104TH CONGRESS

2D SESSION S. 555

AN ACT

To amend the Public Health Service Act to consolidate and

reauthorize health professions and minority and disadvantaged health education programs, and for other

purposes.

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

3 SECTION 1. SHORT TITLE.

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

5 ‘‘Health Professions Education Consolidation and Reau6 thorization Act of 1996’’.
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1 (b) TABLE OF CONTENTS.—The table of contents for

2 this Act is as follows:

Sec. 1. Short title.

TITLE I—HEALTH PROFESSIONS EDUCATION AND FINANCIAL

ASSISTANCE PROGRAMS

Subtitle A—Health Professions Education Programs

Sec. 101. Minority and disadvantaged health professions grant program.

Sec. 102. Training in family medicine, general internal medicine, general pediatrics, preventive medicine, physician assistants, and general

dentistry.

Sec. 103. Enhanced health education and training.

Sec. 104. Health professions workforce development.

Sec. 105. General provisions.

Sec. 106. Preference in certain programs.

Sec. 107. Definitions.

Sec. 108. Savings provision.

Subtitle B—Nursing Education

Sec. 121. Short title.

Sec. 122. Purpose.

Sec. 123. Amendments to Public Health Service Act.

Sec. 124. Savings provision.

Subtitle C—Financial Assistance

PART 1—NATIONAL HEALTH SERVICE CORPS FINANCIAL ASSISTANCE

PROGRAMS

Sec. 131. General amendments with respect to federally supported loans.

Sec. 132. Restructuring and technical amendments.

Sec. 133. Definition of underserved areas.

Sec. 134. Conforming amendments.

PART 2—SCHOOL-BASED REVOLVING LOAN FUNDS

Sec. 135. Primary care loan program.

Sec. 136. Loans for disadvantaged students.

Sec. 137. Student loans regarding schools of nursing.

Sec. 138. General provisions.

PART 3—INSURED HEALTH EDUCATION ASSISTANCE LOANS TO GRADUATE

STUDENTS

Sec. 141. Health education assistance loan program.

Sec. 142. HEAL lender and holder performance standards.

Sec. 143. Reauthorization.

PART 4—SCHOLARSHIPS FOR DISADVANTAGED STUDENTS

Sec. 151. Scholarships for disadvantaged students.

TITLE II—OFFICE OF MINORITY HEALTH
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Sec. 201. Revision and extension of programs of Office of Minority Health.

TITLE III—SELECTED INITIATIVES

Sec. 301. Programs regarding birth defects.

Sec. 302. State offices of rural health.

Sec. 303. Health services for Pacific Islanders.

Sec. 304. Demonstration projects regarding Alzheimer’s Disease.

TITLE IV—MISCELLANEOUS PROVISIONS

Sec. 401. Technical corrections regarding Public Law 103–183.

Sec. 402. Certain authorities of Centers for Disease Control and Prevention.

Sec. 403. Administration of certain requirements.

Sec. 404. Technical corrections relating to health professions programs.

Sec. 405. Clinical traineeships.

Sec. 406. Construction of regional centers for research on primates.

Sec. 407. Required consultation by Secretary.

1 TITLE I—HEALTH PROFESSIONS

2 EDUCATION AND FINANCIAL

3 ASSISTANCE PROGRAMS

4 Subtitle A—Health Professions

5 Education Programs

6 SEC. 101. MINORITY AND DISADVANTAGED HEALTH PRO7 FESSIONS GRANT PROGRAM.

8 (a) IN GENERAL.—Part B of title VII of the Public

9 Health Service Act (42 U.S.C. 293 et seq.) is amended

10 to read as follows:

11 ‘‘PART B—DISADVANTAGED HEALTH

12 PROFESSIONS TRAINING

13 ‘‘SEC. 736. STATEMENT OF PURPOSE.

14 ‘‘(a) IN GENERAL.—The Secretary shall make grants

15 to or enter into contracts with eligible entities for the pur16 pose of establishing, enhancing, and expanding programs

17 to increase the number and the quality of disadvantaged
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1 health professionals, particularly those who provide health

2 services to disadvantaged populations or in medically un3 derserved areas or rural areas.

4 ‘‘(b) USE OF FUNDS.—Amounts provided under a

5 grant or contract awarded under this part may be used

6 for costs of planning, developing, or operating centers of

7 excellence in minority health professions education, pro8 grams for assisting individuals from disadvantaged back9 grounds to enter a health profession, minority faculty de10 velopment, minority faculty loan repayment or fellowships,

11 trainee support, technical assistance, workforce analysis,

12 and dissemination of information.

13 ‘‘(c) CONSORTIUM.—Schools within a consortium

14 that applies for a grant or contract under this part shall

15 enter into an agreement to allocate the funds received

16 under the grant or contract among such schools and ex17 pend such funds in accordance with the application for

18 such grant or contract.

19 ‘‘SEC. 737. PREFERENCES.

20 ‘‘In awarding grants or contracts to eligible entities

21 under this part, the Secretary shall give preference to—

22 ‘‘(1) projects that involve more than one health

23 professions discipline or training institution and

24 have an above average record of retention and grad-
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1 uation of individuals from disadvantaged back2 grounds; and

3 ‘‘(2) centers of excellence at Historically Black

4 Colleges and Universities (as defined in section 739)

5 beginning in fiscal year 1999 and for each fiscal

6 year thereafter.

7 ‘‘SEC. 738. AUTHORIZATION OF APPROPRIATION.

8 ‘‘(a) IN GENERAL.—There are authorized to be ap9 propriated to carry out this part, $51,000,000 for fiscal

10 year 1996, and such sums as may be necessary for each

11 of the fiscal years 1997 through 1999.

12 ‘‘(b) SET-ASIDE.—The Secretary shall set-aside

13 $12,000,000 of the amount appropriated under subsection

14 (a) in each fiscal year for the purpose of making grants

15 under section 736 to centers of excellence at certain His16 torically Black Colleges and Universities.

17 ‘‘(c) NO LIMITATION.—Nothing in this section shall

18 be construed as limiting the centers of excellence referred

19 to in subsection (b) to the set-aside amount, or to preclude

20 such entities from competing for other grants under sec21 tion 736.

22 ‘‘SEC. 739. DEFINITIONS.

23 ‘‘As used in this part:
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1 ‘‘(1) CENTERS OF EXCELLENCE.—The term

2 ‘centers of excellence’ means a health professions

3 school that—

4 ‘‘(A)(i) has a significant number of minor5 ity individuals enrolled in the school, including

6 individuals accepted for enrollment in the

7 school;

8 ‘‘(ii) has been effective in assisting minor9 ity students of the school to complete the pro10 gram of education and receive the degree in11 volved;

12 ‘‘(iii) has been effective in recruiting mi13 nority individuals to attend the school and en14 couraging minority students of secondary edu15 cational institutions to attend the health profes16 sions school; and

17 ‘‘(iv) has made significant recruitment ef18 forts to increase the number of minority indi19 viduals serving in faculty or administrative posi20 tions at the school; or

21 ‘‘(B) is a center of excellence at certain

22 Historically Black Colleges and Universities.

23 ‘‘(2) CONSORTIUM.—The term ‘consortium’

24 means the designated eligible entity seeking a grant

25 under this part and one or more schools of medicine,
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1 osteopathic medicine, dentistry, pharmacy, nursing,

2 allied health, public health, or graduate programs in

3 mental health practice.

4 ‘‘(3) ELIGIBLE ENTITIES.—The term ‘eligible

5 entities’ means schools of medicine, osteopathic med6 icine, dentistry, pharmacy, podiatric medicine, op7 tometry, veterinary medicine, public health, or allied

8 health or schools offering graduate programs in

9 mental health practice, State or local governments,

10 and other public or nonprofit private entities deter11 mined appropriate by the Secretary that submit to

12 the Secretary an application.

13 ‘‘(4) HISTORICALLY BLACK COLLEGES AND

14 UNIVERSITIES.—The term ‘Historically Black Col15 leges and Universities’ means a school described in

16 section 799B(1) that has received a contract under

17 section 788B for fiscal year 1987, as such section

18 was in effect for such fiscal year.’’.

19 (b) REPEAL.—

20 (1) IN GENERAL.—Section 795 of the Public

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

22 (2) NONTERMINATION OF AUTHORITY.—The

23 amendments made by this section shall not be con24 strued to terminate agreements that, on the day be25 fore the date of enactment of this Act, are in effect
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1 pursuant to section 795 of the Public Health Service

2 Act (42 U.S.C. 795) as such section existed on such

3 date. Such agreements shall continue in effect in ac4 cordance with the terms of the agreements. With re5 spect to compliance with such agreements, any pe6 riod of practice as a provider of primary health serv7 ices shall be counted towards the satisfaction of the

8 requirement of practice pursuant to such section

9 795.

10 (c) CONFORMING AMENDMENTS.—Section

11 481A(c)(3)(D)(i) of the Public Health Service Act (42

12 U.S.C. 287a-2(c)(3)(D)(i)) is amended by striking ‘‘sec13 tion 739’’ and inserting ‘‘part B of title VII’’.

14 SEC. 102. TRAINING IN FAMILY MEDICINE, GENERAL INTER15 NAL MEDICINE, GENERAL PEDIATRICS, PRE16 VENTIVE MEDICINE, PHYSICIAN ASSISTANTS,

17 AND GENERAL DENTISTRY.

18 Part C of title VII of the Public Health Service Act

19 (42 U.S.C. 293 et seq.) is amended—

20 (1) in the part heading by striking ‘‘PRIMARY

21 HEALTH CARE’’ and inserting ‘‘FAMILY MEDI22 CINE, GENERAL INTERNAL MEDICINE, GEN23 ERAL PEDIATRICS, PREVENTIVE MEDICINE,

24 PHYSICIAN ASSISTANTS, AND GENERAL

25 DENTISTRY’’;
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1 (2) by repealing section 746 and sections 748

2 through 752 (42 U.S.C. 293j and 293l through

3 293p); and

4 (3) in section 747 (42 U.S.C. 293k)—

5 (A) by striking the section heading and in6 serting the following:

7 ‘‘SEC. 747. FAMILY MEDICINE, GENERAL INTERNAL MEDI8 CINE, GENERAL PEDIATRICS, PREVENTIVE

9 MEDICINE, GENERAL DENTISTRY, AND PHYSI10 CIAN ASSISTANTS.’’;

11 (B) in subsection (a)—

12 (i) in paragraph (1)—

13 (I) by inserting ‘‘, internal medi14 cine, or pediatrics’’ after ‘‘family med15 icine’’; and

16 (II) by inserting before the semi17 colon the following: ‘‘that emphasizes

18 training for the practice of family

19 medicine, general internal medicine,

20 or general pediatrics (as defined by

21 the Secretary)’’;

22 (ii) in paragraph (2), by inserting ‘‘,

23 general internal medicine, or general pedi24 atrics’’ before the semicolon;
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1 (iii) in paragraphs (3) and (4), by in2 serting ‘‘, general internal medicine (in3 cluding geriatrics), or general pediatrics’’

4 after ‘‘family medicine’’;

5 (iv) in paragraphs (3) and (4), by in6 serting ‘‘(including geriatrics) after ‘‘fam7 ily medicine’’;

8 (v) in paragraph (3), by striking

9 ‘‘and’’ at the end thereof;

10 (vi) in paragraph (4), by striking the

11 period and inserting a semicolon; and

12 (vii) by adding at the end thereof the

13 following new paragraphs:

14 ‘‘(5) to meet the costs of projects to plan, de15 velop, and operate or maintain programs for the

16 training of physician assistants (as defined in sec17 tion 799B), and for the training of individuals who

18 will teach in programs to provide such training;

19 ‘‘(6) to meet the costs of projects—

20 ‘‘(A) to plan and develop new residency

21 training programs and to maintain or improve

22 existing residency training programs in preven23 tive medicine, that have available full-time fac24 ulty members with training and experience in

25 the fields of preventive medicine; and
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1 ‘‘(B) to provide financial assistance to resi2 dency trainees enrolled in such programs; and

3 ‘‘(7) to meet the costs of planning, developing,

4 or operating programs, and to provide financial as5 sistance to residents in such programs, that would

6 lead to a significantly greater ratio of participating

7 individuals in such programs eventually entering

8 practice in general dentistry in rural and medically

9 underserved communities compared to the current

10 ratio of all dentists nationally practicing general

11 dentistry in rural and medically underserved commu12 nities.

13 For purposes of paragraph (7), entities eligible for such

14 grants or contracts shall include entities that have pro15 grams in dental schools, approved residency programs in

16 the general practice of dentistry, or approved advanced

17 education programs in the general practice of dentistry.

18 The Secretary may only fund programs under such para19 graph if such programs provide a significant amount of

20 care for underserved populations and other high-risk

21 groups.’’;

22 (C) in paragraphs (1) and (2)(A) of sub23 section (b), by inserting ‘‘, general internal

24 medicine, or general pediatrics’’ after ‘‘family

25 medicine’’;
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1 (D) by redesignating subsections (c) and

2 (d) as subsections (d) and (e), respectively;

3 (E) by inserting after subsection (b), the

4 following new subsection:

5 ‘‘(c) PRIORITY AND LIMITATION.—

6 ‘‘(1) PRIORITY.—With respect to programs for

7 the training of interns or residents, the Secretary

8 shall give priority in awarding grants under this sec9 tion to qualified applicants that have a record of

10 training the greatest percentage of providers, or that

11 have demonstrated significant improvements in the

12 percentage of providers, which enter and remain in

13 primary care practice or general dentistry upon com14 pletion of their first period of training required to

15 obtain initial board certification. Each program shall

16 designate the primary care training or general den17 tistry positions that such program shall provide with

18 grant funding to support and for which such pro19 gram shall be held accountable regarding the pri20 mary care or general dentistry requirement set forth

21 in this section.

22 ‘‘(2) LIMITATION.—With respect to programs

23 for the training and education of medical students,

24 the Secretary may only provide grants or contracts

25 under this section to administrative units in general
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1 pediatrics or general internal medicine if a qualified

2 administrative unit applicant demonstrates that its

3 medical school has—

4 ‘‘(A) a mission statement that has a pri5 mary care medical education objective;

6 ‘‘(B) faculty role models and administra7 tive units in primary care; and

8 ‘‘(C) required undergraduate ambulatory

9 medical student clerkships in family medicine,

10 internal medicine, and pediatrics.

11 Where a medical school does not have an adminis12 trative unit in family medicine, clerkships in family

13 medicine shall not be required.’’; and

14 (F) in subsection (e) (as so redesignated

15 by subparagraph (D))—

16 (i) in paragraph (1), by striking

17 ‘‘$54,000,000’’ and all that follows and in18 serting ‘‘$76,000,000 for fiscal year 1996,

19 and such sums as may be necessary for

20 each of the fiscal years 1997 through

21 1999.’’; and

22 (ii) in paragraph (2)—

23 (I) by striking ‘‘20’’ and insert24 ing ‘‘12’’; and
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1 (II) by inserting ‘‘for family med2 icine academic administrative units’’

3 after ‘‘under subsection (b)’’.

4 SEC. 103. ENHANCED HEALTH EDUCATION AND TRAINING.

5 Part D of title VII of the Public Health Service Act

6 (42 U.S.C. 294 et seq.) is amended to read as follows:

7 ‘‘PART D—AREA HEALTH EDUCATION CENTERS

8 ‘‘SEC. 750. AREA HEALTH EDUCATION CENTERS.

9 ‘‘(a) IN GENERAL.—The Secretary may award grants

10 to and enter into contracts with eligible entities for

11 projects which —

12 ‘‘(1) improve the recruitment, distribution, sup13 ply, quality, utilization, and efficiency of personnel

14 providing health services in urban and rural areas

15 and to populations that have demonstrated serious

16 unmet health care need;

17 ‘‘(2) encourage the regionalization of edu18 cational responsibilities of the health professions

19 schools;

20 ‘‘(3) are designed to prepare, through field

21 placements, preceptorships, the conduct of or affili22 ation with community-based primary care residency

23 programs, agreements with community-based organi24 zations for the delivery of education and training in

25 the health professions, and other programs, individ-
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1 uals to effectively provide health services in health

2 professional shortage areas;

3 ‘‘(4) conduct health professions education and

4 training activities consistent with national and State

5 priorities, including geriatrics;

6 ‘‘(5) encourage health promotion and disease

7 prevention activities;

8 ‘‘(6) conduct interdisciplinary training and

9 practice involving other health professionals;

10 ‘‘(7) conduct continuing education programs for

11 health professionals or coordinate with such pro12 grams; and

13 ‘‘(8) address other areas as determined appro14 priate by the Secretary.

