II

104TH CONGRESS

1ST SESSION S. 555

To amend the Public Health Service Act to consolidate and reauthorize

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

IN THE SENATE OF THE UNITED STATES

MARCH 14 (legislative day, MARCH 6), 1995

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

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

Labor and Human Resources

A BILL

To amend the Public Health Service Act to consolidate and

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

purposes.

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

3 SECTION 1. SHORT TITLE.

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

5 ‘‘Health Professions Education Consolidation and Reau6 thorization Act of 1995’’.

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

8 this Act is as follows:
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Sec. 1. Short title.

TITLE I—HEALTH PROFESSIONS EDUCATION AND FINANCIAL

ASSISTANCE PROGRAMS

Subtitle A—Health Professions Education Programs

Sec. 101. Minority health professions grant program.

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

Sec. 103. Enhanced health education and training.

Sec. 104. Health profession workforce development.

Sec. 105. General provisions.

Sec. 106. Preference and required information in certain programs.

Sec. 107. Definitions.

Sec. 108. Savings provision.

Subtitle B—Nursing Education

Sec. 121. Short title.

Sec. 122. Purpose.

Sec. 123. Amendments to Public Health Service Act.

Sec. 124. Savings provision.

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

Subtitle C—Financial Assistance

PART 1—NATIONAL HEALTH SERVICE CORPS FINANCIAL ASSISTANCE

PROGRAMS

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

Sec. 132. Restructuring and technical amendments.

Sec. 133. Definition of underserved areas.

Sec. 134. Conforming amendments.

PART 2—SCHOOL-BASED REVOLVING LOAN FUNDS

Sec. 135. Primary care loan program.

Sec. 136. Loans for disadvantaged students.

Sec. 137. Student loans regarding schools of nursing.

PART 3—INSURED HEALTH EDUCATION ASSISTANCE LOANS TO GRADUATE

STUDENTS

Sec. 141. Health education assistance loan program.

PART 4—SCHOLARSHIPS FOR DISADVANTAGED STUDENTS

Sec. 151. Scholarships for disadvantaged students.

TITLE II—OFFICE OF MINORITY HEALTH

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

TITLE III—SELECTED INITIATIVES

Sec. 301. Programs regarding birth defects.

Sec. 302. Traumatic brain injury.

Sec. 303. State offices of rural health.

Sec. 304. Health services for Pacific Islanders.
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Sec. 305. Demonstration projects regarding Alzheimer’s Disease.

TITLE IV—MISCELLANEOUS PROVISIONS

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

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

Sec. 403. Administration of certain requirements.

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

Sec. 405. Clinical traineeships.

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

1 TITLE I—HEALTH PROFESSIONS

2 EDUCATION AND FINANCIAL

3 ASSISTANCE PROGRAMS

4 Subtitle A—Health Professions

5 Education Programs

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

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

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

10 to read as follows:

11 ‘‘PART B—DISADVANTAGED HEALTH PROFESSIONS

12 TRAINING

13 ‘‘§ 736. Statement of purpose

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

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

17 to increase the number and the quality of disadvantaged

18 health professionals, particularly those who provide health

19 services to disadvantaged populations or in medically un20 derserved areas or rural areas.
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1 ‘‘(b) USE OF FUNDS.—Amounts provided under a

2 grant or contract awarded under this part may be used

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

4 excellence in minority health professions education, pro5 grams for assisting individuals from disadvantaged back6 grounds to enter a health profession, minority faculty de7 velopment, minority faculty loan repayment or fellowships,

8 trainee support, technical assistance, workforce analysis,

9 and dissemination of information.

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

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

12 enter into an agreement to allocate the funds received

13 under the grant or contract among such schools and ex14 pend such funds in accordance with the application for

15 such grant or contract.

16 ‘‘§ 737. Preferences

17 ‘‘In awarding grants or contracts to eligible entities

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

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

20 professions discipline or training institution and

21 have an above average record of retention and grad22 uation of individuals from disadvantaged back23 grounds; and

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

25 Colleges and Universities (as defined in section 739)
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1 beginning in fiscal year 1999 and for each fiscal

2 year thereafter.

3 ‘‘§ 738. Authorization of appropriation

4 ‘‘(a) IN GENERAL.—There are authorized to be ap5 propriated to carry out this part, $51,000,000 for fiscal

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

7 of the fiscal years 1997 through 1999.

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

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

10 23.5 percent of the amount appropriated under subsection

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

12 grants under section 736 to centers of excellence at certain

13 Historically Black Colleges and Universities.

14 ‘‘§ 739. Definitions

15 ‘‘As used in this part:

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

17 ‘centers of excellence’ means a health professions

18 school that—

19 ‘‘(A)(i) has a significant number of minor20 ity individuals enrolled in the school, including

21 individuals accepted for enrollment in the

22 school;

23 ‘‘(ii) has been effective in assisting minor24 ity students of the school to complete the pro-
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1 gram of education and receive the degree in2 volved;

3 ‘‘(iii) has been effective in recruiting mi4 nority individuals to attend the school and en5 couraging minority students of secondary edu6 cational institutions to attend the health profes7 sions school; and

8 ‘‘(iv) has made significant recruitment ef9 forts to increase the number of minority indi10 viduals serving in faculty or administrative posi11 tions at the school; or

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

13 Historically Black Colleges and Universities.

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

15 means the designated eligible entity seeking a grant

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

17 osteopathic medicine, dentistry, pharmacy, nursing,

18 allied health, public health, or graduate programs in

19 mental health practice.

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

21 entities’ means schools of medicine, osteopathic med22 icine, dentistry, pharmacy, podiatric medicine, op23 tometry, veterinary medicine, public health, or allied

24 health or schools offering graduate programs in

25 mental health practice, State or local governments,
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1 and other public or nonprofit private entities deter2 mined appropriate by the Secretary that submit to

3 the Secretary an application.

4 ‘‘(4) HISTORICALLY BLACK COLLEGES AND

5 UNIVERSITIES.—The term ‘Historically Black Col6 leges and Universities’ means a school described in

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

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

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

10 (b) REPEAL.—

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

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

13 (2) NONTERMINATION OF AUTHORITY.—The

14 amendments made by this section shall not be con15 strued to terminate agreements that, on the day be16 fore the date of enactment of this Act, are in effect

17 pursuant to section 795 of the Public Health Service

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

19 date. Such agreements shall continue in effect in ac20 cordance with the terms of the agreements. With re21 spect to compliance with such agreements, any pe22 riod of practice as a provider of primary health serv23 ices shall be counted towards the satisfaction of the

24 requirement of practice pursuant to such section

25 795.
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1 (c) CONFORMING AMENDMENTS.—Section

2 481A(c)(3)(D)(i) of the Public Health Service Act (42

3 U.S.C. 287a–2(c)(3)(D)(i)) is amended by striking ‘‘sec4 tion 739’’ and inserting ‘‘part B of title VII’’.

5 SEC. 102. TRAINING IN PRIMARY HEALTH CARE AND PRE6 VENTIVE MEDICINE.

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

8 is amended—

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

10 inserting ‘‘CARE AND PREVENTIVE MEDICINE’’;

11 (2) by repealing section 746 and sections 748

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

13 293p); and

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

15 (A) by striking the section heading and in16 serting the following:

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

18 general pediatrics, preventive medicine,

19 and physician assistants’’;

20 (B) in subsection (a)—

21 (i) in paragraph (1)—

22 (I) by inserting ‘‘, internal medi23 cine, or pediatrics’’ after ‘‘family med24 icine’’; and
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1 (II) by inserting before the semi2 colon the following: ‘‘that emphasizes

3 training for the practice of family

4 medicine, general internal medicine,

5 or general pediatrics (as defined in

6 regulations promulgated by the Sec7 retary)’’;

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

9 general internal medicine, or pediatrics’’

10 before the semicolon;

11 (iii) in paragraphs (3) and (4), by in12 serting ‘‘, general internal medicine (in13 cluding geriatrics), or general pediatrics’’

14 after ‘‘family medicine’’;

15 (iv) in paragraphs (3) and (4), by in16 serting ‘‘(including geriatrics) after ‘‘fam17 ily medicine’’;

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

19 ‘‘and’’ at the end thereof;

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

21 period and inserting a semicolon; and

22 (vii) by adding at the end thereof the

23 following new paragraphs:

24 ‘‘(5) to meet the costs of projects to plan, de25 velop, and operate or maintain programs for the
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1 training of physician assistants (as defined in sec2 tion 799), and for the training of individuals who

3 will teach programs to provide such training; and

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

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

6 training programs and to maintain or improve

7 existing residency training programs in preven8 tive medicine, that have available full-time fac9 ulty members with training and experience in

10 the fields of preventive medicine; and

11 ‘‘(B) to provide financial assistance to resi12 dency trainees enrolled in such programs.’’;

13 (C) in paragraphs (1) and (2)(A) of sub14 section (b), by inserting ‘‘, general internal

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

16 medicine’’;

17 (D) by redesignating subsections (c) and

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

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

20 following new subsection:

21 ‘‘(c) PRIORITY AND LIMITATION.—

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

23 the training of interns or residents, the Secretary

24 shall give priority in awarding grants under this sec25 tion to qualified applicants that have a record of
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1 training the greatest percentage of providers, or that

2 have demonstrated significant improvements in the

3 percentage of providers, which enter and remain in

4 primary care practice upon completion of their first

5 period of training required to obtain initial board

6 certification. Each program shall designate the pri7 mary care training positions that such program shall

8 provide with grant funding to support and for which

9 such program shall be held accountable regarding

10 the primary care requirement set forth in this sec11 tion.

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

13 for the training and education of medical students,

14 the Secretary may only provide grants or contracts

15 under this section to administrative units in general

16 pediatrics or general internal medicine if a qualified

17 administrative unit applicant demonstrates that its

18 medical school has—

19 ‘‘(A) a mission statement that has a pri20 mary care medical education objective;

21 ‘‘(B) faculty role models and administra22 tive units in primary care; and

23 ‘‘(C) required undergraduate ambulatory

24 medical student clerkships in family medicine,

25 internal medicine, and pediatrics.
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1 Where a medical school does not have an adminis2 trative unit in family medicine clerkships in family

3 medicine shall not be required.’’; and

4 (F) in subsection (e) (as so redesig5 nated)—

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

7 ‘‘$54,000,000’’ and all that follows and in8 serting ‘‘$76,000,000 for fiscal year 1996,

9 and such sums as may be necessary for

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

11 and

12 (ii) in paragraph (2)—

13 (I) by striking ‘‘20’’ and insert14 ing ‘‘12’’; and

15 (II) by inserting ‘‘for family med16 icine academic administrative units’’

17 after ‘‘under subsection (b)’’.

18 SEC. 103. ENHANCED HEALTH EDUCATION AND TRAINING.

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

20 (42 U.S.C. 294 et seq.) is amended to read as follows:

21 ‘‘PART D—AREA HEALTH EDUCATION CENTERS

22 ‘‘§ 750. Area health education centers

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

24 to and enter into contracts with eligible entities for

25 projects which—
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1 ‘‘(1) improve the recruitment, distribution, sup2 ply, quality, utilization, and efficiency of personnel

3 providing health services in urban and rural areas

4 and populations that have demonstrated serious

5 unmet health care need;

6 ‘‘(2) encourage the regionalization of edu7 cational responsibilities of the health professions

8 schools;

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

10 placements, preceptorships, the conduct or affiliation

11 with community-based primary care residency pro12 grams, agreements with community-based organiza13 tions for the delivery of education and training in

14 the health professions, and other programs, individ15 uals to effectively provide health services in health

16 professional shortage areas;

17 ‘‘(4) conduct health professions education and

18 training activities consistent with national and State

19 priorities, including geriatrics;

20 ‘‘(5) encourage health promotion and disease

21 prevention activities;

22 ‘‘(6) conduct interdisciplinary training and

23 practice involving other health professionals;
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1 ‘‘(7) conduct continuing education programs for

2 health professionals or coordinates with such pro3 grams; and

4 ‘‘(8) address other areas as determined appro5 priate by the Secretary.

6 ‘‘(b) PREFERENCES.—In awarding grants or con7 tracts to eligible entities under this part, the Secretary

8 shall give preference to projects that—

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

10 discipline or training institution;

11 ‘‘(2) have a good record of retention and grad12 uation of individuals that enter practice in medically

13 underserved communities; and

14 ‘‘(3) have a higher percentage of medical stu15 dents or residents that enter primary care practice.

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

17 may award grants or contracts under this section for the

18 establishment of geriatric education centers. In making a

19 determination to fund such centers the Secretary shall

20 consider the impact the programs under section 747, this

21 part, and title VIII have made in the production of person22 nel to care for geriatric populations.

