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[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 555 Engrossed in Senate (ES)]

  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
104th CONGRESS
  2d Session
                                 S. 555

_______________________________________________________________________

                                 AN ACT

 
 To amend the Public Health Service Act to consolidate and reauthorize 
  health professions and minority and disadvantaged health education 
                   programs, and for other purposes.

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

SECTION 1. SHORT TITLE.

    (a) Short Title.--This Act may be cited as the ``Health Professions 
Education Consolidation and Reauthorization Act of 1996''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title.
TITLE I--HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS

           Subtitle A--Health Professions Education Programs

Sec. 101. Minority and disadvantaged health professions grant program.
Sec. 102. Training in family medicine, general internal medicine, 
                            general pediatrics, preventive medicine, 
                            physician assistants, and general 
                            dentistry.
Sec. 103. Enhanced health education and training.
Sec. 104. Health professions workforce development.
Sec. 105. General provisions.
Sec. 106. Preference in certain programs.
Sec. 107. Definitions.
Sec. 108. Savings provision.
                     Subtitle B--Nursing Education

Sec. 121. Short title.
Sec. 122. Purpose.
Sec. 123. Amendments to Public Health Service Act.
Sec. 124. Savings provision.
                    Subtitle C--Financial Assistance

  Part 1--National Health Service Corps Financial Assistance Programs

Sec. 131. General amendments with respect to federally supported loans.
Sec. 132. Restructuring and technical amendments.
Sec. 133. Definition of underserved areas.
Sec. 134. Conforming amendments.
               Part 2--School-based Revolving Loan Funds

Sec. 135. Primary care loan program.
Sec. 136. Loans for disadvantaged students.
Sec. 137. Student loans regarding schools of nursing.
Sec. 138. General provisions.
 Part 3--Insured Health Education Assistance Loans to Graduate Students

Sec. 141. Health education assistance loan program.
Sec. 142. HEAL lender and holder performance standards.
Sec. 143. Reauthorization.
            Part 4--Scholarships for Disadvantaged Students

Sec. 151. Scholarships for disadvantaged students.
                  TITLE II--OFFICE OF MINORITY HEALTH

Sec. 201. Revision and extension of programs of Office of Minority 
                            Health.
                    TITLE III--SELECTED INITIATIVES

Sec. 301. Programs regarding birth defects.
Sec. 302. State offices of rural health.
Sec. 303. Health services for Pacific Islanders.
Sec. 304. Demonstration projects regarding Alzheimer's Disease.
                   TITLE IV--MISCELLANEOUS PROVISIONS

Sec. 401. Technical corrections regarding Public Law 103-183.
Sec. 402. Certain authorities of Centers for Disease Control and 
                            Prevention.
Sec. 403. Administration of certain requirements.
Sec. 404. Technical corrections relating to health professions 
                            programs.
Sec. 405. Clinical traineeships.
Sec. 406. Construction of regional centers for research on primates.
Sec. 407. Required consultation by Secretary.

TITLE I--HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE PROGRAMS

           Subtitle A--Health Professions Education Programs

SEC. 101. MINORITY AND DISADVANTAGED HEALTH PROFESSIONS GRANT PROGRAM.

    (a) In General.--Part B of title VII of the Public Health Service 
Act (42 U.S.C. 293 et seq.) is amended to read as follows:

          ``PART B--DISADVANTAGED HEALTH PROFESSIONS TRAINING

``SEC. 736. STATEMENT OF PURPOSE.

    ``(a) In General.--The Secretary shall make grants to or enter into 
contracts with eligible entities for the purpose of establishing, 
enhancing, and expanding programs to increase the number and the 
quality of disadvantaged health professionals, particularly those who 
provide health services to disadvantaged populations or in medically 
underserved areas or rural areas.
    ``(b) Use of Funds.--Amounts provided under a grant or contract 
awarded under this part may be used for costs of planning, developing, 
or operating centers of excellence in minority health professions 
education, programs for assisting individuals from disadvantaged 
backgrounds to enter a health profession, minority faculty development, 
minority faculty loan repayment or fellowships, trainee support, 
technical assistance, workforce analysis, and dissemination of 
information.
    ``(c) Consortium.--Schools within a consortium that applies for a 
grant or contract under this part shall enter into an agreement to 
allocate the funds received under the grant or contract among such 
schools and expend such funds in accordance with the application for 
such grant or contract.

``SEC. 737. PREFERENCES.

    ``In awarding grants or contracts to eligible entities under this 
part, the Secretary shall give preference to--
            ``(1) projects that involve more than one health 
        professions discipline or training institution and have an 
        above average record of retention and graduation of individuals 
        from disadvantaged backgrounds; and
            ``(2) centers of excellence at Historically Black Colleges 
        and Universities (as defined in section 739) beginning in 
        fiscal year 1999 and for each fiscal year thereafter.

``SEC. 738. AUTHORIZATION OF APPROPRIATION.

    ``(a) In General.--There are authorized to be appropriated to carry 
out this part, $51,000,000 for fiscal year 1996, and such sums as may 
be necessary for each of the fiscal years 1997 through 1999.
    ``(b) Set-Aside.--The Secretary shall set-aside $12,000,000 of the 
amount appropriated under subsection (a) in each fiscal year for the 
purpose of making grants under section 736 to centers of excellence at 
certain Historically Black Colleges and Universities.
    ``(c) No Limitation.--Nothing in this section shall be construed as 
limiting the centers of excellence referred to in subsection (b) to the 
set-aside amount, or to preclude such entities from competing for other 
grants under section 736.

``SEC. 739. DEFINITIONS.

    ``As used in this part:
            ``(1) Centers of excellence.--The term `centers of 
        excellence' means a health professions school that--
                    ``(A)(i) has a significant number of minority 
                individuals enrolled in the school, including 
                individuals accepted for enrollment in the school;
                    ``(ii) has been effective in assisting minority 
                students of the school to complete the program of 
                education and receive the degree involved;
                    ``(iii) has been effective in recruiting minority 
                individuals to attend the school and encouraging 
                minority students of secondary educational institutions 
                to attend the health professions school; and
                    ``(iv) has made significant recruitment efforts to 
                increase the number of minority individuals serving in 
                faculty or administrative positions at the school; or
                    ``(B) is a center of excellence at certain 
                Historically Black Colleges and Universities.
            ``(2) Consortium.--The term `consortium' means the 
        designated eligible entity seeking a grant under this part and 
        one or more schools of medicine, osteopathic medicine, 
        dentistry, pharmacy, nursing, allied health, public health, or 
        graduate programs in mental health practice.
            ``(3) Eligible entities.--The term `eligible entities' 
        means schools of medicine, osteopathic medicine, dentistry, 
        pharmacy, podiatric medicine, optometry, veterinary medicine, 
        public health, or allied health or schools offering graduate 
        programs in mental health practice, State or local governments, 
        and other public or nonprofit private entities determined 
        appropriate by the Secretary that submit to the Secretary an 
        application.
            ``(4) Historically black colleges and universities.--The 
        term `Historically Black Colleges and Universities' means a 
        school described in section 799B(1) that has received a 
        contract under section 788B for fiscal year 1987, as such 
        section was in effect for such fiscal year.''.
    (b) Repeal.--
            (1) In general.--Section 795 of the Public Health Service 
        Act (42 U.S.C. 295n) is repealed.
            (2) Nontermination of authority.--The amendments made by 
        this section shall not be construed to terminate agreements 
        that, on the day before the date of enactment of this Act, are 
        in effect pursuant to section 795 of the Public Health Service 
        Act (42 U.S.C. 795) as such section existed on such date. Such 
        agreements shall continue in effect in accordance with the 
        terms of the agreements. With respect to compliance with such 
        agreements, any period of practice as a provider of primary 
        health services shall be counted towards the satisfaction of 
        the requirement of practice pursuant to such section 795.
    (c) Conforming Amendments.--Section 481A(c)(3)(D)(i) of the Public 
Health Service Act (42 U.S.C. 287a-2(c)(3)(D)(i)) is amended by 
striking ``section 739'' and inserting ``part B of title VII''.

SEC. 102. TRAINING IN FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, 
              GENERAL PEDIATRICS, PREVENTIVE MEDICINE, PHYSICIAN 
              ASSISTANTS, AND GENERAL DENTISTRY.

    Part C of title VII of the Public Health Service Act (42 U.S.C. 293 
et seq.) is amended--
            (1) in the part heading by striking ``PRIMARY HEALTH CARE'' 
        and inserting ``FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, 
        GENERAL PEDIATRICS, PREVENTIVE MEDICINE, PHYSICIAN ASSISTANTS, 
        AND GENERAL DENTISTRY'';
            (2) by repealing section 746 and sections 748 through 752 
        (42 U.S.C. 293j and 293l through 293p); and
            (3) in section 747 (42 U.S.C. 293k)--
                    (A) by striking the section heading and inserting 
                the following:

``SEC. 747. FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, GENERAL 
              PEDIATRICS, PREVENTIVE MEDICINE, GENERAL DENTISTRY, AND 
              PHYSICIAN ASSISTANTS.'';

                    (B) in subsection (a)--
                            (i) in paragraph (1)--
                                    (I) by inserting ``, internal 
                                medicine, or pediatrics'' after 
                                ``family medicine''; and
                                    (II) by inserting before the 
                                semicolon the following: ``that 
                                emphasizes training for the practice of 
                                family medicine, general internal 
                                medicine, or general pediatrics (as 
                                defined by the Secretary)'';
                            (ii) in paragraph (2), by inserting ``, 
                        general internal medicine, or general 
                        pediatrics'' before the semicolon;
                            (iii) in paragraphs (3) and (4), by 
                        inserting ``, general internal medicine 
                        (including geriatrics), or general pediatrics'' 
                        after ``family medicine'';
                            (iv) in paragraphs (3) and (4), by 
                        inserting ``(including geriatrics) after 
                        ``family medicine'';
                            (v) in paragraph (3), by striking ``and'' 
                        at the end thereof;
                            (vi) in paragraph (4), by striking the 
                        period and inserting a semicolon; and
                            (vii) by adding at the end thereof the 
                        following new paragraphs:
            ``(5) to meet the costs of projects to plan, develop, and 
        operate or maintain programs for the training of physician 
        assistants (as defined in section 799B), and for the training 
        of individuals who will teach in programs to provide such 
        training;
            ``(6) to meet the costs of projects--
                    ``(A) to plan and develop new residency training 
                programs and to maintain or improve existing residency 
                training programs in preventive medicine, that have 
                available full-time faculty members with training and 
                experience in the fields of preventive medicine; and
                    ``(B) to provide financial assistance to residency 
                trainees enrolled in such programs; and
            ``(7) to meet the costs of planning, developing, or 
        operating programs, and to provide financial assistance to 
        residents in such programs, that would lead to a significantly 
        greater ratio of participating individuals in such programs 
        eventually entering practice in general dentistry in rural and 
        medically underserved communities compared to the current ratio 
        of all dentists nationally practicing general dentistry in 
        rural and medically underserved communities.
For purposes of paragraph (7), entities eligible for such grants or 
contracts shall include entities that have programs in dental schools, 
approved residency programs in the general practice of dentistry, or 
approved advanced education programs in the general practice of 
dentistry. The Secretary may only fund programs under such paragraph if 
such programs provide a significant amount of care for underserved 
populations and other high-risk groups.'';
                    (C) in paragraphs (1) and (2)(A) of subsection (b), 
                by inserting ``, general internal medicine, or general 
                pediatrics'' after ``family medicine'';
                    (D) by redesignating subsections (c) and (d) as 
                subsections (d) and (e), respectively;
                    (E) by inserting after subsection (b), the 
                following new subsection:
    ``(c) Priority and Limitation.--
            ``(1) Priority.--With respect to programs for the training 
        of interns or residents, the Secretary shall give priority in 
        awarding grants under this section to qualified applicants that 
        have a record of training the greatest percentage of providers, 
        or that have demonstrated significant improvements in the 
        percentage of providers, which enter and remain in primary care 
        practice or general dentistry upon completion of their first 
        period of training required to obtain initial board 
        certification. Each program shall designate the primary care 
        training or general dentistry positions that such program shall 
        provide with grant funding to support and for which such 
        program shall be held accountable regarding the primary care or 
        general dentistry requirement set forth in this section.
            ``(2) Limitation.--With respect to programs for the 
        training and education of medical students, the Secretary may 
        only provide grants or contracts under this section to 
        administrative units in general pediatrics or general internal 
        medicine if a qualified administrative unit applicant 
        demonstrates that its medical school has--
                    ``(A) a mission statement that has a primary care 
                medical education objective;
                    ``(B) faculty role models and administrative units 
                in primary care; and
                    ``(C) required undergraduate ambulatory medical 
                student clerkships in family medicine, internal 
                medicine, and pediatrics.
        Where a medical school does not have an administrative unit in 
        family medicine, clerkships in family medicine shall not be 
        required.''; and
                    (F) in subsection (e) (as so redesignated by 
                subparagraph (D))--
                            (i) in paragraph (1), by striking 
                        ``$54,000,000'' and all that follows and 
                        inserting ``$76,000,000 for fiscal year 1996, 
                        and such sums as may be necessary for each of 
                        the fiscal years 1997 through 1999.''; and
                            (ii) in paragraph (2)--
                                    (I) by striking ``20'' and 
                                inserting ``12''; and
                                    (II) by inserting ``for family 
                                medicine academic administrative 
                                units'' after ``under subsection (b)''.

SEC. 103. ENHANCED HEALTH EDUCATION AND TRAINING.

    Part D of title VII of the Public Health Service Act (42 U.S.C. 294 
et seq.) is amended to read as follows:

                ``PART D--AREA HEALTH EDUCATION CENTERS

``SEC. 750. AREA HEALTH EDUCATION CENTERS.