15 ‘‘(b) OTHER ELIGIBLE PROGRAMS.—

16 ‘‘(1) GERIATRIC EDUCATION CENTERS.—The

17 Secretary shall award grants or contracts under this

18 section for the establishment or operation of geri19 atric education centers.

20 ‘‘(2) PUBLIC HEALTH TRAINING CENTERS.—

21 ‘‘(A) IN GENERAL.—The Secretary shall

22 award grants or contracts under this section for

23 the operation of public health training centers.

24 ‘‘(B) ELIGIBLE ENTITIES.—A public

25 health training center shall be an accredited
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1 school of public health, or another public or

2 nonprofit private institution accredited for the

3 provision of graduate or specialized training in

4 public health, that plans, develops, operates,

5 and evaluates projects that are in furtherance

6 of the goals established by the Secretary for the

7 year 2000 in the areas of preventive medicine,

8 health promotion and disease prevention, or im9 proving access to and quality of health services

10 in medically underserved communities.

11 ‘‘(C) CERTAIN REQUIREMENTS.—With re12 spect to a public health training center, an

13 award may not be made under subparagraph

14 (A) unless the program agrees that it—

15 ‘‘(i) will establish or strengthen field

16 placements for students in public or non17 profit private health agencies or organiza18 tions; and

19 ‘‘(ii) will involve faculty members and

20 students in collaborative projects to en21 hance public health services to medically

22 underserved communities.

23 ‘‘(c) ELIGIBLE ENTITIES.—As used in this part, the

24 term ‘eligible entities’ means schools of medicine, osteo25 pathic medicine, dentistry, pharmacy, podiatric medicine,
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1 optometry, veterinary medicine, public health, or allied

2 health or schools offering graduate programs in mental

3 health practice or physician assistant training programs,

4 State or local governments, and other public or nonprofit

5 private entities determined appropriate by the Secretary

6 that submit to the Secretary an application.

7 ‘‘(d) GERIATRIC EDUCATION CENTERS.—A geriatric

8 education center shall be an accredited health professions

9 school or program that—

10 ‘‘(1) improves the training of health profes11 sionals in geriatrics, including geriatric residencies,

12 traineeships, or fellowships;

13 ‘‘(2) develops and disseminates curricula relat14 ing to the treatment of the health problems of elder15 ly individuals;

16 ‘‘(3) supports the training and retraining of

17 faculty to provide instruction in geriatrics;

18 ‘‘(4) supports continuing education of health

19 professionals who provide geriatric care; and

20 ‘‘(5) provides students with clinical training in

21 geriatrics in nursing homes, chronic and acute dis22 ease hospitals, ambulatory care centers, and senior

23 centers.
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1 ‘‘SEC. 751. AUTHORIZATION OF APPROPRIATIONS.

2 ‘‘There are authorized to be appropriated to carry out

3 this part, $43,000,000 for fiscal year 1996, such sums as

4 may be necessary for each of the fiscal years 1997 and

5 1998, and $29,000,000 for fiscal year 1999.’’.

6 SEC. 104. HEALTH PROFESSIONS WORKFORCE DEVELOP7 MENT.

8 (a) IN GENERAL.—Part E of title VII of the Public

9 Health Service Act (42 U.S.C. 294n et seq.) is amended—

10 (1) in the part heading to read as follows:

11 ‘‘PART E—HEALTH PROFESSIONS WORKFORCE

12 DEVELOPMENT’’;

13 (2) by redesignating section 776 (42 U.S.C.

14 294n) as section 761; and

15 (3) by striking sections 777 and 778 (42 U.S.C.

16 294o and 294p) and inserting the following new sec17 tion:

18 ‘‘SEC. 762. HEALTH PROFESSIONS WORKFORCE DEVELOP19 MENT.

20 ‘‘(a) IN GENERAL.—The Secretary may award grants

21 to and enter into contracts with eligible entities for

22 projects to strengthen capacity for health professions edu23 cation and practice.

24 ‘‘(b) ELIGIBLE APPLICANTS.—Applicants eligible to

25 obtain funds under subsection (a) shall include schools of

26 medicine, osteopathic medicine, dentistry, veterinary medi-
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1 cine, pharmacy, podiatric medicine, chiropractic medicine,

2 optometry, public health, or allied health, graduate pro3 grams in mental health practice, physician assistant train4 ing programs, and other public and nonprofit private enti5 ties.

6 ‘‘(c) PRIORITY AREAS.—In awarding grants or con7 tracts under subsection (a), the Secretary shall give prior8 ity to entities that will use amounts provided under such

9 grants or contracts to enhance the education of health pro10 fessionals for purposes of—

11 ‘‘(1) providing care for underserved populations

12 and other high-risk groups;

13 ‘‘(2) increasing the number of individuals who

14 are pursuing a course of study in a health profes15 sions field in which there is a severe shortage of

16 health professionals;

17 ‘‘(3) conducting health professions research and

18 data collection; and

19 ‘‘(4) carrying out other activities in areas deter20 mined appropriate by the Secretary.

21 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—

22 ‘‘(1) IN GENERAL.—There are authorized to be

23 appropriated to carry out this section, $16,000,000

24 for fiscal year 1996, and such sums as may be nec-
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1 essary for each of the fiscal years 1997 through

2 1999.

3 ‘‘(2) RESERVATION.—Of the amounts appro4 priated under subsection (a) for a fiscal year, the

5 Secretary shall reserve not less than $2,000,000 for

6 conducting health professions research and for car7 rying out data collection and analysis in accordance

8 with section 792.’’.

9 (b) HEALTH PROFESSIONS DATA.—The second sen10 tence of section 792(a) of the Public Health Service Act

11 (42 U.S.C. 295k(a)) is amended—

12 (1) by striking ‘‘is authorized to’’ and inserting

13 ‘‘shall’’; and

14 (2) by inserting ‘‘clinical social workers,’’ after

15 ‘‘clinical psychologists,’’.

16 (c) COUNCIL ON GRADUATE MEDICAL EDUCATION.—

17 Section 301 of the Health Professions Education Exten18 sion Amendments of 1992 (Public Law 102-408) is

19 amended—

20 (1) in subsection (j), by striking ‘‘1995’’ and

21 inserting ‘‘1999’’;

22 (2) in subsection (k), by striking ‘‘1995’’ and

23 inserting ‘‘1999’’;

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

25 new subsection:
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1 ‘‘(l) FUNDING.—Amounts otherwise appropriated

2 under this title may be utilized by the Secretary to support

3 the activities of the Council.’’;

4 (4) by transferring such section to part E of

5 title VII of the Public Health Service Act (as

6 amended by subsection (a));

7 (5) by redesignating such section as section

8 763; and

9 (6) by inserting such section after section 762.

10 SEC. 105. GENERAL PROVISIONS.

11 (a) IN GENERAL.—

12 (1) Part F of title VII of the Public Health

13 Service Act (42 U.S.C. 295 et seq.) is repealed.

14 (2) Part G of title VII of the Public Health

15 Service Act (42 U.S.C. 295j et seq.) is amended—

16 (A) by redesignating such part as part F;

17 (B) in section 791 (42 U.S.C. 295j)—

18 (i) by striking subsection (b); and

19 (ii) redesignating subsection (c) as

20 subsection (b);

21 (C) by repealing section 793 (42 U.S.C.

22 295l);

23 (D) by repealing section 798;

24 (E) by redesignating section 799 as section

25 799B; and
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1 (F) by inserting after section 794, the fol2 lowing new sections:

3 ‘‘SEC. 796. APPLICATION.

4 ‘‘(a) IN GENERAL.—To be eligible to receive a grant

5 or contract under this title, an eligible entity shall prepare

6 and submit to the Secretary an application that meets the

7 requirements of this section, at such time, in such manner,

8 and containing such information as the Secretary may re9 quire.

10 ‘‘(b) PLAN.—An application submitted under this

11 section shall contain the plan of the applicant for carrying

12 out a project with amounts received under this title. Such

13 plan shall be consistent with relevant Federal, State, or

14 regional program plans.

15 ‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An ap16 plication submitted under this section shall contain a spec17 ification by the applicant entity of performance outcome

18 standards that the project to be funded under the grant

19 or contract will be measured against. Such standards shall

20 address relevant health workforce needs that the project

21 will meet. The recipient of a grant or contract under this

22 section shall meet the standards set forth in the grant or

23 contract application.

24 ‘‘(d) LINKAGES.—An application submitted under

25 this section shall contain a description of the linkages with
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1 relevant educational and health care entities, including

2 training programs for other health professionals as appro3 priate, that the project to be funded under the grant or

4 contract will establish.

5 ‘‘SEC. 797. USE OF FUNDS.

6 ‘‘(a) IN GENERAL.—Amounts provided under a grant

7 or contract awarded under this title may be used for train8 ing program development and support, faculty develop9 ment, model demonstrations, trainee support including

10 tuition, books, program fees and reasonable living ex11 penses during the period of training, technical assistance,

12 workforce analysis, and dissemination of information, as

13 appropriate to meet recognized health workforce objec14 tives, in accordance with this title.

15 ‘‘(b) MAINTENANCE OF EFFORT.—With respect to

16 activities for which a grant awarded under this title is to

17 be expended, the entity shall agree to maintain expendi18 tures of non-Federal amounts for such activities at a level

19 that is not less than the level of such expenditures main20 tained by the entity for the fiscal year preceding the fiscal

21 year for which the entity receives such a grant.

22 ‘‘SEC. 798. MATCHING REQUIREMENT.

23 ‘‘The Secretary may require that an entity that ap24 plies for a grant or contract under this title provide non25 Federal matching funds, as appropriate, to ensure the in-
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1 stitutional commitment of the entity to the projects funded

2 under the grant. As determined by the Secretary, such

3 non-Federal matching funds may be provided directly or

4 through donations from public or private entities and may

5 be in cash or in-kind, fairly evaluated, including plant,

6 equipment, or services.

7 ‘‘SEC. 799. GENERALLY APPLICABLE PROVISIONS.

8 ‘‘(a) AWARDING OF GRANTS AND CONTRACTS.—The

9 Secretary shall ensure that grants and contracts under

10 this title are awarded on a competitive basis, as appro11 priate, to carry out innovative demonstration projects or

12 provide for strategic workforce supplementation activities

13 as needed to meet health workforce goals and in accord14 ance with this title. Contracts may be entered into under

15 this title with public or private entities as may be nec16 essary.

17 ‘‘(b) INFORMATION REQUIREMENTS.—Recipients of

18 grants and contracts under this title shall meet informa19 tion requirements as specified by the Secretary.

20 ‘‘(c) TRAINING PROGRAMS.—Training programs con21 ducted with amounts received under this title shall meet

22 applicable accreditation and quality standards.

23 ‘‘(d) DURATION OF ASSISTANCE.—

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

25 in the case of an award to an entity of a grant, co-
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1 operative agreement, or contract under this title, the

2 period during which payments are made to the en3 tity under the award may not exceed 5 years. The

4 provision of payments under the award shall be sub5 ject to annual approval by the Secretary of the pay6 ments and subject to the availability of appropria7 tions for the fiscal year involved to make the pay8 ments. This paragraph may not be construed as lim9 iting the number of awards under the program in10 volved that may be made to the entity.

11 ‘‘(2) LIMITATION.—In the case of an award to

12 an entity of a grant, cooperative agreement, or con13 tract under this title, paragraph (1) shall apply only

14 to the extent not inconsistent with any other provi15 sion of this title that relates to the period during

16 which payments may be made under the award.

17 ‘‘(e) PEER REVIEW REGARDING CERTAIN PRO18 GRAMS.—Each application for a grant under this title, ex19 cept any scholarship or loan program, including those

20 under sections 701, 721, or 723, shall be submitted to a

21 peer review group for an evaluation of the merits of the

22 proposals made in the application. The Secretary may not

23 approve such an application unless a peer review group

24 has recommended the application for approval. Each peer

25 review group under this subsection shall be composed prin-
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1 cipally of individuals who are not officers or employees of

2 the Federal Government. This subsection shall be carried

3 out by the Secretary acting through the Administrator of

4 the Health Resources and Services Administration.

5 ‘‘(f) PREFERENCE OR PRIORITY CONSIDERATIONS.—

6 In considering a preference or priority for funding which

7 is based on outcome measures for an eligible entity under

8 this title, the Secretary may also consider the future abil9 ity of the eligible entity to meet the outcome preference

10 or priority through improvements in the eligible entity’s

11 program design.

12 ‘‘SEC. 799A. TECHNICAL ASSISTANCE.

13 ‘‘Funds appropriated under this title may be used by

14 the Secretary to provide technical assistance in relation

15 to any of the authorities under this title.’’.

16 SEC. 106. PREFERENCE IN CERTAIN PROGRAMS.

17 (a) IN GENERAL.—Section 791 of the Public Health

18 Service Act (42 U.S.C. 295j), as amended by section

19 105(a)(2)(B), is further amended by adding at the end

20 thereof the following subsection:

21 ‘‘(c) EXCEPTIONS FOR NEW PROGRAMS.—

22 ‘‘(1) IN GENERAL.—To permit new programs to

23 compete equitably for funding under this section,

24 those new programs that meet the criteria described
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1 in paragraph (3) shall qualify for a funding pref2 erence under this section.

3 ‘‘(2) DEFINITION.—As used in this subsection,

4 the term ‘new program’ means any program that

5 has graduated less than three classes. Upon grad6 uating at least three classes, a program shall have

7 the capability to provide the information necessary

8 to qualify the program for the general funding pref9 erences described in subsection (a).

10 ‘‘(3) CRITERIA.—The criteria referred to in

11 paragraph (1) are the following:

12 ‘‘(A) The mission statement of the pro13 gram identifies a specific purpose of the pro14 gram as being the preparation of health profes15 sionals to serve underserved populations.

16 ‘‘(B) The curriculum of the program in17 cludes content which will help to prepare practi18 tioners to serve underserved populations.

19 ‘‘(C) Substantial clinical training experi20 ence is required under the program in medically

21 underserved communities.

22 ‘‘(D) A minimum of 20 percent of the clin23 ical faculty of the program spend at least 50

24 percent of their time providing or supervising

25 care in medically underserved communities.
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1 ‘‘(E) The entire program or a substantial

2 portion of the program is physically located in

3 a medically underserved community.

4 ‘‘(F) Student assistance, which is linked to

5 service in medically underserved communities

6 following graduation, is available to the stu7 dents in the program.

8 ‘‘(G) The program provides a placement

9 mechanism for deploying graduates to medically

10 underserved communities.’’.

11 (b) CONFORMING AMENDMENTS.—Section 791(a) of

12 the Public Health Service Act (42 U.S.C. 295j(a)) is

13 amended—

14 (1) in paragraph (1), by striking ‘‘sections 747’’

15 and all that follows through ‘‘767’’ and inserting

16 ‘‘sections 747 and 750’’; and

17 (2) in paragraph (2), by striking ‘‘under section

18 798(a)’’.

19 SEC. 107. DEFINITIONS.

20 (a) PROFESSIONAL PSYCHOLOGY.—Section

21 799B(1)(B) of the Public Health Service Act (42 U.S.C.

22 295p(1)(B)) (as so redesignated by section 105(a)(2)(E))

23 is amended by striking ‘‘program in clinical psychology’’

24 and inserting ‘‘graduate programs in professional psychol25 ogy’’.
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1 (b) MEDICALLY UNDERSERVED COMMUNITY.—Sec2 tion 799B(6) of the Public Health Service Act (42 U.S.C.