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

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

2 health or schools offering graduate programs in mental

3 health practice, State or local governments, and other pub4 lic or nonprofit private entities determined appropriate by

5 the Secretary that submit to the Secretary an application.

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

7 education center shall be an accredited health professions

8 school or program that—

9 ‘‘(1) improves the training of health profes10 sionals in geriatrics, including geriatric residencies,

11 traineeships, or fellowships;

12 ‘‘(2) develops and disseminates curricula relat13 ing to the treatment of the health problems of elder14 ly individuals;

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

16 faculty to provide instruction in geriatrics;

17 ‘‘(4) supports continuing education of health

18 professionals who provide geriatric care; and

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

20 geriatrics in nursing homes, chronic and acute dis21 ease hospitals, ambulatory care centers, and senior

22 centers.

23 ‘‘§ 751. Authorization of appropriations

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

25 this part, $39,000,000 for fiscal year 1996, such sums as
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1 may be necessary for each of the fiscal years 1997 and

2 1998, and $25,000,000 for fiscal year 1999.’’.

3 SEC. 104. HEALTH PROFESSION WORKFORCE DEVELOP4 MENT.

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

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

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

8 ‘‘PART E—HEALTH PROFESSION WORKFORCE

9 DEVELOPMENT’’;

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

11 294n) as section 761; and

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

13 294o and 294p) and inserting the following new sec14 tion:

15 ‘‘§ 762. Health profession workforce development

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

17 to and enter into contracts with eligible entities for

18 projects to strengthen capacity for health professions edu19 cation and practice.

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

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

22 medicine, osteopathic medicine, dentistry, veterinary medi23 cine, pharmacy, podiatric medicine, chiropractic medicine,

24 optometry, public health, or allied health, graduate pro25 grams in mental health practice, physician assistant train-
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1 ing programs, and other public and nonprofit private enti2 ties.

3 ‘‘(c) PRIORITY AREAS.—In awarding grants or con4 tracts under subsection (a), the Secretary shall give prior5 ity to entities that will use amounts provided under such

6 grants or contracts to enhance the education of health pro7 fessionals for purposes of—

8 ‘‘(1) providing care for underserved populations

9 and other high-risk groups;

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

11 are pursuing a course of study in a health profes12 sions field in which there is a severe shortage of

13 health professionals;

14 ‘‘(3) conducting health professions research and

15 data collection; and

16 ‘‘(4) carrying out other activities in areas deter17 mined appropriate by the Secretary.

18 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—

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

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

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

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

23 $5,000,000 for fiscal year 1999.

24 ‘‘(2) RESERVATION.—Of the amounts appro25 priated under subsection (a) for a fiscal year, the
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1 Secretary may reserve not more than $2,000,000 for

2 conducting health professions research and data col3 lection in accordance with section 792.’’.

4 (b) HEALTH PROFESSIONS DATA.—The second sen5 tence of section 792(a) of the Public Health Service Act

6 (42 U.S.C. 295k(a)) is amended by striking ‘‘is authorized

7 to’’ and inserting ‘‘shall’’.

8 (c) COUNCIL ON GRADUATE MEDICAL EDUCATION.—

9 Section 301 of the Health Professions Education Exten10 sion Amendments of 1992 (Public Law 102-408) is

11 amended—

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

13 inserting ‘‘1999’’;

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

15 inserting ‘‘1999’’;

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

17 new subsection:

18 ‘‘(l) FUNDING.—Amounts otherwise appropriated

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

20 the medical education activities of the Council.’’;

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

22 title VII of the Public Health Service Act (as

23 amended by subsection (a));

24 (5) by redesignating such section as section

25 763; and
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1 (6) by inserting such section after section 762.

2 SEC. 105. GENERAL PROVISIONS.

3 (a) IN GENERAL.—

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

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

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

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

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

9 (B) in section 791 (42 U.S.C. 295j) by

10 striking subsection (b);

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

12 295l);

13 (D) by repealing section 798;

14 (E) by redesignating section 799 as section

15 799B; and

16 (F) by inserting after section 794, the fol17 lowing new sections:

18 ‘‘§ 796. Application

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

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

21 and submit to the Secretary an application that meets the

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

23 and containing such information as the Secretary may re24 quire.
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1 ‘‘(b) PLAN.—An application submitted under this

2 section shall contain the plan of the applicant for carrying

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

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

5 regional program plans.

6 ‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An ap7 plication submitted under this section shall contain a spec8 ification by the applicant entity of performance outcome

9 standards that the project to be funded under the grant

10 or contract will be measured against. Such standards shall

11 address relevant health workforce needs that the project

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

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

14 contract application.

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

16 this section shall contain a description of the linkages with

17 relevant educational and health care entities, including

18 training programs for other health professionals as appro19 priate, that the project to be funded under the grant or

20 contract will establish.

21 ‘‘§ 797. Use of funds

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

23 or contract awarded under this title may be used for train24 ing program development and support, faculty develop25 ment, model demonstrations, trainee support including
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1 tuition, books, program fees and reasonable living ex2 penses during the period of training, technical assistance,

3 workforce analysis, and dissemination of information, as

4 appropriate to meet recognized health workforce objec5 tives, in accordance with this title.

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

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

8 be expended, the entity shall agree to maintain expendi9 tures of non-Federal amounts for such activities at a level

10 that is not less than the level of such expenditures main11 tained by the entity for the fiscal year preceding the fiscal

12 year for which the entity receives such a grant.

13 ‘‘§ 798. Matching requirement

14 ‘‘The Secretary may require that an entity that ap15 plies for a grant or contract under this title provide non16 Federal matching funds, as appropriate, to ensure the in17 stitutional commitment of the entity to the projects funded

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

19 non-Federal matching funds may be provided directly or

20 through donations from public or private entities and may

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

22 equipment, or services.

23 ‘‘§ 799. Generally applicable provisions

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

25 Secretary shall ensure that grants and contracts under
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1 this title are awarded on a competitive basis, as appro2 priate, to carry out innovative demonstration projects or

3 provide for strategic workforce supplementation activities

4 as needed to meet health workforce goals and in accord5 ance with this title.

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

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

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

11 applicable accreditation and quality standards.

12 ‘‘(d) DURATION OF ASSISTANCE.—

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

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

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

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

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

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

6 which payments may be made under the award.

7 ‘‘(e) PEER REVIEW REGARDING CERTAIN PRO8 GRAMS.—Each application for a grant under this title, ex9 cept any scholarship or loan program, including those

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

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

12 proposals made in the application. The Secretary may not

13 approve such an application unless a peer review group

14 has recommended the application for approval. Each peer

15 review group under this subsection shall be composed prin16 cipally of individuals who are not officers or employees of

17 the Federal Government. This subsection shall be carried

18 out by the Secretary acting through the Administrator of

19 the Health Resources and Services Administration.

20 ‘‘(f) PREFERENCE CONSIDERATIONS.—In consider21 ing a preference for funding which is based on outcome

22 measures for an eligible entity under this title, the Sec23 retary shall also consider the future ability of the eligible

24 entity to meet the outcome preference through improve25 ments in the eligible entity’s program design.
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1 ‘‘§ 799A. Technical assistance

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

3 the Secretary to provide technical assistance in relation

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

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

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

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

8 prior to the date of enactment of the Health Professions

9 Education Consolidation and Reauthorization Act of

10 1995’’ before the period.

11 SEC. 106. PREFERENCE AND REQUIRED INFORMATION IN

12 CERTAIN PROGRAMS.

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

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

15 end thereof the following subsection:

16 ‘‘(d) EXCEPTIONS.—

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

18 compete equitably for funding under this section,

19 those new programs that meet the criteria described

20 in paragraph (3) shall qualify for a funding pref21 erence under this section.

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

23 the term ‘new program’ means any program that

24 has graduated less than three classes. Upon grad25 uating at least three classes, a program shall have

26 the capability to provide the information necessary
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1 to qualify the program for the general funding pref2 erences described in subsection (a).

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

4 paragraph (1) are the following:

5 ‘‘(A) The mission statement of the pro6 gram identifies a specific purpose of the pro7 gram as being the preparation of health profes8 sionals to serve underserved populations.

9 ‘‘(B) The curriculum of the program in10 cludes content which will help to prepare practi11 tioners to serve underserved populations.

12 ‘‘(C) Substantial clinical training experi13 ence is required under the program in medically

14 underserved communities.

15 ‘‘(D) A minimum of 20 percent of the clin16 ical faculty of the program spend at least 50

17 percent of their time providing or supervising

18 care in medically underserved communities.

19 ‘‘(E) The entire program or a substantial

20 portion of the program is physically located in

21 a medically underserved community.

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

23 service in medically underserved communities

24 following graduation, is available to the stu25 dents in the program.
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1 ‘‘(G) The program provides a placement

2 mechanism for deploying graduates to medically

3 underserved communities.’’.

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

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

6 amended—

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

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

9 ‘‘section 747’’; and

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

11 798(a)’’.

12 SEC. 107. DEFINITIONS.

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

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

15 105(a)(2)(E)) is amended—

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

17 the end thereof;

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

19 and inserting ‘‘; or’’; and

20 (3) by adding at the end the following new sub21 paragraph:

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

23 that has a severe shortage of public health per24 sonnel as determined under criteria established

25 by the Secretary.’’.
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1 SEC. 108. SAVINGS PROVISION.

2 In the case of any authority for making awards of

3 grants or contracts that is terminated by the amendments

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

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

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

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

9 of any such grant or contract not exceeding the period

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

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

13 of such assistance, as the case may be.

14 Subtitle B—Nursing Education

15 SEC. 121. SHORT TITLE.

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

17 Consolidation and Reauthorization Act of 1995’’.

18 SEC. 122. PURPOSE.

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

20 education authorities of title VIII of the Public Health

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

23 development.

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

25 Title VIII of the Public Health Service Act (42

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

3 sections 855 and 860; and inserting the following:

4 ‘‘TITLE VIII—NURSING WORKFORCE

5 DEVELOPMENT’’;

6 (2) in subpart II of part B, by striking the sub7 part heading and inserting the following:

8 ‘‘PART E—STUDENT LOANS

9 ‘‘SUBPART I—GENERAL PROGRAM’’;

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

11 (4) by striking section 837;

12 (5) by inserting after the title heading the fol13 lowing new parts:

14 ‘‘PART A—GENERAL PROVISIONS

15 ‘‘§ 801. Definitions

16 ‘‘As used in this title:

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

18 entities’ means schools of nursing, nursing centers,

19 State or local governments, and other public or non20 profit private entities determined appropriate by the

21 Secretary that submit to the Secretary an applica22 tion in accordance with section 802.

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

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

25 diploma school of nursing in a State.
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1 ‘‘(3) COLLEGIATE SCHOOL OF NURSING.—The

2 term ‘collegiate school of nursing’ means a depart3 ment, division, or other administrative unit in a col4 lege or university which provides primarily or exclu5 sively a program of education in professional nursing

6 and related subjects leading to the degree of bach7 elor of arts, bachelor of science, bachelor of nursing,

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

9 in nursing, and including advanced training related

10 to such program of education provided by such

11 school, but only if such program, or such unit, col12 lege or university is accredited.

13 ‘‘(4) ASSOCIATE DEGREE SCHOOL OF NURS14 ING.—The term ‘associate degree school of nursing’

15 means a department, division, or other administra16 tive unit in a junior college, community college, col17 lege, or university which provides primarily or exclu18 sively a two-year program of education in profes19 sional nursing and allied subjects leading to an asso20 ciate degree in nursing or to an equivalent degree,

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

22 university is accredited.

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

24 term ‘diploma school of nursing’ means a school af25 filiated with a hospital or university, or an independ-
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1 ent school, which provides primarily or exclusively a

2 program of education in professional nursing and al3 lied subjects leading to a diploma or to equivalent

4 indicia that such program has been satisfactorily

5 completed, but only if such program, or such affili6 ated school or such hospital or university or such

7 independent school is accredited.

8 ‘‘(6) ACCREDITED.—

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

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

11 applied to any program of nurse education

12 means a program accredited by a recognized

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

14 for such purpose by the Secretary of Education

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

16 or university (or a unit thereof) means a hos17 pital, school, college, or university (or a unit

18 thereof) which is accredited by a recognized

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

20 for such purpose by the Secretary of Education.

21 For the purpose of this paragraph, the Sec22 retary of Education shall publish a list of recog23 nized accrediting bodies, and of State agencies,

24 which the Secretary of Education determines to
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1 be reliable authority as to the quality of edu2 cation offered.