    ``(a) In General.--The Secretary may award grants to and enter into 
contracts with eligible entities for projects which --
            ``(1) improve the recruitment, distribution, supply, 
        quality, utilization, and efficiency of personnel providing 
        health services in urban and rural areas and to populations 
        that have demonstrated serious unmet health care need;
            ``(2) encourage the regionalization of educational 
        responsibilities of the health professions schools;
            ``(3) are designed to prepare, through field placements, 
        preceptorships, the conduct of or affiliation with community-
        based primary care residency programs, agreements with 
        community-based organizations for the delivery of education and 
        training in the health professions, and other programs, 
        individuals to effectively provide health services in health 
        professional shortage areas;
            ``(4) conduct health professions education and training 
        activities consistent with national and State priorities, 
        including geriatrics;
            ``(5) encourage health promotion and disease prevention 
        activities;
            ``(6) conduct interdisciplinary training and practice 
        involving other health professionals;
            ``(7) conduct continuing education programs for health 
        professionals or coordinate with such programs; and
            ``(8) address other areas as determined appropriate by the 
        Secretary.
    ``(b) Other Eligible Programs.--
            ``(1) Geriatric education centers.--The Secretary shall 
        award grants or contracts under this section for the 
        establishment or operation of geriatric education centers.
            ``(2) Public health training centers.--
                    ``(A) In general.--The Secretary shall award grants 
                or contracts under this section for the operation of 
                public health training centers.
                    ``(B) Eligible entities.--A public health training 
                center shall be an accredited school of public health, 
                or another public or nonprofit private institution 
                accredited for the provision of graduate or specialized 
                training in public health, that plans, develops, 
                operates, and evaluates projects that are in 
                furtherance of the goals established by the Secretary 
                for the year 2000 in the areas of preventive medicine, 
                health promotion and disease prevention, or improving 
                access to and quality of health services in medically 
                underserved communities.
                    ``(C) Certain requirements.--With respect to a 
                public health training center, an award may not be made 
                under subparagraph (A) unless the program agrees that 
                it--
                            ``(i) will establish or strengthen field 
                        placements for students in public or nonprofit 
                        private health agencies or organizations; and
                            ``(ii) will involve faculty members and 
                        students in collaborative projects to enhance 
                        public health services to medically underserved 
                        communities.
    ``(c) Eligible Entities.--As used in this part, the term `eligible 
entities' means schools of medicine, osteopathic medicine, dentistry, 
pharmacy, podiatric medicine, optometry, veterinary medicine, public 
health, or allied health or schools offering graduate programs in 
mental health practice or physician assistant training programs, State 
or local governments, and other public or nonprofit private entities 
determined appropriate by the Secretary that submit to the Secretary an 
application.
    ``(d) Geriatric Education Centers.--A geriatric education center 
shall be an accredited health professions school or program that--
            ``(1) improves the training of health professionals in 
        geriatrics, including geriatric residencies, traineeships, or 
        fellowships;
            ``(2) develops and disseminates curricula relating to the 
        treatment of the health problems of elderly individuals;
            ``(3) supports the training and retraining of faculty to 
        provide instruction in geriatrics;
            ``(4) supports continuing education of health professionals 
        who provide geriatric care; and
            ``(5) provides students with clinical training in 
        geriatrics in nursing homes, chronic and acute disease 
        hospitals, ambulatory care centers, and senior centers.

``SEC. 751. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated to carry out this part, 
$43,000,000 for fiscal year 1996, such sums as may be necessary for 
each of the fiscal years 1997 and 1998, and $29,000,000 for fiscal year 
1999.''.

SEC. 104. HEALTH PROFESSIONS WORKFORCE DEVELOPMENT.

    (a) In General.--Part E of title VII of the Public Health Service 
Act (42 U.S.C. 294n et seq.) is amended--
            (1) in the part heading to read as follows:

         ``PART E--HEALTH PROFESSIONS WORKFORCE DEVELOPMENT'';

            (2) by redesignating section 776 (42 U.S.C. 294n) as 
        section 761; and
            (3) by striking sections 777 and 778 (42 U.S.C. 294o and 
        294p) and inserting the following new section:

``SEC. 762. HEALTH PROFESSIONS WORKFORCE DEVELOPMENT.

    ``(a) In General.--The Secretary may award grants to and enter into 
contracts with eligible entities for projects to strengthen capacity 
for health professions education and practice.
    ``(b) Eligible Applicants.--Applicants eligible to obtain funds 
under subsection (a) shall include schools of medicine, osteopathic 
medicine, dentistry, veterinary medicine, pharmacy, podiatric medicine, 
chiropractic medicine, optometry, public health, or allied health, 
graduate programs in mental health practice, physician assistant 
training programs, and other public and nonprofit private entities.
    ``(c) Priority Areas.--In awarding grants or contracts under 
subsection (a), the Secretary shall give priority to entities that will 
use amounts provided under such grants or contracts to enhance the 
education of health professionals for purposes of--
            ``(1) providing care for underserved populations and other 
        high-risk groups;
            ``(2) increasing the number of individuals who are pursuing 
        a course of study in a health professions field in which there 
        is a severe shortage of health professionals;
            ``(3) conducting health professions research and data 
        collection; and
            ``(4) carrying out other activities in areas determined 
        appropriate by the Secretary.
    ``(d) Authorization of Appropriations.--
            ``(1) In general.--There are authorized to be appropriated 
        to carry out this section, $16,000,000 for fiscal year 1996, 
        and such sums as may be necessary for each of the fiscal years 
        1997 through 1999.
            ``(2) Reservation.--Of the amounts appropriated under 
        subsection (a) for a fiscal year, the Secretary shall reserve 
        not less than $2,000,000 for conducting health professions 
        research and for carrying out data collection and analysis in 
        accordance with section 792.''.
    (b) Health Professions Data.--The second sentence of section 792(a) 
of the Public Health Service Act (42 U.S.C. 295k(a)) is amended--
            (1) by striking ``is authorized to'' and inserting 
        ``shall''; and
            (2) by inserting ``clinical social workers,'' after 
        ``clinical psychologists,''.
    (c) Council on Graduate Medical Education.--Section 301 of the 
Health Professions Education Extension Amendments of 1992 (Public Law 
102-408) is amended--
            (1) in subsection (j), by striking ``1995'' and inserting 
        ``1999'';
            (2) in subsection (k), by striking ``1995'' and inserting 
        ``1999'';
            (3) by adding at the end thereof the following new 
        subsection:
    ``(l) Funding.--Amounts otherwise appropriated under this title may 
be utilized by the Secretary to support the activities of the 
Council.'';
            (4) by transferring such section to part E of title VII of 
        the Public Health Service Act (as amended by subsection (a));
            (5) by redesignating such section as section 763; and
            (6) by inserting such section after section 762.

SEC. 105. GENERAL PROVISIONS.

    (a) In General.--
            (1) Part F of title VII of the Public Health Service Act 
        (42 U.S.C. 295 et seq.) is repealed.
            (2) Part G of title VII of the Public Health Service Act 
        (42 U.S.C. 295j et seq.) is amended--
                    (A) by redesignating such part as part F;
                    (B) in section 791 (42 U.S.C. 295j)--
                            (i) by striking subsection (b); and
                            (ii) redesignating subsection (c) as 
                        subsection (b);
                    (C) by repealing section 793 (42 U.S.C. 295l);
                    (D) by repealing section 798;
                    (E) by redesignating section 799 as section 799B; 
                and
                    (F) by inserting after section 794, the following 
                new sections:

``SEC. 796. APPLICATION.

    ``(a) In General.--To be eligible to receive a grant or contract 
under this title, an eligible entity shall prepare and submit to the 
Secretary an application that meets the requirements of this section, 
at such time, in such manner, and containing such information as the 
Secretary may require.
    ``(b) Plan.--An application submitted under this section shall 
contain the plan of the applicant for carrying out a project with 
amounts received under this title. Such plan shall be consistent with 
relevant Federal, State, or regional program plans.
    ``(c) Performance Outcome Standards.--An application submitted 
under this section shall contain a specification by the applicant 
entity of performance outcome standards that the project to be funded 
under the grant or contract will be measured against. Such standards 
shall address relevant health workforce needs that the project will 
meet. The recipient of a grant or contract under this section shall 
meet the standards set forth in the grant or contract application.
    ``(d) Linkages.--An application submitted under this section shall 
contain a description of the linkages with relevant educational and 
health care entities, including training programs for other health 
professionals as appropriate, that the project to be funded under the 
grant or contract will establish.

``SEC. 797. USE OF FUNDS.

    ``(a) In General.--Amounts provided under a grant or contract 
awarded under this title may be used for training program development 
and support, faculty development, model demonstrations, trainee support 
including tuition, books, program fees and reasonable living expenses 
during the period of training, technical assistance, workforce 
analysis, and dissemination of information, as appropriate to meet 
recognized health workforce objectives, in accordance with this title.
    ``(b) Maintenance of Effort.--With respect to activities for which 
a grant awarded under this title is to be expended, the entity shall 
agree to maintain expenditures of non-Federal amounts for such 
activities at a level that is not less than the level of such 
expenditures maintained by the entity for the fiscal year preceding the 
fiscal year for which the entity receives such a grant.

``SEC. 798. MATCHING REQUIREMENT.

    ``The Secretary may require that an entity that applies for a grant 
or contract under this title provide non-Federal matching funds, as 
appropriate, to ensure the institutional commitment of the entity to 
the projects funded under the grant. As determined by the Secretary, 
such non-Federal matching funds may be provided directly or through 
donations from public or private entities and may be in cash or in-
kind, fairly evaluated, including plant, equipment, or services.

``SEC. 799. GENERALLY APPLICABLE PROVISIONS.

    ``(a) Awarding of Grants and Contracts.--The Secretary shall ensure 
that grants and contracts under this title are awarded on a competitive 
basis, as appropriate, to carry out innovative demonstration projects 
or provide for strategic workforce supplementation activities as needed 
to meet health workforce goals and in accordance with this title. 
Contracts may be entered into under this title with public or private 
entities as may be necessary.
    ``(b) Information Requirements.--Recipients of grants and contracts 
under this title shall meet information requirements as specified by 
the Secretary.
    ``(c) Training Programs.--Training programs conducted with amounts 
received under this title shall meet applicable accreditation and 
quality standards.
    ``(d) Duration of Assistance.--
            ``(1) In general.--Subject to paragraph (2), in the case of 
        an award to an entity of a grant, cooperative agreement, or 
        contract under this title, the period during which payments are 
        made to the entity under the award may not exceed 5 years. The 
        provision of payments under the award shall be subject to 
        annual approval by the Secretary of the payments and subject to 
        the availability of appropriations for the fiscal year involved 
        to make the payments. This paragraph may not be construed as 
        limiting the number of awards under the program involved that 
        may be made to the entity.
            ``(2) Limitation.--In the case of an award to an entity of 
        a grant, cooperative agreement, or contract under this title, 
        paragraph (1) shall apply only to the extent not inconsistent 
        with any other provision of this title that relates to the 
        period during which payments may be made under the award.
    ``(e) Peer Review Regarding Certain Programs.--Each application for 
a grant under this title, except any scholarship or loan program, 
including those under sections 701, 721, or 723, shall be submitted to 
a peer review group for an evaluation of the merits of the proposals 
made in the application. The Secretary may not approve such an 
application unless a peer review group has recommended the application 
for approval. Each peer review group under this subsection shall be 
composed principally of individuals who are not officers or employees 
of the Federal Government. This subsection shall be carried out by the 
Secretary acting through the Administrator of the Health Resources and 
Services Administration.
    ``(f) Preference or priority Considerations.--In considering a 
preference or priority for funding which is based on outcome measures 
for an eligible entity under this title, the Secretary may also 
consider the future ability of the eligible entity to meet the outcome 
preference or priority through improvements in the eligible entity's 
program design.

``SEC. 799A. TECHNICAL ASSISTANCE.

    ``Funds appropriated under this title may be used by the Secretary 
to provide technical assistance in relation to any of the authorities 
under this title.''.

SEC. 106. PREFERENCE IN CERTAIN PROGRAMS.

    (a) In General.--Section 791 of the Public Health Service Act (42 
U.S.C. 295j), as amended by section 105(a)(2)(B), is further amended by 
adding at the end thereof the following subsection:
    ``(c) Exceptions for New Programs.--
            ``(1) In general.--To permit new programs to compete 
        equitably for funding under this section, those new programs 
        that meet the criteria described in paragraph (3) shall qualify 
        for a funding preference under this section.
            ``(2) Definition.--As used in this subsection, the term 
        `new program' means any program that has graduated less than 
        three classes. Upon graduating at least three classes, a 
        program shall have the capability to provide the information 
        necessary to qualify the program for the general funding 
        preferences described in subsection (a).
            ``(3) Criteria.--The criteria referred to in paragraph (1) 
        are the following:
                    ``(A) The mission statement of the program 
                identifies a specific purpose of the program as being 
                the preparation of health professionals to serve 
                underserved populations.
                    ``(B) The curriculum of the program includes 
                content which will help to prepare practitioners to 
                serve underserved populations.
                    ``(C) Substantial clinical training experience is 
                required under the program in medically underserved 
                communities.
                    ``(D) A minimum of 20 percent of the clinical 
                faculty of the program spend at least 50 percent of 
                their time providing or supervising care in medically 
                underserved communities.
                    ``(E) The entire program or a substantial portion 
                of the program is physically located in a medically 
                underserved community.
                    ``(F) Student assistance, which is linked to 
                service in medically underserved communities following 
                graduation, is available to the students in the 
                program.
                    ``(G) The program provides a placement mechanism 
                for deploying graduates to medically underserved 
                communities.''.
    (b) Conforming Amendments.--Section 791(a) of the Public Health 
Service Act (42 U.S.C. 295j(a)) is amended--
            (1) in paragraph (1), by striking ``sections 747'' and all 
        that follows through ``767'' and inserting ``sections 747 and 
        750''; and
            (2) in paragraph (2), by striking ``under section 798(a)''.

SEC. 107. DEFINITIONS.

    (a) Professional Psychology.--Section 799B(1)(B) of the Public 
Health Service Act (42 U.S.C. 295p(1)(B)) (as so redesignated by 
section 105(a)(2)(E)) is amended by striking ``program in clinical 
psychology'' and inserting ``graduate programs in professional 
psychology''.
    (b) Medically Underserved Community.--Section 799B(6) of the Public 
Health Service Act (42 U.S.C. 295p(6)) (as so redesignated by section 
105(a)(2)(E)) is amended--
            (1) in subparagraph (B), by striking ``or'' at the end 
        thereof;
            (2) in subparagraph (C), by striking the period and 
        inserting a semicolon; and
            (3) by adding at the end the following new subparagraphs:
                    ``(D) is a State or local health department that 
                has a severe shortage of public health personnel as 
                determined under criteria established by the Secretary;
                    ``(E) has ambulatory practice sites designated by 
                State Governors as shortage areas or medically 
                underserved communities for purposes of State 
                scholarships or loan repayment or related programs; or
                    ``(F) has practices or facilities in which not less 
                than 50 percent of the patients are recipients of aid 
                under title XIX of the Social Security Act or eligible 
                and uninsured.''.
    (c) Programs for the Training of Physician Assistants.--Paragraph 
(3) of section 799B of the Public Health Service Act (42 U.S.C. 295p) 
(as so redesignated by section 105(a)(2)(E)) is amended to read as 
follows:
            ``(3) The term `program for the training of physician 
        assistants' means an educational program that--
                    ``(A) has as its objective the education of 
                individuals who will, upon completion of their studies 
                in the program, be qualified to provide primary care 
                under the supervision of a physician;
                    ``(B) extends for at least one academic year and 
                consists of--
                            ``(i) supervised clinical practice; and
                            ``(ii) at least four months (in the 
                        aggregate) of classroom instruction, directed 
                        toward preparing students to deliver health 
                        care;
                    ``(C) has an enrollment of not less than eight 
                students; and
                    ``(D) trains students in primary care, disease 
                prevention, health promotion, geriatric medicine, and 
                home health care.''.