3 295p(6)) (as so redesignated by section 105(a)(2)(E)) is

4 amended—

5 (1) in subparagraph (B), by striking ‘‘or’’ at

6 the end thereof;

7 (2) in subparagraph (C), by striking the period

8 and inserting a semicolon; and

9 (3) by adding at the end the following new sub10 paragraphs:

11 ‘‘(D) is a State or local health department

12 that has a severe shortage of public health per13 sonnel as determined under criteria established

14 by the Secretary;

15 ‘‘(E) has ambulatory practice sites des16 ignated by State Governors as shortage areas or

17 medically underserved communities for purposes

18 of State scholarships or loan repayment or re19 lated programs; or

20 ‘‘(F) has practices or facilities in which not

21 less than 50 percent of the patients are recipi22 ents of aid under title XIX of the Social Secu23 rity Act or eligible and uninsured.’’.

24 (c) PROGRAMS FOR THE TRAINING OF PHYSICIAN

25 ASSISTANTS.—Paragraph (3) of section 799B of the Pub-
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1 lic Health Service Act (42 U.S.C. 295p) (as so redesig2 nated by section 105(a)(2)(E)) is amended to read as fol3 lows:

4 ‘‘(3) The term ‘program for the training of phy5 sician assistants’ means an educational program

6 that—

7 ‘‘(A) has as its objective the education of

8 individuals who will, upon completion of their

9 studies in the program, be qualified to provide

10 primary care under the supervision of a physi11 cian;

12 ‘‘(B) extends for at least one academic

13 year and consists of—

14 ‘‘(i) supervised clinical practice; and

15 ‘‘(ii) at least four months (in the ag16 gregate) of classroom instruction, directed

17 toward preparing students to deliver health

18 care;

19 ‘‘(C) has an enrollment of not less than

20 eight students; and

21 ‘‘(D) trains students in primary care, dis22 ease prevention, health promotion, geriatric

23 medicine, and home health care.’’.
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1 SEC. 108. SAVINGS PROVISION.

2 In the case of any authority for making awards of

3 grants or contracts that is terminated by the amendments

4 made by this subtitle, the Secretary of Health and Human

5 Services may, notwithstanding the termination of the au6 thority, continue in effect any grant or contract made

7 under the authority that is in effect on the day before the

8 date of the enactment of this Act, subject to the duration

9 of any such grant or contract not exceeding the period

10 determined by the Secretary in first approving such finan11 cial assistance, or in approving the most recent request

12 made (before the date of such enactment) for continuation

13 of such assistance, as the case may be.

14 Subtitle B—Nursing Education

15 SEC. 121. SHORT TITLE.

16 This title may be cited as the ‘‘Nursing Education

17 Consolidation and Reauthorization Act of 1996’’.

18 SEC. 122. PURPOSE.

19 It is the purpose of this title to restructure the nurse

20 education authorities of title VIII of the Public Health

21 Service Act to permit a comprehensive, flexible, and effec22 tive approach to Federal support for nursing workforce

23 development.

24 SEC. 123. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.

25 Title VIII of the Public Health Service Act (42

26 U.S.C. 296k et seq.) is amended—
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1 (1) by striking the title heading and all that fol2 lows except for subparts II and III of part B and

3 section 855; and inserting the following:

4 ‘‘TITLE VIII—NURSING

5 WORKFORCE DEVELOPMENT’’;

6 (2) by redesignating subpart III of part B as

7 subpart II;

8 (3) in subpart II of part B, by striking the sub9 part heading and inserting the following:

10 ‘‘PART E—STUDENT LOANS

11 ‘‘Subpart I—General Program’’;

12 (4) by striking section 837;

13 (5) by inserting after the title heading the fol14 lowing new parts:

15 ‘‘PART A—GENERAL PROVISIONS

16 ‘‘SEC. 801. DEFINITIONS.

17 ‘‘As used in this title:

18 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible

19 entities’ means schools of nursing, nursing centers,

20 State or local governments, and other public or non21 profit private entities determined appropriate by the

22 Secretary that submit to the Secretary an applica23 tion in accordance with section 802.
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1 ‘‘(2) SCHOOL OF NURSING.—The term ‘school

2 of nursing’ means a collegiate, associate degree, or

3 diploma school of nursing in a State.

4 ‘‘(3) COLLEGIATE SCHOOL OF NURSING.—The

5 term ‘collegiate school of nursing’ means a depart6 ment, division, or other administrative unit in a col7 lege or university which provides primarily or exclu8 sively a program of education in professional nursing

9 and related subjects leading to the degree of bach10 elor of arts, bachelor of science, bachelor of nursing,

11 or to an equivalent degree, or to a graduate degree

12 in nursing, and including advanced training related

13 to such program of education provided by such

14 school, but only if such program, or such unit, col15 lege or university is accredited.

16 ‘‘(4) ASSOCIATE DEGREE SCHOOL OF NURS17 ING.—The term ‘associate degree school of nursing’

18 means a department, division, or other administra19 tive unit in a junior college, community college, col20 lege, or university which provides primarily or exclu21 sively a two-year program of education in profes22 sional nursing and allied subjects leading to an asso23 ciate degree in nursing or to an equivalent degree,

24 but only if such program, or such unit, college, or

25 university is accredited.
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1 ‘‘(5) DIPLOMA SCHOOL OF NURSING.—The

2 term ‘diploma school of nursing’ means a school af3 filiated with a hospital or university, or an independ4 ent school, which provides primarily or exclusively a

5 program of education in professional nursing and al6 lied subjects leading to a diploma or to equivalent

7 indicia that such program has been satisfactorily

8 completed, but only if such program, or such affili9 ated school or such hospital or university or such

10 independent school is accredited.

11 ‘‘(6) ACCREDITED.—

12 ‘‘(A) IN GENERAL.—Except as provided in

13 subparagraph (B), the term ‘accredited’ when

14 applied to any program of nurse education

15 means a program accredited by a recognized

16 body or bodies, or by a State agency, approved

17 for such purpose by the Secretary of Education

18 and when applied to a hospital, school, college,

19 or university (or a unit thereof) means a hos20 pital, school, college, or university (or a unit

21 thereof) which is accredited by a recognized

22 body or bodies, or by a State agency, approved

23 for such purpose by the Secretary of Education.

24 For the purpose of this paragraph, the Sec25 retary of Education shall publish a list of recog-
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1 nized accrediting bodies, and of State agencies,

2 which the Secretary of Education determines to

3 be reliable authority as to the quality of edu4 cation offered.

5 ‘‘(B) NEW PROGRAMS.—A new school of

6 nursing that, by reason of an insufficient period

7 of operation, is not, at the time of the submis8 sion of an application for a grant or contract

9 under this title, eligible for accreditation by

10 such a recognized body or bodies or State agen11 cy, shall be deemed accredited for purposes of

12 this title if the Secretary of Education finds,

13 after consultation with the appropriate accredi14 tation body or bodies, that there is reasonable

15 assurance that the school will meet the accredi16 tation standards of such body or bodies prior to

17 the beginning of the academic year following

18 the normal graduation date of students of the

19 first entering class in such school.

20 ‘‘(7) NONPROFIT.—The term ‘nonprofit’ as ap21 plied to any school, agency, organization, or institu22 tion means one which is a corporation or association,

23 or is owned and operated by one or more corpora24 tions or associations, no part of the net earnings of
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1 which inures, or may lawfully inure, to the benefit

2 of any private shareholder or individual.

3 ‘‘(8) STATE.—The term ‘State’ means a State,

4 the Commonwealth of Puerto Rico, the District of

5 Columbia, the Commonwealth of the Northern Mari6 ana Islands, Guam, American Samoa, the Virgin Is7 lands, or the Trust Territory of the Pacific Islands.

8 ‘‘SEC. 802. APPLICATION.

9 ‘‘(a) IN GENERAL.—To be eligible to receive a grant

10 or contract under this title, an eligible entity shall prepare

11 and submit to the Secretary an application that meets the

12 requirements of this section, at such time, in such manner,

13 and containing such information as the Secretary may re14 quire.

15 ‘‘(b) PLAN.—An application submitted under this

16 section shall contain the plan of the applicant for carrying

17 out a project with amounts received under this title. Such

18 plan shall be consistent with relevant Federal, State, or

19 regional program plans.

20 ‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An ap21 plication submitted under this section shall contain a spec22 ification by the applicant entity of performance outcome

23 standards that the project to be funded under the grant

24 or contract will be measured against. Such standards shall

25 address relevant national nursing needs that the project
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1 will meet. The recipient of a grant or contract under this

2 section shall meet the standards set forth in the grant or

3 contract application.

4 ‘‘(d) LINKAGES.—An application submitted under

5 this section shall contain a description of the linkages with

6 relevant educational and health care entities, including

7 training programs for other health professionals as appro8 priate, that the project to be funded under the grant or

9 contract will establish.

10 ‘‘SEC. 803. USE OF FUNDS.

11 ‘‘(a) IN GENERAL.—Amounts provided under a grant

12 or contract awarded under this title may be used for train13 ing program development and support, faculty develop14 ment, model demonstrations, trainee support including

15 tuition, books, program fees and reasonable living ex16 penses during the period of training, technical assistance,

17 workforce analysis, and dissemination of information, as

18 appropriate to meet recognized nursing objectives, in ac19 cordance with this title.

20 ‘‘(b) MAINTENANCE OF EFFORT.—With respect to

21 activities for which a grant awarded under this title is to

22 be expended, the entity shall agree to maintain expendi23 tures of non-Federal amounts for such activities at a level

24 that is not less than the level of such expenditures main-
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1 tained by the entity for the fiscal year preceding the fiscal

2 year for which the entity receives such a grant.

3 ‘‘SEC. 804. MATCHING REQUIREMENT.

4 ‘‘The Secretary may require that an entity that ap5 plies for a grant or contract under this title provide non6 Federal matching funds, as appropriate, to ensure the in7 stitutional commitment of the entity to the projects funded

8 under the grant. Such non-Federal matching funds may

9 be provided directly or through donations from public or

10 private entities and may be in cash or in-kind, fairly evalu11 ated, including plant, equipment, or services.

12 ‘‘SEC. 805. PREFERENCE.

13 ‘‘In awarding grants or contracts under this title, the

14 Secretary shall give preference to applicants with projects

15 that will substantially benefit rural or underserved popu16 lations, or help meet public health nursing needs in State

17 or local health departments.

18 ‘‘SEC. 806. GENERALLY APPLICABLE PROVISIONS.

19 ‘‘(a) AWARDING OF GRANTS AND CONTRACTS.—The

20 Secretary shall ensure that grants and contracts under

21 this title are awarded on a competitive basis, as appro22 priate, to carry out innovative demonstration projects or

23 provide for strategic workforce supplementation activities

24 as needed to meet national nursing service goals and in

25 accordance with this title. Contracts may be entered into
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1 under this title with public or private entities as deter2 mined necessary by the Secretary.

3 ‘‘(b) INFORMATION REQUIREMENTS.—Recipients of

4 grants and contracts under this title shall meet informa5 tion requirements as specified by the Secretary.

6 ‘‘(c) TRAINING PROGRAMS.—Training programs con7 ducted with amounts received under this title shall meet

8 applicable accreditation and quality standards.

9 ‘‘(d) DURATION OF ASSISTANCE.—

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

11 in the case of an award to an entity of a grant, co12 operative agreement, or contract under this title, the

13 period during which payments are made to the en14 tity under the award may not exceed 5 years. The

15 provision of payments under the award shall be sub16 ject to annual approval by the Secretary of the pay17 ments and subject to the availability of appropria18 tions for the fiscal year involved to make the pay19 ments. This paragraph may not be construed as lim20 iting the number of awards under the program in21 volved that may be made to the entity.

22 ‘‘(2) LIMITATION.—In the case of an award to

23 an entity of a grant, cooperative agreement, or con24 tract under this title, paragraph (1) shall apply only

25 to the extent not inconsistent with any other provi-
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1 sion of this title that relates to the period during

2 which payments may be made under the award.

3 ‘‘(e) PEER REVIEW REGARDING CERTAIN PRO4 GRAMS.—Each application for a grant under this title, ex5 cept advanced nurse traineeship grants under section

6 811(a)(2), shall be submitted to a peer review group for

7 an evaluation of the merits of the proposals made in the

8 application. The Secretary may not approve such an appli9 cation unless a peer review group has recommended the

10 application for approval. Each peer review group under

11 this subsection shall be composed principally of individuals

12 who are not officers or employees of the Federal Govern13 ment. This subsection shall be carried out by the Secretary

14 acting through the Administrator of the Health Resources

15 and Services Administration.

16 ‘‘SEC. 807. NATIONAL ADVISORY COUNCIL ON NURSE EDU17 CATION AND PRACTICE.

18 ‘‘(a) ESTABLISHMENT.—There is hereby established

19 a National Advisory Council on Nurse Education and

20 Practice (in this section referred to as the ‘Council’), con21 sisting of the Secretary or the delegate of the Secretary

22 (who shall be an ex officio member and shall serve as the

23 Chairperson), and 15 members appointed by the Secretary

24 without regard to the Federal civil service laws, of which—
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1 ‘‘(1) 2 shall be selected from full-time students

2 enrolled in schools of nursing;

3 ‘‘(2) 3 shall be selected from the general public;

4 ‘‘(3) 2 shall be selected from practicing profes5 sional nurses; and

6 ‘‘(4) 8 shall be selected from among the leading

7 authorities in the various fields of nursing, higher,

8 and secondary education, and from representatives

9 of hospitals and other institutions and organizations

10 which provide nursing services.

11 A majority of the members shall be nurses. The student12 members of the Council shall be appointed for terms of

13 one year and shall be eligible for reappointment to the

14 Council.

15 ‘‘(b) DUTIES.—The Council shall advise the Sec16 retary in the preparation of general regulations and with

17 respect to policy matters arising in the administration of

18 this title, including the range of issues relating to nurse

19 supply, education and practice improvement.

20 ‘‘(c) FUNDING.—Amounts appropriated under this

21 title may be utilized by the Secretary to support the nurse

22 education and practice activities of the Council.
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1 ‘‘SEC. 808. TECHNICAL ASSISTANCE.

2 ‘‘Funds appropriated under this title may be used by

3 the Secretary to provide technical assistance in relation

4 to any of the authorities under this title.

5 ‘‘SEC. 809. RECOVERY FOR CONSTRUCTION ASSISTANCE.

6 ‘‘(a) IN GENERAL.—If at any time within 20 years

7 (or within such shorter period as the Secretary may pre8 scribe by regulation for an interim facility) after the com9 pletion of construction of a facility with respect to which

10 funds have been paid under subpart I of part A (as such

11 subpart was in effect on September 30, 1985)—

12 ‘‘(1) the owner of the facility ceases to be a

13 public or nonprofit school;

14 ‘‘(2) the facility ceases to be used for the train15 ing purposes for which it was constructed; or

16 ‘‘(3) the facility is used for sectarian instruction

17 or as a place for religious worship,

18 the United States shall be entitled to recover from the

19 owner of the facility the base amount prescribed by sub20 section (c)(1) plus the interest (if any) prescribed by sub21 section (c)(2).

22 ‘‘(b) NOTICE OF CHANGE IN STATUS.—The owner of

23 a facility which ceases to be a public or nonprofit school

24 as described in paragraph (1) of subsection (a), or the

25 owner of a facility the use of which changes as described

26 in paragraph (2) or (3) of such subsection shall provide
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1 the Secretary written notice of such cessation or change

2 of use within 10 days after the date on which such ces3 sation or change of use occurs or within 30 days after

4 the date of enactment of the Health Professions Training

5 Assistance Act of 1985, whichever is later.

6 ‘‘(c) AMOUNT OF RECOVERY.—

7 ‘‘(1) BASE AMOUNT.—The base amount that

8 the United States is entitled to recover under sub9 section (a) is the amount bearing the same ratio to

10 the then value (as determined by the agreement of

11 the parties or in an action brought in the district

12 court of the United States for the district in which

13 the facility is situated) of the facility as the amount

14 of the Federal participation bore to the cost of the

15 construction.