3 ‘‘(B) NEW PROGRAMS.—A new school of

4 nursing that, by reason of an insufficient period

5 of operation, is not, at the time of the submis6 sion of an application for a grant or contract

7 under this title, eligible for accreditation by

8 such a recognized body or bodies or State agen9 cy, shall be deemed accredited for purposes of

10 this title if the Secretary of Education finds,

11 after consultation with the appropriate accredi12 tation body or bodies, that there is reasonable

13 assurance that the school will meet the accredi14 tation standards of such body or bodies prior to

15 the beginning of the academic year following

16 the normal graduation date of students of the

17 first entering class in such school.

18 ‘‘(7) NONPROFIT.—The term ‘nonprofit’ as ap19 plied to any school, agency, organization, or institu20 tion means one which is a corporation or association,

21 or is owned and operated by one or more corpora22 tions or associations, no part of the net earnings of

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

24 of any private shareholder or individual.
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1 ‘‘(8) STATE.—The term ‘State’ means a State,

2 the Commonwealth of Puerto Rico, the District of

3 Columbia, the Commonwealth of the Northern Mari4 ana Islands, Guam, American Samoa, the Virgin Is5 lands, or the Trust Territory of the Pacific Islands.

6 ‘‘§ 802. Application

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

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

9 and submit to the Secretary an application that meets the

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

11 and containing such information as the Secretary may re12 quire.

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

14 section shall contain the plan of the applicant for carrying

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

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

17 regional program plans.

18 ‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An ap19 plication submitted under this section shall contain a spec20 ification by the applicant entity of performance outcome

21 standards that the project to be funded under the grant

22 or contract will be measured against. Such standards shall

23 address relevant national nursing needs that the project

24 will meet. The recipient of a grant or contract under this
33

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

2 contract application.

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

4 this section shall contain a description of the linkages with

5 relevant educational and health care entities, including

6 training programs for other health professionals as appro7 priate, that the project to be funded under the grant or

8 contract will establish.

9 ‘‘§ 803. Use of funds

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

11 or contract awarded under this title may be used for train12 ing program development and support, faculty develop13 ment, model demonstrations, trainee support including

14 tuition, books, program fees and reasonable living ex15 penses during the period of training, technical assistance,

16 workforce analysis, and dissemination of information, as

17 appropriate to meet recognized nursing objectives, in ac18 cordance with this title.

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

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

21 be expended, the entity shall agree to maintain expendi22 tures of non-Federal amounts for such activities at a level

23 that is not less than the level of such expenditures main24 tained by the entity for the fiscal year preceding the fiscal

25 year for which the entity receives such a grant.
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1 ‘‘§ 804. Matching requirement

2 ‘‘The Secretary may require that an entity that ap3 plies for a grant or contract under this title provide non4 Federal matching funds, as appropriate, to ensure the in5 stitutional commitment of the entity to the projects funded

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

7 be provided directly or through donations from public or

8 private entities and may be in cash or in-kind, fairly evalu9 ated, including plant, equipment, or services.

10 ‘‘§ 805. Preference

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

12 Secretary shall give preference to applicants with projects

13 that will substantially benefit rural or underserved popu14 lations, or public health personnel shortage professions in

15 State or local health departments.

16 ‘‘§ 806. Generally applicable provisions

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

18 Secretary shall ensure that grants and contracts under

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

20 innovative demonstration projects or provide for strategic

21 workforce supplementation activities as needed to meet

22 national nursing service goals and in accordance with this

23 title.

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

25 grants and contracts under this title shall meet informa26 tion requirements as specified by the Secretary.
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1 ‘‘(c) TRAINING PROGRAMS.—Training programs con2 ducted with amounts received under this title shall meet

3 applicable accreditation and quality standards.

4 ‘‘(d) DURATION OF ASSISTANCE.—

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

6 in the case of an award to an entity of a grant, co7 operative agreement, or contract under this title, the

8 period during which payments are made to the en9 tity under the award may not exceed 5 years. The

10 provision of payments under the award shall be sub11 ject to annual approval by the Secretary of the pay12 ments and subject to the availability of appropria13 tions for the fiscal year involved to make the pay14 ments. This paragraph may not be construed as lim15 iting the number of awards under the program in16 volved that may be made to the entity.

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

18 an entity of a grant, cooperative agreement, or con19 tract under this title, paragraph (1) shall apply only

20 to the extent not inconsistent with any other provi21 sion of this title that relates to the period during

22 which payments may be made under the award.

23 ‘‘(e) PEER REVIEW REGARDING CERTAIN PRO24 GRAMS.—Each application for a grant under this title, ex25 cept advanced nurse traineeship grants under section
36

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1 811(a)(2), shall be submitted to a peer review group for

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

3 application. The Secretary may not approve such an appli4 cation unless a peer review group has recommended the

5 application for approval. Each peer review group under

6 this subsection shall be composed principally of individuals

7 who are not officers or employees of the Federal Govern8 ment. This subsection shall be carried out by the Secretary

9 acting through the Administrator of the Health Resources

10 and Services Administration.

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

12 and practice

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

14 a National Advisory Council on Nurse Education and

15 Practice (in this section referred to as the ‘Council’), con16 sisting of the Secretary or the delegate of the Secretary

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

18 Chairperson), and 15 members appointed by the Secretary

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

20 ‘‘(1) 2 shall be selected from full-time students

21 enrolled in schools of nursing;

22 ‘‘(2) 3 shall be selected from the general public;

23 ‘‘(3) 2 shall be selected from practicing profes24 sional nurses; and
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1 ‘‘(4) 8 shall be selected from among the leading

2 authorities in the various fields of nursing, higher,

3 and secondary education, and from representatives

4 of hospitals and other institutions and organizations

5 which provide nursing services.

6 A majority of the members shall be nurses. The student7 members of the Council shall be appointed for terms of

8 one year and shall be eligible for reappointment to the

9 Council.

10 ‘‘(b) DUTIES.—The Council shall advise the Sec11 retary in the preparation of general regulations and with

12 respect to policy matters arising in the administration of

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

14 supply, education and practice improvement.

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

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

17 education and practice activities of the Council.

18 ‘‘§ 808. Technical assistance

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

20 the Secretary to provide technical assistance in relation

21 to any of the authorities under this title.

22 ‘‘§ 809. Recovery for construction assistance

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

24 (or within such shorter period as the Secretary may pre25 scribe by regulation for an interim facility) after the com-
38

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1 pletion of construction of a facility with respect to which

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

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

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

5 public or nonprofit school,

6 ‘‘(2) the facility ceases to be used for the train7 ing purposes for which it was constructed, or

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

9 or as a place for religious worship,

10 the United States shall be entitled to recover from the

11 owner of the facility the base amount prescribed by sub12 section (c)(1) plus the interest (if any) prescribed by sub13 section (c)(2).

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

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

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

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

18 in paragraph (2) or (3) of such subsection shall provide

19 the Secretary written notice of such cessation or change

20 of use within 10 days after the date on which such ces21 sation or change of use occurs or within 30 days after

22 the date of enactment of the Health Professions Training

23 Assistance Act of 1985, whichever is later.

24 ‘‘(c) AMOUNT OF RECOVERY.—
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1 ‘‘(1) BASE AMOUNT.—The base amount that

2 the United States is entitled to recover under sub3 section (a) is the amount bearing the same ratio to

4 the then value (as determined by the agreement of

5 the parties or in an action brought in the district

6 court of the United States for the district in which

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

8 of the Federal participation bore to the cost of the

9 construction.

10 ‘‘(2) INTEREST.—

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

12 United States is entitled to recover under sub13 section (a) is the interest for the period (if any)

14 described in subparagraph (B) at a rate (deter15 mined by the Secretary) based on the average

16 of the bond equivalent rates of 91-day Treasury

17 bills auctioned during such period.

18 ‘‘(B) TIME PERIOD.—The period referred

19 to in subparagraph (A) is the period begin20 ning—

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

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

23 on which the owner of the facility ceases to

24 be a public or nonprofit school as described

25 in paragraph (1) of subsection (a), or 191
40

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1 days after the date on which the use of the

2 facility changes as described in paragraph

3 (2) or (3) of such subsection, or

4 ‘‘(ii) if notice is not provided as pre5 scribed by subsection (b), 11 days after the

6 date on which such cessation or change of

7 use occurs,

8 and ending on the date the amount the United

9 States is entitled to recover if collected.

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

11 the recovery rights of the United States under subsection

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

13 the Secretary may establish by regulation) if the Secretary

14 determines that there is good cause for waiving such

15 rights.

16 ‘‘(e) LIMITATION ON LIENS.—The right of recovery

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

18 to judgment, constitute a lien on any facility.

19 ‘‘PART B—NURSE PRACTITIONERS, NURSE MIDWIVES,

20 AND OTHER ADVANCED PRACTICE NURSES

21 ‘‘§ 811. Advanced practice nursing grants

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

23 to and enter into contracts with eligible entities to meet

24 the costs of—
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1 ‘‘(1) projects that support the enhancement of

2 advanced practice nursing education and practice;

3 and

4 ‘‘(2) traineeships for individuals in advanced

5 practice nursing programs.

6 ‘‘(b) DEFINITION OF ADVANCED PRACTICE

7 NURSES.—For purposes of this section, the term ‘ad8 vanced practice nurses’ means nurses trained in advanced

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

10 Master’s degree programs, post-nursing master’s certifi11 cate programs, or, in the case of nurse midwives or nurse

12 anesthetists, in certificate programs that received funding

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

14 date of enactment of this section, to serve as nurse practi15 tioners, nurse midwives, nurse anesthetists, nurse edu16 cators, or public health nurses, or in other nurse special17 ties determined by the secretary to require advanced edu18 cation.

19 ‘‘(c) AUTHORIZED NURSE PRACTITIONER AND

20 NURSE-MIDWIFERY PROGRAMS.—

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

22 nurse midwifery programs eligible for support under

23 this section are educational programs for registered

24 nurses (irrespective of the type of school of nursing

25 in which the nurses received their training) that—
42

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1 ‘‘(A) meet guidelines prescribed by the

2 Secretary in accordance with paragraph (2);

3 and

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

5 of nurses who will upon completion of their

6 studies in such programs, be qualified to effec7 tively provide primary health care, including

8 primary health care in homes and in ambula9 tory care facilities, long-term care facilities and

10 other health care institutions.

11 ‘‘(2) GUIDELINES.—After consultation with ap12 propriate educational organizations and professional

13 nursing and medical organizations, the Secretary

14 shall prescribe guidelines for programs described in

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

16 require that such a program—

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

18 and consist of—

19 ‘‘(i) supervised clinical practice di20 rected toward preparing nurses to deliver

21 primary health care; and

22 ‘‘(ii) at least four months (in the ag23 gregate) of classroom instruction that is so

24 directed; and
43

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

2 six full-time equivalent students.

3 ‘‘(d) OTHER AUTHORIZED EDUCATIONAL PRO4 GRAMS.—The Secretary shall prescribe guidelines as ap5 propriate for other advanced practice nurse education pro6 grams eligible for support under this section.

7 ‘‘(e) TRAINEESHIPS.—

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

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

10 unless the applicant involved agrees that

11 traineeships provided with the grant will only pay all

12 or part of the costs of—

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

14 program of advanced nursing practice with re15 spect to which the traineeship is provided; and

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

17 individual during the period for which the

18 traineeship is provided.

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

20 may not obligate more than 10 percent of the

21 traineeships under subsection (a) for individuals in

22 doctorate degree programs.

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

24 awards of grants and contracts under subsection

25 (a)(2), the Secretary shall give special consideration
44

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1 to an eligible entity that agrees to expend the award

2 to train advanced practice nurses who will practice

3 in health professional shortage areas designated

4 under section 332.

5 ‘‘PART C—INCREASING NURSING WORKFORCE

6 DIVERSITY

7 ‘‘§ 821. Workforce diversity grants

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

9 to and enter into contracts with eligible entities to meet

10 the costs of special projects to increase nursing education

11 opportunities for individuals who are from disadvantaged

12 racial and ethnic backgrounds underrepresented among

13 registered nurses by providing student scholarships or sti14 pends, pre-entry preparation, and retention activities.

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

16 Secretary shall take into consideration the recommenda17 tions of the First and Second Invitational Congresses for

18 Minority Nurse Leaders on ‘Caring for the Emerging Ma19 jority,’ in 1992 and 1993, and consult with nursing asso20 ciations including the American Nurses Association, the

21 National League for Nursing, the American Association

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

23 Association of Hispanic Nurses, the Association of Asian

24 American and Pacific Islander Nurses, the National
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1 Nurses Association, the Native American Indian and Alas2 kan Nurses Association.