SEC. 108. SAVINGS PROVISION.

    In the case of any authority for making awards of grants or 
contracts that is terminated by the amendments made by this subtitle, 
the Secretary of Health and Human Services may, notwithstanding the 
termination of the authority, continue in effect any grant or contract 
made under the authority that is in effect on the day before the date 
of the enactment of this Act, subject to the duration of any such grant 
or contract not exceeding the period determined by the Secretary in 
first approving such financial assistance, or in approving the most 
recent request made (before the date of such enactment) for 
continuation of such assistance, as the case may be.

                     Subtitle B--Nursing Education

SEC. 121. SHORT TITLE.

    This title may be cited as the ``Nursing Education Consolidation 
and Reauthorization Act of 1996''.

SEC. 122. PURPOSE.

    It is the purpose of this title to restructure the nurse education 
authorities of title VIII of the Public Health Service Act to permit a 
comprehensive, flexible, and effective approach to Federal support for 
nursing workforce development.

SEC. 123. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.

    Title VIII of the Public Health Service Act (42 U.S.C. 296k et 
seq.) is amended--
            (1) by striking the title heading and all that follows 
        except for subparts II and III of part B and section 855; and 
        inserting the following:

             ``TITLE VIII--NURSING WORKFORCE DEVELOPMENT'';

            (2) by redesignating subpart III of part B as subpart II;
            (3) in subpart II of part B, by striking the subpart 
        heading and inserting the following:

                        ``PART E--STUDENT LOANS

                    ``Subpart I--General Program'';

            (4) by striking section 837;
            (5) by inserting after the title heading the following new 
        parts:

                      ``PART A--GENERAL PROVISIONS

``SEC. 801. DEFINITIONS.

    ``As used in this title:
            ``(1) Eligible entities.--The term `eligible entities' 
        means schools of nursing, nursing centers, State or local 
        governments, and other public or nonprofit private entities 
        determined appropriate by the Secretary that submit to the 
        Secretary an application in accordance with section 802.
            ``(2) School of nursing.--The term `school of nursing' 
        means a collegiate, associate degree, or diploma school of 
        nursing in a State.
            ``(3) Collegiate school of nursing.--The term `collegiate 
        school of nursing' means a department, division, or other 
        administrative unit in a college or university which provides 
        primarily or exclusively a program of education in professional 
        nursing and related subjects leading to the degree of bachelor 
        of arts, bachelor of science, bachelor of nursing, or to an 
        equivalent degree, or to a graduate degree in nursing, and 
        including advanced training related to such program of 
        education provided by such school, but only if such program, or 
        such unit, college or university is accredited.
            ``(4) Associate degree school of nursing.--The term 
        `associate degree school of nursing' means a department, 
        division, or other administrative unit in a junior college, 
        community college, college, or university which provides 
        primarily or exclusively a two-year program of education in 
        professional nursing and allied subjects leading to an 
        associate degree in nursing or to an equivalent degree, but 
        only if such program, or such unit, college, or university is 
        accredited.
            ``(5) Diploma school of nursing.--The term `diploma school 
        of nursing' means a school affiliated with a hospital or 
        university, or an independent school, which provides primarily 
        or exclusively a program of education in professional nursing 
        and allied subjects leading to a diploma or to equivalent 
        indicia that such program has been satisfactorily completed, 
        but only if such program, or such affiliated school or such 
        hospital or university or such independent school is 
        accredited.
            ``(6) Accredited.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), the term `accredited' when applied to 
                any program of nurse education means a program 
                accredited by a recognized body or bodies, or by a 
                State agency, approved for such purpose by the 
                Secretary of Education and when applied to a hospital, 
                school, college, or university (or a unit thereof) 
                means a hospital, school, college, or university (or a 
                unit thereof) which is accredited by a recognized body 
                or bodies, or by a State agency, approved for such 
                purpose by the Secretary of Education. For the purpose 
                of this paragraph, the Secretary of Education shall 
                publish a list of recognized accrediting bodies, and of 
                State agencies, which the Secretary of Education 
                determines to be reliable authority as to the quality 
                of education offered.
                    ``(B) New programs.--A new school of nursing that, 
                by reason of an insufficient period of operation, is 
                not, at the time of the submission of an application 
                for a grant or contract under this title, eligible for 
                accreditation by such a recognized body or bodies or 
                State agency, shall be deemed accredited for purposes 
                of this title if the Secretary of Education finds, 
                after consultation with the appropriate accreditation 
                body or bodies, that there is reasonable assurance that 
                the school will meet the accreditation standards of 
                such body or bodies prior to the beginning of the 
                academic year following the normal graduation date of 
                students of the first entering class in such school.
            ``(7) Nonprofit.--The term `nonprofit' as applied to any 
        school, agency, organization, or institution means one which is 
        a corporation or association, or is owned and operated by one 
        or more corporations or associations, no part of the net 
        earnings of which inures, or may lawfully inure, to the benefit 
        of any private shareholder or individual.
            ``(8) State.--The term `State' means a State, the 
        Commonwealth of Puerto Rico, the District of Columbia, the 
        Commonwealth of the Northern Mariana Islands, Guam, American 
        Samoa, the Virgin Islands, or the Trust Territory of the 
        Pacific Islands.

``SEC. 802. APPLICATION.

    ``(a) In General.--To be eligible to receive a grant or contract 
under this title, an eligible entity shall prepare and submit to the 
Secretary an application that meets the requirements of this section, 
at such time, in such manner, and containing such information as the 
Secretary may require.
    ``(b) Plan.--An application submitted under this section shall 
contain the plan of the applicant for carrying out a project with 
amounts received under this title. Such plan shall be consistent with 
relevant Federal, State, or regional program plans.
    ``(c) Performance Outcome Standards.--An application submitted 
under this section shall contain a specification by the applicant 
entity of performance outcome standards that the project to be funded 
under the grant or contract will be measured against. Such standards 
shall address relevant national nursing needs that the project will 
meet. The recipient of a grant or contract under this section shall 
meet the standards set forth in the grant or contract application.
    ``(d) Linkages.--An application submitted under this section shall 
contain a description of the linkages with relevant educational and 
health care entities, including training programs for other health 
professionals as appropriate, that the project to be funded under the 
grant or contract will establish.

``SEC. 803. USE OF FUNDS.

    ``(a) In General.--Amounts provided under a grant or contract 
awarded under this title may be used for training program development 
and support, faculty development, model demonstrations, trainee support 
including tuition, books, program fees and reasonable living expenses 
during the period of training, technical assistance, workforce 
analysis, and dissemination of information, as appropriate to meet 
recognized nursing objectives, in accordance with this title.
    ``(b) Maintenance of Effort.--With respect to activities for which 
a grant awarded under this title is to be expended, the entity shall 
agree to maintain expenditures of non-Federal amounts for such 
activities at a level that is not less than the level of such 
expenditures maintained by the entity for the fiscal year preceding the 
fiscal year for which the entity receives such a grant.

``SEC. 804. MATCHING REQUIREMENT.

    ``The Secretary may require that an entity that applies for a grant 
or contract under this title provide non-Federal matching funds, as 
appropriate, to ensure the institutional commitment of the entity to 
the projects funded under the grant. Such non-Federal matching funds 
may be provided directly or through donations from public or private 
entities and may be in cash or in-kind, fairly evaluated, including 
plant, equipment, or services.

``SEC. 805. PREFERENCE.

    ``In awarding grants or contracts under this title, the Secretary 
shall give preference to applicants with projects that will 
substantially benefit rural or underserved populations, or help meet 
public health nursing needs in State or local health departments.

``SEC. 806. GENERALLY APPLICABLE PROVISIONS.

    ``(a) Awarding of Grants and Contracts.--The Secretary shall ensure 
that grants and contracts under this title are awarded on a competitive 
basis, as appropriate, to carry out innovative demonstration projects 
or provide for strategic workforce supplementation activities as needed 
to meet national nursing service goals and in accordance with this 
title. Contracts may be entered into under this title with public or 
private entities as determined necessary by the Secretary.
    ``(b) Information Requirements.--Recipients of grants and contracts 
under this title shall meet information requirements as specified by 
the Secretary.
    ``(c) Training Programs.--Training programs conducted with amounts 
received under this title shall meet applicable accreditation and 
quality standards.
    ``(d) Duration of Assistance.--
            ``(1) In general.--Subject to paragraph (2), in the case of 
        an award to an entity of a grant, cooperative agreement, or 
        contract under this title, the period during which payments are 
        made to the entity under the award may not exceed 5 years. The 
        provision of payments under the award shall be subject to 
        annual approval by the Secretary of the payments and subject to 
        the availability of appropriations for the fiscal year involved 
        to make the payments. This paragraph may not be construed as 
        limiting the number of awards under the program involved that 
        may be made to the entity.
            ``(2) Limitation.--In the case of an award to an entity of 
        a grant, cooperative agreement, or contract under this title, 
        paragraph (1) shall apply only to the extent not inconsistent 
        with any other provision of this title that relates to the 
        period during which payments may be made under the award.
    ``(e) Peer Review Regarding Certain Programs.--Each application for 
a grant under this title, except advanced nurse traineeship grants 
under section 811(a)(2), shall be submitted to a peer review group for 
an evaluation of the merits of the proposals made in the application. 
The Secretary may not approve such an application unless a peer review 
group has recommended the application for approval. Each peer review 
group under this subsection shall be composed principally of 
individuals who are not officers or employees of the Federal 
Government. This subsection shall be carried out by the Secretary 
acting through the Administrator of the Health Resources and Services 
Administration.

``SEC. 807. NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND PRACTICE.

    ``(a) Establishment.--There is hereby established a National 
Advisory Council on Nurse Education and Practice (in this section 
referred to as the `Council'), consisting of the Secretary or the 
delegate of the Secretary (who shall be an ex officio member and shall 
serve as the Chairperson), and 15 members appointed by the Secretary 
without regard to the Federal civil service laws, of which--
            ``(1) 2 shall be selected from full-time students enrolled 
        in schools of nursing;
            ``(2) 3 shall be selected from the general public;
            ``(3) 2 shall be selected from practicing professional 
        nurses; and
            ``(4) 8 shall be selected from among the leading 
        authorities in the various fields of nursing, higher, and 
        secondary education, and from representatives of hospitals and 
        other institutions and organizations which provide nursing 
        services.
A majority of the members shall be nurses. The student-members of the 
Council shall be appointed for terms of one year and shall be eligible 
for reappointment to the Council.
    ``(b) Duties.--The Council shall advise the Secretary in the 
preparation of general regulations and with respect to policy matters 
arising in the administration of this title, including the range of 
issues relating to nurse supply, education and practice improvement.
    ``(c) Funding.--Amounts appropriated under this title may be 
utilized by the Secretary to support the nurse education and practice 
activities of the Council.

``SEC. 808. TECHNICAL ASSISTANCE.

    ``Funds appropriated under this title may be used by the Secretary 
to provide technical assistance in relation to any of the authorities 
under this title.

``SEC. 809. RECOVERY FOR CONSTRUCTION ASSISTANCE.

    ``(a) In General.--If at any time within 20 years (or within such 
shorter period as the Secretary may prescribe by regulation for an 
interim facility) after the completion of construction of a facility 
with respect to which funds have been paid under subpart I of part A 
(as such subpart was in effect on September 30, 1985)--
            ``(1) the owner of the facility ceases to be a public or 
        nonprofit school;
            ``(2) the facility ceases to be used for the training 
        purposes for which it was constructed; or
            ``(3) the facility is used for sectarian instruction or as 
        a place for religious worship,
the United States shall be entitled to recover from the owner of the 
facility the base amount prescribed by subsection (c)(1) plus the 
interest (if any) prescribed by subsection (c)(2).
    ``(b) Notice of Change in Status.--The owner of a facility which 
ceases to be a public or nonprofit school as described in paragraph (1) 
of subsection (a), or the owner of a facility the use of which changes 
as described in paragraph (2) or (3) of such subsection shall provide 
the Secretary written notice of such cessation or change of use within 
10 days after the date on which such cessation or change of use occurs 
or within 30 days after the date of enactment of the Health Professions 
Training Assistance Act of 1985, whichever is later.
    ``(c) Amount of Recovery.--
            ``(1) Base amount.--The base amount that the United States 
        is entitled to recover under subsection (a) is the amount 
        bearing the same ratio to the then value (as determined by the 
        agreement of the parties or in an action brought in the 
        district court of the United States for the district in which 
        the facility is situated) of the facility as the amount of the 
        Federal participation bore to the cost of the construction.
            ``(2) Interest.--
                    ``(A) In general.--The interest that the United 
                States is entitled to recover under subsection (a) is 
                the interest for the period (if any) described in 
                subparagraph (B) at a rate (determined by the 
                Secretary) based on the average of the bond equivalent 
                rates of 91-day Treasury bills auctioned during such 
                period.
                    ``(B) Time period.--The period referred to in 
                subparagraph (A) is the period beginning--
                            ``(i) if notice is provided as prescribed 
                        by subsection (b), 191 days after the date on 
                        which the owner of the facility ceases to be a 
                        public or nonprofit school as described in 
                        paragraph (1) of subsection (a), or 191 days 
                        after the date on which the use of the facility 
                        changes as described in paragraph (2) or (3) of 
                        such subsection; or
                            ``(ii) if notice is not provided as 
                        prescribed by subsection (b), 11 days after the 
                        date on which such cessation or change of use 
                        occurs,
                and ending on the date the amount the United States is 
                entitled to recover is collected.
    ``(d) Waiver of Rights.--The Secretary may waive the recovery 
rights of the United States under subsection (a)(2) with respect to a 
facility (under such conditions as the Secretary may establish by 
regulation) if the Secretary determines that there is good cause for 
waiving such rights.
    ``(e) Limitation on Liens.--The right of recovery of the United 
States under subsection (a) shall not, prior to judgment, constitute a 
lien on any facility.

