103D CONGRESS

2D SESSION S. 1569

AN ACT

To amend the Public Health Service Act to estabbackgrounds, and for other purposes. the health of individuals from disadvantaged lish, reauthorize and revise provisions to improve
103D CONGRESS

2D SESSION S. 1569

AN ACT

To amend the Public Health Service Act to establish, reauthorize and revise provisions to improve the health of

individuals from disadvantaged backgrounds, 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; REFERENCE; TABLE OF CON4 TENTS.

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

6 ‘‘Disadvantaged Minority Health Improvement Act of

7 1994’’.
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1 (b) REFERENCE.—Except as otherwise expressly pro2 vided, whenever in this Act an amendment or a repeal is

3 expressed in terms of an amendment to, or a repeal of,

4 a section or other provision, the reference shall be consid5 ered to be made to a section or other provision of the Pub6 lic Health Service Act (42 U.S.C. 201 et seq.).

7 (c) TABLE OF CONTENTS.—The table of contents is

8 as follows:

Sec. 1. Short title; reference; table of contents.

Sec. 2. Findings.

TITLE I—HEALTH POLICY

Sec. 101. Office of Minority Health.

Sec. 102. Agency Offices of Minority Health.

Sec. 103. State Offices of Minority Health.

Sec. 104. Assistant Secretary of Health and Human Services for Civil Rights.

TITLE II—HEALTH SERVICES

Sec. 201. Health services for residents of public housing.

Sec. 202. Issuance of regulations regarding language as impediment to receipt

of services.

Sec. 203. Health services for Pacific Islanders.

TITLE III—HEALTH PROFESSIONS

Sec. 301. Loans for disadvantaged students.

Sec. 302. Cesar Chavez primary care scholarship program.

Sec. 303. Thurgood Marshall scholarship program.

Sec. 304. Loan repayments and fellowships regarding faculty positions at

health professions schools.

Sec. 305. Centers of excellence.

Sec. 306. Educational assistance regarding undergraduates.

Sec. 307. Area health education centers.

TITLE IV—RESEARCH AND DATA COLLECTION

Sec. 401. Office of Research on Minority Health.

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

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

TITLE V—MISCELLANEOUS

Sec. 501. Revision and extension of program for State Offices of Rural Health.

Sec. 502. Technical corrections relating to health professions.

Sec. 503. Clinical traineeships.

Sec. 504. Demonstration project grants to States for Alzheimer’s disease.
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Sec. 505. Medically underserved area study.

Sec. 506. Programs regarding birth defects.

Sec. 507. Demonstration projects regarding diabetic-retinopathy.

Sec. 508. Mexican Border State Analytical Laboratories.

Sec. 509. Construction of regional centers for research on primates.

TITLE VI—MULTIETHNIC PLACEMENT

Sec. 601. Short title.

Sec. 602. Findings and purpose.

Sec. 603. Multiethnic placements.

TITLE VII—VOLUNTARY MUTUAL REUNIONS

Sec. 701. Facilitation of reunions.

TITLE VIII—GENERAL PROVISIONS

Sec. 801. Effective date.

1 SEC. 2. FINDINGS.

2 Section 1(b) of the Disadvantaged Minority Health

3 Improvement Act of 1990 (42 U.S.C. 300u–6 note) is

4 amended to read as follows—

5 ‘‘(b) FINDINGS.—Congress finds that—

6 ‘‘(1) the health status of individuals from racial

7 and ethnic minorities in the United States is signifi8 cantly lower than the health status of the general

9 population and has not improved significantly since

10 the issuance of the 1985 report entitled ‘‘Report of

11 the Secretary’s Task Force on Black and Minority

12 Health’’;

13 ‘‘(2) racial and ethnic minorities are dispropor14 tionately represented among the poor;

15 ‘‘(3) racial and ethnic minorities suffer dis16 proportionately high rates of cancer, heart disease,
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1 diabetes, substance abuse, acquired immune defi2 ciency syndrome, and other diseases and disorders;

3 ‘‘(4) the incidence of infant mortality among

4 African Americans is almost double that for the gen5 eral population;

6 ‘‘(5) Mexican-American and Puerto Rican

7 adults have diabetes rates twice that of non-His8 panic whites;

9 ‘‘(6) a third of American Indian deaths occur

10 before the age of 45;

11 ‘‘(7) according to the 1990 Census, African

12 Americans, Hispanics, American Indians, and Asian/

13 Pacific Islanders constitute approximately 12.1 per14 cent, 9 percent, 0.08 percent, and 2.9 percent, re15 spectively, of the population of the United States;

16 ‘‘(8) minority health professionals have histori17 cally tended to practice in low-income areas, medi18 cally underserved areas, and to serve racial and eth19 nic minorities;

20 ‘‘(9) minority health professionals have histori21 cally tended to engage in the general practice of

22 medicine and specialties providing primary care;

23 ‘‘(10) reports published in leading medical jour24 nals indicate that access to health care among mi-
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1 norities can be substantially improved by increasing

2 the number of minority professionals;

3 ‘‘(11) diversity in the faculty and student body

4 of health professions schools enhances the quality of

5 education for all students attending the schools; and

6 ‘‘(12) health professionals need greater access

7 to continuing medical education programs to enable

8 such professionals to upgrade their skills (including

9 linguistic and cultural competence skills) and im10 prove the quality of medical care rendered in minor11 ity communities.’’.

12 TITLE I—HEALTH POLICY

13 SEC. 101. OFFICE OF MINORITY HEALTH.

14 Section 1707 (42 U.S.C. 300u–6) is amended by

15 striking subsection (b) and all that follows and inserting

16 the following:

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

18 of racial and ethnic minorities, the Secretary, acting

19 through the Deputy Assistant Secretary for Minority

20 Health, shall carry out the following:

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

22 and objectives and coordinate all other activities

23 within the Public Health Service that relate to dis24 ease prevention, health promotion, service delivery,

25 and research concerning such individuals. The Direc-
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1 tor of the Centers for Disease Control and Preven2 tion, the Administrator of the Health Resources and

3 Services Administration, the Director of the Agency

4 for Health Care Policy and Research, the Adminis5 trator of the Substance Abuse and Mental Health

6 Services Administration and the Director of the Na7 tional Institutes of Health shall consult with the

8 Deputy Assistant Secretary for Minority Health to

9 ensure the coordination of all activities within the

10 Public Health Service as they relate to disease pre11 vention, health promotion, service delivery, and re12 search concerning such individuals.

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

14 by entering into interagency agreements with other

15 agencies of the Public Health Service:

16 ‘‘(A) Support research, demonstrations and

17 evaluations to test new and innovative models.

18 ‘‘(B) Increase knowledge and understand19 ing of health risk factors.

20 ‘‘(C) Develop mechanisms that support

21 better information dissemination, education,

22 prevention, and service delivery to individuals

23 from disadvantaged backgrounds, including ra24 cial and ethnic minorities.
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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) Establish a national center that shall carry

16 out programs to improve access to health care serv17 ices for individuals with limited English proficiency

18 by facilitating the removal of impediments to the re19 ceipt of health care that result from such limitation.

20 ‘‘(5) With respect to grants and contracts that

21 are available under certain minority health pro22 grams, the Secretary shall ensure that the agencies

23 of the Public Health Service—

24 ‘‘(A) inform entities, as appropriate, that

25 the entities may be eligible for the awards;
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1 ‘‘(B) provide technical assistance to such

2 entities in the process of preparing and submit3 ting applications for the awards in accordance

4 with the policies of the Secretary regarding

5 such application; and

6 ‘‘(C) inform populations, as appropriate,

7 that members of the populations may be eligible

8 to receive services or otherwise participate in

9 the activities carried out with such awards.