3 ‘‘(c) REQUIRED INFORMATION AND CONDITIONS FOR

4 AWARD RECIPIENTS.—

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

6 this section may be required, where requested, to re7 port to the Secretary concerning the annual admis8 sion, retention, and graduation rates for ethnic and

9 racial minorities in the school or schools involved in

10 the projects.

11 ‘‘(2) FALLING RATES.—If any of the rates re12 ported under paragraph (1) fall below the average of

13 the two previous years, the grant or contract recipi14 ent shall provide the Secretary with plans for imme15 diately improving such rates.

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

17 paragraph (2) shall be ineligible for continued fund18 ing under this section if the plan of the recipient

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

20 beginning on the date such plan is implemented.

21 ‘‘PART D—STRENGTHENING CAPACITY FOR BASIC

22 NURSE EDUCATION AND PRACTICE

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

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

25 to and enter into contracts with eligible entities for
46

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1 projects to strengthen capacity for basic nurse education

2 and practice.

3 ‘‘(b) PRIORITY AREAS.—In awarding grants or con4 tracts under this section the Secretary shall give priority

5 to entities that will use amounts provided under such a

6 grant or contract to enhance the education mix and utili7 zation of the basic nursing workforce by strengthening

8 programs that provide basic nurse education for purposes

9 of—

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

11 other community settings;

12 ‘‘(2) providing care for underserved populations

13 and other high-risk groups such as the elderly, indi14 viduals with HIV-AIDS, substance abusers, home15 less, and battered women;

16 ‘‘(3) providing case management, quality im17 provement, delegation and supervision, other skills

18 needed under new health care systems;

19 ‘‘(4) developing cultural competencies among

20 nurses;

21 ‘‘(5) providing emergency health services;

22 ‘‘(6) promoting career mobility for nursing per23 sonnel in a variety of training settings and cross

24 training or specialty training among diverse popu25 lation groups; or
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1 ‘‘(7) other priority areas as determined by the

2 Secretary.

3 ‘‘PART E—AUTHORIZATION OF APPROPRIATIONS

4 ‘‘§ 841. Authorization of appropriations

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

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

7 1996, such sums as may be necessary in each of the fiscal

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

9 1999.’’; and

10 (6) by redesignating sections 855 and 860 as

11 sections 810 and 810A, and transferring such sec12 tions so as to appear after section 809 (as added by

13 the amendment made by paragraph (5)).

14 SEC. 124. SAVINGS PROVISION.

15 In the case of any authority for making awards of

16 grants or contracts that is terminated by the amendment

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

18 Services may, notwithstanding the termination of the au19 thority, continue in effect any grant or contract made

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

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

22 of any such grant or contract not exceeding the period

23 determined by the Secretary in first approving such finan24 cial assistance, or in approving the most recent request
48

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

2 of such assistance, as the case may be.

3 SEC. 125. PREFERENCE AND REQUIRED INFORMATION IN

4 CERTAIN PROGRAMS.

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

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

7 amended by adding at the end thereof the following sub8 section:

9 ‘‘(f) EXCEPTIONS.—

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

11 compete equitably for funding under this section,

12 those new programs that meet the criteria described

13 in paragraph (3) shall qualify for a funding pref14 erence under this section.

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

16 the term ‘new program’ means any program that

17 has graduated less than three classes. Upon grad18 uating at least three classes, a program shall have

19 the capability to provide the information necessary

20 to qualify the program for the general funding pref21 erences described in subsection (a).

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

23 paragraph (1) are the following:

24 ‘‘(A) The mission statement of the pro25 gram identifies a specific purpose of the pro-
49

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1 gram as being the preparation of nurses to

2 serve underserved populations.

3 ‘‘(B) The curriculum of the program in4 cludes content which will help to prepare practi5 tioners to serve underserved populations.

6 ‘‘(C) Substantial clinical training experi7 ence is required under the program in medically

8 underserved communities.

9 ‘‘(D) A minimum of 20 percent of the fac10 ulty of the program spend at least 50 percent

11 of their time providing or supervising care in

12 medically underserved communities.

13 ‘‘(E) The entire program or a substantial

14 portion of the program is physically located in

15 a medically underserved community.

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

17 service in medically underserved communities

18 following graduation, is available to the stu19 dents in the program.

20 ‘‘(G) The program provides a placement

21 mechanism for deploying graduates to medically

22 underserved communities.’’.

23 SEC. 126. EFFECTIVE DATE.

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

25 date of enactment of this Act, whichever is later.
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1 Subtitle C—Financial Assistance

2 PART 1—NATIONAL HEALTH SERVICE CORPS

3 FINANCIAL ASSISTANCE PROGRAMS

4 SEC. 131. GENERAL AMENDMENTS WITH RESPECT TO FED5 ERALLY SUPPORTED LOANS.

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

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

8 amended—

9 (1) in subsection (a)—

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

11 by inserting ‘‘and public health disease preven12 tion and health promotion activities’’ before the

13 dash; and

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

15 physician assistants’’ and inserting ‘‘physician

16 assistants, and public health professionals’’;

17 (2) in subsection (b)(1)—

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

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

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

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

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

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

24 (3) in subsection (c)(4)—
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1 (A) in subparagraph (A), by inserting

2 ‘‘and schools of public health’’ after ‘‘profes3 sions schools’’;

4 (B) in subparagraph (B)(i)—

5 (i) by inserting ‘‘or public health pro6 fessional’’ after ‘‘and health professional’’;

7 and

8 (ii) by inserting ‘‘or public health dis9 ease prevention and health promotion ac10 tivities’’ before the period;

11 (C) in subparagraph (C)—

12 (i) by inserting ‘‘or public health dis13 ease prevention and health promotion ac14 tivities,’’ after primary health services,’’;

15 (ii) by inserting ‘‘or public health pro16 fessions’’ after ‘‘health professions’’; and

17 (iii) by inserting ‘‘or public health

18 professionals’’ after ‘‘health professionals’’

19 each place that such occurs;

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

21 public health disease prevention and health pro22 motion activities’’ after ‘‘primary health services’’;

23 (5) in subsection (g)(2)(A)(iii)—

24 (A) by inserting ‘‘or public health profes25 sional’’ after ‘‘the health professional’’; and
52

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

2 prevention and health promotion activities’’

3 after ‘‘primary health services’’; and

4 (6) in subsection (i)(8), —

5 (A) by inserting ‘‘or public health profes6 sionals’’ after ‘‘health professionals’’; and

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

8 prevention and health promotion activities’’

9 after ‘‘primary health services’’.

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

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

12 amended—

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

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

15 (2) in subparagraph (E)—

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

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

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

19 health,’’ after ‘‘dentistry,’’.

20 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

21 338H of the Public Health Service Act (42 U.S.C. 254q)

22 is amended to read as follows:

23 ‘‘§ 338h. Authorization of appropriations

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

25 purpose of carrying out this subpart, there are authorized
53

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

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

3 1997 through 2000.

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

5 shall determine the most appropriate manner in which to

6 allocate amounts appropriated under subsection (a) be7 tween the programs authorized in chapter 1, chapter 2,

8 and chapter 3. In determining the manner in which to allo9 cate such amounts, the Secretary shall give priority to

10 funding State-based programs as appropriate under chap11 ter 3. The Secretary shall distribute such amounts among

12 the various programs in such chapters in a manner which

13 furthers both Federal and State needs for health profes14 sionals in underserved areas.’’.

15 (d) GRANTS FOR LOAN REPAYMENT PROGRAM.—

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

17 254q-1) is amended—

18 (1) in subsection (a)—

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

20 health professional shortage areas’’ and insert21 ing ‘‘or public health disease prevention and

22 health promotion activities in Federal health

23 professional shortage areas or approved State

24 designated health professional shortage areas’’;

25 and
54

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1 (B) in paragraph (2)—

2 (i) by inserting ‘‘or public health pro3 fessionals’’ after ‘‘health professionals’’;

4 and

5 (ii) by striking ‘‘in health professional

6 shortage areas’’ and inserting ‘‘or public

7 health disease prevention and health pro8 motion activities in Federal health profes9 sional shortage areas or approved State

10 designated health professional shortage

11 areas’’;

12 (2) in subsection (c)—

13 (A) in paragraph (1)—

14 (i) in the paragraph heading, by strik15 ing ‘‘FEDERAL’’ and inserting ‘‘FEDERAL

16 OR APPROVED STATE’’; and

17 (ii) by inserting before the period the

18 following: ‘‘or approved State designated

19 health professional shortage areas’’;

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

21 public health professionals’’ after ‘‘health pro22 fessionals’’;

23 (C) in paragraph (3)—

24 (i) in subparagraph (A)—
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1 (I) in the matter preceding clause

2 (i), by inserting ‘‘or public health pro3 fessionals’’ after ‘‘health profes4 sionals’’; and

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

6 health’’;

7 (ii) in subparagraph (B)—

8 (I) in the matter preceding clause

9 (i), by inserting ‘‘or public health pro10 fessional’’ after ‘‘health professional’’;

11 and

12 (II) in clause (ii)—

13 (aa) by inserting ‘‘or public

14 health professional’’ after ‘‘the

15 health professional’’; and

16 (bb) by striking ‘‘services in

17 a’’ and inserting ‘‘services or

18 public health disease prevention

19 and health promotion activities in

20 a Federal’’; and

21 (D) by adding at the end thereof the fol22 lowing new paragraph:

23 ‘‘(4) PRIVATE PRACTICE.—

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

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

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

5 to provide primary health services in a full-time

6 private clinical practice in a health professional

7 shortage area.

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

9 under subsection (a) unless the State involved

10 agrees that, if the State provides a waiver

11 under subparagraph (A) for a health profes12 sional, section 338D(b)(1) will apply to the

13 agreement under such subparagraph between

14 the State and the health professional to the

15 same extent and in the same manner as such

16 section applies to an agreement between the

17 Secretary and a health professional regarding a

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

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

20 ‘‘(h) DEFINITIONS.—Unless specifically provided oth21 erwise, as used in this subpart and section 338F:

22 ‘‘(1) APPROVED STATE DESIGNATED HEALTH

23 PROFESSIONAL SHORTAGE AREA.—The term ‘ap24 proved State designated health professional shortage

25 area’ means an area designated by the State as un-
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1 derserved using specific methodology and criteria to

2 identify such areas. Such criteria and methodology

3 shall be approved by the Secretary.

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

5 ‘community organization’ means a public or non6 profit private entity.

7 ‘‘(3) PRIMARY HEALTH CARE.—The term ‘pri8 mary health care’ means health services regarding

9 family medicine, general internal medicine, general

10 pediatrics, or may include obstetrics and gynecology,

11 that are provided by physicians, certified nurse prac12 titioners, certified nurse midwives, or physician as13 sistants.

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

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

16 (e) COMMUNITY SCHOLARSHIP PROGRAMS.—Section

17 338L of the Public Health Service Act (42 U.S.C. 254t)

18 is amended—

19 (1) in the section heading, by striking ‘‘dem20 onstration grants to states for’’

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

22 shortage areas’’ and inserting ‘‘Federal health pro23 fessional shortage areas and in approved State des24 ignated health professional shortage areas’’;

25 (3) in subsection (c)—
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1 (A) in the matter preceding paragraph (1),

2 by striking ‘‘manpower shortage areas’’ and in3 serting ‘‘Federal health professional shortage

4 areas and in approved State designated health

5 professional shortage areas’’; and

6 (B) in paragraph (2), by striking ‘‘man7 power shortage areas’’ and inserting ‘‘Federal

8 health professional shortage areas and in ap9 proved State designated health professional

10 shortage areas’’;

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

12 shortage areas’’ and inserting ‘‘Federal health pro13 fessional shortage areas and in approved State des14 ignated health professional shortage areas’’;

15 (5) in subsection (f)(1)(A), by striking ‘‘man16 power shortage areas’’ and inserting ‘‘Federal health

17 professional shortage areas and in approved State

18 designated health professional shortage areas’’;

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

20 shortage areas’’ each place that such appears and

21 inserting ‘‘Federal health professional shortage areas

22 and in approved State designated health professional

23 shortage areas’’; and

24 (7) by striking subsections (j) through (l).
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1 SEC. 132. RESTRUCTURING AND TECHNICAL AMENDMENTS.

