Union Calendar No. 281

103D CONGRESS

2D SESSION H. R. 3869

[Report No. 103–501]

A BILL

To amend the Public Health Service Act to revise

and for other purposes.dividuals who are members of minority groups,and extend programs relating to the health of inMAY 11, 1994

Reported with an amendment, committed to the Commitordered to be printed tee of the Whole House on the State of the Union, and
IB

Union Calendar No. 281

103D CONGRESS

2D SESSION H. R. 3869

[Report No. 103–501]

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

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

and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 11, 1994

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

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

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

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

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

Committee on Energy and Commerce

MAY 11, 1994

Additional sponsors: Mr. ORTIZ, Mr. TORRES, Mr. BECERRA, and Mr.

FOGLIETTA

MAY 11, 1994

Reported with an amendment, committed to the Committee of the Whole

House on the State of the Union, and ordered to be printed

[Strike out all after the enacting clause and insert the part printed in italic]

[For text of introduced bill, see copy of bill as introduced on February 11, 1994]

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.
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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 ‘‘Mi5 nority 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.

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

of Public Health Service.

TITLE II—PRIMARY HEALTH SERVICES

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

Sec. 202. Health services for the homeless.

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

Sec. 204. Grants to States for loan repayment programs regarding obligated service of health professionals.

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

Sec. 206. Demonstration grants to States for community scholarship programs regarding obligated service of health professionals.

Sec. 207. Programs regarding birth defects.

Sec. 208. Healthy start for infants.

Sec. 209. Demonstration projects regarding diabetic-retinopathy.

TITLE III—HEALTH PROFESSIONS PROGRAMS

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

Sec. 302. Scholarships generally; certain other purposes.

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

Sec. 304. Centers of Excellence.

Sec. 305. Educational assistance regarding undergraduates.

Sec. 306. Student loans regarding schools of nursing.

Sec. 307. Federally-supported student loans funds.

TITLE IV—RESEARCH

Sec. 401. Office of Research on Minority Health.

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

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

TITLE V—NATIVE HAWAIIAN HEALTH CARE

Sec. 501. Clarification of 1992 amendments.
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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—WOMEN’S HEALTH

Sec. 601. Establishment of Office of Women’s Health.

Sec. 602. Women’s scientific employment regarding National Institutes of Health.

Sec. 603. Information and education regarding female genital mutilation.

Sec. 604. Study regarding curricula of medical schools and women’s health conditions.

TITLE VII—TRAUMATIC BRAIN INJURY

Sec. 701. Programs of Centers for Disease Control and Prevention.

Sec. 702. Programs of National Institutes of Health.

Sec. 703. Programs of Health Resources and Services Administration.

Sec. 704. Study; consensus conference.

TITLE VIII—MISCELLANEOUS PROVISIONS

Sec. 801. Technical amendment to Indian Health Care Improvement Act.

Sec. 802. Health services for Pacific Islanders.

Sec. 803. Technical corrections regarding Public Law 103–183.

Sec. 804. Certain authorities of Centers for Disease Control and Prevention.

Sec. 805. Establishment of public health analytical laboratory.

Sec. 806. Administration of certain requirements.

Sec. 807. Revisions to eligibility requirements for entities subject to drug pricing

limitations.

TITLE IX—GENERAL PROVISIONS

Sec. 901. Effective date.

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 sub7 section (b) and all that follows and inserting the following:

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

9 of minority groups, the Secretary shall carry out the follow10 ing:
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1 ‘‘(1) In consultation with the advisory council

2 under subsection (c), establish goals and objectives re3 garding disease prevention, health promotion, service

4 delivery, and research, and coordinate all activities

5 within the Department of Health and Human Serv6 ices that relate to such goals and objectives.

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

8 into interagency agreements with other agencies of the

9 Service, and under such agreements provide amounts

10 to such agencies, to carry out the following:

11 ‘‘(A) Support research, demonstrations and

12 evaluations to test new and innovative models of

13 delivering services.

14 ‘‘(B) Increase knowledge and understanding

15 of health risk factors.

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

17 Health Statistics collects data on the health sta18 tus of each minority group.

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

20 proficiency in speaking the English language,

21 enter into contracts with public and nonprofit

22 private providers of primary health services for

23 the purpose of increasing the access of the indi24 viduals to such services by developing and carry-
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1 ing out programs to provide bilingual or inter2 pretive services.

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

4 the following:

5 ‘‘(A) Facilitate the exchange of information

6 regarding matters relating to health information

7 and health promotion, preventive health services,

8 and education in the appropriate use of health

9 care.

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

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

12 problems relating to such matters.

13 ‘‘(D) Provide technical assistance with re14 spect to the exchange of such information (in15 cluding facilitating the development of materials

16 for such technical assistance).

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

18 purpose of carrying out programs to improve access

19 to health care services for individuals who lack pro20 ficiency in speaking the English language by develop21 ing and carrying out programs to provide bilingual

22 or interpretive services.

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

24 that—
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1 ‘‘(i) the center under such subparagraph

2 conducts research, develops and evaluates model

3 projects, and provides technical assistance to

4 health care providers; and

5 ‘‘(ii) such center is not operated by the en6 tity that operates the center established under

7 paragraph (3).

8 ‘‘(c) ADVISORY COMMITTEE.—

9 ‘‘(1) IN GENERAL.—The Secretary shall establish

10 an advisory committee to be known as the Advisory

11 Committee on Minority Health (in this subsection re12 ferred to as the ‘Committee’).

13 ‘‘(2) DUTIES.—The Committee shall provide ad14 vice to the Secretary on carrying out this section, in15 cluding advice on carrying out paragraphs (1) and

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

17 ‘‘(3) COMPOSITION.—

18 ‘‘(A) The Committee shall be composed of 12

19 voting members appointed in accordance with

20 subparagraph (B) and the nonvoting, ex officio

21 members designated under subparagraph (C).

22 ‘‘(B) The voting members of the Committee

23 shall be appointed from among individuals who

24 have expertise regarding the health status of mi25 nority groups and the access of such groups to
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1 health services, which individuals are not officers

2 or employees of the Federal Government. The ap3 pointed membership of the Committee shall be

4 broadly representative of the various minority

5 groups.

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

7 officio members of the Committee the heads of the

8 minority health offices referred to in section

9 1707A.

10 ‘‘(d) APPROPRIATE CONTEXT OF SERVICES.—The Sec11 retary shall ensure that information and services provided

12 pursuant to subsection (b) are provided in the language and

13 cultural context that is most appropriate for the individuals

14 for whom the information and services are intended.

15 ‘‘(e) EQUITABLE ALLOCATION OF SERVICES.—The Sec16 retary shall ensure that services provided under subsection

17 (b) are equitably allocated among the various minority

18 groups.

19 ‘‘(f) CONSULTATION WITH INDIVIDUAL MINORITY

20 HEALTH OFFICES.—In carrying out subsection (b) regard21 ing a specified agency, the Secretary shall consult with the

22 head of the minority health office of the agency. For pur23 poses of the preceding sentence, the terms ‘specified agency’

24 and ‘minority health office’ have the meaning given such

25 terms in section 1707A(f).
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1 ‘‘(g) BIENNIAL REPORTS.—Not later than February 1

2 of fiscal year 1996 and of each second year thereafter, the

3 Secretary shall submit to the Committee on Energy and

4 Commerce of the House of Representatives, and to the Com5 mittee on Labor and Human Resources of the Senate, a

6 report describing the activities carried out under this sec7 tion during the preceding 2 fiscal years and evaluating the

8 extent to which such activities have been effective in improv9 ing the health of minority groups. Each such report shall

10 include the biennial reports submitted to the Secretary

11 under section 1707A(e) for such years by the heads of the

12 minority health offices.

13 ‘‘(h) DEFINITION.—For purposes of this section, the

14 term ‘minority groups’ means African Americans, Amer15 ican Indians, Asian Americans, Hispanics, and Pacific Is16 landers.

17 ‘‘(i) FUNDING.—

18 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—For

19 the purpose of carrying out this section, there is au20 thorized to be appropriated $21,000,000 for each of

21 the fiscal years 1995 through 1997.

22 ‘‘(2) ALLOCATION OF FUNDS BY SECRETARY.—Of

23 the amounts appropriated under paragraph (1) for a

24 fiscal year, the Secretary shall make available not less
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1 than $3,000,000 for carrying out subsection

2 (b)(2)(D).’’.

3 (b) MISCELLANEOUS AMENDMENT.—Section 1707 of

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

5 amended in the heading for the section by striking ‘‘ESTAB6 LISHMENT OF’’.

7 SEC. 102. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MI8 NORITY HEALTH WITHIN AGENCIES OF PUB9 LIC HEALTH SERVICE.

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

11 300u et seq.) is amended by inserting after section 1707

12 the following section:

13 ‘‘INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN

14 PUBLIC HEALTH SERVICE

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

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

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

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

19 shall be appointed by the head of the agency within which

20 the Office is established, and who shall report directly to

21 the head of the agency. The head of such agency shall carry

22 out this section (as this section relates to the agency) acting

23 through such Director.

24 ‘‘(b) SPECIFIED AGENCIES.—

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

26 subsection (a) are the following:
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1 ‘‘(A) The Centers for Disease Control and

2 Prevention.

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

4 and Research.

5 ‘‘(C) The Health Resources and Services Ad6 ministration.

7 ‘‘(D) The Substance Abuse and Mental

8 Health Services Administration.

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

10 purposes of subsection (c) and the subsequent provi11 sions of this section, the term ‘minority health office’’

12 includes the Office of Research on Minority Health es13 tablished within the National Institutes of Health.

14 The Director of the National Institutes of Health shall

15 carry out this section (as this section relates to the

16 agency) acting through the Director of such Office.

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

18 shall ensure that the officers and employees of the minority

19 health office of the agency are, collectively, experienced in

20 carrying out community-based health programs for each of

21 the various minority groups that are present in significant

22 numbers in the United States. The head of such agency shall

23 ensure that, of such officers and employees who are members

24 of minority groups, no such group is disproportionately

25 represented.
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1 ‘‘(d) DUTIES.—Each Director of a minority health of2 fice shall monitor the programs of the specified agency of

3 such office in order to—

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

5 of the programs are being carried out with respect to

6 minority groups;

7 ‘‘(2) determine the extent to which members of

8 such groups are represented among the Federal offi9 cers and employees who administer the programs; and

10 ‘‘(3) make recommendations to the head of such

11 agency on carrying out the programs with respect to

12 such groups.

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

14 each specified agency shall submit to the Secretary for in15 clusion in each biennial report under section 1707(g) (with16 out change) a biennial report describing—

17 ‘‘(1) the extent to which the minority health of18 fice of the agency employs individuals who are mem19 bers of minority groups, including a specification by

20 minority group of the number of such individuals em21 ployed by such office; and

22 ‘‘(2) the manner in which the agency is comply23 ing with Public Law 94–311 (relating to data on

24 Americans of Spanish origin or descent).

25 ‘‘(f) DEFINITIONS.—For purposes of this section:
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1 ‘‘(1) The term ‘minority health office’ means an

2 office established under subsection (a), subject to sub3 section (b)(2).

4 ‘‘(2) The term ‘minority group’ has the meaning

5 given such term in section 1707(h).

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

7 ‘‘(A) an agency specified in subsection

8 (b)(1); and

9 ‘‘(B) the National Institutes of Health.

10 ‘‘(g) FUNDING.—

11 ‘‘(1) ALLOCATIONS.—Of the amounts appro12 priated for a specified agency for a fiscal year, the

13 Secretary may reserve not more than 0.5 percent for

14 the purpose of carrying out activities under this sec15 tion through the minority health office of the agency.

16 In reserving an amount under the preceding sentence

17 for a minority health office for a fiscal year, the Sec18 retary shall reduce, by substantially the same percent19 age, the amount that otherwise would be available for

20 each of the programs of the designated agency in21 volved.

22 ‘‘(2) AVAILABILITY OF FUNDS FOR STAFFING.—

23 The purposes for which amounts made available

24 under paragraph (1) may be expended by a minority
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1 health office include the costs of employing staff for

2 such office.’’.

3 TITLE II—PRIMARY HEALTH

4 SERVICES

5 SEC. 201. MIGRANT HEALTH CENTERS; COMMUNITY

6 HEALTH CENTERS.

7 (a) MIGRANT HEALTH CENTERS.—

8 (1) TREATMENT OF PREGNANT WOMEN FOR SUB9 STANCE ABUSE.—Section 329(a) of the Public Health

10 Service Act (42 U.S.C. 254b(a)) is amended—

11 (A) in paragraph (1)(C)—

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

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

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

15 and

16 (iii) by adding at the end the following

17 clause:

18 ‘‘(ii) to the State official responsible for carrying

19 out programs under subpart II of part B of title XIX,

20 and in accordance with the provisions of section 543

21 regarding the disclosure of information, a notification

22 if a pregnant woman is provided a referral for the

23 treatment of substance abuse but the entity involved

24 does not have the capacity to admit additional indi25 viduals for treatment,’’; and
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1 (B) in paragraph (7)—

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

3 ‘‘and’’ at the end;

4 (ii) by redesignating subparagraph

5 (M) as subparagraph (N); and

6 (iii) by inserting after subparagraph

7 (L) the following subparagraph:

8 ‘‘(M) treatment of pregnant women for substance

9 abuse; and’’.

10 (2) OVERLAP IN CATCHMENT AREAS.—Section

11 329(a) of the Public Health Service Act (42 U.S.C.

12 254b(a)) is amended by adding at the end the follow13 ing paragraph:

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

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

16 operation of more than one migrant health center in a

17 catchment area in any case in which the Secretary deter18 mines that in such area there are workers or other individ19 uals described in subsection (a)(1) (in the matter after and

20 below subparagraph (H)) who otherwise will have a short21 age of personal health services. The preceding sentence may

22 not be construed as requiring that, in such a case, the

23 catchment areas of the centers involved be identical.’’.

24 (3) OFFSITE ACTIVITIES.—Section 329(a) of the

25 Public Health Service Act, as amended by paragraph
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1 (2) of this subsection, is amended by adding at the

2 end the following paragraph:

3 ‘‘(9) In making grants under this section, the Sec4 retary may, to the extent determined by the Secretary to

5 be appropriate, authorize migrant health centers to provide

6 services at locations other than the center.’’.

7 (4) AMOUNT OF GRANT; USE OF CERTAIN

8 FUNDS.—Section 329(d)(4) of the Public Health Serv9 ice Act (42 U.S.C. 254b(d)(4)) is amended to read as

10 follows:

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

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

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

14 the period for which the grant is made)—

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

16 expected to incur in carrying out the plan approved

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

18 and

19 ‘‘(ii) the amounts that the center may reasonably

20 be expected to receive as State, local, and other oper21 ational funding (exclusive of amounts to be provided

22 in the grant under this section) and as fees, pre23 miums, and third-party reimbursements.

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

25 restrict the purposes for which a migrant health center ex-
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1 pends the amounts described in subparagraph (A)(ii) (in2 cluding restrictions imposed pursuant to Federal cost prin3 ciples).

4 ‘‘(ii) The Secretary may require that amounts de5 scribed in subparagraph (A)(ii) be expended for purposes

6 that are consistent with the purposes specified in this sec7 tion.

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

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

10 in such installments as the Secretary finds necessary. Ad11 justments in such payments may be made for overpayments

12 or underpayments, subject to clause (ii).

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

14 paragraph (1) to a migrant health center, the sum of the

15 amount of the grant and the amounts described in subpara16 graph (A)(ii) that the center actually received exceeded the

17 costs of the center in carrying out the plan approved by

18 the Secretary pursuant to subsection (f)(3)(H), then the cen19 ter is entitled to retain such excess amount if the center

20 agrees to expend such amount only for the following pur21 poses:

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

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

24 ‘‘(III) To acquire, modernize, or expand facili25 ties, or to construct facilities.
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1 ‘‘(IV) To improve the administration of service

2 programs.

3 ‘‘(V) To establish financial reserves.

4 ‘‘(D) With respect to funds that are amounts described

5 in subparagraph (A)(ii) or excess amounts described in sub6 paragraph (C)(ii), this paragraph may not be construed as

7 limiting the authority of the Secretary to require the sub8 mission of such plans, budgets, and other information as

9 may be necessary to ensure that the funds are expended in

10 accordance with subparagraph (B)(ii), or clauses (I)

11 through (V) of subparagraph (C)(ii), respectively.’’.

12 (5) AUTHORIZATION OF APPROPRIATIONS.—Sec13 tion 329(h) of the Public Health Service Act (42

14 U.S.C. 254b(h)) is amended—

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

16 ‘‘1994’’ and inserting ‘‘1998’’; and

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

18 ‘‘1994’’ and inserting ‘‘1998’’.