10 ‘‘(6) Not later than September 1 of each year,

11 the Deputy Assistant Secretary of Minority Health

12 shall prepare and submit to the Secretary a report

13 summarizing the activities of each Office of Minority

14 Health within the Public Health Service, including

15 the Office of Research on Minority Health at the

16 National Institutes of Health.

17 ‘‘(c) ADVISORY COMMITTEE.—

18 ‘‘(1) IN GENERAL.—The Secretary shall estab19 lish an advisory committee to be known as the Advi20 sory Committee on Minority Health (in this sub21 section referred to as the ‘Committee’).

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

23 advice to the Secretary on carrying out this section,

24 including advice on the development of goals and
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1 specific program activities under subsection (b)(1)

2 for each racial and ethnic group.

3 ‘‘(3) CHAIRPERSON.—The Deputy Assistant

4 Secretary for Minority Health shall serve as the

5 Chairperson of the Committee.

6 ‘‘(4) COMPOSITION.—The Committee shall be

7 composed of no fewer than 12, and not more than

8 18 individuals, who are not officers or employees of

9 the Federal Government. The Secretary shall ap10 point the members of the Committee from among in11 dividuals with expertise regarding issues of minority

12 health. The membership of the Committee shall be

13 equitably representative of the various racial and

14 ethnic groups. The Secretary may appoint represent15 atives from selected Federal agencies to serve as ex

16 officio, non-voting members of the Committee.

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

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

19 Secretary shall initially appoint a portion of the

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

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

22 Committee, a new member shall be appointed by the

23 Secretary within 90 days from the date that the va24 cancy occurs, and serve for the remainder of the

25 term for which the predecessor of such member was
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1 appointed. The vacancy shall not affect the power of

2 the remaining members to execute the duties of the

3 Committee.

4 ‘‘(7) COMPENSATION.—Members of the Com5 mittee who are officers or employees of the United

6 States shall serve without compensation. Members of

7 the Committee who are not officers or employees of

8 the United States shall receive, for each day (includ9 ing travel time) they are engaged in the performance

10 of the functions of the Committee, compensation at

11 rates that do not exceed the daily equivalent of the

12 annual rate in effect for grade GS–18 of the General

13 Schedule under title 5, United States Code.

14 ‘‘(d) CERTAIN REQUIREMENTS REGARDING DU15 TIES.—

16 ‘‘(1) RECOMMENDATIONS REGARDING LAN17 GUAGE AS IMPEDIMENT TO HEALTH CARE.—The

18 Secretary, acting through the Director of the Office

19 of Refugee 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, shall make recommendations regarding ac23 tivities under subsection (b)(4).

24 ‘‘(2) EQUITABLE ALLOCATION REGARDING AC25 TIVITIES.—In awarding grants or contracts under
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1 section 338A, 338B, 340A, 724, 737, 738, or 1707,

2 the Secretary shall ensure that such awards are eq3 uitably allocated with respect to the various racial

4 and ethnic populations.

5 ‘‘(3) CULTURAL COMPETENCY OF SERVICES.—

6 The Secretary shall ensure that information and

7 services provided pursuant to subsection (b) are pro8 vided in the language and cultural context that is

9 most appropriate for the individuals for whom the

10 information and services are intended.

11 ‘‘(4) PEER REVIEW.—The Secretary shall en12 sure that each application for a grant, contract or

13 cooperative agreement under this section undergoes

14 appropriate peer review.

15 ‘‘(e) REPORTS.—Not later than January 31 of fiscal

16 year 1995 and of each second year thereafter, the Sec17 retary shall submit to the Congress a report describing

18 the activities carried out under this section during the pre19 ceding 2 fiscal years and evaluating the extent to which

20 such activities have been effective in improving the health

21 of racial and ethnic minorities.

22 ‘‘(f) GRANTS AND CONTRACTS REGARDING DU23 TIES.—
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1 ‘‘(1) AUTHORITY.—In carrying out subsection

2 (b), the Secretary may enter into grants and con3 tracts with public and nonprofit private entities.

4 ‘‘(2) EVALUATION AND DISSEMINATION.—The

5 Secretary shall, directly or through contracts with

6 public and private entities, provide for evaluations of

7 projects carried out with financial assistance pro8 vided under paragraph (1) during the preceding 2

9 fiscal years. The report shall be included in the re10 port required under subsection (e) for the fiscal year

11 involved.

12 ‘‘(g) DEFINITION.—As used in this section, the term

13 ‘racial and ethnic minority group’ means Hispanics,

14 Blacks, Asian Americans, Pacific Islanders, Native Ameri15 cans, and Alaskan Natives. The term ‘Hispanic’ means in16 dividuals whose origin is Mexican, Puerto Rican, Cuban,

17 Central or South American, or any other Spanish-speak18 ing country, including Spain or the Caribbean Islands, and

19 individuals identifying themselves as Hispanic, Latino,

20 Spanish, or Spanish-American.

21 ‘‘(h) FUNDING.—

22 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

23 For the purpose of carrying out this section, there

24 is authorized to be appropriated $20,500,000 for fis-
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1 cal year 1994, and such sums as may be necessary

2 for each of the fiscal years 1995 through 1998.

3 ‘‘(2) ALLOCATION OF FUNDS BY SECRETARY.—

4 Of the amounts appropriated under paragraph (1)

5 for a fiscal year in excess of $15,000,000, the Sec6 retary shall make available not less than $3,000,000

7 for activities to improve access to health care serv8 ices for individuals with limited English proficiency,

9 including activities identified in subsection (b)(4).’’.

10 SEC. 102. AGENCY OFFICES OF MINORITY HEALTH.

11 Title XVII (42 U.S.C. 300u et seq.) is amended by

12 adding at the end the following new section:

13 ‘‘SEC. 1709. AGENCY OFFICES OF MINORITY HEALTH.

14 ‘‘(a) IN GENERAL.—The Secretary shall ensure that

15 an Office of Minority Health is operating at the Centers

16 for Disease Control and Prevention, the Health Resources

17 and Services Administration, the Substance Abuse and

18 Mental Health Services Administration, and the Agency

19 for Health Care Policy and Research. Such Offices shall

20 ensure that services and programs carried out within each

21 such respective agency or office—

22 ‘‘(1) are equitably delivered with respect to ra23 cial and ethnic groups;

24 ‘‘(2) provide culturally and linguistically com25 petent services; and
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1 ‘‘(3) utilize racial and ethnic minority commu2 nity-based organizations to deliver services.

3 ‘‘(b) REPORTS.—Each Office of Minority Health

4 within the Public Health Service, including the Office of

5 Research on Minority Health at the National Institutes

6 of Health, shall submit a report, not later than May 1

7 of each year, to the Deputy Assistant Secretary for Minor8 ity Health (as provided for in section 1707(b)) describing

9 the accomplishments or programs of the plan, the budget

10 allocation and expenditures for, and the development and

11 implementation of, such health programs targeting racial

12 and ethnic minority populations. The Secretary shall en13 sure the participation and cooperation of each Agency in

14 the development of the annual report.’’.

15 SEC. 103. STATE OFFICES OF MINORITY HEALTH.

16 Title XVII (42 U.S.C. 300u et seq.), as amended by

17 section 102, is further amended by adding at the end the

18 following new section:

19 ‘‘SEC. 1710. GRANTS TO STATES FOR OPERATION OF OF20 FICES OF MINORITY HEALTH.

21 ‘‘(a) IN GENERAL.—The Secretary, acting through

22 the Deputy Assistant Secretary for Minority Health (as

23 provided for in section 1707), may make grants to States

24 for the purpose of improving the health status in minority

25 communities, through the operation of State offices of mi-
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1 nority health established to monitor and facilitate the

2 achievement of the Health Objectives for the Year 2000

3 as they affect minority populations.