   ``PART B--NURSE PRACTITIONERS, NURSE MIDWIVES, AND OTHER ADVANCED 
                            PRACTICE NURSES

``SEC. 811. ADVANCED PRACTICE NURSING GRANTS.

    ``(a) In General.--The Secretary may award grants to and enter into 
contracts with eligible entities to meet the costs of--
            ``(1) projects that support the enhancement of advanced 
        practice nursing education and practice; and
            ``(2) traineeships for individuals in advanced practice 
        nursing programs.
    ``(b) Definition of Advanced Practice Nurses.--For purposes of this 
section, the term `advanced practice nurses' means nurses trained in 
advanced degree programs including individuals in combined R.N./
Master's degree programs, post-nursing master's certificate programs, 
or, in the case of nurse midwives or nurse anesthetists, in certificate 
programs in existence on the date that is one day prior to the date of 
enactment of this section, to serve as nurse practitioners, nurse 
midwives, nurse anesthetists, nurse educators, or public health nurses, 
or in other nurse specialties determined by the Secretary to require 
advanced education.
    ``(c) Authorized Nurse Practitioner and Nurse-Midwifery Programs.--
Nurse practitioner and nurse midwifery programs eligible for support 
under this section are educational programs for registered nurses 
(irrespective of the type of school of nursing in which the nurses 
received their training) that--
            ``(1) meet guidelines prescribed by the Secretary; and
            ``(2) have as their objective the education of nurses who 
        will upon completion of their studies in such programs, be 
        qualified to effectively provide primary health care, including 
        primary health care in homes and in ambulatory care facilities, 
        long-term care facilities and other health care institutions.
    ``(d) Other Authorized Educational Programs.--The Secretary shall 
prescribe guidelines as appropriate for other advanced practice nurse 
education programs eligible for support under this section.
    ``(e) Traineeships.--
            ``(1) In general.--The Secretary may not award a grant to 
        an applicant under subsection (a) unless the applicant involved 
        agrees that traineeships provided with the grant will only pay 
        all or part of the costs of--
                    ``(A) the tuition, books, and fees of the program 
                of advanced nursing practice with respect to which the 
                traineeship is provided; and
                    ``(B) the reasonable living expenses of the 
                individual during the period for which the traineeship 
                is provided.
            ``(2) Doctoral programs.--The Secretary may not obligate 
        more than 10 percent of the traineeships under subsection (a) 
        for individuals in doctorate degree programs.
            ``(3) Special consideration.--In making awards of grants 
        and contracts under subsection (a)(2), the Secretary shall give 
        special consideration to an eligible entity that agrees to 
        expend the award to train advanced practice nurses who will 
        practice in health professional shortage areas designated under 
        section 332.

            ``PART C--INCREASING NURSING WORKFORCE DIVERSITY

``SEC. 821. WORKFORCE DIVERSITY GRANTS.

    ``(a) In General.--The Secretary may award grants to and enter into 
contracts with eligible entities to meet the costs of special projects 
to increase nursing education opportunities for individuals who are 
from disadvantaged backgrounds (including racial and ethnic minorities 
underrepresented among registered nurses) by providing student 
scholarships or stipends, pre-entry preparation, and retention 
activities.
    ``(b) Guidance.--In carrying out subsection (a), the Secretary 
shall take into consideration the recommendations of the First and 
Second Invitational Congresses for Minority Nurse Leaders on `Caring 
for the Emerging Majority,' in 1992 and 1993, and consult with nursing 
associations including the American Nurses Association, the National 
League for Nursing, the American Association of Colleges of Nursing, 
the Black Nurses Association, the Association of Hispanic Nurses, the 
Association of Asian American and Pacific Islander Nurses, the National 
Nurses Association, and the Native American Indian and Alaskan Nurses 
Association.
    ``(c) Required Information and Conditions for Award Recipients.--
            ``(1) In general.--Recipients of awards under this section 
        may be required, where requested, to report to the Secretary 
        concerning the annual admission, retention, and graduation 
        rates for ethnic and racial minorities in the school or schools 
        involved in the projects.
            ``(2) Falling rates.--If any of the rates reported under 
        paragraph (1) fall below the average of the two previous years, 
        the grant or contract recipient shall provide the Secretary 
        with plans for immediately improving such rates.
            ``(3) Ineligibility.--A recipient described in paragraph 
        (2) shall be ineligible for continued funding under this 
        section if the plan of the recipient fails to improve the rates 
        within the 1-year period beginning on the date such plan is 
        implemented.

``PART D--STRENGTHENING CAPACITY FOR BASIC NURSE EDUCATION AND PRACTICE

``SEC. 831. BASIC NURSE EDUCATION AND PRACTICE GRANTS.

    ``(a) In General.--The Secretary may award grants to and enter into 
contracts with eligible entities for projects to strengthen capacity 
for basic nurse education and practice.
    ``(b) Priority Areas.--In awarding grants or contracts under this 
section the Secretary shall give priority to entities that will use 
amounts provided under such a grant or contract to enhance the 
education mix and utilization of the basic nursing workforce by 
strengthening programs that provide basic nurse education for purposes 
of--
            ``(1) improving nursing services in schools and other 
        community settings;
            ``(2) providing care for underserved populations and other 
        high-risk groups such as the elderly, individuals with HIV-
        AIDS, substance abusers, homeless, and battered women;
            ``(3) providing managed care, quality improvement, and 
        other skills needed under new systems of organized health care 
        systems;
            ``(4) developing cultural competencies among nurses;
            ``(5) providing emergency health services;
            ``(6) promoting career mobility for nursing personnel in a 
        variety of training settings and cross training or specialty 
        training among diverse population groups; or
            ``(7) other priority areas as determined by the Secretary.

               ``PART F--AUTHORIZATION OF APPROPRIATIONS

``SEC. 841. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated to carry out sections 
811, 821, and 831, $62,000,000 for fiscal year 1996, such sums as may 
be necessary in each of the fiscal years 1997 and 1998, and $59,000,000 
for fiscal year 1999.''; and
            (6) by redesignating section 855 as section 810, and 
        transferring such section so as to appear after section 809 (as 
        added by the amendment made by paragraph (5)).

SEC. 124. SAVINGS PROVISION.

    In the case of any authority for making awards of grants or 
contracts that is terminated by the amendment made by section 123, the 
Secretary of Health and Human Services may, notwithstanding the 
termination of the authority, continue in effect any grant or contract 
made under the authority that is in effect on the day before the date 
of the enactment of this Act, subject to the duration of any such grant 
or contract not exceeding the period determined by the Secretary in 
first approving such financial assistance, or in approving the most 
recent request made (before the date of such enactment) for 
continuation of such assistance, as the case may be.

                    Subtitle C--Financial Assistance

  PART 1--NATIONAL HEALTH SERVICE CORPS FINANCIAL ASSISTANCE PROGRAMS

SEC. 131. GENERAL AMENDMENTS WITH RESPECT TO FEDERALLY SUPPORTED LOANS.

    (a) Loan Repayment Program.--Section 338B of the Public Health 
Service Act (42 U.S.C. 254l-1) is amended--
            (1) in subsection (a)--
                    (A) in the matter preceding paragraph (1), by 
                inserting ``and public health disease prevention and 
                health promotion activities'' before the dash; and
                    (B) in paragraph (1), by striking ``and physician 
                assistants'' and inserting ``physician assistants, and 
                public health professionals'';
            (2) in subsection (b)(1)--
                    (A) in subparagraph (A), by inserting ``public 
                health,'' after ``dentistry,'';
                    (B) in subparagraph (B), by inserting ``public 
                health,'' after ``dentistry,''; and
                    (C) in subparagraph (C), by inserting ``public 
                health,'' after ``dentistry,'';
            (3) in subsection (c)(4)--
                    (A) in subparagraph (A), by inserting ``and schools 
                of public health'' after ``professions schools'';
                    (B) in subparagraph (B)(i)--
                            (i) by inserting ``or public health 
                        professional'' after ``any health 
                        professional''; and
                            (ii) by inserting ``or public health 
                        disease prevention and health promotion 
                        activities'' before the period;
                    (C) in subparagraph (C)--
                            (i) by inserting ``or public health disease 
                        prevention and health promotion activities,'' 
                        after ``primary health services,'';
                            (ii) by inserting ``or public health 
                        professions'' after ``health professions''; and
                            (iii) by inserting ``or public health 
                        professionals'' after ``health professionals'' 
                        each place that such occurs;
            (4) in subsection (f)(1)(B)(iv), by inserting ``or public 
        health disease prevention and health promotion activities'' 
        after ``primary health services'';
            (5) in subsection (g)(2)(A)(iii)--
                    (A) by inserting ``or public health professional'' 
                after ``the health professional''; and
                    (B) by inserting ``or public health disease 
                prevention and health promotion activities'' after 
                ``primary health services''; and
            (6) in subsection (i)(8), --
                    (A) by inserting ``or public health professionals'' 
                after ``health professionals''; and
                    (B) by inserting ``or public health disease 
                prevention and health promotion activities'' after 
                ``primary health services''.
    (b) Obligated Service.--Section 338C(b)(5) of the Public Health 
Service Act (42 U.S.C. 254m(b)(5)) is amended--
            (1) in subparagraph (A), by inserting ``public health,'' 
        after ``dentistry,''; and
            (2) in subparagraph (E)--
                    (A) in clause (ii), by inserting ``public health,'' 
                after ``dentistry,''; and
                    (B) in clause (iii), by inserting ``public 
                health,'' after ``dentistry,''.
    (c) Authorization of Appropriations.--Section 338H of the Public 
Health Service Act (42 U.S.C. 254q) is amended to read as follows:

``SEC. 338H. AUTHORIZATION OF APPROPRIATIONS.

    ``(a) Authorization of Appropriations.--For the purpose of carrying 
out this subpart, there are authorized to be appropriated $90,000,000 
for fiscal year 1996 and such sums as may be necessary for each of the 
fiscal years 1997 through 2000.
    ``(b) Distribution of Amounts.--The Secretary shall determine the 
most appropriate manner in which to allocate amounts appropriated under 
subsection (a) between the programs authorized in chapter 1, chapter 2, 
and chapter 3. In determining the manner in which to allocate such 
amounts, the Secretary shall give priority to funding State-based 
programs as appropriate under chapter 3. The Secretary shall distribute 
such amounts among the various programs in such chapters in a manner 
which furthers both Federal and State needs for health professionals in 
underserved areas.''.
    (d) Grants for Loan Repayment Program.--Section 338I of the Public 
Health Service Act (42 U.S.C. 254q-1) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by striking ``in health 
                professional shortage areas'' and inserting ``or public 
                health disease prevention and health promotion 
                activities in Federal health professional shortage 
                areas or approved State designated health professional 
                shortage areas''; and
                    (B) in paragraph (2)--
                            (i) by inserting ``or public health 
                        professionals'' after ``health professionals''; 
                        and
                            (ii) by striking ``in health professional 
                        shortage areas'' and inserting ``or public 
                        health disease prevention and health promotion 
                        activities in Federal health professional 
                        shortage areas or approved State designated 
                        health professional shortage areas'';
            (2) in subsection (c)--
                    (A) in paragraph (1)--
                            (i) in the paragraph heading, by striking 
                        ``federal'' and inserting ``federal or approved 
                        state''; and
                            (ii) by inserting before the period the 
                        following: ``or approved State designated 
                        health professional shortage areas'';
                    (B) in paragraph (2), by inserting ``or public 
                health professionals'' after ``health professionals'';
                    (C) in paragraph (3)--
                            (i) in subparagraph (A)--
                                    (I) in the matter preceding clause 
                                (i), by inserting ``or public health 
                                professionals'' after ``health 
                                professionals''; and
                                    (II) in clause (ii), by striking 
                                health'';
                            (ii) in subparagraph (B)--
                                    (I) in the matter preceding clause 
                                (i), by inserting ``or public health 
                                professional'' after ``health 
                                professional''; and
                                    (II) in clause (ii)--
                                            (aa) by inserting ``or 
                                        public health professional'' 
                                        after ``the health 
                                        professional''; and
                                            (bb) by striking ``services 
                                        in a'' and inserting ``services 
                                        or public health disease 
                                        prevention and health promotion 
                                        activities in a Federal''; and
                    (D) by adding at the end thereof the following new 
                paragraph:
            ``(4) Private practice.--
                    ``(A) In carrying out the program operated with a 
                grant under subsection (a), a State may waive the 
                requirement of paragraph (1) regarding the assignment 
                of a health professional if, subject to subparagraph 
                (B), the health professional enters into an agreement 
                with the State to provide primary health services in a 
                full-time private clinical practice in a health 
                professional shortage area.
                    ``(B) The Secretary may not make a grant under 
                subsection (a) unless the State involved agrees that, 
                if the State provides a waiver under subparagraph (A) 
                for a health professional, section 338D(b)(1) will 
                apply to the agreement under such subparagraph between 
                the State and the health professional to the same 
                extent and in the same manner as such section applies 
                to an agreement between the Secretary and a health 
                professional regarding a full-time private clinical 
                practice.''; and
            (3) in subsection (h), to read as follows:
    ``(h) Definitions.--Unless specifically provided otherwise, as used 
in this subpart and section 338F:
            ``(1) Approved state designated health professional 
        shortage area.--The term `approved State designated health 
        professional shortage area' means an area designated by the 
        State as underserved using specific methodology and criteria to 
        identify such areas. Such criteria and methodology shall be 
        approved by the Secretary.
            ``(2) Community organization.--The term `community 
        organization' means a public or nonprofit private entity.
            ``(3) Primary health care.--The term `primary health care' 
        means health services regarding family medicine, general 
        internal medicine, general pediatrics, dentistry, or may 
include obstetrics and gynecology, that are provided by physicians, 
dentists, certified nurse practitioners, certified nurse midwives, or 
physician assistants.
            ``(4) State.--The term `State' means each of the several 
        States and the District of Columbia.''.
    (e) Community Scholarship Programs.--Section 338L of the Public 
Health Service Act (42 U.S.C. 254t) is amended--
            (1) in the section heading, by striking ``demonstration 
        grants to states for'';
            (2) in subsection (a), by striking ``health manpower 
        shortage areas'' and inserting ``Federal health professional 
        shortage areas and in approved State designated health 
        professional shortage areas'';
            (3) in subsection (c)--
                    (A) in the matter preceding paragraph (1), by 
                striking ``health manpower shortage areas'' and 
                inserting ``Federal health professional shortage areas 
                and in approved State designated health professional 
                shortage areas''; and
                    (B) in paragraph (2), by striking ``health manpower 
                shortage areas'' and inserting ``Federal health 
                professional shortage areas and in approved State 
                designated health professional shortage areas'';
            (4) in subsection (e)(1), by striking ``health manpower 
        shortage areas'' and inserting ``Federal health professional 
        shortage areas and in approved State designated health 
        professional shortage areas'';
            (5) in subsection (f)(1)(A), by striking ``health manpower 
        shortage areas'' and inserting ``Federal health professional 
        shortage areas and in approved State designated health 
        professional shortage areas'';
            (6) in subsection (g), by striking ``health manpower 
        shortage areas'' each place that such appears and inserting 
        ``Federal health professional shortage areas and in approved 
        State designated health professional shortage areas''; and
            (7) by striking subsections (j) through (l).