19 (b) COMMUNITY HEALTH CENTERS.—

20 (1) TREATMENT OF PREGNANT WOMEN FOR SUB21 STANCE ABUSE.—Section 330 of the Public Health

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

23 (A) in subsection (a)(3)—

24 (i) by inserting ‘‘(A)’’ after ‘‘(3)’’;
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1 (ii) in subparagraph (A) (as so des2 ignated), by adding ‘‘and’’ after the comma

3 at the end; and

4 (iii) by adding at the end the following

5 subparagraph:

6 ‘‘(B) to the State official responsible for carrying

7 out programs under subpart II of part B of title XIX,

8 and in accordance with the provisions of section 543

9 regarding the disclosure of information, a notification

10 if a pregnant woman is provided a referral for the

11 treatment of substance abuse but the entity involved

12 does not have the capacity to admit additional indi13 viduals for treatment,’’; and

14 (B) in subsection (b)(2)—

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

16 ‘‘and’’ at the end;

17 (ii) by redesignating subparagraph

18 (M) as subparagraph (N); and

19 (iii) by inserting after subparagraph

20 (L) the following subparagraph:

21 ‘‘(M) treatment of pregnant women for substance

22 abuse; and’’.

23 (2) OVERLAP IN CATCHMENT AREAS.—Section

24 330(b) of the Public Health Service Act (42 U.S.C.
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1 254c(b)) is amended by adding at the end the follow2 ing paragraph:

3 ‘‘(7) 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 community health center in a

6 catchment area in any case in which the Secretary deter7 mines that there is a population group in such area that

8 otherwise will have a shortage of personal health services.

9 The preceding sentence may not be construed as requiring

10 that, in such a case, the catchment areas of the centers in11 volved be identical.’’.

12 (3) OFFSITE ACTIVITIES.—Section 330(b) of the

13 Public Health Service Act, as amended by paragraph

14 (2) of this subsection, is amended by adding at the

15 end the following paragraph:

16 ‘‘(8) In making grants under this section, the Sec17 retary may, to the extent determined by the Secretary to

18 be appropriate, authorize community health centers to pro19 vide services at locations other than the center.’’.

20 (4) AMOUNT OF GRANT; USE OF CERTAIN

21 FUNDS.—Section 330(d)(4) of the Public Health Serv22 ice Act (42 U.S.C. 254c(d)(4)) is amended to read as

23 follows:

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

25 or under subsection (c) for a community health center shall
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1 be determined by the Secretary, taking into account (for

2 the period for which the grant is made)—

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

4 expected to incur in carrying out the plan approved

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

6 and

7 ‘‘(ii) the amounts that the center may reasonably

8 be expected to receive as State, local, and other oper9 ational funding (exclusive of amounts to be provided

10 in the grant under this section) and as fees, pre11 miums, and third-party reimbursements.

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

13 restrict the purposes for which a community health center

14 expends the amounts described in subparagraph (A)(ii) (in15 cluding restrictions imposed pursuant to Federal cost prin16 ciples).

17 ‘‘(ii) The Secretary may require that amounts de18 scribed in subparagraph (A)(ii) be expended for purposes

19 that are consistent with the purposes specified in this sec20 tion.

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

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

23 in such installments as the Secretary finds necessary. Ad24 justments in such payments may be made for overpayments

25 or underpayments, subject to clause (ii).
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1 ‘‘(ii) If, for the period for which a grant is made under

2 paragraph (1) to a community health center, the sum of

3 the amount of the grant and the amounts described in sub4 paragraph (A)(ii) that the center actually received exceeded

5 the costs of the center in carrying out the plan approved

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

7 center is entitled to retain such excess amount if the center

8 agrees to expend such amount only for the following pur9 poses:

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

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

12 ‘‘(III) To acquire, modernize, or expand facili13 ties, or to construct facilities.

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

15 programs.

16 ‘‘(V) To establish financial reserves.

17 ‘‘(D) With respect to funds that are amounts described

18 in subparagraph (A)(ii) or excess amounts described in sub19 paragraph (C)(ii), this paragraph may not be construed as

20 limiting the authority of the Secretary to require the sub21 mission of such plans, budgets, and other information as

22 may be necessary to ensure that the funds are expended in

23 accordance with subparagraph (B)(ii), or clauses (I)

24 through (V) of subparagraph (C)(ii), respectively.’’.
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1 (5) AUTHORIZATION OF APPROPRIATIONS.—Sec2 tion 330(g) of the Public Health Service Act (42

3 U.S.C. 254c(g)) is amended—

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

5 ‘‘1994’’ and inserting ‘‘1998’’; and

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

7 ‘‘1994’’ and inserting ‘‘1998’’.

8 SEC. 202. HEALTH SERVICES FOR THE HOMELESS.

9 Section 340(q)(1) of the Public Health Service Act (42

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

11 inserting ‘‘through 1998’’.

12 SEC. 203. HEALTH SERVICES FOR RESIDENTS OF PUBLIC

13 HOUSING.

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

15 (42 U.S.C. 256a(p)(1)) is amended by striking ‘‘and 1993’’

16 and inserting ‘‘through 1998’’.

17 SEC. 204. GRANTS TO STATES FOR LOAN REPAYMENT PRO18 GRAMS REGARDING OBLIGATED SERVICE OF

19 HEALTH PROFESSIONALS.

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

21 U.S.C. 254q–1(c)) is amended by adding at the end the fol22 lowing paragraph:

23 ‘‘(4) PRIVATE PRACTICE.—

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

25 with a grant under subsection (a), a State may
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1 waive the requirement of paragraph (1) regard2 ing the assignment of a health professional if,

3 subject to subparagraph (B), the health profes4 sional enters into an agreement with the State to

5 provide primary health services in a full-time

6 private clinical practice in a health professional

7 shortage area.

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

9 under subsection (a) unless the State involved

10 agrees that, if the State provides a waiver under

11 subparagraph (A) for a health professional, sec12 tion 338D(b)(1) will apply to the agreement

13 under such subparagraph between the State and

14 the health professional to the same extent and in

15 the same manner as such section applies to an

16 agreement between the Secretary and a health

17 professional regarding a full-time private clini18 cal practice.’’.

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

20 OFFICES OF RURAL HEALTH.

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

22 U.S.C. 254r) is amended—

23 (1) in subsection (b)(1), in the matter preceding

24 subparagraph (A), by striking ‘‘in cash’’; and

25 (2) in subsection (j)(1)—
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1 (A) by striking ‘‘and’’ after ‘‘1992,’’; and

2 (B) by inserting before the period the follow3 ing: ‘‘, and such sums as may be necessary for

4 each of the fiscal years 1995 through 1997’’.

5 SEC. 206. DEMONSTRATION GRANTS TO STATES FOR COM6 MUNITY SCHOLARSHIP PROGRAMS REGARD7 ING OBLIGATED SERVICE OF HEALTH PRO8 FESSIONALS.

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

10 U.S.C. 254t) is amended—

11 (1) by striking ‘‘health manpower shortage’’ each

12 place such term appears and inserting ‘‘health profes13 sional shortage’’;

14 (2) in subsection (e)—

15 (A) by striking paragraph (1);

16 (B) by redesignating paragraphs (2)

17 through (6) as paragraphs (1) through (5), re18 spectively; and

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

20 by inserting after ‘‘the individual’’ the following:

21 ‘‘who is to receive the scholarship under the con22 tract’’;

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

24 medicine, pediatrics,’’ and inserting ‘‘general internal

25 medicine, general pediatrics,’’; and
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1 (4) in subsection (l)(1)—

2 (A) by striking ‘‘and’’ after ‘‘1992,’’; and

3 (B) by inserting before the period the follow4 ing: ‘‘, and such sums as may be necessary for

5 each of the fiscal years 1995 through 1997’’.

6 SEC. 207. PROGRAMS REGARDING BIRTH DEFECTS.

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

8 U.S.C. 247b–4) is amended to read as follows:

9 ‘‘PROGRAMS REGARDING BIRTH DEFECTS

10 ‘‘SEC. 317C. (a) The Secretary, acting through the Di11 rector of the Centers for Disease Control and Prevention,

12 shall carry out programs—

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

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

16 causes of such defects and on the incidence and preva17 lence of such defects;

18 ‘‘(2) to support primary birth-defect prevention,

19 including information and education to the public on

20 the prevention of such defects;

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

22 clinical skills of health professionals with respect to

23 the prevention of such defects;

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

25 prevention of such defects; and
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1 ‘‘(5) to operate regional centers for the conduct

2 of applied epidemiological research on the prevention

3 of such defects.

4 ‘‘(b) ADDITIONAL PROVISIONS REGARDING COLLEC5 TION OF DATA.—

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

7 (a)(1), the Secretary—

8 ‘‘(A) shall collect and analyze data by gen9 der and by racial and ethnic group, including

10 Hispanics, non-Hispanic whites, African Ameri11 cans, Native Americans, Asian Americans, and

12 Pacific Islanders;

13 ‘‘(B) shall collect data under subparagraph

14 (A) from birth certificates, death certificates, hos15 pital records, and such other sources as the Sec16 retary determines to be appropriate; and

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

18 improve programs for the collection and analysis

19 of epidemiological data on birth defects, and to

20 make the data available.

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

22 out subsection (a)(1), the Secretary shall establish and

23 maintain a National Information Clearinghouse on

24 Birth Defects to collect and disseminate to health pro-
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1 fessionals and the general public information on birth

2 defects, including the prevention of such defects.

3 ‘‘(c) GRANTS AND CONTRACTS.—

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

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

6 contracts with public and nonprofit private entities.

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

8 AWARD FUNDS.—

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

10 award of a grant or contract under paragraph

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

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

13 for the purpose of aiding the recipient in carry14 ing out the purposes for which the award is

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

16 recipient any officer or employee of the Depart17 ment of Health and Human Services.

18 ‘‘(B) With respect to a request described in

19 subparagraph (A), the Secretary shall reduce the

20 amount of payments under the award involved

21 by an amount equal to the costs of detailing per22 sonnel and the fair market value of any supplies,

23 equipment, or services provided by the Secretary.

24 The Secretary shall, for the payment of expenses
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1 incurred in complying with such request, expend

2 the amounts withheld.

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

4 may make an award of a grant or contract under

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

6 is submitted to the Secretary and the application is

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

8 such agreements, assurances, and information as the

9 Secretary determines to be necessary to carry out the

10 purposes for which the award is to be made.

11 ‘‘(d) BIENNIAL REPORT.—Not later than February 1

12 of fiscal year 1995 and of every second such year thereafter,

13 the Secretary shall submit to the Committee on Energy and

14 Commerce of the House of Representatives, and the Commit15 tee on Labor and Human Resources of the Senate, a report

16 that, with respect to the preceding 2 fiscal years—

17 ‘‘(1) contains information regarding the inci18 dence and prevalence of birth defects and the extent

19 to which birth defects have contributed to the inci20 dence and prevalence of infant mortality;

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

22 that is specific to various racial and ethnic groups

23 (including Hispanics, non-Hispanic whites, African

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

2 which various approaches of preventing birth defects

3 have been effective;

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

5 this section; and

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

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

9 purpose of carrying out this section, there are authorized

10 to be appropriated such sums as may be necessary for each

11 of the fiscal years 1995 through 1997.’’.

12 SEC. 208. HEALTHY START FOR INFANTS.

13 (a) TECHNICAL CORRECTION REGARDING AMEND14 ATORY INSTRUCTIONS.—Part D of title III of the Public

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

16 by section 104 of Public Law 103–183 (107 Stat. 2230),

17 is amended in the heading for subpart VIII by striking

18 ‘‘Bulk’’ and all that follows and inserting the following:

19 ‘‘Miscellaneous Provisions Regarding Primary Health

20 Care’’. The amendment made by the preceding sentence is

21 deemed to have taken effect immediately after the enactment

22 of Public Law 103–183.

23 (b) HEALTHY START FOR INFANTS.—Part D of title

24 III of the Public Health Service Act, as amended by sub-
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1 section (a) of this section, is amended by adding at the end

2 of subpart VIII the following section:

3 ‘‘HEALTHY START FOR INFANTS

4 ‘‘SEC. 340E. (a) GRANTS FOR COMPREHENSIVE SERV5 ICES.—

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

7 grants for the operation of not more than 19 dem8 onstration projects to provide the services described in

9 subsection (b) for the purpose of reducing, in the geo10 graphic areas in which the projects are carried out—

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

12 morbidity;

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

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

15 ‘‘(D) the incidence of fetal alcohol syn16 drome; and

17 ‘‘(E) the incidence of low-birthweight births.

18 ‘‘(2) ACHIEVEMENT OF YEAR 2000 HEALTH STA19 TUS OBJECTIVES.—With respect to the objectives es20 tablished by the Secretary for the health status of the

21 population of the United States for the year 2000, the

22 Secretary shall, in providing for a demonstration

23 project under paragraph (1) in a geographic area,

24 seek to meet the objectives that are applicable to the

25 purpose described in such paragraph and the popu26 lations served by the project.
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1 ‘‘(b) AUTHORIZED SERVICES.—

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

3 services referred to in this subsection are comprehen4 sive services (including preventive and primary

5 health services for pregnant women and infants and

6 childhood immunizations in accordance with the

7 schedule recommended by the Secretary) for carrying

8 out the purpose described in subsection (a), including

9 services other than health services.

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

11 make a grant under subsection (a) only if the appli12 cant involved agrees that, in making any arrange13 ments under which other entities provide authorized

14 services in the demonstration project involved, the ap15 plicant will include among the entities with which the

16 arrangements are made grantees under any of sec17 tions 329, 330, 340, and 340A, if such grantees are

18 providing services in the service area of such project

19 and the grantees are willing to make such arrange20 ments with the applicant.

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

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

23 ‘‘(1) the applicant for the grant specifies the geo24 graphic area in which the demonstration project

25 under such subsection is to be carried out and agrees
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1 that the project will not be carried out in other areas;

2 and

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

4 year for which the applicant is to receive such a

5 grant, the rate of infant mortality in the geographic

6 area equals or exceeds 150 percent of the national av7 erage in the United States of such rates.

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

9 ‘‘(1) PUBLIC OR NONPROFIT PRIVATE ENTI10 TIES.—The Secretary may make a grant under sub11 section (a) only if the applicant for the grant is a

12 State or local department of health, or other public or

13 nonprofit private entity, or a consortium of public or

14 nonprofit private entities.

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

16 With respect to a proposed demonstration project

17 under subsection (a), the Secretary may make a grant

18 under such subsection only if—

19 ‘‘(A) the chief executive officer of each polit20 ical subdivision in the service area of such

21 project approves the applicant for the grant as

22 being qualified to carry out the project; and

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

24 tribal organization with jurisdiction over any

25 portion of such area so approves the applicant.
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1 ‘‘(3) STATUS AS MEDICAID PROVIDER.—

2 ‘‘(A) In the case of any service described in

3 subsection (b) that is available pursuant to the

4 State plan approved under title XIX of the So5 cial Security Act for a State in which a dem6 onstration project under subsection (a) is carried

7 out, the Secretary may make a grant under such

8 subsection for the project only if, subject to sub9 paragraph (B)—

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

11 provide the service directly, and the appli12 cant has entered into a participation agree13 ment under the State plan and is qualified

14 to receive payments under such plan; or

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

16 agreement with a public or private entity

17 under which the entity will provide the

18 service, and the entity has entered into such

19 a participation agreement under the State

20 plan and is qualified to receive such pay21 ments.

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

23 agreement pursuant to subparagraph (A)(ii) re24 garding the provision of services, the requirement

25 established in such subparagraph regarding a
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1 participation agreement shall be waived by the

2 Secretary if the entity does not, in providing

3 health care services, impose a charge or accept

4 reimbursement available from any third-party

5 payor, including reimbursement under any in6 surance policy or under any Federal or State

7 health benefits plan.

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

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

10 the criteria for a waiver under such clause shall

11 be made without regard to whether the entity ac12 cepts voluntary donations regarding the provi13 sion of services to the public.

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

15 a proposed demonstration project under subsection (a), the

16 Secretary may make a grant under such subsection to the

17 applicant involved only if—

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

19 which the project is to be carried out approves the

20 proposal of the applicant for carrying out the project;

21 and

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

23 organization with jurisdiction over any portion of the

24 service area of the project so approves the proposal.
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1 ‘‘(f) ELIGIBILITY FOR SERVICES PROVIDED WITH

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

3 subsection (a) only if the applicant involved agrees as fol4 lows:

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

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

7 State involved is required or has elected to provide

8 under title XIX of the Social Security Act, the grant

9 will not be expended to provide the service to any in10 dividual to whom the State is required or has elected

11 under such title to provide the service.

