Calendar No. 121

104TH CONGRESS

1ST SESSION S. 555

[Report No. 104–93]

A BILL

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 miJUNE 6 (legislative day, JUNE 5), 1995

Reported with an amendment
II

Calendar No. 121

104TH CONGRESS

1ST SESSION S. 555

[Report No. 104–93]

To amend the Public Health Service Act to consolidate and reauthorize

health professions and minority and disadvantaged health education programs, and for other purposes.

IN THE SENATE OF THE UNITED STATES

MARCH 14 (legislative day, MARCH 6), 1995

Mrs. KASSEBAUM (for herself, Mr. KENNEDY, and Mr. FRIST) introduced the

following bill; which was read twice and referred to the Committee on

Labor and Human Resources

JUNE 6 (legislative day, JUNE 5), 1995

Reported by Mrs. KASSEBAUM, with an amendment

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

A BILL

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,
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1 SECTION 1. SHORT TITLE.

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

3 ‘‘Health Professions Education Consolidation and Reau4 thorization Act of 1995’’.

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

6 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 health professions grant program.

Sec. 102. Training in primary health care and preventive medicine.

Sec. 103. Enhanced health education and training.

Sec. 104. Health profession workforce development.

Sec. 105. General provisions.

Sec. 106. Preference and required information 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.

Sec. 125. Preference and required information in certain programs.

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.

PART 3—INSURED HEALTH EDUCATION ASSISTANCE LOANS TO GRADUATE

STUDENTS

Sec. 141. Health education assistance loan program.
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PART 4—SCHOLARSHIPS FOR DISADVANTAGED STUDENTS

Sec. 151. Scholarships for disadvantaged students.

TITLE II—OFFICE OF MINORITY HEALTH

Sec. 201. Revision and extension of programs of Office of Minority Health.

TITLE III—SELECTED INITIATIVES

Sec. 301. Programs regarding birth defects.

Sec. 302. Traumatic brain injury.

Sec. 303. State offices of rural health.

Sec. 304. Health services for Pacific Islanders.

Sec. 305. 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.

1 TITLE I—HEALTH PROFESSIONS

2 EDUCATION AND FINANCIAL

3 ASSISTANCE PROGRAMS

4 Subtitle A—Health Professions

5 Education Programs

6 SEC. 101. MINORITY HEALTH PROFESSIONS GRANT PRO7 GRAM.

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 PROFESSIONS

12 TRAINING

13 ‘‘§ 736. Statement of purpose

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

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

2 to increase the number and the quality of disadvantaged

3 health professionals, particularly those who provide health

4 services to disadvantaged populations or in medically un5 derserved areas or rural areas.

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

7 grant or contract awarded under this part may be used

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

9 excellence in minority health professions education, pro10 grams for assisting individuals from disadvantaged back11 grounds to enter a health profession, minority faculty de12 velopment, minority faculty loan repayment or fellowships,

13 trainee support, technical assistance, workforce analysis,

14 and dissemination of information.

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

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

17 enter into an agreement to allocate the funds received

18 under the grant or contract among such schools and ex19 pend such funds in accordance with the application for

20 such grant or contract.

21 ‘‘§ 737. Preferences

22 ‘‘In awarding grants or contracts to eligible entities

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

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

25 professions discipline or training institution and
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1 have an above average record of retention and grad2 uation of individuals from disadvantaged back3 grounds; and

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

5 Colleges and Universities (as defined in section 739)

6 beginning in fiscal year 1999 and for each fiscal

7 year thereafter.

8 ‘‘§ 738. Authorization of appropriation

9 ‘‘(a) IN GENERAL.—There are authorized to be ap10 propriated to carry out this part, $51,000,000 for fiscal

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

12 of the fiscal years 1997 through 1999.

13 ‘‘(b) SET-ASIDE.—With respect to each of the fiscal

14 years 1996, 1997, and 1998, the Secretary shall set-aside

15 23.5 percent of the amount appropriated under subsection

16 (a) in each such fiscal year for the purpose of making

17 grants under section 736 to centers of excellence at certain

18 Historically Black Colleges and Universities.

19 ‘‘§ 739. Definitions

20 ‘‘As used in this part:

21 ‘‘(1) CENTERS OF EXCELLENCE.—The term

22 ‘centers of excellence’ means a health professions

23 school that—

24 ‘‘(A)(i) has a significant number of minor25 ity individuals enrolled in the school, including
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1 individuals accepted for enrollment in the

2 school;

3 ‘‘(ii) has been effective in assisting minor4 ity students of the school to complete the pro5 gram of education and receive the degree in6 volved;

7 ‘‘(iii) has been effective in recruiting mi8 nority individuals to attend the school and en9 couraging minority students of secondary edu10 cational institutions to attend the health profes11 sions school; and

12 ‘‘(iv) has made significant recruitment ef13 forts to increase the number of minority indi14 viduals serving in faculty or administrative posi15 tions at the school; or

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

17 Historically Black Colleges and Universities.

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

19 means the designated eligible entity seeking a grant

20 under this part and one or more schools of medicine,

21 osteopathic medicine, dentistry, pharmacy, nursing,

22 allied health, public health, or graduate programs in

23 mental health practice.

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

25 entities’ means schools of medicine, osteopathic med-
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1 icine, dentistry, pharmacy, podiatric medicine, op2 tometry, veterinary medicine, public health, or allied

3 health or schools offering graduate programs in

4 mental health practice, State or local governments,

5 and other public or nonprofit private entities deter6 mined appropriate by the Secretary that submit to

7 the Secretary an application.

8 ‘‘(4) HISTORICALLY BLACK COLLEGES AND

9 UNIVERSITIES.—The term ‘Historically Black Col10 leges and Universities’ means a school described in

11 section 799(1) that has received a contract under

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

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

14 (b) REPEAL.—

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

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

17 (2) NONTERMINATION OF AUTHORITY.—The

18 amendments made by this section shall not be con19 strued to terminate agreements that, on the day be20 fore the date of enactment of this Act, are in effect

21 pursuant to section 795 of the Public Health Service

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

23 date. Such agreements shall continue in effect in ac24 cordance with the terms of the agreements. With re25 spect to compliance with such agreements, any pe-
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1 riod of practice as a provider of primary health serv2 ices shall be counted towards the satisfaction of the

3 requirement of practice pursuant to such section

4 795.

5 (c) CONFORMING AMENDMENTS.—Section

6 481A(c)(3)(D)(i) of the Public Health Service Act (42

7 U.S.C. 287a–2(c)(3)(D)(i)) is amended by striking ‘‘sec8 tion 739’’ and inserting ‘‘part B of title VII’’.

9 SEC. 102. TRAINING IN PRIMARY HEALTH CARE AND PRE10 VENTIVE MEDICINE.

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

12 is amended—

13 (1) in the part heading by striking ‘‘CARE’’ and

14 inserting ‘‘CARE AND PREVENTIVE MEDICINE’’;

15 (2) by repealing section 746 and sections 748

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

17 293p); and

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

19 (A) by striking the section heading and in20 serting the following:

21 ‘‘§ 747. Family medicine, general internal medicine,

22 general pediatrics, preventive medicine,

23 and physician assistants’’;

24 (B) in subsection (a)—

25 (i) in paragraph (1)—
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1 (I) by inserting ‘‘, internal medi2 cine, or pediatrics’’ after ‘‘family med3 icine’’; and

4 (II) by inserting before the semi5 colon the following: ‘‘that emphasizes

6 training for the practice of family

7 medicine, general internal medicine,

8 or general pediatrics (as defined in

9 regulations promulgated by the Sec10 retary)’’;

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

12 general internal medicine, or pediatrics’’

13 before the semicolon;

14 (iii) in paragraphs (3) and (4), by in15 serting ‘‘, general internal medicine (in16 cluding geriatrics), or general pediatrics’’

17 after ‘‘family medicine’’;

18 (iv) in paragraphs (3) and (4), by in19 serting ‘‘(including geriatrics) after ‘‘fam20 ily medicine’’;

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

22 ‘‘and’’ at the end thereof;

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

24 period and inserting a semicolon; and
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1 (vii) by adding at the end thereof the

2 following new paragraphs:

3 ‘‘(5) to meet the costs of projects to plan, de4 velop, and operate or maintain programs for the

5 training of physician assistants (as defined in sec6 tion 799), and for the training of individuals who

7 will teach programs to provide such training; and

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

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

10 training programs and to maintain or improve

11 existing residency training programs in preven12 tive medicine, that have available full-time fac13 ulty members with training and experience in

14 the fields of preventive medicine; and

15 ‘‘(B) to provide financial assistance to resi16 dency trainees enrolled in such programs.’’;

17 (C) in paragraphs (1) and (2)(A) of sub18 section (b), by inserting ‘‘, general internal

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

20 medicine’’;

21 (D) by redesignating subsections (c) and

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

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

24 following new subsection:

25 ‘‘(c) PRIORITY AND LIMITATION.—
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1 ‘‘(1) PRIORITY.—With respect to programs for

2 the training of interns or residents, the Secretary

3 shall give priority in awarding grants under this sec4 tion to qualified applicants that have a record of

5 training the greatest percentage of providers, or that

6 have demonstrated significant improvements in the

7 percentage of providers, which enter and remain in

8 primary care practice upon completion of their first

9 period of training required to obtain initial board

10 certification. Each program shall designate the pri11 mary care training positions that such program shall

12 provide with grant funding to support and for which

13 such program shall be held accountable regarding

14 the primary care requirement set forth in this sec15 tion.

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

17 for the training and education of medical students,

18 the Secretary may only provide grants or contracts

19 under this section to administrative units in general

20 pediatrics or general internal medicine if a qualified

21 administrative unit applicant demonstrates that its

22 medical school has—

23 ‘‘(A) a mission statement that has a pri24 mary care medical education objective;
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1 ‘‘(B) faculty role models and administra2 tive units in primary care; and

3 ‘‘(C) required undergraduate ambulatory

4 medical student clerkships in family medicine,

5 internal medicine, and pediatrics.

6 Where a medical school does not have an adminis7 trative unit in family medicine clerkships in family

8 medicine shall not be required.’’; and

9 (F) in subsection (e) (as so redesig10 nated)—

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

12 ‘‘$54,000,000’’ and all that follows and in13 serting ‘‘$76,000,000 for fiscal year 1996,

14 and such sums as may be necessary for

15 each of the fiscal years 1997 and 1999.’’;

16 and

17 (ii) in paragraph (2)—

18 (I) by striking ‘‘20’’ and insert19 ing ‘‘12’’; and

20 (II) by inserting ‘‘for family med21 icine academic administrative units’’

22 after ‘‘under subsection (b)’’.

23 SEC. 103. ENHANCED HEALTH EDUCATION AND TRAINING.

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

25 (42 U.S.C. 294 et seq.) is amended to read as follows:
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1 ‘‘PART D—AREA HEALTH EDUCATION CENTERS

2 ‘‘§ 750. Area health education centers

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

4 to and enter into contracts with eligible entities for

5 projects which—

6 ‘‘(1) improve the recruitment, distribution, sup7 ply, quality, utilization, and efficiency of personnel

8 providing health services in urban and rural areas

9 and populations that have demonstrated serious

10 unmet health care need;

11 ‘‘(2) encourage the regionalization of edu12 cational responsibilities of the health professions

13 schools;

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

15 placements, preceptorships, the conduct or affiliation

16 with community-based primary care residency pro17 grams, agreements with community-based organiza18 tions for the delivery of education and training in

19 the health professions, and other programs, individ20 uals to effectively provide health services in health

21 professional shortage areas;

22 ‘‘(4) conduct health professions education and

23 training activities consistent with national and State

24 priorities, including geriatrics;
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1 ‘‘(5) encourage health promotion and disease

2 prevention activities;

3 ‘‘(6) conduct interdisciplinary training and

4 practice involving other health professionals;

5 ‘‘(7) conduct continuing education programs for

6 health professionals or coordinates with such pro7 grams; and

8 ‘‘(8) address other areas as determined appro9 priate by the Secretary.

10 ‘‘(b) PREFERENCES.—In awarding grants or con11 tracts to eligible entities under this part, the Secretary

12 shall give preference to projects that—

13 ‘‘(1) involve more than one health professions

14 discipline or training institution;

15 ‘‘(2) have a good record of retention and grad16 uation of individuals that enter practice in medically

17 underserved communities; and

18 ‘‘(3) have a higher percentage of medical stu19 dents or residents that enter primary care practice.

20 ‘‘(c) OTHER ELIGIBLE PROGRAMS.—The Secretary

21 may award grants or contracts under this section for the

22 establishment of geriatric education centers. In making a

23 determination to fund such centers the Secretary shall

24 consider the impact the programs under section 747, this
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1 part, and title VIII have made in the production of person2 nel to care for geriatric populations.

3 ‘‘(d) ELIGIBLE ENTITIES.—As used in this part, the

4 term ‘eligible entities’ means schools of medicine, osteo5 pathic medicine, dentistry, pharmacy, podiatric medicine,

6 optometry, veterinary medicine, public health, or allied

7 health or schools offering graduate programs in mental

8 health practice, State or local governments, and other pub9 lic or nonprofit private entities determined appropriate by

10 the Secretary that submit to the Secretary an application.

11 ‘‘(e) GERIATRIC EDUCATION CENTERS.—A geriatric

12 education center shall be an accredited health professions

13 school or program that—

14 ‘‘(1) improves the training of health profes15 sionals in geriatrics, including geriatric residencies,

16 traineeships, or fellowships;

17 ‘‘(2) develops and disseminates curricula relat18 ing to the treatment of the health problems of elder19 ly individuals;

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

21 faculty to provide instruction in geriatrics;

22 ‘‘(4) supports continuing education of health

23 professionals who provide geriatric care; and

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

25 geriatrics in nursing homes, chronic and acute dis-
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1 ease hospitals, ambulatory care centers, and senior

2 centers.

3 ‘‘§ 751. Authorization of appropriations

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

5 this part, $39,000,000 for fiscal year 1996, such sums as

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

7 1998, and $25,000,000 for fiscal year 1999.’’.

8 SEC. 104. HEALTH PROFESSION WORKFORCE DEVELOP9 MENT.

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

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

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

13 ‘‘PART E—HEALTH PROFESSION WORKFORCE

14 DEVELOPMENT’’;

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

16 294n) as section 761; and

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

18 294o and 294p) and inserting the following new sec19 tion:

20 ‘‘§ 762. Health profession workforce development

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

22 to and enter into contracts with eligible entities for

23 projects to strengthen capacity for health professions edu24 cation and practice.
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1 ‘‘(b) ELIGIBLE APPLICANTS.—Applicants eligible to

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

3 medicine, osteopathic medicine, dentistry, veterinary medi4 cine, pharmacy, podiatric medicine, chiropractic medicine,

5 optometry, public health, or allied health, graduate pro6 grams in mental health practice, physician assistant train7 ing programs, and other public and nonprofit private enti8 ties.

9 ‘‘(c) PRIORITY AREAS.—In awarding grants or con10 tracts under subsection (a), the Secretary shall give prior11 ity to entities that will use amounts provided under such

12 grants or contracts to enhance the education of health pro13 fessionals for purposes of—

14 ‘‘(1) providing care for underserved populations

15 and other high-risk groups;

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

17 are pursuing a course of study in a health profes18 sions field in which there is a severe shortage of

19 health professionals;

20 ‘‘(3) conducting health professions research and

21 data collection; and

22 ‘‘(4) carrying out other activities in areas deter23 mined appropriate by the Secretary.

24 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—
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1 ‘‘(1) IN GENERAL.—There are authorized to be

2 appropriated to carry out this section, $20,000,000

3 for fiscal year 1996, such sums as may be necessary

4 for each of the fiscal years 1997 and 1998, and

5 $5,000,000 for fiscal year 1999.

6 ‘‘(2) RESERVATION.—Of the amounts appro7 priated under subsection (a) for a fiscal year, the

8 Secretary may reserve not more than $2,000,000 for

9 conducting health professions research and data col10 lection in accordance with section 792.’’.

11 (b) HEALTH PROFESSIONS DATA.—The second sen12 tence of section 792(a) of the Public Health Service Act

13 (42 U.S.C. 295k(a)) is amended by striking ‘‘is authorized

14 to’’ and inserting ‘‘shall’’.

15 (c) COUNCIL ON GRADUATE MEDICAL EDUCATION.—

16 Section 301 of the Health Professions Education Exten17 sion Amendments of 1992 (Public Law 102-408) is

18 amended—

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

20 inserting ‘‘1999’’;

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

22 inserting ‘‘1999’’;

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

24 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 medical education 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) by

18 striking subsection (b);

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

20 295l);

21 (D) by repealing section 798;

22 (E) by redesignating section 799 as section

23 799B; and

24 (F) by inserting after section 794, the fol25 lowing new sections:
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1 ‘‘§ 796. Application

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

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

4 and submit to the Secretary an application that meets the

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

6 and containing such information as the Secretary may re7 quire.

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

9 section shall contain the plan of the applicant for carrying

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

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

12 regional program plans.

13 ‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An ap14 plication submitted under this section shall contain a spec15 ification by the applicant entity of performance outcome

16 standards that the project to be funded under the grant

17 or contract will be measured against. Such standards shall

18 address relevant health workforce needs that the project

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

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

21 contract application.

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

23 this section shall contain a description of the linkages with

24 relevant educational and health care entities, including

25 training programs for other health professionals as appro-
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1 priate, that the project to be funded under the grant or

2 contract will establish.

3 ‘‘§ 797. Use of funds

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

5 or contract awarded under this title may be used for train6 ing program development and support, faculty develop7 ment, model demonstrations, trainee support including

8 tuition, books, program fees and reasonable living ex9 penses during the period of training, technical assistance,

10 workforce analysis, and dissemination of information, as

11 appropriate to meet recognized health workforce objec12 tives, in accordance with this title.

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

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

15 be expended, the entity shall agree to maintain expendi16 tures of non-Federal amounts for such activities at a level

17 that is not less than the level of such expenditures main18 tained by the entity for the fiscal year preceding the fiscal

19 year for which the entity receives such a grant.

20 ‘‘§ 798. Matching requirement

21 ‘‘The Secretary may require that an entity that ap22 plies for a grant or contract under this title provide non23 Federal matching funds, as appropriate, to ensure the in24 stitutional commitment of the entity to the projects funded

25 under the grant. As determined by the Secretary, such
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1 non-Federal matching funds may be provided directly or

2 through donations from public or private entities and may

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

4 equipment, or services.

5 ‘‘§ 799. Generally applicable provisions

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

7 Secretary shall ensure that grants and contracts under

8 this title are awarded on a competitive basis, as appro9 priate, to carry out innovative demonstration projects or

10 provide for strategic workforce supplementation activities

11 as needed to meet health workforce goals and in accord12 ance with this title.

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

14 grants and contracts under this title shall meet informa15 tion requirements as specified by the Secretary.

16 ‘‘(c) TRAINING PROGRAMS.—Training programs con17 ducted with amounts received under this title shall meet

18 applicable accreditation and quality standards.

19 ‘‘(d) DURATION OF ASSISTANCE.—

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

21 in the case of an award to an entity of a grant, co22 operative agreement, or contract under this title, the

23 period during which payments are made to the en24 tity under the award may not exceed 5 years. The

25 provision of payments under the award shall be sub-
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1 ject to annual approval by the Secretary of the pay2 ments and subject to the availability of appropria3 tions for the fiscal year involved to make the pay4 ments. This paragraph may not be construed as lim5 iting the number of awards under the program in6 volved that may be made to the entity.

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

8 an entity of a grant, cooperative agreement, or con9 tract under this title, paragraph (1) shall apply only

10 to the extent not inconsistent with any other provi11 sion of this title that relates to the period during

12 which payments may be made under the award.

13 ‘‘(e) PEER REVIEW REGARDING CERTAIN PRO14 GRAMS.—Each application for a grant under this title, ex15 cept any scholarship or loan program, including those

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

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

18 proposals made in the application. The Secretary may not

19 approve such an application unless a peer review group

20 has recommended the application for approval. Each peer

21 review group under this subsection shall be composed prin22 cipally of individuals who are not officers or employees of

23 the Federal Government. This subsection shall be carried

24 out by the Secretary acting through the Administrator of

25 the Health Resources and Services Administration.
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1 ‘‘(f) PREFERENCE CONSIDERATIONS.—In consider2 ing a preference for funding which is based on outcome

3 measures for an eligible entity under this title, the Sec4 retary shall also consider the future ability of the eligible

5 entity to meet the outcome preference through improve6 ments in the eligible entity’s program design.

7 ‘‘§ 799A. Technical assistance

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

9 the Secretary to provide technical assistance in relation

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

11 (b) CONFORMING AMENDMENTS.—Section 791(a)(2)

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

13 amended by inserting ‘‘as such section existed one day

14 prior to the date of enactment of the Health Professions

15 Education Consolidation and Reauthorization Act of

16 1995’’ before the period.

17 SEC. 106. PREFERENCE AND REQUIRED INFORMATION IN

18 CERTAIN PROGRAMS.

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

20 Service Act (42 U.S.C. 295j) is amended by adding at the

21 end thereof the following subsection:

22 ‘‘(d) EXCEPTIONS.—

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

24 compete equitably for funding under this section,

25 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 ‘‘section 747’’; and

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

18 798(a)’’.

19 SEC. 107. DEFINITIONS.

20 Section 799B(6) of the Public Health Service Act (42

21 U.S.C. 295p(6)) (as so redesignated by section

22 105(a)(2)(E)) is amended—

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

24 the end thereof;
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•S 555 RS

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

2 and inserting ‘‘; or’’; and

3 (3) by adding at the end the following new sub4 paragraph:

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

6 that has a severe shortage of public health per7 sonnel as determined under criteria established

8 by the Secretary.’’.

9 SEC. 108. SAVINGS PROVISION.

10 In the case of any authority for making awards of

11 grants or contracts that is terminated by the amendments

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

13 Services may, notwithstanding the termination of the au14 thority, continue in effect any grant or contract made

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

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

17 of any such grant or contract not exceeding the period

18 determined by the Secretary in first approving such finan19 cial assistance, or in approving the most recent request

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

21 of such assistance, as the case may be.

22 Subtitle B—Nursing Education

23 SEC. 121. SHORT TITLE.

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

25 Consolidation and Reauthorization Act of 1995’’.
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1 SEC. 122. PURPOSE.

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

3 education authorities of title VIII of the Public Health

4 Service Act to permit a comprehensive, flexible, and effec5 tive approach to Federal support for nursing workforce

6 development.

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

8 Title VIII of the Public Health Service Act (42

9 U.S.C. 296k et seq.) is amended—

10 (1) by striking the title heading and all that fol11 lows except for subparts II and III of part B and

12 sections 855 and 860; and inserting the following:

13 ‘‘TITLE VIII—NURSING WORKFORCE

14 DEVELOPMENT’’;

15 (2) in subpart II of part B, by striking the sub16 part heading and inserting the following:

17 ‘‘PART E—STUDENT LOANS

18 ‘‘SUBPART I—GENERAL PROGRAM’’;

19 (3) by redesignating subpart III as subpart II;

20 (4) by striking section 837;

21 (5) by inserting after the title heading the fol22 lowing new parts:

23 ‘‘PART A—GENERAL PROVISIONS

24 ‘‘§ 801. Definitions

25 ‘‘As used in this title:
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•S 555 RS

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

2 entities’ means schools of nursing, nursing centers,

3 State or local governments, and other public or non4 profit private entities determined appropriate by the

5 Secretary that submit to the Secretary an applica6 tion in accordance with section 802.

7 ‘‘(2) SCHOOL OF NURSING.—The term ‘school

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

9 diploma school of nursing in a State.

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

11 term ‘collegiate school of nursing’ means a depart12 ment, division, or other administrative unit in a col13 lege or university which provides primarily or exclu14 sively a program of education in professional nursing

15 and related subjects leading to the degree of bach16 elor of arts, bachelor of science, bachelor of nursing,

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

18 in nursing, and including advanced training related

19 to such program of education provided by such

20 school, but only if such program, or such unit, col21 lege or university is accredited.

22 ‘‘(4) ASSOCIATE DEGREE SCHOOL OF NURS23 ING.—The term ‘associate degree school of nursing’

24 means a department, division, or other administra25 tive unit in a junior college, community college, col-
30

•S 555 RS

1 lege, or university which provides primarily or exclu2 sively a two-year program of education in profes3 sional nursing and allied subjects leading to an asso4 ciate degree in nursing or to an equivalent degree,

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

6 university is accredited.

7 ‘‘(5) DIPLOMA SCHOOL OF NURSING.—The

8 term ‘diploma school of nursing’ means a school af9 filiated with a hospital or university, or an independ10 ent school, which provides primarily or exclusively a

11 program of education in professional nursing and al12 lied subjects leading to a diploma or to equivalent

13 indicia that such program has been satisfactorily

14 completed, but only if such program, or such affili15 ated school or such hospital or university or such

16 independent school is accredited.

17 ‘‘(6) ACCREDITED.—

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

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

20 applied to any program of nurse education

21 means a program accredited by a recognized

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

23 for such purpose by the Secretary of Education

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

25 or university (or a unit thereof) means a hos-
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•S 555 RS

1 pital, school, college, or university (or a unit

2 thereof) which is accredited by a recognized

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

4 for such purpose by the Secretary of Education.

5 For the purpose of this paragraph, the Sec6 retary of Education shall publish a list of recog7 nized accrediting bodies, and of State agencies,

8 which the Secretary of Education determines to

9 be reliable authority as to the quality of edu10 cation offered.

11 ‘‘(B) NEW PROGRAMS.—A new school of

12 nursing that, by reason of an insufficient period

13 of operation, is not, at the time of the submis14 sion of an application for a grant or contract

15 under this title, eligible for accreditation by

16 such a recognized body or bodies or State agen17 cy, shall be deemed accredited for purposes of

18 this title if the Secretary of Education finds,

19 after consultation with the appropriate accredi20 tation body or bodies, that there is reasonable

21 assurance that the school will meet the accredi22 tation standards of such body or bodies prior to

23 the beginning of the academic year following

24 the normal graduation date of students of the

25 first entering class in such school.
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1 ‘‘(7) NONPROFIT.—The term ‘nonprofit’ as ap2 plied to any school, agency, organization, or institu3 tion means one which is a corporation or association,

4 or is owned and operated by one or more corpora5 tions or associations, no part of the net earnings of

6 which inures, or may lawfully inure, to the benefit

7 of any private shareholder or individual.

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

9 the Commonwealth of Puerto Rico, the District of

10 Columbia, the Commonwealth of the Northern Mari11 ana Islands, Guam, American Samoa, the Virgin Is12 lands, or the Trust Territory of the Pacific Islands.

13 ‘‘§ 802. Application

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

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

16 and submit to the Secretary an application that meets the

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

18 and containing such information as the Secretary may re19 quire.