SEC. 132. RESTRUCTURING AND TECHNICAL AMENDMENTS.

    (a) Redesignations.--Subpart III of part D of title III of the 
Public Health Service Act (42 U.S.C. 254l et seq.) is amended--
            (1) by redesignating sections 338J and 338K (42 U.S.C. 254s 
        and 254t) as sections 338M and 338N, respectively;
            (2) by redesignating sections 338C through 338H (42 U.S.C. 
        254m through 254q) as sections 338G through 338L, respectively;
            (3) by redesignating section 338I (as such section exists 
        one day prior to the date of enactment of this Act) (42 U.S.C. 
        254r) as section 338E;
            (4) by redesignating section 338L (as such section exists 
        one day prior to the date of enactment of this Act) (42 U.S.C. 
        254u) as section 338F;
    (b) Consolidation of Certain Programs.--Subpart III of part D of 
title III of the Public Health Service Act (42 U.S.C. 254l et seq.) (as 
amended by subsection (a)) is further amended--
            (1) by striking the subpart heading and inserting the 
        following:

       ``Subpart III--Federally Supported Scholarships and Loans

    ``CHAPTER 1--NATIONAL HEALTH SERVICE CORPS SCHOLARSHIPS PROGRAMS

            (2) by redesignating section 338B as section 338C;
            (3) by inserting before section 338C (as so redesignated) 
        the following:

   ``CHAPTER 2--NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT PROGRAMS

               ``Subchapter A--Loan Repayment Program'';

            and
            (4) by inserting after section 338C (as so redesignated) 
        the following:

           ``Subchapter B--Nursing Loan Repayment Program''.

    (c) Transfers and Redesignations of Nursing Loan Repayment 
Program.--Subpart II of part E of title VIII (42 U.S.C. 297n et seq.) 
(as so redesignated by section 123(3)) is amended--
            (1) by striking the subpart heading;
            (2) by transferring section 846 (42 U.S.C. 297n) to 
        subchapter B of chapter 2 of subpart III of part D of title III 
        (as added by subsection (b)(4)); and
            (3) in section 846--
                    (A) by striking the section heading and inserting 
                the following:

``SEC. 338D. NURSING LOAN REPAYMENT PROGRAM.'';

                    (B) by striking subsection (d); and
                    (C) by striking subsection (g).
    (d) Transfers and Redesignations of State Loan Repayment and 
Community Scholarship Programs.--Subpart III of part D of title III of 
the Public Health Service Act (42 U.S.C. 254l et seq.) (as amended by 
subsections (a) through (c)) is further amended--
            (1) by inserting after section 338D (as so transferred and 
        redesignated by subsection (c)(3)) the following:

  ``CHAPTER 3--STATE LOAN REPAYMENT AND COMMUNITY SCHOLARSHIP PROGRAMS

            ``Subchapter A--State Loan Repayment Programs'';

            (2) by transferring section 338E (as so redesignated by 
        subsection (a)(3)) to subchapter A of chapter 3 of such subpart 
        (as added by paragraph (1));
            (3) by inserting after section 338E (as transferred by 
        paragraph (2)) the following:

           ``Subchapter B--Community Scholarship Programs'';

            (4) by transferring section 338F (as so redesignated by 
        subsection (a)(4)) to subchapter B of chapter 3 of such subpart 
        (as added by paragraph (3)); and
            (5) by inserting after section 338F (as transferred by 
        paragraph (4)) the following:

                   ``CHAPTER 4--GENERAL PROVISIONS''.

    (e) Clinical Researchers.--Paragraph (3) of section 487E(a) of the 
Public Health Service Act (42 U.S.C. 288-5(a)(3)) is amended to read as 
follows:
            ``(3) Applicability of certain provisions regarding 
        obligated service.--With respect to the National Health Service 
        Corps loan repayment program established in subpart III of part 
        D of title III, the provisions of such subpart shall, except as 
        inconsistent with this section, apply to the program 
        established in subsection (a) in the same manner and to the 
        same extent as such provisions apply to the National Health 
        Service Corps loan repayment programs.''.

SEC. 133. DEFINITION OF UNDERSERVED AREAS.

    Section 332(a)(1) of the Public Health Service Act (42 U.S.C. 
254e(a)(1)) is amended in the first sentence--
            (1) by striking ``, or (C)'' and inserting ``, (C)''; and
            (2) by inserting before the period the following: ``, or 
        (D) a State or local health department that has a severe 
        shortage of public health personnel as determined under 
        criteria established by the Secretary''.

SEC. 134. CONFORMING AMENDMENTS.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended--
            (1) in subparagraphs (A) and (B) of section 303(d)(4) (42 
        U.S.C. 242a(d)(4)(A) and (B)), by striking ``338C or 338D'' 
        each place that such occurs and inserting ``338G or 338H'';
            (2) in section 331(c) (42 U.S.C. 254d(c)), by striking 
        ``338D'' and inserting ``338H'';
            (3) in section 337(a) (42 U.S.C. 254j(a)), by striking 
        ``338G'' and inserting ``338K'';
            (4) in 338A (42 U.S.C. 254l)--
                    (A) in subsection (c)(1)--
                            (i) in subparagraph (A), by striking 
                        ``338D'' and inserting ``338I''; and
                            (ii) in subparagraph (B), by striking 
                        ``338C'' and inserting ``338H'';
                    (B) in subsection (f)(3), by striking ``338D'' and 
                inserting ``338I''; and
                    (C) in subsection (i)(5)--
                            (i) in subparagraph (A), by striking 
                        ``338E'' and inserting ``338I''; and
                            (ii) in subparagraph (B)(ii), by striking 
                        ``338E'' and inserting ``338I'';
            (5) in section 338C (as so redesignated) (42 U.S.C. 254l-
        1)--
                    (A) in subsection (c)(1)--
                            (i) in subparagraph (A), by striking 
                        ``338E'' and inserting ``338I''; and
                            (ii) in subparagraph (B), by striking 
                        ``338D'' and inserting ``338H'';
                    (B) in subsection (f)(1)(B)(iv), by striking 
                ``338D'' and inserting ``338H'';
                    (C) in subsection (f)(4), by striking ``338E'' and 
                inserting ``338I''; and
                    (D) in subsection (i)(7)--
                            (i) in subparagraph (A), by striking 
                        ``338E'' and inserting ``338I''; and
                            (ii) in subparagraph (B)(ii), by striking 
                        ``338E'' and inserting ``338I'';
            (6) in section 338E(d)(1)(C) (as so redesignated by section 
        132), by striking ``338J'' and inserting ``338M'';
            (7) in section 338G (as so redesignated by section 132)--
                    (A) in subsection (a)--
                            (i) by striking ``338D'' and inserting 
                        ``338H''; and
                            (ii) by striking ``338B'' and inserting 
                        ``338C''; and
                    (B) in subsection (c)(2), by striking ``338D'' and 
                inserting ``338H'';
            (8) in section 338H (as so redesignated by section 132)--
                    (A) in subsection (a), by striking ``338C'' and 
                inserting ``338G''; and
                    (B) in subsection (c), by striking ``338B'' and 
                inserting ``338C'';
            (9) in section 338I (as so redesignated by section 132)--
                    (A) in subsection (b)(1)(A)--
                            (i) by striking ``338F'' and inserting 
                        ``338J'';
                            (ii) by striking ``338C or 338D'' and 
                        inserting ``338G or 338H'';
                            (iii) by striking ``338C'' and inserting 
                        ``338G''; and
                            (iv) by striking ``338D'' and inserting 
                        ``338H''; and
                    (B) in subsection (c)(1)--
                            (i) by striking ``338F'' and inserting 
                        ``338K'';
                            (ii) by striking ``338B'' and inserting 
                        ``338C''; and
                            (iii) by striking ``338C or 338D'' and 
                        inserting ``338G or 338H'';
            (10) in section 338J(b) (as so redesignated by section 
        132)--
                    (A) in paragraph (1)--
                            (i) by striking ``338E'' and inserting 
                        ``338I''; and
                            (ii) by striking ``338B'' and inserting 
                        ``338C''; and
                    (B) in paragraph (2), by striking ``338I'' and 
                inserting ``338E'';
            (11) in section 338K (as so redesignated by section 132)--
                    (A) in subsection (a)(2), by striking ``338D'' and 
                inserting ``338H''; and
                    (B) in subsection (d)(1), by striking ``338E'' and 
                inserting ``338I''; and
            (12) in section 338M(e)(1)(B)(ii)(III) (as so redesignated 
        by section 132), by striking ``338I'' and inserting ``338E''.

               PART 2--SCHOOL-BASED REVOLVING LOAN FUNDS

SEC. 135. PRIMARY CARE LOAN PROGRAM.

    (a) Requirement for Schools.--Section 723(b)(1) of the Public 
Health Service Act (42 U.S.C. 292s(b)(1)), as amended by section 
2014(c)(2)(A)(ii) of Public Law 103-43 (107 Stat. 216), is amended by 
striking ``3 years before'' and inserting ``4 years before''.
    (b) Service Requirement for Primary Care Loan Borrowers.--Section 
723(a) of the Public Health Service Act (42 U.S.C. 292s(a)) is amended 
in subparagraph (B) of paragraph (1), by striking ``through the date on 
which the loan is repaid in full'' and inserting ``for 5 years after 
completing the residency program''.
    (c) Report Requirement.--Section 723 of the Public Health Service 
Act (42 U.S.C. 292s) is amended--
            (1) by striking subsection (c); and
            (2) by redesignating subsection (d) as subsection (c).

SEC. 136. LOANS FOR DISADVANTAGED STUDENTS.

    (a) Authorization of Appropriations.--Section 724(f)(1) of the 
Public Health Service Act (42 U.S.C. 292t(f)(1)) is amended by striking 
``$15,000,000 for fiscal year 1993'' and inserting ``$8,000,000 for 
each of the fiscal years 1996 through 1998''.
    (b) Repeal.--Effective October 1, 1998, paragraph (1) of section 
724(f) of the Public Health Service Act (42 U.S.C. 292t(f)(1)) is 
repealed.

SEC. 137. STUDENT LOANS REGARDING SCHOOLS OF NURSING.

    (a) In General.--Section 836(b) of the Public Health Service Act 
(42 U.S.C. 297b(b)) is amended--
            (1) in paragraph (1), by striking the period at the end and 
        inserting a semicolon;
            (2) in paragraph (2)--
                    (A) in subparagraph (A), by striking ``and'' at the 
                end; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (C) such additional periods 
                under the terms of paragraph (8) of this subsection'';
            (3) in paragraph (7), by striking the period at the end and 
        inserting ``; and''; and
            (4) by adding at the end the following paragraph:
            ``(8) pursuant to uniform criteria established by the 
        Secretary, the repayment period established under paragraph (2) 
        for any student borrower who during the repayment period failed 
        to make consecutive payments and who, during the last 12 months 
        of the repayment period, has made at least 12 consecutive 
        payments may be extended for a period not to exceed 10 
        years.''.
    (b) Minimum Monthly Payments.--Section 836(g) of the Public Health 
Service Act (42 U.S.C. 297b(g)) is amended by striking ``$15'' and 
inserting ``$40''.
    (c) Elimination of Statute of Limitation for Loan Collections.--
            (1) In general.--Section 836 of the Public Health Service 
        Act (42 U.S.C. 297b) is amended by adding at the end the 
        following new subsection:
    ``(l) Elimination of Statute of Limitation for Loan Collections.--
            ``(1) Purpose.--It is the purpose of this subsection to 
        ensure that obligations to repay loans under this section are 
        enforced without regard to any Federal or State statutory, 
        regulatory, or administrative limitation on the period within 
        which debts may be enforced.
            ``(2) Prohibition.--Notwithstanding any other provision of 
        Federal or State law, no limitation shall terminate the period 
        within which suit may be filed, a judgment may be enforced, or 
        an offset, garnishment, or other action may be initiated or 
        taken by a school of nursing that has an agreement with the 
        Secretary pursuant to section 835 that is seeking the repayment 
        of the amount due from a borrower on a loan made under this 
        subpart after the default of the borrower on such loan.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall be effective with respect to actions pending on or after 
        the date of enactment of this Act.
    (d) Breach of Agreements.--Section 338D of the Public Health 
Service Act (as so redesignated and amended under section 132(c)) is 
amended by adding at the end thereof the following new subsection:
    ``(g) Breach of Agreement.--
            ``(1) In general.--In the case of any program under this 
        section under which an individual makes an agreement to provide 
        health services for a period of time in accordance with such 
        program in consideration of receiving an award of Federal funds 
        regarding education as a nurse (including an award for the 
        repayment of loans), the following applies if the agreement 
        provides that this subsection is applicable:
                    ``(A) In the case of a program under this section 
                that makes an award of Federal funds for attending an 
                accredited program of nursing (in this section referred 
                to as a `nursing program'), the individual is liable to 
                the Federal Government for the amount of such award 
                (including amounts provided for expenses related to 
                such attendance), and for interest on such amount at 
                the maximum legal prevailing rate, if the individual--
                            ``(i) fails to maintain an acceptable level 
                        of academic standing in the nursing program (as 
                        indicated by the program in accordance with 
                        requirements established by the Secretary);
                            ``(ii) is dismissed from the nursing 
                        program for disciplinary reasons; or
                            ``(iii) voluntarily terminates the nursing 
                        program.
                    ``(B) The individual is liable to the Federal 
                Government for the amount of such award (including 
                amounts provided for expenses related to such 
                attendance), and for interest on such amount at the 
                maximum legal prevailing rate, if the individual fails 
                to provide health services in accordance with the 
                program under this section for the period of time 
                applicable under the program.
            ``(2) Waiver or suspension of liability.--In the case of an 
        individual or health facility making an agreement for purposes 
        of paragraph (1), the Secretary shall provide for the waiver or 
        suspension of liability under such subsection if compliance by 
        the individual or the health facility, as the case may be, with 
        the agreements involved is impossible, or would involve extreme 
        hardship to the individual or facility, and if enforcement of 
        the agreements with respect to the individual or facility would 
        be unconscionable.
            ``(3) Date certain for recovery.--Subject to paragraph (2), 
        any amount that the Federal Government is entitled to recover 
        under paragraph (1) shall be paid to the United States not 
        later than the expiration of the 3-year period beginning on the 
        date the United States becomes so entitled.
            ``(4) Availability.--Amounts recovered under paragraph (1) 
        with respect to a program under this section shall be available 
        for the purposes of such program, and shall remain available 
        for such purposes until expended.''.
    (e) Technical Amendments.--Section 839 of the Public Health Service 
Act (42 U.S.C. 297e) is amended--
            (1) in subsection (a)--
                    (A) by striking the matter preceding paragraph (1) 
                and inserting the following:
    ``(a) If a school terminates a loan fund established under an 
agreement pursuant to section 835(b), or if the Secretary for good 
cause terminates the agreement with the school, there shall be a 
capital distribution as follows:''; and
                    (B) in paragraph (1), by striking ``at the close of 
                September 30, 1999,'' and inserting ``on the date of 
                termination of the fund''; and
            (2) in subsection (b), to read as follows:
    ``(b) If a capital distribution is made under subsection (a), the 
school involved shall, after such capital distribution, pay to the 
Secretary, not less often than quarterly, the same proportionate share 
of amounts received by the school in payment of principal or interest 
on loans made from the loan fund established under section 835(b) as 
determined by the Secretary under subsection (a).''.