16 ‘‘(2) INTEREST.—

17 ‘‘(A) IN GENERAL.—The interest that the

18 United States is entitled to recover under sub19 section (a) is the interest for the period (if any)

20 described in subparagraph (B) at a rate (deter21 mined by the Secretary) based on the average

22 of the bond equivalent rates of 91-day Treasury

23 bills auctioned during such period.
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1 ‘‘(B) TIME PERIOD.—The period referred

2 to in subparagraph (A) is the period begin3 ning—

4 ‘‘(i) if notice is provided as prescribed

5 by subsection (b), 191 days after the date

6 on which the owner of the facility ceases to

7 be a public or nonprofit school as described

8 in paragraph (1) of subsection (a), or 191

9 days after the date on which the use of the

10 facility changes as described in paragraph

11 (2) or (3) of such subsection; or

12 ‘‘(ii) if notice is not provided as pre13 scribed by subsection (b), 11 days after the

14 date on which such cessation or change of

15 use occurs,

16 and ending on the date the amount the United

17 States is entitled to recover is collected.

18 ‘‘(d) WAIVER OF RIGHTS.—The Secretary may waive

19 the recovery rights of the United States under subsection

20 (a)(2) with respect to a facility (under such conditions as

21 the Secretary may establish by regulation) if the Secretary

22 determines that there is good cause for waiving such

23 rights.
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1 ‘‘(e) LIMITATION ON LIENS.—The right of recovery

2 of the United States under subsection (a) shall not, prior

3 to judgment, constitute a lien on any facility.

4 ‘‘PART B—NURSE PRACTITIONERS, NURSE MID5 WIVES, AND OTHER ADVANCED PRACTICE

6 NURSES

7 ‘‘SEC. 811. ADVANCED PRACTICE NURSING GRANTS.

8 ‘‘(a) IN GENERAL.—The Secretary may award grants

9 to and enter into contracts with eligible entities to meet

10 the costs of—

11 ‘‘(1) projects that support the enhancement of

12 advanced practice nursing education and practice;

13 and

14 ‘‘(2) traineeships for individuals in advanced

15 practice nursing programs.

16 ‘‘(b) DEFINITION OF ADVANCED PRACTICE

17 NURSES.—For purposes of this section, the term ‘ad18 vanced practice nurses’ means nurses trained in advanced

19 degree programs including individuals in combined R.N./

20 Master’s degree programs, post-nursing master’s certifi21 cate programs, or, in the case of nurse midwives or nurse

22 anesthetists, in certificate programs in existence on the

23 date that is one day prior to the date of enactment of

24 this section, to serve as nurse practitioners, nurse mid25 wives, nurse anesthetists, nurse educators, or public health
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1 nurses, or in other nurse specialties determined by the

2 Secretary to require advanced education.

3 ‘‘(c) AUTHORIZED NURSE PRACTITIONER AND

4 NURSE-MIDWIFERY PROGRAMS.—Nurse practitioner and

5 nurse midwifery programs eligible for support under this

6 section are educational programs for registered nurses (ir7 respective of the type of school of nursing in which the

8 nurses received their training) that—

9 ‘‘(1) meet guidelines prescribed by the Sec10 retary; and

11 ‘‘(2) have as their objective the education of

12 nurses who will upon completion of their studies in

13 such programs, be qualified to effectively provide

14 primary health care, including primary health care

15 in homes and in ambulatory care facilities, long-term

16 care facilities and other health care institutions.

17 ‘‘(d) OTHER AUTHORIZED EDUCATIONAL PRO18 GRAMS.—The Secretary shall prescribe guidelines as ap19 propriate for other advanced practice nurse education pro20 grams eligible for support under this section.

21 ‘‘(e) TRAINEESHIPS.—

22 ‘‘(1) IN GENERAL.—The Secretary may not

23 award a grant to an applicant under subsection (a)

24 unless the applicant involved agrees that
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1 traineeships provided with the grant will only pay all

2 or part of the costs of—

3 ‘‘(A) the tuition, books, and fees of the

4 program of advanced nursing practice with re5 spect to which the traineeship is provided; and

6 ‘‘(B) the reasonable living expenses of the

7 individual during the period for which the

8 traineeship is provided.

9 ‘‘(2) DOCTORAL PROGRAMS.—The Secretary

10 may not obligate more than 10 percent of the

11 traineeships under subsection (a) for individuals in

12 doctorate degree programs.

13 ‘‘(3) SPECIAL CONSIDERATION.—In making

14 awards of grants and contracts under subsection

15 (a)(2), the Secretary shall give special consideration

16 to an eligible entity that agrees to expend the award

17 to train advanced practice nurses who will practice

18 in health professional shortage areas designated

19 under section 332.

20 ‘‘PART C—INCREASING NURSING WORKFORCE

21 DIVERSITY

22 ‘‘SEC. 821. WORKFORCE DIVERSITY GRANTS.

23 ‘‘(a) IN GENERAL.—The Secretary may award grants

24 to and enter into contracts with eligible entities to meet

25 the costs of special projects to increase nursing education
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1 opportunities for individuals who are from disadvantaged

2 backgrounds (including racial and ethnic minorities under3 represented among registered nurses) by providing stu4 dent scholarships or stipends, pre-entry preparation, and

5 retention activities.

6 ‘‘(b) GUIDANCE.—In carrying out subsection (a), the

7 Secretary shall take into consideration the recommenda8 tions of the First and Second Invitational Congresses for

9 Minority Nurse Leaders on ‘Caring for the Emerging Ma10 jority,’ in 1992 and 1993, and consult with nursing asso11 ciations including the American Nurses Association, the

12 National League for Nursing, the American Association

13 of Colleges of Nursing, the Black Nurses Association, the

14 Association of Hispanic Nurses, the Association of Asian

15 American and Pacific Islander Nurses, the National

16 Nurses Association, and the Native American Indian and

17 Alaskan Nurses Association.

18 ‘‘(c) REQUIRED INFORMATION AND CONDITIONS FOR

19 AWARD RECIPIENTS.—

20 ‘‘(1) IN GENERAL.—Recipients of awards under

21 this section may be required, where requested, to re22 port to the Secretary concerning the annual admis23 sion, retention, and graduation rates for ethnic and

24 racial minorities in the school or schools involved in

25 the projects.
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1 ‘‘(2) FALLING RATES.—If any of the rates re2 ported under paragraph (1) fall below the average of

3 the two previous years, the grant or contract recipi4 ent shall provide the Secretary with plans for imme5 diately improving such rates.

6 ‘‘(3) INELIGIBILITY.—A recipient described in

7 paragraph (2) shall be ineligible for continued fund8 ing under this section if the plan of the recipient

9 fails to improve the rates within the 1-year period

10 beginning on the date such plan is implemented.

11 ‘‘PART D—STRENGTHENING CAPACITY FOR

12 BASIC NURSE EDUCATION AND PRACTICE

13 ‘‘SEC. 831. BASIC NURSE EDUCATION AND PRACTICE

14 GRANTS.

15 ‘‘(a) IN GENERAL.—The Secretary may award grants

16 to and enter into contracts with eligible entities for

17 projects to strengthen capacity for basic nurse education

18 and practice.

19 ‘‘(b) PRIORITY AREAS.—In awarding grants or con20 tracts under this section the Secretary shall give priority

21 to entities that will use amounts provided under such a

22 grant or contract to enhance the education mix and utili23 zation of the basic nursing workforce by strengthening

24 programs that provide basic nurse education for purposes

25 of—
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1 ‘‘(1) improving nursing services in schools and

2 other community settings;

3 ‘‘(2) providing care for underserved populations

4 and other high-risk groups such as the elderly, indi5 viduals with HIV–AIDS, substance abusers, home6 less, and battered women;

7 ‘‘(3) providing managed care, quality improve8 ment, and other skills needed under new systems of

9 organized health care systems;

10 ‘‘(4) developing cultural competencies among

11 nurses;

12 ‘‘(5) providing emergency health services;

13 ‘‘(6) promoting career mobility for nursing per14 sonnel in a variety of training settings and cross

15 training or specialty training among diverse popu16 lation groups; or

17 ‘‘(7) other priority areas as determined by the

18 Secretary.

19 ‘‘PART F—AUTHORIZATION OF APPROPRIATIONS

20 ‘‘SEC. 841. AUTHORIZATION OF APPROPRIATIONS.

21 ‘‘There are authorized to be appropriated to carry out

22 sections 811, 821, and 831, $62,000,000 for fiscal year

23 1996, such sums as may be necessary in each of the fiscal

24 years 1997 and 1998, and $59,000,000 for fiscal year

25 1999.’’; and
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1 (6) by redesignating section 855 as section 810,

2 and transferring such section so as to appear after

3 section 809 (as added by the amendment made by

4 paragraph (5)).

5 SEC. 124. SAVINGS PROVISION.

6 In the case of any authority for making awards of

7 grants or contracts that is terminated by the amendment

8 made by section 123, the Secretary of Health and Human

9 Services may, notwithstanding the termination of the au10 thority, continue in effect any grant or contract made

11 under the authority that is in effect on the day before the

12 date of the enactment of this Act, subject to the duration

13 of any such grant or contract not exceeding the period

14 determined by the Secretary in first approving such finan15 cial assistance, or in approving the most recent request

16 made (before the date of such enactment) for continuation

17 of such assistance, as the case may be.

18 Subtitle C—Financial Assistance

19 PART 1—NATIONAL HEALTH SERVICE CORPS

20 FINANCIAL ASSISTANCE PROGRAMS

21 SEC. 131. GENERAL AMENDMENTS WITH RESPECT TO FED22 ERALLY SUPPORTED LOANS.

23 (a) LOAN REPAYMENT PROGRAM.—Section 338B of

24 the Public Health Service Act (42 U.S.C. 254l-1) is

25 amended—
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1 (1) in subsection (a)—

2 (A) in the matter preceding paragraph (1),

3 by inserting ‘‘and public health disease preven4 tion and health promotion activities’’ before the

5 dash; and

6 (B) in paragraph (1), by striking ‘‘and

7 physician assistants’’ and inserting ‘‘physician

8 assistants, and public health professionals’’;

9 (2) in subsection (b)(1)—

10 (A) in subparagraph (A), by inserting

11 ‘‘public health,’’ after ‘‘dentistry,’’;

12 (B) in subparagraph (B), by inserting

13 ‘‘public health,’’ after ‘‘dentistry,’’; and

14 (C) in subparagraph (C), by inserting

15 ‘‘public health,’’ after ‘‘dentistry,’’;

16 (3) in subsection (c)(4)—

17 (A) in subparagraph (A), by inserting

18 ‘‘and schools of public health’’ after ‘‘profes19 sions schools’’;

20 (B) in subparagraph (B)(i)—

21 (i) by inserting ‘‘or public health pro22 fessional’’ after ‘‘any health professional’’;

23 and
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1 (ii) by inserting ‘‘or public health dis2 ease prevention and health promotion ac3 tivities’’ before the period;

4 (C) in subparagraph (C)—

5 (i) by inserting ‘‘or public health dis6 ease prevention and health promotion ac7 tivities,’’ after ‘‘primary health services,’’;

8 (ii) by inserting ‘‘or public health pro9 fessions’’ after ‘‘health professions’’; and

10 (iii) by inserting ‘‘or public health

11 professionals’’ after ‘‘health professionals’’

12 each place that such occurs;

13 (4) in subsection (f)(1)(B)(iv), by inserting ‘‘or

14 public health disease prevention and health pro15 motion activities’’ after ‘‘primary health services’’;

16 (5) in subsection (g)(2)(A)(iii)—

17 (A) by inserting ‘‘or public health profes18 sional’’ after ‘‘the health professional’’; and

19 (B) by inserting ‘‘or public health disease

20 prevention and health promotion activities’’

21 after ‘‘primary health services’’; and

22 (6) in subsection (i)(8), —

23 (A) by inserting ‘‘or public health profes24 sionals’’ after ‘‘health professionals’’; and
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1 (B) by inserting ‘‘or public health disease

2 prevention and health promotion activities’’

3 after ‘‘primary health services’’.

4 (b) OBLIGATED SERVICE.—Section 338C(b)(5) of the

5 Public Health Service Act (42 U.S.C. 254m(b)(5)) is

6 amended—

7 (1) in subparagraph (A), by inserting ‘‘public

8 health,’’ after ‘‘dentistry,’’; and

9 (2) in subparagraph (E)—

10 (A) in clause (ii), by inserting ‘‘public

11 health,’’ after ‘‘dentistry,’’; and

12 (B) in clause (iii), by inserting ‘‘public

13 health,’’ after ‘‘dentistry,’’.

14 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

15 338H of the Public Health Service Act (42 U.S.C. 254q)

16 is amended to read as follows:

17 ‘‘SEC. 338H. AUTHORIZATION OF APPROPRIATIONS.

18 ‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—For the

19 purpose of carrying out this subpart, there are authorized

20 to be appropriated $90,000,000 for fiscal year 1996 and

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

22 1997 through 2000.

23 ‘‘(b) DISTRIBUTION OF AMOUNTS.—The Secretary

24 shall determine the most appropriate manner in which to

25 allocate amounts appropriated under subsection (a) be-
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1 tween the programs authorized in chapter 1, chapter 2,

2 and chapter 3. In determining the manner in which to allo3 cate such amounts, the Secretary shall give priority to

4 funding State-based programs as appropriate under chap5 ter 3. The Secretary shall distribute such amounts among

6 the various programs in such chapters in a manner which

7 furthers both Federal and State needs for health profes8 sionals in underserved areas.’’.

9 (d) GRANTS FOR LOAN REPAYMENT PROGRAM.—

10 Section 338I of the Public Health Service Act (42 U.S.C.

11 254q–1) is amended—

12 (1) in subsection (a)—

13 (A) in paragraph (1), by striking ‘‘in

14 health professional shortage areas’’ and insert15 ing ‘‘or public health disease prevention and

16 health promotion activities in Federal health

17 professional shortage areas or approved State

18 designated health professional shortage areas’’;

19 and

20 (B) in paragraph (2)—

21 (i) by inserting ‘‘or public health pro22 fessionals’’ after ‘‘health professionals’’;

23 and

24 (ii) by striking ‘‘in health professional

25 shortage areas’’ and inserting ‘‘or public
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1 health disease prevention and health pro2 motion activities in Federal health profes3 sional shortage areas or approved State

4 designated health professional shortage

5 areas’’;

6 (2) in subsection (c)—

7 (A) in paragraph (1)—

8 (i) in the paragraph heading, by strik9 ing ‘‘FEDERAL’’ and inserting ‘‘FEDERAL

10 OR APPROVED STATE’’; and

11 (ii) by inserting before the period the

12 following: ‘‘or approved State designated

13 health professional shortage areas’’;

14 (B) in paragraph (2), by inserting ‘‘or

15 public health professionals’’ after ‘‘health pro16 fessionals’’;

17 (C) in paragraph (3)—

18 (i) in subparagraph (A)—

19 (I) in the matter preceding clause

20 (i), by inserting ‘‘or public health pro21 fessionals’’ after ‘‘health profes22 sionals’’; and

23 (II) in clause (ii), by striking

24 health’’;

25 (ii) in subparagraph (B)—
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1 (I) in the matter preceding clause

2 (i), by inserting ‘‘or public health pro3 fessional’’ after ‘‘health professional’’;

4 and

5 (II) in clause (ii)—

6 (aa) by inserting ‘‘or public

7 health professional’’ after ‘‘the

8 health professional’’; and

9 (bb) by striking ‘‘services in

10 a’’ and inserting ‘‘services or

11 public health disease prevention

12 and health promotion activities in

13 a Federal’’; and

14 (D) by adding at the end thereof the fol15 lowing new paragraph:

16 ‘‘(4) PRIVATE PRACTICE.—

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

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

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

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

23 to provide primary health services in a full-time

24 private clinical practice in a health professional

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

2 under subsection (a) unless the State involved

3 agrees that, if the State provides a waiver

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

6 agreement under such subparagraph between

7 the State and the health professional to the

8 same extent and in the same manner as such

9 section applies to an agreement between the

10 Secretary and a health professional regarding a

11 full-time private clinical practice.’’; and

12 (3) in subsection (h), to read as follows:

13 ‘‘(h) DEFINITIONS.—Unless specifically provided oth14 erwise, as used in this subpart and section 338F:

15 ‘‘(1) APPROVED STATE DESIGNATED HEALTH

16 PROFESSIONAL SHORTAGE AREA.—The term ‘ap17 proved State designated health professional shortage

18 area’ means an area designated by the State as un19 derserved using specific methodology and criteria to

20 identify such areas. Such criteria and methodology

21 shall be approved by the Secretary.