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

21 section shall contain the plan of the applicant for carrying

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

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

24 regional program plans.
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1 ‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An ap2 plication submitted under this section shall contain a spec3 ification by the applicant entity of performance outcome

4 standards that the project to be funded under the grant

5 or contract will be measured against. Such standards shall

6 address relevant national nursing needs that the project

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

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

9 contract application.

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

11 this section shall contain a description of the linkages with

12 relevant educational and health care entities, including

13 training programs for other health professionals as appro14 priate, that the project to be funded under the grant or

15 contract will establish.

16 ‘‘§ 803. Use of funds

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

18 or contract awarded under this title may be used for train19 ing program development and support, faculty develop20 ment, model demonstrations, trainee support including

21 tuition, books, program fees and reasonable living ex22 penses during the period of training, technical assistance,

23 workforce analysis, and dissemination of information, as

24 appropriate to meet recognized nursing objectives, in ac25 cordance with this title.
34

•S 555 RS

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

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

3 be expended, the entity shall agree to maintain expendi4 tures of non-Federal amounts for such activities at a level

5 that is not less than the level of such expenditures main6 tained by the entity for the fiscal year preceding the fiscal

7 year for which the entity receives such a grant.

8 ‘‘§ 804. Matching requirement

9 ‘‘The Secretary may require that an entity that ap10 plies for a grant or contract under this title provide non11 Federal matching funds, as appropriate, to ensure the in12 stitutional commitment of the entity to the projects funded

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

14 be provided directly or through donations from public or

15 private entities and may be in cash or in-kind, fairly evalu16 ated, including plant, equipment, or services.

17 ‘‘§ 805. Preference

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

19 Secretary shall give preference to applicants with projects

20 that will substantially benefit rural or underserved popu21 lations, or public health personnel shortage professions in

22 State or local health departments.

23 ‘‘§ 806. Generally applicable provisions

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

25 Secretary shall ensure that grants and contracts under
35

•S 555 RS

1 this title are awarded on a competitive basis to carry out

2 innovative demonstration projects or provide for strategic

3 workforce supplementation activities as needed to meet

4 national nursing service goals and in accordance with this

5 title.

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

7 grants and contracts under this title shall meet informa8 tion requirements as specified by the Secretary.

9 ‘‘(c) TRAINING PROGRAMS.—Training programs con10 ducted with amounts received under this title shall meet

11 applicable accreditation and quality standards.

12 ‘‘(d) DURATION OF ASSISTANCE.—

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

14 in the case of an award to an entity of a grant, co15 operative agreement, or contract under this title, the

16 period during which payments are made to the en17 tity under the award may not exceed 5 years. The

18 provision of payments under the award shall be sub19 ject to annual approval by the Secretary of the pay20 ments and subject to the availability of appropria21 tions for the fiscal year involved to make the pay22 ments. This paragraph may not be construed as lim23 iting the number of awards under the program in24 volved that may be made to the entity.
36

•S 555 RS

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

2 an entity of a grant, cooperative agreement, or con3 tract under this title, paragraph (1) shall apply only

4 to the extent not inconsistent with any other provi5 sion of this title that relates to the period during

6 which payments may be made under the award.

7 ‘‘(e) PEER REVIEW REGARDING CERTAIN PRO8 GRAMS.—Each application for a grant under this title, ex9 cept advanced nurse traineeship grants under section

10 811(a)(2), shall be submitted to a peer review group for

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

12 application. The Secretary may not approve such an appli13 cation unless a peer review group has recommended the

14 application for approval. Each peer review group under

15 this subsection shall be composed principally of individuals

16 who are not officers or employees of the Federal Govern17 ment. This subsection shall be carried out by the Secretary

18 acting through the Administrator of the Health Resources

19 and Services Administration.

20 ‘‘§ 807. National advisory council on nurse education

21 and practice

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

23 a National Advisory Council on Nurse Education and

24 Practice (in this section referred to as the ‘Council’), con25 sisting of the Secretary or the delegate of the Secretary
37

•S 555 RS

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

2 Chairperson), and 15 members appointed by the Secretary

3 without regard to the Federal civil service laws, of which—

4 ‘‘(1) 2 shall be selected from full-time students

5 enrolled in schools of nursing;

6 ‘‘(2) 3 shall be selected from the general public;

7 ‘‘(3) 2 shall be selected from practicing profes8 sional nurses; and

9 ‘‘(4) 8 shall be selected from among the leading

10 authorities in the various fields of nursing, higher,

11 and secondary education, and from representatives

12 of hospitals and other institutions and organizations

13 which provide nursing services.

14 A majority of the members shall be nurses. The student15 members of the Council shall be appointed for terms of

16 one year and shall be eligible for reappointment to the

17 Council.

18 ‘‘(b) DUTIES.—The Council shall advise the Sec19 retary in the preparation of general regulations and with

20 respect to policy matters arising in the administration of

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

22 supply, education and practice improvement.

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

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

25 education and practice activities of the Council.
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1 ‘‘§ 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 ‘‘§ 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
39

•S 555 RS

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.
40

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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 if 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 MIDWIVES,

5 AND OTHER ADVANCED PRACTICE NURSES

6 ‘‘§ 811. Advanced practice nursing grants

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

8 to and enter into contracts with eligible entities to meet

9 the costs of—

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

11 advanced practice nursing education and practice;

12 and

13 ‘‘(2) traineeships for individuals in advanced

14 practice nursing programs.

15 ‘‘(b) DEFINITION OF ADVANCED PRACTICE

16 NURSES.—For purposes of this section, the term ‘ad17 vanced practice nurses’ means nurses trained in advanced

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

19 Master’s degree programs, post-nursing master’s certifi20 cate programs, or, in the case of nurse midwives or nurse

21 anesthetists, in certificate programs that received funding

22 under this title on the date that is one day prior to the

23 date of enactment of this section, to serve as nurse practi24 tioners, nurse midwives, nurse anesthetists, nurse edu25 cators, or public health nurses, or in other nurse special-
42

•S 555 RS

1 ties determined by the secretary to require advanced edu2 cation.

3 ‘‘(c) AUTHORIZED NURSE PRACTITIONER AND

4 NURSE-MIDWIFERY PROGRAMS.—

5 ‘‘(1) IN GENERAL.—Nurse practitioner and

6 nurse midwifery programs eligible for support under

7 this section are educational programs for registered

8 nurses (irrespective of the type of school of nursing

9 in which the nurses received their training) that—

10 ‘‘(A) meet guidelines prescribed by the

11 Secretary in accordance with paragraph (2);

12 and

13 ‘‘(B) have as their objective the education

14 of nurses who will upon completion of their

15 studies in such programs, be qualified to effec16 tively provide primary health care, including

17 primary health care in homes and in ambula18 tory care facilities, long-term care facilities and

19 other health care institutions.

20 ‘‘(2) GUIDELINES.—After consultation with ap21 propriate educational organizations and professional

22 nursing and medical organizations, the Secretary

23 shall prescribe guidelines for programs described in

24 paragraph (1). Such guidelines shall, as a minimum,

25 require that such a program—
43

•S 555 RS

1 ‘‘(A) extend for at least one academic year

2 and consist of—

3 ‘‘(i) supervised clinical practice di4 rected toward preparing nurses to deliver

5 primary health care; and

6 ‘‘(ii) at least four months (in the ag7 gregate) of classroom instruction that is so

8 directed; and

9 ‘‘(B) have an enrollment of not less than

10 six full-time equivalent students.

11 ‘‘(d) OTHER AUTHORIZED EDUCATIONAL PRO12 GRAMS.—The Secretary shall prescribe guidelines as ap13 propriate for other advanced practice nurse education pro14 grams eligible for support under this section.

15 ‘‘(e) TRAINEESHIPS.—

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

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

18 unless the applicant involved agrees that

19 traineeships provided with the grant will only pay all

20 or part of the costs of—

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

22 program of advanced nursing practice with re23 spect to which the traineeship is provided; and
44

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

2 individual during the period for which the

3 traineeship is provided.

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

5 may not obligate more than 10 percent of the

6 traineeships under subsection (a) for individuals in

7 doctorate degree programs.

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

9 awards of grants and contracts under subsection

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

11 to an eligible entity that agrees to expend the award

12 to train advanced practice nurses who will practice

13 in health professional shortage areas designated

14 under section 332.

15 ‘‘PART C—INCREASING NURSING WORKFORCE

16 DIVERSITY

17 ‘‘§ 821. Workforce diversity grants

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

19 to and enter into contracts with eligible entities to meet

20 the costs of special projects to increase nursing education

21 opportunities for individuals who are from disadvantaged

22 racial and ethnic backgrounds underrepresented among

23 registered nurses by providing student scholarships or sti24 pends, pre-entry preparation, and retention activities.
45

•S 555 RS

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

2 Secretary shall take into consideration the recommenda3 tions of the First and Second Invitational Congresses for

4 Minority Nurse Leaders on ‘Caring for the Emerging Ma5 jority,’ in 1992 and 1993, and consult with nursing asso6 ciations including the American Nurses Association, the

7 National League for Nursing, the American Association

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

9 Association of Hispanic Nurses, the Association of Asian

10 American and Pacific Islander Nurses, the National

11 Nurses Association, the Native American Indian and Alas12 kan Nurses Association.

13 ‘‘(c) REQUIRED INFORMATION AND CONDITIONS FOR

14 AWARD RECIPIENTS.—

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

16 this section may be required, where requested, to re17 port to the Secretary concerning the annual admis18 sion, retention, and graduation rates for ethnic and

19 racial minorities in the school or schools involved in

20 the projects.

21 ‘‘(2) FALLING RATES.—If any of the rates re22 ported under paragraph (1) fall below the average of

23 the two previous years, the grant or contract recipi24 ent shall provide the Secretary with plans for imme25 diately improving such rates.
46

•S 555 RS

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

2 paragraph (2) shall be ineligible for continued fund3 ing under this section if the plan of the recipient

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

5 beginning on the date such plan is implemented.

6 ‘‘PART D—STRENGTHENING CAPACITY FOR BASIC

7 NURSE EDUCATION AND PRACTICE

8 ‘‘§ 831. Basic nurse education and practice grants

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

10 to and enter into contracts with eligible entities for

11 projects to strengthen capacity for basic nurse education

12 and practice.

13 ‘‘(b) PRIORITY AREAS.—In awarding grants or con14 tracts under this section the Secretary shall give priority

15 to entities that will use amounts provided under such a

16 grant or contract to enhance the education mix and utili17 zation of the basic nursing workforce by strengthening

18 programs that provide basic nurse education for purposes

19 of—

20 ‘‘(1) improving nursing services in schools and

21 other community settings;

22 ‘‘(2) providing care for underserved populations

23 and other high-risk groups such as the elderly, indi24 viduals with HIV-AIDS, substance abusers, home25 less, and battered women;
47

•S 555 RS

1 ‘‘(3) providing case management, quality im2 provement, delegation and supervision, other skills

3 needed under new health care systems;

4 ‘‘(4) developing cultural competencies among

5 nurses;

6 ‘‘(5) providing emergency health services;

7 ‘‘(6) promoting career mobility for nursing per8 sonnel in a variety of training settings and cross

9 training or specialty training among diverse popu10 lation groups; or

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

12 Secretary.

13 ‘‘PART E—AUTHORIZATION OF APPROPRIATIONS

14 ‘‘§ 841. Authorization of appropriations

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

16 section 811, 821, and 831, $62,000,000 for fiscal year

17 1996, such sums as may be necessary in each of the fiscal

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

19 1999.’’; and

20 (6) by redesignating sections 855 and 860 as

21 sections 810 and 810A, and transferring such sec22 tions so as to appear after section 809 (as added by

23 the amendment made by paragraph (5)).
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1 SEC. 124. SAVINGS PROVISION.

2 In the case of any authority for making awards of

3 grants or contracts that is terminated by the amendment

4 made by section 123, 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 SEC. 125. PREFERENCE AND REQUIRED INFORMATION IN

15 CERTAIN PROGRAMS.

16 Section 810A of the Public Health Service Act (42

17 U.S.C. 298b–7) (as so redesignated by section 123(6)) is

18 amended by adding at the end thereof the following sub19 section:

20 ‘‘(f) EXCEPTIONS.—

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

22 compete equitably for funding under this section,

23 those new programs that meet the criteria described

24 in paragraph (3) shall qualify for a funding pref25 erence under this section.
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1 ‘‘(2) DEFINITION.—As used in this subsection,

2 the term ‘new program’ means any program that

3 has graduated less than three classes. Upon grad4 uating at least three classes, a program shall have

5 the capability to provide the information necessary

6 to qualify the program for the general funding pref7 erences described in subsection (a).

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

9 paragraph (1) are the following:

10 ‘‘(A) The mission statement of the pro11 gram identifies a specific purpose of the pro12 gram as being the preparation of nurses to

13 serve underserved populations.

14 ‘‘(B) The curriculum of the program in15 cludes content which will help to prepare practi16 tioners to serve underserved populations.

17 ‘‘(C) Substantial clinical training experi18 ence is required under the program in medically

19 underserved communities.

20 ‘‘(D) A minimum of 20 percent of the fac21 ulty of the program spend at least 50 percent

22 of their time providing or supervising care in

23 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 SEC. 126. EFFECTIVE DATE.

12 This title shall take effect on October 1, 1995, or the

13 date of enactment of this Act, whichever is later.

14 Subtitle C—Financial Assistance

15 PART 1—NATIONAL HEALTH SERVICE CORPS

16 FINANCIAL ASSISTANCE PROGRAMS

17 SEC. 131. GENERAL AMENDMENTS WITH RESPECT TO FED18 ERALLY SUPPORTED LOANS.

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

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

21 amended—

22 (1) in subsection (a)—

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

24 by inserting ‘‘and public health disease preven-
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1 tion and health promotion activities’’ before the

2 dash; and

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

4 physician assistants’’ and inserting ‘‘physician

5 assistants, and public health professionals’’;

6 (2) in subsection (b)(1)—

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

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

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

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

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

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

13 (3) in subsection (c)(4)—

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

15 ‘‘and schools of public health’’ after ‘‘profes16 sions schools’’;

17 (B) in subparagraph (B)(i)—

18 (i) by inserting ‘‘or public health pro19 fessional’’ after ‘‘and health professional’’;

20 and

21 (ii) by inserting ‘‘or public health dis22 ease prevention and health promotion ac23 tivities’’ before the period;

24 (C) in subparagraph (C)—
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1 (i) by inserting ‘‘or public health dis2 ease prevention and health promotion ac3 tivities,’’ after primary health services,’’;

4 (ii) by inserting ‘‘or public health pro5 fessions’’ after ‘‘health professions’’; and

6 (iii) by inserting ‘‘or public health

7 professionals’’ after ‘‘health professionals’’

8 each place that such occurs;

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

10 public health disease prevention and health pro11 motion activities’’ after ‘‘primary health services’’;

12 (5) in subsection (g)(2)(A)(iii)—

13 (A) by inserting ‘‘or public health profes14 sional’’ after ‘‘the health professional’’; and

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

16 prevention and health promotion activities’’

17 after ‘‘primary health services’’; and

18 (6) in subsection (i)(8), —

19 (A) by inserting ‘‘or public health profes20 sionals’’ after ‘‘health professionals’’; and

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

22 prevention and health promotion activities’’

23 after ‘‘primary health services’’.
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1 (b) OBLIGATED SERVICE.—Section 338C(b)(5) of the

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

3 amended—

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

5 health,’’ after ‘‘dentistry,’’; and

6 (2) in subparagraph (E)—

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

8 health,’’ after ‘‘dentistry,’’; and

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

10 health,’’ after ‘‘dentistry,’’.

11 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

12 338H of the Public Health Service Act (42 U.S.C. 254q)

13 is amended to read as follows:

14 ‘‘§ 338h. Authorization of appropriations

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

16 purpose of carrying out this subpart, there are authorized

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

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

19 1997 through 2000.

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

21 shall determine the most appropriate manner in which to

22 allocate amounts appropriated under subsection (a) be23 tween the programs authorized in chapter 1, chapter 2,

24 and chapter 3. In determining the manner in which to allo25 cate such amounts, the Secretary shall give priority to
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1 funding State-based programs as appropriate under chap2 ter 3. The Secretary shall distribute such amounts among

3 the various programs in such chapters in a manner which

4 furthers both Federal and State needs for health profes5 sionals in underserved areas.’’.

6 (d) GRANTS FOR LOAN REPAYMENT PROGRAM.—

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

8 254q-1) is amended—

9 (1) in subsection (a)—

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

11 health professional shortage areas’’ and insert12 ing ‘‘or public health disease prevention and

13 health promotion activities in Federal health

14 professional shortage areas or approved State

15 designated health professional shortage areas’’;

16 and

17 (B) in paragraph (2)—

18 (i) by inserting ‘‘or public health pro19 fessionals’’ after ‘‘health professionals’’;

20 and

21 (ii) by striking ‘‘in health professional

22 shortage areas’’ and inserting ‘‘or public

23 health disease prevention and health pro24 motion activities in Federal health profes25 sional shortage areas or approved State
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1 designated health professional shortage

2 areas’’;

3 (2) in subsection (c)—

4 (A) in paragraph (1)—

5 (i) in the paragraph heading, by strik6 ing ‘‘FEDERAL’’ and inserting ‘‘FEDERAL

7 OR APPROVED STATE’’; and

8 (ii) by inserting before the period the

9 following: ‘‘or approved State designated

10 health professional shortage areas’’;

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

12 public health professionals’’ after ‘‘health pro13 fessionals’’;

14 (C) in paragraph (3)—

15 (i) in subparagraph (A)—

16 (I) in the matter preceding clause

17 (i), by inserting ‘‘or public health pro18 fessionals’’ after ‘‘health profes19 sionals’’; and

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

21 health’’;

22 (ii) in subparagraph (B)—

23 (I) in the matter preceding clause

24 (i), by inserting ‘‘or public health pro-
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1 fessional’’ after ‘‘health professional’’;

2 and

3 (II) in clause (ii)—

4 (aa) by inserting ‘‘or public

5 health professional’’ after ‘‘the

6 health professional’’; and

7 (bb) by striking ‘‘services in

8 a’’ and inserting ‘‘services or

9 public health disease prevention

10 and health promotion activities in

11 a Federal’’; and

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

14 ‘‘(4) PRIVATE PRACTICE.—

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

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

17 waive the requirement of paragraph (1) regard18 ing the assignment of a health professional if,

19 subject to subparagraph (B), the health profes20 sional enters into an agreement with the State

21 to provide primary health services in a full-time

22 private clinical practice in a health professional

23 shortage area.

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

25 under subsection (a) unless the State involved
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1 agrees that, if the State provides a waiver

2 under subparagraph (A) for a health profes3 sional, section 338D(b)(1) will apply to the

4 agreement under such subparagraph between

5 the State and the health professional to the

6 same extent and in the same manner as such

7 section applies to an agreement between the

8 Secretary and a health professional regarding a

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

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

11 ‘‘(h) DEFINITIONS.—Unless specifically provided oth12 erwise, as used in this subpart and section 338F:

13 ‘‘(1) APPROVED STATE DESIGNATED HEALTH

14 PROFESSIONAL SHORTAGE AREA.—The term ‘ap15 proved State designated health professional shortage

16 area’ means an area designated by the State as un17 derserved using specific methodology and criteria to

18 identify such areas. Such criteria and methodology

19 shall be approved by the Secretary.

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

21 ‘community organization’ means a public or non22 profit private entity.

23 ‘‘(3) PRIMARY HEALTH CARE.—The term ‘pri24 mary health care’ means health services regarding

25 family medicine, general internal medicine, general
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1 pediatrics, or may include obstetrics and gynecology,

2 that are provided by physicians, certified nurse prac3 titioners, certified nurse midwives, or physician as4 sistants.

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

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

7 (e) COMMUNITY SCHOLARSHIP PROGRAMS.—Section

8 338L of the Public Health Service Act (42 U.S.C. 254t)

9 is amended—

10 (1) in the section heading, by striking ‘‘dem11 onstration grants to states for’’

12 (2) in subsection (a), by striking ‘‘manpower

13 shortage areas’’ and inserting ‘‘Federal health pro14 fessional shortage areas and in approved State des15 ignated health professional shortage areas’’;

16 (3) in subsection (c)—

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

18 by striking ‘‘manpower shortage areas’’ and in19 serting ‘‘Federal health professional shortage

20 areas and in approved State designated health

21 professional shortage areas’’; and

22 (B) in paragraph (2), by striking ‘‘man23 power shortage areas’’ and inserting ‘‘Federal

24 health professional shortage areas and in ap-
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1 proved State designated health professional

2 shortage areas’’;

3 (4) in subsection (e)(1), by striking ‘‘manpower

4 shortage areas’’ and inserting ‘‘Federal health pro5 fessional shortage areas and in approved State des6 ignated health professional shortage areas’’;

7 (5) in subsection (f)(1)(A), by striking ‘‘man8 power shortage areas’’ and inserting ‘‘Federal health

9 professional shortage areas and in approved State

10 designated health professional shortage areas’’;

11 (6) in subsection (g), by striking ‘‘manpower

12 shortage areas’’ each place that such appears and

13 inserting ‘‘Federal health professional shortage areas

14 and in approved State designated health professional

15 shortage areas’’; and

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

17 SEC. 132. RESTRUCTURING AND TECHNICAL AMENDMENTS.

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

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

20 seq.) is amended—

21 (1) by redesignating sections 338J and 338K

22 (42 U.S.C. 254s and 254t) as sections 338M and

23 338N, respectively;
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1 (2) by redesignating sections 338C through

2 338H (42 U.S.C. 254m through 254q) as sections

3 338G through 338L, respectively;

4 (3) by redesignating section 338I (as such sec5 tion exists one day prior to the date of enactment

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

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

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

10 (b) CONSOLIDATION OF CERTAIN PROGRAMS.—Sub11 part III of part D of title III of the Public Health Service

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

13 (a)) is further amended—

14 (1) by striking the subpart heading and insert15 ing the following:

16 ‘‘SUBPART III—FEDERALLY SUPPORTED SCHOLARSHIPS

17 AND LOANS

18 ‘‘CHAPTER 1—NATIONAL HEALTH SERVICE

19 CORPS SCHOLARSHIPS PROGRAMS

20 (2) by redesignating section 338b as section

21 338c;

22 (3) by inserting before section 338c (as so re23 designated) the following:
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1 ‘‘CHAPTER 2—NATIONAL HEALTH SERVICE

2 CORPS LOAN REPAYMENT PROGRAMS

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

4 and

5 (4) by inserting after section 338C (as so redes6 ignated) the following:

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

8 (c) TRANSFERS AND REDESIGNATIONS OF NURSING

9 LOAN REPAYMENT PROGRAM.—Subpart III of part B of

10 title VIII (42 U.S.C. 297n et seq.) is amended—

11 (1) by striking the subpart heading;

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

13 297n) to subchapter B of chapter 2 of subpart III

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

15 and

16 (3) in section 846—

17 (A) by striking the section heading and in18 serting the following:

19 ‘‘§ 338d. Nursing loan repayment program’’;

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

21 (C) by striking subsection (g).

22 (d) TRANSFERS AND REDESIGNATIONS OF STATE

23 LOAN REPAYMENT AND COMMUNITY SCHOLARSHIP PRO24 GRAMS.—Subpart III of part D of title III of the Public

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

26 by subsections (a) through (c)) is further amended—
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1 (1) by inserting after section 338D (as so

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

3 the following:

4 ‘‘CHAPTER 3—STATE LOAN REPAYMENT AND

5 COMMUNITY SCHOLARSHIP PROGRAMS

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

7 (2) by transferring section 338E (as so redesig8 nated by subsection (a)(3)) to subchapter A of chap9 ter 3 of such subpart (as added by paragraph (1));

10 (3) by inserting after section 338E (as trans11 ferred by paragraph (2)) the following:

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

13 (4) by transferring section 338F (as so redesig14 nated by subsection (a)(4)) to subchapter B of chap15 ter 3 of such subpart (as added by paragraph (3));

16 and

17 (5) by inserting after section 338F (as trans18 ferred by paragraph (4)) the following:

19 ‘‘CHAPTER 4—GENERAL PROVISIONS’’

20 (e) CLINICAL RESEARCHERS.—Paragraph (3) of sec21 tion 487E(a) of the Public Health Service Act (42 U.S.C.

22 288–5(a)(3)) is amended to read as follows:

23 ‘‘(3) APPLICABILITY OF CERTAIN PROVISIONS

24 REGARDING OBLIGATED SERVICE.—With respect to

25 the National Health Service Corps loan repayment
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1 program established in subpart III of part D of title

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

3 inconsistent with this section, apply to the program

4 established in subsection (a) in the same manner

5 and to the same extent as such provisions apply to

6 the National Health Service Corps loan repayment

7 programs.’’.

8 SEC. 133. DEFINITION OF UNDERSERVED AREAS.

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

10 (42 U.S.C. 254e(a)(1)) is amended in the first sentence—

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

12 and

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

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

15 has a severe shortage of public health personnel as

16 determined under criteria established by the Sec17 retary’’.

18 SEC. 134. CONFORMING AMENDMENTS.

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

20 241 et seq.) is amended—

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

22 303(d)(4) (42 U.S.C. 242a(d)(4)(A) and (B)), by

23 striking ‘‘338C or 338D’’ each place that such oc24 curs and inserting ‘‘338G or 338H’’;
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1 (2) in section 331(c) (42 U.S.C. 254d(c)), by

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

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

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

5 (4) in 338A (42 U.S.C. 254l)—

6 (A) in subsection (c)(1)—

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

8 ‘‘338D’’ and inserting ‘‘338I’’; and

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

10 ‘‘338C’’ and inserting ‘‘338H’’;

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

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

13 (C) in subsection (i)(5)—

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

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

16 (ii) in subparagraph (B)(ii), by strik17 ing ‘‘338E’’ and inserting ‘‘338I’’;

18 (5) in section 338B (42 U.S.C. 254l–1)—

19 (A) in subsection (c)(1)—

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

21 ‘‘338E’’ and inserting ‘‘338I’’; and

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

23 ‘‘338D’’ and inserting ‘‘338H’’;

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

25 ‘‘338D’’ and inserting ‘‘338H’’;
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1 (C) in subsection (f)(4), by striking

2 ‘‘338E’’ and inserting ‘‘338I’’; and

3 (D) in subsection (i)(7)—

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

5 ‘‘338E’’ and inserting ‘‘338I’’; and

6 (ii) in subparagraph (B)(ii), by strik7 ing ‘‘338E’’ and inserting ‘‘338I’’;

8 (6) in section 338E(d)(1)(C) (as so redesig9 nated by section 102), by striking ‘‘338J’’ and in10 serting ‘‘338M’’;

11 (7) in section 338G (as so redesignated by sec12 tion 102)—

13 (A) in subsection (a), by striking ‘‘338D’’

14 and inserting ‘‘338H’’; and

15 (B) in subsection (c)(2), by striking

16 ‘‘338D’’ and inserting ‘‘338H’’;

17 (8) in section 338H(a) (as so redesignated by

18 section 102), by striking ‘‘338C’’ and inserting

19 ‘‘338G’’;

20 (9) in section 338I (as so redesignated by sec21 tion 102)—

22 (A) in subsection (b)(1)(A)—

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

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

2 inserting ‘‘338G or 338H’’;

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

4 ‘‘338G’’; and

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

6 ‘‘338H’’; and

7 (B) in subsection (c)(1)—

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

9 ‘‘338K’’; and

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

11 inserting ‘‘338G or 338H’’;

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

13 section 102)—

14 (A) in paragraph (1), by striking ‘‘338E’’

15 and inserting ‘‘338I’’; and

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

17 and inserting ‘‘338E’’;

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

19 section 102)—

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

21 ‘‘338D’’ and inserting ‘‘338H’’; and

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

23 ‘‘338E’’ and inserting ‘‘338I’’; and
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1 (12) in section 338M(e)(1)(B)(ii)(III) (as so re2 designated by section 102), by striking ‘‘338I’’ and

3 inserting ‘‘338E’’.