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

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

4 seq.) is amended—

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

6 (42 U.S.C. 254s and 254t) as sections 338M and

7 338N, respectively;

8 (2) by redesignating sections 338C through

9 338H (42 U.S.C. 254m through 254q) as sections

10 338G through 338L, respectively;

11 (3) by redesignating section 338I (as such sec12 tion exists one day prior to the date of enactment

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

14 (4) by redesignating section 338L (as such sec15 tion exists one day prior to the date of enactment

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

17 (b) CONSOLIDATION OF CERTAIN PROGRAMS.—Sub18 part III of part D of title III of the Public Health Service

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

20 (a)) is further amended—

21 (1) by striking the subpart heading and insert22 ing the following:
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1 ‘‘SUBPART III—FEDERALLY SUPPORTED SCHOLARSHIPS

2 AND LOANS

3 ‘‘CHAPTER 1—NATIONAL HEALTH SERVICE

4 CORPS SCHOLARSHIPS PROGRAMS

5 (2) by redesignating section 338b as section

6 338c;

7 (3) by inserting before section 338c (as so re8 designated) the following:

9 ‘‘CHAPTER 2—NATIONAL HEALTH SERVICE

10 CORPS LOAN REPAYMENT PROGRAMS

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

12 and

13 (4) by inserting after section 338C (as so redes14 ignated) the following:

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

16 (c) TRANSFERS AND REDESIGNATIONS OF NURSING

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

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

19 (1) by striking the subpart heading;

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

21 297n) to subchapter B of chapter 2 of subpart III

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

23 and

24 (3) in section 846—
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1 (A) by striking the section heading and in2 serting the following:

3 ‘‘§ 338d. Nursing loan repayment program’’;

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

5 (C) by striking subsection (g).

6 (d) TRANSFERS AND REDESIGNATIONS OF STATE

7 LOAN REPAYMENT AND COMMUNITY SCHOLARSHIP PRO8 GRAMS.—Subpart III of part D of title III of the Public

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

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

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

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

13 the following:

14 ‘‘CHAPTER 3—STATE LOAN REPAYMENT AND

15 COMMUNITY SCHOLARSHIP PROGRAMS

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

17 (2) by transferring section 338E (as so redesig18 nated by subsection (a)(3)) to subchapter A of chap19 ter 3 of such subpart (as added by paragraph (1));

20 (3) by inserting after section 338E (as trans21 ferred by paragraph (2)) the following:

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

23 (4) by transferring section 338F (as so redesig24 nated by subsection (a)(4)) to subchapter B of chap-
62

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1 ter 3 of such subpart (as added by paragraph (3));

2 and

3 (5) by inserting after section 338F (as trans4 ferred by paragraph (4)) the following:

5 ‘‘CHAPTER 4—GENERAL PROVISIONS’’

6 (e) CLINICAL RESEARCHERS.—Paragraph (3) of sec7 tion 487E(a) of the Public Health Service Act (42 U.S.C.

8 288–5(a)(3)) is amended to read as follows:

9 ‘‘(3) APPLICABILITY OF CERTAIN PROVISIONS

10 REGARDING OBLIGATED SERVICE.—With respect to

11 the National Health Service Corps loan repayment

12 program established in subpart III of part D of title

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

14 inconsistent with this section, apply to the program

15 established in subsection (a) in the same manner

16 and to the same extent as such provisions apply to

17 the National Health Service Corps loan repayment

18 programs.’’.

19 SEC. 133. DEFINITION OF UNDERSERVED AREAS.

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

21 (42 U.S.C. 254e(a)(1)) is amended in the first sentence—

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

23 and

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

25 ‘‘, or (D) a State or local health department that
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1 has a severe shortage of public health personnel as

2 determined under criteria established by the Sec3 retary’’.

4 SEC. 134. CONFORMING AMENDMENTS.

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

6 241 et seq.) is amended—

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

8 303(d)(4) (42 U.S.C. 242a(d)(4)(A) and (B)), by

9 striking ‘‘338C or 338D’’ each place that such oc10 curs and inserting ‘‘338G or 338H’’;

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

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

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

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

15 (4) in 338A (42 U.S.C. 254l)—

16 (A) in subsection (c)(1)—

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

18 ‘‘338D’’ and inserting ‘‘338I’’; and

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

20 ‘‘338C’’ and inserting ‘‘338H’’;

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

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

23 (C) in subsection (i)(5)—

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

25 ‘‘338E’’ and inserting ‘‘338I’’; and
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1 (ii) in subparagraph (B)(ii), by strik2 ing ‘‘338E’’ and inserting ‘‘338I’’;

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

4 (A) in subsection (c)(1)—

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

6 ‘‘338E’’ and inserting ‘‘338I’’; and

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

8 ‘‘338D’’ and inserting ‘‘338H’’;

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

10 ‘‘338D’’ and inserting ‘‘338H’’;

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

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

13 (D) in subsection (i)(7)—

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

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

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

18 (6) in section 338E(d)(1)(C) (as so redesig19 nated by section 102), by striking ‘‘338J’’ and in20 serting ‘‘338M’’;

21 (7) in section 338G (as so redesignated by sec22 tion 102)—

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

24 and inserting ‘‘338H’’; and
65

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

2 ‘‘338D’’ and inserting ‘‘338H’’;

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

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

5 ‘‘338G’’;

6 (9) in section 338I (as so redesignated by sec7 tion 102)—

8 (A) in subsection (b)(1)(A)—

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

10 ‘‘338K’’;

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

12 inserting ‘‘338G or 338H’’;

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

14 ‘‘338G’’; and

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

16 ‘‘338H’’; and

17 (B) in subsection (c)(1)—

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

19 ‘‘338K’’; and

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

21 inserting ‘‘338G or 338H’’;

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

23 section 102)—

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

25 and inserting ‘‘338I’’; and
66

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

2 and inserting ‘‘338E’’;

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

4 section 102)—

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

6 ‘‘338D’’ and inserting ‘‘338H’’; and

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

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

9 (12) in section 338M(e)(1)(B)(ii)(III) (as so re10 designated by section 102), by striking ‘‘338I’’ and

11 inserting ‘‘338E’’.

12 PART 2—SCHOOL-BASED REVOLVING LOAN

13 FUNDS

14 SEC. 135. PRIMARY CARE LOAN PROGRAM.

15 (a) REQUIREMENT FOR SCHOOLS.—Section

16 723(b)(1) of the Public Health Service Act (42 U.S.C.

17 292s(b)(1)), as amended by section 2014(c)(2)(A)(ii) of

18 Public Law 103–43 (107 Stat. 216), is amended by strik19 ing ‘‘3 years before’’ and inserting ‘‘4 years before’’.

20 (b) SERVICE REQUIREMENT FOR PRIMARY CARE

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

22 Service Act (42 U.S.C. 292s(a)) is amended in subpara23 graph (B) of paragraph (1), by striking ‘‘through the date

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

25 years after completing the residency program’’.
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1 SEC. 136. LOANS FOR DISADVANTAGED STUDENTS.

2 (a) AUTHORIZATION OF APPROPRIATIONS.—Section

3 724(f)(1) of the Public Health Service Act (42 U.S.C.

4 292t(f)(1)) is amended by striking ‘‘$15,000,000 for fiscal

5 year 1993’’ and inserting ‘‘$8,000,000 for each of the fis6 cal years 1996 through 1998’’.

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

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

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

10 SEC. 137. STUDENT LOANS REGARDING SCHOOLS OF NURS11 ING.

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

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

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

15 the end and inserting a semicolon;

16 (2) in paragraph (2)—

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

18 ‘‘and’’ at the end; and

19 (B) by inserting before the semicolon at

20 the end the following: ‘‘, and (C) such addi21 tional periods under the terms of paragraph (8)

22 of this subsection’’;

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

24 the end and inserting ‘‘; and’’; and

25 (4) by adding at the end the following para26 graph:
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1 ‘‘(8) pursuant to uniform criteria established by

2 the Secretary, the repayment period established

3 under paragraph (2) for any student borrower who

4 during the repayment period failed to make consecu5 tive payments and who, during the last 12 months

6 of the repayment period, has made at least 12 con7 secutive payments may be extended for a period not

8 to exceed 10 years.’’.

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

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

11 297a et seq.) is amended by adding at the end thereof

12 the following new section:

13 ‘‘§ 843. Breach of agreement

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

15 under this subpart under which an individual makes an

16 agreement to provide health services for a period of time

17 in accordance with such program in consideration of re18 ceiving an award of Federal funds regarding education as

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

20 the following applies if the agreement provides that this

21 section is applicable:

22 ‘‘(1) In the case of a program under this sub23 part that makes an award of Federal funds for at24 tending an accredited program of nursing (in this

25 section referred to as a ‘nursing program’), the indi-
69

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1 vidual is liable to the Federal Government for the

2 amount of such award (including amounts provided

3 for expenses related to such attendance), and for in4 terest on such amount at the maximum legal prevail5 ing rate, if the individual—

6 ‘‘(A) fails to maintain an acceptable level

7 of academic standing in the nursing program

8 (as indicated by the program in accordance

9 with requirements established by the Sec10 retary);

11 ‘‘(B) is dismissed from the nursing pro12 gram for disciplinary reasons; or

13 ‘‘(C) voluntarily terminates the nursing

14 program.

15 ‘‘(2) The individual is liable to the Federal Gov16 ernment for the amount of such award (including

17 amounts provided for expenses related to such at18 tendance), and for interest on such amount at the

19 maximum legal prevailing rate, if the individual fails

20 to provide health services in accordance with the

21 program under this subpart for the period of time

22 applicable under the program.

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

24 case of an individual or health facility making an agree25 ment for purposes of subsection (a), the Secretary shall
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1 provide for the waiver or suspension of liability under such

2 subsection if compliance by the individual or the health

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

4 is impossible, or would involve extreme hardship to the in5 dividual or facility, and if enforcement of the agreements

6 with respect to the individual or facility would be uncon7 scionable.

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

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

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

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

12 3-year period beginning on the date the United States be13 comes so entitled.

14 ‘‘(d) AVAILABILITY.—Amounts recovered under sub15 section (a) with respect to a program under this subpart

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

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

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

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

20 (1) in subsection (a)—

21 (A) by striking the matter preceding para22 graph (1) and inserting the following:

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

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

25 Secretary for good cause terminates the agreement with
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1 the school, there shall be a capital distribution as fol2 lows:’’; and

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

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

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

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

7 ‘‘(b) If a capital distribution is made under sub8 section (a), the school involved shall, after such capital dis9 tribution, pay to the Secretary, not less often than quar10 terly, the same proportionate share of amounts received

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

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

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

14 PART 3—INSURED HEALTH EDUCATION

15 ASSISTANCE LOANS TO GRADUATE STUDENTS

16 SEC. 141. HEALTH EDUCATION ASSISTANCE LOAN PRO17 GRAM.

18 (a) HEALTH EDUCATION ASSISTANCE LOAN

19 DEFERMENT FOR BORROWERS PROVIDING HEALTH

20 SERVICES TO INDIANS.—

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

22 Public Health Service Act is amended by striking

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

24 years, during which the borrower is providing health

25 care services to Indians through an Indian health
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1 program (as defined in section 108(a)(2)(A) of the

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

3 1616a(a)(2)(A)); and (xi)’’.

4 (2) CONFORMING AMENDMENTS.—Section

5 705(a)(2)(C) of the Public Health Service Act is fur6 ther amended—

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

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

9 (B) in the matter following such clause

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

11 (3) EFFECTIVE DATE.—The amendments made

12 by this subsection shall apply with respect to serv13 ices provided on or after the first day of the third

14 month that begins after the date of the enactment

15 of this Act.

16 (b) MAXIMUM STUDENT LOAN PROVISION.—

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

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

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

20 103–43, is amended by striking ‘‘the sum of’’ and

21 all that follows through the end thereof and insert22 ing ‘‘the cost of attendance (including tuition, other

23 reasonable educational expenses, and reasonable liv24 ing costs) for that year at the educational institution
73

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1 attended by the student (as determined by such edu2 cational institution).’’.

3 (2) THIRD AND FOURTH YEARS.—Section

4 722(a)(2) of the Public Health Service Act (42

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

6 2014(b)(1) of Public Law 103–43, is amended by

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

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

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

10 fourth year of a student at school of medicine or os11 teopathic medicine, be increased to the extent nec12 essary’’.

13 PART 4—SCHOLARSHIPS FOR DISADVANTAGED

14 STUDENTS

15 SEC. 151. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.

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

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

18 adding at the end thereof the following new section:

19 ‘‘§ 740. Scholarships for disadvantaged students

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

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

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

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

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

25 scholarships may be expended only for tuition expenses,
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1 other reasonable educational expenses, and reasonable liv2 ing expenses incurred in the attendance of such school,

3 and may not, for any year of such attendance for which

4 the scholarship is provided, provide an amount exceeding

5 the total amount required for the year.