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

13 payment for any item or service to the extent that

14 payment has been made, or can reasonably be ex15 pected to be made, with respect to such item or serv16 ice—

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

18 plan (including a group health plan or a pre19 paid health plan);

20 ‘‘(B) under any Federal or State health ben21 efits program, including any program under

22 title V, XVIII, or XIX of the Social Security Act;

23 or

24 ‘‘(C) under subpart II of part B of title XIX

25 of this Act.
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1 ‘‘(g) MAINTENANCE OF EFFORT.—

2 ‘‘(1) GRANTEE.—With respect to authorized serv3 ices under subsection (b), the Secretary may make a

4 grant under subsection (a) only if the applicant in5 volved agrees to maintain expenditures of non-Federal

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

7 than the level of such expenditures maintained by the

8 applicant for fiscal year 1991.

9 ‘‘(2) RELEVANT POLITICAL SUBDIVISIONS.—With

10 respect to authorized services under subsection (b), the

11 Secretary may make a grant under subsection (a)

12 only if each political subdivision in the service area

13 of the demonstration project involved agrees to main14 tain expenditures of non-Federal amounts for such

15 services at a level that is not less than the level of

16 such expenditures maintained by the political sub17 division for fiscal year 1991.

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

19 ‘‘(1) IN GENERAL.—Except as provided in para20 graph (3), the Secretary may make a grant under

21 subsection (a) only if the applicant involved agrees

22 that the grant will not be expended—

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

24 with respect to residential treatment for sub-
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1 stance abuse provided in settings other than hos2 pitals;

3 ‘‘(B) to make cash payments to intended re4 cipients of health services or mental health serv5 ices; or

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

7 (other than minor remodeling of existing im8 provements to real property) or to purchase

9 major medical equipment (other than mobile

10 medical units for providing ambulatory prenatal

11 services).

12 ‘‘(2) ADMINISTRATIVE EXPENSES; DATA COLLEC13 TION.—The Secretary may make a grant under sub14 section (a) only if the applicant involved agrees that

15 not more than an aggregate 10 percent of the grant

16 will be expended for administering the grant and the

17 collection and analysis of data.

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

19 purpose described in subsection (a) cannot otherwise

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

21 otherwise qualified applicant, waive the restriction es22 tablished in paragraph (1)(C).

23 ‘‘(i) DETERMINATION OF CAUSE OF INFANT

24 DEATHS.—The Secretary may make a grant under sub25 section (a) only if the applicant involved—
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1 ‘‘(1) agrees to provide for a determination of the

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

3 demonstration project involved; and

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

5 with public entities as may be necessary to carry out

6 paragraph (1).

7 ‘‘(j) ANNUAL REPORTS TO SECRETARY.—The Sec8 retary may make a grant under subsection (a) only if the

9 applicant involved agrees that, for each fiscal year for

10 which the applicant operates a demonstration project under

11 such subsection the applicant will, not later than April 1

12 of the subsequent fiscal year, submit to the Secretary a re13 port providing the following information with respect to the

14 project:

15 ‘‘(1) The number of individuals that received au16 thorized services, and the demographic characteristics

17 of the population of such individuals.

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

19 including the types of ambulatory prenatal services

20 provided and the trimester of the pregnancy in which

21 the services were provided.

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

23 services provided.

24 ‘‘(4) The extent to which children under age 2 re25 ceiving authorized services have received the appro-
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1 priate number and variety of immunizations against

2 vaccine-preventable diseases.

3 ‘‘(5) An analysis of the causes of death deter4 mined under subsection (i).

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

6 meeting the health status objectives specified in sub7 section (a)(2).

8 ‘‘(7) The extent to which, in the service area in9 volved, progress is being made toward meeting the

10 participation goals established for the State by the

11 Secretary under section 1905(r) of the Social Security

12 Act (relating to early periodic screening, diagnostic,

13 and treatment services for children under the age of

14 21).

15 ‘‘(k) COMMUNITY PARTICIPATION.—The Secretary may

16 make a grant under subsection (a) only if the applicant

17 involved agrees that, in preparing the proposal of the appli18 cant for the demonstration project involved, and in the op19 eration of the project, the applicant will consult with the

20 residents of the service area for the project and with public

21 and nonprofit private entities that provide authorized serv22 ices to such residents.

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

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

25 for the grant is submitted to the Secretary and the applica-
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1 tion is in such form, is made in such manner, and contains

2 such agreements, assurances, and information as the Sec3 retary determines to be necessary to carry out this sub4 section.

5 ‘‘(m) REPORT TO CONGRESS.—Not later than Feb6 ruary 1, 1998, the Secretary shall submit to the Committee

7 on Energy and Commerce of the House of Representatives,

8 and the Committee on Labor and Human Resources of the

9 Senate, a report—

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

11 Secretary under subsection (j);

12 ‘‘(2) describing the extent to which the Secretary

13 has, in the service areas of such projects, been success14 ful in meeting the health status objectives specified in

15 subsection (a)(2); and

16 ‘‘(3) describing the extent to which demonstra17 tion projects under subsection (a) have been cost effec18 tive.

19 ‘‘(n) LIMITATION ON CERTAIN EXPENSES OF SEC20 RETARY.—Of the amounts appropriated under subsection

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

22 than an aggregate 5 percent for the administrative costs

23 of the Secretary in carrying out this section, for the provi24 sion of technical assistance regarding demonstration
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1 projects under subsection (a), and for evaluations of such

2 projects.

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

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

5 services specified in subsection (b).

6 ‘‘(2) The terms ‘Indian tribe’ and ‘tribal organi7 zation’ have the meaning given such terms in section

8 4(b) and section 4(c) of the Indian Self-Determina9 tion and Education Assistance Act.

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

11 demonstration project under subsection (a), means the

12 geographic area specified in subsection (c).

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

14 purpose of carrying out this section, there are authorized

15 to be appropriated such sums as may be necessary for each

16 of the fiscal years 1995 through 1997.

17 ‘‘(q) SUNSET.—Effective October 1, 1997, this section

18 is repealed.’’.

19 (b) CERTAIN PROVISIONS REGARDING REPORTS.—

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

21 under section 340E of the Public Health Service Act

22 (as added by subsection (b) of this section), the Sec23 retary of Health and Human Services may make a

24 grant under such section for fiscal year 1995 only if

25 the applicant for the grant agrees to submit to the
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1 Secretary, not later than April 1 of such year, a re2 port on any federally-supported project of the appli3 cant that is substantially similar to the demonstra4 tion projects authorized in such section 340E, which

5 report provides, to the extent practicable, the informa6 tion described in subsection (j) of such section.

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

8 for fiscal year 1997 under section 340E of the Public

9 Health Service Act (as added by subsection (b) of this

10 section), the requirement under subsection (j) of such

11 section that a report be submitted not later than

12 April 1, 1998, remains in effect notwithstanding the

13 repeal of such section pursuant to subsection (q) of

14 such section.

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

16 unexpended portions of amounts appropriated for grants

17 under 340E of the Public Health Service Act (as added by

18 subsection (b) of this section) are unavailable for obligation

19 or expenditure, without regard to whether the amounts have

20 been received by the grantees involved.

21 (d) USE OF GENERAL AUTHORITY UNDER PUBLIC

22 HEALTH SERVICE ACT.—With respect to the program es23 tablished in section 340E of the Public Health Service Act

24 (as added by subsection (b) of this section), section 301 of

25 such Act may not be construed as providing to the Secretary
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1 of Health and Human Services any authority to carry out,

2 during any fiscal year in which such program is in oper3 ation, any demonstration project to provide any of the serv4 ices specified in subsection (b) of such section 340E.

5 SEC. 209. DEMONSTRATION PROJECTS REGARDING DIA6 BETIC-RETINOPATHY.

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

8 Human Services, acting through the Director of the Centers

9 for Disease Control and Prevention and in consultation

10 with the Director of the National Eye Institute, may make

11 grants to public and nonprofit private entities for dem12 onstration projects to serve the populations specified in sub13 section (b) by carrying out, with respect to the eye disorder

14 known as diabetic retinopathy, activities regarding infor15 mation, identification, dissemination, education, and pre16 vention.

17 (b) RELEVANT POPULATIONS.—The populations re18 ferred to in subsection (a) are minority populations that

19 are at significant risk of contracting diabetes mellitus.

20 (c) AUTHORIZATION OF APPROPRIATIONS.—For the

21 purpose of carrying out this section, there is authorized to

22 be appropriated $1,000,000 for each of the fiscal years 1995

23 through 1997.
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1 TITLE III—HEALTH

2 PROFESSIONS PROGRAMS

3 SEC. 301. PRIMARY CARE SCHOLARSHIPS FOR STUDENTS

4 FROM DISADVANTAGED BACKGROUNDS.

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

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

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

8 FROM DISADVANTAGED BACKGROUNDS.

9 ‘‘(a) IN GENERAL.—The Secretary may in accordance

10 with this section award scholarships to individuals de11 scribed in subsection (b) for the purpose of assisting the in12 dividuals with the costs of attending schools of medicine or

13 osteopathic medicine, schools of dentistry, schools of nursing

14 (as defined in section 853), graduate programs in mental

15 health practice, and programs for the training of physician

16 assistants.

17 ‘‘(b) ELIGIBLE INDIVIDUALS.—An individual referred

18 to in subsection (a) is any individual meeting the following

19 conditions:

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

21 background.

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

23 enrollment) at an eligible school as a full-time student

24 in a program leading to a degree in a health profes25 sion.
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1 ‘‘(3) The individual enters into the contract re2 quired pursuant to subsection (d) as a condition of

3 receiving the scholarship (relating to an agreement to

4 provide primary health services in a health profes5 sional shortage area designated under section 332).

6 ‘‘(c) PREFERENCES REGARDING AWARDS; SPECIAL

7 CONSIDERATION.—In awarding scholarships under sub8 section (a), the Secretary shall—

9 ‘‘(1) give preference to eligible individuals for

10 whom the costs of attending the school involved would

11 constitute a severe financial hardship; and

12 ‘‘(2) give special consideration to eligible indi13 viduals who received scholarships pursuant to this

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

15 year 1993 or 1994 and are seeking scholarships for

16 attendance at eligible schools that received a grant

17 under any of such sections for any of such fiscal

18 years.

19 ‘‘(d) APPLICABILITY OF CERTAIN PROVISIONS.—Ex20 cept as inconsistent with this section, the provisions of sub21 part III of part D of title III apply to an award of a schol22 arship under subsection (a) to the same extent and in the

23 same manner as such provisions apply to an award of a

24 scholarship under section 338A. This section shall be car25 ried out by the bureau that administers such subpart III.
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1 ‘‘(e) DEFINITIONS.—For purposes of this section:

2 ‘‘(1) The term ‘eligible individual’ means an in3 dividual described in subsection (b).

4 ‘‘(2) The term ‘eligible school’ means a school or

5 program specified in subsection (a).

6 ‘‘(f) FUNDING.—

7 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—For

8 the purpose of carrying out this section, there are au9 thorized to be appropriated $28,000,000 for fiscal

10 year 1995, $38,000,000 for fiscal year 1996, and

11 $48,000,000 for fiscal year 1997. Such authorization

12 is in addition to the authorization of appropriations

13 established in section 740(e).

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

15 amounts appropriated for a fiscal year under para16 graph (1), the Secretary shall make available—

17 ‘‘(A) 20 percent for scholarships under sub18 section (a) for attendance at schools of nursing;

19 and

20 ‘‘(B) 15 percent for scholarships under such

21 subsection for attendance at graduate programs

22 in mental health practice.’’.

23 (b) CERTAIN PROGRAMS OF OBLIGATED SERVICE.—

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

25 Service Act (42 U.S.C. 295n) is repealed.
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1 (2) RULE OF CONSTRUCTION.—Paragraph (1)

2 does not terminate agreements that, on the day before

3 the effective date under section 901, are in effect pur4 suant to section 795 of the Public Health Service Act.

5 Such agreements continue in effect in accordance with

6 the terms of the agreements. With respect to compli7 ance with such agreements, any period of practice as

8 a provider of primary health services (whether pro9 vided pursuant to other agreements with the Federal

10 Government or whether provided otherwise) counts to11 ward satisfaction of the requirement of practice pur12 suant to such section 795.

13 SEC. 302. SCHOLARSHIPS GENERALLY; CERTAIN OTHER

14 PURPOSES.

15 (a) RELEVANT HEALTH PROFESSIONS SCHOOLS.—

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

17 U.S.C. 293a(a)(3)) is amended—

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

19 through ‘‘dentistry,’’; and

20 (2) by striking ‘‘allied health,’’ and all that fol21 lows and inserting ‘‘allied health.’’.

22 (b) ELIGIBLE INDIVIDUALS.—

23 (1) IN GENERAL.—Section 737(a)(2) of the Pub24 lic Health Service Act (42 U.S.C. 293a(a)(2)) is

25 amended to read as follows:
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1 ‘‘(2) ELIGIBLE INDIVIDUALS.—An individual re2 ferred to in paragraph (1) is any individual meeting

3 the following conditions:

4 ‘‘(A) The individual is from a disadvan5 taged background.

6 ‘‘(B) The individual is enrolled (or accepted

7 for enrollment) as a full-time student in a health

8 professions school specified in paragraph (3).

9 ‘‘(C) The individual enters into the contract

10 required pursuant to subsection (e) as a condi11 tion of receiving the scholarship under para12 graph (1) (relating to an agreement to provide

13 services).’’.

14 (2) CERTAIN REQUIREMENT.—Section 737 of the

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

16 amended—

17 (A) in subsection (a)(1), by striking ‘‘sub18 section (e)’’ and inserting ‘‘subsection (f)’’;

19 (B) by redesignating subsections (e) through

20 (h) as subsections (f) through (i), respectively;

21 and

22 (C) by inserting after subsection (d) the fol23 lowing subsection:

24 ‘‘(e) APPLICABILITY OF CERTAIN PROVISIONS.—
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1 ‘‘(1) IN GENERAL.—Except as inconsistent with

2 this section, and subject to paragraph (2), the provi3 sions of subpart III of part D of title III apply to

4 an award of a scholarship under subsection (a) to the

5 same extent and in the same manner as such provi6 sions apply to an award of a scholarship under sec7 tion 338A. This section shall be carried out by the bu8 reau that administers such subpart III.

9 ‘‘(2) CERTAIN INDIVIDUALS.—

10 ‘‘(A) In the case of an individual who re11 ceives a scholarship under subsection (a) for at12 tendance at a school of veterinary medicine, the

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

14 contract under which the individual agrees that,

15 after completing training in such medicine, the

16 individual will, in accordance with requirements

17 established under subparagraph (B), conduct or

18 assist in the conduct of research regarding

19 human health or safety. Except as inconsistent

20 with this section, the provisions specified in

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

22 such a scholarship to the same extent and in the

23 same manner as such provisions apply to an

24 award of a scholarship under section 338A.
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1 ‘‘(B) The Secretary shall establish require2 ments regarding contracts under subparagraph

3 (A).’’.

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

5 Service Act, as redesignated by subsection (b)(2) of this sec6 tion, is amended—

7 (1) in paragraph (1), by inserting before the pe8 riod the following: ‘‘, and $6,000,000 for each of the

9 fiscal years 1994 through 1997’’; and

10 (2) in paragraph (2)(A), by striking ‘‘30 per11 cent’’ and all that follows and inserting the following:

12 ‘‘50 percent for such grants to schools of allied health;

13 and’’.

14 SEC. 303. LOAN REPAYMENTS AND FELLOWSHIPS REGARD15 ING FACULTY POSITIONS.

16 (a) LOAN REPAYMENTS.—Section 738(a) of the Public

17 Health Service Act (42 U.S.C. 293b(a)) is amended—

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

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

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

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

22 amending subparagraph (B) to read as follows:

23 ‘‘(B) the contract referred to in subpara24 graph (A) provides that the school, in making a

25 determination of the amount of compensation to
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1 be provided by the school to the individual for

2 serving as a member of the faculty, will make the

3 determination without regard to the amount of

4 payments made (or to be made) to the individual

5 by the Federal Government under paragraph

6 (1).’’.

7 (b) AUTHORIZATION OF APPROPRIATIONS REGARDING

8 LOAN REPAYMENTS AND FELLOWSHIPS.—Section 738(c) of

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

10 amended by striking ‘‘there is’’ and all that follows and in11 serting the following: ‘‘there is authorized to be appro12 priated $1,000,000 for each of the fiscal years 1995 through

13 1997.’’.

14 SEC. 304. CENTERS OF EXCELLENCE.

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

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

17 (1) by striking ‘‘health professions schools’’ each

18 place such term appears and inserting ‘‘designated

19 health professions schools’’; and

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

21 place such term appears and inserting ‘‘designated

22 health professions school’’.