4 ‘‘(b) ADMINISTRATION OF PROGRAM.—The Secretary

5 may not make a grant to a State under subsection (a)

6 unless such State agrees that the program carried out by

7 the State with amounts received under the grant will be

8 administered directly by a single State agency.

9 ‘‘(c) CERTAIN REQUIRED ACTIVITIES.—The Sec10 retary may not make a grant to a State under subsection

11 (a) unless such State agrees that activities carried out by

12 an office operated under the grant received pursuant to

13 such subsection will—

14 ‘‘(1) establish and maintain within the State a

15 clearinghouse for collecting and disseminating infor16 mation on—

17 ‘‘(A) minority health care issues;

18 ‘‘(B) research findings relating to minority

19 health care; and

20 ‘‘(C) innovative approaches to the delivery

21 of health care and social services in minority

22 communities;

23 ‘‘(2) coordinate the activities carried out in the

24 State that relate to minority health care, including
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1 providing coordination for the purpose of avoiding

2 redundancy in such activities;

3 ‘‘(3) identify Federal and State programs re4 garding minority health, and providing technical as5 sistance to public and nonprofit entities regarding

6 participation in such program; and

7 ‘‘(4) develop additional Healthy People 2000

8 objectives for the State that are necessary to address

9 the most prevalent morbidity, mortality and disabil10 ity concerns for racial and ethnic minority groups in

11 the State.

12 ‘‘(d) REQUIREMENT REGARDING ANNUAL BUDGET

13 FOR THE OFFICE.—The Secretary may not make a grant

14 to a State under subsection (a) unless such State agrees

15 that, for any fiscal year for which the State receives such

16 a grant, the office operated under such grant will be pro17 vided with an annual budget of not less than $75,000.

18 ‘‘(e) CERTAIN USES OF FUNDS.—

19 ‘‘(1) RESTRICTIONS.—The Secretary may not

20 make a grant to a State under subsection (a) unless

21 such State agrees that—

22 ‘‘(A) if research with respect to minority

23 health is conducted pursuant to the grant, not

24 more than 10 percent of the amount received
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1 under the grant will be expended for such re2 search; and

3 ‘‘(B) amounts provided under the grant

4 will not be expended—

5 ‘‘(i) to provide health care (including

6 providing cash payments regarding such

7 care);

8 ‘‘(ii) to conduct activities for which

9 Federal funds are expended—

10 ‘‘(I) within the State to provide

11 technical and other nonfinancial as12 sistance under subsection (m) of sec13 tion 340A;

14 ‘‘(II) under a memorandum of

15 agreement entered into with the State

16 under subsection (h) of such section;

17 or

18 ‘‘(III) under a grant under sec19 tion 388I;

20 ‘‘(iii) to purchase medical equipment,

21 to purchase ambulances, aircraft, or other

22 vehicles, or to purchase major communica23 tions equipment;

24 ‘‘(iv) to purchase or improve real

25 property; or
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1 ‘‘(v) to carry out any activity regard2 ing a certificate of need.

3 ‘‘(2) AUTHORITIES.—Activities for which a

4 State may expend amounts received under a grant

5 under subsection (a) include—

6 ‘‘(A) paying the costs of establishing an of7 fice of minority health for purposes of sub8 section (a);

9 ‘‘(B) subject to paragraph (1)(B)(ii)(III),

10 paying the costs of any activity carried out with

11 respect to recruiting and retaining health pro12 fessionals to serve in minority communities or

13 underserved areas in the State; and

14 ‘‘(C) providing grants and contracts to

15 public and nonprofit entities to carry out activi16 ties authorized in this section.

17 ‘‘(f) REPORTS.—The Secretary may not make a

18 grant to a State under subsection (a) unless such State

19 agrees—

20 ‘‘(1) to submit to the Secretary reports contain21 ing such information as the Secretary may require

22 regarding activities carried out under this section by

23 the State; and

24 ‘‘(2) to submit a report not later than January

25 10 of each fiscal year immediately following any fis-
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1 cal year for which the State has received such a

2 grant.

3 ‘‘(g) REIMBURSEMENT OF APPLICATION.—The Sec4 retary may not make a grant to a State under subsection

5 (a) unless an application for the grant is submitted to the

6 Secretary and the application in such form, is made in

7 such manner, and contains such agreements, assurances,

8 and information as the Secretary determines to be nec9 essary to carry out such subsection.

10 ‘‘(h) NONCOMPLIANCE.—The Secretary may not

11 make payments under subsection (a) to a State for any

12 fiscal year subsequent to the first fiscal year of such pay13 ments unless the Secretary determines that, for the imme14 diately preceding fiscal year, the State has complied with

15 each of the agreements made by the State under this sec16 tion.

17 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—

18 ‘‘(1) IN GENERAL.—For purposes of making

19 grants under subsection (a) there are authorized to

20 be appropriated $3,000,000 for fiscal year 1995,

21 $4,000,000 for fiscal year 1996, and $3,000,000 for

22 fiscal year 1997.

23 ‘‘(2) AVAILABILITY.—Amounts appropriated

24 under paragraph (1) shall remain available until ex25 pended.
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1 ‘‘(j) TERMINATION OF PROGRAM.—No grant may be

2 made under this section after the aggregate amounts ap3 propriated under subsection (i)(1) are equal to

4 $10,000,000.’’.

5 SEC. 104. ASSISTANT SECRETARY OF HEALTH AND HUMAN

6 SERVICES FOR CIVIL RIGHTS.

7 (a) IN GENERAL.—Part A of title II (42 U.S.C. 202

8 et seq.), as amended by section 2010 of Public Law 103–

9 43, is amended by adding at the end the following new

10 section:

11 ‘‘SEC. 229. ASSISTANT SECRETARY FOR CIVIL RIGHTS.

12 ‘‘(a) ESTABLISHMENT OF POSITION.—There shall be

13 in the Department of Health and Human Services an As14 sistant Secretary for Civil Rights, who shall be appointed

15 by the President, by and with the advice and consent of

16 the Senate.

17 ‘‘(b) RESPONSIBILITIES.—The Assistant Secretary

18 shall perform such functions relating to civil rights as the

19 Secretary may assign.’’.

20 (b) CONFORMING AMENDMENT.—Section 5315 of

21 title 5, United States Code, is amended, in the item relat22 ing to Assistant Secretaries of Health and Human Serv23 ices, by striking ‘‘(5)’’ and inserting ‘‘(6)’’.
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1 TITLE II—HEALTH SERVICES

2 SEC. 201. HEALTH SERVICES FOR RESIDENTS OF PUBLIC

3 HOUSING.

4 Section 340A(p)(1) (42 U.S.C. 256a(p)(1)) is amend5 ed—

6 (1) by striking ‘‘$35,000,000 for fiscal year

7 1991’’ and inserting ‘‘$12,000,000 for fiscal year

8 1994’’; and

9 (2) by striking ‘‘1992 and 1993’’ and inserting

10 ‘‘1995 and 1996’’.

11 SEC. 202. ISSUANCE OF REGULATIONS REGARDING LAN12 GUAGE AS IMPEDIMENT TO RECEIPT OF

13 SERVICES.

14 (a) PROPOSED RULE.—Not later than the expiration

15 of the 90-day period beginning on the date of the enact16 ment of this Act, the Secretary of Health and Human

17 Services (in this section referred to as the ‘‘Secretary’’)

18 shall issue a proposed rule regarding policies to reduce the

19 extent to which having limited English proficiency con20 stitutes a significant impediment to individuals in estab21 lishing the eligibility of the individuals for—

22 (1) participation in health programs under the

23 Public Health Service Act;
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1 (2) the receipt of services under such programs

2 and under programs under titles XVIII and XIX of

3 the Social Security Act; or

4 (3) participation in programs or activities oth5 erwise receiving financial assistance from the Sec6 retary or receiving services under such programs or

7 activities.