4 PART 2—SCHOOL-BASED REVOLVING LOAN

5 FUNDS

6 SEC. 135. PRIMARY CARE LOAN PROGRAM.

7 (a) REQUIREMENT FOR SCHOOLS.—Section

8 723(b)(1) of the Public Health Service Act (42 U.S.C.

9 292s(b)(1)), as amended by section 2014(c)(2)(A)(ii) of

10 Public Law 103–43 (107 Stat. 216), is amended by strik11 ing ‘‘3 years before’’ and inserting ‘‘4 years before’’.

12 (b) SERVICE REQUIREMENT FOR PRIMARY CARE

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

14 Service Act (42 U.S.C. 292s(a)) is amended in subpara15 graph (B) of paragraph (1), by striking ‘‘through the date

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

17 years after completing the residency program’’.

18 SEC. 136. LOANS FOR DISADVANTAGED STUDENTS.

19 (a) AUTHORIZATION OF APPROPRIATIONS.—Section

20 724(f)(1) of the Public Health Service Act (42 U.S.C.

21 292t(f)(1)) is amended by striking ‘‘$15,000,000 for fiscal

22 year 1993’’ and inserting ‘‘$8,000,000 for each of the fis23 cal years 1996 through 1998’’.
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1 (b) REPEAL.—Effective October 1, 1998, paragraph

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

3 U.S.C. 292t(f)(1)) is repealed.

4 SEC. 137. STUDENT LOANS REGARDING SCHOOLS OF NURS5 ING.

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

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

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

9 the end and inserting a semicolon;

10 (2) in paragraph (2)—

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

12 ‘‘and’’ at the end; and

13 (B) by inserting before the semicolon at

14 the end the following: ‘‘, and (C) such addi15 tional periods under the terms of paragraph (8)

16 of this subsection’’;

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

18 the end and inserting ‘‘; and’’; and

19 (4) by adding at the end the following para20 graph:

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

22 the Secretary, the repayment period established

23 under paragraph (2) for any student borrower who

24 during the repayment period failed to make consecu25 tive payments and who, during the last 12 months
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1 of the repayment period, has made at least 12 con2 secutive payments may be extended for a period not

3 to exceed 10 years.’’.

4 (b) BREACH OF AGREEMENTS.—Subpart II of part

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

6 297a et seq.) is amended by adding at the end thereof

7 the following new section:

8 ‘‘§ 843. Breach of agreement

9 ‘‘(a) IN GENERAL.—In the case of any program

10 under this subpart under which an individual makes an

11 agreement to provide health services for a period of time

12 in accordance with such program in consideration of re13 ceiving an award of Federal funds regarding education as

14 a nurse (including an award for the repayment of loans),

15 the following applies if the agreement provides that this

16 section is applicable:

17 ‘‘(1) In the case of a program under this sub18 part that makes an award of Federal funds for at19 tending an accredited program of nursing (in this

20 section referred to as a ‘nursing program’), the indi21 vidual is liable to the Federal Government for the

22 amount of such award (including amounts provided

23 for expenses related to such attendance), and for in24 terest on such amount at the maximum legal prevail25 ing rate, if the individual—
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1 ‘‘(A) fails to maintain an acceptable level

2 of academic standing in the nursing program

3 (as indicated by the program in accordance

4 with requirements established by the Sec5 retary);

6 ‘‘(B) is dismissed from the nursing pro7 gram for disciplinary reasons; or

8 ‘‘(C) voluntarily terminates the nursing

9 program.

10 ‘‘(2) The individual is liable to the Federal Gov11 ernment for the amount of such award (including

12 amounts provided for expenses related to such at13 tendance), and for interest on such amount at the

14 maximum legal prevailing rate, if the individual fails

15 to provide health services in accordance with the

16 program under this subpart for the period of time

17 applicable under the program.

18 ‘‘(b) WAIVER OR SUSPENSION OF LIABILITY.—In the

19 case of an individual or health facility making an agree20 ment for purposes of subsection (a), the Secretary shall

21 provide for the waiver or suspension of liability under such

22 subsection if compliance by the individual or the health

23 facility, as the case may be, with the agreements involved

24 is impossible, or would involve extreme hardship to the in25 dividual or facility, and if enforcement of the agreements
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1 with respect to the individual or facility would be uncon2 scionable.

3 ‘‘(c) DATE CERTAIN FOR RECOVERY.—Subject to

4 subsection (b), any amount that the Federal Government

5 is entitled to recover under subsection (a) shall be paid

6 to the United States not later than the expiration of the

7 3-year period beginning on the date the United States be8 comes so entitled.

9 ‘‘(d) AVAILABILITY.—Amounts recovered under sub10 section (a) with respect to a program under this subpart

11 shall be available for the purposes of such program, and

12 shall remain available for such purposes until expended.’’.

13 (c) TECHNICAL AMENDMENTS.—Section 839 of the

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

15 (1) in subsection (a)—

16 (A) by striking the matter preceding para17 graph (1) and inserting the following:

18 ‘‘(a) If a school terminates a loan fund established

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

20 Secretary for good cause terminates the agreement with

21 the school, there shall be a capital distribution as fol22 lows:’’; and

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

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

25 ‘‘on the date of termination of the fund’’; and
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1 (2) in subsection (b), to read as follows:

2 ‘‘(b) If a capital distribution is made under sub3 section (a), the school involved shall, after such capital dis4 tribution, pay to the Secretary, not less often than quar5 terly, the same proportionate share of amounts received

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

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

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

9 PART 3—INSURED HEALTH EDUCATION

10 ASSISTANCE LOANS TO GRADUATE STUDENTS

11 SEC. 141. HEALTH EDUCATION ASSISTANCE LOAN PRO12 GRAM.

13 (a) HEALTH EDUCATION ASSISTANCE LOAN

14 DEFERMENT FOR BORROWERS PROVIDING HEALTH

15 SERVICES TO INDIANS.—

16 (1) IN GENERAL.—Section 705(a)(2)(C) of the

17 Public Health Service Act is amended by striking

18 ‘‘and (x)’’ and inserting ‘‘(x) not in excess of three

19 years, during which the borrower is providing health

20 care services to Indians through an Indian health

21 program (as defined in section 108(a)(2)(A) of the

22 Indian Health Care Improvement Act (25 U.S.C.

23 1616a(a)(2)(A)); and (xi)’’.
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1 (2) CONFORMING AMENDMENTS.—Section

2 705(a)(2)(C) of the Public Health Service Act is fur3 ther amended—

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

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

6 (B) in the matter following such clause

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

8 (3) EFFECTIVE DATE.—The amendments made

9 by this subsection shall apply with respect to serv10 ices provided on or after the first day of the third

11 month that begins after the date of the enactment

12 of this Act.

13 (b) MAXIMUM STUDENT LOAN PROVISION.—

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

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

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

17 103–43, is amended by striking ‘‘the sum of’’ and

18 all that follows through the end thereof and insert19 ing ‘‘the cost of attendance (including tuition, other

20 reasonable educational expenses, and reasonable liv21 ing costs) for that year at the educational institution

22 attended by the student (as determined by such edu23 cational institution).’’.

24 (2) THIRD AND FOURTH YEARS.—Section

25 722(a)(2) of the Public Health Service Act (42
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1 U.S.C. 292r(a)(2)), as amended by section

2 2014(b)(1) of Public Law 103–43, is amended by

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

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

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

6 fourth year of a student at school of medicine or os7 teopathic medicine, be increased to the extent nec8 essary’’.

9 PART 4—SCHOLARSHIPS FOR DISADVANTAGED

10 STUDENTS

11 SEC. 151. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.

12 Part B of title VII of the Public Health Service Act

13 (as amended by section 101(a)) is further amended by

14 adding at the end thereof the following new section:

15 ‘‘§ 740. Scholarships for disadvantaged students

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

17 or enter into a contract with an eligible entity (as defined

18 in subsection (f)(1)) under this section for the awarding

19 of scholarships by schools to any full-time student who is

20 an eligible individual as defined in subsection (f). Such

21 scholarships may be expended only for tuition expenses,

22 other reasonable educational expenses, and reasonable liv23 ing expenses incurred in the attendance of such school,

24 and may not, for any year of such attendance for which
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1 the scholarship is provided, provide an amount exceeding

2 the total amount required for the year.

3 ‘‘(b) PREFERENCE IN PROVIDING SCHOLARSHIPS.—

4 The Secretary may not make a grant to or enter into a

5 contract with an entity under subsection (a) unless the

6 health professions school involved agrees that, in providing

7 scholarships pursuant to the grant or contract, the school

8 will give preference to students for whom the costs of at9 tending the school would constitute a severe financial

10 hardship.

11 ‘‘(c) AMOUNT OF AWARD.—In awarding grants and

12 contracts to eligible entities that are health professions

13 schools, the Secretary shall give priority to eligible entities

14 based on the proportion of graduating students going into

15 primary care, the proportion of minority students, and the

16 proportion of graduates working in medically underserved

17 areas.

18 ‘‘(d) MAXIMUM SCHOLARSHIP AWARD.—The maxi19 mum scholarship that an individual may receive in any

20 year from an eligible entity that is a health professions

21 school shall be $3000.

22 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There

23 are authorized to be appropriated to carry out this section,

24 $32,000,000 for each of the fiscal years 1996 through

25 1999.
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1 ‘‘(f) DEFINITIONS.—As used in this section:

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

3 entities’ means an entity that—

4 ‘‘(A) is a school of medicine, osteopathic

5 medicine, dentistry, nursing, pharmacy,

6 podiatric medicine, optometry, veterinary medi7 cine, public health, or allied health, a school of8 fering graduate programs in mental health

9 practices, or an entity providing programs of10 fering physician assistant training; and

11 ‘‘(B) is carrying out a program for recruit12 ing and retaining students from disadvantaged

13 backgrounds, including students who are mem14 bers of racial and ethnic minority groups.

15 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible

16 individual’ means an individual who—

17 ‘‘(A) is from a disadvantaged background;

18 ‘‘(B) has a financial need for a scholar19 ship; and

20 ‘‘(C) is enrolled (or accepted for enroll21 ment) at an eligible health profession school as

22 a full-time student in a program leading to a

23 degree in a health profession.’’.
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1 TITLE II—OFFICE OF MINORITY

2 HEALTH

3 SEC. 201. REVISION AND EXTENSION OF PROGRAMS OF OF4 FICE OF MINORITY HEALTH.

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

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

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

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

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

11 through the Deputy Assistant Secretary for Minority

12 Health (in this section referred to as the ‘Deputy Assist13 ant Secretary’), shall carry out the following:

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

15 and objectives and coordinate all other activities

16 within the Public Health Service that relate to dis17 ease prevention, health promotion, service delivery,

18 and research concerning such individuals. The heads

19 of each of the agencies of the Service shall consult

20 with the Deputy Assistant Secretary to ensure the

21 coordination of such activities.

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

23 by entering into interagency agreements with other

24 agencies of the Public Health Service:
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1 ‘‘(A) Support research, demonstrations and

2 evaluations to test new and innovative models.

3 ‘‘(B) Increase knowledge and understand4 ing of health risk factors.

5 ‘‘(C) Develop mechanisms that support

6 better information dissemination, education,

7 prevention, and service delivery to individuals

8 from disadvantaged backgrounds, including in9 dividuals who are members of racial or ethnic

10 minority groups.

11 ‘‘(D) Ensure that the National Center for

12 Health Statistics collects data on the health

13 status of each minority group.

14 ‘‘(E) With respect to individuals who lack

15 proficiency in speaking the English language,

16 enter into contracts with public and nonprofit

17 private providers of primary health services for

18 the purpose of increasing the access of the indi19 viduals to such services by developing and car20 rying out programs to provide bilingual or in21 terpretive services.

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

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

2 services, and education in the appropriate use

3 of health care.

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

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

6 problems relating to such matters.

7 ‘‘(D) Provide technical assistance with re8 spect to the exchange of such information (in9 cluding facilitating the development of materials

10 for such technical assistance).

11 ‘‘(4) Carry out programs to improve access to

12 health care services for individuals with limited pro13 ficiency in speaking the English language by facili14 tating the removal of impediments to the receipt of

15 health care that result from such limitation. Activi16 ties under the preceding sentence shall include con17 ducting research and developing and evaluating

18 model projects.

19 ‘‘(5) Not later than June 8 of each year, the

20 heads of the Public Health Service agencies shall

21 submit to the Deputy Assistant Secretary a report

22 summarizing the minority health activities of each of

23 the respective agencies.

24 ‘‘(c) ADVISORY COMMITTEE.—
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1 ‘‘(1) IN GENERAL.—The Secretary shall estab2 lish an advisory committee to be known as the Advi3 sory Committee on Minority Health (in this sub4 section referred to as the ‘Committee’). The Deputy

5 Assistant Secretary shall consult with the Committee

6 in carrying out this section.

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

8 advice to the Deputy Assistant Secretary carrying

9 out this section, including advice on the development

10 of goals and specific program activities under para11 graphs (1) and (2) of subsection (b) for each racial

12 and ethnic minority group.

13 ‘‘(3) CHAIR.—The Deputy Assistant Secretary

14 shall serve as the chair of the Committee.

15 ‘‘(4) COMPOSITION.—

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

17 12 voting members appointed in accordance

18 with subparagraph (B), and nonvoting, ex

19 officio members designated in subparagraph

20 (C).

21 ‘‘(B) The voting members of the Commit22 tee shall be appointed by the Secretary from

23 among individuals who are not officers or em24 ployees of the Federal Government and who

25 have expertise regarding issues of minority
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1 health. The racial and ethnic minority groups

2 shall be equally represented among such mem3 bers.

4 ‘‘(C) The nonvoting, ex officio members of

5 the Committee shall be the directors of each of

6 the minority health offices, and such additional

7 officials of the Department of Health and

8 Human Services as the Secretary determines to

9 be appropriate.

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

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

12 Secretary shall initially appoint a portion of the

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

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

15 Committee, a new member shall be appointed by the

16 Secretary within 90 days from the date that the va17 cancy occurs, and serve for the remainder of the

18 term for which the predecessor of such member was

19 appointed. The vacancy shall not affect the power of

20 the remaining members to execute the duties of the

21 Committee.

22 ‘‘(7) COMPENSATION.—Members of the Com23 mittee who are officers or employees of the United

24 States shall serve without compensation. Members of

25 the Committee who are not officers or employees of
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1 the United States shall receive compensation, for

2 each day (including travel time) they are engaged in

3 the performance of the functions of the Committee.

4 Such compensation may not be in an amount in ex5 cess of the daily equivalent of the annual maximum

6 rate of basic pay payable under the General Sched7 ule (under title 5, United States Code) for positions

8 above GS–15.

9 ‘‘(d) CERTAIN REQUIREMENTS REGARDING DU10 TIES.—

11 ‘‘(1) RECOMMENDATIONS REGARDING LAN12 GUAGE AS IMPEDIMENT TO HEALTH CARE.—The

13 Deputy Assistant Secretary for Minority Health

14 shall consult with the Director of the Office of Refu15 gee Health, the Director of the Office of Civil

16 Rights, and the Director of the Office of Minority

17 Health of the Health Resources and Services Admin18 istration, and other appropriate offices, regarding

19 recommendations for carrying out activities under

20 subsection (b)(4).

21 ‘‘(2) EQUITABLE ALLOCATION REGARDING AC22 TIVITIES.—

23 ‘‘(A) In making awards of grants, coopera24 tive agreements, or contracts under this section

25 or section 338A, 338B, 340A, 404, or 724, or
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1 part B of title VII, the Secretary, acting as ap2 propriate through the Deputy Assistant Sec3 retary or the Administrator of the Health Re4 sources and Services Administration, shall en5 sure that such awards are equitably allocated

6 with respect to the various racial and minority

7 populations.

8 ‘‘(B) With respect to grants, cooperative

9 agreements, and contracts that are available

10 under the sections specified in subparagraph

11 (A), the Secretary shall—

12 ‘‘(i) carry out activities to inform enti13 ties, as appropriate, that the entities may

14 be eligible for awards of such assistance;

15 ‘‘(ii) provide technical assistance to

16 such entities in the process of preparing

17 and submitting applications for the awards

18 in accordance with the policies of the Sec19 retary regarding such application; and

20 ‘‘(iii) inform populations, as appro21 priate, that members of the populations

22 may be eligible to receive services or other23 wise participate in the activities carried out

24 with such awards.
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1 ‘‘(3) CULTURAL COMPETENCY OF SERVICES.—

2 The Secretary shall ensure that information and

3 services provided pursuant to subsection (b) are pro4 vided in the language, educational, and cultural con5 text that is most appropriate for the individuals for

6 whom the information and services are intended.

7 ‘‘(e) GRANTS AND CONTRACTS REGARDING DU8 TIES.—

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

10 (b), the Deputy Assistant Secretary may make

11 awards of grants, cooperative agreements, and con12 tracts to public and nonprofit private entities.

13 ‘‘(2) PROCESS FOR MAKING AWARDS.—The

14 Deputy Assistant Secretary shall ensure that awards

15 under paragraph (1) are made only on a competitive

16 basis, and that a grant is awarded for a proposal

17 only if the proposal has been recommended for such

18 an award through a process of peer review and has

19 been so recommended by the advisory committee es20 tablished under subsection (c).

21 ‘‘(3) EVALUATION AND DISSEMINATION.—The

22 Deputy Assistant Secretary, directly or through con23 tracts with public and private entities, shall provide

24 for evaluations of projects carried out with awards

25 made under paragraph (1) during the preceding 2
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1 fiscal years. The report shall be included in the re2 port required under subsection (f) for the fiscal year

3 involved.

4 ‘‘(f) BIENNIAL REPORTS.—Not later than February

5 1 of fiscal year 1996 and of each second year thereafter,

6 the Deputy Assistant Secretary shall submit to the Com7 mittee on Energy and Commerce of the House of Rep8 resentatives, and to the Committee on Labor and Human

9 Resources of the Senate, a report describing the activities

10 carried out under this section during the preceding 2 fiscal

11 years and evaluating the extent to which such activities

12 have been effective in improving the health of racial and

13 ethnic minority groups. Each such report shall include the

14 biennial reports submitted to the Deputy Assistant Sec15 retary under section 201(b)(5) for such years by the heads

16 of the Public Health Service agencies.

17 ‘‘(g) DEFINITION.—For purposes of this section:

18 ‘‘(1) The term ‘racial and ethnic minority

19 group’ means American Indians (including Alaska

20 Natives, Eskimos, and Aleuts); Asian Americans and

21 Pacific Islanders; Blacks; and Hispanics.

22 ‘‘(2) The term ‘Hispanic’ means individuals

23 whose origin is Mexican, Puerto Rican, Cuban,

24 Central or South American, or any other Spanish25 speaking country.
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1 ‘‘(h) FUNDING.—For the purpose of carrying out this

2 section, there are authorized to be appropriated

3 $21,000,000 for fiscal year 1996, such sums as may be

4 necessary for each of the fiscal years 1997 and 1998, and

5 $19,000,000 for fiscal year 1999.’’.

6 (b) MISCELLANEOUS AMENDMENT.—Section 1707 of

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

8 amended in the heading for the section by striking ‘‘ES9 TABLISHMENT OF’’.

10 TITLE III—SELECTED

11 INITIATIVES

12 SEC. 301. PROGRAMS REGARDING BIRTH DEFECTS.

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

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

15 ‘‘PROGRAMS REGARDING BIRTH DEFECTS

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

17 Director of the Centers for Disease Control and Preven18 tion, shall carry out programs—

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

20 on birth defects (in a manner that facilitates compli21 ance with subsection (d)(2)), including data on the

22 causes of such defects and on the incidence and

23 prevalence of such defects; and

24 ‘‘(2) to operate regional centers for the conduct

25 of applied epidemiological research on the prevention

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

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

4 (a)(1), the Secretary—

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

7 Hispanics, non-Hispanic whites, Blacks, Native

8 Americans, Asian Americans, and Pacific Is9 landers;

10 ‘‘(B) shall collect data under subparagraph

11 (A) from birth certificates, death certificates,

12 hospital records, and such other sources as the

13 Secretary determines to be appropriate; and

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

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

17 to make the data available.

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

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

20 and maintain a National Information Clearinghouse

21 on Birth Defects to collect and disseminate to health

22 professionals and the general public information on

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

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

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

3 into contracts with public and nonprofit private enti4 ties.

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

6 AWARD FUNDS.—

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

8 award of a grant or contract under paragraph

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

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

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

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

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

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

17 in subparagraph (A), the Secretary shall reduce

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

21 any supplies, equipment, or services provided by

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

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

2 may make an award of a grant or contract under

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

4 is submitted to the Secretary and the application is

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

6 such agreements, assurances, and information as the

7 Secretary determines to be necessary to carry out

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

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

10 1 of fiscal year 1997 and of every second such year there11 after, the Secretary shall submit to the Committee on En12 ergy and Commerce of the House of Representatives, and

13 the Committee on Labor and Human Resources of the

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

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

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

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

21 that is specific to various racial and ethnic groups

22 (including Hispanics, non-Hispanic whites, Blacks,

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

2 which various approaches of preventing birth defects

3 have been effective;

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

5 this section; and

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

8 SEC. 302. TRAUMATIC BRAIN INJURY.

9 (a) PROGRAMS OF NATIONAL INSTITUTES OF

10 HEALTH.—Section 1261 of the Public Health Service Act

11 (42 U.S.C. 300d–61) is amended—

12 (1) in subsection (d)—

13 (A) in paragraph (2), by striking ‘‘and’’

14 after the semicolon at the end;

15 (B) in paragraph (3), by striking the pe16 riod and inserting ‘‘; and’’; and

17 (C) by adding at the end the following

18 paragraph:

19 ‘‘(4) the authority to make awards of grants or

20 contracts to public or nonprofit private entities for

21 the conduct of basic and applied research regarding

22 traumatic brain injury, which research may in23 clude—

24 ‘‘(A) the development of new methods and

25 modalities for the more effective diagnosis,
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1 measurement of degree of injury, post-injury

2 monitoring and prognostic assessment of head

3 injury for acute, subacute and later phases of

4 care;

5 ‘‘(B) the development, modification and

6 evaluation of therapies that retard, prevent or

7 reverse brain damage after acute head injury,

8 that arrest further deterioration following in9 jury and that provide the restitution of function

10 for individuals with long-term injuries;

11 ‘‘(C) the development of research on a con12 tinuum of care from acute care through reha13 bilitation, designed, to the extent practicable, to

14 integrate rehabilitation and long-term outcome

15 evaluation with acute care research; and

16 ‘‘(D) the development of programs that in17 crease the participation of academic centers of

18 excellence in head injury treatment and reha19 bilitation research and training.’’; and

20 (2) in subsection (h), by adding at the end the

21 following paragraph:

22 ‘‘(4) The term ‘traumatic brain injury’ means

23 an acquired injury to the brain. Such term does not

24 include brain dysfunction caused by congenital or

25 degenerative disorders, nor birth trauma, but may
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1 include brain injuries caused by anoxia due to near

2 drowning.’’.

3 (b) PROGRAMS OF HEALTH RESOURCES AND SERV4 ICES ADMINISTRATION.—Part E of title XII of the Public

5 Health Service Act (42 U.S.C. 300d–51 et seq.) is amend6 ed by adding at the end the following new section:

7 ‘‘§ 1252. State grants for demonstration projects re8 garding traumatic brain injury

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

10 the Administrator of the Health Resources and Services

11 Administration, may make grants to States for the pur12 pose of carrying out demonstration projects to improve the

13 availability of health services regarding traumatic brain

14 injury.

15 ‘‘(b) STATE ADVISORY BOARD.—

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

17 grant under subsection (a) only if the State involved

18 agrees to establish an advisory board within the ap19 propriate health department of the State or within

20 another department as designated by the chief exec21 utive officer of the State.

22 ‘‘(2) FUNCTIONS.—An advisory board estab23 lished under paragraph (1) shall be cognizant of

24 findings and concerns of Federal, State and local

25 agencies, citizens groups, and private industry (such
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1 as insurance, health care, automobile, and other in2 dustry entities). Such advisory boards shall encour3 age citizen participation through the establishment

4 of public hearings and other types of community

5 outreach programs.

6 ‘‘(3) COMPOSITION.—An advisory board estab7 lished under paragraph (1) shall be composed of—

8 ‘‘(A) representatives of—

9 ‘‘(i) the corresponding State agencies

10 involved;

11 ‘‘(ii) public and nonprofit private

12 health related organizations;

13 ‘‘(iii) other disability advisory or plan14 ning groups within the State;

15 ‘‘(iv) members of an organization or

16 foundation representing traumatic brain

17 injury survivors in that State; and

18 ‘‘(v) injury control programs at the

19 State or local level if such programs exist;

20 and

21 ‘‘(B) a substantial number of individuals

22 who are survivors of traumatic brain injury, or

23 the family members of such individuals.

24 ‘‘(c) MATCHING FUNDS.—
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1 ‘‘(1) IN GENERAL.—With respect to the costs to

2 be incurred by a State in carrying out the purpose

3 described in subsection (a), the Secretary may make

4 a grant under such subsection only if the State

5 agrees to make available, in cash, non-Federal con6 tributions toward such costs in an amount that is

7 not less than $1 for each $2 of Federal funds pro8 vided under the grant.

9 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB10 UTED.—In determining the amount of non-Federal

11 contributions in cash that a State has provided pur12 suant to paragraph (1), the Secretary may not in13 clude any amounts provided to the State by the Fed14 eral Government.