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

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

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

9 health professions school involved agrees that, in providing

10 scholarships pursuant to the grant or contract, the school

11 will give preference to students for whom the costs of at12 tending the school would constitute a severe financial

13 hardship.

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

15 contracts to eligible entities that are health professions

16 schools, the Secretary shall give priority to eligible entities

17 based on the proportion of graduating students going into

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

19 proportion of graduates working in medically underserved

20 areas.

21 ‘‘(d) MAXIMUM SCHOLARSHIP AWARD.—The maxi22 mum scholarship that an individual may receive in any

23 year from an eligible entity that is a health professions

24 school shall be $3000.
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1 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There

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

3 $32,000,000 for each of the fiscal years 1996 through

4 1999.

5 ‘‘(f) DEFINITIONS.—As used in this section:

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

7 entities’ means an entity that—

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

9 medicine, dentistry, nursing, pharmacy,

10 podiatric medicine, optometry, veterinary medi11 cine, public health, or allied health, a school of12 fering graduate programs in mental health

13 practices, or an entity providing programs of14 fering physician assistant training; and

15 ‘‘(B) is carrying out a program for recruit16 ing and retaining students from disadvantaged

17 backgrounds, including students who are mem18 bers of racial and ethnic minority groups.

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

20 individual’ means an individual who—

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

22 ‘‘(B) has a financial need for a scholar23 ship; and

24 ‘‘(C) is enrolled (or accepted for enroll25 ment) at an eligible health profession school as
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1 a full-time student in a program leading to a

2 degree in a health profession.’’.

3 TITLE II—OFFICE OF MINORITY

4 HEALTH

5 SEC. 201. REVISION AND EXTENSION OF PROGRAMS OF OF6 FICE OF MINORITY HEALTH.

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

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

9 subsection (b) and all that follows and inserting the follow10 ing:

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

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

13 through the Deputy Assistant Secretary for Minority

14 Health (in this section referred to as the ‘Deputy Assist15 ant Secretary’), shall carry out the following:

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

17 and objectives and coordinate all other activities

18 within the Public Health Service that relate to dis19 ease prevention, health promotion, service delivery,

20 and research concerning such individuals. The heads

21 of each of the agencies of the Service shall consult

22 with the Deputy Assistant Secretary to ensure the

23 coordination of such activities.
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1 ‘‘(2) Carry out the following types of activities

2 by entering into interagency agreements with other

3 agencies of the Public Health Service:

4 ‘‘(A) Support research, demonstrations and

5 evaluations to test new and innovative models.

6 ‘‘(B) Increase knowledge and understand7 ing of health risk factors.

8 ‘‘(C) Develop mechanisms that support

9 better information dissemination, education,

10 prevention, and service delivery to individuals

11 from disadvantaged backgrounds, including in12 dividuals who are members of racial or ethnic

13 minority groups.

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

15 Health Statistics collects data on the health

16 status of each minority group.

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

18 proficiency in speaking the English language,

19 enter into contracts with public and nonprofit

20 private providers of primary health services for

21 the purpose of increasing the access of the indi22 viduals to such services by developing and car23 rying out programs to provide bilingual or in24 terpretive services.
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1 ‘‘(3) Support a national minority health re2 source center to carry out the following:

3 ‘‘(A) Facilitate the exchange of informa4 tion regarding matters relating to health infor5 mation and health promotion, preventive health

6 services, and education in the appropriate use

7 of health care.

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

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

10 problems relating to such matters.

11 ‘‘(D) Provide technical assistance with re12 spect to the exchange of such information (in13 cluding facilitating the development of materials

14 for such technical assistance).

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

16 health care services for individuals with limited pro17 ficiency in speaking the English language by facili18 tating the removal of impediments to the receipt of

19 health care that result from such limitation. Activi20 ties under the preceding sentence shall include con21 ducting research and developing and evaluating

22 model projects.

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

24 heads of the Public Health Service agencies shall

25 submit to the Deputy Assistant Secretary a report
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1 summarizing the minority health activities of each of

2 the respective agencies.

3 ‘‘(c) ADVISORY COMMITTEE.—

4 ‘‘(1) IN GENERAL.—The Secretary shall estab5 lish an advisory committee to be known as the Advi6 sory Committee on Minority Health (in this sub7 section referred to as the ‘Committee’). The Deputy

8 Assistant Secretary shall consult with the Committee

9 in carrying out this section.

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

11 advice to the Deputy Assistant Secretary carrying

12 out this section, including advice on the development

13 of goals and specific program activities under para14 graphs (1) and (2) of subsection (b) for each racial

15 and ethnic minority group.

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

17 shall serve as the chair of the Committee.

18 ‘‘(4) COMPOSITION.—

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

20 12 voting members appointed in accordance

21 with subparagraph (B), and nonvoting, ex

22 officio members designated in subparagraph

23 (C).

24 ‘‘(B) The voting members of the Commit25 tee shall be appointed by the Secretary from
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1 among individuals who are not officers or em2 ployees of the Federal Government and who

3 have expertise regarding issues of minority

4 health. The racial and ethnic minority groups

5 shall be equally represented among such mem6 bers.

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

8 the Committee shall be the directors of each of

9 the minority health offices, and such additional

10 officials of the Department of Health and

11 Human Services as the Secretary determines to

12 be appropriate.

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

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

15 Secretary shall initially appoint a portion of the

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

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

18 Committee, a new member shall be appointed by the

19 Secretary within 90 days from the date that the va20 cancy occurs, and serve for the remainder of the

21 term for which the predecessor of such member was

22 appointed. The vacancy shall not affect the power of

23 the remaining members to execute the duties of the

24 Committee.
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1 ‘‘(7) COMPENSATION.—Members of the Com2 mittee who are officers or employees of the United

3 States shall serve without compensation. Members of

4 the Committee who are not officers or employees of

5 the United States shall receive compensation, for

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

7 the performance of the functions of the Committee.

8 Such compensation may not be in an amount in ex9 cess of the daily equivalent of the annual maximum

10 rate of basic pay payable under the General Sched11 ule (under title 5, United States Code) for positions

12 above GS–15.

13 ‘‘(d) CERTAIN REQUIREMENTS REGARDING DU14 TIES.—

15 ‘‘(1) RECOMMENDATIONS REGARDING LAN16 GUAGE AS IMPEDIMENT TO HEALTH CARE.—The

17 Deputy Assistant Secretary for Minority Health

18 shall consult with the Director of the Office of Refu19 gee Health, the Director of the Office of Civil

20 Rights, and the Director of the Office of Minority

21 Health of the Health Resources and Services Admin22 istration, and other appropriate offices, regarding

23 recommendations for carrying out activities under

24 subsection (b)(4).
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1 ‘‘(2) EQUITABLE ALLOCATION REGARDING AC2 TIVITIES.—

3 ‘‘(A) In making awards of grants, coopera4 tive agreements, or contracts under this section

5 or section 338A, 338B, 340A, 404, or 724, or

6 part B of title VII, the Secretary, acting as ap7 propriate through the Deputy Assistant Sec8 retary or the Administrator of the Health Re9 sources and Services Administration, shall en10 sure that such awards are equitably allocated

11 with respect to the various racial and minority

12 populations.

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

14 agreements, and contracts that are available

15 under the sections specified in subparagraph

16 (A), the Secretary shall—

17 ‘‘(i) carry out activities to inform enti18 ties, as appropriate, that the entities may

19 be eligible for awards of such assistance;

20 ‘‘(ii) provide technical assistance to

21 such entities in the process of preparing

22 and submitting applications for the awards

23 in accordance with the policies of the Sec24 retary regarding such application; and
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1 ‘‘(iii) inform populations, as appro2 priate, that members of the populations

3 may be eligible to receive services or other4 wise participate in the activities carried out

5 with such awards.

6 ‘‘(3) CULTURAL COMPETENCY OF SERVICES.—

7 The Secretary shall ensure that information and

8 services provided pursuant to subsection (b) are pro9 vided in the language, educational, and cultural con10 text that is most appropriate for the individuals for

11 whom the information and services are intended.

12 ‘‘(e) GRANTS AND CONTRACTS REGARDING DU13 TIES.—

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

15 (b), the Deputy Assistant Secretary may make

16 awards of grants, cooperative agreements, and con17 tracts to public and nonprofit private entities.

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

19 Deputy Assistant Secretary shall ensure that awards

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

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

22 only if the proposal has been recommended for such

23 an award through a process of peer review and has

24 been so recommended by the advisory committee es25 tablished under subsection (c).
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1 ‘‘(3) EVALUATION AND DISSEMINATION.—The

2 Deputy Assistant Secretary, directly or through con3 tracts with public and private entities, shall provide

4 for evaluations of projects carried out with awards

5 made under paragraph (1) during the preceding 2

6 fiscal years. The report shall be included in the re7 port required under subsection (f) for the fiscal year

8 involved.

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

10 1 of fiscal year 1996 and of each second year thereafter,

11 the Deputy Assistant Secretary shall submit to the Com12 mittee on Energy and Commerce of the House of Rep13 resentatives, and to the Committee on Labor and Human

14 Resources of the Senate, a report describing the activities

15 carried out under this section during the preceding 2 fiscal

16 years and evaluating the extent to which such activities

17 have been effective in improving the health of racial and

18 ethnic minority groups. Each such report shall include the

19 biennial reports submitted to the Deputy Assistant Sec20 retary under section 201(b)(5) for such years by the heads

21 of the Public Health Service agencies.

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

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

24 group’ means American Indians (including Alaska
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1 Natives, Eskimos, and Aleuts); Asian Americans and

2 Pacific Islanders; Blacks; and Hispanics.

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

4 whose origin is Mexican, Puerto Rican, Cuban,

5 Central or South American, or any other Spanish6 speaking country.

7 ‘‘(h) FUNDING.—For the purpose of carrying out this

8 section, there are authorized to be appropriated

9 $21,000,000 for fiscal year 1996, such sums as may be

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

11 $19,000,000 for fiscal year 1999.’’.

12 (b) MISCELLANEOUS AMENDMENT.—Section 1707 of

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

14 amended in the heading for the section by striking ‘‘ES15 TABLISHMENT OF’’.

16 TITLE III—SELECTED

17 INITIATIVES

18 SEC. 301. PROGRAMS REGARDING BIRTH DEFECTS.

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

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

21 ‘‘PROGRAMS REGARDING BIRTH DEFECTS

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

23 Director of the Centers for Disease Control and Preven24 tion, shall carry out programs—

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

26 on birth defects (in a manner that facilitates compli-
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1 ance with subsection (d)(2)), including data on the

2 causes of such defects and on the incidence and

3 prevalence of such defects; and

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

5 of applied epidemiological research on the prevention

6 of such defects.

7 ‘‘(b) ADDITIONAL PROVISIONS REGARDING COLLEC8 TION OF DATA.—

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

10 (a)(1), the Secretary—

11 ‘‘(A) shall collect and analyze data by gen12 der and by racial and ethnic group, including

13 Hispanics, non-Hispanic whites, Blacks, Native

14 Americans, Asian Americans, and Pacific Is15 landers;

16 ‘‘(B) shall collect data under subparagraph

17 (A) from birth certificates, death certificates,

18 hospital records, and such other sources as the

19 Secretary determines to be appropriate; and

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

21 improve programs for the collection and analy22 sis of epidemiological data on birth defects, and

23 to make the data available.

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

25 out subsection (a)(1), the Secretary shall establish
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1 and maintain a National Information Clearinghouse

2 on Birth Defects to collect and disseminate to health

3 professionals and the general public information on

4 birth defects, including the prevention of such de5 fects.

6 ‘‘(c) GRANTS AND CONTRACTS.—

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

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

9 into contracts with public and nonprofit private enti10 ties.

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

12 AWARD FUNDS.—

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

14 award of a grant or contract under paragraph

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

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

17 for the purpose of aiding the recipient in carry18 ing out the purposes for which the award is

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

20 recipient any officer or employee of the Depart21 ment of Health and Human Services.

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

23 in subparagraph (A), the Secretary shall reduce

24 the amount of payments under the award in25 volved by an amount equal to the costs of de-
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1 tailing personnel and the fair market value of

2 any supplies, equipment, or services provided by

3 the Secretary. The Secretary shall, for the pay4 ment of expenses incurred in complying with

5 such request, expend the amounts withheld.