SEC. 138. GENERAL PROVISIONS.

    (a) Maximum Student Loan Provisions and Minimum Payments.--
            (1) In general.--Section 722(a)(1) of the Public Health 
        Service Act (42 U.S.C. 292r(a)(1)), as amended by section 
        2014(b)(1) of Public Law 103-43, is amended by striking ``the 
        sum of'' and all that follows through the end thereof and 
        inserting ``the cost of attendance (including tuition, other 
        reasonable educational expenses, and reasonable living costs) 
        for that year at the educational institution attended by the 
        student (as determined by such educational institution).''.
            (2) Third and fourth years.--Section 722(a)(2) of the 
        Public Health Service Act (42 U.S.C. 292r(a)(2)), as amended by 
        section 2014(b)(1) of Public Law 103-43, is amended by striking 
        ``the amount $2,500'' and all that follows through ``including 
        such $2,500'' and inserting ``the amount of the loan may, in 
        the case of the third or fourth year of a student at a school 
        of medicine or osteopathic medicine, be increased to the extent 
        necessary''.
            (3) Repayment period.--Section 722(c) of the Public Health 
        Service Act (42 U.S.C. 292r(c)), as amended by section 
        2014(b)(1) of Public Law 103-43, is amended--
                    (A) in the subsection heading by striking ``Ten-
                Year'' and inserting ``Repayment'';
                    (B) by striking ``ten-year period which begins'' 
                and inserting ``period of not less than 10 years nor 
                more than 25 years which begins''; and
                    (C) by striking ``such ten-year period'' and 
                inserting ``such period''.
            (4) Minimum payments.--Section 722(j) of the Public Health 
        Service Act (42 U.S.C. 292r(j)), as amended by section 
        2014(b)(1) of Public Law 103-43, is amended by striking ``$15'' 
        and inserting $40''.
    (b) Elimination of Statute of Limitation for Loan Collections.--
            (1) In general.--Section 722 of the Public Health Service 
        Act (42 U.S.C. 292r), as amended by section 2014(b)(1) of 
        Public Law 103-43, is amended by adding at the end the 
        following new subsection:
    ``(m) Elimination of Statute of Limitation for Loan Collections.--
            ``(1) Purpose.--It is the purpose of this subsection to 
        ensure that obligations to repay loans under this section are 
        enforced without regard to any Federal or State statutory, 
        regulatory, or administrative limitation on the period within 
        which debts may be enforced.
            ``(2) Prohibition.--Notwithstanding any other provision of 
        Federal or State law, no limitation shall terminate the period 
        within which suit may be filed, a judgment may be enforced, or 
        an offset, garnishment, or other action may be initiated or 
        taken by a school that has an agreement with the Secretary 
        pursuant to section 721 that is seeking the repayment of the 
        amount due from a borrower on a loan made under this subpart 
        after the default of the borrower on such loan.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall be effective with respect to actions pending on or after 
        the date of enactment of this Act.
    (c) Date Certain for Contributions.--Paragraph (2) of section 
735(e) of the Public Health Service Act (42 U.S.C. 292y(e)(2)) is 
amended to read as follows:
            ``(2) Date certain for contributions.--Amounts described in 
        paragraph (1) that are returned to the Secretary shall be 
        obligated before the end of the succeeding fiscal year.''.

 PART 3--INSURED HEALTH EDUCATION ASSISTANCE LOANS TO GRADUATE STUDENTS

SEC. 141. HEALTH EDUCATION ASSISTANCE LOAN PROGRAM.

    (a) Health Education Assistance Loan Deferment for Borrowers 
Providing Health Services to Indians.--
            (1) In general.--Section 705(a)(2)(C) of the Public Health 
        Service Act (42 U.S.C. 292d(a)(2)(C)) is amended by striking 
        ``and (x)'' and inserting ``(x) not in excess of three years, 
        during which the borrower is providing health care services to 
        Indians through an Indian health program (as defined in section 
        108(a)(2)(A) of the Indian Health Care Improvement Act (25 
        U.S.C. 1616a(a)(2)(A)); and (xi)''.
            (2) Conforming amendments.--Section 705(a)(2)(C) of the 
        Public Health Service Act (42 U.S.C. 292d(a)(2)(C)) is further 
        amended--
                    (A) in clause (xi) (as so redesignated) by striking 
                ``(ix)'' and inserting ``(x)''; and
                    (B) in the matter following such clause (xi), by 
                striking ``(x)'' and inserting ``(xi)''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply with respect to services provided on or after the 
        first day of the third month that begins after the date of the 
        enactment of this Act.
    (b) Report Requirement.--Section 709(b) of the Public Health 
Service Act (42 U.S.C. 292h(b)) is amended--
            (1) in paragraph (4)(B), by adding ``and'' after the 
        semicolon;
            (2) in paragraph (5), by striking ``; and'' and inserting a 
        period; and
            (3) by striking paragraph (6).
    (c) Collection from Estates.--Section 714 of the Public Health 
Service Act (42 U.S.C. 292m) is amended by adding at the end the 
following new sentence: ``Notwithstanding the first sentence, the 
Secretary may, in the case of a borrower who dies, collect any 
remaining unpaid balance owed to the lender, the holder of the loan, or 
the Federal Government from the borrower's estate.''.

SEC. 142. HEAL LENDER AND HOLDER PERFORMANCE STANDARDS.

    (a) General Amendments.--Section 707(a) of the Public Health 
Service Act (42 U.S.C. 292f) is amended--
            (1) by striking the last sentence;
            (2) by striking ``determined.'' and inserting ``determined, 
        except that, if the insurance beneficiary including any 
        servicer of the loan is not designated for `exceptional 
        performance', as set forth in paragraph (2), the Secretary 
        shall pay to the beneficiary a sum equal to 98 percent of the 
        amount of the loss sustained by the insured upon that loan.'';
            (3) by striking ``Upon'' and inserting:
            ``(1) In general.--Upon''; and
            (4) by adding at the end the following new paragraph:
            ``(2) Exceptional performance.--
                    ``(A) Authority.--Where the Secretary determines 
                that an eligible lender, holder, or servicer has a 
                compliance performance rating that equals or exceeds 97 
                percent, the Secretary shall designate that eligible 
                lender, holder, or servicer, as the case may be, for 
                exceptional performance.
                    ``(B) Compliance performance rating.--For purposes 
                of subparagraph (A), a compliance performance rating is 
                determined with respect to compliance with due 
                diligence in the disbursement, servicing, and 
                collection of loans under this subpart for each year 
                for which the determination is made. Such rating shall 
                be equal to the percentage of all due diligence 
                requirements applicable to each loan, on average, as 
                established by the Secretary, with respect to loans 
                serviced during the period by the eligible lender, 
                holder, or servicer.
                    ``(C) Annual audits for lenders, holders, and 
                servicers.--Each eligible lender, holder, or servicer 
                desiring a designation under subparagraph (A) shall 
                have an annual financial and compliance audit conducted 
                with respect to the loan portfolio of such eligible 
                lender, holder, or servicer, by a qualified independent 
                organization from a list of qualified organizations 
                identified by the Secretary and in accordance with 
                standards established by the Secretary. The standards 
                shall measure the lender's, holder's, or servicer's 
                compliance with due diligence standards and shall 
                include a defined statistical sampling technique 
                designed to measure the performance rating of the 
                eligible lender, holder, or servicer for the purpose of 
                this section. Each eligible lender, holder, or servicer 
                shall submit the audit required by this section to the 
                Secretary.
                    ``(D) Secretary's determinations.--The Secretary 
                shall make the determination under subparagraph (A) 
                based upon the audits submitted under this paragraph 
                and any information in the possession of the Secretary 
                or submitted by any other agency or office of the 
                Federal Government.
                    ``(E) Quarterly compliance audit.--To maintain its 
                status as an exceptional performer, the lender, holder, 
                or servicer shall undergo a quarterly compliance audit 
                at the end of each quarter (other than the quarter in 
                which status as an exceptional performer is established 
                through a financial and compliance audit, as described 
                in subparagraph (C)), and submit the results of such 
                audit to the Secretary. The compliance audit shall 
                review compliance with due diligence requirements for 
                the period beginning on the day after the ending date 
                of the previous audit, in accordance with standards 
                determined by the Secretary.
                    ``(F) Revocation authority.--The Secretary shall 
                revoke the designation of a lender, holder, or servicer 
                under subparagraph (A) if any quarterly audit required 
                under subparagraph (E) is not received by the Secretary 
                by the date established by the Secretary or if the 
                audit indicates the lender, holder, or servicer has 
                failed to meet the standards for designation as an 
                exceptional performer under subparagraph (A). A lender, 
                holder, or servicer receiving a compliance audit not 
                meeting the standard for designation as an exceptional 
                performer may reapply for designation under 
                subparagraph (A) at any time.
                    ``(G) Documentation.--Nothing in this section shall 
                restrict or limit the authority of the Secretary to 
                require the submission of claims documentation 
                evidencing servicing performed on loans, except that 
                the Secretary may not require exceptional performers to 
                submit greater documentation than that required for 
                lenders, holders, and servicers not designated under 
                subparagraph (A).
                    ``(H) Cost of audits.--Each eligible lender, 
                holder, or servicer shall pay for all the costs 
                associated with the audits required under this section.
                    ``(I) Additional revocation authority.--
                Notwithstanding any other provision of this section, a 
                designation under subparagraph (A) may be revoked at 
                any time by the Secretary if the Secretary determines 
                that the eligible lender, holder, or servicer has 
                failed to maintain an overall level of compliance 
                consistent with the audit submitted by the eligible 
                lender, holder, or servicer under this paragraph or if 
                the Secretary asserts that the lender, holder, or 
                servicer may have engaged in fraud in securing 
                designation under subparagraph (A) or is failing to 
                service loans in accordance with program requirements.
                    ``(J) Noncompliance.--A lender, holder, or servicer 
                designated under subparagraph (A) that fails to service 
                loans or otherwise comply with applicable program 
                regulations shall be considered in violation of the 
                Federal False Claims Act.''.
    (b) Definition.--Section 707(e) of the Public Health Service Act 
(42 U.S.C. 292f(e)) is amended by adding at the end the following new 
paragraph:
            ``(4) The term `servicer' means any agency acting on behalf 
        of the insurance beneficiary.''.
    (c) Effective Date.--The amendments made by subsections (a) and (b) 
shall apply with respect to loans submitted to the Secretary for 
payment on or after the first day of the sixth month that begins after 
the date of enactment of this Act.

SEC. 143. REAUTHORIZATION.

    (a) Loan Program.--Section 702(a) of the Public Health Service Act 
(42 U.S.C. 292a(a)) is amended--
            (1) by striking ``$350,000,000'' and all that follows 
        through ``1995'' and inserting ``$260,000,000 for fiscal year 
        1996, $160,000,000 for fiscal year 1997, and $80,000,000 for 
        fiscal year 1998'';
            (2) by striking ``obtained prior loans insured under this 
        subpart'' and inserting ``obtained loans insured under this 
        subpart in fiscal year 1996 or in prior fiscal years''; and
            (3) by adding at the end thereof the following new 
        sentence: ``The Secretary may establish guidelines and 
        procedures that lenders must follow in distributing funds under 
        this subpart.''.
    (b) Insurance Program.--Section 710(a)(2)(B) of the Public Health 
Service Act (42 U.S.C. 292i(a)(2)(B)) is amended by striking ``any of 
the fiscal years 1993 through 1996'' and inserting ``fiscal year 1993 
and subsequent fiscal years''.

            PART 4--SCHOLARSHIPS FOR DISADVANTAGED STUDENTS

SEC. 151. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.

    Part B of title VII of the Public Health Service Act (as amended by 
section 101(a)) is further amended by adding at the end thereof the 
following new section:

``SEC. 740. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.

    ``(a) In General.--The Secretary may make a grant to an eligible 
entity (as defined in subsection (f)(1)) under this section for the 
awarding of scholarships by schools to any full-time student who is an 
eligible individual as defined in subsection (f). Such scholarships may 
be expended only for tuition expenses, other reasonable educational 
expenses, and reasonable living expenses incurred in the attendance of 
such school, and may not, for any year of such attendance for which the 
scholarship is provided, provide an amount exceeding the total amount 
required for the year.
    ``(b) Preference in Providing Scholarships.--The Secretary may not 
make a grant to an entity under subsection (a) unless the health 
professions and nursing schools involved agrees that, in providing 
scholarships pursuant to the grant, the school will give preference to 
students for whom the costs of attending the school would constitute a 
severe financial hardship and, notwithstanding other provisions of this 
section, to former recipients of scholarships under sections 736 and 
740(d)(2)(B) (as such sections existed on the day before the date of 
enactment of this section).
    ``(c) Amount of Award.--In awarding grants to eligible entities 
that are health professions and nursing schools, the Secretary shall 
give priority to eligible entities based on the proportion of 
graduating students going into primary care, the proportion of minority 
students, and the proportion of graduates working in medically 
underserved areas.
    ``(d) Maximum Scholarship Award.--The maximum scholarship that an 
individual may receive in any year from an eligible entity that is a 
health professions and nursing schools shall be $3,000.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $32,000,000 for each of the 
fiscal years 1996 through 1999. Of the amount appropriated in any 
fiscal year, the Secretary shall ensure that not less than 16 percent 
shall be distributed to schools of nursing.
    ``(f) Definitions.--As used in this section:
            ``(1) Eligible entities.--The term `eligible entities' 
        means an entity that--
                    ``(A) is a school of medicine, osteopathic 
                medicine, dentistry, nursing (as defined in section 
                801), pharmacy, podiatric medicine, optometry, 
                veterinary medicine, public health, or allied health, a 
                school offering a graduate program in mental health 
                practice, or an entity providing programs for the 
                training of physician assistant; and
                    ``(B) is carrying out a program for recruiting and 
                retaining students from disadvantaged backgrounds, 
                including students who are members of racial and ethnic 
                minority groups.
            ``(2) Eligible individual.--The term `eligible individual' 
        means an individual who--
                    ``(A) is from a disadvantaged background;
                    ``(B) has a financial need for a scholarship; and
                    ``(C) is enrolled (or accepted for enrollment) at 
                an eligible health profession or nursing school as a 
                full-time student in a program leading to a degree in a 
                health profession or nursing.''.