15 ‘‘(d) APPLICATION FOR GRANT.—The Secretary may

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

17 for the grant is submitted to the Secretary and the appli18 cation is in such form, is made in such manner, and con19 tains such agreements, assurances, and information as the

20 Secretary determines to be necessary to carry out this sec21 tion.

22 ‘‘(e) COORDINATION OF ACTIVITIES.—The Secretary

23 shall ensure that activities under this section are coordi24 nated as appropriate with other agencies of the Public
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1 Health Service that carry out activities regarding trau2 matic brain injury.

3 ‘‘(f) REPORT.—Not later than 2 years after the date

4 of enactment of this section, the Secretary shall submit

5 to the Committee on Energy and Commerce of the House

6 of Representatives, and to the Committee on Labor and

7 Human Resources of the Senate, a report describing the

8 findings and results of the programs established under

9 this section, including measures of outcomes and

10 consumer and surrogate satisfaction.

11 ‘‘(g) DEFINITION.—For purposes of this section, the

12 term ‘traumatic brain injury’ means an acquired injury

13 to the brain. Such term does not include brain dysfunction

14 caused by congenital or degenerative disorders, nor birth

15 trauma, but may include brain injuries caused by anoxia

16 due to near drowning.

17 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There

18 are authorized to be appropriated to carry out this section,

19 $5,000,000 for fiscal year 1996, and such sums as may

20 be necessary for each of the fiscal years 1997 and 1998.’’.

21 (c) STUDY; CONSENSUS CONFERENCE.—

22 (1) STUDY.—

23 (A) IN GENERAL.—The Secretary of

24 Health and Human Services (in this subsection

25 referred to as the ‘‘Secretary’’), acting through
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1 the appropriate agencies of the Public Health

2 Service, shall conduct a study for the purpose

3 of carrying out the following with respect to

4 traumatic brain injury:

5 (i) In collaboration with appropriate

6 State and local health-related agencies—

7 (I) determine the incidence and

8 prevalence of traumatic brain injury;

9 and

10 (II) develop a uniform reporting

11 system under which States report inci12 dence of traumatic brain injury, if the

13 Secretary determines that such a sys14 tem is appropriate.

15 (ii) Identify common therapeutic

16 interventions which are used for the reha17 bilitation of individuals with such injuries,

18 and shall, subject to the availability of in19 formation, include an analysis of—

20 (I) the effectiveness of each such

21 intervention in improving the func22 tioning of individuals with brain inju23 ries;

24 (II) the comparative effectiveness

25 of interventions employed in the
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1 course of rehabilitation of individuals

2 with brain injuries to achieve the

3 same or similar clinical outcome; and

4 (III) the adequacy of existing

5 measures of outcomes and knowledge

6 of factors influencing differential out7 comes.

8 (iii) Develop practice guidelines for

9 the rehabilitation of traumatic brain injury

10 at such time as appropriate scientific re11 search becomes available.

12 (B) DATES CERTAIN FOR REPORTS.—

13 (i) Not later than 18 months after the

14 date of enactment of this Act, the Sec15 retary shall submit to the Committee on

16 Commerce of the House of Representa17 tives, and to the Committee on Labor and

18 Human Resources of the Senate, a report

19 describing the findings made as a result of

20 carrying out subparagraph (A)(i).

21 (ii) Not later than 3 years after the

22 date of enactment of this Act, the Sec23 retary shall submit to the Committees

24 specified in clause (i) a report describing

25 the findings made as a result of carrying
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1 out clauses (ii) and (iii) of subparagraph

2 (A).

3 (2) CONSENSUS CONFERENCE.—The Secretary,

4 acting through the Director of the National Center

5 for Medical Rehabilitation Research within the Na6 tional Institute for Child Health and Human Devel7 opment, shall conduct a national consensus con8 ference on managing traumatic brain injury and re9 lated rehabilitation concerns.

10 (3) DEFINITION.—For purposes of this sub11 section, the term ‘‘traumatic brain injury’’ means an

12 acquired injury to the brain. Such term does not in13 clude brain dysfunction caused by congenital or de14 generative disorders, nor birth trauma, but may in15 clude brain injuries caused by anoxia due to near

16 drowning.

17 SEC. 303. STATE OFFICES OF RURAL HEALTH.

18 (a) IN GENERAL.—Section 338M of the Public

19 Health Service Act (as so redesignated by section 132)

20 is amended—

21 (1) in subsection (b)(1), in the matter preced22 ing subparagraph (A), by striking ‘‘in cash’’; and

23 (2) in subsection (j)(1)—

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

3 for each of the fiscal years 1996 through

4 1997’’; and

5 (3) in subsection (k), by striking

6 ‘‘$10,000,000’’ and inserting ‘‘$20,000,000’’.

7 (b) REPEAL.—Effective on October 1, 1997, section

8 338M of the Public Health Service Act (as so redesignated

9 by section 132) is repealed.

10 SEC. 304. HEALTH SERVICES FOR PACIFIC ISLANDERS.

11 Section 10 of the Disadvantaged Minority Health Im12 provement Act of 1990 (42 U.S.C. 254c–1) is amended—

13 (1) in subsection (b)—

14 (A) in paragraph (2)—

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

16 after ‘‘availability of health’’; and

17 (ii) by striking ‘‘, including improved

18 health data systems’’;

19 (B) in paragraph (3)—

20 (i) by striking ‘‘manpower’’ and in21 serting ‘‘care providers’’; and

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

23 follows through the end thereof and insert24 ing a semicolon;

25 (C) by striking paragraphs (5) and (6);
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1 (D) by redesignating paragraphs (7), and

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

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

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

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

6 by striking the period and inserting a semi7 colon; and

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

9 redesignated), the following new paragraphs:

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

11 health care, and related training to American Sa12 moan health care professionals; and

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

14 disease prevention services for rural American

15 Samoa.’’;

16 (2) in subsection (f)—

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

18 ‘‘there are’’; and

19 (B) by striking ‘‘$10,000,000’’ and all that

20 follows through ‘‘1993’’ and inserting

21 ‘‘$3,000,000 for fiscal year 1995, $4,000,000

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

23 year 1997’’; and

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

25 new subsection:
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1 ‘‘(g) STUDY AND REPORT.—

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

3 the date of enactment of this subsection, the Sec4 retary, acting through the Administrator of the

5 Health Resources and Services Administration, shall

6 enter into a contract with a public or nonprofit pri7 vate entity for the conduct of a study to determine

8 the effectiveness of projects funded under this sec9 tion.

10 ‘‘(2) REPORT.—Not later than July 1, 1996,

11 the Secretary shall prepare and submit to the Com12 mittee on Labor and Human Resources of the Sen13 ate and the Committee on Energy and Commerce of

14 the House of Representatives a report describing the

15 findings made with respect to the study conducted

16 under paragraph (1).’’.

17 SEC. 305. DEMONSTRATION PROJECTS REGARDING ALZ18 HEIMER’S DISEASE.

19 (a) IN GENERAL.—Section 398(a) of the Public

20 Health Service Act (42 U.S.C. 280c–3(a)) is amended—

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

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

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

3 or in congregate settings’’; and

4 (B) by striking ‘‘and’’ at the end;

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

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

9 ‘‘(3) to improve the access of such individuals

10 to home-based or community-based long-term care

11 services (subject to the services being provided by

12 entities that were providing such services in the

13 State involved as of October 1, 1995), particularly

14 such individuals who are members of racial or ethnic

15 minority groups, who have limited proficiency in

16 speaking the English language, or who live in rural

17 areas; and’’.

18 (b) DURATION.—Section 398A of the Public Health

19 Service Act (42 U.S.C. 280c–4) is amended—

20 (1) in the heading for the section, by striking

21 ‘‘limitation’’ and all that follows and inserting

22 ‘‘requirement of matching funds’’;

23 (2) by striking subsection (a);

24 (3) by redesignating subsections (b) and (c) as

25 subsections (a) and (b), respectively;
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1 (4) in subsection (a) (as so redesignated), in

2 each of paragraphs (1)(C) and (2)(C), by striking

3 ‘‘third year’’ and inserting ‘‘third or subsequent

4 year’’.

5 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

6 398B(e) of the Public Health Service Act (42 U.S.C.

7 280c–5(e)) is amended by striking ‘‘and 1993’’ and insert8 ing ‘‘through 1998’’.

9 TITLE IV—MISCELLANEOUS

10 PROVISIONS

11 SEC. 401. TECHNICAL CORRECTIONS REGARDING PUBLIC

12 LAW 103–183.

13 (a) AMENDATORY INSTRUCTIONS.—Public Law 103–

14 183 is amended—

15 (1) in section 601—

16 (A) in subsection (b), in the matter preced17 ing paragraph (1), by striking ‘‘Section 1201 of

18 the Public Health Service Act (42 U.S.C.

19 300d)’’ and inserting ‘‘Title XII of the Public

20 Health Service Act (42 U.S.C. 300d et seq.)’’;

21 and

22 (B) in subsection (f)(1), by striking ‘‘in

23 section 1204(c)’’ and inserting ‘‘in section

24 1203(c) (as redesignated by subsection (b)(2) of

25 this section)’’;
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1 (2) in section 602, by striking ‘‘for the pur2 pose’’ and inserting ‘‘For the purpose’’; and

3 (3) in section 705(b), by striking ‘‘317D((l)(1)’’

4 and inserting ‘‘317D(l)(1)’’.

5 (b) PUBLIC HEALTH SERVICE ACT.—The Public

6 Health Service Act, as amended by Public Law 103–183

7 and by subsection (a) of this section, is amended—

8 (1) in section 317E(g)(2), by striking ‘‘making

9 grants under subsection (b)’’ and inserting ‘‘carrying

10 out subsection (b)’’;

11 (2) in section 318, in subsection (e) as in effect

12 on the day before the date of the enactment of Pub13 lic Law 103–183, by redesignating the subsection as

14 subsection (f);

15 (3) in subpart 6 of part C of title IV—

16 (A) by transferring the first section 447

17 (added by section 302 of Public Law 103–183)

18 from the current placement of the section;

19 (B) by redesignating the section as section

20 447A; and

21 (C) by inserting the section after section

22 447;

23 (4) in section 1213(a)(8), by striking ‘‘provides

24 for for’’ and inserting ‘‘provides for’’;
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1 (5) in section 1501, by redesignating the second

2 subsection (c) (added by section 101(f) of Public

3 Law 103–183) as subsection (d); and

4 (6) in section 1505(3), by striking ‘‘nonprofit’’.

5 (c) MISCELLANEOUS CORRECTION.—Section

6 401(c)(3) of Public Law 103–183 is amended in the mat7 ter preceding subparagraph (A) by striking ‘‘(d)(5)’’ and

8 inserting ‘‘(e)(5)’’.

9 (d) EFFECTIVE DATE.—This section is deemed to

10 have taken effect immediately after the enactment of Pub11 lic Law 103–183.

12 SEC. 402. CERTAIN AUTHORITIES OF CENTERS FOR DIS13 EASE CONTROL AND PREVENTION.

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

15 Health Service Act is amended by inserting after section

16 317H the following section:

17 ‘‘MISCELLANEOUS AUTHORITIES REGARDING CENTERS

18 FOR DISEASE CONTROL AND PREVENTION

19 ‘‘SEC. 317I. (a) TECHNICAL AND SCIENTIFIC PEER

20 REVIEW GROUPS.—The Secretary, acting through the Di21 rector of the Centers for Disease Control and Prevention,

22 may, without regard to the provisions of title 5, United

23 States Code, governing appointments in the competitive

24 service, and without regard to the provisions of chapter

25 51 and subchapter III of chapter 53 of such title relating

26 to classification and General Schedule pay rates, establish
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1 such technical and scientific peer review groups and sci2 entific program advisory committees as are needed to

3 carry out the functions of such Centers and appoint and

4 pay the members of such groups, except that officers and

5 employees of the United States shall not receive additional

6 compensation for service as members of such groups. The

7 Federal Advisory Committee Act shall not apply to the

8 duration of such peer review groups. Not more than one9 fourth of the members of any such group shall be officers

10 or employees of the United States.

11 ‘‘(b) FELLOWSHIP AND TRAINING PROGRAMS.—The

12 Secretary, acting through the Director of the Centers for

13 Disease Control and Prevention, shall establish fellowship

14 and training programs to be conducted by such Centers

15 to train individuals to develop skills in epidemiology, sur16 veillance, laboratory analysis, and other disease detection

17 and prevention methods. Such programs shall be designed

18 to enable health professionals and health personnel trained

19 under such programs to work, after receiving such train20 ing, in local, State, national, and international efforts to21 ward the prevention and control of diseases, injuries, and

22 disabilities. Such fellowships and training may be adminis23 tered through the use of either appointment or

24 nonappointment procedures.’’.
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1 (b) EFFECTIVE DATE.—This section is deemed to

2 have taken effect July 1, 1995.

3 SEC. 403. ADMINISTRATION OF CERTAIN REQUIREMENTS.

4 (a) IN GENERAL.—Section 2004 of Public Law 103–

5 43 (107 Stat. 209) is amended by striking subsection (a).

6 (b) CONFORMING AMENDMENTS.—Section 2004 of

7 Public Law 103–43, as amended by subsection (a) of this

8 section, is amended—

9 (1) by striking ‘‘(b) SENSE’’ and all that follows

10 through ‘‘In the case’’ and inserting the following:

11 ‘‘(a) SENSE OF CONGRESS REGARDING PURCHASE

12 OF AMERICAN-MADE EQUIPMENT AND PRODUCTS.—In

13 the case’’;

14 (2) by striking ‘‘(2) NOTICE TO RECIPIENTS OF

15 ASSISTANCE’’ and inserting the following:

16 ‘‘(b) NOTICE TO RECIPIENTS OF ASSISTANCE’’; and

17 (3) in subsection (b), as redesignated by para18 graph (2) of this subsection, by striking ‘‘paragraph

19 (1)’’ and inserting ‘‘subsection (a)’’.

20 (c) EFFECTIVE DATE.—This section is deemed to

21 have taken effect immediately after the enactment of Pub22 lic Law 103–43.
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1 SEC. 404. TECHNICAL CORRECTIONS RELATING TO HEALTH

2 PROFESSIONS PROGRAMS.

3 (a) DEFINITIONS.—Section 799B(6) of the Public

4 Health Service Act (as so redesignated by section

5 105(a)(2)(C)) is amended—

6 (1) in subparagraph (B) by striking ‘‘; or’’ at

7 the end thereof;

8 (2) in subparagraph (C) by striking the period

9 and inserting a semicolon; and

10 (3) by adding at the end thereof the following:

11 ‘‘(D) ambulatory practice sites designated

12 by State Governors as shortage areas or medi13 cally underserved communities for purposes of

14 State scholarships or loan repayment or related

15 programs; or

16 ‘‘(E) practices or facilities in which not

17 less than 50 percent of the patients are recipi18 ents of aid under title XIX of the Social Secu19 rity Act or eligible and uninsured.’’.

20 (b) RECOVERY.—Part G of title VII of the Public

21 Health Service Act (42 U.S.C. 295j et seq.) is amended

22 by inserting after section 794 the following section:

23 ‘‘§ 794a. Recovery

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

25 (or within such shorter period as the Secretary may pre26 scribe by regulation for an interim facility) after the com-
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1 pletion of construction of a facility with respect to which

2 funds have been paid under section 720(a) (as such sec3 tion existed one day prior to the date of enactment of the

4 Health Professions Education Extension Amendments of

5 1992 (Public Law 102–408)—

6 ‘‘(1)(A) in case of a facility which was an affili7 ated hospital or outpatient facility with respect to

8 which funds have been paid under such section

9 720(a)(1), the owner of the facility ceases to be a

10 public or other nonprofit agency that would have

11 been qualified to file an application under section

12 605;

13 ‘‘(B) in case of a facility which was not an af14 filiated hospital or outpatient facility but was a facil15 ity with respect to which funds have been paid under

16 paragraph (1) or (3) of such section 720(a), the

17 owner of the facility ceases to be a public or non18 profit school, or

19 ‘‘(C) in case of a facility which was a facility

20 with respect to which funds have been paid under

21 such section 720(a)(2), the owner of the facility

22 ceases to be a public or nonprofit entity,

23 ‘‘(2) the facility ceases to be used for the teach24 ing or training purposes (or other purposes per25 mitted under section 722 (as such section existed
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1 one day prior to the date of enactment of the Health

2 Professions Education Extension Amendments of

3 1992 (Public Law 102–408)) for which it was con4 structed, or

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

6 or as a place for religious worship,

7 the United States shall be entitled to recover from the

8 owner of the facility the base amount prescribed by sub9 section (c)(1) plus the interest (if any) prescribed by sub10 section (c)(2).

11 ‘‘(b) NOTICE.—The owner of a facility which ceases

12 to be a public or nonprofit agency, school, or entity as

13 described in subparagraph (A), (B), or (C) of subsection

14 (a)(1), as the case may be, or the owner of a facility the

15 use of which changes as described in paragraph (2) or (3)

16 of subsection (a), shall provide the Secretary written no17 tice of such cessation or change of use within 10 days after

18 the date on which such cessation or change of use occurs

19 or within 30 days after the date of enactment of this sub20 section, whichever is later.

21 ‘‘(c) AMOUNT.—

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

23 the United States is entitled to recover under sub24 section (a) is the amount bearing the same ratio to

25 the then value (as determined by the agreement of
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1 the parties or in an action brought in the district

2 court of the United States for the district in which

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

4 of the Federal participation bore to the cost of con5 struction.

6 ‘‘(2) INTEREST.—

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

8 United States is entitled to recover under sub9 section (a) is the interest for the period (if any)

10 described in subparagraph (B) at a rate (deter11 mined by the Secretary) based on the average

12 of the bond equivalent rates of ninety-one-day

13 Treasury bills auctioned during that period.

14 ‘‘(B) PERIOD.—The period referred to in

15 subparagraph (A) is the period beginning—

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

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

18 on which the owner of the facility ceases to

19 be a public or nonprofit agency, school, or

20 entity as described in subparagraph (A),

21 (B), or (C) of subsection (a)(1), as the

22 case may be, or 191 days after the date on

23 which the use of the facility changes as de24 scribed in paragraph (2) or (3) of sub25 section (a), or
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1 ‘‘(ii) if notice is not provided as pre2 scribed by subsection (b), 11 days after the

3 date on which such cessation or change of

4 use occurs,

5 and ending on the date the amount the United

6 States is entitled to recover is collected.

7 ‘‘(d) WAIVER.—The Secretary may waive the recov8 ery rights of the United States under subsection (a)(2)

9 with respect to a facility (under such conditions as the

10 Secretary may establish by regulation) if the Secretary de11 termines that there is good cause for waiving such rights.

12 ‘‘(e) LIEN.—The right of recovery of the United

13 States under subsection (a) shall not, prior to judgment,

14 constitute a lien on any facility.’’.

15 SEC. 405. CLINICAL TRAINEESHIPS.

16 Section 303(d)(1) of the Public Health Service Act

17 (42 U.S.C. 242a(d)(1)) is amended by inserting ‘‘counsel18 ing’’ after ‘‘family therapy,’’.

19 SEC. 406. CONSTRUCTION OF REGIONAL CENTERS FOR RE20 SEARCH ON PRIMATES.

21 Section 481B(a) of the Public Health Service Act (42

22 U.S.C. 287a–3(a)) is amended by striking ‘‘$5,000,000’’

23 and inserting ‘‘$2,500,000’’.
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1 SECTION 1. SHORT TITLE.

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

3 ‘‘Health Professions Education Consolidation and Reau4 thorization Act of 1995’’.

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

6 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.
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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

Sec. 201. Revision and extension of programs of Office of Minority Health.

TITLE III—SELECTED INITIATIVES

Sec. 301. Programs regarding birth defects.

Sec. 302. Traumatic brain injury.

Sec. 303. State offices of rural health.

Sec. 304. Health services for Pacific Islanders.

Sec. 305. 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 to

10 read as follows:
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1 ‘‘PART B—DISADVANTAGED HEALTH

2 PROFESSIONS TRAINING

3 ‘‘SEC. 736. STATEMENT OF PURPOSE.

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

5 to or enter into contracts with eligible entities for the pur6 pose of establishing, enhancing, and expanding programs

7 to increase the number and the quality of disadvantaged

8 health professionals, particularly those who provide health

9 services to disadvantaged populations or in medically un10 derserved areas or rural areas.

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

12 grant or contract awarded under this part may be used for

13 costs of planning, developing, or operating centers of excel14 lence in minority health professions education, programs

15 for assisting individuals from disadvantaged backgrounds

16 to enter a health profession, minority faculty development,

17 minority faculty loan repayment or fellowships, trainee

18 support, technical assistance, workforce analysis, and dis19 semination of information.

20 ‘‘(c) CONSORTIUM.—Schools within a consortium that

21 applies for a grant or contract under this part shall enter

22 into an agreement to allocate the funds received under the

23 grant or contract among such schools and expend such

24 funds in accordance with the application for such grant or

25 contract.
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1 ‘‘SEC. 737. PREFERENCES.

2 ‘‘In awarding grants or contracts to eligible entities

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

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

5 professions discipline or training institution and

6 have an above average record of retention and grad7 uation of individuals from disadvantaged back8 grounds; and

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

10 Colleges and Universities (as defined in section 739)

11 beginning in fiscal year 1999 and for each fiscal year

12 thereafter.

13 ‘‘SEC. 738. AUTHORIZATION OF APPROPRIATION.

14 ‘‘(a) IN GENERAL.—There are authorized to be appro15 priated to carry out this part, $51,000,000 for fiscal year

16 1996, and such sums as may be necessary for each of the

17 fiscal years 1997 through 1999.

18 ‘‘(b) SET-ASIDE.—With respect to each of the fiscal

19 years 1996, 1997 and 1998, the Secretary shall set-aside

20 $12,000,000 of the amount appropriated under subsection

21 (a) in each such fiscal year for the purpose of making

22 grants under section 736 to centers of excellence at certain

23 Historically Black Colleges and Universities.

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

25 construed as limiting the centers of excellence referred to
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1 in subsection (b) to the set-aside amount, or to preclude such

2 entities from competing for other grants under section 736.

3 ‘‘SEC. 739. DEFINITIONS.

4 ‘‘As used in this part:

5 ‘‘(1) CENTERS OF EXCELLENCE.—The term ‘cen6 ters of excellence’ means a health professions school

7 that—

8 ‘‘(A)(i) has a significant number of minor9 ity individuals enrolled in the school, including

10 individuals accepted for enrollment in the school;

11 ‘‘(ii) has been effective in assisting minority

12 students of the school to complete the program of

13 education and receive the degree involved;

14 ‘‘(iii) has been effective in recruiting minor15 ity individuals to attend the school and encour16 aging minority students of secondary edu17 cational institutions to attend the health profes18 sions school; and

19 ‘‘(iv) has made significant recruitment ef20 forts to increase the number of minority individ21 uals serving in faculty or administrative posi22 tions at the school; or

23 ‘‘(B) is a center of excellence at certain His24 torically Black Colleges and Universities.
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1 ‘‘(2) CONSORTIUM.—The term ‘consortium’

2 means the designated eligible entity seeking a grant

3 under this part and one or more schools of medicine,

4 osteopathic medicine, dentistry, pharmacy, nursing,

5 allied health, public health, or graduate programs in

6 mental health practice.

7 ‘‘(3) ELIGIBLE ENTITIES.—The term ‘eligible en8 tities’ means schools of medicine, osteopathic medi9 cine, dentistry, pharmacy, podiatric medicine, optom10 etry, veterinary medicine, public health, or allied

11 health or schools offering graduate programs in men12 tal health practice, State or local governments, and

13 other public or nonprofit private entities determined

14 appropriate by the Secretary that submit to the Sec15 retary an application.

16 ‘‘(4) HISTORICALLY BLACK COLLEGES AND UNI17 VERSITIES.—The term ‘Historically Black Colleges

18 and Universities’ means a school described in section

19 799B(1) that has received a contract under section

20 788B for fiscal year 1987, as such section was in ef21 fect for such fiscal year.’’.

22 (b) REPEAL.—

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

24 Health Service Act (42 U.S.C. 295n) is repealed.
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1 (2) NONTERMINATION OF AUTHORITY.—The

2 amendments made by this section shall not be con3 strued to terminate agreements that, on the day before

4 the date of enactment of this Act, are in effect pursu5 ant to section 795 of the Public Health Service Act

6 (42 U.S.C. 795) as such section existed on such date.

7 Such agreements shall continue in effect in accord8 ance with the terms of the agreements. With respect

9 to compliance with such agreements, any period of

10 practice as a provider of primary health services shall

11 be counted towards the satisfaction of the requirement

12 of practice pursuant to such section 795.

13 (c) CONFORMING AMENDMENTS.—Section

14 481A(c)(3)(D)(i) of the Public Health Service Act (42

15 U.S.C. 287a-2(c)(3)(D)(i)) is amended by striking ‘‘section

16 739’’ and inserting ‘‘part B of title VII’’.

17 SEC. 102. TRAINING IN FAMILY MEDICINE, GENERAL INTER18 NAL MEDICINE, GENERAL PEDIATRICS, PRE19 VENTIVE MEDICINE, PHYSICIAN ASSISTANTS,

20 AND GENERAL DENTISTRY.

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

22 (42 U.S.C. 293 et seq.) is amended—

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

24 HEALTH CARE’’ and inserting ‘‘FAMILY MEDI25 CINE, GENERAL INTERNAL MEDICINE, GEN-
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1 ERAL PEDIATRICS, PREVENTIVE MEDICINE,

2 PHYSICIAN ASSISTANTS, AND GENERAL DEN3 TISTRY’’;

4 (2) by repealing section 746 and sections 748

5 through 752 (42 U.S.C. 293j and 293l through 293p);

6 and

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

8 (A) by striking the section heading and in9 serting the following:

10 ‘‘SEC. 747. FAMILY MEDICINE, GENERAL INTERNAL MEDI11 CINE, GENERAL PEDIATRICS, PREVENTIVE

12 MEDICINE, GENERAL DENTISTRY, AND PHYSI13 CIAN ASSISTANTS.’’;

14 (B) in subsection (a)—

15 (i) in paragraph (1)—

16 (I) by inserting ‘‘, internal medi17 cine, or pediatrics’’ after ‘‘family med18 icine’’; and

19 (II) by inserting before the semi20 colon the following: ‘‘that emphasizes

21 training for the practice of family

22 medicine, general internal medicine, or

23 general pediatrics (as defined by the

24 Secretary)’’;
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1 (ii) in paragraph (2), by inserting ‘‘,

2 general internal medicine, or general pedi3 atrics’’ before the semicolon;

4 (iii) in paragraphs (3) and (4), by in5 serting ‘‘, general internal medicine (includ6 ing geriatrics), or general pediatrics’’ after

7 ‘‘family medicine’’;

8 (iv) in paragraphs (3) and (4), by in9 serting ‘‘(including geriatrics) after ‘‘family

10 medicine’’;

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

12 ‘‘and’’ at the end thereof;

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

14 period and inserting a semicolon; and

15 (vii) by adding at the end thereof the

16 following new paragraphs:

17 ‘‘(5) to meet the costs of projects to plan, develop,

18 and operate or maintain programs for the training of

19 physician assistants (as defined in section 799B), and

20 for the training of individuals who will teach in pro21 grams to provide such training;

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

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

24 training programs and to maintain or improve

25 existing residency training programs in preven-
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1 tive medicine, that have available full-time fac2 ulty members with training and experience in

3 the fields of preventive medicine; and

4 ‘‘(B) to provide financial assistance to resi5 dency trainees enrolled in such programs; and

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

7 operating programs, and to provide financial assist8 ance to residents in such programs, that would lead

9 to a significantly greater ratio of participating indi10 viduals in such programs eventually entering practice

11 in general dentistry in rural and medically under12 served communities compared to the current ratio of

13 all dentists nationally practicing general dentistry in

14 rural and medically underserved communities.