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

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

25 by subsection (a), is amended—
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1 (1) by striking paragraph (2);

2 (2) by redesignating paragraph (1) as para3 graph (2);

4 (3) by inserting before paragraph (2) (as so re5 designated) the following paragraph:

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

7 private entities to carry out community-based pro8 grams to recruit students of secondary schools and in9 stitutions of higher education and to prepare the stu10 dents academically for pursuing a career in the

11 health professions;’’;

12 (4) in paragraph (5)—

13 (A) by striking ‘‘faculty and student re14 search’’ and inserting ‘‘student research’’; and

15 (B) by inserting before the period the follow16 ing: ‘‘, including research on issues relating to

17 the delivery of health care’’; and

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

19 the semicolon at the end;

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

21 the end and inserting ‘‘; and’’; and

22 (C) by adding at the end the following para23 graph:

24 ‘‘(6) to carry out a program to train students of

25 the school in providing health services through train-
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1 ing provided at community-based health facilities

2 that provide such services to a significant number of

3 disadvantaged individuals and that are located at a

4 site remote from the main site of the teaching facili5 ties of the school.’’.

6 (c) REQUIREMENTS REGARDING CONSORTIA.—

7 (1) IN GENERAL.—Section 739(c)(1) of the Pub8 lic Health Service Act (42 U.S.C. 293c(c)(1)), as

9 amended by subsection (a), is amended—

10 (A) in subparagraph (A), in the matter pre11 ceding clause (i), by striking ‘‘specified in sub12 paragraph (B)’’ and inserting ‘‘specified in sub13 paragraphs (B) and (C)’’;

14 (B) by redesignating subparagraph (C) as

15 subparagraph (D); and

16 (C) by inserting after subparagraph (B) the

17 following subparagraph:

18 ‘‘(C) The condition specified in this sub19 paragraph is that, in accordance with subsection

20 (e)(1), the designated health professions school

21 involved has with other health profession schools

22 (designated or otherwise) formed a consortium to

23 carry out the purposes described in subsection

24 (b) at the schools of the consortium. The grant

25 involved may be expended with respect to the
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1 other schools without regard to whether such

2 schools meet the conditions specified in subpara3 graph (B).’’.

4 (2) CERTAIN REQUIREMENTS.—Section 739(e) of

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

6 amended by subsection (a), is amended to read as fol7 lows:

8 ‘‘(e) PROVISIONS REGARDING CONSORTIA.—

9 ‘‘(1) REQUIREMENTS.—For purposes of sub10 section (c)(1)(C), a consortium of schools has been

11 formed in accordance with this subsection if—

12 ‘‘(A) the consortium consists of—

13 ‘‘(i) the designated health professions

14 school seeking the grant under subsection

15 (a); and

16 ‘‘(ii) 1 or more schools of medicine, os17 teopathic medicine, dentistry, pharmacy,

18 nursing, allied health, or public health, or

19 graduate programs in mental health prac20 tice;

21 ‘‘(B) the schools of the consortium have en22 tered into an agreement for the allocation of such

23 grant among the schools; and

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

25 grant in accordance with this section.
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1 ‘‘(2) AUTHORITY REGARDING NATIVE AMERICANS

2 CENTERS OF EXCELLENCE.—With respect to meeting

3 the conditions specified in subsection (c)(4), the Sec4 retary may make a grant under subsection (a) to a

5 designated health professions school that does not meet

6 such conditions if—

7 ‘‘(A) the school has formed a consortium in

8 accordance with paragraph (1); and

9 ‘‘(B) the schools of the consortium collec10 tively meet such conditions, without regard to

11 whether the schools individually meet such condi12 tions.’’.

13 (3) CONFORMING AMENDMENTS.—Section 739 of

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

15 amended by subsection (a), is amended—

16 (A) in subsection (b), in the matter preced17 ing paragraph (1), by inserting ‘‘, subject to sub18 section (c)(1)(C),’’ after ‘‘agrees’’; and

19 (B) in subsection (d)—

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

21 and inserting ‘‘(e)(2)’’; and

22 (ii) by adding at the end the following

23 paragraph:

24 ‘‘(4) RULE OF CONSTRUCTION.—Except as pro25 vided in paragraph (3) regarding a consortium under
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1 subsection (e)(2), a health professions school that does

2 not meet the conditions specified in subsection

3 (c)(1)(B) may not be designated as a center of excel4 lence for purposes of this section. The preceding sen5 tence applies without regard to whether a grant under

6 subsection (a) is, pursuant to subsection (c)(1)(C),

7 being expended with respect to the school.’’.

8 (d) DEFINITION OF HEALTH PROFESSIONS SCHOOL.—

9 (1) GRADUATE PROGRAMS IN MENTAL HEALTH

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

11 Service Act (42 U.S.C. 293c(h)(1)(A)), as amended by

12 subsection (a), is amended by—

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

14 (B) by inserting before the period the follow15 ing: ‘‘, or a graduate program in mental health

16 practice’’.

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

18 through 1997, the Secretary of Health and Human

19 Services may not make more than one grant under

20 section 739 of the Public Health Service Act directly

21 to a graduate program in mental health practice (as

22 defined in section 799 of such Act).

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

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

25 (a), is amended to read as follows:
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1 ‘‘(i) FUNDING.—

2 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—For

3 the purpose of making grants under subsection (a),

4 there are authorized to be appropriated $28,000,000

5 for fiscal year 1995, $30,000,000 for fiscal year 1996,

6 and $32,000,000 for fiscal year 1997.

7 ‘‘(2) ALLOCATIONS BY SECRETARY.—

8 ‘‘(A) Of the amounts appropriated under

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

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

11 under subsection (a) to health professions schools

12 that are eligible for such grants pursuant to

13 meeting the conditions described in paragraph

14 (2)(A) of subsection (c).

15 ‘‘(B) Of the amounts appropriated under

16 paragraph (1) for a fiscal year and available

17 after compliance with subparagraph (A), the

18 Secretary shall make available 65 percent for

19 grants under subsection (a) to health professions

20 schools that are eligible for such grants pursuant

21 to meeting the conditions described in paragraph

22 (3) or (4) of subsection (c) (including meeting

23 conditions pursuant to subsection (e)(2)).

24 ‘‘(C)(i) Of the amounts appropriated under

25 paragraph (1) for a fiscal year and available
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1 after compliance with subparagraph (A), the

2 Secretary shall make available 35 percent for

3 grants under subsection (a) to health professions

4 schools that are eligible for such grants pursuant

5 to meeting the conditions described in paragraph

6 (5) of subsection (c).

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

8 under subsection (a) that includes amounts

9 available under subparagraph (A) may not in10 clude amounts available under clause (i) unless

11 each of the following conditions is met:

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

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

14 included in grants made pursuant to sub15 section (c)(3), the aggregate number of such

16 grants is not less than such aggregate num17 ber for the preceding fiscal year, and one or

18 more of such grants is made in an amount

19 that is not less than the lowest amount

20 among grants made from amounts available

21 under subparagraph (A).

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

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

24 included in grants made pursuant to sub25 section (c)(4), the aggregate number of such
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1 grants is not less than such aggregate num2 ber for the preceding fiscal year, and one or

3 more of such grants is made in an amount

4 that is not less than the lowest amount

5 among grants made from amounts available

6 under subparagraph (A).

7 ‘‘(III) In the case of amounts available

8 under clause (i) and included in grants

9 made pursuant to subsection (c)(5) (exclu10 sive of grants that include amounts avail11 able under subparagraph (A) or (B)), the

12 aggregate number of such grants is not less

13 than such aggregate number for the preced14 ing fiscal year, and one or more of such

15 grants is made in an amount that is not

16 less than the lowest amount among grants

17 made from amounts available under sub18 paragraph (A).

19 ‘‘(IV) The aggregate amount of grants

20 under subsection (a) made from amounts

21 available under subparagraph (B) and

22 clause (i) (other than grants that include

23 amounts available under subparagraph (A))

24 is, in the case of fiscal year 1995, not less

25 than the sum of such aggregate amount for
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1 fiscal year 1994 and the total amount by

2 which grants are required under subclauses

3 (I) through (III) to be increased; and is, in

4 the case of fiscal year 1996 and each subse5 quent fiscal year, not less than such aggre6 gate amount for the preceding fiscal year.’’.

7 (f) CONFORMING AMENDMENTS.—Section 739(c) of the

8 Public Health Service Act (42 U.S.C. 293c(c)), as amended

9 by subsection (a), is amended—

10 (1) in paragraph (3)(B), by striking ‘‘the des11 ignated health professions school’’ and inserting ‘‘the

12 school’’; and

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

14 (B) and (C), by striking ‘‘the designated health pro15 fessions school’’ and inserting ‘‘the school’’.

16 (g) TRANSITIONAL AND SAVINGS PROVISIONS.—

17 (1) IN GENERAL.—In the case of any entity re18 ceiving a grant under section 739 of the Public

19 Health Service Act for fiscal year 1994, the Secretary

20 of Health and Human Services shall, during the pe21 riod specified in paragraph (2), waive any or all of

22 the additional requirements established pursuant to

23 this section for the receipt or expenditure of such a

24 grant, subject to the entity providing assurances satis-
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1 factory to the Secretary that the entity is making

2 progress toward meeting such requirements.

3 (2) RELEVANT PERIOD.—In the case of any en4 tity receiving a grant under section 739 of the Public

5 Health Service Act for fiscal year 1994, the period re6 ferred to in paragraph (1) is the period that, in first

7 approving the grant, the Secretary specified as the

8 duration of the grant.

9 SEC. 305. EDUCATIONAL ASSISTANCE REGARDING UNDER10 GRADUATES.

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

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

13 ‘‘SEC. 740. ASSISTANCE REGARDING HEALTH PROFESSIONS

14 AS CAREER CHOICE.

15 ‘‘(a) IN GENERAL.—

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

17 Subject to the provisions of this section, the Secretary

18 may make grants and enter into contracts for pur19 poses of—

20 ‘‘(A) identifying individuals who—

21 ‘‘(i) are students of elementary schools,

22 or students or graduates of secondary

23 schools or of institutions of higher edu24 cation;
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1 ‘‘(ii) are from disadvantaged back2 grounds; and

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

4 health professions; and

5 ‘‘(B) providing to such individuals aca6 demic assistance, counseling, and other services

7 to prepare the students to meet the academic re8 quirements for entry into health professions

9 schools.

10 ‘‘(2) RECIPIENTS OF GRANTS AND CONTRACTS.—

11 The Secretary may make an award of a grant or con12 tract under paragraph (1) only if the applicant for

13 the award is a nonprofit private community-based or14 ganization or other public or nonprofit private entity.

15 Such other entities include schools of medicine, osteo16 pathic medicine, public health, dentistry, veterinary

17 medicine, optometry, pharmacy, allied health, chiro18 practic, and podiatric medicine, and include grad19 uate programs in mental health practice.

20 ‘‘(3) CERTAIN USES OF AWARDS.—The purposes

21 for which the Secretary may authorize an award

22 under paragraph (1) to be expended include the fol23 lowing:

24 ‘‘(A) Assisting elementary and secondary

25 schools and institutions of higher education in
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1 developing or improving programs to prepare

2 students to meet the academic requirements for

3 entry into health professions schools.

4 ‘‘(B) Establishing arrangements with non5 profit private community-based providers of pri6 mary health services under which students are

7 provided with opportunities to visit or work at

8 facilities of such providers and gain experience

9 regarding a career in a field of primary health

10 care.

11 ‘‘(C) Developing or improving programs to

12 enhance the academic preparation of advanced,

13 prehealth professions students or

14 postbaccalaureate individuals to successfully

15 enter a health professions school.

16 ‘‘(D) In the case of an award under para17 graph (1) that the Secretary has authorized to be

18 expended for the purpose described in subpara19 graph (B) or (C), paying such stipends as the

20 Secretary may approve for individuals from dis21 advantaged backgrounds for any period of edu22 cation in student-enhancement programs (other

23 than regular courses), except that such a stipend

24 may not be provided to an individual for more

25 than 12 months, and such a stipend shall be in
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1 an amount of $25 per day (notwithstanding any

2 other provision of law regarding the amount of

3 stipends).

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

5 ‘‘(1) ASSURANCES REGARDING FINANCIAL CAPAC6 ITY.—The Secretary may make an award of a grant

7 or contract under subsection (a) only if the applicant

8 provides assurances satisfactory to the Secretary that,

9 with respect to the activities for which the award is

10 to be made, the applicant has or will have the finan11 cial capacity to continue the activities after the eligi12 bility of the applicant for such awards for such ac13 tivities is terminated pursuant to subsection (d).

14 ‘‘(2) COLLABORATION AMONG VARIOUS ENTI15 TIES.—The Secretary may make an award of a grant

16 or contract under subsection (a) only if the applicant

17 for the award has entered into an agreement with any

18 schools, institutions, community-based organizations,

19 or other entities with which the applicant will col20 laborate in carrying out activities under the award,

21 and the agreement specifies whether and to what ex22 tent the award will be allocated among the applicant

23 and the entities.

24 ‘‘(3) MATCHING FUNDS.—
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1 ‘‘(A) With respect to the costs of the activi2 ties to be carried out under subsection (a) by an

3 applicant, the Secretary may make an award of

4 a grant or contract under such subsection only

5 if the applicant agrees to make available (di6 rectly or through donations from public or pri7 vate entities), in cash, non-Federal contributions

8 toward such costs in an amount that—

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

10 which the applicant receives such a grant,

11 is not less than 20 percent of such costs;

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

13 not less than 20 percent of such costs;

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

15 is not less than 40 percent of such costs;

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

17 not less than 60 percent of such costs; and

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

19 fiscal year, is not less than 80 percent of

20 such costs.

21 ‘‘(B) Amounts provided by the Federal Gov22 ernment may not be included in determining the

23 amount of non-Federal contributions required in

24 subparagraph (A).
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1 ‘‘(C) The Secretary may not require non2 Federal contributions for the first fiscal year for

3 which an applicant receives a grant under sub4 section (a).

5 ‘‘(c) PREFERENCE IN MAKING AWARDS.—

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

7 making awards of grants and contracts under sub8 section (a), the Secretary shall give preference to any

9 applicant that has made an arrangement with 1 or

10 more elementary schools, an arrangement with 1 or

11 more secondary schools, an arrangement with 1 or

12 more institutions of higher education, an arrange13 ment with 1 or more health professions schools, and

14 an arrangement with 1 or more community-based or15 ganizations, the purpose of which arrangements is to

16 establish a program as follows:

17 ‘‘(A) With respect to the elementary schools

18 involved, the program carries out the purposes

19 described in subsection (a)(1).

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

21 paragraph (1) enters the secondary school in22 volved, the program continues to carry out such

23 purposes with respect to the student.

24 ‘‘(C) After graduating from the secondary

25 school, the student enters the institution of higher
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1 education involved, subject to meeting reasonable

2 academic requirements, and the program contin3 ues to carry out such purposes with respect to

4 the student.

5 ‘‘(D) After graduating from the institution

6 of higher education, the student enters the health

7 professions school involved, subject to meeting

8 reasonable academic requirements.

9 ‘‘(2) REQUIREMENT REGARDING SCHOOLS AND

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

11 applicant may not receive preference unless the

12 schools or institutions with which arrangements have

13 been made are schools or institutions whose enroll14 ment of students includes a significant number of in15 dividuals from disadvantaged backgrounds.

16 ‘‘(d) LIMITATION ON YEARS OF FUNDING FOR PAR17 TICULAR ACTIVITIES.—With respect to a particular activity

18 carried out under paragraph (1) or (3) of subsection (a)

19 by an entity, the Secretary may not, for the activity in20 volved, provide more than 6 years of financial assistance

21 under such subsection to the entity.

22 ‘‘(e) FUNDING.—

23 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—For

24 the purpose of carrying out this section and section

25 736, there are authorized to be appropriated
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1 $32,000,000 for fiscal year 1995, $36,000,000 for fis2 cal year 1996, and $38,000,000 for fiscal year 1997.

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

5 Secretary shall obligate not less than 20 percent for

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

7 20 percent for providing scholarships under section

8 736.’’.

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

10 case of an entity that received an award of a grant or con11 tract for fiscal year 1994 under section 740 of the Public

12 Health Service Act, the Secretary of Health and Human

13 Services may continue in effect the award in accordance

14 with the terms of the award, subject to the duration of the

15 award not exceeding the period determined by the Secretary

16 in first approving the award. The preceding sentence ap17 plies notwithstanding the amendment made by subsection

18 (a) of this section.

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

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

22 U.S.C. 297b(b)) is amended—

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

24 the end and inserting a semicolon;

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

2 at the end; and

3 (B) by inserting before the semicolon at the

4 end the following: ‘‘, and (C) such additional pe5 riods under the terms of paragraph (8) of this

6 subsection’’;

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

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

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

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

12 the Secretary, the repayment period established under

13 paragraph (2) for any student borrower who during

14 the repayment period failed to make consecutive pay15 ments and who, during the last 12 months of the re16 payment period, has made at least 12 consecutive

17 payments may be extended for a period not to exceed

18 10 years.’’.