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

7 may make an award of a grant or contract under

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

9 is submitted to the Secretary and the application is

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

11 such agreements, assurances, and information as the

12 Secretary determines to be necessary to carry out

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

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

15 1 of fiscal year 1997 and of every second such year there16 after, the Secretary shall submit to the Committee on En17 ergy and Commerce of the House of Representatives, and

18 the Committee on Labor and Human Resources of the

19 Senate, a report that, with respect to the preceding 2 fis20 cal years—

21 ‘‘(1) contains information regarding the inci22 dence and prevalence of birth defects and the extent

23 to which birth defects have contributed to the inci24 dence and prevalence of infant mortality;
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1 ‘‘(2) contains information under paragraph (1)

2 that is specific to various racial and ethnic groups

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

4 Native Americans, and Asian Americans);

5 ‘‘(3) contains an assessment of the extent to

6 which various approaches of preventing birth defects

7 have been effective;

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

9 this section; and

10 ‘‘(5) contains any recommendations of the Sec11 retary regarding this section.’’.

12 SEC. 302. TRAUMATIC BRAIN INJURY.

13 (a) PROGRAMS OF NATIONAL INSTITUTES OF

14 HEALTH.—Section 1261 of the Public Health Service Act

15 (42 U.S.C. 300d–61) is amended—

16 (1) in subsection (d)—

17 (A) in paragraph (2), by striking ‘‘and’’

18 after the semicolon at the end;

19 (B) in paragraph (3), by striking the pe20 riod and inserting ‘‘; and’’; and

21 (C) by adding at the end the following

22 paragraph:

23 ‘‘(4) the authority to make awards of grants or

24 contracts to public or nonprofit private entities for

25 the conduct of basic and applied research regarding
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1 traumatic brain injury, which research may in2 clude—

3 ‘‘(A) the development of new methods and

4 modalities for the more effective diagnosis,

5 measurement of degree of injury, post-injury

6 monitoring and prognostic assessment of head

7 injury for acute, subacute and later phases of

8 care;

9 ‘‘(B) the development, modification and

10 evaluation of therapies that retard, prevent or

11 reverse brain damage after acute head injury,

12 that arrest further deterioration following in13 jury and that provide the restitution of function

14 for individuals with long-term injuries;

15 ‘‘(C) the development of research on a con16 tinuum of care from acute care through reha17 bilitation, designed, to the extent practicable, to

18 integrate rehabilitation and long-term outcome

19 evaluation with acute care research; and

20 ‘‘(D) the development of programs that in21 crease the participation of academic centers of

22 excellence in head injury treatment and reha23 bilitation research and training.’’; and

24 (2) in subsection (h), by adding at the end the

25 following paragraph:
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1 ‘‘(4) The term ‘traumatic brain injury’ means

2 an acquired injury to the brain. Such term does not

3 include brain dysfunction caused by congenital or

4 degenerative disorders, nor birth trauma, but may

5 include brain injuries caused by anoxia due to near

6 drowning.’’.

7 (b) PROGRAMS OF HEALTH RESOURCES AND SERV8 ICES ADMINISTRATION.—Part E of title XII of the Public

9 Health Service Act (42 U.S.C. 300d–51 et seq.) is amend10 ed by adding at the end the following new section:

11 ‘‘§ 1252. State grants for demonstration projects re12 garding traumatic brain injury

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

14 the Administrator of the Health Resources and Services

15 Administration, may make grants to States for the pur16 pose of carrying out demonstration projects to improve the

17 availability of health services regarding traumatic brain

18 injury.

19 ‘‘(b) STATE ADVISORY BOARD.—

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

21 grant under subsection (a) only if the State involved

22 agrees to establish an advisory board within the ap23 propriate health department of the State or within

24 another department as designated by the chief exec25 utive officer of the State.
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1 ‘‘(2) FUNCTIONS.—An advisory board estab2 lished under paragraph (1) shall be cognizant of

3 findings and concerns of Federal, State and local

4 agencies, citizens groups, and private industry (such

5 as insurance, health care, automobile, and other in6 dustry entities). Such advisory boards shall encour7 age citizen participation through the establishment

8 of public hearings and other types of community

9 outreach programs.

10 ‘‘(3) COMPOSITION.—An advisory board estab11 lished under paragraph (1) shall be composed of—

12 ‘‘(A) representatives of—

13 ‘‘(i) the corresponding State agencies

14 involved;

15 ‘‘(ii) public and nonprofit private

16 health related organizations;

17 ‘‘(iii) other disability advisory or plan18 ning groups within the State;

19 ‘‘(iv) members of an organization or

20 foundation representing traumatic brain

21 injury survivors in that State; and

22 ‘‘(v) injury control programs at the

23 State or local level if such programs exist;

24 and
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1 ‘‘(B) a substantial number of individuals

2 who are survivors of traumatic brain injury, or

3 the family members of such individuals.

4 ‘‘(c) MATCHING FUNDS.—

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

6 be incurred by a State in carrying out the purpose

7 described in subsection (a), the Secretary may make

8 a grant under such subsection only if the State

9 agrees to make available, in cash, non-Federal con10 tributions toward such costs in an amount that is

11 not less than $1 for each $2 of Federal funds pro12 vided under the grant.

13 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB14 UTED.—In determining the amount of non-Federal

15 contributions in cash that a State has provided pur16 suant to paragraph (1), the Secretary may not in17 clude any amounts provided to the State by the Fed18 eral Government.

19 ‘‘(d) APPLICATION FOR GRANT.—The Secretary may

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

21 for the grant is submitted to the Secretary and the appli22 cation is in such form, is made in such manner, and con23 tains such agreements, assurances, and information as the

24 Secretary determines to be necessary to carry out this sec25 tion.
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1 ‘‘(e) COORDINATION OF ACTIVITIES.—The Secretary

2 shall ensure that activities under this section are coordi3 nated as appropriate with other agencies of the Public

4 Health Service that carry out activities regarding trau5 matic brain injury.

6 ‘‘(f) REPORT.—Not later than 2 years after the date

7 of enactment of this section, the Secretary shall submit

8 to the Committee on Energy and Commerce of the House

9 of Representatives, and to the Committee on Labor and

10 Human Resources of the Senate, a report describing the

11 findings and results of the programs established under

12 this section, including measures of outcomes and

13 consumer and surrogate satisfaction.

14 ‘‘(g) DEFINITION.—For purposes of this section, the

15 term ‘traumatic brain injury’ means an acquired injury

16 to the brain. Such term does not include brain dysfunction

17 caused by congenital or degenerative disorders, nor birth

18 trauma, but may include brain injuries caused by anoxia

19 due to near drowning.

20 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There

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

22 $5,000,000 for fiscal year 1996, and such sums as may

23 be necessary for each of the fiscal years 1997 and 1998.’’.

24 (c) STUDY; CONSENSUS CONFERENCE.—

25 (1) STUDY.—
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1 (A) IN GENERAL.—The Secretary of

2 Health and Human Services (in this subsection

3 referred to as the ‘‘Secretary’’), acting through

4 the appropriate agencies of the Public Health

5 Service, shall conduct a study for the purpose

6 of carrying out the following with respect to

7 traumatic brain injury:

8 (i) In collaboration with appropriate

9 State and local health-related agencies—

10 (I) determine the incidence and

11 prevalence of traumatic brain injury;

12 and

13 (II) develop a uniform reporting

14 system under which States report inci15 dence of traumatic brain injury, if the

16 Secretary determines that such a sys17 tem is appropriate.

18 (ii) Identify common therapeutic

19 interventions which are used for the reha20 bilitation of individuals with such injuries,

21 and shall, subject to the availability of in22 formation, include an analysis of—

23 (I) the effectiveness of each such

24 intervention in improving the func-
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1 tioning of individuals with brain inju2 ries;

3 (II) the comparative effectiveness

4 of interventions employed in the

5 course of rehabilitation of individuals

6 with brain injuries to achieve the

7 same or similar clinical outcome; and

8 (III) the adequacy of existing

9 measures of outcomes and knowledge

10 of factors influencing differential out11 comes.

12 (iii) Develop practice guidelines for

13 the rehabilitation of traumatic brain injury

14 at such time as appropriate scientific re15 search becomes available.

16 (B) DATES CERTAIN FOR REPORTS.—

17 (i) Not later than 18 months after the

18 date of enactment of this Act, the Sec19 retary shall submit to the Committee on

20 Commerce of the House of Representa21 tives, and to the Committee on Labor and

22 Human Resources of the Senate, a report

23 describing the findings made as a result of

24 carrying out subparagraph (A)(i).
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1 (ii) Not later than 3 years after the

2 date of enactment of this Act, the Sec3 retary shall submit to the Committees

4 specified in clause (i) a report describing

5 the findings made as a result of carrying

6 out clauses (ii) and (iii) of subparagraph

7 (A).

8 (2) CONSENSUS CONFERENCE.—The Secretary,

9 acting through the Director of the National Center

10 for Medical Rehabilitation Research within the Na11 tional Institute for Child Health and Human Devel12 opment, shall conduct a national consensus con13 ference on managing traumatic brain injury and re14 lated rehabilitation concerns.

15 (3) DEFINITION.—For purposes of this sub16 section, the term ‘‘traumatic brain injury’’ means an

17 acquired injury to the brain. Such term does not in18 clude brain dysfunction caused by congenital or de19 generative disorders, nor birth trauma, but may in20 clude brain injuries caused by anoxia due to near

21 drowning.

22 SEC. 303. STATE OFFICES OF RURAL HEALTH.

23 (a) IN GENERAL.—Section 338M of the Public

24 Health Service Act (as so redesignated by section 132)

25 is amended—
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1 (1) in subsection (b)(1), in the matter preced2 ing subparagraph (A), by striking ‘‘in cash’’; and

3 (2) in subsection (j)(1)—

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

5 (B) by inserting before the period the fol6 lowing: ‘‘, and such sums as may be necessary

7 for each of the fiscal years 1996 through

8 1997’’; and

9 (3) in subsection (k), by striking

10 ‘‘$10,000,000’’ and inserting ‘‘$20,000,000’’.

11 (b) REPEAL.—Effective on October 1, 1997, section

12 338M of the Public Health Service Act (as so redesignated

13 by section 132) is repealed.

14 SEC. 304. HEALTH SERVICES FOR PACIFIC ISLANDERS.

15 Section 10 of the Disadvantaged Minority Health Im16 provement Act of 1990 (42 U.S.C. 254c–1) is amended—

17 (1) in subsection (b)—

18 (A) in paragraph (2)—

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

20 after ‘‘availability of health’’; and

21 (ii) by striking ‘‘, including improved

22 health data systems’’;

23 (B) in paragraph (3)—

24 (i) by striking ‘‘manpower’’ and in25 serting ‘‘care providers’’; and
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1 (ii) by striking ‘‘by—’’ and all that

2 follows through the end thereof and insert3 ing a semicolon;

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

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

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

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

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

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

10 by striking the period and inserting a semi11 colon; and

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

13 redesignated), the following new paragraphs:

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

15 health care, and related training to American Sa16 moan health care professionals; and

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

18 disease prevention services for rural American

19 Samoa.’’;

20 (2) in subsection (f)—

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

22 ‘‘there are’’; and

23 (B) by striking ‘‘$10,000,000’’ and all that

24 follows through ‘‘1993’’ and inserting

25 ‘‘$3,000,000 for fiscal year 1995, $4,000,000
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1 for fiscal year 1996, and $5,000,000 for fiscal

2 year 1997’’; and

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

4 new subsection:

5 ‘‘(g) STUDY AND REPORT.—

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

7 the date of enactment of this subsection, the Sec8 retary, acting through the Administrator of the

9 Health Resources and Services Administration, shall

10 enter into a contract with a public or nonprofit pri11 vate entity for the conduct of a study to determine

12 the effectiveness of projects funded under this sec13 tion.

14 ‘‘(2) REPORT.—Not later than July 1, 1996,

15 the Secretary shall prepare and submit to the Com16 mittee on Labor and Human Resources of the Sen17 ate and the Committee on Energy and Commerce of

18 the House of Representatives a report describing the

19 findings made with respect to the study conducted

20 under paragraph (1).’’.

21 SEC. 305. DEMONSTRATION PROJECTS REGARDING ALZ22 HEIMER’S DISEASE.

23 (a) IN GENERAL.—Section 398(a) of the Public

24 Health Service Act (42 U.S.C. 280c–3(a)) is amended—
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1 (1) in the matter preceding paragraph (1), by

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

3 (2) in paragraph (2)—

4 (A) by inserting after ‘‘disorders’’ the fol5 lowing: ‘‘who are living in single family homes

6 or in congregate settings’’; and

7 (B) by striking ‘‘and’’ at the end;

8 (3) by redesignating paragraph (3) as para9 graph (4); and

10 (4) by inserting after paragraph (2) the follow11 ing:

12 ‘‘(3) to improve the access of such individuals

13 to home-based or community-based long-term care

14 services (subject to the services being provided by

15 entities that were providing such services in the

16 State involved as of October 1, 1995), particularly

17 such individuals who are members of racial or ethnic

18 minority groups, who have limited proficiency in

19 speaking the English language, or who live in rural

20 areas; and’’.