8 (b) FINAL RULE.—

9 (1) IN GENERAL.—Not later than the expira10 tion of the 1-year period beginning on the date of

11 the enactment of this Act, the Secretary shall issue

12 a final rule regarding the policies described in sub13 section (a).

14 (2) FAILURE TO ISSUE BY DATE CERTAIN.—If

15 the Secretary fails to issue a final rule under para16 graph (1) before the expiration of the period speci17 fied in such paragraph, the proposed rule issued

18 under subsection (a) is upon such expiration deemed

19 to be the final rule under paragraph (1) (and shall

20 remain in effect until the Secretary issues a final

21 rule under such paragraph).

22 SEC. 203. HEALTH SERVICES FOR PACIFIC ISLANDERS.

23 Section 10 of the Disadvantaged Minority Health Im24 provement Act of 1990 (42 U.S.C. 254c–1) is amended—

25 (1) in subsection (b)—
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1 (A) in paragraph (2)—

2 (i) by inserting ‘‘, substance abuse’’

3 after ‘‘availability of health’’; and

4 (ii) by striking ‘‘, including improved

5 health data systems’’;

6 (B) in paragraph (3)—

7 (i) by striking ‘‘manpower’’ and in8 serting ‘‘care providers’’; and

9 (ii) by striking ‘‘by—’’ and all that

10 follows through the end thereof and insert11 ing a semicolon;

12 (C) by striking paragraphs (5) and (6);

13 (D) by redesignating paragraphs (7), and

14 (8) as paragraphs (5) and (6), respectively;

15 (E) in paragraph (5) (as so redesignated),

16 by striking ‘‘and’’ at the end thereof;

17 (F) in paragraph (6) (as so redesignated),

18 by striking the period and inserting a semi19 colon; and

20 (G) by inserting after paragraph (6) (as so

21 redesignated), the following new paragraphs:

22 ‘‘(7) to provide primary health care, preventive

23 health care, and related training to American Sa24 moan health care professionals; and
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1 ‘‘(8) to improve access to health promotion and

2 disease prevention services for rural American

3 Samoa.’’;

4 (2) in subsection (f)—

5 (A) by striking ‘‘there is’’ and inserting

6 ‘‘there are’’; and

7 (B) by striking ‘‘$10,000,000’’ and all that

8 follows through ‘‘1993’’ and inserting

9 ‘‘$5,000,000 for fiscal year 1994, and such

10 sums as may be necessary for each of the fiscal

11 years 1995 and 1996’’; and

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

13 new subsection:

14 ‘‘(g) STUDY AND REPORT.—

15 ‘‘(1) STUDY.—Not later than 180 days after

16 the date of enactment of this subsection, the Sec17 retary, acting through the Administrator of the

18 Health Resources and Services Administration, shall

19 enter into a contract with a public or nonprofit pri20 vate entity for the conduct of a study to determine

21 the effectiveness of projects funded under this sec22 tion.

23 ‘‘(2) REPORT.—Not later than July 1, 1995,

24 the Secretary shall prepare and submit to the Com25 mittee on Labor and Human Resources of the Sen-
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1 ate and the Committee on Energy and Commerce of

2 the House of Representatives a report describing the

3 findings made with respect to the study conducted

4 under paragraph (1).’’.

5 TITLE III—HEALTH

6 PROFESSIONS

7 SEC. 301. LOANS FOR DISADVANTAGED STUDENTS.

8 Section 724(f)(1) (42 U.S.C. 292t(f)(1)) is amend9 ed—

10 (1) by striking ‘‘there is’’ and inserting ‘‘there

11 are’’; and

12 (2) by striking ‘‘$15,000,000 for fiscal year

13 1993’’ and inserting ‘‘$8,000,000 for fiscal year

14 1994, and such sums as may be necessary for each

15 of the fiscal years 1995 and 1996’’.

16 SEC. 302. CESAR CHAVEZ PRIMARY CARE SCHOLARSHIP

17 PROGRAM.

18 Section 736 (42 U.S.C. 293) is amended—

19 (1) by striking the section heading and insert20 ing the following:

21 ‘‘SEC. 736. CESAR CHAVEZ PRIMARY CARE SCHOLARSHIP

22 PROGRAM.’’;

23 (2) in subsection (c)—

24 (A) by striking ‘‘there is’’ and inserting

25 ‘‘there are’’; and
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1 (B) by striking ‘‘$11,000,000 for fiscal

2 year 1993’’ and inserting ‘‘$10,500,000 for fis3 cal year 1994, and such sums as may be nec4 essary for each of the fiscal years 1995 and

5 1996’’.

6 SEC. 303. THURGOOD MARSHALL SCHOLARSHIP PROGRAM.

7 Section 737 (42 U.S.C. 293a) is amended—

8 (1) by striking the section heading and insert9 ing the following:

10 ‘‘SEC. 737. THURGOOD MARSHALL SCHOLARSHIP PRO11 GRAM.’’;

12 (2) in subsection (a)—

13 (A) in paragraph (1), by inserting ‘‘(to be

14 known as Thurgood Marshall Scholars)’’ after

15 ‘‘providing scholarships to individuals’’; and

16 (B) in paragraph (3), by inserting ‘‘schools

17 offering programs for the training of physician

18 assistants,’’ after ‘‘public health,’’; and

19 (3) in subsection (h), by striking paragraph (1)

20 and inserting the following new paragraph:

21 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

22 For the purpose of carrying out this section, there

23 are authorized to be appropriated $17,100,000 for

24 fiscal year 1994, and such sums as may be nec25 essary for each of the fiscal years 1995 and 1996.’’.
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1 SEC. 304. LOAN REPAYMENTS AND FELLOWSHIPS REGARD2 ING FACULTY POSITIONS AT HEALTH PRO3 FESSIONS SCHOOLS.

4 Section 738 (42 U.S.C. 293b) is amended—

5 (1) in subsection (a)—

6 (A) in paragraph (2), by striking ‘‘dis7 advantaged backgrounds who—’’ and inserting

8 ‘‘racial or ethnic groups that are under-rep9 resented in the health professions who—’’

10 (B) in paragraph (5)—

11 (i) by striking ‘‘; and’’ in subpara12 graph (A) and inserting a period;

13 (ii) by striking ‘‘unless—’’ and all

14 that follows through ‘‘the individual in15 volved’’ in subparagraph (A) and inserting

16 ‘‘unless the individual involved’’; and

17 (iii) striking subparagraph (B);

18 (C) by striking paragraph (6); and

19 (D) by redesignating paragraph (7) as

20 paragraph (6); and

21 (2) in subsection (b)(2)(B), by striking

22 ‘‘$30,000’’ and inserting ‘‘$50,000’’;

23 (3) in subsection (c)—

24 (A) by striking ‘‘there is’’ and inserting

25 ‘‘there are’’; and
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1 (B) by striking ‘‘$4,000,000 for fiscal year

2 1993’’ and inserting ‘‘$1,100,000 for fiscal year

3 1994, and such sums as may be necessary for

4 each of the fiscal years 1995 and 1996’’.