22 ‘‘(2) COMMUNITY ORGANIZATION.—The term

23 ‘community organization’ means a public or non24 profit private entity.
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1 ‘‘(3) PRIMARY HEALTH CARE.—The term ‘pri2 mary health care’ means health services regarding

3 family medicine, general internal medicine, general

4 pediatrics, dentistry, or may include obstetrics and

5 gynecology, that are provided by physicians, dentists,

6 certified nurse practitioners, certified nurse mid7 wives, or physician assistants.

8 ‘‘(4) STATE.—The term ‘State’ means each of

9 the several States and the District of Columbia.’’.

10 (e) COMMUNITY SCHOLARSHIP PROGRAMS.—Section

11 338L of the Public Health Service Act (42 U.S.C. 254t)

12 is amended—

13 (1) in the section heading, by striking ‘‘dem14 onstration grants to states for’’;

15 (2) in subsection (a), by striking ‘‘health man16 power shortage areas’’ and inserting ‘‘Federal health

17 professional shortage areas and in approved State

18 designated health professional shortage areas’’;

19 (3) in subsection (c)—

20 (A) in the matter preceding paragraph (1),

21 by striking ‘‘health manpower shortage areas’’

22 and inserting ‘‘Federal health professional

23 shortage areas and in approved State des24 ignated health professional shortage areas’’;

25 and
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1 (B) in paragraph (2), by striking ‘‘health

2 manpower shortage areas’’ and inserting ‘‘Fed3 eral health professional shortage areas and in

4 approved State designated health professional

5 shortage areas’’;

6 (4) in subsection (e)(1), by striking ‘‘health

7 manpower shortage areas’’ and inserting ‘‘Federal

8 health professional shortage areas and in approved

9 State designated health professional shortage

10 areas’’;

11 (5) in subsection (f)(1)(A), by striking ‘‘health

12 manpower shortage areas’’ and inserting ‘‘Federal

13 health professional shortage areas and in approved

14 State designated health professional shortage

15 areas’’;

16 (6) in subsection (g), by striking ‘‘health man17 power shortage areas’’ each place that such appears

18 and inserting ‘‘Federal health professional shortage

19 areas and in approved State designated health pro20 fessional shortage areas’’; and

21 (7) by striking subsections (j) through (l).

22 SEC. 132. RESTRUCTURING AND TECHNICAL AMENDMENTS.

23 (a) REDESIGNATIONS.—Subpart III of part D of title

24 III of the Public Health Service Act (42 U.S.C. 254l et

25 seq.) is amended—
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1 (1) by redesignating sections 338J and 338K

2 (42 U.S.C. 254s and 254t) as sections 338M and

3 338N, respectively;

4 (2) by redesignating sections 338C through

5 338H (42 U.S.C. 254m through 254q) as sections

6 338G through 338L, respectively;

7 (3) by redesignating section 338I (as such sec8 tion exists one day prior to the date of enactment

9 of this Act) (42 U.S.C. 254r) as section 338E;

10 (4) by redesignating section 338L (as such sec11 tion exists one day prior to the date of enactment

12 of this Act) (42 U.S.C. 254u) as section 338F;

13 (b) CONSOLIDATION OF CERTAIN PROGRAMS.—Sub14 part III of part D of title III of the Public Health Service

15 Act (42 U.S.C. 254l et seq.) (as amended by subsection

16 (a)) is further amended—

17 (1) by striking the subpart heading and insert18 ing the following:

19 ‘‘Subpart III—Federally Supported

20 Scholarships and Loans

21 ‘‘CHAPTER 1—NATIONAL HEALTH SERVICE

22 CORPS SCHOLARSHIPS PROGRAMS

23 (2) by redesignating section 338B as section

24 338C;
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1 (3) by inserting before section 338C (as so re2 designated) the following:

3 ‘‘CHAPTER 2—NATIONAL HEALTH SERVICE

4 CORPS LOAN REPAYMENT PROGRAMS

5 ‘‘Subchapter A—Loan Repayment Program’’;

6 and

7 (4) by inserting after section 338C (as so redes8 ignated) the following:

9 ‘‘Subchapter B—Nursing Loan Repayment Program’’.

10 (c) TRANSFERS AND REDESIGNATIONS OF NURSING

11 LOAN REPAYMENT PROGRAM.—Subpart II of part E of

12 title VIII (42 U.S.C. 297n et seq.) (as so redesignated

13 by section 123(3)) is amended—

14 (1) by striking the subpart heading;

15 (2) by transferring section 846 (42 U.S.C.

16 297n) to subchapter B of chapter 2 of subpart III

17 of part D of title III (as added by subsection (b)(4));

18 and

19 (3) in section 846—

20 (A) by striking the section heading and in21 serting the following:

22 ‘‘SEC. 338D. NURSING LOAN REPAYMENT PROGRAM.’’;

23 (B) by striking subsection (d); and

24 (C) by striking subsection (g).
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1 (d) TRANSFERS AND REDESIGNATIONS OF STATE

2 LOAN REPAYMENT AND COMMUNITY SCHOLARSHIP PRO3 GRAMS.—Subpart III of part D of title III of the Public

4 Health Service Act (42 U.S.C. 254l et seq.) (as amended

5 by subsections (a) through (c)) is further amended—

6 (1) by inserting after section 338D (as so

7 transferred and redesignated by subsection (c)(3))

8 the following:

9 ‘‘CHAPTER 3—STATE LOAN REPAYMENT AND

10 COMMUNITY SCHOLARSHIP PROGRAMS

11 ‘‘Subchapter A—State Loan Repayment Programs’’;

12 (2) by transferring section 338E (as so redesig13 nated by subsection (a)(3)) to subchapter A of chap14 ter 3 of such subpart (as added by paragraph (1));

15 (3) by inserting after section 338E (as trans16 ferred by paragraph (2)) the following:

17 ‘‘Subchapter B—Community Scholarship Programs’’;

18 (4) by transferring section 338F (as so redesig19 nated by subsection (a)(4)) to subchapter B of chap20 ter 3 of such subpart (as added by paragraph (3));

21 and

22 (5) by inserting after section 338F (as trans23 ferred by paragraph (4)) the following:
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1 ‘‘CHAPTER 4—GENERAL PROVISIONS’’.

2 (e) CLINICAL RESEARCHERS.—Paragraph (3) of sec3 tion 487E(a) of the Public Health Service Act (42 U.S.C.

4 288–5(a)(3)) is amended to read as follows:

5 ‘‘(3) APPLICABILITY OF CERTAIN PROVISIONS

6 REGARDING OBLIGATED SERVICE.—With respect to

7 the National Health Service Corps loan repayment

8 program established in subpart III of part D of title

9 III, the provisions of such subpart shall, except as

10 inconsistent with this section, apply to the program

11 established in subsection (a) in the same manner

12 and to the same extent as such provisions apply to

13 the National Health Service Corps loan repayment

14 programs.’’.

15 SEC. 133. DEFINITION OF UNDERSERVED AREAS.

16 Section 332(a)(1) of the Public Health Service Act

17 (42 U.S.C. 254e(a)(1)) is amended in the first sentence—

18 (1) by striking ‘‘, or (C)’’ and inserting ‘‘, (C)’’;

19 and

20 (2) by inserting before the period the following:

21 ‘‘, or (D) a State or local health department that

22 has a severe shortage of public health personnel as

23 determined under criteria established by the Sec24 retary’’.
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1 SEC. 134. CONFORMING AMENDMENTS.

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

3 241 et seq.) is amended—

4 (1) in subparagraphs (A) and (B) of section

5 303(d)(4) (42 U.S.C. 242a(d)(4)(A) and (B)), by

6 striking ‘‘338C or 338D’’ each place that such oc7 curs and inserting ‘‘338G or 338H’’;

8 (2) in section 331(c) (42 U.S.C. 254d(c)), by

9 striking ‘‘338D’’ and inserting ‘‘338H’’;

10 (3) in section 337(a) (42 U.S.C. 254j(a)), by

11 striking ‘‘338G’’ and inserting ‘‘338K’’;

12 (4) in 338A (42 U.S.C. 254l)—

13 (A) in subsection (c)(1)—

14 (i) in subparagraph (A), by striking

15 ‘‘338D’’ and inserting ‘‘338I’’; and

16 (ii) in subparagraph (B), by striking

17 ‘‘338C’’ and inserting ‘‘338H’’;

18 (B) in subsection (f)(3), by striking

19 ‘‘338D’’ and inserting ‘‘338I’’; and

20 (C) in subsection (i)(5)—

21 (i) in subparagraph (A), by striking

22 ‘‘338E’’ and inserting ‘‘338I’’; and

23 (ii) in subparagraph (B)(ii), by strik24 ing ‘‘338E’’ and inserting ‘‘338I’’;

25 (5) in section 338C (as so redesignated) (42

26 U.S.C. 254l-1)—
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1 (A) in subsection (c)(1)—

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

3 ‘‘338E’’ and inserting ‘‘338I’’; and

4 (ii) in subparagraph (B), by striking

5 ‘‘338D’’ and inserting ‘‘338H’’;

6 (B) in subsection (f)(1)(B)(iv), by striking

7 ‘‘338D’’ and inserting ‘‘338H’’;

8 (C) in subsection (f)(4), by striking

9 ‘‘338E’’ and inserting ‘‘338I’’; and

10 (D) in subsection (i)(7)—

11 (i) in subparagraph (A), by striking

12 ‘‘338E’’ and inserting ‘‘338I’’; and

13 (ii) in subparagraph (B)(ii), by strik14 ing ‘‘338E’’ and inserting ‘‘338I’’;

15 (6) in section 338E(d)(1)(C) (as so redesig16 nated by section 132), by striking ‘‘338J’’ and in17 serting ‘‘338M’’;

18 (7) in section 338G (as so redesignated by sec19 tion 132)—

20 (A) in subsection (a)—

21 (i) by striking ‘‘338D’’ and inserting

22 ‘‘338H’’; and

23 (ii) by striking ‘‘338B’’ and inserting

24 ‘‘338C’’; and
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1 (B) in subsection (c)(2), by striking

2 ‘‘338D’’ and inserting ‘‘338H’’;

3 (8) in section 338H (as so redesignated by sec4 tion 132)—

5 (A) in subsection (a), by striking ‘‘338C’’

6 and inserting ‘‘338G’’; and

7 (B) in subsection (c), by striking ‘‘338B’’

8 and inserting ‘‘338C’’;

9 (9) in section 338I (as so redesignated by sec10 tion 132)—

11 (A) in subsection (b)(1)(A)—

12 (i) by striking ‘‘338F’’ and inserting

13 ‘‘338J’’;

14 (ii) by striking ‘‘338C or 338D’’ and

15 inserting ‘‘338G or 338H’’;

16 (iii) by striking ‘‘338C’’ and inserting

17 ‘‘338G’’; and

18 (iv) by striking ‘‘338D’’ and inserting

19 ‘‘338H’’; and

20 (B) in subsection (c)(1)—

21 (i) by striking ‘‘338F’’ and inserting

22 ‘‘338K’’;

23 (ii) by striking ‘‘338B’’ and inserting

24 ‘‘338C’’; and
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1 (iii) by striking ‘‘338C or 338D’’ and

2 inserting ‘‘338G or 338H’’;

3 (10) in section 338J(b) (as so redesignated by

4 section 132)—

5 (A) in paragraph (1)—

6 (i) by striking ‘‘338E’’ and inserting

7 ‘‘338I’’; and

8 (ii) by striking ‘‘338B’’ and inserting

9 ‘‘338C’’; and

10 (B) in paragraph (2), by striking ‘‘338I’’

11 and inserting ‘‘338E’’;

12 (11) in section 338K (as so redesignated by

13 section 132)—

14 (A) in subsection (a)(2), by striking

15 ‘‘338D’’ and inserting ‘‘338H’’; and

16 (B) in subsection (d)(1), by striking

17 ‘‘338E’’ and inserting ‘‘338I’’; and

18 (12) in section 338M(e)(1)(B)(ii)(III) (as so re19 designated by section 132), by striking ‘‘338I’’ and

20 inserting ‘‘338E’’.

21 PART 2—SCHOOL-BASED REVOLVING LOAN

22 FUNDS

23 SEC. 135. PRIMARY CARE LOAN PROGRAM.

24 (a) REQUIREMENT FOR SCHOOLS.—Section

25 723(b)(1) of the Public Health Service Act (42 U.S.C.
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1 292s(b)(1)), as amended by section 2014(c)(2)(A)(ii) of

2 Public Law 103–43 (107 Stat. 216), is amended by strik3 ing ‘‘3 years before’’ and inserting ‘‘4 years before’’.

4 (b) SERVICE REQUIREMENT FOR PRIMARY CARE

5 LOAN BORROWERS.—Section 723(a) of the Public Health

6 Service Act (42 U.S.C. 292s(a)) is amended in subpara7 graph (B) of paragraph (1), by striking ‘‘through the date

8 on which the loan is repaid in full’’ and inserting ‘‘for 5

9 years after completing the residency program’’.

10 (c) REPORT REQUIREMENT.—Section 723 of the

11 Public Health Service Act (42 U.S.C. 292s) is amended—

12 (1) by striking subsection (c); and

13 (2) by redesignating subsection (d) as sub14 section (c).

15 SEC. 136. LOANS FOR DISADVANTAGED STUDENTS.

16 (a) AUTHORIZATION OF APPROPRIATIONS.—Section

17 724(f)(1) of the Public Health Service Act (42 U.S.C.

18 292t(f)(1)) is amended by striking ‘‘$15,000,000 for fiscal

19 year 1993’’ and inserting ‘‘$8,000,000 for each of the fis20 cal years 1996 through 1998’’.

21 (b) REPEAL.—Effective October 1, 1998, paragraph

22 (1) of section 724(f) of the Public Health Service Act (42

23 U.S.C. 292t(f)(1)) is repealed.
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1 SEC. 137. STUDENT LOANS REGARDING SCHOOLS OF

2 NURSING.

3 (a) IN GENERAL.—Section 836(b) of the Public

4 Health Service Act (42 U.S.C. 297b(b)) is amended—

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

6 the end and inserting a semicolon;

7 (2) in paragraph (2)—

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

9 ‘‘and’’ at the end; and

10 (B) by inserting before the semicolon at

11 the end the following: ‘‘, and (C) such addi12 tional periods under the terms of paragraph (8)

13 of this subsection’’;

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

15 the end and inserting ‘‘; and’’; and

16 (4) by adding at the end the following para17 graph:

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

19 the Secretary, the repayment period established

20 under paragraph (2) for any student borrower who

21 during the repayment period failed to make consecu22 tive payments and who, during the last 12 months

23 of the repayment period, has made at least 12 con24 secutive payments may be extended for a period not

25 to exceed 10 years.’’.
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1 (b) MINIMUM MONTHLY PAYMENTS.—Section 836(g)

2 of the Public Health Service Act (42 U.S.C. 297b(g)) is

3 amended by striking ‘‘$15’’ and inserting ‘‘$40’’.

4 (c) ELIMINATION OF STATUTE OF LIMITATION FOR

5 LOAN COLLECTIONS.—

6 (1) IN GENERAL.—Section 836 of the Public

7 Health Service Act (42 U.S.C. 297b) is amended by

8 adding at the end the following new subsection:

9 ‘‘(l) ELIMINATION OF STATUTE OF LIMITATION FOR

10 LOAN COLLECTIONS.—

11 ‘‘(1) PURPOSE.—It is the purpose of this sub12 section to ensure that obligations to repay loans

13 under this section are enforced without regard to

14 any Federal or State statutory, regulatory, or ad15 ministrative limitation on the period within which

16 debts may be enforced.

17 ‘‘(2) PROHIBITION.—Notwithstanding any other

18 provision of Federal or State law, no limitation shall

19 terminate the period within which suit may be filed,

20 a judgment may be enforced, or an offset, garnish21 ment, or other action may be initiated or taken by

22 a school of nursing that has an agreement with the

23 Secretary pursuant to section 835 that is seeking

24 the repayment of the amount due from a borrower
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1 on a loan made under this subpart after the default

2 of the borrower on such loan.’’.