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

20 (a) AUTHORIZATION OF APPROPRIATIONS REGARDING

21 CERTAIN MEDICAL SCHOOLS.—

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

23 VII of the Public Health Service Act (42 U.S.C. 292q

24 et seq.) is amended—
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1 (A) by transferring subsection (f) of section

2 735 from the current placement of the subsection;

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

4 section 723;

5 (C) by redesignating the subsection as sub6 section (e); and

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

8 so redesignated), by striking ‘‘1996’’ and insert9 ing ‘‘1997’’.

10 (2) CONFORMING AMENDMENTS.—Section 723 of

11 the Public Health Service Act (42 U.S.C. 292s), as

12 amended by paragraph (1) of this subsection, is

13 amended in subsection (e)(2)(A)—

14 (A) by striking ‘‘section 723(b)(2)’’ and in15 serting ‘‘subsection (b)(2)’’; and

16 (B) by striking ‘‘such section’’ and inserting

17 ‘‘such subsection’’.

18 (b) AUTHORIZATION OF APPROPRIATIONS REGARDING

19 INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.—Sec20 tion 724(f)(1) of the Public Health Service Act (42 U.S.C.

21 292t(f)(1)) is amended to read as follows:

22 ‘‘(1) IN GENERAL.—With respect to making Fed23 eral capital contributions to student loan funds for

24 purposes of subsection (a), other than the student loan

25 fund of any school of medicine or osteopathic medi-
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1 cine, there is authorized to be appropriated

2 $5,000,000 for each of the fiscal years 1995 through

3 1997.’’.

4 TITLE IV—RESEARCH

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

6 Section 404 of the Public Health Service Act (42

7 U.S.C. 283(b)) is amended by adding at the end the follow8 ing subsections:

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

10 the Office, in consultation with the advisory committee es11 tablished under subsection (d), shall develop and implement

12 a plan for carrying out the duties established in subsection

13 (b). The Director shall review the plan not less than annu14 ally, and revise the plan as appropriate.

15 ‘‘(d) ADVISORY COMMITTEE.—

16 ‘‘(1) In carrying out subsection (b), the Director

17 of the Office shall establish an advisory committee to

18 be known as the Advisory Committee on Research on

19 Minority Health (in this subsection referred to as the

20 ‘Committee’).

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

22 nonvoting, ex officio members designated in accord23 ance with subparagraph (B) and voting members ap24 pointed in accordance with subparagraph (C).
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1 ‘‘(B) The Secretary shall designate as ex officio

2 members of the Committee the Directors of each of the

3 national research institutes and the Deputy Assistant

4 Secretary for Minority Health (except that any of

5 such officials may designate another officer or em6 ployee of the office or agency involved to serve as a

7 member of the Committee in lieu of the official).

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

9 voting members of the Committee not fewer than 12

10 and not more than 18 individuals who are not offi11 cers or employees of the Federal Government. The ap12 pointments shall be made from among scientists and

13 health professionals whose clinical practice, research

14 specialization, or professional expertise includes sig15 nificant expertise in research on minority health. The

16 appointed membership of the Advisory Committee

17 shall be broadly representative of the various minority

18 groups.

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

20 chair of the Committee.

21 ‘‘(4) The Committee shall—

22 ‘‘(A) advise the Director of the Office on ap23 propriate research activities to be undertaken by

24 the national research institutes with respect to—

25 ‘‘(i) research on minority health;
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1 ‘‘(ii) research on racial and ethnic dif2 ferences in clinical drug trials, including

3 responses to pharmacological drugs;

4 ‘‘(iii) research on racial and ethnic

5 differences in disease etiology, course, and

6 treatment; and

7 ‘‘(iv) research on minority health con8 ditions which require a multidisciplinary

9 approach;

10 ‘‘(B) report to the Director of the Office on

11 such research;

12 ‘‘(C) provide recommendations to such Di13 rector regarding activities of the Office (includ14 ing recommendations on priorities in carrying

15 out research described in subparagraph (A)); and

16 ‘‘(D) assist in monitoring compliance with

17 section 492B regarding the inclusion of minori18 ties in clinical research.

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

20 biennial reports describing the activities of the Com21 mittee, including findings made by the Committee re22 garding—

23 ‘‘(i) compliance with section 492B;
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1 ‘‘(ii) the extent of expenditures made for re2 search on minority health by the agencies of the

3 National Institutes of Health; and

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

5 research.

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

7 be submitted to the Director of NIH for inclusion in

8 the report required in section 403 for the period in9 volved.

10 ‘‘(e) REPRESENTATION OF MINORITIES AMONG RE11 SEARCHERS.—The Secretary, acting through the Assistant

12 Secretary for Personnel and in collaboration with the Di13 rector of the Office, shall determine the extent to which the

14 various minority groups are represented among adminis15 trators, senior physicians, and scientists of the national re16 search institutes and among physicians and scientists con17 ducting research with funds provided by such institutes,

18 and as appropriate, carry out activities to increase the ex19 tent of such representation.

20 ‘‘(f) REQUIREMENT REGARDING GRANTS AND CON21 TRACTS.—Any award of a grant, cooperative agreement, or

22 contract that the Director of the Office is authorized to make

23 shall be made only on a competitive basis.

24 ‘‘(g) DEFINITIONS.—For purposes of this section:
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1 ‘‘(1) The term ‘minority health conditions’, with

2 respect to individuals who are members of minority

3 groups, means all diseases, disorders, and conditions

4 (including with respect to mental health)—

5 ‘‘(A) unique to, more serious, or more prev6 alent in such individuals;

7 ‘‘(B) for which the factors of medical risk or

8 types of medical intervention are different for

9 such individuals, or for which it is unknown

10 whether such factors or types are different for

11 such individuals; or

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

13 insufficient clinical research involving such indi14 viduals as subjects or insufficient clinical data

15 on such individuals.

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

17 means research on minority health conditions, includ18 ing research on preventing such conditions.

19 ‘‘(3) The term ‘minority groups’ has the meaning

20 given such term in section 1707(h).’’.

21 SEC. 402. ACTIVITIES OF AGENCY FOR HEALTH CARE POL22 ICY AND RESEARCH.

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

24 299 et seq.) is amended—
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1 (1) in section 902, by amending subsection (b) to

2 read as follows:

3 ‘‘(b) REQUIREMENTS WITH RESPECT TO CERTAIN

4 POPULATIONS.—In carrying out subsection (a), the Admin5 istrator shall undertake and support research, demonstra6 tion projects, and evaluations with respect to the health sta7 tus of, and the delivery of health care to—

8 ‘‘(1) the populations of medically underserved

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

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

11 the elderly.’’; and

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

13 following sentence: ‘‘Of the amounts appropriated

14 under the preceding sentence for a fiscal year, the Ad15 ministrator shall reserve not less than 8 percent for

16 carrying out section 902(b)(2).’’.

17 SEC. 403. DATA COLLECTION BY NATIONAL CENTER FOR

18 HEALTH STATISTICS.

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

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

21 Public Law 103–183 (107 Stat. 2237), is amended to read

22 as follows:

23 ‘‘(n)(1) For health statistical and epidemiological ac24 tivities undertaken or supported under this section, there
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1 are authorized to be appropriated such sums as may be nec2 essary for each of the fiscal years 1995 through 1998.

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

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

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

6 (h), (l), and (m) with respect to particular racial and eth7 nic population groups.’’.

8 TITLE V—NATIVE HAWAIIAN

9 HEALTH CARE

10 SEC. 501. CLARIFICATION OF 1992 AMENDMENTS.

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

12 9168 of the Department of Defense Appropriations Act,

13 1993 (106 Stat. 1948) is amended by striking ‘‘September

14 12, 1992,’’ and inserting ‘‘August 7, 1992,’’.

15 (b) EFFECTIVE DATE.—The amendment made by sub16 section (a) shall take effect as of October 6, 1992.

17 SEC. 502. AMENDMENT OF NATIVE HAWAIIAN HEALTH CARE

18 IMPROVEMENT ACT TO REFLECT 1992 AGREE19 MENT.

20 Effective on the date of enactment of this Act, the Na21 tive Hawaiian Health Care Improvement Act (42 U.S.C.

22 11701 et seq.) is amended to read as follows:

23 ‘‘SECTION 1. SHORT TITLE.

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

25 Health Care Improvement Act’.
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1 ‘‘SEC. 2. FINDINGS; DECLARATION OF POLICY; INTENT OF

2 CONGRESS.

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

4 ‘‘(1) the United States retains the legal respon5 sibility to enforce the administration of the public

6 trust responsibility of the State of Hawaii for the bet7 terment of the conditions of Native Hawaiians under

8 section 5(f) of Public Law 86–3 (73 Stat. 6; com9 monly referred to as the ‘Hawaii Statehood Admis10 sions Act’);

11 ‘‘(2) in furtherance of the State of Hawaii’s pub12 lic trust responsibility for the betterment of the condi13 tions of Native Hawaiians, contributions by the Unit14 ed States to the provision of comprehensive health

15 promotion and disease prevention services to main16 tain and improve the health status of Native Hawai17 ians are consistent with the historical and unique

18 legal relationship of the United States with the gov19 ernment that represented the indigenous native people

20 of Hawaii; and

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

22 the health status of Native Hawaiians to the highest

23 possible level and to encourage the maximum partici24 pation of Native Hawaiians in order to achieve this

25 objective.
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1 ‘‘(b) DECLARATION OF POLICY.—The Congress hereby

2 declares that it is the policy of the United States in fulfill3 ment of its special responsibilities and legal obligations to

4 the indigenous people of Hawaii resulting from the unique

5 and historical relationship between the United States and

6 the Government of the indigenous people of Hawaii—

7 ‘‘(1) to raise the health status of Native Hawai8 ians to the highest possible health level; and

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

10 care programs with all resources necessary to effec11 tuate this policy.

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

13 Congress that the Nation meet the following health objectives

14 with respect to Native Hawaiians by the year 2000:

15 ‘‘(1) Reduce coronary heart disease deaths to no

16 more than 100 per 100,000.

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

18 100,000.

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

20 least 50 percent of people with high blood pressure.

21 ‘‘(4) Reduce blood cholesterol to an average of no

22 more than 200 mg/dl.

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

24 achieve a rate of no more than 42 per 100,000.
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1 ‘‘(6) Reduce breast cancer deaths to no more

2 than 20.6 per 100,000 women.

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

4 least 85 percent of women age 18 and older.

5 ‘‘(8) Increase fecal occult blood testing every 1 to

6 2 years to at least 50 percent of people age 50 and

7 older.

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

9 than 34 per 100,000.

10 ‘‘(10) Reduce the most severe complications of di11 abetes as follows:

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

13 than 1.4 in 1,000.

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

15 1,000.

16 ‘‘(C) Lower extremity amputation to no

17 more than 4.9 in 1,000.

18 ‘‘(D) Perinatal mortality to no more than 2

19 percent.

20 ‘‘(E) Major congenital malformations to no

21 more than 4 percent.

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

23 7 deaths per 1,000 live births.

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

25 5 percent of live births.
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1 ‘‘(13) Increase first trimester prenatal care to at

2 least 90 percent of live births.

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

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

5 ‘‘(15) Reduce unintended pregnancies to no more

6 than 30 percent of pregnancies.

7 ‘‘(16) Increase to at least 60 percent the propor8 tion of primary care providers who provide age-ap9 propriate preconception care and counseling.

10 ‘‘(17) Increase years of healthy life to at least 65

11 years.

12 ‘‘(18) Eliminate financial barriers to clinical

13 preventive services.

14 ‘‘(19) Increase childhood immunization levels to

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

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

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

18 ‘‘(21) Reduce untreated dental caries so that the

19 proportion of children with untreated caries (in per20 manent or primary teeth) is no more than 20 percent

21 among children age 6 through 8 and no more than 15

22 percent among adolescents age 15.

23 ‘‘(22) Reduce edentulism to no more than 20 per24 cent in people age 65 and older.
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1 ‘‘(23) Increase moderate daily physical activity

2 to at least 30 percent of the population.

3 ‘‘(24) Reduce sedentary lifestyles to no more than

4 15 percent of the population.

5 ‘‘(25) Reduce overweight to a prevalence of no

6 more than 20 percent of the population.

7 ‘‘(26) Reduce dietary fat intake to an average of

8 30 percent of calories or less.

9 ‘‘(27) Increase to at least 75 percent the propor10 tion of primary care providers who provide nutrition

11 assessment and counseling or referral to qualified nu12 tritionists or dieticians.

13 ‘‘(28) Reduce cigarette smoking prevalence to no

14 more than 15 percent of adults.

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

16 than 15 percent by age 20.

17 ‘‘(30) Reduce alcohol-related motor vehicle crash

18 deaths to no more than 8.5 per 100,000 adjusted for

19 age.

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

21 12 to 17 to less than 13 percent.

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

23 25 to less than 8 percent.

24 ‘‘(33) Reduce cocaine use by youth age 18 to 25

25 to less than 3 percent.
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1 ‘‘(34) Confine HIV infection to no more than

2 800 per 100,000.

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

4 than 225 per 100,000.

5 ‘‘(36) Reduce syphilis infections to no more that

6 10 per 100,000.

7 ‘‘(37) Reduce significant hearing impairment to

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

9 ‘‘(38) Reduce acute middle ear infections among

10 children age 4 and younger, as measured by days of

11 restricted activity or school absenteeism, to no more

12 than 105 days per 100 children.

13 ‘‘(39) Reduce indigenous cases of vaccine-pre14 ventable diseases as follows:

15 ‘‘(A) Diphtheria among individuals age 25

16 and younger to 0.

17 ‘‘(B) Tetanus among individuals age 25

18 and younger to 0.

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

20 ‘‘(D) Measles to 0.

21 ‘‘(E) Rubella to 0.

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

23 ‘‘(G) Mumps to 500.

24 ‘‘(H) Pertussis to 1,000.
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1 ‘‘(40) Reduce significant visual impairment to a

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

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

4 President, for inclusion in each report required to be trans5 mitted to the Congress under section 9, a report on the

6 progress made toward meeting each of the objectives de7 scribed in subsection (c).

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

9 FOR NATIVE HAWAIIANS.

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

11 a contract with, Papa Ola Lokahi for the purpose of coordi12 nating, implementing, and updating a Native Hawaiian

13 comprehensive health care master plan designed to promote

14 comprehensive health promotion and disease prevention

15 services and to maintain and improve the health status of

16 Native Hawaiians. The master plan shall be based upon

17 an assessment of the health care status and health care

18 needs of Native Hawaiians. To the extent practicable, as19 sessments made as of the date of such grant or contract shall

20 be used by Papa Ola Lokahi, except that any such assess21 ment shall be updated as appropriate.

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

23 ‘‘(a) COMPREHENSIVE HEALTH PROMOTION, DISEASE

24 PREVENTION, AND PRIMARY HEALTH SERVICES.—(1)(A)

25 The Secretary, in consultation with Papa Ola Lokahi, may
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1 make grants to, or enter into contracts with, any qualified

2 entity for the purpose of providing comprehensive health

3 promotion and disease prevention services as well as pri4 mary health services to Native Hawaiians.

5 ‘‘(B) In making grants and entering into contracts

6 under this paragraph, the Secretary shall give preference

7 to Native Hawaiian health care systems and Native Hawai8 ian organizations, and, to the extent feasible, health pro9 motion and disease prevention services shall be performed

10 through Native Hawaiian health care systems.

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

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

13 Lokahi for the purpose of planning Native Hawaiian health

14 care systems to serve the health needs of Native Hawaiian

15 communities on the islands of O’ahu, Moloka’i, Maui, Ha16 wai’i, Lana’i, Kaua’i, and Ni’ihau in the State of Hawaii.

17 ‘‘(b) QUALIFIED ENTITY.—An entity is a qualified en18 tity for purposes of subsection (a)(1) if the entity is a Na19 tive Hawaiian health care system.

20 ‘‘(c) SERVICES TO BE PROVIDED.—(1) Each recipient

21 of funds under subsection (a)(1) shall provide the following

22 services:

23 ‘‘(A) Outreach services to inform Native Hawai24 ians of the availability of health services.
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1 ‘‘(B) Education in health promotion and disease

2 prevention of the Native Hawaiian population by

3 (wherever possible) Native Hawaiian health care

4 practitioners, community outreach workers, coun5 selors, and cultural educators.

6 ‘‘(C) Services of physicians, physicians’ assist7 ants, or nurse practitioners.

8 ‘‘(D) Immunizations.

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

10 blood pressure, and otitis media.

11 ‘‘(F) Pregnancy and infant care.

