $3,000,000 for

5 fiscal year 1996.

6 ‘‘(2) AVAILABILITY.—Amounts appropriated

7 under paragraph (1) shall remain available until ex8 pended.

9 ‘‘(k) TERMINATION OF PROGRAM.—No grant may be

10 made under this section after the aggregate amounts ap11 propriated under subsection (j)(1) are equal to

12 $10,000,000.’’.

13 SEC. 503. GRANTS AND CONTRACTS REGARDING ORGAN

14 AND BONE MARROW TRANSPLANTATION

15 WITH RESPECT TO MINORITY POPULATIONS.

16 (a) TRANSPLANTATION OF ORGANS.—Section 371(a)

17 (42 U.S.C. 273(a)) is amended—

18 (1) by striking paragraphs (2) and (3); and

19 (2) by inserting after paragraph (1) the follow20 ing paragraph:

21 ‘‘(2)(A) The Secretary may make grants to, and enter

22 into contracts with, qualified organ procurement organiza23 tions described in subsection (b) and other public or non24 profit private entities for the purpose of—
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1 ‘‘(i) planning and conducting programs to pro2 vide information and education to the public on the

3 need for organ and tissues donations, with priority

4 given to such information and education for mem5 bers of racial and ethnic minority groups; and

6 ‘‘(ii) training individuals in requesting such do7 nations.

8 ‘‘(B) In making awards of grants and contracts

9 under subparagraph (A), the Secretary shall give priority

10 to carrying out the purpose described in such subpara11 graph with respect to minority populations. For purposes

12 of complying with the preceding sentence, the Secretary

13 shall reserve not less than 50 percent of the amounts ap14 propriated for such grants and contracts for a fiscal year.

15 ‘‘(C) In making awards of grants and contracts under

16 subparagraph (A), the Secretary shall give preference to

17 community-based organizations.’’.

18 (b) TRANSPLANTATION OF BONE MARROW.—Part I

19 of title III (42 U.S.C. 274k et seq.) is amended by insert20 ing after section 379A the following section:

21 ‘‘INFORMATION, EDUCATION, AND TRAINING

22 ‘‘SEC. 379B. (a) IN GENERAL.—The Secretary may

23 make grants to, and enter into contracts with, public or

24 nonprofit private entities for the purpose of—

25 ‘‘(1) planning and conducting programs to pro26 vide information and education to the public on the
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1 need for donations of bone marrow, with priority

2 given to such information and education for mem3 bers of racial and ethnic minority groups; and

4 ‘‘(2) training individuals in requesting such do5 nations.

6 ‘‘(b) PRIORITIES REGARDING CERTAIN ACTIVI7 TIES.—In making awards of grants and contracts under

8 subsection (a), the Secretary shall give priority to carrying

9 out the purpose described in such subsection with respect

10 to minority populations. For purposes of complying with

11 the preceding sentence, the Secretary shall reserve not less

12 than 50 percent of the amounts appropriated for such

13 grants and contracts for a fiscal year.

14 ‘‘(c) PREFERENCES REGARDING CERTAIN APPLI15 CANTS.—In making awards of grants and contracts under

16 subsection (a), the Secretary shall give preference to com17 munity-based organizations.’’.

18 SEC. 504. DEMONSTRATION PROJECT GRANTS TO STATES

19 FOR ALZHEIMER’S DISEASE.

20 Section 398(a) (42 U.S.C. 280c–3(a)) is amended—

21 (1) in the matter preceding paragraph (1), by

22 striking ‘‘not less than 5, and not more than 15,’’;

23 (2) in paragraph (2)—
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1 (A) by inserting after ‘‘disorders’’ the fol2 lowing: ‘‘who are living in single family homes

3 or in congregate settings’’; and

4 (B) by striking ‘‘and’’ at the end;

5 (3) by redesignating paragraph (3) as para6 graph (4); and

7 (4) by inserting after paragraph (2) the follow8 ing:

9 ‘‘(3) to improve access for individuals with Alz10 heimer’s disease or related disorders, particularly

11 such individuals from ethnic, cultural, or language

12 minorities and such individuals who are living in iso13 lated rural areas, to services that are home-based or

14 community-based long-term care services; and’’.

15 SEC. 505. WAIVERS REGARDING OBLIGATED SERVICE IN

16 PRIMARY HEALTH CARE.

17 Section 795 (42 U.S.C. 295N) is amended by adding

18 at the end the following subsection:

19 ‘‘(c) INAPPLICABILITY TO CERTAIN INDIVIDUALS.—

20 Any obligation under this section regarding training or

21 practicing in primary health care is waived for individuals

22 from disadvantaged backgrounds who are under23 represented in the health professions.’’.

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