3 (2) EFFECTIVE DATE.—The amendment made

4 by paragraph (1) shall be effective with respect to

5 actions pending on or after the date of enactment of

6 this Act.

7 (d) BREACH OF AGREEMENTS.—Section 338D of the

8 Public Health Service Act (as so redesignated and amend9 ed under section 132(c)) is amended by adding at the end

10 thereof the following new subsection:

11 ‘‘(g) BREACH OF AGREEMENT.—

12 ‘‘(1) IN GENERAL.—In the case of any program

13 under this section under which an individual makes

14 an agreement to provide health services for a period

15 of time in accordance with such program in consid16 eration of receiving an award of Federal funds re17 garding education as a nurse (including an award

18 for the repayment of loans), the following applies if

19 the agreement provides that this subsection is appli20 cable:

21 ‘‘(A) In the case of a program under this

22 section that makes an award of Federal funds

23 for attending an accredited program of nursing

24 (in this section referred to as a ‘nursing pro25 gram’), the individual is liable to the Federal
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1 Government for the amount of such award (in2 cluding amounts provided for expenses related

3 to such attendance), and for interest on such

4 amount at the maximum legal prevailing rate,

5 if the individual—

6 ‘‘(i) fails to maintain an acceptable

7 level of academic standing in the nursing

8 program (as indicated by the program in

9 accordance with requirements established

10 by the Secretary);

11 ‘‘(ii) is dismissed from the nursing

12 program for disciplinary reasons; or

13 ‘‘(iii) voluntarily terminates the nurs14 ing program.

15 ‘‘(B) The individual is liable to the Federal

16 Government for the amount of such award (in17 cluding amounts provided for expenses related

18 to such attendance), and for interest on such

19 amount at the maximum legal prevailing rate,

20 if the individual fails to provide health services

21 in accordance with the program under this sec22 tion for the period of time applicable under the

23 program.

24 ‘‘(2) WAIVER OR SUSPENSION OF LIABILITY.—

25 In the case of an individual or health facility making
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1 an agreement for purposes of paragraph (1), the

2 Secretary shall provide for the waiver or suspension

3 of liability under such subsection if compliance by

4 the individual or the health facility, as the case may

5 be, with the agreements involved is impossible, or

6 would involve extreme hardship to the individual or

7 facility, and if enforcement of the agreements with

8 respect to the individual or facility would be uncon9 scionable.

10 ‘‘(3) DATE CERTAIN FOR RECOVERY.—Subject

11 to paragraph (2), any amount that the Federal Gov12 ernment is entitled to recover under paragraph (1)

13 shall be paid to the United States not later than the

14 expiration of the 3-year period beginning on the date

15 the United States becomes so entitled.

16 ‘‘(4) AVAILABILITY.—Amounts recovered under

17 paragraph (1) with respect to a program under this

18 section shall be available for the purposes of such

19 program, and shall remain available for such pur20 poses until expended.’’.

21 (e) TECHNICAL AMENDMENTS.—Section 839 of the

22 Public Health Service Act (42 U.S.C. 297e) is amended—

23 (1) in subsection (a)—

24 (A) by striking the matter preceding para25 graph (1) and inserting the following:
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1 ‘‘(a) If a school terminates a loan fund established

2 under an agreement pursuant to section 835(b), or if the

3 Secretary for good cause terminates the agreement with

4 the school, there shall be a capital distribution as fol5 lows:’’; and

6 (B) in paragraph (1), by striking ‘‘at the

7 close of September 30, 1999,’’ and inserting

8 ‘‘on the date of termination of the fund’’; and

9 (2) in subsection (b), to read as follows:

10 ‘‘(b) If a capital distribution is made under sub11 section (a), the school involved shall, after such capital dis12 tribution, pay to the Secretary, not less often than quar13 terly, the same proportionate share of amounts received

14 by the school in payment of principal or interest on loans

15 made from the loan fund established under section 835(b)

16 as determined by the Secretary under subsection (a).’’.

17 SEC. 138. GENERAL PROVISIONS.

18 (a) MAXIMUM STUDENT LOAN PROVISIONS AND

19 MINIMUM PAYMENTS.—

20 (1) IN GENERAL.—Section 722(a)(1) of the

21 Public Health Service Act (42 U.S.C. 292r(a)(1)),

22 as amended by section 2014(b)(1) of Public Law

23 103–43, is amended by striking ‘‘the sum of’’ and

24 all that follows through the end thereof and insert25 ing ‘‘the cost of attendance (including tuition, other
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1 reasonable educational expenses, and reasonable liv2 ing costs) for that year at the educational institution

3 attended by the student (as determined by such edu4 cational institution).’’.

5 (2) THIRD AND FOURTH YEARS.—Section

6 722(a)(2) of the Public Health Service Act (42

7 U.S.C. 292r(a)(2)), as amended by section

8 2014(b)(1) of Public Law 103–43, is amended by

9 striking ‘‘the amount $2,500’’ and all that follows

10 through ‘‘including such $2,500’’ and inserting ‘‘the

11 amount of the loan may, in the case of the third or

12 fourth year of a student at a school of medicine or

13 osteopathic medicine, be increased to the extent nec14 essary’’.

15 (3) REPAYMENT PERIOD.—Section 722(c) of

16 the Public Health Service Act (42 U.S.C. 292r(c)),

17 as amended by section 2014(b)(1) of Public Law

18 103–43, is amended—

19 (A) in the subsection heading by striking

20 ‘‘TEN-YEAR’’ and inserting ‘‘REPAYMENT’’;

21 (B) by striking ‘‘ten-year period which be22 gins’’ and inserting ‘‘period of not less than 10

23 years nor more than 25 years which begins’’;

24 and
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1 (C) by striking ‘‘such ten-year period’’ and

2 inserting ‘‘such period’’.

3 (4) MINIMUM PAYMENTS.—Section 722(j) of

4 the Public Health Service Act (42 U.S.C. 292r(j)),

5 as amended by section 2014(b)(1) of Public Law

6 103–43, is amended by striking ‘‘$15’’ and inserting

7 $40’’.

8 (b) ELIMINATION OF STATUTE OF LIMITATION FOR

9 LOAN COLLECTIONS.—

10 (1) IN GENERAL.—Section 722 of the Public

11 Health Service Act (42 U.S.C. 292r), as amended by

12 section 2014(b)(1) of Public Law 103–43, is amend13 ed by adding at the end the following new sub14 section:

15 ‘‘(m) ELIMINATION OF STATUTE OF LIMITATION FOR

16 LOAN COLLECTIONS.—

17 ‘‘(1) PURPOSE.—It is the purpose of this sub18 section to ensure that obligations to repay loans

19 under this section are enforced without regard to

20 any Federal or State statutory, regulatory, or ad21 ministrative limitation on the period within which

22 debts may be enforced.

23 ‘‘(2) PROHIBITION.—Notwithstanding any other

24 provision of Federal or State law, no limitation shall

25 terminate the period within which suit may be filed,
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1 a judgment may be enforced, or an offset, garnish2 ment, or other action may be initiated or taken by

3 a school that has an agreement with the Secretary

4 pursuant to section 721 that is seeking the repay5 ment of the amount due from a borrower on a loan

6 made under this subpart after the default of the bor7 rower on such loan.’’.

8 (2) EFFECTIVE DATE.—The amendment made

9 by paragraph (1) shall be effective with respect to

10 actions pending on or after the date of enactment of

11 this Act.

12 (c) DATE CERTAIN FOR CONTRIBUTIONS.—Para13 graph (2) of section 735(e) of the Public Health Service

14 Act (42 U.S.C. 292y(e)(2)) is amended to read as follows:

15 ‘‘(2) DATE CERTAIN FOR CONTRIBUTIONS.—

16 Amounts described in paragraph (1) that are re17 turned to the Secretary shall be obligated before the

18 end of the succeeding fiscal year.’’.

19 PART 3—INSURED HEALTH EDUCATION

20 ASSISTANCE LOANS TO GRADUATE STUDENTS

21 SEC. 141. HEALTH EDUCATION ASSISTANCE LOAN PRO22 GRAM.

23 (a) HEALTH EDUCATION ASSISTANCE LOAN

24 DEFERMENT FOR BORROWERS PROVIDING HEALTH

25 SERVICES TO INDIANS.—
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1 (1) IN GENERAL.—Section 705(a)(2)(C) of the

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

3 292d(a)(2)(C)) is amended by striking ‘‘and (x)’’

4 and inserting ‘‘(x) not in excess of three years, dur5 ing which the borrower is providing health care serv6 ices to Indians through an Indian health program

7 (as defined in section 108(a)(2)(A) of the Indian

8 Health Care Improvement Act (25 U.S.C.

9 1616a(a)(2)(A)); and (xi)’’.

10 (2) CONFORMING AMENDMENTS.—Section

11 705(a)(2)(C) of the Public Health Service Act (42

12 U.S.C. 292d(a)(2)(C)) is further amended—

13 (A) in clause (xi) (as so redesignated) by

14 striking ‘‘(ix)’’ and inserting ‘‘(x)’’; and

15 (B) in the matter following such clause

16 (xi), by striking ‘‘(x)’’ and inserting ‘‘(xi)’’.

17 (3) EFFECTIVE DATE.—The amendments made

18 by this subsection shall apply with respect to serv19 ices provided on or after the first day of the third

20 month that begins after the date of the enactment

21 of this Act.

22 (b) REPORT REQUIREMENT.—Section 709(b) of the

23 Public Health Service Act (42 U.S.C. 292h(b)) is

24 amended—
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1 (1) in paragraph (4)(B), by adding ‘‘and’’ after

2 the semicolon;

3 (2) in paragraph (5), by striking ‘‘; and’’ and

4 inserting a period; and

5 (3) by striking paragraph (6).

6 (c) COLLECTION FROM ESTATES.—Section 714 of

7 the Public Health Service Act (42 U.S.C. 292m) is amend8 ed by adding at the end the following new sentence: ‘‘Not9 withstanding the first sentence, the Secretary may, in the

10 case of a borrower who dies, collect any remaining unpaid

11 balance owed to the lender, the holder of the loan, or the

12 Federal Government from the borrower’s estate.’’.

13 SEC. 142. HEAL LENDER AND HOLDER PERFORMANCE

14 STANDARDS.

15 (a) GENERAL AMENDMENTS.—Section 707(a) of the

16 Public Health Service Act (42 U.S.C. 292f) is amended—

17 (1) by striking the last sentence;

18 (2) by striking ‘‘determined.’’ and inserting

19 ‘‘determined, except that, if the insurance bene20 ficiary including any servicer of the loan is not des21 ignated for ‘exceptional performance’, as set forth in

22 paragraph (2), the Secretary shall pay to the bene23 ficiary a sum equal to 98 percent of the amount of

24 the loss sustained by the insured upon that loan.’’;

25 (3) by striking ‘‘Upon’’ and inserting:
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1 ‘‘(1) IN GENERAL.—Upon’’; and

2 (4) by adding at the end the following new

3 paragraph:

4 ‘‘(2) EXCEPTIONAL PERFORMANCE.—

5 ‘‘(A) AUTHORITY.—Where the Secretary

6 determines that an eligible lender, holder, or

7 servicer has a compliance performance rating

8 that equals or exceeds 97 percent, the Secretary

9 shall designate that eligible lender, holder, or

10 servicer, as the case may be, for exceptional

11 performance.

12 ‘‘(B) COMPLIANCE PERFORMANCE RAT13 ING.—For purposes of subparagraph (A), a

14 compliance performance rating is determined

15 with respect to compliance with due diligence in

16 the disbursement, servicing, and collection of

17 loans under this subpart for each year for

18 which the determination is made. Such rating

19 shall be equal to the percentage of all due dili20 gence requirements applicable to each loan, on

21 average, as established by the Secretary, with

22 respect to loans serviced during the period by

23 the eligible lender, holder, or servicer.

24 ‘‘(C) ANNUAL AUDITS FOR LENDERS,

25 HOLDERS, AND SERVICERS.—Each eligible lend-
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1 er, holder, or servicer desiring a designation

2 under subparagraph (A) shall have an annual

3 financial and compliance audit conducted with

4 respect to the loan portfolio of such eligible

5 lender, holder, or servicer, by a qualified inde6 pendent organization from a list of qualified or7 ganizations identified by the Secretary and in

8 accordance with standards established by the

9 Secretary. The standards shall measure the

10 lender’s, holder’s, or servicer’s compliance with

11 due diligence standards and shall include a de12 fined statistical sampling technique designed to

13 measure the performance rating of the eligible

14 lender, holder, or servicer for the purpose of

15 this section. Each eligible lender, holder, or

16 servicer shall submit the audit required by this

17 section to the Secretary.

18 ‘‘(D) SECRETARY’S DETERMINATIONS.—

19 The Secretary shall make the determination

20 under subparagraph (A) based upon the audits

21 submitted under this paragraph and any infor22 mation in the possession of the Secretary or

23 submitted by any other agency or office of the

24 Federal Government.
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1 ‘‘(E) QUARTERLY COMPLIANCE AUDIT.—

2 To maintain its status as an exceptional per3 former, the lender, holder, or servicer shall un4 dergo a quarterly compliance audit at the end

5 of each quarter (other than the quarter in

6 which status as an exceptional performer is es7 tablished through a financial and compliance

8 audit, as described in subparagraph (C)), and

9 submit the results of such audit to the Sec10 retary. The compliance audit shall review com11 pliance with due diligence requirements for the

12 period beginning on the day after the ending

13 date of the previous audit, in accordance with

14 standards determined by the Secretary.

15 ‘‘(F) REVOCATION AUTHORITY.—The Sec16 retary shall revoke the designation of a lender,

17 holder, or servicer under subparagraph (A) if

18 any quarterly audit required under subpara19 graph (E) is not received by the Secretary by

20 the date established by the Secretary or if the

21 audit indicates the lender, holder, or servicer

22 has failed to meet the standards for designation

23 as an exceptional performer under subpara24 graph (A). A lender, holder, or servicer receiv25 ing a compliance audit not meeting the stand-
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1 ard for designation as an exceptional performer

2 may reapply for designation under subpara3 graph (A) at any time.

4 ‘‘(G) DOCUMENTATION.—Nothing in this

5 section shall restrict or limit the authority of

6 the Secretary to require the submission of

7 claims documentation evidencing servicing per8 formed on loans, except that the Secretary may

9 not require exceptional performers to submit

10 greater documentation than that required for

11 lenders, holders, and servicers not designated

12 under subparagraph (A).

13 ‘‘(H) COST OF AUDITS.—Each eligible

14 lender, holder, or servicer shall pay for all the

15 costs associated with the audits required under

16 this section.

17 ‘‘(I) ADDITIONAL REVOCATION AUTHOR18 ITY.—Notwithstanding any other provision of

19 this section, a designation under subparagraph

20 (A) may be revoked at any time by the Sec21 retary if the Secretary determines that the eligi22 ble lender, holder, or servicer has failed to

23 maintain an overall level of compliance consist24 ent with the audit submitted by the eligible

25 lender, holder, or servicer under this paragraph
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1 or if the Secretary asserts that the lender, hold2 er, or servicer may have engaged in fraud in se3 curing designation under subparagraph (A) or

4 is failing to service loans in accordance with

5 program requirements.

6 ‘‘(J) NONCOMPLIANCE.—A lender, holder,

7 or servicer designated under subparagraph (A)

8 that fails to service loans or otherwise comply

9 with applicable program regulations shall be

10 considered in violation of the Federal False

11 Claims Act.’’.

12 (b) DEFINITION.—Section 707(e) of the Public

13 Health Service Act (42 U.S.C. 292f(e)) is amended by

14 adding at the end the following new paragraph:

15 ‘‘(4) The term ‘servicer’ means any agency act16 ing on behalf of the insurance beneficiary.’’.

17 (c) EFFECTIVE DATE.—The amendments made by

18 subsections (a) and (b) shall apply with respect to loans

19 submitted to the Secretary for payment on or after the

20 first day of the sixth month that begins after the date

21 of enactment of this Act.