12 ‘‘(G) Improvement of nutrition.

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

14 paragraph (1), the following services may be provided pur15 suant to subsection (a)(1):

16 ‘‘(A) Identification, treatment, control, and re17 duction of the incidence of preventable illnesses and

18 conditions endemic to Native Hawaiians.

19 ‘‘(B) Collection of data related to the prevention

20 of diseases and illnesses among Native Hawaiians.

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

22 ‘health promotion’, ‘disease prevention’, and ‘primary

23 health services’, as such terms are defined in section

24 10, which are not specifically referred to in para25 graph (1) of this subsection.
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1 ‘‘(3) The health care services referred to in paragraphs

2 (1) and (2) which are provided under grants or contracts

3 under subsection (a)(1) may be provided by traditional Na4 tive Hawaiian healers.

5 ‘‘(d) LIMITATION ON NUMBER OF ENTITIES.—During

6 a fiscal year, the Secretary under this Act may make a

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

8 Hawaiian health care systems.

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

10 make a grant or provide funds pursuant to a contract under

11 subsection (a)(1) to an entity—

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

13 costs of providing health services under the grant or

14 contract; and

15 ‘‘(B) unless the entity agrees that the entity will

16 make available, directly or through donations to the

17 entity, non-Federal contributions toward such costs in

18 an amount equal to not less than $1 (in cash or in

19 kind under paragraph (2)) for each $3 of Federal

20 funds provided in such grant or contract.

21 ‘‘(2) Non-Federal contributions required in paragraph

22 (1) may be in cash or in kind, fairly evaluated, including

23 plant, equipment, or services. Amounts provided by the Fed24 eral Government or services assisted or subsidized to any

25 significant extent by the Federal Government may not be
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1 included in determining the amount of such non-Federal

2 contributions.

3 ‘‘(3) The Secretary may waive the requirement estab4 lished in paragraph (1) if—

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

6 entity described in subsection (b); and

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

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

9 entity to comply with such requirement.

10 ‘‘(f) RESTRICTION ON USE OF GRANT AND CONTRACT

11 FUNDS.—The Secretary may not make a grant to, or enter

12 into a contract with, an entity under subsection (a)(1) un13 less the entity agrees that amounts received pursuant to

14 such subsection will not, directly or through contract, be

15 expended—

16 ‘‘(1) for any purpose other than the purposes de17 scribed in subsection (c);

18 ‘‘(2) to provide inpatient services;

19 ‘‘(3) to make cash payments to intended recipi20 ents of health services; or

21 ‘‘(4) to purchase or improve real property (other

22 than minor remodeling of existing improvements to

23 real property) or to purchase major medical equip24 ment.
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1 ‘‘(g) LIMITATION ON CHARGES FOR SERVICES.—The

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

3 with, an entity under subsection (a)(1) unless the entity

4 agrees that, whether health services are provided directly or

5 through contract—

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

7 will be provided without regard to ability to pay for

8 the health services; and

9 ‘‘(2) the entity will impose a charge for the deliv10 ery of health services, and such charge—

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

12 of charges that is made available to the public,

13 and

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

15 of the individual involved.

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

17 LOKAHI.

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

19 ‘‘(1) coordinate, implement, and update, as ap20 propriate, the comprehensive health care master plan

21 developed pursuant to section 3;

22 ‘‘(2) to the maximum extent possible, coordinate

23 and assist the health care programs and services pro24 vided to Native Hawaiians;
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1 ‘‘(3) provide for the training of the persons de2 scribed in section 4(c)(1)(B);

3 ‘‘(4) develop an action plan outlining the con4 tributions that each member organization of Papa

5 Ola Lokahi will make in carrying out this Act;

6 ‘‘(5) serve as a clearinghouse for—

7 ‘‘(A) the collection and maintenance of data

8 associated with the health status of Native Ha9 waiians;

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

11 diseases affecting Native Hawaiians;

12 ‘‘(C) the availability of Native Hawaiian

13 project funds, research projects, and publications;

14 and

15 ‘‘(D) the timely dissemination of informa16 tion relating to Native Hawaiian health care

17 systems;

18 ‘‘(6) perform the recognition and certification

19 functions specified in sections 10(6)(F) and 10(6)(G);

20 and

21 ‘‘(7) provide technical support and coordination

22 of training and technical assistance to Native Hawai23 ian health care systems.

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

25 may receive project funds that may be appropriated for the
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1 purpose of research on the health status of Native Hawai2 ians or for the purpose of addressing the health care needs

3 of Native Hawaiians.

4 ‘‘(c) GRANTS.—In addition to any other grant or con5 tract under this Act, the Secretary may make grants to,

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

7 ‘‘(1) carrying out the functions described in sub8 section (a); and

9 ‘‘(2) administering any special project funds re10 ceived under the authority of subsection (b).

11 ‘‘(d) RELATIONSHIPS WITH OTHER AGENCIES.—Papa

12 Ola Lokahi may enter into agreements or memoranda of

13 understanding with relevant agencies or organizations that

14 are capable of providing resources or services to Native Ha15 waiian health care systems.

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

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

18 include in any grant made or contract entered into under

19 this Act such terms and conditions as the Secretary consid20 ers necessary or appropriate to ensure that the objectives

21 of such grant or contract are achieved.

22 ‘‘(b) PERIODIC REVIEW.—The Secretary shall periodi23 cally evaluate the performance of, and compliance with,

24 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 under

3 this Act with an entity unless the entity—

4 ‘‘(1) agrees to establish such procedures for fiscal

5 control and fund accounting as may be necessary to

6 ensure proper disbursement and accounting with re7 spect 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 individual,

22 fluent in both English and the appropriate lan23 guage, to assist in carrying out the plan;
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1 ‘‘(4) with respect to health services that are cov2 ered 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 the

21 utilization and costs of health services provided under

22 the grant or contract (including the average cost of

23 health services per user) and that provides such other

24 information as the Secretary determines to be appro25 priate.
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1 ‘‘(d) CONTRACT EVALUATION.—(1) If, as a result of

2 evaluations conducted by the Secretary, the Secretary deter3 mines that an entity has not complied with or satisfactorily

4 performed a contract entered into under section 4, the Sec5 retary shall, prior to renewing such contract, attempt to

6 resolve the areas of noncompliance or unsatisfactory per7 formance and modify such contract to prevent future occur8 rences of such noncompliance or unsatisfactory perform9 ance. If the Secretary determines that such noncompliance

10 or unsatisfactory performance cannot be resolved and pre11 vented in the future, the Secretary shall not renew such con12 tract with such entity and is authorized to enter into a con13 tract under section 4 with another entity referred to in sec14 tion 4(b) that provides services to the same population of

15 Native Hawaiians which is served by the entity whose con16 tract is not renewed by reason of this subsection.

17 ‘‘(2) In determining whether to renew a contract en18 tered into with an entity under this Act, the Secretary shall

19 consider the results of evaluation under this section.

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

21 this Act shall be in accordance with all Federal contracting

22 laws and regulations except that, in the discretion of the

23 Secretary, such contracts may be negotiated without adver24 tising and may be exempted from the provisions of the Act

25 of August 24, 1935 (40 U.S.C. 270a et seq.).
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1 ‘‘(4) Payments made under any contract entered into

2 under this Act may be made in advance, by means of reim3 bursement, or in installments and shall be made on such

4 conditions as the Secretary deems necessary to carry out

5 the purposes of this Act.

6 ‘‘(e) LIMITATION ON USE OF FUNDS FOR ADMINISTRA7 TIVE EXPENSES.—Except for grants and contracts under

8 section 5(c), the Secretary may not make a grant to, or

9 enter into a contract with, an entity under this Act unless

10 the entity agrees that the entity will not expend more than

11 10 percent of amounts received pursuant to this Act for the

12 purpose of administering the grant or contract.

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

14 an entity receives or expends funds pursuant to a grant

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

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

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

18 grant or contract;

19 ‘‘(B) the amounts and purposes for which Fed20 eral funds were expended; and

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

22 may request.

23 ‘‘(2) The reports and records of any entity which con24 cern any grant or contract under this Act shall be subject

25 to audit by the Secretary, the Inspector General of Health
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1 and Human Services, and the Comptroller General of the

2 United States.

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

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

5 under this Act the cost of an annual private audit con6 ducted by a certified public accountant.

7 ‘‘SEC. 7. ASSIGNMENT OF PERSONNEL.

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

9 enter into an agreement with any entity under which the

10 Secretary is authorized to assign personnel of the Depart11 ment of Health and Human Services with expertise identi12 fied by such entity to such entity on detail for the purposes

13 of providing comprehensive health promotion and disease

14 prevention services to Native Hawaiians.

15 ‘‘(b) APPLICABLE FEDERAL PERSONNEL PROVI16 SIONS.—Any assignment of personnel made by the Sec17 retary under any agreement entered into under the author18 ity of subsection (a) shall be treated as an assignment of

19 Federal personnel to a local government that is made in

20 accordance with subchapter VI of chapter 33 of title 5,

21 United States Code.

22 ‘‘SEC. 8. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.

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

24 make scholarship grants to students who—
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1 ‘‘(1) meet the requirements of section 338A(b) of

2 the Public Health Service Act (42 U.S.C. 254l(b));

3 and

4 ‘‘(2) are Native Hawaiians.

5 ‘‘(b) TERMS AND CONDITIONS.—(1) Scholarship grants

6 provided under subsection (a) shall be provided under the

7 same terms and subject to the same conditions, regulations,

8 and rules that apply to scholarship grants provided under

9 section 338A of the Public Health Service Act (42 U.S.C.

10 254l), except that—

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

12 of health care profession training shall correspond to

13 the need for each type of health care professional to

14 serve Native Hawaiian health care systems, as identi15 fied by Papa Ola Lokahi;

16 ‘‘(B) in selecting scholarship recipients, the Sec17 retary shall give priority to individuals included on

18 a list of eligible applicants submitted by the Kameha19 meha Schools/Bishop Estate; and

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

21 scholarship recipient shall be fulfilled through service,

22 in order of priority, in—

23 ‘‘(i) any one of the five Native Hawaiian

24 health care systems which, during the fiscal year

25 in which the obligated service requirement is as-
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1 signed, has received a grant or entered into a

2 contract pursuant to section 4; or

3 ‘‘(ii) health professions shortage areas,

4 medically underserved areas, or geographic areas

5 or facilities similarly designated by the United

6 States Public Health Service in the State of Ha7 waii.

8 ‘‘(2) The Secretary shall enter into a cooperative agree9 ment with the Kamehameha Schools/Bishop Estate under

10 which such organization shall provide recruitment, reten11 tion, counseling, and other support services intended to im12 prove the operation of the scholarship program established

13 under this section.

14 ‘‘(3) The Native Hawaiian Health Scholarship pro15 gram shall not be administered by or through the Indian

16 Health Service.

17 ‘‘SEC. 9. REPORT.

18 ‘‘The President shall, at the time the budget is submit19 ted under section 1105 of title 31, United States Code, for

20 each fiscal year transmit to the Congress the report required

21 pursuant to section 2(d).

22 ‘‘SEC. 10. DEFINITIONS.

23 ‘‘For purposes of this Act:

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

25 prevention’ includes—
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1 ‘‘(A) immunizations,

2 ‘‘(B) control of high blood pressure,

3 ‘‘(C) control of sexually transmittable dis4 eases,

5 ‘‘(D) prevention and control of diabetes,

6 ‘‘(E) control of toxic agents,

7 ‘‘(F) occupational safety and health,

8 ‘‘(G) accident prevention,

9 ‘‘(H) fluoridation of water,

10 ‘‘(I) control of infectious agents, and

11 ‘‘(J) provision of mental health care.

12 ‘‘(2) HEALTH PROMOTION.—The term ‘health

13 promotion’ includes—

14 ‘‘(A) pregnancy and infant care, including

15 prevention of fetal alcohol syndrome,

16 ‘‘(B) cessation of tobacco smoking,

17 ‘‘(C) reduction in the misuse of alcohol and

18 drugs,

19 ‘‘(D) improvement of nutrition,

20 ‘‘(E) improvement in physical fitness,

21 ‘‘(F) family planning, and

22 ‘‘(G) control of stress.

23 ‘‘(3) NATIVE HAWAIIAN.—The term ‘Native Ha24 waiian’ means any individual who is—

25 ‘‘(A) a citizen of the United States; and
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1 ‘‘(B) a descendant of the aboriginal people,

2 who prior to 1778, occupied and exercised sov3 ereignty in the area that now constitutes the

4 State of Hawaii, as evidenced by—

5 ‘‘(i) genealogical records;

6 ‘‘(ii) Kupuna (elders) or Kama’aina

7 (long-term community residents) verifica8 tion; or

9 ‘‘(iii) birth records of the State of Ha10 waii.

11 ‘‘(4) NATIVE HAWAIIAN HEALTH CENTER.—The

12 term ‘Native Hawaiian health center’ means an en13 tity—

14 ‘‘(A) which is organized under the laws of

15 the State of Hawaii,

16 ‘‘(B) which provides or arranges for health

17 care services through practitioners licensed by

18 the State of Hawaii, where licensure require19 ments are applicable,

20 ‘‘(C) which is a public or nonprofit private

21 entity, and

22 ‘‘(D) in which Native Hawaiian health

23 practitioners significantly participate in the

24 planning, management, monitoring, and evalua25 tion of health services.
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1 ‘‘(5) NATIVE HAWAIIAN ORGANIZATION.—The

2 term ‘Native Hawaiian organization’ means any or3 ganization—

4 ‘‘(A) which serves the interests of Native

5 Hawaiians,

6 ‘‘(B) which is—

7 ‘‘(i) recognized by Papa Ola Lokahi for

8 the purpose of planning, conducting, or ad9 ministering programs (or portions of pro10 grams) authorized under this Act for the

11 benefit of Native Hawaiians, and

12 ‘‘(ii) certified by Papa Ola Lokahi as

13 having the qualifications and capacity to

14 provide the services, and meet the require15 ments, under the contract the organization

16 enters into with, or grant the organization

17 receives from, the Secretary under this Act,

18 ‘‘(C) in which Native Hawaiian health

19 practitioners significantly participate in the

20 planning, management, monitoring, and evalua21 tion of health services, and

22 ‘‘(D) which is a public or nonprofit private

23 entity.
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1 ‘‘(6) NATIVE HAWAIIAN HEALTH CARE SYSTEM.—

2 The term ‘Native Hawaiian health care system’

3 means an entity—

4 ‘‘(A) which is organized under the laws of

5 the State of Hawaii;

6 ‘‘(B) which provides or arranges for health

7 care services through practitioners licensed by

8 the State of Hawaii, where licensure require9 ments are applicable;

10 ‘‘(C) which is a public or nonprofit private

11 entity;

12 ‘‘(D) in which Native Hawaiian health

13 practitioners significantly participate in the

14 planning, management, monitoring, and evalua15 tion of health care services;

16 ‘‘(E) which may be composed of as many

17 Native Hawaiian health centers as necessary to

18 meet the health care needs of Native Hawaiians

19 residing on the island or islands served by such

20 entity;

21 ‘‘(F) which is recognized by Papa Ola

22 Lokahi for the purpose of providing comprehen23 sive health promotion and disease prevention

24 services as well as primary health services to Na25 tive Hawaiians under this Act; and
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1 ‘‘(G) which is certified by Papa Ola Lokahi

2 as having the qualifications and the capacity to

3 provide the services and meet the requirements of

4 a contract entered into, or a grant received,

5 under section 4.

6 ‘‘(7) PAPA OLA LOKAHI.—(A) Subject to sub7 paragraph (B), the term ‘Papa Ola Lokahi’ means an

8 organization composed of—

9 ‘‘(i) E Ola Mau;

10 ‘‘(ii) the Office of Hawaiian Affairs of the

11 State of Hawaii;

12 ‘‘(iii) Alu Like Inc.;

13 ‘‘(iv) the University of Hawaii;

14 ‘‘(v) the Office of Hawaiian Health of the

15 Hawaii State Department of Health;

16 ‘‘(vi) Ho’ola Lahui Hawaii, or a health

17 care system serving the islands of Kaua’i and

18 Ni’ihau;

19 ‘‘(vii) Ke Ola Mamo, or a health care sys20 tem serving the island of O’ahu;

21 ‘‘(viii) Na Pu’uwai or a health care system

22 serving the islands of Moloka’i and Lana’i;

23 ‘‘(ix) Hui No Ke Ola Pono, or a health care

24 system serving the island of Maui;
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1 ‘‘(x) Hui Malama Ola Ha’Oiwi or a health

2 care system serving the island of Hawaii; and

3 ‘‘(xi) such other member organizations as

4 the Board of Papa Ola Lokahi may admit from

5 time to time, based upon satisfactory demonstra6 tion of a record of contribution to the health and

7 well-being of Native Hawaiians, and upon satis8 factory development of a mission statement in

9 relation to this Act, including clearly defined

10 goals and objectives, a 5-year action plan outlin11 ing the contributions that each organization will

12 make in carrying out the policy of this Act, and

13 an estimated budget.