5 SEC. 305. CENTERS OF EXCELLENCE.

6 Section 739 (42 U.S.C. 293c) is amended—

7 (1) in subsection (b)—

8 (A) in paragraph (2), by inserting before

9 the semicolon the following: ‘‘through collabora10 tion with public and nonprofit private entities

11 to carry out community-based programs to pre12 pare students in secondary schools and institu13 tions of higher education for attendance at the

14 health professions school’’;

15 (B) in paragraph (4), by striking ‘‘and’’ at

16 the end thereof;

17 (C) in paragraph (5), by striking the pe18 riod and inserting ‘‘; and’’; and

19 (D) by adding at the end thereof the fol20 lowing new paragraph:

21 ‘‘(6) to train the students of the school at com22 munity-based health facilities that provide health

23 services to a significant number of minority individ24 uals and that are located at a site remote from the

25 main site of the teaching facilities of the school.’’;
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1 (2) in subsection (e)—

2 (A) by striking the subsection heading and

3 inserting ‘‘AUTHORITY REGARDING CONSOR4 TIA.—’’;

5 (B) by striking paragraph (1) and insert6 ing the following new paragraph:

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

8 grant under subsection (a) to any school of medi9 cine, osteopathic medicine, dentistry, clinical psy10 chology, or pharmacy that has in accordance with

11 paragraph (2) formed a consortium of schools.’’;

12 (C) in paragraph (2), by striking subpara13 graphs (A) through (D) and inserting the fol14 lowing new subparagraphs:

15 ‘‘(A) the consortium consists of—

16 ‘‘(i) the health professions school

17 seeking the grant under subsection (a);

18 and

19 ‘‘(ii) one or more schools of medicine,

20 osteopathic medicine, dentistry, pharmacy,

21 nursing, allied health, or public health, or

22 graduate programs in mental health prac23 tice;
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1 ‘‘(B) the schools of the consortium have

2 entered into an agreement for the allocation of

3 such grant among the schools; and

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

5 the grant in accordance with this section.’’; and

6 (D) by adding at the end the following

7 paragraph:

8 ‘‘(3) AUTHORITY FOR COLLECTIVELY MEETING

9 RELEVANT REQUIREMENTS IN CERTAIN CASES.—

10 With respect to meeting the conditions specified in

11 subsection (c)(4) for Native American Centers of

12 Excellence, the Secretary may make a grant to any

13 school that has in accordance with paragraphs (1)

14 and (2) formed a consortium of schools that meets

15 such conditions (without regard to whether the

16 schools of the consortium individually meet such

17 conditions).’’; and

18 (3) in subsection (i)—

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

20 sums as may be necessary for fiscal year 1993’’

21 and inserting ‘‘$25,000,000 for fiscal year

22 1994, and such sums as may be necessary for

23 each of the fiscal years 1995 and 1996’’; and

24 (B) in paragraph (2)(C) by adding at the

25 end the following: ‘‘Health professions schools
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1 described in subsection (c)(2)(A) shall be eligi2 ble for grants under this subparagraph in a fis3 cal year if the amount appropriated for the fis4 cal year under paragraph (1) is greater than

5 $23,500,000. Such schools shall be eligible to

6 apply only for grants made from the portion of

7 such amount that exceeds $23,500,000.’’.

8 SEC. 306. EDUCATIONAL ASSISTANCE REGARDING UNDER9 GRADUATES.

10 Section 740 (42 U.S.C. 293d) is amended—

11 (1) in subsection (a)(1), by adding at the end

12 the following new sentence: ‘‘To be eligible for such

13 a grant, a school shall have in place a program to

14 assist individuals from disadvantaged backgrounds

15 in gaining entry into a health professions school or

16 completing the course of study at such a school.’’;

17 (2) in subsection (d)(1)—

18 (A) by striking ‘‘there is’’ and inserting

19 ‘‘there are’’; and

20 (B) by striking ‘‘1993’’ and inserting

21 ‘‘1994, and such sums as may be necessary for

22 each of the fiscal years 1995 and 1996’’.

23 (3) in subsection (d)(2)(B), by adding at the

24 end thereof the following new sentence: ‘‘Scholarship
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1 recipients under this section shall be known as

2 ‘Cesar Chavez Primary Care Scholars’.’’.

3 SEC. 307. AREA HEALTH EDUCATION CENTERS.

4 Section 746(d)(2)(D) (42 U.S.C. 293j(d)(2)(D)) is

5 amended by inserting ‘‘and minority health’’ after ‘‘dis6 ease prevention’’.

7 TITLE IV—RESEARCH AND DATA

8 COLLECTION

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

10 Section 404 (42 U.S.C. 283b), as added by section

11 151 of Public Law 103–43, is amended by adding at the

12 end the following subsections:

13 ‘‘(c) PLAN.—The Director of the Office, shall collabo14 rate with the Deputy Assistant Secretary for Minority

15 Health (as provided for in section 1707), to develop and

16 implement a plan for carrying out the duties required by

17 subsection (b). The Director, in consultation with the Dep18 uty Assistant Secretary for Minority Health, shall review

19 the plan not less often than annually, and revise the plan

20 as appropriate.

21 ‘‘(d) EQUITY REGARDING VARIOUS GROUPS.—The

22 Director of the Office shall ensure that activities under

23 subsection (b) address equitably all minority groups.

24 ‘‘(e) ADVISORY COMMITTEE.—
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1 ‘‘(1) ESTABLISHMENT.—In carrying out sub2 section (b), the Secretary shall establish an advisory

3 committee to be known as the Advisory Committee

4 on Research on Minority Health (in this subsection

5 referred to as the ‘Advisory Committee’).

6 ‘‘(2) COMPOSITION.—

7 ‘‘(A) VOTING AND NONVOTING MEM8 BERS.—The Advisory Committee shall be com9 posed of voting members appointed in accord10 ance with subparagraph (B) and the ex officio

11 nonvoting members described in subparagraph

12 (C).

13 ‘‘(B) VOTING MEMBERS.—The Advisory

14 Committee shall include not fewer than 12, and

15 not more than 18, voting members who are not

16 officers or employees of the Federal Govern17 ment. The Director of the Office shall appoint

18 such members to the Advisory Committee from

19 among physicians, practitioners, scientists, con20 sumers and other health professionals, whose

21 clinical practices, research specialization, or

22 professional expertise includes a significant

23 focus on research on minority health or on the

24 barriers that minorities must overcome to par25 ticipate in clinical trials. The membership of the
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1 Advisory Committee shall be equitably rep2 resentative of the minority groups served by the

3 Office.

4 ‘‘(C) EX OFFICIO NONVOTING MEMBERS.—

5 The Deputy Assistant Secretary for Minority

6 Health and the Directors of each of the na7 tional research entities shall serve as ex officio

8 nonvoting members of the Advisory Committee

9 (except that any of such Directors may des10 ignate an official of the institute involved to

11 serve as such member of the Committee in lieu

12 of the Director).

13 ‘‘(3) CHAIRPERSON.—The Director of the Of14 fice shall serve as the chairperson of the Advisory

15 Committee.

16 ‘‘(4) DUTIES.—The Advisory Committee

17 shall—

18 ‘‘(A) advise the Director of the Office on

19 appropriate research activities to be undertaken

20 by the national research institutes with respect

21 to—

22 ‘‘(i) research on minority health;

23 ‘‘(ii) research on racial and ethnic dif24 ferences in clinical drug trials, including

25 responses to pharmacological drugs;
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1 ‘‘(iii) research on racial and ethnic

2 differences in disease etiology, course, and

3 treatment; and

4 ‘‘(iv) research on minority health con5 ditions which require a multidisciplinary

6 approach;

7 ‘‘(B) report to the Director of the Office

8 on such research;

9 ‘‘(C) provide recommendations to such Di10 rector regarding activities of the Office (includ11 ing recommendations on priorities in carrying

12 out research described in subparagraph (A));

13 and

14 ‘‘(D) assist in monitoring compliance with

15 section 492B regarding the inclusion of minori16 ties in clinical research.

17 ‘‘(5) BIENNIAL REPORT.—

18 ‘‘(A) PREPARATION.—The Advisory Com19 mittee shall prepare a biennial report describing

20 the activities of the Committee, including find21 ings made by the Committee regarding—

22 ‘‘(i) compliance with section 492B;

23 ‘‘(ii) the extent of expenditures made

24 for research on minority health by the
36

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1 agencies of the National Institutes of

2 Health; and

3 ‘‘(iii) the level of funding needed for

4 such research.