22 SEC. 143. REAUTHORIZATION.

23 (a) LOAN PROGRAM.—Section 702(a) of the Public

24 Health Service Act (42 U.S.C. 292a(a)) is amended—
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1 (1) by striking ‘‘$350,000,000’’ and all that fol2 lows through ‘‘1995’’ and inserting ‘‘$260,000,000

3 for fiscal year 1996, $160,000,000 for fiscal year

4 1997, and $80,000,000 for fiscal year 1998’’;

5 (2) by striking ‘‘obtained prior loans insured

6 under this subpart’’ and inserting ‘‘obtained loans

7 insured under this subpart in fiscal year 1996 or in

8 prior fiscal years’’; and

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

10 new sentence: ‘‘The Secretary may establish guide11 lines and procedures that lenders must follow in dis12 tributing funds under this subpart.’’.

13 (b) INSURANCE PROGRAM.—Section 710(a)(2)(B) of

14 the Public Health Service Act (42 U.S.C. 292i(a)(2)(B))

15 is amended by striking ‘‘any of the fiscal years 1993

16 through 1996’’ and inserting ‘‘fiscal year 1993 and subse17 quent fiscal years’’.

18 PART 4—SCHOLARSHIPS FOR DISADVANTAGED

19 STUDENTS

20 SEC. 151. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.

21 Part B of title VII of the Public Health Service Act

22 (as amended by section 101(a)) is further amended by

23 adding at the end thereof the following new section:
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1 ‘‘SEC. 740. SCHOLARSHIPS FOR DISADVANTAGED STU2 DENTS.

3 ‘‘(a) IN GENERAL.—The Secretary may make a grant

4 to an eligible entity (as defined in subsection (f)(1)) under

5 this section for the awarding of scholarships by schools

6 to any full-time student who is an eligible individual as

7 defined in subsection (f). Such scholarships may be ex8 pended only for tuition expenses, other reasonable edu9 cational expenses, and reasonable living expenses incurred

10 in the attendance of such school, and may not, for any

11 year of such attendance for which the scholarship is pro12 vided, provide an amount exceeding the total amount re13 quired for the year.

14 ‘‘(b) PREFERENCE IN PROVIDING SCHOLARSHIPS.—

15 The Secretary may not make a grant to an entity under

16 subsection (a) unless the health professions and nursing

17 schools involved agrees that, in providing scholarships pur18 suant to the grant, the school will give preference to stu19 dents for whom the costs of attending the school would

20 constitute a severe financial hardship and, notwithstand21 ing other provisions of this section, to former recipients

22 of scholarships under sections 736 and 740(d)(2)(B) (as

23 such sections existed on the day before the date of enact24 ment of this section).

25 ‘‘(c) AMOUNT OF AWARD.—In awarding grants to eli26 gible entities that are health professions and nursing
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1 schools, the Secretary shall give priority to eligible entities

2 based on the proportion of graduating students going into

3 primary care, the proportion of minority students, and the

4 proportion of graduates working in medically underserved

5 areas.

6 ‘‘(d) MAXIMUM SCHOLARSHIP AWARD.—The maxi7 mum scholarship that an individual may receive in any

8 year from an eligible entity that is a health professions

9 and nursing schools shall be $3,000.

10 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There

11 are authorized to be appropriated to carry out this section,

12 $32,000,000 for each of the fiscal years 1996 through

13 1999. Of the amount appropriated in any fiscal year, the

14 Secretary shall ensure that not less than 16 percent shall

15 be distributed to schools of nursing.

16 ‘‘(f) DEFINITIONS.—As used in this section:

17 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible

18 entities’ means an entity that—

19 ‘‘(A) is a school of medicine, osteopathic

20 medicine, dentistry, nursing (as defined in sec21 tion 801), pharmacy, podiatric medicine, optom22 etry, veterinary medicine, public health, or al23 lied health, a school offering a graduate pro24 gram in mental health practice, or an entity
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1 providing programs for the training of physi2 cian assistant; and

3 ‘‘(B) is carrying out a program for recruit4 ing and retaining students from disadvantaged

5 backgrounds, including students who are mem6 bers of racial and ethnic minority groups.

7 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible

8 individual’ means an individual who—

9 ‘‘(A) is from a disadvantaged background;

10 ‘‘(B) has a financial need for a scholar11 ship; and

12 ‘‘(C) is enrolled (or accepted for enroll13 ment) at an eligible health profession or nurs14 ing school as a full-time student in a program

15 leading to a degree in a health profession or

16 nursing.’’.

17 TITLE II—OFFICE OF MINORITY

18 HEALTH

19 SEC. 201. REVISION AND EXTENSION OF PROGRAMS OF OF20 FICE OF MINORITY HEALTH.

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

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

23 subsection (b) and all that follows and inserting the follow24 ing:
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1 ‘‘(b) DUTIES.—With respect to improving the health

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

3 through the Deputy Assistant Secretary for Minority

4 Health (in this section referred to as the ‘Deputy Assist5 ant Secretary’), shall carry out the following:

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

7 and objectives and coordinate all other activities

8 within the Public Health Service that relate to dis9 ease prevention, health promotion, service delivery,

10 and research concerning such individuals. The heads

11 of each of the agencies of the Service shall consult

12 with the Deputy Assistant Secretary to ensure the

13 coordination of such activities.

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

15 by entering into interagency agreements with other

16 agencies of the Public Health Service:

17 ‘‘(A) Support research, demonstrations and

18 evaluations to test new and innovative models.

19 ‘‘(B) Increase knowledge and understand20 ing of health risk factors.

21 ‘‘(C) Develop mechanisms that support

22 better information dissemination, education,

23 prevention, and service delivery to individuals

24 from disadvantaged backgrounds, including in-
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1 dividuals who are members of racial or ethnic

2 minority groups.

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

4 Health Statistics collects data on the health

5 status of each minority group.

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

7 proficiency in speaking the English language,

8 enter into contracts with public and nonprofit

9 private providers of primary health services for

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

14 ‘‘(3) Support a national minority health re15 source center to carry out the following:

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

19 services, and education in the appropriate use

20 of health care.

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

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

23 problems relating to such matters.

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

2 for such technical assistance).

3 ‘‘(4) Carry out programs to improve access to

4 health care services for individuals with limited pro5 ficiency in speaking the English language by facili6 tating the removal of impediments to the receipt of

7 health care that result from such limitation. Activi8 ties under the preceding sentence shall include con9 ducting research and developing and evaluating

10 model projects.

11 ‘‘(5) Not later than June 8 of each year, the

12 heads of the Public Health Service agencies shall

13 submit to the Deputy Assistant Secretary a report

14 summarizing the minority health activities of each of

15 the respective agencies.

16 ‘‘(c) ADVISORY COMMITTEE.—

17 ‘‘(1) IN GENERAL.—The Secretary shall estab18 lish an advisory committee to be known as the Advi19 sory Committee on Minority Health (in this sub20 section referred to as the ‘Committee’). The Deputy

21 Assistant Secretary shall consult with the Committee

22 in carrying out this section.

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

24 advice to the Deputy Assistant Secretary carrying

25 out this section, including advice on the development
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1 of goals and specific program activities under para2 graphs (1) and (2) of subsection (b) for each racial

3 and ethnic minority group.

4 ‘‘(3) CHAIR.—The Deputy Assistant Secretary

5 shall serve as the chair of the Committee.

6 ‘‘(4) COMPOSITION.—

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

8 12 voting members appointed in accordance

9 with subparagraph (B), and nonvoting, ex

10 officio members designated in subparagraph

11 (C).

12 ‘‘(B) The voting members of the Commit13 tee shall be appointed by the Secretary from

14 among individuals who are not officers or em15 ployees of the Federal Government and who

16 have expertise regarding issues of minority

17 health. The racial and ethnic minority groups

18 shall be equally represented among such mem19 bers.

20 ‘‘(C) The nonvoting, ex officio members of

21 the Committee shall be the directors of each of

22 the minority health offices, and such additional

23 officials of the Department of Health and

24 Human Services as the Secretary determines to

25 be appropriate.
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1 ‘‘(5) TERMS.—Each member of the Committee

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

3 Secretary shall initially appoint a portion of the

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

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

6 Committee, a new member shall be appointed by the

7 Secretary within 90 days from the date that the va8 cancy occurs, and serve for the remainder of the

9 term for which the predecessor of such member was

10 appointed. The vacancy shall not affect the power of

11 the remaining members to execute the duties of the

12 Committee.

13 ‘‘(7) COMPENSATION.—Members of the Com14 mittee who are officers or employees of the United

15 States shall serve without compensation. Members of

16 the Committee who are not officers or employees of

17 the United States shall receive compensation, for

18 each day (including travel time) they are engaged in

19 the performance of the functions of the Committee.

20 Such compensation may not be in an amount in ex21 cess of the daily equivalent of the annual maximum

22 rate of basic pay payable under the General Sched23 ule (under title 5, United States Code) for positions

24 above GS–15.
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1 ‘‘(d) CERTAIN REQUIREMENTS REGARDING DU2 TIES.—

3 ‘‘(1) RECOMMENDATIONS REGARDING LAN4 GUAGE AS IMPEDIMENT TO HEALTH CARE.—The

5 Deputy Assistant Secretary for Minority Health

6 shall consult with the Director of the Office of Refu7 gee Health, the Director of the Office of Civil

8 Rights, and the Director of the Office of Minority

9 Health of the Health Resources and Services Admin10 istration, and other appropriate offices, regarding

11 recommendations for carrying out activities under

12 subsection (b)(4).

13 ‘‘(2) EQUITABLE ALLOCATION REGARDING AC14 TIVITIES.—

15 ‘‘(A) In making awards of grants, coopera16 tive agreements, or contracts under this section

17 or section 338A, 338B, 340A, 404, or 724, or

18 part B of title VII, the Secretary, acting as ap19 propriate through the Deputy Assistant Sec20 retary or the Administrator of the Health Re21 sources and Services Administration, shall en22 sure that such awards are equitably allocated

23 with respect to the various racial and minority

24 populations.
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1 ‘‘(B) With respect to grants, cooperative

2 agreements, and contracts that are available

3 under the sections specified in subparagraph

4 (A), the Secretary shall—

5 ‘‘(i) carry out activities to inform enti6 ties, as appropriate, that the entities may

7 be eligible for awards of such assistance;

8 ‘‘(ii) provide technical assistance to

9 such entities in the process of preparing

10 and submitting applications for the awards

11 in accordance with the policies of the Sec12 retary regarding such application; and

13 ‘‘(iii) inform populations, as appro14 priate, that members of the populations

15 may be eligible to receive services or other16 wise participate in the activities carried out

17 with such awards.

18 ‘‘(3) CULTURAL COMPETENCY OF SERVICES.—

19 The Secretary shall ensure that information and

20 services provided pursuant to subsection (b) are pro21 vided in the language, educational, and cultural con22 text that is most appropriate for the individuals for

23 whom the information and services are intended.

24 ‘‘(e) GRANTS AND CONTRACTS REGARDING DU25 TIES.—
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1 ‘‘(1) IN GENERAL.—In carrying out subsection

2 (b), the Deputy Assistant Secretary may make

3 awards of grants, cooperative agreements, and con4 tracts to public and nonprofit private entities.

5 ‘‘(2) PROCESS FOR MAKING AWARDS.—The

6 Deputy Assistant Secretary shall ensure that awards

7 under paragraph (1) are made only on a competitive

8 basis, and that a grant is awarded for a proposal

9 only if the proposal has been recommended for such

10 an award through a process of peer review and has

11 been so recommended by the advisory committee es12 tablished under subsection (c).

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

14 Deputy Assistant Secretary, directly or through con15 tracts with public and private entities, shall provide

16 for evaluations of projects carried out with awards

17 made under paragraph (1) during the preceding 2

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

20 involved.

21 ‘‘(f) BIENNIAL REPORTS.—Not later than February

22 1 of fiscal year 1996 and of each second year thereafter,

23 the Deputy Assistant Secretary shall submit to the Com24 mittee on Energy and Commerce of the House of Rep25 resentatives, and to the Committee on Labor and Human
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1 Resources of the Senate, a report describing the activities

2 carried out under this section during the preceding 2 fiscal

3 years and evaluating the extent to which such activities

4 have been effective in improving the health of racial and

5 ethnic minority groups. Each such report shall include the

6 biennial reports submitted to the Deputy Assistant Sec7 retary under section 201(b)(5) for such years by the heads

8 of the Public Health Service agencies.

9 ‘‘(g) DEFINITION.—For purposes of this section:

10 ‘‘(1) The term ‘racial and ethnic minority

11 group’ means American Indians (including Alaska

12 Natives, Eskimos, and Aleuts); Asian Americans and

13 Pacific Islanders; Blacks; and Hispanics.

14 ‘‘(2) The term ‘Hispanic’ means individuals

15 whose origin is Mexican, Puerto Rican, Cuban,

16 Central or South American, or any other Spanish17 speaking country.

18 ‘‘(h) FUNDING.—For the purpose of carrying out this

19 section, there are authorized to be appropriated

20 $21,000,000 for fiscal year 1996, such sums as may be

21 necessary for each of the fiscal years 1997 and 1998, and

22 $19,000,000 for fiscal year 1999.’’.

23 (b) MISCELLANEOUS AMENDMENT.—Section 1707 of

24 the Public Health Service Act (42 U.S.C. 300u–6) is
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1 amended in the heading for the section by striking ‘‘ES2 TABLISHMENT OF’’.

3 TITLE III—SELECTED

4 INITIATIVES

5 SEC. 301. PROGRAMS REGARDING BIRTH DEFECTS.

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

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

8 ‘‘PROGRAMS REGARDING BIRTH DEFECTS

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

10 Director of the Centers for Disease Control and Preven11 tion, shall carry out programs—

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

13 on birth defects (in a manner that facilitates compli14 ance with subsection (d)(2)), including data on the

15 causes of such defects and on the incidence and

16 prevalence of such defects; and

17 ‘‘(2) to operate regional centers for the conduct

18 of applied epidemiological research on the prevention

19 of such defects.

20 ‘‘(b) ADDITIONAL PROVISIONS REGARDING COLLEC21 TION OF DATA.—

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

23 (a)(1), the Secretary—

24 ‘‘(A) shall collect and analyze data by gen25 der and by racial and ethnic group, including

26 Hispanics, non-Hispanic whites, Blacks, Native
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1 Americans, Asian Americans, and Pacific Is2 landers;

3 ‘‘(B) shall collect data under subparagraph

4 (A) from birth certificates, death certificates,

5 hospital records, and such other sources as the

6 Secretary determines to be appropriate; and

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

8 improve programs for the collection and analy9 sis of epidemiological data on birth defects, and

10 to make the data available.

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

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

13 and maintain a National Information Clearinghouse

14 on Birth Defects to collect and disseminate to health

15 professionals and the general public information on

16 birth defects, including the prevention of such de17 fects.

18 ‘‘(c) GRANTS AND CONTRACTS.—

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

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

21 into contracts with public and nonprofit private enti22 ties.

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

24 AWARD FUNDS.—
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1 ‘‘(A) Upon the request of a recipient of an

2 award of a grant or contract under paragraph

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

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

5 for the purpose of aiding the recipient in carry6 ing out the purposes for which the award is

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

8 recipient any officer or employee of the Depart9 ment of Health and Human Services.

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

11 in subparagraph (A), the Secretary shall reduce

12 the amount of payments under the award in13 volved by an amount equal to the costs of de14 tailing personnel and the fair market value of

15 any supplies, equipment, or services provided by

16 the Secretary. The Secretary shall, for the pay17 ment of expenses incurred in complying with

18 such request, expend the amounts withheld.

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

20 may make an award of a grant or contract under

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

22 is submitted to the Secretary and the application is

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

24 such agreements, assurances, and information as the
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1 Secretary determines to be necessary to carry out

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

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

4 1 of fiscal year 1997 and of every second such year there5 after, the Secretary shall submit to the Committee on En6 ergy and Commerce of the House of Representatives, and

7 the Committee on Labor and Human Resources of the

8 Senate, a report that, with respect to the preceding 2 fis9 cal years—

10 ‘‘(1) contains information regarding the inci11 dence and prevalence of birth defects and the extent

12 to which birth defects have contributed to the inci13 dence and prevalence of infant mortality;

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

15 that is specific to various racial and ethnic groups

16 (including Hispanics, non-Hispanic whites, Blacks,

17 Native Americans, and Asian Americans);

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

19 which various approaches of preventing birth defects

20 have been effective;

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

22 this section; and

23 ‘‘(5) contains any recommendations of the Sec24 retary regarding this section.’’.
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1 SEC. 302. STATE OFFICES OF RURAL HEALTH.