14 ‘‘(B) Such term does not include any organiza15 tion identified in subparagraph (A) if the Secretary

16 determines that such organization does not have a

17 mission statement with clearly defined goals and ob18 jectives for the contributions the organization will

19 make to Native Hawaiian health care systems and an

20 action plan for carrying out such goals and objectives.

21 ‘‘(8) PRIMARY HEALTH SERVICES.—The term

22 ‘primary health services’ means—

23 ‘‘(A) services of physicians, physicians’ as24 sistants and nurse practitioners;
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1 ‘‘(B) diagnostic laboratory and radiologic

2 services;

3 ‘‘(C) preventive health services (including

4 children’s eye and ear examinations to determine

5 the need for vision and hearing correction,

6 perinatal services, well child services, and family

7 planning services);

8 ‘‘(D) emergency medical services;

9 ‘‘(E) transportation services as required for

10 adequate patient care;

11 ‘‘(F) preventive dental services; and

12 ‘‘(G) pharmaceutical services, as may be

13 appropriate for particular health centers.

14 ‘‘(9) SECRETARY.—The term ‘Secretary’ means

15 the Secretary of Health and Human Services.

16 ‘‘(10) TRADITIONAL NATIVE HAWAIIAN HEAL17 ER.—The term ‘traditional Native Hawaiian healer’

18 means a practitioner—

19 ‘‘(A) who—

20 ‘‘(i) is of Hawaiian ancestry, and

21 ‘‘(ii) has the knowledge, skills, and ex22 perience in direct personal health care of

23 individuals, and
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1 ‘‘(B) whose knowledge, skills, and experience

2 are based on a demonstrated learning of Native

3 Hawaiian healing practices acquired by—

4 ‘‘(i) direct practical association with

5 Native Hawaiian elders, and

6 ‘‘(ii) oral traditions transmitted from

7 generation to generation.

8 ‘‘SEC. 11. RULE OF CONSTRUCTION.

9 ‘‘Nothing in this Act shall be construed to restrict the

10 authority of the State of Hawaii to license health practi11 tioners.

12 ‘‘SEC. 12. COMPLIANCE WITH BUDGET ACT.

13 ‘‘Any new spending authority (described in subsection

14 (c)(2) (A) or (B) of section 401 of the Congressional Budget

15 Act of 1974) which is provided under this Act shall be effec16 tive for any fiscal year only to such extent or in such

17 amounts as are provided in appropriation Acts.

18 ‘‘SEC. 13. SEVERABILITY.

19 ‘‘If any provision of this Act, or the application of any

20 such provision to any person or circumstances is held to

21 be invalid, the remainder of this Act, and the application

22 of such provision or amendment to persons or circumstances

23 other than those to which it is held invalid, shall not be

24 affected thereby.
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1 ‘‘SEC. 14. AUTHORIZATION OF APPROPRIATIONS.

2 ‘‘There is authorized to be appropriated for each of the

3 fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000

4 such sums as may be necessary to carry out the purposes

5 of this Act.

6 ‘‘SEC. 15. PROHIBITION AGAINST EXCLUSION FROM PAR7 TICIPATION.

8 ‘‘Notwithstanding any other provision of this Act, no

9 person shall, on the basis of race, color, or national origin,

10 be excluded from participation in, or be denied the benefits

11 of, or be subjected to discrimination under, any program

12 or activity receiving Federal financial assistance under this

13 Act.’’.

14 SEC. 503. REPEAL OF PUBLIC HEALTH SERVICE ACT PROVI15 SION.

16 (a) IN GENERAL.—The Public Health Service Act (42

17 U.S.C. 201 et seq.), as amended by section 206 of this Act,

18 is amended by repealing section 338K and redesignating

19 section 338L as section 338K. Such repeal shall not be con20 strued to terminate contracts in effect under such section

21 on the date of the enactment of this Act. Any such contracts

22 shall continue according to the terms and conditions of such

23 contracts.

24 (b) EFFECTIVE DATE.—Subsection (a) takes effect on

25 the date of the enactment of this Act.
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1 TITLE VI—WOMEN’S HEALTH

2 SEC. 601. ESTABLISHMENT OF OFFICE OF WOMEN’S

3 HEALTH.

4 Title XVII of the Public Health Service Act (42 U.S.C.

5 300u et seq.), as amended by section 704 of Public Law

6 103–183 (107 Stat. 2240), is amended by adding at the

7 end the following section:

8 ‘‘OFFICE OF WOMEN’S HEALTH

9 ‘‘SEC. 1710. (a) IN GENERAL.—There is established an

10 Office of Women’s Health within the Office of the Assistant

11 Secretary for Health. There shall be in the Department of

12 Health and Human Services a Deputy Assistant Secretary

13 for Women’s Health, who shall be the head of the Office of

14 Women’s Health. The Secretary, acting through such Dep15 uty Assistant Secretary, shall carry out this section.

16 ‘‘(b) DUTIES.—

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

18 or support programs and activities regarding wom19 en’s health conditions. In carrying out the preceding

20 sentence, the Secretary shall—

21 ‘‘(A) monitor the programs and activities of

22 the agencies specified in paragraph (2) in order

23 to determine the extent to which the purposes of

24 the programs and activities are being carried out
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1 with respect to women’s health conditions (as de2 fined in section 486);

3 ‘‘(B) provide advice to the heads of such

4 agencies on improving programs and activities

5 that relate to such conditions; and

6 ‘‘(C) coordinate such programs and activi7 ties of the agencies.

8 ‘‘(2) SPECIFIED AGENCIES.—For purposes of

9 paragraph (1), the agencies referred to in this para10 graph are the following:

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

12 Prevention.

13 ‘‘(B) The National Institutes of Health.

14 ‘‘(C) The Agency for Health Care Policy

15 and Research.

16 ‘‘(D) The Health Resources and Services

17 Administration.

18 ‘‘(E) The Substance Abuse and Mental

19 Health Services Administration.

20 ‘‘(F) The Food and Drug Administration.

21 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the

22 purpose of carrying out this section, there are authorized

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

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

25 1996 and 1997.’’.
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1 SEC. 602. WOMEN’S SCIENTIFIC EMPLOYMENT REGARDING

2 NATIONAL INSTITUTES OF HEALTH.

3 (a) IN GENERAL.—Part A of title IV of the Public

4 Health Service Act (42 U.S.C. 281 et seq.) is amended by

5 adding at the end the following section:

6 ‘‘WOMEN’S SCIENTIFIC EMPLOYMENT

7 ‘‘SEC. 404F. (a) IN GENERAL.—The Director of NIH

8 shall—

9 ‘‘(1) establish policies for the National Institutes

10 of Health on matters relating to the employment by

11 such Institutes of women as scientists;

12 ‘‘(2) monitor the extent of compliance with such

13 policies, including through the implementation of an

14 accountability system under the Federal Equal Op15 portunity Recruitment Program; and

16 ‘‘(3) establish and maintain a process for re17 sponding to incidents of noncompliance with such

18 policies.

19 ‘‘(b) CERTAIN POLICIES.—In establishing policies

20 under subsection (a)(1), the Director of NIH shall provide

21 for the following policies regarding the employment of

22 women as scientists at the National Institutes of Health:

23 ‘‘(1) A policy on the granting of tenured status.

24 ‘‘(2) A policy on family leave.

25 ‘‘(3) A policy on the recruitment of minority

26 women.
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1 ‘‘(4) A policy on the inclusion of women sci2 entists in intramural and extramural conferences,

3 workshops, international congresses, and similar

4 events funded or sponsored by such Institutes.

5 ‘‘(c) AVAILABILITY OF POLICIES.—The Director of

6 NIH shall ensure that copies of policies established under

7 subsection (a) are available to scientists of the National In8 stitutes of Health.

9 ‘‘(d) DEFINITION.—For purposes of this section, the

10 term ‘Federal Equal Opportunity Recruitment Program’

11 means the program carried out under part 720 of title 5,

12 Code of Federal Regulations (5 CFR 720).’’.

13 (b) STUDIES.—

14 (1) PAY EQUITY.—The Director of the National

15 Institutes of Health shall provide for a study to iden16 tify any pay differences among men and women sci17 entists employed (both tenured and untenured) by the

18 National Institutes of Health. The study shall include

19 recommendations on measures to adjust any inequi20 ties, and on making available information on salary

21 ranges to all scientists of such Institutes.

22 (2) STUDY ON TERMINATION OF EMPLOYMENT.—

23 The Comptroller General of the United States shall

24 conduct a study for the purpose of determining the

25 reasons underlying the employment termination of
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1 scientists of the National Institutes of Health. The

2 study shall be carried out with respect to male and

3 female scientists, and with respect to voluntary and

4 involuntary terminations.

5 (3) REPORTS.—Not later than 240 days after the

6 date of the enactment of this Act, the studies required

7 in this subsection shall be completed, and reports de8 scribing the findings and recommendations of the

9 studies shall be submitted to the Committee on En10 ergy and Commerce of the House of Representatives

11 and the Committee on Labor and Human Resources

12 of the Senate.

13 SEC. 603. INFORMATION AND EDUCATION REGARDING FE14 MALE GENITAL MUTILATION.

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

16 Human Services shall ensure that the Deputy Assistant Sec17 retary for Women’s Health and the Deputy Assistant Sec18 retary for Minority Health collaborate for the purpose of

19 carrying out the following activities:

20 (1) Compile data on the number of females liv21 ing in the United States who have been subjected to

22 female genital mutilation (whether in the United

23 States or in their countries of origin), including a

24 specification of the number of girls under the age of

25 18 who have been subjected to such mutilation.
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1 (2) Identify communities in the United States

2 that practice female genital mutilation, and design

3 and carry out outreach activities to educate individ4 uals in the communities on the physical and psycho5 logical health effects of such practice. Such outreach

6 activities shall be designed and implemented in col7 laboration with representatives of the ethnic groups

8 practicing such mutilation and with representatives

9 of organizations with expertise in preventing such

10 practice.

11 (3) Develop recommendations for the education

12 of students of schools of medicine and osteopathic

13 medicine regarding female genital mutilation and

14 complications arising from such mutilation. Such rec15 ommendations shall be disseminated to such schools.

16 (b) DEFINITION.—For purposes of this section, the

17 term ‘‘female genital mutilation’’ means the removal or

18 infibulation (or both) of the whole or part of the clitoris,

19 the labia minor, or the labia major.

20 SEC. 604. STUDY REGARDING CURRICULA OF MEDICAL

21 SCHOOLS AND WOMEN’S HEALTH CONDI22 TIONS.

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

24 Human Services, acting through the Administrator of the

25 Health Resources and Services Administration, shall con-
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1 duct a study for the purpose of determining the contents

2 of the curriculum of schools of medicine and osteopathic

3 medicine and whether such curriculum provides adequate

4 education to students on women’s health conditions.

5 (b) CONSULTATIONS.—The Secretary shall carry out

6 subsection (a) in consultation with the Deputy Assistant

7 Secretary for Women’s Health and the Director of the Office

8 of Research on Women’s Health (of the National Institutes

9 of Health).

10 (c) REPORT.—Not later than April 1, 1995, the Sec11 retary shall complete the study required in subsection (a)

12 and submit to the Committee on Energy and Commerce of

13 the House of Representatives, and to the Committee on

14 Labor and Human Resources of the Senate, a report de15 scribing the findings made as a result of the study and con16 taining any recommendations of the Secretary regarding

17 such findings.

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

19 (1) The term ‘‘Secretary’’ means the Secretary of

20 Health and Human Services.

21 (2) The term ‘‘women’s health conditions’’ has

22 the meaning given such term in section 486 of the

23 Public Health Service Act.
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1 TITLE VII—TRAUMATIC BRAIN

2 INJURY

3 SEC. 701. PROGRAMS OF CENTERS FOR DISEASE CONTROL

4 AND PREVENTION.

5 (a) TECHNICAL CORRECTION REGARDING AMEND6 ATORY INSTRUCTIONS.—Section 301(a) of Public Law 103–

7 183 (107 Stat. 2233) is amended by striking ‘‘(42 U.S.C.

8 242 et seq.)’’ and inserting ‘‘(42 U.S.C. 243 et seq.)’’. The

9 amendment made by the preceding sentence is deemed to

10 have taken effect immediately after the enactment of Public

11 Law 103–183.

12 (b) PROGRAMS OF CENTERS FOR DISEASE CONTROL

13 AND PREVENTION.—Part B of title III of the Public Health

14 Service Act (42 U.S.C. 243 et seq.), as amended pursuant

15 to subsection (a) and as amended by section 703 of Public

16 Law 103–183 (107 Stat. 2240), is amended by inserting

17 after section 317F the following section:

18 ‘‘PREVENTION OF TRAUMATIC BRAIN INJURY

19 ‘‘SEC. 317G. (a) The Secretary, acting through the Di20 rector of the Centers for Disease Control and Prevention,

21 may carry out projects to reduce the incidence of traumatic

22 brain injury. Such projects may be carried out by the Sec23 retary directly or through awards of grants or contracts to

24 public or nonprofit private entities. The Secretary may di25 rectly or through such awards provide technical assistance
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1 with respect to the planning, development, and operation

2 of such projects.

3 ‘‘(b) CERTAIN ACTIVITIES.—Activities under sub4 section (a) may include—

5 ‘‘(1) the conduct of research into identifying ef6 fective strategies for the prevention of traumatic brain

7 injury; and

8 ‘‘(2) the implementation of public information

9 and education programs for the prevention of such in10 jury and for broadening the awareness of the public

11 concerning the public health consequences of such in12 jury.

13 ‘‘(c) COORDINATION OF ACTIVITIES.—The Secretary

14 shall ensure that activities under this section are coordi15 nated as appropriate with other agencies of the Public

16 Health Service that carry out activities regarding trau17 matic brain injury.

18 ‘‘(d) DEFINITION.—For purposes of this section, the

19 term ‘traumatic brain injury’ means an acquired injury

20 to the brain. Such term does not include brain dysfunction

21 caused by congenital or degenerative disorders, nor birth

22 trauma, but may include brain injuries caused by anoxia

23 due to near drowning.’’.
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1 SEC. 702. PROGRAMS OF NATIONAL INSTITUTES OF

2 HEALTH.

3 Section 1261 of the Public Health Service Act (42

4 U.S.C. 300d-61) is amended—

5 (1) in subsection (d)—

6 (A) in paragraph (2), by striking ‘‘and’’

7 after the semicolon at the end;

8 (B) in paragraph (3), by striking the period

9 and inserting ‘‘; and’’; and

10 (C) by adding at the end the following

11 paragraph:

12 ‘‘(4) the authority to make awards of grants or

13 contracts to public or nonprofit private entities for

14 the conduct of basic and applied research regarding

15 traumatic brain injury, which research may in16 clude—

17 ‘‘(A) the development of new methods and

18 modalities for the more effective diagnosis, meas19 urement of degree of injury, post-injury monitor20 ing and prognostic assessment of head injury for

21 acute, subacute and later phases of care;

22 ‘‘(B) the development, modification and

23 evaluation of therapies that retard, prevent or

24 reverse brain damage after acute head injury,

25 that arrest further deterioration following injury
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1 and that provide the restitution of function for

2 individuals with long-term injuries;

3 ‘‘(C) the development of research on a con4 tinuum of care from acute care through rehabili5 tation, designed, to the extent practicable, to in6 tegrate rehabilitation and long-term outcome

7 evaluation with acute care research; and

8 ‘‘(D) the development of programs that in9 crease the participation of academic centers of

10 excellence in head injury treatment and rehabili11 tation research and training.’’; and

12 (2) in subsection (h), by adding at the end the

13 following paragraph:

14 ‘‘(4) The term ‘traumatic brain injury’ means

15 an acquired injury to the brain. Such term does not

16 include brain dysfunction caused by congenital or de17 generative disorders, nor birth trauma, but may in18 clude brain injuries caused by anoxia due to near

19 drowning.’’.

20 SEC. 703. PROGRAMS OF HEALTH RESOURCES AND SERV21 ICES ADMINISTRATION.

22 Part E of title XII of the Public Health Service Act

23 (42 U.S.C. 300d-51 et seq.) is amended by adding at the

24 end the following section:
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1 ‘‘SEC. 1252. STATE GRANTS FOR DEMONSTRATION

2 PROJECTS REGARDING TRAUMATIC BRAIN

3 INJURY.

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

5 Administrator of the Health Resources and Services Admin6 istration, may make grants to States for the purpose of car7 rying out demonstration projects to improve the availabil8 ity of health services regarding traumatic brain injury.