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

16 grants or contracts shall include entities that have pro17 grams in dental schools, approved residency programs in

18 the general practice of dentistry, or approved advanced edu19 cation programs in the general practice of dentistry. The

20 Secretary may only fund programs under such paragraph

21 if such programs provide a significant amount of care for

22 underserved populations and other high-risk groups, and if

23 the Secretary determines that there is a national shortage

24 of general dentists.’’;
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1 (C) in paragraphs (1) and (2)(A) of sub2 section (b), by inserting ‘‘, general internal med3 icine, or general pediatrics’’ after ‘‘family medi4 cine’’;

5 (D) by redesignating subsections (c) and (d)

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

7 (E) by inserting after subsection (b), the fol8 lowing new subsection:

9 ‘‘(c) PRIORITY AND LIMITATION.—

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

11 the training of interns or residents, the Secretary

12 shall give priority in awarding grants under this sec13 tion to qualified applicants that have a record of

14 training the greatest percentage of providers, or that

15 have demonstrated significant improvements in the

16 percentage of providers, which enter and remain in

17 primary care practice or general dentistry upon com18 pletion of their first period of training required to ob19 tain initial board certification. Each program shall

20 designate the primary care training or general den21 tistry positions that such program shall provide with

22 grant funding to support and for which such program

23 shall be held accountable regarding the primary care

24 or general dentistry requirement set forth in this sec25 tion.
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1 ‘‘(2) LIMITATION.—With respect to programs for

2 the training and education of medical students, the

3 Secretary may only provide grants or contracts under

4 this section to administrative units in general pediat5 rics or general internal medicine if a qualified ad6 ministrative unit applicant demonstrates that its

7 medical school has—

8 ‘‘(A) a mission statement that has a pri9 mary care medical education objective;

10 ‘‘(B) faculty role models and administrative

11 units in primary care; and

12 ‘‘(C) required undergraduate ambulatory

13 medical student clerkships in family medicine,

14 internal medicine, and pediatrics.

15 Where a medical school does not have an administra16 tive unit in family medicine, clerkships in family

17 medicine shall not be required.’’; and

18 (F) in subsection (e) (as so redesignated by

19 subparagraph (D))—

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

21 ‘‘$54,000,000’’ and all that follows and in22 serting ‘‘$76,000,000 for fiscal year 1996,

23 and such sums as may be necessary for each

24 of the fiscal years 1997 through 1999.’’; and

25 (ii) in paragraph (2)—
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1 (I) by striking ‘‘20’’ and inserting

2 ‘‘12’’; and

3 (II) by inserting ‘‘for family med4 icine academic administrative units’’

5 after ‘‘under subsection (b)’’.

6 SEC. 103. ENHANCED HEALTH EDUCATION AND TRAINING.

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

8 (42 U.S.C. 294 et seq.) is amended to read as follows:

9 ‘‘PART D—AREA HEALTH EDUCATION CENTERS

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

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

12 to and enter into contracts with eligible entities for projects

13 which —

14 ‘‘(1) improve the recruitment, distribution, sup15 ply, quality, utilization, and efficiency of personnel

16 providing health services in urban and rural areas

17 and to populations that have demonstrated serious

18 unmet health care need;

19 ‘‘(2) encourage the regionalization of educational

20 responsibilities of the health professions schools;

21 ‘‘(3) are designed to prepare, through field place22 ments, preceptorships, the conduct of or affiliation

23 with community-based primary care residency pro24 grams, agreements with community-based organiza25 tions for the delivery of education and training in the
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1 health professions, and other programs, individuals to

2 effectively provide health services in health profes3 sional shortage areas;

4 ‘‘(4) conduct health professions education and

5 training activities consistent with national and State

6 priorities, including geriatrics;

7 ‘‘(5) encourage health promotion and disease

8 prevention activities;

9 ‘‘(6) conduct interdisciplinary training and

10 practice involving other health professionals;

11 ‘‘(7) conduct continuing education programs for

12 health professionals or coordinate with such pro13 grams; and

14 ‘‘(8) address other areas as determined appro15 priate by the Secretary.

16 ‘‘(b) PREFERENCES.—In awarding grants or contracts

17 to eligible entities under this part, the Secretary shall give

18 preference to projects that—

19 ‘‘(1) involve more than one health professions

20 discipline or training institution; and

21 ‘‘(2) have a good record of retention and gradua22 tion of individuals that enter practice in medically

23 underserved communities.

24 ‘‘(c) OTHER ELIGIBLE PROGRAMS.—
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1 ‘‘(1) GERIATRIC EDUCATION CENTERS.—The Sec2 retary shall award grants or contracts under this sec3 tion for the establishment or operation of geriatric

4 education centers.

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

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

7 award grants or contracts under this section for

8 the operation of public health training centers.

9 ‘‘(B) ELIGIBLE ENTITIES.—A public health

10 training center shall be an accredited school of

11 public health, or another public or nonprofit pri12 vate institution accredited for the provision of

13 graduate or specialized training in public health,

14 that plans, develops, operates, and evaluates

15 projects that are in furtherance of the goals es16 tablished by the Secretary for the year 2000 in

17 the areas of preventive medicine, health pro18 motion and disease prevention, or improving ac19 cess to and quality of health services in medi20 cally underserved communities.

21 ‘‘(C) CERTAIN REQUIREMENTS.—With re22 spect to a public health training center, an

23 award may not be made under subparagraph

24 (A) unless the program agrees that it—
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1 ‘‘(i) will establish or strengthen field

2 placements for students in public or non3 profit private health agencies or organiza4 tions; and

5 ‘‘(ii) will involve faculty members and

6 students in collaborative projects to enhance

7 public health services to medically under8 served communities.

9 ‘‘(d) ELIGIBLE ENTITIES.—As used in this part, the

10 term ‘eligible entities’ means schools of medicine, osteo11 pathic medicine, dentistry, pharmacy, podiatric medicine,

12 optometry, veterinary medicine, public health, or allied

13 health or schools offering graduate programs in mental

14 health practice or physician assistant training programs,

15 State or local governments, and other public or nonprofit

16 private entities determined appropriate by the Secretary

17 that submit to the Secretary an application.

18 ‘‘(e) GERIATRIC EDUCATION CENTERS.—A geriatric

19 education center shall be an accredited health professions

20 school or program that—

21 ‘‘(1) improves the training of health professionals

22 in geriatrics, including geriatric residencies,

23 traineeships, or fellowships;
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1 ‘‘(2) develops and disseminates curricula relating

2 to the treatment of the health problems of elderly indi3 viduals;

4 ‘‘(3) supports the training and retraining of fac5 ulty to provide instruction in geriatrics;

6 ‘‘(4) supports continuing education of health

7 professionals who provide geriatric care; and

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

9 geriatrics in nursing homes, chronic and acute disease

10 hospitals, ambulatory care centers, and senior centers.

11 ‘‘SEC. 751. AUTHORIZATION OF APPROPRIATIONS.

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

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

14 may be necessary for each of the fiscal years 1997 and 1998,

15 and $29,000,000 for fiscal year 1999.’’.

16 SEC. 104. HEALTH PROFESSIONS WORKFORCE DEVELOP17 MENT.

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

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

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

21 ‘‘PART E—HEALTH PROFESSIONS WORKFORCE

22 DEVELOPMENT’’;

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

24 294n) as section 761; and
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1 (3) by striking sections 777 and 778 (42 U.S.C.

2 294o and 294p) and inserting the following new sec3 tion:

4 ‘‘SEC. 762. HEALTH PROFESSIONS WORKFORCE DEVELOP5 MENT.

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

7 to and enter into contracts with eligible entities for projects

8 to strengthen capacity for health professions education and

9 practice.

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

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

12 medicine, osteopathic medicine, dentistry, veterinary medi13 cine, pharmacy, podiatric medicine, chiropractic medicine,

14 optometry, public health, or allied health, graduate pro15 grams in mental health practice, physician assistant train16 ing programs, and other public and nonprofit private enti17 ties.

18 ‘‘(c) PRIORITY AREAS.—In awarding grants or con19 tracts under subsection (a), the Secretary shall give priority

20 to entities that will use amounts provided under such grants

21 or contracts to enhance the education of health professionals

22 for purposes of—

23 ‘‘(1) providing care for underserved populations

24 and other high-risk groups;
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1 ‘‘(2) increasing the number of individuals who

2 are pursuing a course of study in a health professions

3 field in which there is a severe shortage of health pro4 fessionals;

5 ‘‘(3) conducting health professions research and

6 data collection; and

7 ‘‘(4) carrying out other activities in areas deter8 mined appropriate by the Secretary.

9 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—

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

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

12 for fiscal year 1996, and such sums as may be nec13 essary for each of the fiscal years 1997 through 1999.

14 ‘‘(2) RESERVATION.—Of the amounts appro15 priated under subsection (a) for a fiscal year, the Sec16 retary shall reserve not less than $2,000,000 for con17 ducting health professions research and for carrying

18 out data collection and analysis in accordance with

19 section 792.’’.

20 (b) HEALTH PROFESSIONS DATA.—The second sen21 tence of section 792(a) of the Public Health Service Act (42

22 U.S.C. 295k(a)) is amended—

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

24 ‘‘shall’’; and
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1 (2) by inserting ‘‘clinical social workers,’’ after

2 ‘‘clinical psychologists,’’.

3 (c) COUNCIL ON GRADUATE MEDICAL EDUCATION.—

4 Section 301 of the Health Professions Education Extension

5 Amendments of 1992 (Public Law 102-408) is amended—

6 (1) in subsection (j), by striking ‘‘1995’’ and in7 serting ‘‘1999’’;

8 (2) in subsection (k), by striking ‘‘1995’’ and in9 serting ‘‘1999’’;

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

11 new subsection:

12 ‘‘(l) FUNDING.—Amounts otherwise appropriated

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

14 the activities of the Council.’’;

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

16 VII of the Public Health Service Act (as amended by

17 subsection (a));

18 (5) by redesignating such section as section 763;

19 and

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

21 SEC. 105. GENERAL PROVISIONS.

22 (a) IN GENERAL.—

23 (1) Part F of title VII of the Public Health Serv24 ice Act (42 U.S.C. 295 et seq.) is repealed.
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1 (2) Part G of title VII of the Public Health Serv2 ice Act (42 U.S.C. 295j et seq.) is amended—

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

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

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

6 (ii) redesignating subsection (c) as sub7 section (b);

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

9 295l);

10 (D) by repealing section 798;

11 (E) by redesignating section 799 as section

12 799B; and

13 (F) by inserting after section 794, the fol14 lowing new sections:

15 ‘‘SEC. 796. APPLICATION.

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

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

18 and submit to the Secretary an application that meets the

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

20 and containing such information as the Secretary may re21 quire.

22 ‘‘(b) PLAN.—An application submitted under this sec23 tion shall contain the plan of the applicant for carrying

24 out a project with amounts received under this title. Such
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1 plan shall be consistent with relevant Federal, State, or re2 gional program plans.

3 ‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An ap4 plication submitted under this section shall contain a speci5 fication by the applicant entity of performance outcome

6 standards that the project to be funded under the grant or

7 contract will be measured against. Such standards shall ad8 dress relevant health workforce needs that the project will

9 meet. The recipient of a grant or contract under this section

10 shall meet the standards set forth in the grant or contract

11 application.

12 ‘‘(d) LINKAGES.—An application submitted under this

13 section shall contain a description of the linkages with rel14 evant educational and health care entities, including train15 ing programs for other health professionals as appropriate,

16 that the project to be funded under the grant or contract

17 will establish.

18 ‘‘SEC. 797. USE OF FUNDS.

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

20 or contract awarded under this title may be used for train21 ing program development and support, faculty develop22 ment, model demonstrations, trainee support including tui23 tion, books, program fees and reasonable living expenses

24 during the period of training, technical assistance,

25 workforce analysis, and dissemination of information, as
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1 appropriate to meet recognized health workforce objectives,

2 in accordance with this title.

3 ‘‘(b) MAINTENANCE OF EFFORT.—With respect to ac4 tivities for which a grant awarded under this title is to

5 be expended, the entity shall agree to maintain expenditures

6 of non-Federal amounts for such activities at a level that

7 is not less than the level of such expenditures maintained

8 by the entity for the fiscal year preceding the fiscal year

9 for which the entity receives such a grant.

10 ‘‘SEC. 798. MATCHING REQUIREMENT.

11 ‘‘The Secretary may require that an entity that ap12 plies for a grant or contract under this title provide non13 Federal matching funds, as appropriate, to ensure the insti14 tutional commitment of the entity to the projects funded

15 under the grant. As determined by the Secretary, such non16 Federal matching funds may be provided directly or

17 through donations from public or private entities and may

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

19 equipment, or services.

20 ‘‘SEC. 799. GENERALLY APPLICABLE PROVISIONS.

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

22 Secretary shall ensure that grants and contracts under this

23 title are awarded on a competitive basis, as appropriate,

24 to carry out innovative demonstration projects or provide

25 for strategic workforce supplementation activities as needed
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1 to meet health workforce goals and in accordance with this

2 title. Contracts may be entered into under this title with

3 public or private entities as may be necessary.

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

5 grants and contracts under this title shall meet information

6 requirements as specified by the Secretary.

7 ‘‘(c) TRAINING PROGRAMS.—Training programs con8 ducted with amounts received under this title shall meet ap9 plicable accreditation and quality standards.

10 ‘‘(d) DURATION OF ASSISTANCE.—

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

12 the case of an award to an entity of a grant, coopera13 tive agreement, or contract under this title, the period

14 during which payments are made to the entity under

15 the award may not exceed 5 years. The provision of

16 payments under the award shall be subject to annual

17 approval by the Secretary of the payments and sub18 ject to the availability of appropriations for the fiscal

19 year involved to make the payments. This paragraph

20 may not be construed as limiting the number of

21 awards under the program involved that may be

22 made to the entity.

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

24 an entity of a grant, cooperative agreement, or con25 tract under this title, paragraph (1) shall apply only
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1 to the extent not inconsistent with any other provi2 sion of this title that relates to the period during

3 which payments may be made under the award.

4 ‘‘(e) PEER REVIEW REGARDING CERTAIN PRO5 GRAMS.—Each application for a grant under this title, ex6 cept any scholarship or loan program, including those

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

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

9 proposals made in the application. The Secretary may not

10 approve such an application unless a peer review group has

11 recommended the application for approval. Each peer re12 view group under this subsection shall be composed prin13 cipally of individuals who are not officers or employees of

14 the Federal Government. This subsection shall be carried

15 out by the Secretary acting through the Administrator of

16 the Health Resources and Services Administration.

17 ‘‘(f) PREFERENCE OR PRIORITY CONSIDERATIONS.—In

18 considering a preference or priority for funding which is

19 based on outcome measures for an eligible entity under this

20 title, the Secretary may also consider the future ability of

21 the eligible entity to meet the outcome preference or priority

22 through improvements in the eligible entity’s program de23 sign.
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1 ‘‘SEC. 799A. TECHNICAL ASSISTANCE.

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

3 the Secretary to provide technical assistance in relation to

4 any of the authorities under this title.’’.

5 SEC. 106. PREFERENCE IN CERTAIN PROGRAMS.

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

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

8 105(a)(2)(B), is further amended by adding at the end

9 thereof the following subsection:

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

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

12 compete equitably for funding under this section,

13 those new programs that meet the criteria described

14 in paragraph (3) shall qualify for a funding pref15 erence under this section.

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

17 the term ‘new program’ means any program that has

18 graduated less than three classes. Upon graduating at

19 least three classes, a program shall have the capabil20 ity to provide the information necessary to qualify the

21 program for the general funding preferences described

22 in subsection (a).

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

24 paragraph (1) are the following:

25 ‘‘(A) The mission statement of the program

26 identifies a specific purpose of the program as
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1 being the preparation of health professionals to

2 serve underserved populations.

3 ‘‘(B) The curriculum of the program in4 cludes content which will help to prepare practi5 tioners to serve underserved populations.

6 ‘‘(C) Substantial clinical training experi7 ence is required under the program in medically

8 underserved communities.

9 ‘‘(D) A minimum of 20 percent of the clini10 cal faculty of the program spend at least 50 per11 cent of their time providing or supervising care

12 in medically underserved communities.

13 ‘‘(E) The entire program or a substantial

14 portion of the program is physically located in

15 a medically underserved community.

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

17 service in medically underserved communities

18 following graduation, is available to the students

19 in the program.

20 ‘‘(G) The program provides a placement

21 mechanism for deploying graduates to medically

22 underserved communities.’’.

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

24 the Public Health Service Act (42 U.S.C. 295j(a)) is amend25 ed—
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1 (1) in paragraph (1), by striking ‘‘sections 747’’

2 and all that follows through ‘‘767’’ and inserting ‘‘sec3 tion 747’’; and

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

5 798(a)’’.

6 SEC. 107. DEFINITIONS.

7 (a) PROFESSIONAL PSYCHOLOGY.—Section

8 799B(1)(B) of the Public Health Service Act (42 U.S.C.

9 295p(1)(B)) (as so redesignated by section 105(a)(2)(E)) is

10 amended by striking ‘‘program in clinical psychology’’ and

11 inserting ‘‘graduate programs in professional psychology’’.

12 (b) MEDICALLY UNDERSERVED COMMUNITY.—Section

13 799B(6) of the Public Health Service Act (42 U.S.C.

14 295p(6)) (as so redesignated by section 105(a)(2)(E)) is

15 amended—

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

17 end thereof;

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

19 and inserting a semicolon; and

20 (3) by adding at the end the following new sub21 paragraphs:

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

23 that has a severe shortage of public health per24 sonnel as determined under criteria established

25 by the Secretary;
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1 ‘‘(E) has ambulatory practice sites des2 ignated by State Governors as shortage areas or

3 medically underserved communities for purposes

4 of State scholarships or loan repayment or relat5 ed programs; or

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

7 less than 50 percent of the patients are recipients

8 of aid under title XIX of the Social Security Act

9 or eligible and uninsured.’’.

10 (c) PROGRAMS FOR THE TRAINING OF PHYSICIAN AS11 SISTANTS.—Paragraph (3) of section 799B of the Public

12 Health Service Act (42 U.S.C. 295p) (as so redesignated

13 by section 105(a)(2)(E)) is amended to read as follows:

14 ‘‘(3) The term ‘program for the training of phy15 sician assistants’ means an educational program

16 that—

17 ‘‘(A) has as its objective the education of in18 dividuals who will, upon completion of their

19 studies in the program, be qualified to provide

20 primary care under the supervision of a physi21 cian;

22 ‘‘(B) extends for at least one academic year

23 and consists of—

24 ‘‘(i) supervised clinical practice; and
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1 ‘‘(ii) at least four months (in the ag2 gregate) of classroom instruction, directed

3 toward preparing students to deliver health

4 care;

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

6 eight students; and

7 ‘‘(D) trains students in primary care, dis8 ease prevention, health promotion, geriatric med9 icine, and home health care.’’.

10 SEC. 108. SAVINGS PROVISION.

11 In the case of any authority for making awards of

12 grants or contracts that is terminated by the amendments

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

14 Services may, notwithstanding the termination of the au15 thority, continue in effect any grant or contract made under

16 the authority that is in effect on the day before the date

17 of the enactment of this Act, subject to the duration of any

18 such grant or contract not exceeding the period determined

19 by the Secretary in first approving such financial assist20 ance, or in approving the most recent request made (before

21 the date of such enactment) for continuation of such assist22 ance, as the case may be.
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1 Subtitle B—Nursing Education

2 SEC. 121. SHORT TITLE.

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

4 Consolidation and Reauthorization Act of 1995’’.

5 SEC. 122. PURPOSE.

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

7 education authorities of title VIII of the Public Health Serv8 ice Act to permit a comprehensive, flexible, and effective ap9 proach to Federal support for nursing workforce develop10 ment.

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

12 Title VIII of the Public Health Service Act (42 U.S.C.

13 296k et seq.) is amended—

14 (1) by striking the title heading and all that fol15 lows except for subparts II and III of part B and sec16 tion 855; and inserting the following:

17 ‘‘TITLE VIII—NURSING

18 WORKFORCE DEVELOPMENT’’;

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

20 subpart II;

21 (3) in subpart II of part B, by striking the sub22 part heading and inserting the following:

23 ‘‘PART E—STUDENT LOANS

24 ‘‘Subpart I—General Program’’;

25 (4) by striking section 837;
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1 (5) by inserting after the title heading the follow2 ing new parts:

3 ‘‘PART A—GENERAL PROVISIONS

4 ‘‘SEC. 801. DEFINITIONS.

5 ‘‘As used in this title:

6 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible en7 tities’ means schools of nursing, nursing centers, State

8 or local governments, and other public or nonprofit

9 private entities determined appropriate by the Sec10 retary that submit to the Secretary an application in

11 accordance with section 802.

12 ‘‘(2) SCHOOL OF NURSING.—The term ‘school of

13 nursing’ means a collegiate, associate degree, or di14 ploma school of nursing in a State.

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

16 term ‘collegiate school of nursing’ means a depart17 ment, division, or other administrative unit in a col18 lege or university which provides primarily or exclu19 sively a program of education in professional nursing

20 and related subjects leading to the degree of bachelor

21 of arts, bachelor of science, bachelor of nursing, or to

22 an equivalent degree, or to a graduate degree in nurs23 ing, and including advanced training related to such

24 program of education provided by such school, but
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1 only if such program, or such unit, college or univer2 sity is accredited.

3 ‘‘(4) ASSOCIATE DEGREE SCHOOL OF NURS4 ING.—The term ‘associate degree school of nursing’

5 means a department, division, or other administra6 tive unit in a junior college, community college, col7 lege, or university which provides primarily or exclu8 sively a two-year program of education in profes9 sional nursing and allied subjects leading to an asso10 ciate degree in nursing or to an equivalent degree, but

11 only if such program, or such unit, college, or univer12 sity is accredited.

13 ‘‘(5) DIPLOMA SCHOOL OF NURSING.—The term

14 ‘diploma school of nursing’ means a school affiliated

15 with a hospital or university, or an independent

16 school, which provides primarily or exclusively a pro17 gram of education in professional nursing and allied

18 subjects leading to a diploma or to equivalent indicia

19 that such program has been satisfactorily completed,

20 but only if such program, or such affiliated school or

21 such hospital or university or such independent school

22 is accredited.

23 ‘‘(6) ACCREDITED.—

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

25 subparagraph (B), the term ‘accredited’ when
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1 applied to any program of nurse education

2 means a program accredited by a recognized

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

4 for such purpose by the Secretary of Education

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

6 or university (or a unit thereof) means a hos7 pital, school, college, or university (or a unit

8 thereof) which is accredited by a recognized body

9 or bodies, or by a State agency, approved for

10 such purpose by the Secretary of Education. For

11 the purpose of this paragraph, the Secretary of

12 Education shall publish a list of recognized ac13 crediting bodies, and of State agencies, which the

14 Secretary of Education determines to be reliable

15 authority as to the quality of education offered.

16 ‘‘(B) NEW PROGRAMS.—A new school of

17 nursing that, by reason of an insufficient period

18 of operation, is not, at the time of the submission

19 of an application for a grant or contract under

20 this title, eligible for accreditation by such a rec21 ognized body or bodies or State agency, shall be

22 deemed accredited for purposes of this title if the

23 Secretary of Education finds, after consultation

24 with the appropriate accreditation body or bod25 ies, that there is reasonable assurance that the
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1 school will meet the accreditation standards of

2 such body or bodies prior to the beginning of the

3 academic year following the normal graduation

4 date of students of the first entering class in such

5 school.

6 ‘‘(7) NONPROFIT.—The term ‘nonprofit’ as ap7 plied to any school, agency, organization, or institu8 tion means one which is a corporation or association,

9 or is owned and operated by one or more corporations

10 or associations, no part of the net earnings of which

11 inures, or may lawfully inure, to the benefit of any

12 private shareholder or individual.

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

14 the Commonwealth of Puerto Rico, the District of Co15 lumbia, the Commonwealth of the Northern Mariana

16 Islands, Guam, American Samoa, the Virgin Islands,

17 or the Trust Territory of the Pacific Islands.

18 ‘‘SEC. 802. APPLICATION.

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

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

21 and submit to the Secretary an application that meets the

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

23 and containing such information as the Secretary may re24 quire.
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1 ‘‘(b) PLAN.—An application submitted under this sec2 tion shall contain the plan of the applicant for carrying

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

4 plan shall be consistent with relevant Federal, State, or re5 gional program plans.

6 ‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An ap7 plication submitted under this section shall contain a speci8 fication by the applicant entity of performance outcome

9 standards that the project to be funded under the grant or

10 contract will be measured against. Such standards shall ad11 dress relevant national nursing needs that the project will

12 meet. The recipient of a grant or contract under this section

13 shall meet the standards set forth in the grant or contract

14 application.

15 ‘‘(d) LINKAGES.—An application submitted under this

16 section shall contain a description of the linkages with rel17 evant educational and health care entities, including train18 ing programs for other health professionals as appropriate,

19 that the project to be funded under the grant or contract

20 will establish.

21 ‘‘SEC. 803. USE OF FUNDS.

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

23 or contract awarded under this title may be used for train24 ing program development and support, faculty develop25 ment, model demonstrations, trainee support including tui-
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1 tion, books, program fees and reasonable living expenses

2 during the period of training, technical assistance,

3 workforce analysis, and dissemination of information, as

4 appropriate to meet recognized nursing objectives, in ac5 cordance with this title.

6 ‘‘(b) MAINTENANCE OF EFFORT.—With respect to ac7 tivities for which a grant awarded under this title is to

8 be expended, the entity shall agree to maintain expenditures

9 of non-Federal amounts for such activities at a level that

10 is not less than the level of such expenditures maintained

11 by the entity for the fiscal year preceding the fiscal year

12 for which the entity receives such a grant.