                  TITLE II--OFFICE OF MINORITY HEALTH

SEC. 201. REVISION AND EXTENSION OF PROGRAMS OF OFFICE OF MINORITY 
              HEALTH.

    (a) In General.--Section 1707 of the Public Health Service Act (42 
U.S.C. 300u-6) is amended by striking subsection (b) and all that 
follows and inserting the following:
    ``(b) Duties.--With respect to improving the health of racial and 
ethnic minority groups, the Secretary, acting through the Deputy 
Assistant Secretary for Minority Health (in this section referred to as 
the `Deputy Assistant Secretary'), shall carry out the following:
            ``(1) Establish short-range and long-range goals and 
        objectives and coordinate all other activities within the 
        Public Health Service that relate to disease prevention, health 
        promotion, service delivery, and research concerning such 
        individuals. The heads of each of the agencies of the Service 
        shall consult with the Deputy Assistant Secretary to ensure the 
        coordination of such activities.
            ``(2) Carry out the following types of activities by 
        entering into interagency agreements with other agencies of the 
        Public Health Service:
                    ``(A) Support research, demonstrations and 
                evaluations to test new and innovative models.
                    ``(B) Increase knowledge and understanding of 
                health risk factors.
                    ``(C) Develop mechanisms that support better 
                information dissemination, education, prevention, and 
                service delivery to individuals from disadvantaged 
                backgrounds, including individuals who are members of 
                racial or ethnic minority groups.
                    ``(D) Ensure that the National Center for Health 
                Statistics collects data on the health status of each 
                minority group.
                    ``(E) With respect to individuals who lack 
                proficiency in speaking the English language, enter 
                into contracts with public and nonprofit private 
                providers of primary health services for the purpose of 
                increasing the access of the individuals to such 
                services by developing and carrying out programs to 
                provide bilingual or interpretive services.
            ``(3) Support a national minority health resource center to 
        carry out the following:
                    ``(A) Facilitate the exchange of information 
                regarding matters relating to health information and 
                health promotion, preventive health services, and 
                education in the appropriate use of health care.
                    ``(B) Facilitate access to such information.
                    ``(C) Assist in the analysis of issues and problems 
                relating to such matters.
                    ``(D) Provide technical assistance with respect to 
                the exchange of such information (including 
                facilitating the development of materials for such 
                technical assistance).
            ``(4) Carry out programs to improve access to health care 
        services for individuals with limited proficiency in speaking 
        the English language by facilitating the removal of impediments 
        to the receipt of health care that result from such limitation. 
        Activities under the preceding sentence shall include 
        conducting research and developing and evaluating model 
        projects.
            ``(5) Not later than June 8 of each year, the heads of the 
        Public Health Service agencies shall submit to the Deputy 
        Assistant Secretary a report summarizing the minority health 
        activities of each of the respective agencies.
    ``(c) Advisory Committee.--
            ``(1) In general.--The Secretary shall establish an 
        advisory committee to be known as the Advisory Committee on 
        Minority Health (in this subsection referred to as the 
        `Committee'). The Deputy Assistant Secretary shall consult with 
        the Committee in carrying out this section.
            ``(2) Duties.--The Committee shall provide advice to the 
        Deputy Assistant Secretary carrying out this section, including 
        advice on the development of goals and specific program 
        activities under paragraphs (1) and (2) of subsection (b) for 
        each racial and ethnic minority group.
            ``(3) Chair.--The Deputy Assistant Secretary shall serve as 
        the chair of the Committee.
            ``(4) Composition.--
                    ``(A) The Committee shall be composed of 12 voting 
                members appointed in accordance with subparagraph (B), 
                and nonvoting, ex officio members designated in 
                subparagraph (C).
                    ``(B) The voting members of the Committee shall be 
                appointed by the Secretary from among individuals who 
                are not officers or employees of the Federal Government 
                and who have expertise regarding issues of minority 
                health. The racial and ethnic minority groups shall be 
                equally represented among such members.
                    ``(C) The nonvoting, ex officio members of the 
                Committee shall be the directors of each of the 
                minority health offices, and such additional officials 
                of the Department of Health and Human Services as the 
                Secretary determines to be appropriate.
            ``(5) Terms.--Each member of the Committee shall serve for 
        a term of 4 years, except that the Secretary shall initially 
        appoint a portion of the members to terms of 1 year, 2 years, 
        and 3 years.
            ``(6) Vacancies.--If a vacancy occurs on the Committee, a 
        new member shall be appointed by the Secretary within 90 days 
        from the date that the vacancy occurs, and serve for the 
        remainder of the term for which the predecessor of such member 
        was appointed. The vacancy shall not affect the power of the 
        remaining members to execute the duties of the Committee.
            ``(7) Compensation.--Members of the Committee who are 
        officers or employees of the United States shall serve without 
        compensation. Members of the Committee who are not officers or 
        employees of the United States shall receive compensation, for 
        each day (including travel time) they are engaged in the 
        performance of the functions of the Committee. Such 
        compensation may not be in an amount in excess of the daily 
        equivalent of the annual maximum rate of basic pay payable 
        under the General Schedule (under title 5, United States Code) 
        for positions above GS-15.
    ``(d) Certain Requirements Regarding Duties.--
            ``(1) Recommendations regarding language as impediment to 
        health care.--The Deputy Assistant Secretary for Minority 
        Health shall consult with the Director of the Office of Refugee 
        Health, the Director of the Office of Civil Rights, and the 
        Director of the Office of Minority Health of the Health 
        Resources and Services Administration, and other appropriate 
        offices, regarding recommendations for carrying out activities 
        under subsection (b)(4).
            ``(2) Equitable allocation regarding activities.--
                    ``(A) In making awards of grants, cooperative 
                agreements, or contracts under this section or section 
                338A, 338B, 340A, 404, or 724, or part B of title VII, 
                the Secretary, acting as appropriate through the Deputy 
                Assistant Secretary or the Administrator of the Health 
                Resources and Services Administration, shall ensure 
                that such awards are equitably allocated with respect 
                to the various racial and minority populations.
                    ``(B) With respect to grants, cooperative 
                agreements, and contracts that are available under the 
                sections specified in subparagraph (A), the Secretary 
                shall--
                            ``(i) carry out activities to inform 
                        entities, as appropriate, that the entities may 
                        be eligible for awards of such assistance;
                            ``(ii) provide technical assistance to such 
                        entities in the process of preparing and 
                        submitting applications for the awards in 
                        accordance with the policies of the Secretary 
                        regarding such application; and
                            ``(iii) inform populations, as appropriate, 
                        that members of the populations may be eligible 
                        to receive services or otherwise participate in 
                        the activities carried out with such awards.
            ``(3) Cultural competency of services.--The Secretary shall 
        ensure that information and services provided pursuant to 
        subsection (b) are provided in the language, educational, and 
        cultural context that is most appropriate for the individuals 
        for whom the information and services are intended.
    ``(e) Grants and Contracts Regarding Duties.--
            ``(1) In general.--In carrying out subsection (b), the 
        Deputy Assistant Secretary may make awards of grants, 
        cooperative agreements, and contracts to public and nonprofit 
        private entities.
            ``(2) Process for making awards.--The Deputy Assistant 
        Secretary shall ensure that awards under paragraph (1) are made 
        only on a competitive basis, and that a grant is awarded for a 
        proposal only if the proposal has been recommended for such an 
        award through a process of peer review and has been so 
        recommended by the advisory committee established under 
        subsection (c).
            ``(3) Evaluation and dissemination.--The Deputy Assistant 
        Secretary, directly or through contracts with public and 
        private entities, shall provide for evaluations of projects 
        carried out with awards made under paragraph (1) during the 
        preceding 2 fiscal years. The report shall be included in the 
        report required under subsection (f) for the fiscal year 
        involved.
    ``(f) Biennial Reports.--Not later than February 1 of fiscal year 
1996 and of each second year thereafter, the Deputy Assistant Secretary 
shall submit to the Committee on Energy and Commerce of the House of 
Representatives, and to the Committee on Labor and Human Resources of 
the Senate, a report describing the activities carried out under this 
section during the preceding 2 fiscal years and evaluating the extent 
to which such activities have been effective in improving the health of 
racial and ethnic minority groups. Each such report shall include the 
biennial reports submitted to the Deputy Assistant Secretary under 
section 201(b)(5) for such years by the heads of the Public Health 
Service agencies.
    ``(g) Definition.--For purposes of this section:
            ``(1) The term `racial and ethnic minority group' means 
        American Indians (including Alaska Natives, Eskimos, and 
        Aleuts); Asian Americans and Pacific Islanders; Blacks; and 
        Hispanics.
            ``(2) The term `Hispanic' means individuals whose origin is 
        Mexican, Puerto Rican, Cuban, Central or South American, or any 
        other Spanish-speaking country.
    ``(h) Funding.--For the purpose of carrying out this section, there 
are authorized to be appropriated $21,000,000 for fiscal year 1996, 
such sums as may be necessary for each of the fiscal years 1997 and 
1998, and $19,000,000 for fiscal year 1999.''.
    (b) Miscellaneous Amendment.--Section 1707 of the Public Health 
Service Act (42 U.S.C. 300u-6) is amended in the heading for the 
section by striking ``establishment of''.

                    TITLE III--SELECTED INITIATIVES

SEC. 301. PROGRAMS REGARDING BIRTH DEFECTS.

    Section 317C of the Public Health Service Act (42 U.S.C. 247b-4) is 
amended to read as follows:

                   ``programs regarding birth defects

    ``Sec. 317C. (a) The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, shall carry out programs--
            ``(1) to collect, analyze, and make available data on birth 
        defects (in a manner that facilitates compliance with 
        subsection (d)(2)), including data on the causes of such 
        defects and on the incidence and prevalence of such defects; 
        and
            ``(2) to operate regional centers for the conduct of 
        applied epidemiological research on the prevention of such 
        defects.
    ``(b) Additional Provisions Regarding Collection of Data.--
            ``(1) In general.--In carrying out subsection (a)(1), the 
        Secretary--
                    ``(A) shall collect and analyze data by gender and 
                by racial and ethnic group, including Hispanics, non-
                Hispanic whites, Blacks, Native Americans, Asian 
                Americans, and Pacific Islanders;
                    ``(B) shall collect data under subparagraph (A) 
                from birth certificates, death certificates, hospital 
                records, and such other sources as the Secretary 
                determines to be appropriate; and
                    ``(C) shall encourage States to establish or 
                improve programs for the collection and analysis of 
                epidemiological data on birth defects, and to make the 
                data available.
            ``(2) National clearinghouse.--In carrying out subsection 
        (a)(1), the Secretary shall establish and maintain a National 
        Information Clearinghouse on Birth Defects to collect and 
        disseminate to health professionals and the general public 
        information on birth defects, including the prevention of such 
        defects.
    ``(c) Grants and Contracts.--
            ``(1) In general.--In carrying out subsection (a), the 
        Secretary may make grants to and enter into contracts with 
        public and nonprofit private entities.
            ``(2) Supplies and services in lieu of award funds.--
                    ``(A) Upon the request of a recipient of an award 
                of a grant or contract under paragraph (1), the 
                Secretary may, subject to subparagraph (B), provide 
                supplies, equipment, and services for the purpose of 
                aiding the recipient in carrying out the purposes for 
                which the award is made and, for such purposes, may 
                detail to the recipient any officer or employee of the 
                Department of Health and Human Services.
                    ``(B) With respect to a request described in 
                subparagraph (A), the Secretary shall reduce the amount 
                of payments under the award involved by an amount equal 
                to the costs of detailing personnel and the fair market 
                value of any supplies, equipment, or services provided 
                by the Secretary. The Secretary shall, for the payment 
                of expenses incurred in complying with such request, 
                expend the amounts withheld.
            ``(3) Application for award.--The Secretary may make an 
        award of a grant or contract under paragraph (1) only if an 
        application for the award is submitted to the Secretary and the 
        application is in such form, is made in such manner, and 
        contains such agreements, assurances, and information as the 
        Secretary determines to be necessary to carry out the purposes 
        for which the award is to be made.
    ``(d) Biennial Report.--Not later than February 1 of fiscal year 
1997 and of every second such year thereafter, the Secretary shall 
submit to the Committee on Energy and Commerce of the House of 
Representatives, and the Committee on Labor and Human Resources of the 
Senate, a report that, with respect to the preceding 2 fiscal years--
            ``(1) contains information regarding the incidence and 
        prevalence of birth defects and the extent to which birth 
        defects have contributed to the incidence and prevalence of 
        infant mortality;
            ``(2) contains information under paragraph (1) that is 
        specific to various racial and ethnic groups (including 
        Hispanics, non-Hispanic whites, Blacks, Native Americans, and 
        Asian Americans);
            ``(3) contains an assessment of the extent to which various 
        approaches of preventing birth defects have been effective;
            ``(4) describes the activities carried out under this 
        section; and
            ``(5) contains any recommendations of the Secretary 
        regarding this section.''.

SEC. 302. STATE OFFICES OF RURAL HEALTH.

    (a) In General.--Section 338M of the Public Health Service Act (as 
so redesignated by section 132) is amended--
            (1) in subsection (b)(1), in the matter preceding 
        subparagraph (A), by striking ``in cash''; and
            (2) in subsection (j)(1)--
                    (A) by striking ``and'' after ``1992,''; and
                    (B) by inserting before the period the following: 
                ``, and such sums as may be necessary for each of the 
                fiscal years 1996 through 1997''; and
            (3) in subsection (k), by striking ``$10,000,000'' and 
        inserting ``$20,000,000''.
    (b) Repeal.--Effective on October 1, 1997, section 338M of the 
Public Health Service Act (as so redesignated by section 132) is 
repealed.