5 ‘‘(B) SUBMISSION.—The report required in

6 subparagraph (A) shall be submitted to the Di7 rector of the National Institutes of Health for

8 inclusion in the report required in section 403.

9 ‘‘(f) REPRESENTATIVES OF MINORITIES AMONG RE10 SEARCHERS.—The Secretary, acting through the Assist11 ant Secretary for Personnel Administration and in collabo12 ration with the Director of the Office, shall determine the

13 extent to which minorities are represented among senior

14 physicians and scientists of the national research insti15 tutes and among physicians and scientists conducting re16 search with funds provided by such institutes, and as ap17 propriate, carry out activities to increase the extent of

18 such representation.

19 ‘‘(g) DEFINITIONS.—For purposes of this part:

20 ‘‘(1) MINORITY HEALTH CONDITIONS.—The

21 term ‘minority health conditions’, with respect to in22 dividuals who are members of minority groups,

23 means all diseases, disorders, and conditions (includ24 ing with respect to mental health)—
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1 ‘‘(A) unique to, more serious, or more

2 prevalent in such individuals;

3 ‘‘(B) for which the factors of medical risk

4 or types of medical intervention are different

5 for such individuals, or for which it is unknown

6 whether such factors or types are different for

7 such individuals; or

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

9 insufficient research involving such individuals

10 as subjects or insufficient data on such individ11 uals.

12 ‘‘(2) RESEARCH ON MINORITY HEALTH.—The

13 term ‘research on minority health’ means research

14 on minority health conditions, including research on

15 preventing such conditions.

16 ‘‘(3) MINORITY GROUPS.—The term ‘minority

17 groups’ means Blacks, American Indians, Alaskan

18 Natives, Asian/Pacific Islanders, and Hispanics, in19 cluding subpopulations of such groups.’’.

20 SEC. 402. ACTIVITIES OF AGENCY FOR HEALTH CARE POL21 ICY AND RESEARCH.

22 Section 902(b) (42 U.S.C. 299a(b)) is amended to

23 read as follows:

24 ‘‘(b) REQUIREMENTS WITH RESPECT TO CERTAIN

25 POPULATIONS.—In carrying out subsection (a), the Ad-
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1 ministrator shall undertake and support research, dem2 onstration projects, and evaluations with respect to the

3 health status of, and the delivery of health care to—

4 ‘‘(1) the populations of medically underserved

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

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

7 the elderly.’’.

8 SEC. 403. DATA COLLECTION BY NATIONAL CENTER FOR

9 HEALTH STATISTICS.

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

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

12 of Public Law 103–183 (107 Stat. 2237), is amended to

13 read as follows:

14 ‘‘(n)(1) For health statistical and epidemiological ac15 tivities undertaken or supported under this section, there

16 are authorized to be appropriated such sums as may be

17 necessary for each of the fiscal years 1995 through 1998.

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

19 (1) for a fiscal year, the Secretary shall obligate not more

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

21 (h), (l), and (m) with respect to particular racial and eth22 nic population groups, except that not more than

23 $100,000 may be expended in the aggregate for the ad24 ministration of activities under subsection (m) and for ac25 tivities described in paragraph (2) of such subsection.’’.
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1 TITLE V—MISCELLANEOUS

2 SEC. 501. REVISION AND EXTENSION OF PROGRAM FOR

3 STATE OFFICES OF RURAL HEALTH.

4 (a) MATCHING FUNDS.—Section 338J(b) (42 U.S.C.

5 254r(b)) is amended to read as follows:

6 ‘‘(b) REQUIREMENT OF MATCHING FUNDS.—

7 ‘‘(1) IN GENERAL.—With respect to the costs to

8 be incurred by a State in carrying out the purpose

9 described in subsection (a), the Secretary may not

10 make a grant under such subsection unless the State

11 agrees to provide non-Federal contributions toward

12 such costs, in cash, in an amount that is not less

13 than $1 for each $1 of Federal funds provided in the

14 grant.

15 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB16 UTED.—In determining the amount of non-Federal

17 contributions in cash that a State has provided pur18 suant to paragraph (1), the Secretary may not in19 clude any amounts provided to the State by the Fed20 eral Government.’’.

21 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

22 338J(j)(1) (42 U.S.C. 254r(j)(1)) is amended—

23 (1) by striking ‘‘and’’ after ‘‘1992,’’; and
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1 (2) by inserting before the period the following:

2 ‘‘, and $5,000,000 for each of the fiscal years 1994

3 through 1996’’.

4 (c) TERMINATION OF PROGRAM.—Section 338J(k)

5 (42 U.S.C. 254r(k)) is amended by striking $10,000,000’’

6 and inserting ‘‘$20,000,000’’.

7 SEC. 502. TECHNICAL CORRECTIONS RELATING TO HEALTH

8 PROFESSIONS.

9 (a) HEALTH EDUCATION ASSISTANCE LOAN

10 DEFERMENT FOR BORROWERS PROVIDING HEALTH

11 SERVICES TO INDIANS.—

12 (1) IN GENERAL.—Section 705(a)(2)(C) is

13 amended by striking ‘‘and (x)’’ and inserting ‘‘(x)

14 not in excess of three years, during which the bor15 rower is providing health care services to Indians

16 through an Indian health program (as defined in

17 section 108(a)(2)(A) of the Indian Health Care Im18 provement Act (25 U.S.C. 1616a(a)(2)(A)); and

19 (xi)’’.

20 (2) CONFORMING AMENDMENTS.—Section

21 705(a)(2)(C) is further amended—

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

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

24 (B) in the matter following such clause

25 (xi), by striking ‘‘(x)’’ and inserting ‘‘(xi)’’.
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1 (3) EFFECTIVE DATE.—The amendments made

2 by this subsection shall apply with respect to serv3 ices provided on or after the first day of the third

4 month that begins after the date of enactment of

5 this Act.

6 (b) MAXIMUM STUDENT LOAN PROVISION.—

7 (1) IN GENERAL.—Section 722(a)(1) (42

8 U.S.C. 292r(a)(1)), as amended by section

9 2014(b)(1) of Public Law 103–43, is amended by

10 striking ‘‘the sum of’’ and all that follows through

11 the end thereof and inserting ‘‘the cost of attend12 ance (including tuition, other reasonable educational

13 expenses, and reasonable living costs) for that year

14 at the educational institution attended by the stu15 dent (as determined by such educational institu16 tion).’’.

17 (2) THIRD AND FOURTH YEARS.—Section

18 722(a)(2) (42 U.S.C. 292r(a)(2)), as amended by

19 section 2014(b)(1) of Public Law 103–43, is amend20 ed by striking ‘‘the amount $2,500’’ and all that fol21 lows through ‘‘including such $2,500’’ and inserting

22 ‘‘the amount of the loan may, in the case of the

23 third or fourth year of a student at school of medi24 cine or osteopathic medicine, be increased to the ex25 tent necessary’’.
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1 (c) REQUIREMENT FOR SCHOOLS.—Section

2 723(b)(1) (42 U.S.C. 292s(b)(1)), as amended by section

3 2014(c)(2)(A)(ii) of Public Law 103-43 (107 Stat. 216),

4 is amended by striking ‘‘3 years before’’ and inserting ‘‘4

5 years before’’.

6 (d) SERVICE REQUIREMENT FOR PRIMARY CARE

7 LOAN BORROWERS.—Section 723(a) (42 U.S.C. 292s(a))

8 is amended in subparagraph (B) of paragraph (1), by

9 striking ‘‘through the date on which the loan is repaid in

10 full’’ and inserting ‘‘for 5 years after completing the resi11 dency program’’.