9 ‘‘(b) STATE ADVISORY BOARD.—

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

11 grant under subsection (a) only if the State involved

12 agrees to establish an advisory board within the ap13 propriate health department of the State or within

14 another department as designated by the chief execu15 tive officer of the State.

16 ‘‘(2) FUNCTIONS.—An advisory board established

17 under paragraph (1) shall be cognizant of findings

18 and concerns of Federal, State and local agencies,

19 citizens groups, and private industry (such as insur20 ance, health care, automobile, and other industry en21 tities). Such advisory boards shall encourage citizen

22 participation through the establishment of public

23 hearings and other types of community outreach pro24 grams.

25 ‘‘(3) COMPOSITION.—An advisory board estab26 lished under paragraph (1) shall be composed of—
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1 ‘‘(A) representatives of—

2 ‘‘(i) the corresponding State agencies

3 involved;

4 ‘‘(ii) public and nonprofit private

5 health related organizations;

6 ‘‘(iii) other disability advisory or

7 planning groups within the State;

8 ‘‘(iv) members of an organization or

9 foundation representing traumatic brain in10 jury survivors in that State; and

11 ‘‘(v) injury control programs at the

12 State or local level if such programs exist;

13 and

14 ‘‘(B) a substantial number of individuals

15 who are survivors of traumatic brain injury, or

16 the family members of such individuals.

17 ‘‘(c) MATCHING FUNDS.—

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

19 be incurred by a State in carrying out the purpose

20 described in subsection (a), the Secretary may make

21 a grant under such subsection only if the State agrees

22 to make available, in cash, non-Federal contributions

23 toward such costs in an amount that is not less than

24 $1 for each $2 of Federal funds provided under the

25 grant.
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1 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB2 UTED.—In determining the amount of non-Federal

3 contributions in cash that a State has provided pur4 suant to paragraph (1), the Secretary may not in5 clude any amounts provided to the State by the Fed6 eral Government.

7 ‘‘(d) APPLICATION FOR GRANT.—The Secretary may

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

9 for the grant is submitted to the Secretary and the applica10 tion is in such form, is made in such manner, and contains

11 such agreements, assurances, and information as the Sec12 retary determines to be necessary to carry out this section.

13 ‘‘(e) COORDINATION OF ACTIVITIES.—The Secretary

14 shall ensure that activities under this section are coordi15 nated as appropriate with other agencies of the Public

16 Health Service that carry out activities regarding trau17 matic brain injury.

18 ‘‘(f) REPORT.—Not later than 2 years after the effec19 tive date under section 901 of the Minority Health Improve20 ment Act of 1994, the Secretary shall submit to the Commit21 tee on Energy and Commerce of the House of Representa22 tives, and to the Committee on Labor and Human Re23 sources of the Senate, a report describing the findings and

24 results of the programs established under this section, in-
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1 cluding measures of outcomes and consumer and surrogate

2 satisfaction.

3 ‘‘(g) DEFINITION.—For purposes of this section, the

4 term ‘traumatic brain injury’ means an acquired injury

5 to the brain. Such term does not include brain dysfunction

6 caused by congenital or degenerative disorders, nor birth

7 trauma, but may include brain injuries caused by anoxia

8 due to near drowning.

9 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There

10 are authorized to be appropriated to carry out this section,

11 $5,000,000 for fiscal year 1995, and such sums as may be

12 necessary for each of the fiscal years 1996 and 1997.’’.

13 SEC. 704. STUDY; CONSENSUS CONFERENCE.

14 (a) STUDY.—

15 (1) IN GENERAL.—The Secretary of Health and

16 Human Services (in this section referred to as the

17 ‘‘Secretary’’), acting through the appropriate agencies

18 of the Public Health Service, shall conduct a study for

19 the purpose of carrying out the following with respect

20 to traumatic brain injury:

21 (A) In collaboration with appropriate State

22 and local health-related agencies—

23 (i) determine the incidence and preva24 lence of traumatic brain injury; and
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1 (ii) develop a uniform reporting sys2 tem under which States report incidences of

3 traumatic brain injury, if the Secretary de4 termines that such a system is appropriate.

5 (B) Identify common therapeutic interven6 tions which are used for the rehabilitation of in7 dividuals with such injuries, and shall, subject to

8 the availability of information, include an anal9 ysis of—

10 (i) the effectiveness of each such inter11 vention in improving the functioning of in12 dividuals with brain injuries;

13 (ii) the comparative effectiveness of

14 interventions employed in the course of re15 habilitation of individuals with brain inju16 ries to achieve the same or similar clinical

17 outcome; and

18 (iii) the adequacy of existing measures

19 of outcomes and knowledge of factors influ20 encing differential outcomes.

21 (C) Develop practice guidelines for the reha22 bilitation of traumatic brain injury at such time

23 as appropriate scientific research becomes avail24 able.

25 (2) DATES CERTAIN FOR REPORTS.—
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1 (A) Not later than 18 months after the effec2 tive date under section 901, the Secretary shall

3 submit to the Committee on Energy and Com4 merce of the House of Representatives, and to the

5 Committee on Labor and Human Resources of

6 the Senate, a report describing the findings made

7 as a result of carrying out paragraph (1)(A).

8 (B) Not later than 3 years after the effective

9 date under section 901, the Secretary shall sub10 mit to the Committees specified in subparagraph

11 (A) a report describing the findings made as a

12 result of carrying out subparagraphs (B) and

13 (C) of paragraph (1).

14 (b) CONSENSUS CONFERENCE.—The Secretary, acting

15 through the Director of the National Center for Medical Re16 habilitation Research within the National Institute for

17 Child Health and Human Development, shall conduct a na18 tional consensus conference on managing traumatic brain

19 injury and related rehabilitation concerns.

20 (c) DEFINITION.—For purposes of this section, the

21 term ‘‘traumatic brain injury’’ means an acquired injury

22 to the brain. Such term does not include brain dysfunction

23 caused by congenital or degenerative disorders, nor birth

24 trauma, but may include brain injuries caused by anoxia

25 due to near drowning.
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1 TITLE VIII—MISCELLANEOUS

2 PROVISIONS

3 SEC. 801. TECHNICAL AMENDMENT TO INDIAN HEALTH

4 CARE IMPROVEMENT ACT.

5 The last sentence of section 818(e)(3) of the Indian

6 Health Care Improvement Act (25 U.S.C. 1680h(e)(3)) is

7 amended—

8 (1) by striking ‘‘services,’’ and inserting ‘‘serv9 ices’’; and

10 (2) by striking ‘‘, shall be recoverable.’’ and in11 serting a period.

12 SEC. 802. HEALTH SERVICES FOR PACIFIC ISLANDERS.

13 Section 10 of the Disadvantaged Minority Health Im14 provement Act of 1990 (42 U.S.C. 254c–1) is amended—

15 (1) in subsection (b)—

16 (A) by striking paragraphs (5) and (6);

17 (B) by redesignating paragraphs (7) and

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

19 (C) in paragraph (2)—

20 (i) by inserting ‘‘substance abuse’’ after

21 ‘‘availability of health’’; and

22 (ii) by striking ‘‘, including improved

23 health data systems’’; and

24 (D) in paragraph (3)—
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1 (i) by striking ‘‘manpower’’ and in2 serting ‘‘care providers’’; and

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

4 follows through the end and inserting a

5 semicolon; and

6 (2) in subsection (f)—

7 (A) by striking ‘‘There is’’ and inserting

8 ‘‘There are’’; and

9 (B) by striking ‘‘$10,000,000’’ and all that

10 follows through ‘‘1993’’ and inserting

11 ‘‘$3,000,000 for each of the fiscal years 1995

12 through 1997’’.

13 SEC. 803. TECHNICAL CORRECTIONS REGARDING PUBLIC

14 LAW 103–183.

15 (a) AMENDATORY INSTRUCTIONS.—Public Law 103–

16 183 is amended—

17 (1) in section 601—

18 (A) in subsection (b), in the matter preced19 ing paragraph (1), by striking ‘‘Section 1201 of

20 the Public Health Service Act (42 U.S.C. 300d)’’

21 and inserting ‘‘Title XII of the Public Health

22 Service Act (42 U.S.C. 300d et seq.)’’; and

23 (B) in subsection (f)(1), by striking ‘‘in sec24 tion 1204(c)’’ and inserting ‘‘in section 1203(c)
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1 (as redesignated by subsection (b)(2) of this sec2 tion)’’;

3 (2) in section 602, by striking ‘‘for the purpose’’

4 and inserting ‘‘For the purpose’’; and

5 (3) in section 705(b), by striking ‘‘317D((l)(1)’’

6 and inserting ‘‘317D(l)(1)’’.

7 (b) PUBLIC HEALTH SERVICE ACT.—The Public

8 Health Service Act, as amended by Public Law 103–183

9 and by subsection (a) of this section, is amended—

10 (1) in section 317E(g)(2), by striking ‘‘making

11 grants under subsection (b)’’ and inserting ‘‘carrying

12 out subsection (b)’’;

13 (2) in section 318, in subsection (e) as in effect

14 on the day before the date of the enactment of Public

15 Law 103–183, by redesignating the subsection as sub16 section (f);

17 (3) in subpart 6 of part C of title IV—

18 (A) by transferring the first section 447

19 (added by section 302 of Public Law 103–183)

20 from the current placement of the section;

21 (B) by redesignating the section as section

22 447A; and

23 (C) by inserting the section after section

24 447;
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1 (4) in section 1213(a)(8), by striking ‘‘provides

2 for for’’ and inserting ‘‘provides for’’;

3 (5) in section 1501, by redesignating the second

4 subsection (c) (added by section 101(f) of Public Law

5 103–183) as subsection (d); and

6 (6) in section 1505(3), by striking ‘‘nonprofit’’.

7 (c) MISCELLANEOUS CORRECTION.—Section 401(c)(3)

8 of Public Law 103–183 is amended in the matter preceding

9 subparagraph (A) by striking ‘‘(d)(5)’’ and inserting

10 ‘‘(e)(5)’’.

11 (d) EFFECTIVE DATE.—This section is deemed to have

12 taken effect immediately after the enactment of Public Law

13 103–183.

14 SEC. 804. CERTAIN AUTHORITIES OF CENTERS FOR DIS15 EASE CONTROL AND PREVENTION.

16 (a) IN GENERAL.—Part B of title III of the Public

17 Health Service Act, as amended by section 701 of this Act,

18 is amended by inserting after section 317G the following

19 section:

20 ‘‘MISCELLANEOUS AUTHORITIES REGARDING CENTERS FOR

21 DISEASE CONTROL AND PREVENTION

22 ‘‘SEC. 317H. (a) TECHNICAL AND SCIENTIFIC PEER

23 REVIEW GROUPS.—The Secretary, acting through the Di24 rector of the Centers for Disease Control and Prevention,

25 may, without regard to the provisions of title 5, United

26 States Code, governing appointments in the competitive
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1 service, and without regard to the provisions of chapter 51

2 and subchapter III of chapter 53 of such title relating to

3 classification and General Schedule pay rates, establish

4 such technical and scientific peer review groups and sci5 entific program advisory committees as are needed to carry

6 out the functions of such Centers and appoint and pay the

7 members of such groups, except that officers and employees

8 of the United States shall not receive additional compensa9 tion for service as members of such groups. The Federal Ad10 visory Committee Act shall not apply to the duration of

11 such peer review groups. Not more than one-fourth of the

12 members of any such group shall be officers or employees

13 of the United States.

14 ‘‘(b) FELLOWSHIP AND TRAINING PROGRAMS.—The

15 Secretary, acting through the Director of the Centers for

16 Disease Control and Prevention, shall establish fellowship

17 and training programs to be conducted by such Centers to

18 train individuals to develop skills in epidemiology, surveil19 lance, laboratory analysis, and other disease detection and

20 prevention methods. Such programs shall be designed to en21 able health professionals and health personnel trained under

22 such programs to work, after receiving such training, in

23 local, State, national, and international efforts toward the

24 prevention and control of diseases, injuries, and disabilities.

25 Such fellowships and training may be administered through
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1 the use of either appointment or nonappointment proce2 dures.’’.

3 (b) EFFECTIVE DATE.—This section takes effect July

4 1, 1994.

5 SEC. 805. ESTABLISHMENT OF PUBLIC HEALTH ANALYT6 ICAL LABORATORY.

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

8 Human Services, acting as appropriate through the Direc9 tor of the Centers for Disease Control and Prevention or

10 through other agencies, may make a grant for the establish11 ment and operation of a laboratory to protect the public

12 health through analyzing human, wildlife, air, water, and

13 soil samples. The laboratory shall be established within the

14 United States at the central point of the international bor15 der between the United States and Mexico (as determined

16 by such Secretary), and the laboratory shall serve the border

17 region.

18 (b) AUTHORIZATION OF APPROPRIATIONS.—For the

19 purpose of carrying out subsection (a), there are authorized

20 to be appropriated such sums as may be necessary for fiscal

21 year 1995 and each subsequent fiscal year.

22 SEC. 806. ADMINISTRATION OF CERTAIN REQUIREMENTS.

23 (a) IN GENERAL.—Section 2004 of Public Law 103–

24 43 (107 Stat. 209) is amended by striking subsection (a).
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1 (b) CONFORMING AMENDMENTS.—Section 2004 of

2 Public Law 103–43, as amended by subsection (a) of this

3 section, is amended—

4 (1) by striking ‘‘(b) SENSE’’ and all that follows

5 through ‘‘In the case’’ and inserting the following:

6 ‘‘(a) SENSE OF CONGRESS REGARDING PURCHASE OF

7 AMERICAN-MADE EQUIPMENT AND PRODUCTS.—In the

8 case’’;

9 (2) by striking ‘‘(2) NOTICE TO RECIPIENTS OF

10 ASSISTANCE’’ and inserting the following:

11 ‘‘(b) NOTICE TO RECIPIENTS OF ASSISTANCE’’; and

12 (3) in subsection (b), as redesignated by para13 graph (2) of this subsection, by striking ‘‘paragraph

14 (1)’’ and inserting ‘‘subsection (a)’’.

15 (c) EFFECTIVE DATE.—This section is deemed to have

16 taken effect immediately after the enactment of Public Law

17 103–43.

18 SEC. 807. REVISIONS TO ELIGIBILITY REQUIREMENTS FOR

19 ENTITIES SUBJECT TO DRUG PRICING LIMI20 TATIONS.

21 (a) TREATMENT OF CERTAIN OUTPATIENT CLINICS AS

22 COVERED ENTITIES.—Section 340B(a)(4) of the Public

23 Health Service Act (42 U.S.C. 256b(a)(4)) is amended by

24 adding at the end the following subparagraph:
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1 ‘‘(M) A diagnostic and treatment center

2 owned and operated by the New York City

3 Health and Hospitals Corporation.’’.

4 (b) LIMITATION ON EXCLUSION BASED ON PARTICIPA5 TION IN GROUP PURCHASING ORGANIZATION.—Section

6 340B(a)(4)(L) of the Public Health Service Act (42 U.S.C.

7 256b(a)(4)(L)) is amended—

8 (1) in clause (i), by striking ‘‘under this title’’

9 and inserting ‘‘under title XIX of such Act’’; and

10 (2) in clause (iii), by inserting before the period

11 at the end the following: ‘‘, other than the Health

12 Services Purchasing Group under the control of Los

13 Angeles County’’.

14 (c) CLARIFICATION OF EFFECTIVE DATE OF EXCLU15 SION BASED ON PARTICIPATION IN GROUP PURCHASING

16 ORGANIZATION.—The Secretary of Health and Human

17 Services may not find that the hospital system for the Dal18 las County Hospital District of Texas (commonly known

19 as Parkland Memorial Hospital) fails to meet the require20 ments for a covered entity under paragraph (4)(L) of sec21 tion 340B(a) of the Public Health Service Act solely because

22 the hospital used a group purchasing organization or other

23 group purchasing arrangement to obtain a covered out24 patient drug before the effective date of the entity guidelines

25 published by the Secretary pursuant to section 602 of the
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1 Veterans Health Care Act of 1992 if, at the time the hospital

2 purchased the drug, the manufacturer of the drug did not

3 offer to furnish the drug to the hospital at the price required

4 to be paid for the drug under paragraph (1) of such section.

5 (d) EFFECTIVE DATES.—Subsections (a) and (b) take

6 effect as if included in the enactment of the Veterans Health

7 Care Act of 1992. Subsection (c) takes effect on the date

8 of the enactment of this Act.

9 TITLE IX—GENERAL PROVISIONS

10 SEC. 901. EFFECTIVE DATE.

11 Except as otherwise provided in this Act, this Act takes

12 effect October 1, 1994, or upon the date of the enactment

13 of this Act, whichever occurs later.

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