13 ‘‘SEC. 804. MATCHING REQUIREMENT.

14 ‘‘The Secretary may require that an entity that ap15 plies for a grant or contract under this title provide non16 Federal matching funds, as appropriate, to ensure the insti17 tutional commitment of the entity to the projects funded

18 under the grant. Such non-Federal matching funds may be

19 provided directly or through donations from public or pri20 vate entities and may be in cash or in-kind, fairly evalu21 ated, including plant, equipment, or services.

22 ‘‘SEC. 805. PREFERENCE.

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

24 Secretary shall give preference to applicants with projects

25 that will substantially benefit rural or underserved popu-
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1 lations, or help meet public health nursing needs in State

2 or local health departments.

3 ‘‘SEC. 806. GENERALLY APPLICABLE PROVISIONS.

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

5 Secretary shall ensure that grants and contracts under this

6 title are awarded on a competitive basis, as appropriate,

7 to carry out innovative demonstration projects or provide

8 for strategic workforce supplementation activities as needed

9 to meet national nursing service goals and in accordance

10 with this title. Contracts may be entered into under this

11 title with public or private entities as determined necessary

12 by the Secretary.

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

14 grants and contracts under this title shall meet information

15 requirements as specified by the Secretary.

16 ‘‘(c) TRAINING PROGRAMS.—Training programs con17 ducted with amounts received under this title shall meet ap18 plicable accreditation and quality standards.

19 ‘‘(d) DURATION OF ASSISTANCE.—

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

21 the case of an award to an entity of a grant, coopera22 tive agreement, or contract under this title, the period

23 during which payments are made to the entity under

24 the award may not exceed 5 years. The provision of

25 payments under the award shall be subject to annual
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1 approval by the Secretary of the payments and sub2 ject to the availability of appropriations for the fiscal

3 year involved to make the payments. This paragraph

4 may not be construed as limiting the number of

5 awards under the program involved that may be

6 made to the entity.

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

8 an entity of a grant, cooperative agreement, or con9 tract under this title, paragraph (1) shall apply only

10 to the extent not inconsistent with any other provi11 sion of this title that relates to the period during

12 which payments may be made under the award.

13 ‘‘(e) PEER REVIEW REGARDING CERTAIN PRO14 GRAMS.—Each application for a grant under this title, ex15 cept advanced nurse traineeship grants under section

16 811(a)(2), shall be submitted to a peer review group for an

17 evaluation of the merits of the proposals made in the appli18 cation. The Secretary may not approve such an application

19 unless a peer review group has recommended the applica20 tion for approval. Each peer review group under this sub21 section shall be composed principally of individuals who are

22 not officers or employees of the Federal Government. This

23 subsection shall be carried out by the Secretary acting

24 through the Administrator of the Health Resources and

25 Services Administration.
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1 ‘‘SEC. 807. NATIONAL ADVISORY COUNCIL ON NURSE EDU2 CATION AND PRACTICE.

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

4 National Advisory Council on Nurse Education and Prac5 tice (in this section referred to as the ‘Council’), consisting

6 of the Secretary or the delegate of the Secretary (who shall

7 be an ex officio member and shall serve as the Chairperson),

8 and 15 members appointed by the Secretary without regard

9 to the Federal civil service laws, of which—

10 ‘‘(1) 2 shall be selected from full-time students

11 enrolled in schools of nursing;

12 ‘‘(2) 3 shall be selected from the general public;

13 ‘‘(3) 2 shall be selected from practicing profes14 sional nurses; and

15 ‘‘(4) 8 shall be selected from among the leading

16 authorities in the various fields of nursing, higher,

17 and secondary education, and from representatives of

18 hospitals and other institutions and organizations

19 which provide nursing services.

20 A majority of the members shall be nurses. The student21 members of the Council shall be appointed for terms of one

22 year and shall be eligible for reappointment to the Council.

23 ‘‘(b) DUTIES.—The Council shall advise the Secretary

24 in the preparation of general regulations and with respect

25 to policy matters arising in the administration of this title,
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1 including the range of issues relating to nurse supply, edu2 cation and practice improvement.

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

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

5 education and practice activities of the Council.

6 ‘‘SEC. 808. TECHNICAL ASSISTANCE.

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

8 the Secretary to provide technical assistance in relation to

9 any of the authorities under this title.

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

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

12 (or within such shorter period as the Secretary may pre13 scribe by regulation for an interim facility) after the com14 pletion of construction of a facility with respect to which

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

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

17 ‘‘(1) the owner of the facility ceases to be a pub18 lic or nonprofit school;

19 ‘‘(2) the facility ceases to be used for the training

20 purposes for which it was constructed; or

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

22 or as a place for religious worship,

23 the United States shall be entitled to recover from the owner

24 of the facility the base amount prescribed by subsection
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1 (c)(1) plus the interest (if any) prescribed by subsection

2 (c)(2).

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

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

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

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

7 in paragraph (2) or (3) of such subsection shall provide

8 the Secretary written notice of such cessation or change of

9 use within 10 days after the date on which such cessation

10 or change of use occurs or within 30 days after the date

11 of enactment of the Health Professions Training Assistance

12 Act of 1985, whichever is later.

13 ‘‘(c) AMOUNT OF RECOVERY.—

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

15 United States is entitled to recover under subsection

16 (a) is the amount bearing the same ratio to the then

17 value (as determined by the agreement of the parties

18 or in an action brought in the district court of the

19 United States for the district in which the facility is

20 situated) of the facility as the amount of the Federal

21 participation bore to the cost of the construction.

22 ‘‘(2) INTEREST.—

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

24 United States is entitled to recover under sub25 section (a) is the interest for the period (if any)
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1 described in subparagraph (B) at a rate (deter2 mined by the Secretary) based on the average of

3 the bond equivalent rates of 91-day Treasury

4 bills auctioned during such period.

5 ‘‘(B) TIME PERIOD.—The period referred to

6 in subparagraph (A) is the period beginning—

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

8 by subsection (b), 191 days after the date on

9 which the owner of the facility ceases to be

10 a public or nonprofit school as described in

11 paragraph (1) of subsection (a), or 191 days

12 after the date on which the use of the facil13 ity changes as described in paragraph (2)

14 or (3) of such subsection; or

15 ‘‘(ii) if notice is not provided as pre16 scribed by subsection (b), 11 days after the

17 date on which such cessation or change of

18 use occurs,

19 and ending on the date the amount the United

20 States is entitled to recover is collected.

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

22 the recovery rights of the United States under subsection

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

24 the Secretary may establish by regulation) if the Secretary

25 determines that there is good cause for waiving such rights.
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1 ‘‘(e) LIMITATION ON LIENS.—The right of recovery of

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

3 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 the

10 costs of—

11 ‘‘(1) projects that support the enhancement of ad12 vanced practice nursing education and practice; and

13 ‘‘(2) traineeships for individuals in advanced

14 practice nursing programs.

15 ‘‘(b) DEFINITION OF ADVANCED PRACTICE NURSES.—

16 For purposes of this section, the term ‘advanced practice

17 nurses’ means nurses trained in advanced degree programs

18 including individuals in combined R.N./Master’s degree

19 programs, post-nursing master’s certificate programs, or, in

20 the case of nurse midwives or nurse anesthetists, in certifi21 cate programs in existence on the date that is one day prior

22 to the date of enactment of this section, to serve as nurse

23 practitioners, nurse midwives, nurse anesthetists, nurse

24 educators, or public health nurses, or in other nurse special-
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1 ties determined by the Secretary to require advanced edu2 cation.

3 ‘‘(c) AUTHORIZED NURSE PRACTITIONER AND NURSE4 MIDWIFERY PROGRAMS.—Nurse practitioner and nurse

5 midwifery programs eligible for support under this section

6 are educational programs for registered nurses (irrespective

7 of the type of school of nursing in which the nurses received

8 their training) that—

9 ‘‘(1) meet guidelines prescribed by the Secretary;

10 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 pri14 mary health care, including primary health care in

15 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 appro19 priate 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 traineeships
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1 provided with the grant will only pay all or part of

2 the costs of—

3 ‘‘(A) the tuition, books, and fees of the pro4 gram of advanced nursing practice with respect

5 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 may

10 not obligate more than 10 percent of the traineeships

11 under subsection (a) for individuals in doctorate de12 gree 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 under

19 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 the

25 costs of special projects to increase nursing education op-
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1 portunities for individuals who are from disadvantaged

2 backgrounds (including racial and ethnic minorities

3 underrepresented among registered nurses) by providing

4 student scholarships or stipends, pre-entry preparation,

5 and 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 of

13 Colleges of Nursing, the Black Nurses Association, the Asso14 ciation of Hispanic Nurses, the Association of Asian Amer15 ican and Pacific Islander Nurses, the National Nurses Asso16 ciation, and the Native American Indian and Alaskan

17 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 recipient

4 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 fails

9 to improve the rates within the 1-year period begin10 ning on the date such plan is implemented.

11 ‘‘PART D—STRENGTHENING CAPACITY FOR BASIC

12 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 projects

17 to strengthen capacity for basic nurse education and prac18 tice.

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 utiliza23 tion of the basic nursing workforce by strengthening pro24 grams that provide basic nurse education for purposes 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, homeless,

6 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 under

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

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

13 such grant or contract not exceeding the period determined

14 by the Secretary in first approving such financial assist15 ance, or in approving the most recent request made (before

16 the date of such enactment) for continuation of such assist17 ance, 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 ‘‘and

18 schools of public health’’ after ‘‘professions

19 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 promotion

15 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’’ after

21 ‘‘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’’ after

3 ‘‘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) between
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1 the programs authorized in chapter 1, chapter 2, and chap2 ter 3. In determining the manner in which to allocate such

3 amounts, the Secretary shall give priority to funding State4 based programs as appropriate under chapter 3. The Sec5 retary shall distribute such amounts among the various pro6 grams in such chapters in a manner which furthers both

7 Federal and State needs for health professionals in under8 served areas.’’.

9 (d) GRANTS FOR LOAN REPAYMENT PROGRAM.—Sec10 tion 338I of the Public Health Service Act (42 U.S.C. 254q–

11 1) is amended—

12 (1) in subsection (a)—

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

14 professional shortage areas’’ and inserting ‘‘or

15 public health disease prevention and health pro16 motion activities in Federal health professional

17 shortage areas or approved State designated

18 health professional shortage areas’’; and

19 (B) in paragraph (2)—

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

22 (ii) by striking ‘‘in health professional

23 shortage areas’’ and inserting ‘‘or public

24 health disease prevention and health pro25 motion activities in Federal health profes-
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1 sional shortage areas or approved State des2 ignated health professional shortage areas’’;

3 (2) in subsection (c)—

4 (A) in paragraph (1)—

5 (i) in the paragraph heading, by strik6 ing ‘‘FEDERAL’’ and inserting ‘‘FEDERAL OR

7 APPROVED STATE’’; and

8 (ii) by inserting before the period the

9 following: ‘‘or approved State designated

10 health professional shortage areas’’;

11 (B) in paragraph (2), by inserting ‘‘or pub12 lic health professionals’’ after ‘‘health profes13 sionals’’;

14 (C) in paragraph (3)—

15 (i) in subparagraph (A)—

16 (I) in the matter preceding clause

17 (i), by inserting ‘‘or public health pro18 fessionals’’ after ‘‘health professionals’’;

19 and

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

21 health’’;

22 (ii) in subparagraph (B)—

23 (I) in the matter preceding clause

24 (i), by inserting ‘‘or public health pro-
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1 fessional’’ after ‘‘health professional’’;

2 and

3 (II) in clause (ii)—

4 (aa) by inserting ‘‘or public

5 health professional’’ after ‘‘the

6 health professional’’; and

7 (bb) by striking ‘‘services in

8 a’’ and inserting ‘‘services or pub9 lic health disease prevention and

10 health promotion activities in a

11 Federal’’; and

12 (D) by adding at the end thereof the follow13 ing new paragraph:

14 ‘‘(4) PRIVATE PRACTICE.—

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

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

17 waive the requirement of paragraph (1) regard18 ing the assignment of a health professional if,

19 subject to subparagraph (B), the health profes20 sional enters into an agreement with the State to

21 provide primary health services in a full-time

22 private clinical practice in a health professional

23 shortage area.

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

25 under subsection (a) unless the State involved
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1 agrees that, if the State provides a waiver under

2 subparagraph (A) for a health professional, sec3 tion 338D(b)(1) will apply to the agreement

4 under such subparagraph between the State and

5 the health professional to the same extent and in

6 the same manner as such section applies to an

7 agreement between the Secretary and a health

8 professional regarding a full-time private clini9 cal practice.’’; and

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

11 ‘‘(h) DEFINITIONS.—Unless specifically provided oth12 erwise, as used in this subpart and section 338F:

13 ‘‘(1) APPROVED STATE DESIGNATED HEALTH

14 PROFESSIONAL SHORTAGE AREA.—The term ‘ap15 proved State designated health professional shortage

16 area’ means an area designated by the State as un17 derserved using specific methodology and criteria to

18 identify such areas. Such criteria and methodology

19 shall be approved by the Secretary.

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

21 ‘community organization’ means a public or non22 profit private entity.

23 ‘‘(3) PRIMARY HEALTH CARE.—The term ‘pri24 mary health care’ means health services regarding

25 family medicine, general internal medicine, general
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1 pediatrics, or may include obstetrics and gynecology,

2 that are provided by physicians, certified nurse prac3 titioners, certified nurse midwives, or physician as4 sistants.

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

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

7 (e) COMMUNITY SCHOLARSHIP PROGRAMS.—Section

8 338L of the Public Health Service Act (42 U.S.C. 254t) is

9 amended—

10 (1) in the section heading, by striking ‘‘DEM11 ONSTRATION GRANTS TO STATES FOR’’;

12 (2) in subsection (a), by striking ‘‘health man13 power shortage areas’’ and inserting ‘‘Federal health

14 professional shortage areas and in approved State

15 designated health professional shortage areas’’;

16 (3) in subsection (c)—

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

18 by striking ‘‘health manpower shortage areas’’

19 and inserting ‘‘Federal health professional short20 age areas and in approved State designated

21 health professional shortage areas’’; and

22 (B) in paragraph (2), by striking ‘‘health

23 manpower shortage areas’’ and inserting ‘‘Fed24 eral health professional shortage areas and in
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1 approved State designated health professional

2 shortage areas’’;

3 (4) in subsection (e)(1), by striking ‘‘health man4 power shortage areas’’ and inserting ‘‘Federal health

5 professional shortage areas and in approved State

6 designated health professional shortage areas’’;

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

8 manpower shortage areas’’ and inserting ‘‘Federal

9 health professional shortage areas and in approved

10 State designated health professional shortage areas’’;

11 (6) in subsection (g), by striking ‘‘health man12 power shortage areas’’ each place that such appears

13 and inserting ‘‘Federal health professional shortage

14 areas and in approved State designated health profes15 sional shortage areas’’; and

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

17 SEC. 132. RESTRUCTURING AND TECHNICAL AMENDMENTS.

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

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

20 is amended—

21 (1) by redesignating sections 338J and 338K (42

22 U.S.C. 254s and 254t) as sections 338M and 338N,

23 respectively;
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1 (2) by redesignating sections 338C through 338H

2 (42 U.S.C. 254m through 254q) as sections 338G

3 through 338L, respectively;

4 (3) by redesignating section 338I (as such section

5 exists one day prior to the date of enactment of this

6 Act) (42 U.S.C. 254r) as section 338E;

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

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

10 (b) CONSOLIDATION OF CERTAIN PROGRAMS.—Sub11 part III of part D of title III of the Public Health Service

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

13 is further amended—

14 (1) by striking the subpart heading and insert15 ing the following:

16 ‘‘Subpart III—Federally Supported

17 Scholarships and Loans

18 ‘‘CHAPTER 1—NATIONAL HEALTH SERVICE

19 CORPS SCHOLARSHIPS PROGRAMS

20 (2) by redesignating section 338B as section

21 338C;

22 (3) by inserting before section 338C (as so redes23 ignated) the following:
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1 ‘‘CHAPTER 2—NATIONAL HEALTH SERVICE

2 CORPS LOAN REPAYMENT PROGRAMS

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

4 and

5 (4) by inserting after section 338C (as so redesig6 nated) the following:

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

8 (c) TRANSFERS AND REDESIGNATIONS OF NURSING

9 LOAN REPAYMENT PROGRAM.—Subpart II of part E of title

10 VIII (42 U.S.C. 297n et seq.) (as so redesignated by section

11 123(3)) is amended—

12 (1) by striking the subpart heading;

13 (2) by transferring section 846 (42 U.S.C. 297n)

14 to subchapter B of chapter 2 of subpart III of part

15 D of title III (as added by subsection (b)(4)); and

16 (3) in section 846—

17 (A) by striking the section heading and in18 serting the following:

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

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

21 (C) by striking subsection (g).

22 (d) TRANSFERS AND REDESIGNATIONS OF STATE

23 LOAN REPAYMENT AND COMMUNITY SCHOLARSHIP PRO24 GRAMS.—Subpart III of part D of title III of the Public

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

26 by subsections (a) through (c)) is further amended—
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1 (1) by inserting after section 338D (as so trans2 ferred and redesignated by subsection (c)(3)) the fol3 lowing:

4 ‘‘CHAPTER 3—STATE LOAN REPAYMENT AND

5 COMMUNITY SCHOLARSHIP PROGRAMS

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

7 (2) by transferring section 338E (as so redesig8 nated by subsection (a)(3)) to subchapter A of chapter

9 3 of such subpart (as added by paragraph (1));

10 (3) by inserting after section 338E (as trans11 ferred by paragraph (2)) the following:

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

13 (4) by transferring section 338F (as so redesig14 nated by subsection (a)(4)) to subchapter B of chapter

15 3 of such subpart (as added by paragraph (3)); and

16 (5) by inserting after section 338F (as trans17 ferred by paragraph (4)) the following:

18 ‘‘CHAPTER 4—GENERAL PROVISIONS’’.

19 (e) CLINICAL RESEARCHERS.—Paragraph (3) of sec20 tion 487E(a) of the Public Health Service Act (42 U.S.C.

21 288–5(a)(3)) is amended to read as follows:

22 ‘‘(3) APPLICABILITY OF CERTAIN PROVISIONS RE23 GARDING OBLIGATED SERVICE.—With respect to the

24 National Health Service Corps loan repayment pro25 gram established in subpart III of part D of title III,
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1 the provisions of such subpart shall, except as incon2 sistent with this section, apply to the program estab3 lished in subsection (a) in the same manner and to

4 the same extent as such provisions apply to the Na5 tional Health Service Corps loan repayment pro6 grams.’’.

7 SEC. 133. DEFINITION OF UNDERSERVED AREAS.

8 Section 332(a)(1) of the Public Health Service Act (42

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

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

11 and

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

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

14 a severe shortage of public health personnel as deter15 mined under criteria established by the Secretary’’.

16 SEC. 134. CONFORMING AMENDMENTS.

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

18 241 et seq.) is amended—

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

20 303(d)(4) (42 U.S.C. 242a(d)(4)(A) and (B)), by

21 striking ‘‘338C or 338D’’ each place that such occurs

22 and inserting ‘‘338G or 338H’’;

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

24 striking ‘‘338D’’ and inserting ‘‘338H’’;
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1 (3) in section 337(a) (42 U.S.C. 254j(a)), by

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

3 (4) in 338A (42 U.S.C. 254l)—

4 (A) in subsection (c)(1)—

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

6 ‘‘338D’’ and inserting ‘‘338I’’; and

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

8 ‘‘338C’’ and inserting ‘‘338H’’;

9 (B) in subsection (f)(3), by striking ‘‘338D’’

10 and inserting ‘‘338I’’; and

11 (C) in subsection (i)(5)—

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

13 ‘‘338E’’ and inserting ‘‘338I’’; and

14 (ii) in subparagraph (B)(ii), by strik15 ing ‘‘338E’’ and inserting ‘‘338I’’;

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

17 U.S.C. 254l-1)—

18 (A) in subsection (c)(1)—

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

20 ‘‘338E’’ and inserting ‘‘338I’’; and

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

22 ‘‘338D’’ and inserting ‘‘338H’’;

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

24 ‘‘338D’’ and inserting ‘‘338H’’;
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1 (C) in subsection (f)(4), by striking ‘‘338E’’

2 and inserting ‘‘338I’’; and

3 (D) in subsection (i)(7)—

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

5 ‘‘338E’’ and inserting ‘‘338I’’; and

6 (ii) in subparagraph (B)(ii), by strik7 ing ‘‘338E’’ and inserting ‘‘338I’’;

8 (6) in section 338E(d)(1)(C) (as so redesignated

9 by section 132), by striking ‘‘338J’’ and inserting

10 ‘‘338M’’;

11 (7) in section 338G (as so redesignated by sec12 tion 132)—

13 (A) in subsection (a)—

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

15 ‘‘338H’’; and

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

17 ‘‘338C’’; and

18 (B) in subsection (c)(2), by striking ‘‘338D’’

19 and inserting ‘‘338H’’;

20 (8) in section 338H (as so redesignated by sec21 tion 132)—

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

23 and inserting ‘‘338G’’; and

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

25 and inserting ‘‘338C’’;
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1 (9) in section 338I (as so redesignated by section

2 132)—

3 (A) in subsection (b)(1)(A)—

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

5 ‘‘338J’’;

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

7 inserting ‘‘338G or 338H’’;

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

9 ‘‘338G’’; and

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

11 ‘‘338H’’; and

12 (B) in subsection (c)(1)—

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

14 ‘‘338K’’;

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

16 ‘‘338C’’; and

17 (iii) by striking ‘‘338C or 338D’’ and

18 inserting ‘‘338G or 338H’’;

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

20 section 132)—

21 (A) in paragraph (1)—

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

23 ‘‘338I’’; and

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

25 ‘‘338C’’; and
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1 (B) in paragraph (2), by striking ‘‘338I’’

2 and inserting ‘‘338E’’;

3 (11) in section 338K (as so redesignated by sec4 tion 132)—

5 (A) in subsection (a)(2), by striking ‘‘338D’’

6 and inserting ‘‘338H’’; and

7 (B) in subsection (d)(1), by striking ‘‘338E’’

8 and inserting ‘‘338I’’; and

9 (12) in section 338M(e)(1)(B)(ii)(III) (as so re10 designated by section 132), by striking ‘‘338I’’ and

11 inserting ‘‘338E’’.

12 PART 2—SCHOOL-BASED REVOLVING LOAN

13 FUNDS

14 SEC. 135. PRIMARY CARE LOAN PROGRAM.

15 (a) REQUIREMENT FOR SCHOOLS.—Section 723(b)(1)

16 of the Public Health Service Act (42 U.S.C. 292s(b)(1)), as

17 amended by section 2014(c)(2)(A)(ii) of Public Law 103–

18 43 (107 Stat. 216), is amended by striking ‘‘3 years before’’

19 and inserting ‘‘4 years before’’.

20 (b) SERVICE REQUIREMENT FOR PRIMARY CARE LOAN

21 BORROWERS.—Section 723(a) of the Public Health Service

22 Act (42 U.S.C. 292s(a)) is amended in subparagraph (B)

23 of paragraph (1), by striking ‘‘through the date on which

24 the loan is repaid in full’’ and inserting ‘‘for 5 years after

25 completing the residency program’’.
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1 (c) REPORT REQUIREMENT.—Section 723 of the Pub2 lic Health Service Act (42 U.S.C. 292s) is amended—

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

4 (2) by redesignating subsection (d) as subsection

5 (c).

6 SEC. 136. LOANS FOR DISADVANTAGED STUDENTS.

7 (a) AUTHORIZATION OF APPROPRIATIONS.—Section

8 724(f)(1) of the Public Health Service Act (42 U.S.C.

9 292t(f)(1)) is amended by striking ‘‘$15,000,000 for fiscal

10 year 1993’’ and inserting ‘‘$8,000,000 for each of the fiscal

11 years 1996 through 1998’’.

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

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

14 U.S.C. 292t(f)(1)) is repealed.

15 SEC. 137. STUDENT LOANS REGARDING SCHOOLS OF

16 NURSING.

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

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

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

20 the end and inserting a semicolon;

21 (2) in paragraph (2)—

22 (A) in subparagraph (A), by striking ‘‘and’’

23 at the end; and

24 (B) by inserting before the semicolon at the

25 end the following: ‘‘, and (C) such additional pe-
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1 riods under the terms of paragraph (8) of this

2 subsection’’;

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

4 the end and inserting ‘‘; and’’; and

5 (4) by adding at the end the following para6 graph:

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

8 the Secretary, the repayment period established under

9 paragraph (2) for any student borrower who during

10 the repayment period failed to make consecutive pay11 ments and who, during the last 12 months of the re12 payment period, has made at least 12 consecutive

13 payments may be extended for a period not to exceed

14 10 years.’’.

15 (b) MINIMUM MONTHLY PAYMENTS.—Section 836(g) of

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

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

18 (c) ELIMINATION OF STATUTE OF LIMITATION FOR

19 LOAN COLLECTIONS.—

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

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

22 adding at the end the following new subsection:

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

24 LOAN COLLECTIONS.—
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1 ‘‘(1) PURPOSE.—It is the purpose of this sub2 section to ensure that obligations to repay loans

3 under this section are enforced without regard to any

4 Federal or State statutory, regulatory, or administra5 tive limitation on the period within which debts may

6 be enforced.

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

8 provision of Federal or State law, no limitation shall

9 terminate the period within which suit may be filed,

10 a judgment may be enforced, or an offset, garnish11 ment, or other action may be initiated or taken by a

12 school of nursing that has an agreement with the Sec13 retary pursuant to section 835 that is seeking the re14 payment of the amount due from a borrower on a

15 loan made under this subpart after the default of the

16 borrower on such loan.’’.

17 (2) EFFECTIVE DATE.—The amendment made by

18 paragraph (1) shall be effective with respect to actions

19 pending on or after the date of enactment of this Act.

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

21 Public Health Service Act (as so redesignated and amended

22 under section 132(c)) is amended by adding at the end

23 thereof the following new subsection:

24 ‘‘(g) BREACH OF AGREEMENT.—
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1 ‘‘(1) IN GENERAL.—In the case of any program

2 under this section under which an individual makes

3 an agreement to provide health services for a period

4 of time in accordance with such program in consider5 ation of receiving an award of Federal funds regard6 ing education as a nurse (including an award for the

7 repayment of loans), the following applies if the

8 agreement provides that this subsection is applicable:

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

10 section that makes an award of Federal funds for

11 attending an accredited program of nursing (in

12 this section referred to as a ‘nursing program’),

13 the individual is liable to the Federal Govern14 ment for the amount of such award (including

15 amounts provided for expenses related to such at16 tendance), and for interest on such amount at

17 the maximum legal prevailing rate, if the indi18 vidual—

19 ‘‘(i) fails to maintain an acceptable

20 level of academic standing in the nursing

21 program (as indicated by the program in

22 accordance with requirements established by

23 the Secretary);

24 ‘‘(ii) is dismissed from the nursing

25 program for disciplinary reasons; or
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1 ‘‘(iii) voluntarily terminates the nurs2 ing program.