12 (e) PREFERENCE AND REQUIRED INFORMATION IN

13 CERTAIN PROGRAMS.—

14 (1) TITLE VII.—Section 791 (42 U.S.C. 295j)

15 is amended by adding at the end thereof the follow16 ing subsection:

17 ‘‘(d) EXCEPTIONS.—

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

19 compete equitably for funding under this section,

20 those new programs that meet the criteria described

21 in paragraph (3) shall qualify for a funding pref22 erence under this section.

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

24 the term ‘new program’ means any program that

25 has graduated less than three classes. Upon grad-
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1 uating at least three classes, a program shall have

2 the capability to provide the information necessary

3 to qualify the program for the general funding pref4 erences described in subsection (a).

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

6 paragraph (1) are the following:

7 ‘‘(A) The mission statement of the pro8 gram identifies a specific purpose of the pro9 gram as being the preparation of health profes10 sionals to serve underserved populations.

11 ‘‘(B) The curriculum of the program in12 cludes content which will help to prepare practi13 tioners to serve underserved populations.

14 ‘‘(C) Substantial clinical training experi15 ence is required under the program in medically

16 underserved communities.

17 ‘‘(D) A minimum of 20 percent of the fac18 ulty of the program spend at least 50 percent

19 of their time providing or supervising care in

20 medically underserved communities.

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

22 portion of the program is physically located in

23 a medically underserved community.

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

25 service in medically underserved communities
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1 following graduation, is available to the stu2 dents in the program.

3 ‘‘(G) The program provides a placement

4 mechanism for deploying graduates to medically

5 underserved communities.’’.

6 (2) TITLE VIII.—Section 860 (42 U.S.C. 298b7 7) is amended by adding at the end thereof the fol8 lowing subsection:

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-
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1 gram as being the preparation of health profes2 sionals to 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 (f) DEFINITIONS.—Section 799(6) (42 U.S.C.

24 295p(6)) is amended—
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1 (1) in subparagraph (B) by striking ‘‘; or’’ at

2 the end thereof;

3 (2) in subparagraph (C) by striking the period

4 and inserting a semicolon; and

5 (3) by adding at the end thereof the following:

6 ‘‘(D) ambulatory practice sites designated

7 by State Governors as shortage areas or medi8 cally underserved communities for purposes of

9 State scholarships or loan repayment or related

10 programs; or

11 ‘‘(E) practices or facilities in which not

12 less than 50 percent of the patients are recipi13 ents of aid under title XIX of the Social Secu14 rity Act or eligible and uninsured.’’.

15 (g) GENERALLY APPLICABLE MODIFICATIONS RE16 GARDING OBLIGATED SERVICE.—

17 (1) IN GENERAL.—Section 795(a)(2) (42

18 U.S.C. 295n(a)(2)), is amended—

19 (A) in subparagraph (A), by striking ‘‘spe20 ciality in’’ and inserting ‘‘field of’’; and

21 (B) in subparagraph (B), by striking ‘‘spe22 ciality’’ and inserting ‘‘field’’; and

23 (2) EFFECTIVE DATE.—Each amendment made

24 by paragraph (1) shall take effect as if such sub25 section had been enacted immediately after the en-
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1 actment of the Health Professions Education Exten2 sion Amendments of 1992.

3 (h) RECOVERY.—Part G of title VII (42 U.S.C. 295j

4 et seq.) is amended by inserting after section 795, the fol5 lowing new section:

6 ‘‘SEC. 796. RECOVERY.

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

8 (or within such shorter period as the Secretary may pre9 scribe by regulation for an interim facility) after the com10 pletion of construction of a facility with respect to which

11 funds have been paid under section 720(a) (as such sec12 tion existed one day prior to the date of enactment of the

13 Health Professions Education Extension Amendments of

14 1992 (Public Law 102–408)—

15 ‘‘(1)(A) in case of a facility which was an affili16 ated hospital or outpatient facility with respect to

17 which funds have been paid under such section

18 720(a)(1), the owner of the facility ceases to be a

19 public or other nonprofit agency that would have

20 been qualified to file an application under section

21 605;

22 ‘‘(B) in case of a facility which was not an af23 filiated hospital or outpatient facility but was a facil24 ity with respect to which funds have been paid under

25 paragraph (1) or (3) of such section 720(a), the
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1 owner of the facility ceases to be a public or non2 profit school, or

3 ‘‘(C) in case of a facility which was a facility

4 with respect to which funds have been paid under

5 such section 720(a)(2), the owner of the facility

6 ceases to be a public or nonprofit entity,

7 ‘‘(2) the facility ceases to be used for the teach8 ing or training purposes (or other purposes per9 mitted under section 722 (as such section existed

10 one day prior to the date of enactment of the Health

11 Professions Education Extension Amendments of

12 1992 (Public Law 102–408)) for which it was con13 structed, or

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

15 or as a place for religious worship,

16 the United States shall be entitled to recover from the

17 owner of the facility the base amount prescribed by sub18 section (c)(1) plus the interest (if any) prescribed by sub19 section (c)(2).

20 ‘‘(b) NOTICE.—The owner of a facility which ceases

21 to be a public or nonprofit agency, school, or entity as

22 described in subparagraph (A), (B), or (C) of subsection

23 (a)(1), as the case may be, or the owner of a facility the

24 use of which changes as described in paragraph (2) or (3)

25 of subsection (a), shall provide the Secretary written no-
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1 tice of such cessation or change of use within 10 days after

2 the date on which such cessation or change of use occurs

3 or within 30 days after the date of enactment of this sub4 section, whichever is later.

5 ‘‘(c) AMOUNT.—

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

7 the United States is entitled to recover under sub8 section (a) is the amount bearing the same ratio to

9 the then value (as determined by the agreement of

10 the parties or in an action brought in the district

11 court of the United States for the district in which

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

13 of the Federal participation bore to the cost of con14 struction.

15 ‘‘(2) INTEREST.—

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

17 United States is entitled to recover under sub18 section (a) is the interest for the period (if any)

19 described in subparagraph (B) at a rate (deter20 mined by the Secretary) based on the average

21 of the bond equivalent rates of ninety-one-day

22 Treasury bills auctioned during that period.

23 ‘‘(B) PERIOD.—The period referred to in

24 subparagraph (A) is the period beginning—
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1 ‘‘(i) if notice is provided as prescribed

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

3 on which the owner of the facility ceases to

4 be a public or nonprofit agency, school, or

5 entity as described in subparagraph (A),

6 (B), or (C) of subsection (a)(1), as the

7 case may be, or 191 days after the date on

8 which the use of the facility changes as de9 scribed in paragraph (2) or (3) of sub10 section (a), or

11 ‘‘(ii) if notice is not provided as pre12 scribed by subsection (b), 11 days after the

13 date on which such cessation or change of

14 use occurs,

15 and ending on the date the amount the United

16 States is entitled to recover is collected.

17 ‘‘(d) WAIVER.—The Secretary may waive the recov18 ery rights of the United States under subsection (a)(2)

19 with respect to a facility (under such conditions as the

20 Secretary may establish by regulation) if the Secretary de21 termines that there is good cause for waiving such rights.

22 ‘‘(e) LIEN.—The right of recovery of the United

23 States under subsection (a) shall not, prior to judgment,

24 constitute a lien on any facility.’’.
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1 SEC. 503. CLINICAL TRAINEESHIPS.

2 Section 303(d)(1) (42 U.S.C. 242a(d)(1)) is amended

3 by inserting ‘‘counseling’’ after ‘‘family therapy,’’.