21 (b) DURATION.—Section 398A of the Public Health

22 Service Act (42 U.S.C. 280c–4) is amended—

23 (1) in the heading for the section, by striking

24 ‘‘limitation’’ and all that follows and inserting

25 ‘‘requirement of matching funds’’;
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1 (2) by striking subsection (a);

2 (3) by redesignating subsections (b) and (c) as

3 subsections (a) and (b), respectively;

4 (4) in subsection (a) (as so redesignated), in

5 each of paragraphs (1)(C) and (2)(C), by striking

6 ‘‘third year’’ and inserting ‘‘third or subsequent

7 year’’.

8 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

9 398B(e) of the Public Health Service Act (42 U.S.C.

10 280c–5(e)) is amended by striking ‘‘and 1993’’ and insert11 ing ‘‘through 1998’’.

12 TITLE IV—MISCELLANEOUS

13 PROVISIONS

14 SEC. 401. TECHNICAL CORRECTIONS REGARDING PUBLIC

15 LAW 103–183.

16 (a) AMENDATORY INSTRUCTIONS.—Public Law 103–

17 183 is amended—

18 (1) in section 601—

19 (A) in subsection (b), in the matter preced20 ing paragraph (1), by striking ‘‘Section 1201 of

21 the Public Health Service Act (42 U.S.C.

22 300d)’’ and inserting ‘‘Title XII of the Public

23 Health Service Act (42 U.S.C. 300d et seq.)’’;

24 and
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1 (B) in subsection (f)(1), by striking ‘‘in

2 section 1204(c)’’ and inserting ‘‘in section

3 1203(c) (as redesignated by subsection (b)(2) of

4 this section)’’;

5 (2) in section 602, by striking ‘‘for the pur6 pose’’ and inserting ‘‘For the purpose’’; and

7 (3) in section 705(b), by striking ‘‘317D((l)(1)’’

8 and inserting ‘‘317D(l)(1)’’.

9 (b) PUBLIC HEALTH SERVICE ACT.—The Public

10 Health Service Act, as amended by Public Law 103–183

11 and by subsection (a) of this section, is amended—

12 (1) in section 317E(g)(2), by striking ‘‘making

13 grants under subsection (b)’’ and inserting ‘‘carrying

14 out subsection (b)’’;

15 (2) in section 318, in subsection (e) as in effect

16 on the day before the date of the enactment of Pub17 lic Law 103–183, by redesignating the subsection as

18 subsection (f);

19 (3) in subpart 6 of part C of title IV—

20 (A) by transferring the first section 447

21 (added by section 302 of Public Law 103–183)

22 from the current placement of the section;

23 (B) by redesignating the section as section

24 447A; and
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1 (C) by inserting the section after section

2 447;

3 (4) in section 1213(a)(8), by striking ‘‘provides

4 for for’’ and inserting ‘‘provides for’’;

5 (5) in section 1501, by redesignating the second

6 subsection (c) (added by section 101(f) of Public

7 Law 103–183) as subsection (d); and

8 (6) in section 1505(3), by striking ‘‘nonprofit’’.

9 (c) MISCELLANEOUS CORRECTION.—Section

10 401(c)(3) of Public Law 103–183 is amended in the mat11 ter preceding subparagraph (A) by striking ‘‘(d)(5)’’ and

12 inserting ‘‘(e)(5)’’.

13 (d) EFFECTIVE DATE.—This section is deemed to

14 have taken effect immediately after the enactment of Pub15 lic Law 103–183.

16 SEC. 402. CERTAIN AUTHORITIES OF CENTERS FOR DIS17 EASE CONTROL AND PREVENTION.

18 (a) IN GENERAL.—Part B of title III of the Public

19 Health Service Act is amended by inserting after section

20 317H the following section:

21 ‘‘MISCELLANEOUS AUTHORITIES REGARDING CENTERS

22 FOR DISEASE CONTROL AND PREVENTION

23 ‘‘SEC. 317I. (a) TECHNICAL AND SCIENTIFIC PEER

24 REVIEW GROUPS.—The Secretary, acting through the Di25 rector of the Centers for Disease Control and Prevention,

26 may, without regard to the provisions of title 5, United
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1 States Code, governing appointments in the competitive

2 service, and without regard to the provisions of chapter

3 51 and subchapter III of chapter 53 of such title relating

4 to classification and General Schedule pay rates, establish

5 such technical and scientific peer review groups and sci6 entific program advisory committees as are needed to

7 carry out the functions of such Centers and appoint and

8 pay the members of such groups, except that officers and

9 employees of the United States shall not receive additional

10 compensation for service as members of such groups. The

11 Federal Advisory Committee Act shall not apply to the

12 duration of such peer review groups. Not more than one13 fourth of the members of any such group shall be officers

14 or employees of the United States.

15 ‘‘(b) FELLOWSHIP AND TRAINING PROGRAMS.—The

16 Secretary, acting through the Director of the Centers for

17 Disease Control and Prevention, shall establish fellowship

18 and training programs to be conducted by such Centers

19 to train individuals to develop skills in epidemiology, sur20 veillance, laboratory analysis, and other disease detection

21 and prevention methods. Such programs shall be designed

22 to enable health professionals and health personnel trained

23 under such programs to work, after receiving such train24 ing, in local, State, national, and international efforts to25 ward the prevention and control of diseases, injuries, and
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1 disabilities. Such fellowships and training may be adminis2 tered through the use of either appointment or

3 nonappointment procedures.’’.

4 (b) EFFECTIVE DATE.—This section is deemed to

5 have taken effect July 1, 1995.

6 SEC. 403. ADMINISTRATION OF CERTAIN REQUIREMENTS.

7 (a) IN GENERAL.—Section 2004 of Public Law 103–

8 43 (107 Stat. 209) is amended by striking subsection (a).

9 (b) CONFORMING AMENDMENTS.—Section 2004 of

10 Public Law 103–43, as amended by subsection (a) of this

11 section, is amended—

12 (1) by striking ‘‘(b) SENSE’’ and all that follows

13 through ‘‘In the case’’ and inserting the following:

14 ‘‘(a) SENSE OF CONGRESS REGARDING PURCHASE

15 OF AMERICAN-MADE EQUIPMENT AND PRODUCTS.—In

16 the case’’;

17 (2) by striking ‘‘(2) NOTICE TO RECIPIENTS OF

18 ASSISTANCE’’ and inserting the following:

19 ‘‘(b) NOTICE TO RECIPIENTS OF ASSISTANCE’’; and

20 (3) in subsection (b), as redesignated by para21 graph (2) of this subsection, by striking ‘‘paragraph

22 (1)’’ and inserting ‘‘subsection (a)’’.

23 (c) EFFECTIVE DATE.—This section is deemed to

24 have taken effect immediately after the enactment of Pub25 lic Law 103–43.
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1 SEC. 404. TECHNICAL CORRECTIONS RELATING TO HEALTH

2 PROFESSIONS PROGRAMS.

3 (a) DEFINITIONS.—Section 799B(6) of the Public

4 Health Service Act (as so redesignated by section

5 105(a)(2)(C)) is amended—

6 (1) in subparagraph (B) by striking ‘‘; or’’ at

7 the end thereof;

8 (2) in subparagraph (C) by striking the period

9 and inserting a semicolon; and

10 (3) by adding at the end thereof the following:

11 ‘‘(D) ambulatory practice sites designated

12 by State Governors as shortage areas or medi13 cally underserved communities for purposes of

14 State scholarships or loan repayment or related

15 programs; or

16 ‘‘(E) practices or facilities in which not

17 less than 50 percent of the patients are recipi18 ents of aid under title XIX of the Social Secu19 rity Act or eligible and uninsured.’’.

20 (b) RECOVERY.—Part G of title VII of the Public

21 Health Service Act (42 U.S.C. 295j et seq.) is amended

22 by inserting after section 794 the following section:

23 ‘‘§ 794a. Recovery

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

25 (or within such shorter period as the Secretary may pre26 scribe by regulation for an interim facility) after the com-
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1 pletion of construction of a facility with respect to which

2 funds have been paid under section 720(a) (as such sec3 tion existed one day prior to the date of enactment of the

4 Health Professions Education Extension Amendments of

5 1992 (Public Law 102–408)—

6 ‘‘(1)(A) in case of a facility which was an affili7 ated hospital or outpatient facility with respect to

8 which funds have been paid under such section

9 720(a)(1), the owner of the facility ceases to be a

10 public or other nonprofit agency that would have

11 been qualified to file an application under section

12 605;

13 ‘‘(B) in case of a facility which was not an af14 filiated hospital or outpatient facility but was a facil15 ity with respect to which funds have been paid under

16 paragraph (1) or (3) of such section 720(a), the

17 owner of the facility ceases to be a public or non18 profit school, or

19 ‘‘(C) in case of a facility which was a facility

20 with respect to which funds have been paid under

21 such section 720(a)(2), the owner of the facility

22 ceases to be a public or nonprofit entity,

23 ‘‘(2) the facility ceases to be used for the teach24 ing or training purposes (or other purposes per25 mitted under section 722 (as such section existed
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1 one day prior to the date of enactment of the Health

2 Professions Education Extension Amendments of

3 1992 (Public Law 102–408)) for which it was con4 structed, or

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

6 or as a place for religious worship,

7 the United States shall be entitled to recover from the

8 owner of the facility the base amount prescribed by sub9 section (c)(1) plus the interest (if any) prescribed by sub10 section (c)(2).

11 ‘‘(b) NOTICE.—The owner of a facility which ceases

12 to be a public or nonprofit agency, school, or entity as

13 described in subparagraph (A), (B), or (C) of subsection

14 (a)(1), as the case may be, or the owner of a facility the

15 use of which changes as described in paragraph (2) or (3)

16 of subsection (a), shall provide the Secretary written no17 tice of such cessation or change of use within 10 days after

18 the date on which such cessation or change of use occurs

19 or within 30 days after the date of enactment of this sub20 section, whichever is later.

21 ‘‘(c) AMOUNT.—

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

23 the United States is entitled to recover under sub24 section (a) is the amount bearing the same ratio to

25 the then value (as determined by the agreement of
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1 the parties or in an action brought in the district

2 court of the United States for the district in which

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

4 of the Federal participation bore to the cost of con5 struction.

6 ‘‘(2) INTEREST.—

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

8 United States is entitled to recover under sub9 section (a) is the interest for the period (if any)

10 described in subparagraph (B) at a rate (deter11 mined by the Secretary) based on the average

12 of the bond equivalent rates of ninety-one-day

13 Treasury bills auctioned during that period.

14 ‘‘(B) PERIOD.—The period referred to in

15 subparagraph (A) is the period beginning—

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

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

18 on which the owner of the facility ceases to

19 be a public or nonprofit agency, school, or

20 entity as described in subparagraph (A),

21 (B), or (C) of subsection (a)(1), as the

22 case may be, or 191 days after the date on

23 which the use of the facility changes as de24 scribed in paragraph (2) or (3) of sub25 section (a), or
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1 ‘‘(ii) if notice is not provided as pre2 scribed by subsection (b), 11 days after the

3 date on which such cessation or change of

4 use occurs,

5 and ending on the date the amount the United

6 States is entitled to recover is collected.

7 ‘‘(d) WAIVER.—The Secretary may waive the recov8 ery rights of the United States under subsection (a)(2)

9 with respect to a facility (under such conditions as the

10 Secretary may establish by regulation) if the Secretary de11 termines that there is good cause for waiving such rights.

12 ‘‘(e) LIEN.—The right of recovery of the United

13 States under subsection (a) shall not, prior to judgment,

14 constitute a lien on any facility.’’.

15 SEC. 405. CLINICAL TRAINEESHIPS.

16 Section 303(d)(1) of the Public Health Service Act

17 (42 U.S.C. 242a(d)(1)) is amended by inserting ‘‘counsel18 ing’’ after ‘‘family therapy,’’.

19 SEC. 406. CONSTRUCTION OF REGIONAL CENTERS FOR RE20 SEARCH ON PRIMATES.

21 Section 481B(a) of the Public Health Service Act (42

22 U.S.C. 287a–3(a)) is amended by striking ‘‘$5,000,000’’

23 and inserting ‘‘$2,500,000’’.

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