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

4 Government for the amount of such award (in5 cluding amounts provided for expenses related to

6 such attendance), and for interest on such

7 amount at the maximum legal prevailing rate, if

8 the individual fails to provide health services in

9 accordance with the program under this section

10 for the period of time applicable under the pro11 gram.

12 ‘‘(2) WAIVER OR SUSPENSION OF LIABILITY.—In

13 the case of an individual or health facility making an

14 agreement for purposes of paragraph (1), the Sec15 retary shall provide for the waiver or suspension of

16 liability under such subsection if compliance by the

17 individual or the health facility, as the case may be,

18 with the agreements involved is impossible, or would

19 involve extreme hardship to the individual or facility,

20 and if enforcement of the agreements with respect to

21 the individual or facility would be unconscionable.

22 ‘‘(3) DATE CERTAIN FOR RECOVERY.—Subject to

23 paragraph (2), any amount that the Federal Govern24 ment is entitled to recover under paragraph (1) shall

25 be paid to the United States not later than the expi-
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1 ration of the 3-year period beginning on the date the

2 United States becomes so entitled.

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

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

5 section shall be available for the purposes of such pro6 gram, and shall remain available for such purposes

7 until expended.’’.

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

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

10 (1) in subsection (a)—

11 (A) by striking the matter preceding para12 graph (1) and inserting the following:

13 ‘‘(a) If a school terminates a loan fund established

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

15 Secretary for good cause terminates the agreement with the

16 school, there shall be a capital distribution as follows:’’; and

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

18 close of September 30, 1999,’’ and inserting ‘‘on

19 the date of termination of the fund’’; and

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

21 ‘‘(b) If a capital distribution is made under subsection

22 (a), the school involved shall, after such capital distribution,

23 pay to the Secretary, not less often than quarterly, the same

24 proportionate share of amounts received by the school in

25 payment of principal or interest on loans made from the
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1 loan fund established under section 835(b) as determined

2 by the Secretary under subsection (a).’’.

3 SEC. 138. GENERAL PROVISIONS.

4 (a) MAXIMUM STUDENT LOAN PROVISIONS AND MINI5 MUM PAYMENTS.—

6 (1) IN GENERAL.—Section 722(a)(1) of the Pub7 lic Health Service Act (42 U.S.C. 292r(a)(1)), as

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

9 is amended by striking ‘‘the sum of’’ and all that fol10 lows through the end thereof and inserting ‘‘the cost

11 of attendance (including tuition, other reasonable

12 educational expenses, and reasonable living costs) for

13 that year at the educational institution attended by

14 the student (as determined by such educational insti15 tution).’’.

16 (2) THIRD AND FOURTH YEARS.—Section

17 722(a)(2) of the Public Health Service Act (42 U.S.C.

18 292r(a)(2)), as amended by section 2014(b)(1) of Pub19 lic Law 103–43, is amended by striking ‘‘the amount

20 $2,500’’ and all that follows through ‘‘including such

21 $2,500’’ and inserting ‘‘the amount of the loan may,

22 in the case of the third or fourth year of a student

23 at a school of medicine or osteopathic medicine, be in24 creased to the extent necessary’’.
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1 (3) REPAYMENT PERIOD.—Section 722(c) of the

2 Public Health Service Act (42 U.S.C. 292r(c)), as

3 amended by section 2014(b)(1) of Public Law 103–43,

4 is amended—

5 (A) in the subsection heading by striking

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

7 (B) by striking ‘‘ten-year period which be8 gins’’ and inserting ‘‘period of not less than 10

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

10 and

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

12 inserting ‘‘such period’’.

13 (4) MINIMUM PAYMENTS.—Section 722(j) of the

14 Public Health Service Act (42 U.S.C. 292r(j)), as

15 amended by section 2014(b)(1) of Public Law 103–43,

16 is amended by striking ‘‘$15’’ and inserting $40’’.

17 (b) ELIMINATION OF STATUTE OF LIMITATION FOR

18 LOAN COLLECTIONS.—

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

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

21 section 2014(b)(1) of Public Law 103–43, is amended

22 by adding at the end the following new subsection:

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

24 LOAN COLLECTIONS.—
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1 ‘‘(1) PURPOSE.—It is the purpose of this sub2 section to ensure that obligations to repay loans

3 under this section are enforced without regard to any

4 Federal or State statutory, regulatory, or administra5 tive limitation on the period within which debts may

6 be enforced.

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

8 provision of Federal or State law, no limitation shall

9 terminate the period within which suit may be filed,

10 a judgment may be enforced, or an offset, garnish11 ment, or other action may be initiated or taken by a

12 school that has an agreement with the Secretary pur13 suant to section 721 that is seeking the repayment of

14 the amount due from a borrower on a loan made

15 under this subpart after the default of the borrower on

16 such loan.’’.

17 (2) EFFECTIVE DATE.—The amendment made by

18 paragraph (1) shall be effective with respect to actions

19 pending on or after the date of enactment of this Act.

20 (c) DATE CERTAIN FOR CONTRIBUTIONS.—Paragraph

21 (2) of section 735(e) of the Public Health Service Act (42

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

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

24 Amounts described in paragraph (1) that are re-
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1 turned to the Secretary shall be obligated before the

2 end of the succeeding fiscal year.’’.

3 PART 3—INSURED HEALTH EDUCATION

4 ASSISTANCE LOANS TO GRADUATE STUDENTS

5 SEC. 141. HEALTH EDUCATION ASSISTANCE LOAN PRO6 GRAM.

7 (a) HEALTH EDUCATION ASSISTANCE LOAN

8 DEFERMENT FOR BORROWERS PROVIDING HEALTH SERV9 ICES TO INDIANS.—

10 (1) IN GENERAL.—Section 705(a)(2)(C) of the

11 Public Health Service Act (42 U.S.C. 292d(a)(2)(C))

12 is amended by striking ‘‘and (x)’’ and inserting ‘‘(x)

13 not in excess of three years, during which the bor14 rower is providing health care services to Indians

15 through an Indian health program (as defined in sec16 tion 108(a)(2)(A) of the Indian Health Care Improve17 ment Act (25 U.S.C. 1616a(a)(2)(A)); and (xi)’’.

18 (2) CONFORMING AMENDMENTS.—Section

19 705(a)(2)(C) of the Public Health Service Act (42

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

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

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

23 (B) in the matter following such clause (xi),

24 by striking ‘‘(x)’’ and inserting ‘‘(xi)’’.
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1 (3) EFFECTIVE DATE.—The amendments made

2 by this subsection shall apply with respect to services

3 provided on or after the first day of the third month

4 that begins after the date of the enactment of this Act.

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

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

7 amended—

8 (1) in paragraph (4)(B), by adding ‘‘and’’ after

9 the semicolon;

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

11 inserting a period; and

12 (3) by striking paragraph (6).

13 (c) COLLECTION FROM ESTATES.—Section 714 of the

14 Public Health Service Act (42 U.S.C. 292m) is amended

15 by adding at the end the following new sentence: ‘‘Notwith16 standing the first sentence, the Secretary may, in the case

17 of a borrower who dies, collect any remaining unpaid bal18 ance owed to the lender, the holder of the loan, or the Fed19 eral Government from the borrower’s estate.’’.

20 SEC. 142. HEAL LENDER AND HOLDER PERFORMANCE

21 STANDARDS.

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

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

24 (1) by striking the last sentence;
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1 (2) by striking ‘‘determined.’’ and inserting ‘‘de2 termined, except that, if the insurance beneficiary in3 cluding any servicer of the loan is not designated for

4 ‘exceptional performance’, as set forth in paragraph

5 (2), the Secretary shall pay to the beneficiary a sum

6 equal to 98 percent of the amount of the loss sustained

7 by the insured upon that loan.’’;

8 (3) by striking ‘‘Upon’’ and inserting:

9 ‘‘(1) IN GENERAL.—Upon’’; and

10 (4) by adding at the end the following new para11 graph:

12 ‘‘(2) EXCEPTIONAL PERFORMANCE.—

13 ‘‘(A) AUTHORITY.—Where the Secretary de14 termines that an eligible lender, holder, or

15 servicer has a compliance performance rating

16 that equals or exceeds 97 percent, the Secretary

17 shall designate that eligible lender, holder, or

18 servicer, as the case may be, for exceptional per19 formance.

20 ‘‘(B) COMPLIANCE PERFORMANCE RAT21 ING.—For purposes of subparagraph (A), a com22 pliance performance rating is determined with

23 respect to compliance with due diligence in the

24 disbursement, servicing, and collection of loans

25 under this subpart for each year for which the
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1 determination is made. Such rating shall be

2 equal to the percentage of all due diligence re3 quirements applicable to each loan, on average,

4 as established by the Secretary, with respect to

5 loans serviced during the period by the eligible

6 lender, holder, or servicer.

7 ‘‘(C) ANNUAL AUDITS FOR LENDERS, HOLD8 ERS, AND SERVICERS.—Each eligible lender,

9 holder, or servicer desiring a designation under

10 subparagraph (A) shall have an annual finan11 cial and compliance audit conducted with re12 spect to the loan portfolio of such eligible lender,

13 holder, or servicer, by a qualified independent

14 organization from a list of qualified organiza15 tions identified by the Secretary and in accord16 ance with standards established by the Secretary.

17 The standards shall measure the lender’s, hold18 er’s, or servicer’s compliance with due diligence

19 standards and shall include a defined statistical

20 sampling technique designed to measure the per21 formance rating of the eligible lender, holder, or

22 servicer for the purpose of this section. Each eli23 gible lender, holder, or servicer shall submit the

24 audit required by this section to the Secretary.
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1 ‘‘(D) SECRETARY’S DETERMINATIONS.—The

2 Secretary shall make the determination under

3 subparagraph (A) based upon the audits submit4 ted under this paragraph and any information

5 in the possession of the Secretary or submitted

6 by any other agency or office of the Federal Gov7 ernment.

8 ‘‘(E) QUARTERLY COMPLIANCE AUDIT.—To

9 maintain its status as an exceptional performer,

10 the lender, holder, or servicer shall undergo a

11 quarterly compliance audit at the end of each

12 quarter (other than the quarter in which status

13 as an exceptional performer is established

14 through a financial and compliance audit, as de15 scribed in subparagraph (C)), and submit the re16 sults of such audit to the Secretary. The compli17 ance audit shall review compliance with due

18 diligence requirements for the period beginning

19 on the day after the ending date of the previous

20 audit, in accordance with standards determined

21 by the Secretary.

22 ‘‘(F) REVOCATION AUTHORITY.—The Sec23 retary shall revoke the designation of a lender,

24 holder, or servicer under subparagraph (A) if

25 any quarterly audit required under subpara-
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1 graph (E) is not received by the Secretary by the

2 date established by the Secretary or if the audit

3 indicates the lender, holder, or servicer has failed

4 to meet the standards for designation as an ex5 ceptional performer under subparagraph (A). A

6 lender, holder, or servicer receiving a compliance

7 audit not meeting the standard for designation

8 as an exceptional performer may reapply for

9 designation under subparagraph (A) at any

10 time.

11 ‘‘(G) DOCUMENTATION.—Nothing in this

12 section shall restrict or limit the authority of the

13 Secretary to require the submission of claims

14 documentation evidencing servicing performed on

15 loans, except that the Secretary may not require

16 exceptional performers to submit greater docu17 mentation than that required for lenders, holders,

18 and servicers not designated under subparagraph

19 (A).

20 ‘‘(H) COST OF AUDITS.—Each eligible lend21 er, holder, or servicer shall pay for all the costs

22 associated with the audits required under this

23 section.

24 ‘‘(I) ADDITIONAL REVOCATION AUTHOR25 ITY.—Notwithstanding any other provision of
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1 this section, a designation under subparagraph

2 (A) may be revoked at any time by the Secretary

3 if the Secretary determines that the eligible lend4 er, holder, or servicer has failed to maintain an

5 overall level of compliance consistent with the

6 audit submitted by the eligible lender, holder, or

7 servicer under this paragraph or if the Secretary

8 asserts that the lender, holder, or servicer may

9 have engaged in fraud in securing designation

10 under subparagraph (A) or is failing to service

11 loans in accordance with program requirements.

12 ‘‘(J) NONCOMPLIANCE.—A lender, holder, or

13 servicer designated under subparagraph (A) that

14 fails to service loans or otherwise comply with

15 applicable program regulations shall be consid16 ered in violation of the Federal False Claims

17 Act.’’.

18 (b) DEFINITION.—Section 707(e) of the Public Health

19 Service Act (42 U.S.C. 292f(e)) is amended by adding at

20 the end the following new paragraph:

21 ‘‘(4) The term ‘servicer’ means any agency act22 ing on behalf of the insurance beneficiary.’’.

23 (c) EFFECTIVE DATE.—The amendments made by sub24 sections (a) and (b) shall apply with respect to loans sub25 mitted to the Secretary for payment on or after the first
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1 day of the sixth month that begins after the date of enact2 ment of this Act.

3 SEC. 143. REAUTHORIZATION.

4 (a) LOAN PROGRAM.—Section 702(a) of the Public

5 Health Service Act (42 U.S.C. 292a(a)) is amended—

6 (1) by striking ‘‘1993’’ and inserting ‘‘1996’’;

7 (2) by striking ‘‘1994’’ and inserting ‘‘1997’’;

8 (3) by striking ‘‘fiscal year 1995’’ and inserting

9 ‘‘each of the fiscal years 1998 and 1999’’; and

10 (4) by striking ‘‘September 30, 1998’’ and insert11 ing ‘‘September 20, 2002’’.

12 (b) INSURANCE PROGRAM.—Section 710(a)(2)(B) of

13 the Public Health Service Act (42 U.S.C. 292i(a)(2)(B)) is

14 amended by striking ‘‘any of the fiscal years 1993 through

15 1996’’ and inserting ‘‘fiscal year 1993 and subsequent fiscal

16 years’’.

17 PART 4—SCHOLARSHIPS FOR DISADVANTAGED

18 STUDENTS

19 SEC. 151. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.

20 Part B of title VII of the Public Health Service Act

21 (as amended by section 101(a)) is further amended by add22 ing 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 to

6 any full-time student who is an eligible individual as de7 fined in subsection (f). Such scholarships may be expended

8 only for tuition expenses, other reasonable educational ex9 penses, and reasonable living expenses incurred in the at10 tendance of such school, and may not, for any year of such

11 attendance for which the scholarship is provided, provide

12 an amount exceeding the total amount required for the year.

13 ‘‘(b) PREFERENCE IN PROVIDING SCHOLARSHIPS.—

14 The Secretary may not make a grant to an entity under

15 subsection (a) unless the health professions and nursing

16 schools involved agrees that, in providing scholarships pur17 suant to the grant, the school will give preference to students

18 for whom the costs of attending the school would constitute

19 a severe financial hardship and, notwithstanding other pro20 visions of this section, to former recipients of scholarships

21 under sections 736 and 740(d)(2)(B) (as such sections ex22 isted on the day before the date of enactment of this section).

23 ‘‘(c) AMOUNT OF AWARD.—In awarding grants to eli24 gible entities that are health professions and nursing

25 schools, the Secretary shall give priority to eligible entities

26 based on the proportion of graduating students going into
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1 primary care, the proportion of minority students, and the

2 proportion of graduates working in medically underserved

3 areas.

4 ‘‘(d) MAXIMUM SCHOLARSHIP AWARD.—The maxi5 mum scholarship that an individual may receive in any

6 year from an eligible entity that is a health professions and

7 nursing schools shall be $3000.

8 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There are

9 authorized to be appropriated to carry out this section,

10 $32,000,000 for each of the fiscal years 1996 through 1999.

11 Of the amount appropriated in any fiscal year, the Sec12 retary shall ensure that not less than 16 percent shall be

13 distributed to schools of nursing.

14 ‘‘(f) DEFINITIONS.—As used in this section:

15 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible en16 tities’ means an entity that—

17 ‘‘(A) is a school of medicine, osteopathic

18 medicine, dentistry, nursing (as defined in sec19 tion 801), pharmacy, podiatric medicine, optom20 etry, veterinary medicine, public health, or allied

21 health, a school offering a graduate program in

22 mental health practice, or an entity providing

23 programs for the training of physician assistant;

24 and
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1 ‘‘(B) is carrying out a program for recruit2 ing and retaining students from disadvantaged

3 backgrounds, including students who are mem4 bers of racial and ethnic minority groups.

5 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible

6 individual’ means an individual who—

7 ‘‘(A) is from a disadvantaged background;

8 ‘‘(B) has a financial need for a scholarship;

9 and

10 ‘‘(C) is enrolled (or accepted for enrollment)

11 at an eligible health profession or nursing school

12 as a full-time student in a program leading to

13 a degree in a health profession or nursing.’’.

14 TITLE II—OFFICE OF MINORITY

15 HEALTH

16 SEC. 201. REVISION AND EXTENSION OF PROGRAMS OF OF17 FICE OF MINORITY HEALTH.

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

19 Service Act (42 U.S.C. 300u–6) is amended by striking sub20 section (b) and all that follows and inserting the following:

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

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

23 through the Deputy Assistant Secretary for Minority

24 Health (in this section referred to as the ‘Deputy Assistant

25 Secretary’), shall carry out the following:
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1 ‘‘(1) Establish short-range and long-range goals

2 and objectives and coordinate all other activities with3 in the Public Health Service that relate to disease

4 prevention, health promotion, service delivery, and re5 search concerning such individuals. The heads of each

6 of the agencies of the Service shall consult with the

7 Deputy Assistant Secretary to ensure the coordination

8 of such activities.

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

10 by entering into interagency agreements with other

11 agencies of the Public Health Service:

12 ‘‘(A) Support research, demonstrations and

13 evaluations to test new and innovative models.

14 ‘‘(B) Increase knowledge and understanding

15 of health risk factors.

16 ‘‘(C) Develop mechanisms that support bet17 ter information dissemination, education, pre18 vention, and service delivery to individuals from

19 disadvantaged backgrounds, including individ20 uals who are members of racial or ethnic minor21 ity groups.

22 ‘‘(D) Ensure that the National Center for

23 Health Statistics collects data on the health sta24 tus of each minority group.
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1 ‘‘(E) With respect to individuals who lack

2 proficiency in speaking the English language,

3 enter into contracts with public and nonprofit

4 private providers of primary health services for

5 the purpose of increasing the access of the indi6 viduals to such services by developing and carry7 ing out programs to provide bilingual or inter8 pretive services.

9 ‘‘(3) Support a national minority health re10 source center to carry out the following:

11 ‘‘(A) Facilitate the exchange of information

12 regarding matters relating to health information

13 and health promotion, preventive health services,

14 and education in the appropriate use of health

15 care.

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

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

18 problems relating to such matters.

19 ‘‘(D) Provide technical assistance with re20 spect to the exchange of such information (in21 cluding facilitating the development of materials

22 for such technical assistance).

23 ‘‘(4) Carry out programs to improve access to

24 health care services for individuals with limited pro25 ficiency in speaking the English language by facili-
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1 tating the removal of impediments to the receipt of

2 health care that result from such limitation. Activities

3 under the preceding sentence shall include conducting

4 research and developing and evaluating model

5 projects.

6 ‘‘(5) Not later than June 8 of each year, the

7 heads of the Public Health Service agencies shall sub8 mit to the Deputy Assistant Secretary a report sum9 marizing the minority health activities of each of the

10 respective agencies.

11 ‘‘(c) ADVISORY COMMITTEE.—

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

13 an advisory committee to be known as the Advisory

14 Committee on Minority Health (in this subsection re15 ferred to as the ‘Committee’). The Deputy Assistant

16 Secretary shall consult with the Committee in carry17 ing out this section.

18 ‘‘(2) DUTIES.—The Committee shall provide ad19 vice to the Deputy Assistant Secretary carrying out

20 this section, including advice on the development of

21 goals and specific program activities under para22 graphs (1) and (2) of subsection (b) for each racial

23 and ethnic minority group.

24 ‘‘(3) CHAIR.—The Deputy Assistant Secretary

25 shall serve as the chair of the Committee.
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1 ‘‘(4) COMPOSITION.—

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

3 voting members appointed in accordance with

4 subparagraph (B), and nonvoting, ex officio

5 members designated in subparagraph (C).

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

7 shall be appointed by the Secretary from among

8 individuals who are not officers or employees of

9 the Federal Government and who have expertise

10 regarding issues of minority health. The racial

11 and ethnic minority groups shall be equally rep12 resented among such members.

13 ‘‘(C) The nonvoting, ex officio members of

14 the Committee shall be the directors of each of the

15 minority health offices, and such additional offi16 cials of the Department of Health and Human

17 Services as the Secretary determines to be appro18 priate.

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

20 shall serve for a term of 4 years, except that the Sec21 retary shall initially appoint a portion of the mem22 bers to terms of 1 year, 2 years, and 3 years.

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

24 Committee, a new member shall be appointed by the

25 Secretary within 90 days from the date that the va-
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1 cancy occurs, and serve for the remainder of the term

2 for which the predecessor of such member was ap3 pointed. The vacancy shall not affect the power of the

4 remaining members to execute the duties of the Com5 mittee.

6 ‘‘(7) COMPENSATION.—Members of the Commit7 tee who are officers or employees of the United States

8 shall serve without compensation. Members of the

9 Committee who are not officers or employees of the

10 United States shall receive compensation, for each

11 day (including travel time) they are engaged in the

12 performance of the functions of the Committee. Such

13 compensation may not be in an amount in excess of

14 the daily equivalent of the annual maximum rate of

15 basic pay payable under the General Schedule (under

16 title 5, United States Code) for positions above GS–

17 15.

18 ‘‘(d) CERTAIN REQUIREMENTS REGARDING DUTIES.—

19 ‘‘(1) RECOMMENDATIONS REGARDING LANGUAGE

20 AS IMPEDIMENT TO HEALTH CARE.—The Deputy As21 sistant Secretary for Minority Health shall consult

22 with the Director of the Office of Refugee Health, the

23 Director of the Office of Civil Rights, and the Director

24 of the Office of Minority Health of the Health Re25 sources and Services Administration, and other ap-
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1 propriate offices, regarding recommendations for car2 rying out activities under subsection (b)(4).

3 ‘‘(2) EQUITABLE ALLOCATION REGARDING AC4 TIVITIES.—

5 ‘‘(A) In making awards of grants, coopera6 tive agreements, or contracts under this section

7 or section 338A, 338B, 340A, 404, or 724, or

8 part B of title VII, the Secretary, acting as ap9 propriate through the Deputy Assistant Sec10 retary or the Administrator of the Health Re11 sources and Services Administration, shall en12 sure that such awards are equitably allocated

13 with respect to the various racial and minority

14 populations.

15 ‘‘(B) With respect to grants, cooperative

16 agreements, and contracts that are available

17 under the sections specified in subparagraph (A),

18 the Secretary shall—

19 ‘‘(i) carry out activities to inform enti20 ties, as appropriate, that the entities may

21 be eligible for awards of such assistance;

22 ‘‘(ii) provide technical assistance to

23 such entities in the process of preparing

24 and submitting applications for the awards
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1 in accordance with the policies of the Sec2 retary regarding such application; and

3 ‘‘(iii) inform populations, as appro4 priate, that members of the populations

5 may be eligible to receive services or other6 wise participate in the activities carried out

7 with such awards.

8 ‘‘(3) CULTURAL COMPETENCY OF SERVICES.—

9 The Secretary shall ensure that information and serv10 ices provided pursuant to subsection (b) are provided

11 in the language, educational, and cultural context

12 that is most appropriate for the individuals for whom

13 the information and services are intended.

14 ‘‘(e) GRANTS AND CONTRACTS REGARDING DUTIES.—

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

16 (b), the Deputy Assistant Secretary may make

17 awards of grants, cooperative agreements, and con18 tracts to public and nonprofit private entities.

19 ‘‘(2) PROCESS FOR MAKING AWARDS.—The Dep20 uty Assistant Secretary shall ensure that awards

21 under paragraph (1) are made only on a competitive

22 basis, and that a grant is awarded for a proposal

23 only if the proposal has been recommended for such

24 an award through a process of peer review and has
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1 been so recommended by the advisory committee es2 tablished under subsection (c).

3 ‘‘(3) EVALUATION AND DISSEMINATION.—The

4 Deputy Assistant Secretary, directly or through con5 tracts with public and private entities, shall provide

6 for evaluations of projects carried out with awards

7 made under paragraph (1) during the preceding 2 fis8 cal years. The report shall be included in the report

9 required under subsection (f) for the fiscal year in10 volved.

11 ‘‘(f) BIENNIAL REPORTS.—Not later than February 1

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

13 Deputy Assistant Secretary shall submit to the Committee

14 on Energy and Commerce of the House of Representatives,

15 and to the Committee on Labor and Human Resources of

16 the Senate, a report describing the activities carried out

17 under this section during the preceding 2 fiscal years and

18 evaluating the extent to which such activities have been ef19 fective in improving the health of racial and ethnic minor20 ity groups. Each such report shall include the biennial re21 ports submitted to the Deputy Assistant Secretary under

22 section 201(b)(5) for such years by the heads of the Public

23 Health Service agencies.

24 ‘‘(g) DEFINITION.—For purposes of this section:
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1 ‘‘(1) The term ‘racial and ethnic minority group’

2 means American Indians (including Alaska Natives,

3 Eskimos, and Aleuts); Asian Americans and Pacific

4 Islanders; Blacks; and Hispanics.

5 ‘‘(2) The term ‘Hispanic’ means individuals

6 whose origin is Mexican, Puerto Rican, Cuban,

7 Central or South American, or any other Spanish8 speaking country.

9 ‘‘(h) FUNDING.—For the purpose of carrying out this

10 section, there are authorized to be appropriated $21,000,000

11 for fiscal year 1996, such sums as may be necessary for

12 each of the fiscal years 1997 and 1998, and $19,000,000

13 for fiscal year 1999.’’.

14 (b) MISCELLANEOUS AMENDMENT.—Section 1707 of

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

16 amended in the heading for the section by striking ‘‘ESTAB17 LISHMENT OF’’.

18 TITLE III—SELECTED

19 INITIATIVES

20 SEC. 301. PROGRAMS REGARDING BIRTH DEFECTS.

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

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

23 ‘‘PROGRAMS REGARDING BIRTH DEFECTS

24 ‘‘SEC. 317C. (a) The Secretary, acting through the Di25 rector of the Centers for Disease Control and Prevention,

26 shall carry out programs—
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1 ‘‘(1) to collect, analyze, and make available data

2 on birth defects (in a manner that facilitates compli3 ance with subsection (d)(2)), including data on the

4 causes of such defects and on the incidence and preva5 lence of such defects; and

6 ‘‘(2) to operate regional centers for the conduct

7 of applied epidemiological research on the prevention

8 of such defects.