SEC. 303. HEALTH SERVICES FOR PACIFIC ISLANDERS.

    Section 10 of the Disadvantaged Minority Health Improvement Act of 
1990 (42 U.S.C. 254c-1) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (2)--
                            (i) by inserting ``, substance abuse'' 
                        after ``availability of health''; and
                            (ii) by striking ``, including improved 
                        health data systems'';
                    (B) in paragraph (3)--
                            (i) by striking ``manpower'' and inserting 
                        ``care providers''; and
                            (ii) by striking ``by--'' and all that 
                        follows through the end thereof and inserting a 
                        semicolon;
                    (C) by striking paragraphs (5) and (6);
                    (D) by redesignating paragraphs (7), and (8) as 
                paragraphs (5) and (6), respectively;
                    (E) in paragraph (5) (as so redesignated), by 
                striking ``and'' at the end thereof;
                    (F) in paragraph (6) (as so redesignated), by 
                striking the period and inserting a semicolon; and
                    (G) by inserting after paragraph (6) (as so 
                redesignated), the following new paragraphs:
            ``(7) to provide primary health care, preventive health 
        care, and related training to American Samoan health care 
        professionals; and
            ``(8) to improve access to health promotion and disease 
        prevention services for rural American Samoa.'';
            (2) in subsection (f)--
                    (A) by striking ``there is'' and inserting ``there 
                are''; and
                    (B) by striking ``$10,000,000'' and all that 
                follows through ``1993'' and inserting ``$3,000,000 for 
                fiscal year 1995, $4,000,000 for fiscal year 1996, and 
                $5,000,000 for fiscal year 1997''; and
            (3) by adding at the end thereof the following new 
        subsection:
    ``(g) Study and Report.--
            ``(1) Study.--Not later than 180 days after the date of 
        enactment of this subsection, the Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, shall enter into a contract with a public or 
        nonprofit private entity for the conduct of a study to 
        determine the effectiveness of projects funded under this 
        section.
            ``(2) Report.--Not later than July 1, 1996, the Secretary 
        shall prepare and submit to the Committee on Labor and Human 
        Resources of the Senate and the Committee on Energy and 
        Commerce of the House of Representatives a report describing 
        the findings made with respect to the study conducted under 
        paragraph (1).''.

SEC. 304. DEMONSTRATION PROJECTS REGARDING ALZHEIMER'S DISEASE.

    (a) In General.--Section 398(a) of the Public Health Service Act 
(42 U.S.C. 280c-3(a)) is amended--
            (1) in the matter preceding paragraph (1), by striking 
        ``not less than 5, and not more than 15,'';
            (2) in paragraph (2)--
                    (A) by inserting after ``disorders'' the following: 
                ``who are living in single family homes or in 
                congregate settings''; and
                    (B) by striking ``and'' at the end;
            (3) by redesignating paragraph (3) as paragraph (4); and
            (4) by inserting after paragraph (2) the following:
            ``(3) to improve the access of such individuals to home-
        based or community-based long-term care services (subject to 
        the services being provided by entities that were providing 
        such services in the State involved as of October 1, 1995), 
        particularly such individuals who are members of racial or 
        ethnic minority groups, who have limited proficiency in 
        speaking the English language, or who live in rural areas; 
        and''.
    (b) Duration.--Section 398A of the Public Health Service Act (42 
U.S.C. 280c-4) is amended--
            (1) in the heading for the section, by striking 
        ``LIMITATION'' and all that follows and inserting ``REQUIREMENT 
        OF MATCHING FUNDS'';
            (2) by striking subsection (a);
            (3) by redesignating subsections (b) and (c) as subsections 
        (a) and (b), respectively;
            (4) in subsection (a) (as so redesignated), in each of 
        paragraphs (1)(C) and (2)(C), by striking ``third year'' and 
        inserting ``third or subsequent year''.
    (c) Authorization of Appropriations.--Section 398B(e) of the Public 
Health Service Act (42 U.S.C. 280c-5(e)) is amended by striking ``and 
1993'' and inserting ``through 1998''.

                   TITLE IV--MISCELLANEOUS PROVISIONS

SEC. 401. TECHNICAL CORRECTIONS REGARDING PUBLIC LAW 103-183.

    (a) Amendatory Instructions.--Public Law 103-183 is amended--
            (1) in section 601--
                    (A) in subsection (b), in the matter preceding 
                paragraph (1), by striking ``Section 1201 of the Public 
                Health Service Act (42 U.S.C. 300d)'' and inserting 
                ``Title XII of the Public Health Service Act (42 U.S.C. 
                300d et seq.)''; and
                    (B) in subsection (f)(1), by striking ``in section 
                1204(c)'' and inserting ``in section 1203(c) (as 
                redesignated by subsection (b)(2) of this section)'';
            (2) in section 602, by striking ``for the purpose'' and 
        inserting ``For the purpose''; and
            (3) in section 705(b), by striking ``317D((l)(1)'' and 
        inserting ``317D(l)(1)''.
    (b) Public Health Service Act.--The Public Health Service Act, as 
amended by Public Law 103-183 and by subsection (a) of this section, is 
amended--
            (1) in section 317E(g)(2), by striking ``making grants 
        under subsection (b)'' and inserting ``carrying out subsection 
        (b)'';
            (2) in section 318, in subsection (e) as in effect on the 
        day before the date of the enactment of Public Law 103-183, by 
        redesignating the subsection as subsection (f);
            (3) in subpart 6 of part C of title IV--
                    (A) by transferring the first section 447 (added by 
                section 302 of Public Law 103-183) from the current 
                placement of the section;
                    (B) by redesignating the section as section 447A; 
                and
                    (C) by inserting the section after section 447;
            (4) in section 1213(a)(8), by striking ``provides for for'' 
        and inserting ``provides for'';
            (5) in section 1501, by redesignating the second subsection 
        (c) (added by section 101(f) of Public Law 103-183) as 
        subsection (d); and
            (6) in section 1505(3), by striking ``nonprivate'' and 
        inserting ``private''.
    (c) Miscellaneous Correction.--Section 401(c)(3) of Public Law 103-
183 is amended in the matter preceding subparagraph (A) by striking 
``(d)(5)'' and inserting ``(e)(5)''.
    (d) Effective Date.--This section is deemed to have taken effect 
immediately after the enactment of Public Law 103-183.

SEC. 402. CERTAIN AUTHORITIES OF CENTERS FOR DISEASE CONTROL AND 
              PREVENTION.

    (a) In General.--Part B of title III of the Public Health Service 
Act is amended by inserting after section 317H the following section:

 ``miscellaneous authorities regarding centers for disease control and 
                               prevention

    ``Sec. 317I. (a) Technical and Scientific Peer Review Groups.--The 
Secretary, acting through the Director of the Centers for Disease 
Control and Prevention, may, without regard to the provisions of title 
5, United States Code, governing appointments in the competitive 
service, and without regard to the provisions of chapter 51 and 
subchapter III of chapter 53 of such title relating to classification 
and General Schedule pay rates, establish such technical and scientific 
peer review groups and scientific program advisory committees as are 
needed to carry out the functions of such Centers and appoint and pay 
the members of such groups, except that officers and employees of the 
United States shall not receive additional compensation for service as 
members of such groups. The Federal Advisory Committee Act shall not 
apply to the duration of such peer review groups. Not more than one-
fourth of the members of any such group shall be officers or employees 
of the United States.
    ``(b) Fellowship and Training Programs.--The Secretary, acting 
through the Director of the Centers for Disease Control and Prevention, 
shall establish fellowship and training programs to be conducted by 
such Centers to train individuals to develop skills in epidemiology, 
surveillance, laboratory analysis, and other disease detection and 
prevention methods. Such programs shall be designed to enable health 
professionals and health personnel trained under such programs to work, 
after receiving such training, in local, State, national, and 
international efforts toward the prevention and control of diseases, 
injuries, and disabilities. Such fellowships and training may be 
administered through the use of either appointment or nonappointment 
procedures.''.
    (b) Effective Date.--This section is deemed to have taken effect 
July 1, 1995.

SEC. 403. ADMINISTRATION OF CERTAIN REQUIREMENTS.

    (a) In General.--Section 2004 of Public Law 103-43 (107 Stat. 209) 
is amended by striking subsection (a).
    (b) Conforming Amendments.--Section 2004 of Public Law 103-43, as 
amended by subsection (a) of this section, is amended--
            (1) by striking ``(b) Sense'' and all that follows through 
        ``In the case'' and inserting the following:
    ``(a) Sense of Congress Regarding Purchase of American-Made 
Equipment and Products.--In the case'';
            (2) by striking ``(2) Notice to recipients of assistance'' 
        and inserting the following:
    ``(b) Notice to Recipients of Assistance''; and
            (3) in subsection (b), as redesignated by paragraph (2) of 
        this subsection, by striking ``paragraph (1)'' and inserting 
        ``subsection (a)''.
    (c) Effective Date.--This section is deemed to have taken effect 
immediately after the enactment of Public Law 103-43.

SEC. 404. TECHNICAL CORRECTIONS RELATING TO HEALTH PROFESSIONS 
              PROGRAMS.

    Part G of title VII of the Public Health Service Act (42 U.S.C. 
295j et seq.) is amended by inserting after section 794 the following 
section:

``SEC. 794A. RECOVERY.

    ``(a) In General.--If at any time within 20 years (or within such 
shorter period as the Secretary may prescribe by regulation for an 
interim facility) after the completion of construction of a facility 
with respect to which funds have been paid under section 720(a) (as 
such section existed one day prior to the date of enactment of the 
Health Professions Education Extension Amendments of 1992 (Public Law 
102-408))--
            ``(1)(A) in the case of a facility which was an affiliated 
        hospital or outpatient facility with respect to which funds 
        have been paid under such section 720(a)(1), the owner of the 
        facility ceases to be a public or other nonprofit agency that 
        would have been qualified to file an application under section 
        605;
            ``(B) in the case of a facility which was not an affiliated 
        hospital or outpatient facility but was a facility with respect 
        to which funds have been paid under paragraph (1) or (3) of 
        such section 720(a), the owner of the facility ceases to be a 
        public or nonprofit school; or
            ``(C) in the case of a facility which was a facility with 
        respect to which funds have been paid under such section 
        720(a)(2), the owner of the facility ceases to be a public or 
        nonprofit entity;
            ``(2) the facility ceases to be used for the teaching or 
        training purposes (or other purposes permitted under section 
        722 (as such section existed one day prior to the date of 
        enactment of the Health Professions Education Extension 
        Amendments of 1992 (Public Law 102-408)) for which it was 
        constructed, or
            ``(3) the facility is used for sectarian instruction or as 
        a place for religious worship,
the United States shall be entitled to recover from the owner of the 
facility the base amount prescribed by subsection (c)(1) plus the 
interest (if any) prescribed by subsection (c)(2).
    ``(b) Notice.--The owner of a facility which ceases to be a public 
or nonprofit agency, school, or entity as described in subparagraph 
(A), (B), or (C) of subsection (a)(1), as the case may be, or the owner 
of a facility the use of which changes as described in paragraph (2) or 
(3) of subsection (a), shall provide the Secretary written notice of 
such cessation or change of use within 10 days after the date on which 
such cessation or change of use occurs or within 30 days after the date 
of enactment of this subsection, whichever is later.
    ``(c) Amount.--
            ``(1) Base amount.--The base amount that the United States 
        is entitled to recover under subsection (a) is the amount 
        bearing the same ratio to the then value (as determined by the 
        agreement of the parties or in an action brought in the 
        district court of the United States for the district in which 
        the facility is situated) of the facility as the amount of the 
        Federal participation bore to the cost of construction.
            ``(2) Interest.--
                    ``(A) In general.--The interest that the United 
                States is entitled to recover under subsection (a) is 
                the interest for the period (if any) described in 
                subparagraph (B) at a rate (determined by the 
                Secretary) based on the average of the bond equivalent 
                rates of ninety-one-day Treasury bills auctioned during 
                that period.
                    ``(B) Period.--The period referred to in 
                subparagraph (A) is the period beginning--
                            ``(i) if notice is provided as prescribed 
                        by subsection (b), 191 days after the date on 
                        which the owner of the facility ceases to be a 
                        public or nonprofit agency, school, or entity 
                        as described in subparagraph (A), (B), or (C) 
                        of subsection (a)(1), as the case may be, or 
                        191 days after the date on which the use of the 
                        facility changes as described in paragraph (2) 
                        or (3) of subsection (a); or
                            ``(ii) if notice is not provided as 
                        prescribed by subsection (b), 11 days after the 
                        date on which such cessation or change of use 
                        occurs,
                and ending on the date the amount the United States is 
                entitled to recover is collected.
    ``(d) Waiver.--The Secretary may waive the recovery rights of the 
United States under subsection (a)(2) with respect to a facility (under 
such conditions as the Secretary may establish by regulation) if the 
Secretary determines that there is good cause for waiving such rights.
    ``(e) Lien.--The right of recovery of the United States under 
subsection (a) shall not, prior to judgment, constitute a lien on any 
facility.''.

SEC. 405. CLINICAL TRAINEESHIPS.

    Section 303(d)(1) of the Public Health Service Act (42 U.S.C. 
242a(d)(1)) is amended by inserting ``counseling,'' after ``family 
therapy,''.

SEC. 406. CONSTRUCTION OF REGIONAL CENTERS FOR RESEARCH ON PRIMATES.

    Section 481B(a) of the Public Health Service Act (42 U.S.C. 287a-
3(a)) is amended by striking ``$5,000,000'' and inserting 
``$2,500,000''.

SEC. 407. REQUIRED CONSULTATION BY SECRETARY.

    The Secretary of Health and Human Services, regarding the programs 
under parts B, C, D, and E of title VII, and parts B, C, and D of title 
VIII, of the Public Health Service Act, as amended by this Act, shall--
            (1) publish in the Federal Register a general program 
        description for the funding of awards under such parts;
            (2) solicit and receive written and oral comments 
        concerning such description, including the holding of a public 
        forum at which interested individuals and groups may provide 
        comment; and
            (3) take into consideration information received under 
        paragraph (2).

            Passed the Senate September 28, 1996.

            Attest:

                                                             Secretary.

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104th CONGRESS

  2d Session

                                 S. 555

_______________________________________________________________________

                                 AN ACT

 To amend the Public Health Service Act to consolidate and reauthorize 
  health professions and minority and disadvantaged health education 
                   programs, and for other purposes.
```