2 (a) IN GENERAL.—Section 338M of the Public

3 Health Service Act (as so redesignated by section 132)

4 is amended—

5 (1) in subsection (b)(1), in the matter preced6 ing subparagraph (A), by striking ‘‘in cash’’; and

7 (2) in subsection (j)(1)—

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

9 (B) by inserting before the period the fol10 lowing: ‘‘, and such sums as may be necessary

11 for each of the fiscal years 1996 through

12 1997’’; and

13 (3) in subsection (k), by striking

14 ‘‘$10,000,000’’ and inserting ‘‘$20,000,000’’.

15 (b) REPEAL.—Effective on October 1, 1997, section

16 338M of the Public Health Service Act (as so redesignated

17 by section 132) is repealed.

18 SEC. 303. HEALTH SERVICES FOR PACIFIC ISLANDERS.

19 Section 10 of the Disadvantaged Minority Health Im20 provement Act of 1990 (42 U.S.C. 254c–1) is amended—

21 (1) in subsection (b)—

22 (A) in paragraph (2)—

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

24 after ‘‘availability of health’’; and

25 (ii) by striking ‘‘, including improved

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

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

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

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

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

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

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

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

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

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

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

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

16 redesignated), the following new paragraphs:

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

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

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

21 disease prevention services for rural American

22 Samoa.’’;

23 (2) in subsection (f)—

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

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

2 follows through ‘‘1993’’ and inserting

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

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

5 year 1997’’; and

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

7 new subsection:

8 ‘‘(g) STUDY AND REPORT.—

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

10 the date of enactment of this subsection, the Sec11 retary, acting through the Administrator of the

12 Health Resources and Services Administration, shall

13 enter into a contract with a public or nonprofit pri14 vate entity for the conduct of a study to determine

15 the effectiveness of projects funded under this sec16 tion.

17 ‘‘(2) REPORT.—Not later than July 1, 1996,

18 the Secretary shall prepare and submit to the Com19 mittee on Labor and Human Resources of the Sen20 ate and the Committee on Energy and Commerce of

21 the House of Representatives a report describing the

22 findings made with respect to the study conducted

23 under paragraph (1).’’.
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1 SEC. 304. DEMONSTRATION PROJECTS REGARDING ALZ2 HEIMER’S DISEASE.

3 (a) IN GENERAL.—Section 398(a) of the Public

4 Health Service Act (42 U.S.C. 280c–3(a)) is amended—

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

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

7 (2) in paragraph (2)—

8 (A) by inserting after ‘‘disorders’’ the fol9 lowing: ‘‘who are living in single family homes

10 or in congregate settings’’; and

11 (B) by striking ‘‘and’’ at the end;

12 (3) by redesignating paragraph (3) as para13 graph (4); and

14 (4) by inserting after paragraph (2) the follow15 ing:

16 ‘‘(3) to improve the access of such individuals

17 to home-based or community-based long-term care

18 services (subject to the services being provided by

19 entities that were providing such services in the

20 State involved as of October 1, 1995), particularly

21 such individuals who are members of racial or ethnic

22 minority groups, who have limited proficiency in

23 speaking the English language, or who live in rural

24 areas; and’’.

25 (b) DURATION.—Section 398A of the Public Health

26 Service Act (42 U.S.C. 280c–4) is amended—
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1 (1) in the heading for the section, by striking

2 ‘‘LIMITATION’’ and all that follows and inserting

3 ‘‘REQUIREMENT OF MATCHING

4 FUNDS’’;

5 (2) by striking subsection (a);

6 (3) by redesignating subsections (b) and (c) as

7 subsections (a) and (b), respectively;

8 (4) in subsection (a) (as so redesignated), in

9 each of paragraphs (1)(C) and (2)(C), by striking

10 ‘‘third year’’ and inserting ‘‘third or subsequent

11 year’’.

12 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

13 398B(e) of the Public Health Service Act (42 U.S.C.

14 280c–5(e)) is amended by striking ‘‘and 1993’’ and insert15 ing ‘‘through 1998’’.

16 TITLE IV—MISCELLANEOUS

17 PROVISIONS

18 SEC. 401. TECHNICAL CORRECTIONS REGARDING PUBLIC

19 LAW 103–183.

20 (a) AMENDATORY INSTRUCTIONS.—Public Law 103–

21 183 is amended—

22 (1) in section 601—

23 (A) in subsection (b), in the matter preced24 ing paragraph (1), by striking ‘‘Section 1201 of

25 the Public Health Service Act (42 U.S.C.
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1 300d)’’ and inserting ‘‘Title XII of the Public

2 Health Service Act (42 U.S.C. 300d et seq.)’’;

3 and

4 (B) in subsection (f)(1), by striking ‘‘in

5 section 1204(c)’’ and inserting ‘‘in section

6 1203(c) (as redesignated by subsection (b)(2) of

7 this section)’’;

8 (2) in section 602, by striking ‘‘for the pur9 pose’’ and inserting ‘‘For the purpose’’; and

10 (3) in section 705(b), by striking ‘‘317D((l)(1)’’

11 and inserting ‘‘317D(l)(1)’’.

12 (b) PUBLIC HEALTH SERVICE ACT.—The Public

13 Health Service Act, as amended by Public Law 103–183

14 and by subsection (a) of this section, is amended—

15 (1) in section 317E(g)(2), by striking ‘‘making

16 grants under subsection (b)’’ and inserting ‘‘carrying

17 out subsection (b)’’;

18 (2) in section 318, in subsection (e) as in effect

19 on the day before the date of the enactment of Pub20 lic Law 103–183, by redesignating the subsection as

21 subsection (f);

22 (3) in subpart 6 of part C of title IV—

23 (A) by transferring the first section 447

24 (added by section 302 of Public Law 103–183)

25 from the current placement of the section;
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1 (B) by redesignating the section as section

2 447A; and

3 (C) by inserting the section after section

4 447;

5 (4) in section 1213(a)(8), by striking ‘‘provides

6 for for’’ and inserting ‘‘provides for’’;

7 (5) in section 1501, by redesignating the second

8 subsection (c) (added by section 101(f) of Public

9 Law 103–183) as subsection (d); and

10 (6) in section 1505(3), by striking ‘‘nonprivate’’

11 and inserting ‘‘private’’.

12 (c) MISCELLANEOUS CORRECTION.—Section

13 401(c)(3) of Public Law 103–183 is amended in the mat14 ter preceding subparagraph (A) by striking ‘‘(d)(5)’’ and

15 inserting ‘‘(e)(5)’’.

16 (d) EFFECTIVE DATE.—This section is deemed to

17 have taken effect immediately after the enactment of Pub18 lic Law 103–183.

19 SEC. 402. CERTAIN AUTHORITIES OF CENTERS FOR DIS20 EASE CONTROL AND PREVENTION.

21 (a) IN GENERAL.—Part B of title III of the Public

22 Health Service Act is amended by inserting after section

23 317H the following section:
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1 ‘‘MISCELLANEOUS AUTHORITIES REGARDING CENTERS

2 FOR DISEASE CONTROL AND PREVENTION

3 ‘‘SEC. 317I. (a) TECHNICAL AND SCIENTIFIC PEER

4 REVIEW GROUPS.—The Secretary, acting through the Di5 rector of the Centers for Disease Control and Prevention,

6 may, without regard to the provisions of title 5, United

7 States Code, governing appointments in the competitive

8 service, and without regard to the provisions of chapter

9 51 and subchapter III of chapter 53 of such title relating

10 to classification and General Schedule pay rates, establish

11 such technical and scientific peer review groups and sci12 entific program advisory committees as are needed to

13 carry out the functions of such Centers and appoint and

14 pay the members of such groups, except that officers and

15 employees of the United States shall not receive additional

16 compensation for service as members of such groups. The

17 Federal Advisory Committee Act shall not apply to the

18 duration of such peer review groups. Not more than one19 fourth of the members of any such group shall be officers

20 or employees of the United States.

21 ‘‘(b) FELLOWSHIP AND TRAINING PROGRAMS.—The

22 Secretary, acting through the Director of the Centers for

23 Disease Control and Prevention, shall establish fellowship

24 and training programs to be conducted by such Centers

25 to train individuals to develop skills in epidemiology, sur-
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1 veillance, laboratory analysis, and other disease detection

2 and prevention methods. Such programs shall be designed

3 to enable health professionals and health personnel trained

4 under such programs to work, after receiving such train5 ing, in local, State, national, and international efforts to6 ward the prevention and control of diseases, injuries, and

7 disabilities. Such fellowships and training may be adminis8 tered through the use of either appointment or non9 appointment procedures.’’.

10 (b) EFFECTIVE DATE.—This section is deemed to

11 have taken effect July 1, 1995.

12 SEC. 403. ADMINISTRATION OF CERTAIN REQUIREMENTS.

13 (a) IN GENERAL.—Section 2004 of Public Law 103–

14 43 (107 Stat. 209) is amended by striking subsection (a).

15 (b) CONFORMING AMENDMENTS.—Section 2004 of

16 Public Law 103–43, as amended by subsection (a) of this

17 section, is amended—

18 (1) by striking ‘‘(b) SENSE’’ and all that follows

19 through ‘‘In the case’’ and inserting the following:

20 ‘‘(a) SENSE OF CONGRESS REGARDING PURCHASE

21 OF AMERICAN-MADE EQUIPMENT AND PRODUCTS.—In

22 the case’’;

23 (2) by striking ‘‘(2) NOTICE TO RECIPIENTS OF

24 ASSISTANCE’’ and inserting the following:

25 ‘‘(b) NOTICE TO RECIPIENTS OF ASSISTANCE’’; and
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1 (3) in subsection (b), as redesignated by para2 graph (2) of this subsection, by striking ‘‘paragraph

3 (1)’’ and inserting ‘‘subsection (a)’’.

4 (c) EFFECTIVE DATE.—This section is deemed to

5 have taken effect immediately after the enactment of Pub6 lic Law 103–43.

7 SEC. 404. TECHNICAL CORRECTIONS RELATING TO HEALTH

8 PROFESSIONS PROGRAMS.

9 Part G of title VII of the Public Health Service Act

10 (42 U.S.C. 295j et seq.) is amended by inserting after sec11 tion 794 the following section:

12 ‘‘SEC. 794A. RECOVERY.

13 ‘‘(a) IN GENERAL.—If at any time within 20 years

14 (or within such shorter period as the Secretary may pre15 scribe by regulation for an interim facility) after the com16 pletion of construction of a facility with respect to which

17 funds have been paid under section 720(a) (as such sec18 tion existed one day prior to the date of enactment of the

19 Health Professions Education Extension Amendments of

20 1992 (Public Law 102–408))—

21 ‘‘(1)(A) in the case of a facility which was an

22 affiliated hospital or outpatient facility with respect

23 to which funds have been paid under such section

24 720(a)(1), the owner of the facility ceases to be a

25 public or other nonprofit agency that would have
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1 been qualified to file an application under section

2 605;

3 ‘‘(B) in the case of a facility which was not an

4 affiliated hospital or outpatient facility but was a fa5 cility with respect to which funds have been paid

6 under paragraph (1) or (3) of such section 720(a),

7 the owner of the facility ceases to be a public or

8 nonprofit school; or

9 ‘‘(C) in the case of a facility which was a facil10 ity with respect to which funds have been paid under

11 such section 720(a)(2), the owner of the facility

12 ceases to be a public or nonprofit entity;

13 ‘‘(2) the facility ceases to be used for the teach14 ing or training purposes (or other purposes per15 mitted under section 722 (as such section existed

16 one day prior to the date of enactment of the Health

17 Professions Education Extension Amendments of

18 1992 (Public Law 102–408)) for which it was con19 structed, or

20 ‘‘(3) the facility is used for sectarian instruction

21 or as a place for religious worship,

22 the United States shall be entitled to recover from the

23 owner of the facility the base amount prescribed by sub24 section (c)(1) plus the interest (if any) prescribed by sub25 section (c)(2).
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1 ‘‘(b) NOTICE.—The owner of a facility which ceases

2 to be a public or nonprofit agency, school, or entity as

3 described in subparagraph (A), (B), or (C) of subsection

4 (a)(1), as the case may be, or the owner of a facility the

5 use of which changes as described in paragraph (2) or (3)

6 of subsection (a), shall provide the Secretary written no7 tice of such cessation or change of use within 10 days after

8 the date on which such cessation or change of use occurs

9 or within 30 days after the date of enactment of this sub10 section, whichever is later.

11 ‘‘(c) AMOUNT.—

12 ‘‘(1) BASE AMOUNT.—The base amount that

13 the United States is entitled to recover under sub14 section (a) is the amount bearing the same ratio to

15 the then value (as determined by the agreement of

16 the parties or in an action brought in the district

17 court of the United States for the district in which

18 the facility is situated) of the facility as the amount

19 of the Federal participation bore to the cost of con20 struction.

21 ‘‘(2) INTEREST.—

22 ‘‘(A) IN GENERAL.—The interest that the

23 United States is entitled to recover under sub24 section (a) is the interest for the period (if any)

25 described in subparagraph (B) at a rate (deter-
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1 mined by the Secretary) based on the average

2 of the bond equivalent rates of ninety-one-day

3 Treasury bills auctioned during that period.

4 ‘‘(B) PERIOD.—The period referred to in

5 subparagraph (A) is the period beginning—

6 ‘‘(i) if notice is provided as prescribed

7 by subsection (b), 191 days after the date

8 on which the owner of the facility ceases to

9 be a public or nonprofit agency, school, or

10 entity as described in subparagraph (A),

11 (B), or (C) of subsection (a)(1), as the

12 case may be, or 191 days after the date on

13 which the use of the facility changes as de14 scribed in paragraph (2) or (3) of sub15 section (a); or

16 ‘‘(ii) if notice is not provided as pre17 scribed by subsection (b), 11 days after the

18 date on which such cessation or change of

19 use occurs,

20 and ending on the date the amount the United

21 States is entitled to recover is collected.

22 ‘‘(d) WAIVER.—The Secretary may waive the recov23 ery rights of the United States under subsection (a)(2)

24 with respect to a facility (under such conditions as the
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1 Secretary may establish by regulation) if the Secretary de2 termines that there is good cause for waiving such rights.

3 ‘‘(e) LIEN.—The right of recovery of the United

4 States under subsection (a) shall not, prior to judgment,

5 constitute a lien on any facility.’’.

6 SEC. 405. CLINICAL TRAINEESHIPS.

7 Section 303(d)(1) of the Public Health Service Act

8 (42 U.S.C. 242a(d)(1)) is amended by inserting ‘‘counsel9 ing,’’ after ‘‘family therapy,’’.

10 SEC. 406. CONSTRUCTION OF REGIONAL CENTERS FOR RE11 SEARCH ON PRIMATES.

12 Section 481B(a) of the Public Health Service Act (42

13 U.S.C. 287a–3(a)) is amended by striking ‘‘$5,000,000’’

14 and inserting ‘‘$2,500,000’’.

15 SEC. 407. REQUIRED CONSULTATION BY SECRETARY.

16 The Secretary of Health and Human Services, re17 garding the programs under parts B, C, D, and E of title

18 VII, and parts B, C, and D of title VIII, of the Public

19 Health Service Act, as amended by this Act, shall—

20 (1) publish in the Federal Register a general

21 program description for the funding of awards under

22 such parts;

23 (2) solicit and receive written and oral com24 ments concerning such description, including the
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1 holding of a public forum at which interested indi2 viduals and groups may provide comment; and

3 (3) take into consideration information received

4 under paragraph (2).

Passed the Senate September 28, 1996.

Attest:

Secretary.
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104TH CONGRESS

2D SESSION S. 555

AN ACT

To amend the Public Health Service Act to consoligrams, and for other purposes. nority and disadvantaged health education pro- date and reauthorize health professions and mi-