9 ‘‘(b) ADDITIONAL PROVISIONS REGARDING COLLEC10 TION OF DATA.—

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

12 (a)(1), the Secretary—

13 ‘‘(A) shall collect and analyze data by gen14 der and by racial and ethnic group, including

15 Hispanics, non-Hispanic whites, Blacks, Native

16 Americans, Asian Americans, and Pacific Is17 landers;

18 ‘‘(B) shall collect data under subparagraph

19 (A) from birth certificates, death certificates, hos20 pital records, and such other sources as the Sec21 retary determines to be appropriate; and

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

23 improve programs for the collection and analysis

24 of epidemiological data on birth defects, and to

25 make the data available.
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1 ‘‘(2) NATIONAL CLEARINGHOUSE.—In carrying

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

3 maintain a National Information Clearinghouse on

4 Birth Defects to collect and disseminate to health pro5 fessionals and the general public information on birth

6 defects, including the prevention of such defects.

7 ‘‘(c) GRANTS AND CONTRACTS.—

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

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

10 contracts with public and nonprofit private entities.

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

12 AWARD FUNDS.—

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

14 award of a grant or contract under paragraph

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

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

17 for the purpose of aiding the recipient in carry18 ing out the purposes for which the award is

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

20 recipient any officer or employee of the Depart21 ment of Health and Human Services.

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

23 subparagraph (A), the Secretary shall reduce the

24 amount of payments under the award involved

25 by an amount equal to the costs of detailing per-
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1 sonnel and the fair market value of any supplies,

2 equipment, or services provided by the Secretary.

3 The Secretary shall, for the payment of expenses

4 incurred in complying with such request, expend

5 the amounts withheld.

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

7 may make an award of a grant or contract under

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

9 is submitted to the Secretary and the application is

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

11 such agreements, assurances, and information as the

12 Secretary determines to be necessary to carry out the

13 purposes for which the award is to be made.

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

15 of fiscal year 1997 and of every second such year thereafter,

16 the Secretary shall submit to the Committee on Energy and

17 Commerce of the House of Representatives, and the Commit18 tee on Labor and Human Resources of the Senate, a report

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

20 ‘‘(1) contains information regarding the inci21 dence and prevalence of birth defects and the extent

22 to which birth defects have contributed to the inci23 dence and prevalence of infant mortality;

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

25 that is specific to various racial and ethnic groups
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1 (including Hispanics, non-Hispanic whites, Blacks,

2 Native Americans, and Asian Americans);

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

4 which various approaches of preventing birth defects

5 have been effective;

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

7 this section; and

8 ‘‘(5) contains any recommendations of the Sec9 retary regarding this section.’’.

10 SEC. 302. TRAUMATIC BRAIN INJURY.

11 (a) PROGRAMS OF NATIONAL INSTITUTES OF

12 HEALTH.—Section 1261 of the Public Health Service Act

13 (42 U.S.C. 300d–61) is amended—

14 (1) in subsection (d)—

15 (A) in paragraph (2), by striking ‘‘and’’

16 after the semicolon at the end;

17 (B) in paragraph (3), by striking the period

18 and inserting ‘‘; and’’; and

19 (C) by adding at the end the following

20 paragraph:

21 ‘‘(4) the authority to make awards of grants or

22 contracts to public or nonprofit private entities for

23 the conduct of basic and applied research regarding

24 traumatic brain injury, which research may in25 clude—
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1 ‘‘(A) the development of new methods and

2 modalities for the more effective diagnosis, meas3 urement of degree of injury, post-injury monitor4 ing and prognostic assessment of head injury for

5 acute, subacute and later phases of care;

6 ‘‘(B) the development, modification and

7 evaluation of therapies that retard, prevent or

8 reverse brain damage after acute head injury,

9 that arrest further deterioration following injury

10 and that provide the restitution of function for

11 individuals with long-term injuries;

12 ‘‘(C) the development of research on a con13 tinuum of care from acute care through rehabili14 tation, designed, to the extent practicable, to in15 tegrate rehabilitation and long-term outcome

16 evaluation with acute care research; and

17 ‘‘(D) the development of programs that in18 crease the participation of academic centers of

19 excellence in head injury treatment and rehabili20 tation research and training.’’; and

21 (2) in subsection (h), by adding at the end the

22 following paragraph:

23 ‘‘(4) The term ‘traumatic brain injury’ means

24 an acquired injury to the brain. Such term does not

25 include brain dysfunction caused by congenital or de-
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1 generative disorders, nor birth trauma, but may in2 clude brain injuries caused by anoxia due to near

3 drowning.’’.

4 (b) PROGRAMS OF HEALTH RESOURCES AND SERV5 ICES ADMINISTRATION.—Part E of title XII of the Public

6 Health Service Act (42 U.S.C. 300d–51 et seq.) is amended

7 by adding at the end the following new section:

8 ‘‘SEC. 1252. STATE GRANTS FOR DEMONSTRATION

9 PROJECTS REGARDING TRAUMATIC BRAIN

10 INJURY.

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

12 Administrator of the Health Resources and Services Admin13 istration, may make grants to States for the purpose of car14 rying out demonstration projects to improve the availabil15 ity of health services regarding traumatic brain injury.

16 ‘‘(b) STATE ADVISORY BOARD.—

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

18 grant under subsection (a) only if the State involved

19 agrees to establish an advisory board within the ap20 propriate health department of the State or within

21 another department as designated by the chief execu22 tive officer of the State.

23 ‘‘(2) FUNCTIONS.—An advisory board established

24 under paragraph (1) shall be cognizant of findings

25 and concerns of Federal, State and local agencies,
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1 citizens groups, and private industry (such as insur2 ance, health care, automobile, and other industry en3 tities). Such advisory boards shall encourage citizen

4 participation through the establishment of public

5 hearings and other types of community outreach pro6 grams.

7 ‘‘(3) COMPOSITION.—An advisory board estab8 lished under paragraph (1) shall be composed of—

9 ‘‘(A) representatives of—

10 ‘‘(i) the corresponding State agencies

11 involved;

12 ‘‘(ii) public and nonprofit private

13 health related organizations;

14 ‘‘(iii) other disability advisory or

15 planning groups within the State;

16 ‘‘(iv) members of an organization or

17 foundation representing traumatic brain in18 jury survivors in that State; and

19 ‘‘(v) injury control programs at the

20 State or local level if such programs exist;

21 and

22 ‘‘(B) a substantial number of individuals

23 who are survivors of traumatic brain injury, or

24 the family members of such individuals.

25 ‘‘(c) MATCHING FUNDS.—
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1 ‘‘(1) IN GENERAL.—With respect to the costs to

2 be incurred by a State in carrying out the purpose

3 described in subsection (a), the Secretary may make

4 a grant under such subsection only if the State agrees

5 to make available, in cash, non-Federal contributions

6 toward such costs in an amount that is not less than

7 $1 for each $2 of Federal funds provided under the

8 grant.

9 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB10 UTED.—In determining the amount of non-Federal

11 contributions in cash that a State has provided pur12 suant to paragraph (1), the Secretary may not in13 clude any amounts provided to the State by the Fed14 eral Government.

15 ‘‘(d) APPLICATION FOR GRANT.—The Secretary may

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

17 for the grant is submitted to the Secretary and the applica18 tion is in such form, is made in such manner, and contains

19 such agreements, assurances, and information as the Sec20 retary determines to be necessary to carry out this section.

21 ‘‘(e) COORDINATION OF ACTIVITIES.—The Secretary

22 shall ensure that activities under this section are coordi23 nated as appropriate with other agencies of the Public

24 Health Service that carry out activities regarding trau25 matic brain injury.
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1 ‘‘(f) REPORT.—Not later than 2 years after the date

2 of enactment of this section, the Secretary shall submit to

3 the Committee on Energy and Commerce of the House of

4 Representatives, and to the Committee on Labor and

5 Human Resources of the Senate, a report describing the

6 findings and results of the programs established under this

7 section, including measures of outcomes and consumer and

8 surrogate satisfaction.

9 ‘‘(g) DEFINITION.—For purposes of this section, the

10 term ‘traumatic brain injury’ means an acquired injury

11 to the brain. Such term does not include brain dysfunction

12 caused by congenital or degenerative disorders, nor birth

13 trauma, but may include brain injuries caused by anoxia

14 due to near drowning.

15 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There

16 are authorized to be appropriated to carry out this section,

17 $5,000,000 for fiscal year 1995, and such sums as may be

18 necessary for each of the fiscal years 1996 and 1997.’’.

19 (c) STUDY; CONSENSUS CONFERENCE.—

20 (1) STUDY.—

21 (A) IN GENERAL.—The Secretary of Health

22 and Human Services (in this subsection referred

23 to as the ‘‘Secretary’’), acting through the appro24 priate agencies of the Public Health Service,

25 shall conduct a study for the purpose of carrying
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1 out the following with respect to traumatic brain

2 injury:

3 (i) In collaboration with appropriate

4 State and local health-related agencies—

5 (I) determine the incidence and

6 prevalence of traumatic brain injury;

7 and

8 (II) develop a uniform reporting

9 system under which States report inci10 dence of traumatic brain injury, if the

11 Secretary determines that such a sys12 tem is appropriate.

13 (ii) Identify common therapeutic inter14 ventions which are used for the rehabilita15 tion of individuals with such injuries, and

16 shall, subject to the availability of informa17 tion, include an analysis of—

18 (I) the effectiveness of each such

19 intervention in improving the func20 tioning of individuals with brain inju21 ries;

22 (II) the comparative effectiveness

23 of interventions employed in the course

24 of rehabilitation of individuals with
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1 brain injuries to achieve the same or

2 similar clinical outcome; and

3 (III) the adequacy of existing

4 measures of outcomes and knowledge of

5 factors influencing differential out6 comes.

7 (iii) Develop practice guidelines for the

8 rehabilitation of traumatic brain injury at

9 such time as appropriate scientific research

10 becomes available.

11 (B) DATES CERTAIN FOR REPORTS.—

12 (i) Not later than 18 months after the

13 date of enactment of this Act, the Secretary

14 shall submit to the Committee on Commerce

15 of the House of Representatives, and to the

16 Committee on Labor and Human Resources

17 of the Senate, a report describing the find18 ings made as a result of carrying out sub19 paragraph (A)(i).

20 (ii) Not later than 3 years after the

21 date of enactment of this Act, the Secretary

22 shall submit to the Committees specified in

23 clause (i) a report describing the findings

24 made as a result of carrying out clauses (ii)

25 and (iii) of subparagraph (A).
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1 (2) CONSENSUS CONFERENCE.—The Secretary,

2 acting through the Director of the National Center for

3 Medical Rehabilitation Research within the National

4 Institute for Child Health and Human Development,

5 shall conduct a national consensus conference on

6 managing traumatic brain injury and related reha7 bilitation concerns.

8 (3) DEFINITION.—For purposes of this sub9 section, the term ‘‘traumatic brain injury’’ means an

10 acquired injury to the brain. Such term does not in11 clude brain dysfunction caused by congenital or de12 generative disorders, nor birth trauma, but may in13 clude brain injuries caused by anoxia due to near

14 drowning.

15 SEC. 303. STATE OFFICES OF RURAL HEALTH.

16 (a) IN GENERAL.—Section 338M of the Public Health

17 Service Act (as so redesignated by section 132) is

18 amended—

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

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

21 (2) in subsection (j)(1)—

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

23 (B) by inserting before the period the follow24 ing: ‘‘, and such sums as may be necessary for

25 each of the fiscal years 1996 through 1997’’; and
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1 (3) in subsection (k), by striking ‘‘$10,000,000’’

2 and inserting ‘‘$20,000,000’’.

3 (b) REPEAL.—Effective on October 1, 1997, section

4 338M of the Public Health Service Act (as so redesignated

5 by section 132) is repealed.

6 SEC. 304. HEALTH SERVICES FOR PACIFIC ISLANDERS.

7 Section 10 of the Disadvantaged Minority Health Im8 provement Act of 1990 (42 U.S.C. 254c–1) is amended—

9 (1) in subsection (b)—

10 (A) in paragraph (2)—

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

12 after ‘‘availability of health’’; and

13 (ii) by striking ‘‘, including improved

14 health data systems’’;

15 (B) in paragraph (3)—

16 (i) by striking ‘‘manpower’’ and in17 serting ‘‘care providers’’; and

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

19 follows through the end thereof and insert20 ing a semicolon;

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

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

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

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

25 by striking ‘‘and’’ at the end thereof;
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1 (F) in paragraph (6) (as so redesignated),

2 by striking the period and inserting a semicolon;

3 and

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

5 redesignated), the following new paragraphs:

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

7 health care, and related training to American Sa8 moan health care professionals; and

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

10 disease prevention services for rural American

11 Samoa.’’;

12 (2) in subsection (f)—

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

14 ‘‘there are’’; and

15 (B) by striking ‘‘$10,000,000’’ and all that

16 follows through ‘‘1993’’ and inserting

17 ‘‘$3,000,000 for fiscal year 1995, $4,000,000 for

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

19 1997’’; and

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

21 new subsection:

22 ‘‘(g) STUDY AND REPORT.—

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

24 date of enactment of this subsection, the Secretary,

25 acting through the Administrator of the Health Re-
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1 sources and Services Administration, shall enter into

2 a contract with a public or nonprofit private entity

3 for the conduct of a study to determine the effective4 ness of projects funded under this section.

5 ‘‘(2) REPORT.—Not later than July 1, 1996, the

6 Secretary shall prepare and submit to the Committee

7 on Labor and Human Resources of the Senate and

8 the Committee on Energy and Commerce of the House

9 of Representatives a report describing the findings

10 made with respect to the study conducted under para11 graph (1).’’.

12 SEC. 305. DEMONSTRATION PROJECTS REGARDING ALZ13 HEIMER’S DISEASE.

14 (a) IN GENERAL.—Section 398(a) of the Public Health

15 Service Act (42 U.S.C. 280c–3(a)) is amended—

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

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

18 (2) in paragraph (2)—

19 (A) by inserting after ‘‘disorders’’ the fol20 lowing: ‘‘who are living in single family homes

21 or in congregate settings’’; and

22 (B) by striking ‘‘and’’ at the end;

23 (3) by redesignating paragraph (3) as para24 graph (4); and
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1 (4) by inserting after paragraph (2) the follow2 ing:

3 ‘‘(3) to improve the access of such individuals to

4 home-based or community-based long-term care serv5 ices (subject to the services being provided by entities

6 that were providing such services in the State in7 volved as of October 1, 1995), particularly such indi8 viduals who are members of racial or ethnic minority

9 groups, who have limited proficiency in speaking the

10 English language, or who live in rural areas; and’’.

11 (b) DURATION.—Section 398A of the Public Health

12 Service Act (42 U.S.C. 280c–4) is amended—

13 (1) in the heading for the section, by striking

14 ‘‘LIMITATION’’ and all that follows and inserting

15 ‘‘REQUIREMENT OF MATCHING

16 FUNDS’’;

17 (2) by striking subsection (a);

18 (3) by redesignating subsections (b) and (c) as

19 subsections (a) and (b), respectively;

20 (4) in subsection (a) (as so redesignated), in each

21 of paragraphs (1)(C) and (2)(C), by striking ‘‘third

22 year’’ and inserting ‘‘third or subsequent year’’.

23 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

24 398B(e) of the Public Health Service Act (42 U.S.C. 280c–
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1 5(e)) is amended by striking ‘‘and 1993’’ and inserting

2 ‘‘through 1998’’.

3 TITLE IV—MISCELLANEOUS

4 PROVISIONS

5 SEC. 401. TECHNICAL CORRECTIONS REGARDING PUBLIC

6 LAW 103–183.

7 (a) AMENDATORY INSTRUCTIONS.—Public Law 103–

8 183 is amended—

9 (1) in section 601—

10 (A) in subsection (b), in the matter preced11 ing paragraph (1), by striking ‘‘Section 1201 of

12 the Public Health Service Act (42 U.S.C. 300d)’’

13 and inserting ‘‘Title XII of the Public Health

14 Service Act (42 U.S.C. 300d et seq.)’’; and

15 (B) in subsection (f)(1), by striking ‘‘in sec16 tion 1204(c)’’ and inserting ‘‘in section 1203(c)

17 (as redesignated by subsection (b)(2) of this sec18 tion)’’;

19 (2) in section 602, by striking ‘‘for the purpose’’

20 and inserting ‘‘For the purpose’’; and

21 (3) in section 705(b), by striking ‘‘317D((l)(1)’’

22 and inserting ‘‘317D(l)(1)’’.

23 (b) PUBLIC HEALTH SERVICE ACT.—The Public

24 Health Service Act, as amended by Public Law 103–183

25 and by subsection (a) of this section, is amended—
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1 (1) in section 317E(g)(2), by striking ‘‘making

2 grants under subsection (b)’’ and inserting ‘‘carrying

3 out subsection (b)’’;

4 (2) in section 318, in subsection (e) as in effect

5 on the day before the date of the enactment of Public

6 Law 103–183, by redesignating the subsection as sub7 section (f);

8 (3) in subpart 6 of part C of title IV—

9 (A) by transferring the first section 447

10 (added by section 302 of Public Law 103–183)

11 from the current placement of the section;

12 (B) by redesignating the section as section

13 447A; and

14 (C) by inserting the section after section

15 447;

16 (4) in section 1213(a)(8), by striking ‘‘provides

17 for for’’ and inserting ‘‘provides for’’;

18 (5) in section 1501, by redesignating the second

19 subsection (c) (added by section 101(f) of Public Law

20 103–183) as subsection (d); and

21 (6) in section 1505(3), by striking ‘‘nonprivate’’

22 and inserting ‘‘private’’.

23 (c) MISCELLANEOUS CORRECTION.—Section 401(c)(3)

24 of Public Law 103–183 is amended in the matter preceding
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1 subparagraph (A) by striking ‘‘(d)(5)’’ and inserting

2 ‘‘(e)(5)’’.

3 (d) EFFECTIVE DATE.—This section is deemed to have

4 taken effect immediately after the enactment of Public Law

5 103–183.

6 SEC. 402. CERTAIN AUTHORITIES OF CENTERS FOR DIS7 EASE CONTROL AND PREVENTION.

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

9 Health Service Act is amended by inserting after section

10 317H the following section:

11 ‘‘MISCELLANEOUS AUTHORITIES REGARDING CENTERS FOR

12 DISEASE CONTROL AND PREVENTION

13 ‘‘SEC. 317I. (a) TECHNICAL AND SCIENTIFIC PEER

14 REVIEW GROUPS.—The Secretary, acting through the Di15 rector of the Centers for Disease Control and Prevention,

16 may, without regard to the provisions of title 5, United

17 States Code, governing appointments in the competitive

18 service, and without regard to the provisions of chapter 51

19 and subchapter III of chapter 53 of such title relating to

20 classification and General Schedule pay rates, establish

21 such technical and scientific peer review groups and sci22 entific program advisory committees as are needed to carry

23 out the functions of such Centers and appoint and pay the

24 members of such groups, except that officers and employees

25 of the United States shall not receive additional compensa26 tion for service as members of such groups. The Federal Ad-
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1 visory Committee Act shall not apply to the duration of

2 such peer review groups. Not more than one-fourth of the

3 members of any such group shall be officers or employees

4 of the United States.

5 ‘‘(b) FELLOWSHIP AND TRAINING PROGRAMS.—The

6 Secretary, acting through the Director of the Centers for

7 Disease Control and Prevention, shall establish fellowship

8 and training programs to be conducted by such Centers to

9 train individuals to develop skills in epidemiology, surveil10 lance, laboratory analysis, and other disease detection and

11 prevention methods. Such programs shall be designed to en12 able health professionals and health personnel trained under

13 such programs to work, after receiving such training, in

14 local, State, national, and international efforts toward the

15 prevention and control of diseases, injuries, and disabilities.

16 Such fellowships and training may be administered through

17 the use of either appointment or nonappointment proce18 dures.’’.

19 (b) EFFECTIVE DATE.—This section is deemed to have

20 taken effect July 1, 1995.

21 SEC. 403. ADMINISTRATION OF CERTAIN REQUIREMENTS.

22 (a) IN GENERAL.—Section 2004 of Public Law 103–

23 43 (107 Stat. 209) is amended by striking subsection (a).
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1 (b) CONFORMING AMENDMENTS.—Section 2004 of

2 Public Law 103–43, as amended by subsection (a) of this

3 section, is amended—

4 (1) by striking ‘‘(b) SENSE’’ and all that follows

5 through ‘‘In the case’’ and inserting the following:

6 ‘‘(a) SENSE OF CONGRESS REGARDING PURCHASE OF

7 AMERICAN-MADE EQUIPMENT AND PRODUCTS.—In the

8 case’’;

9 (2) by striking ‘‘(2) NOTICE TO RECIPIENTS OF

10 ASSISTANCE’’ and inserting the following:

11 ‘‘(b) NOTICE TO RECIPIENTS OF ASSISTANCE’’; and

12 (3) in subsection (b), as redesignated by para13 graph (2) of this subsection, by striking ‘‘paragraph

14 (1)’’ and inserting ‘‘subsection (a)’’.

15 (c) EFFECTIVE DATE.—This section is deemed to have

16 taken effect immediately after the enactment of Public Law

17 103–43.

18 SEC. 404. TECHNICAL CORRECTIONS RELATING TO HEALTH

19 PROFESSIONS PROGRAMS.

20 Part G of title VII of the Public Health Service Act

21 (42 U.S.C. 295j et seq.) is amended by inserting after sec22 tion 794 the following section:

23 ‘‘SEC. 794A. RECOVERY.

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

25 (or within such shorter period as the Secretary may pre-
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1 scribe by regulation for an interim facility) after the com2 pletion of construction of a facility with respect to which

3 funds have been paid under section 720(a) (as such section

4 existed one day prior to the date of enactment of the Health

5 Professions Education Extension Amendments of 1992

6 (Public Law 102–408))—

7 ‘‘(1)(A) in the case of a facility which was an

8 affiliated hospital or outpatient facility with respect

9 to which funds have been paid under such section

10 720(a)(1), the owner of the facility ceases to be a pub11 lic or other nonprofit agency that would have been

12 qualified to file an application under section 605;

13 ‘‘(B) in the case of a facility which was not an

14 affiliated hospital or outpatient facility but was a fa15 cility with respect to which funds have been paid

16 under paragraph (1) or (3) of such section 720(a), the

17 owner of the facility ceases to be a public or nonprofit

18 school; or

19 ‘‘(C) in the case of a facility which was a facil20 ity with respect to which funds have been paid under

21 such section 720(a)(2), the owner of the facility ceases

22 to be a public or nonprofit entity;

23 ‘‘(2) the facility ceases to be used for the teaching

24 or training purposes (or other purposes permitted

25 under section 722 (as such section existed one day
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1 prior to the date of enactment of the Health Profes2 sions Education Extension Amendments of 1992

3 (Public Law 102–408)) for which it was constructed,

4 or

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

6 or as a place for religious worship,

7 the United States shall be entitled to recover from the owner

8 of the facility the base amount prescribed by subsection

9 (c)(1) plus the interest (if any) prescribed by subsection

10 (c)(2).

11 ‘‘(b) NOTICE.—The owner of a facility which ceases to

12 be a public or nonprofit agency, school, or entity as de13 scribed in subparagraph (A), (B), or (C) of subsection

14 (a)(1), as the case may be, or the owner of a facility the

15 use of which changes as described in paragraph (2) or (3)

16 of subsection (a), shall provide the Secretary written notice

17 of such cessation or change of use within 10 days after the

18 date on which such cessation or change of use occurs or

19 within 30 days after the date of enactment of this sub20 section, whichever is later.

21 ‘‘(c) AMOUNT.—

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

23 United States is entitled to recover under subsection

24 (a) is the amount bearing the same ratio to the then

25 value (as determined by the agreement of the parties
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1 or in an action brought in the district court of the

2 United States for the district in which the facility is

3 situated) of the facility as the amount of the Federal

4 participation bore to the cost of construction.

5 ‘‘(2) INTEREST.—

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

7 United States is entitled to recover under sub8 section (a) is the interest for the period (if any)

9 described in subparagraph (B) at a rate (deter10 mined by the Secretary) based on the average of

11 the bond equivalent rates of ninety-one-day

12 Treasury bills auctioned during that period.

13 ‘‘(B) PERIOD.—The period referred to in

14 subparagraph (A) is the period beginning—

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

16 by subsection (b), 191 days after the date on

17 which the owner of the facility ceases to be

18 a public or nonprofit agency, school, or en19 tity as described in subparagraph (A), (B),

20 or (C) of subsection (a)(1), as the case may

21 be, or 191 days after the date on which the

22 use of the facility changes as described in

23 paragraph (2) or (3) of subsection (a); or

24 ‘‘(ii) if notice is not provided as pre25 scribed by subsection (b), 11 days after the
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1 date on which such cessation or change of

2 use occurs,

3 and ending on the date the amount the United

4 States is entitled to recover is collected.

5 ‘‘(d) WAIVER.—The Secretary may waive the recovery

6 rights of the United States under subsection (a)(2) with re7 spect to a facility (under such conditions as the Secretary

8 may establish by regulation) if the Secretary determines

9 that there is good cause for waiving such rights.

10 ‘‘(e) LIEN.—The right of recovery of the United States

11 under subsection (a) shall not, prior to judgment, constitute

12 a lien on any facility.’’.

13 SEC. 405. CLINICAL TRAINEESHIPS.

14 Section 303(d)(1) of the Public Health Service Act (42

15 U.S.C. 242a(d)(1)) is amended by inserting ‘‘counseling,’’

16 after ‘‘family therapy,’’.

17 SEC. 406. CONSTRUCTION OF REGIONAL CENTERS FOR RE18 SEARCH ON PRIMATES.

19 Section 481B(a) of the Public Health Service Act (42

20 U.S.C. 287a–3(a)) is amended by striking ‘‘$5,000,000’’

21 and inserting ‘‘$2,500,000’’.

22 SEC. 407. REQUIRED CONSULTATION BY SECRETARY.

23 The Secretary of Health and Human Services, regard24 ing the programs under parts B, C, D, and E of title VII,
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1 and parts B, C, and D of title VIII, of the Public Health

2 Service Act, as amended by this Act, shall—

3 (1) publish in the Federal Register a general

4 program description for the funding of awards under

5 such parts;

6 (2) solicit and receive written and oral com7 ments concerning such description, including the

8 holding of a public forum at which interested individ9 uals and groups may provide comment; and

10 (3) take into consideration information received

11 under paragraph (2).

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