4 SEC. 504. DEMONSTRATION PROJECT GRANTS TO STATES

5 FOR ALZHEIMER’S DISEASE.

6 (a) IN GENERAL.—Section 398(a) (42 U.S.C. 280c–

7 3(a)) is amended—

8 (1) in the matter preceding paragraph (1), by

9 striking ‘‘not less than 5, and not more than 15,’’;

10 (2) in paragraph (2)—

11 (A) by inserting after ‘‘disorders’’ the fol12 lowing: ‘‘who are living in single family homes

13 or in congregate settings’’; and

14 (B) by striking ‘‘and’’ at the end;

15 (3) by redesignating paragraph (3) as para16 graph (4); and

17 (4) by inserting after paragraph (2) the follow18 ing:

19 ‘‘(3) to improve access for individuals with Alz20 heimer’s disease or related disorders, particularly

21 such individuals from ethnic, cultural, or language

22 minorities and such individuals who are living in iso23 lated rural areas, to services that—

24 ‘‘(A) are home-based or community-based

25 long-term care services; and
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1 ‘‘(B) exist on the date of enactment of this

2 paragraph; and’’.

3 (b) DURATION.—Section 398A (42 U.S.C. 280c–4)

4 is amended—

5 (1) in the title, by striking ‘‘LIMITATION

6 ON’’;

7 (2) in subsection (a)—

8 (A) in the heading, by striking ‘‘LIMITA9 TION ON’’; and

10 (B) by striking ‘‘may not exceed’’ and in11 serting ‘‘may exceed’’; and

12 (3) in subsection (b), in paragraphs (1)(C) and

13 (2)(C), by inserting ‘‘, and any subsequent year,’’

14 after ‘‘third year’’.

15 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

16 398B(e) (42 U.S.C. 280c–5(e)) is amended by striking

17 ‘‘and 1993’’ and inserting ‘‘through 1998’’.

18 SEC. 505. MEDICALLY UNDERSERVED AREA STUDY.

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

20 Human Services shall conduct a study concerning the fea21 sibility and desirability of, and the criteria to be used for,

22 combining the designations of ‘‘health professional short23 age area’’ and ‘‘medically underserved area’’ into a single

24 health professional shortage area designation.
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1 (b) REQUIREMENTS.—As part of the study conducted

2 under subsection (a), the Secretary of Health and Human

3 Services, in considering the statutory and regulatory re4 quirements necessary for the creation of a single health

5 professional shortage area designation, shall—

6 (1) review and report on the application of cur7 rent statutory and regulatory criteria used—

8 (A) in designating an area as a health pro9 fessional shortage area;

10 (B) in designating an area as a medically

11 underserved area; and

12 (C) by a State in the determination of the

13 health professional shortage area designations

14 of such State; and

15 (2) review the suggestions of public health and

16 primary care experts.

17 (c) REPORT.—Not later than 1 year after the date

18 of enactment of this Act, the Secretary of Health and

19 Human Services shall prepare and submit to the appro20 priate committees of Congress a report concerning the

21 findings of the study conducted under subsection (a) to22 gether with the recommendations of the Secretary.

23 (d) RECOMMENDATIONS.—In making recommenda24 tions under subsection (c), the Secretary of Health and

25 Human Services shall give special consideration to (and
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1 describe in the report) the unique impact of designation

2 criteria on different rural and urban populations, and eth3 nic and racial minorities, including—

4 (1) rational service areas, and their application

5 to frontier areas and inner-city communities;

6 (2) indicators of high medical need, including

7 fertility rates, infant mortality rates, pediatric popu8 lation, elderly population, poverty rates, and physi9 cian to population ratios; and

10 (3) indicators of insufficient service capacity,

11 including language proficiency criteria for ethnic

12 populations, annual patient visits per physician,

13 waiting times for appointments, waiting times in a

14 primary care physician office, excessive use of emer15 gency facilities, low annual office visit rate, and de16 mand on physicians in contiguous rural or urban

17 areas.

18 SEC. 506. PROGRAMS REGARDING BIRTH DEFECTS.

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

20 U.S.C. 247b–4), as added by section 306 of Public Law

21 102–531 (106 Stat. 3494), is amended to read as follows:

22 ‘‘PROGRAMS REGARDING BIRTH DEFECTS

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

24 Director of the Centers for Disease Control and Preven25 tion, shall carry out programs—
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1 ‘‘(1) to collect, analyze, and make available data

2 on birth defects, including data on the causes of

3 such defects and on the incidence and prevalence of

4 such defects;

5 ‘‘(2) to provide information and education to

6 the public on the prevention of such defects;

7 ‘‘(3) to operate centers for the conduct of ap8 plied epidemiologic research and study of such de9 fects, and to improve the education, training, and

10 clinical skills of health professionals with respect to

11 the prevention of such defects; and

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

13 prevention of such defects.

14 ‘‘(b) NATIONAL CLEARINGHOUSE.—In carrying out

15 subsection (a)(1), the Secretary shall establish and main16 tain a National Information Clearinghouse on Birth De17 fects to collect and disseminate to health professionals and

18 the general public information on birth defects, including

19 the prevention of such defects.

20 ‘‘(c) GRANTS AND CONTRACTS.—

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

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

23 into contracts with public and nonprofit private enti24 ties. Recipients of assistance under this subsection
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1 shall collect and analyze demographic data utilizing

2 appropriate sources as determined by the Secretary.

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

4 AWARD FUNDS.—

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

6 award of a grant or contract under paragraph

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

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

9 for the purpose of aiding the recipient in carry10 ing out the purposes for which the award is

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

12 recipient any officer or employee of the Depart13 ment of Health and Human Services.

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

15 in subparagraph (A), the Secretary shall reduce

16 the amount of payments under the award in17 volved by an amount equal to the costs of de18 tailing personnel and the fair market value of

19 any supplies, equipment, or services provided by

20 the Secretary. The Secretary shall, for the pay21 ment of expenses incurred in complying with

22 such request, expend the amounts withheld.

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

24 may make an award of a grant or contract under

25 paragraph (1) only if an application for the award
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1 is submitted to the Secretary and the application is

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

3 such agreements, assurances, and information as the

4 Secretary determines to be necessary to carry out

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

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

7 1 of fiscal year 1995 and of every second such year there8 after, the Secretary shall submit to the Committee on En9 ergy and Commerce of the House of Representatives, and

10 the Committee on Labor and Human Resources of the

11 Senate, a report that, with respect to the preceding 2 fis12 cal years—

13 ‘‘(1) contains information regarding the inci14 dence and prevalence of birth defects and the extent

15 to which birth defects have contributed to the inci16 dence and prevalence of infant mortality;

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

18 that is specific to various racial and ethnic groups;

19 and

20 ‘‘(3) contains an assessment of the extent to

21 which each approach to preventing birth defects has

22 been effective, including a description of effective23 ness in relation to cost;

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

25 this section; and
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1 ‘‘(5) contains any recommendations of the Sec2 retary regarding this section.

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

4 purpose of carrying out this section, there are authorized

5 to be appropriated such sums as may be necessary for

6 each of the fiscal years 1994 through 1997.’’.

7 SEC. 507. DEMONSTRATION PROJECTS REGARDING DIA8 BETIC-RETINOPATHY.

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

10 Human Services, acting through the Director of the Na11 tional Eye Institute and in consultation with the Director

12 of the Centers for Disease Control and Prevention, may

13 make grants to public and nonprofit private entities for

14 demonstration projects to serve the populations specified

15 in subsection (b) by carrying out, with respect to the eye

16 disorder known as diabetic retinopathy, all activities re17 garding information, dissemination, early detection, edu18 cation, and prevention.

19 (b) RELEVANT POPULATIONS.—The populations re20 ferred to in subsection (a) are minority populations that

21 have diabetes mellitus.

22 (c) AUTHORIZATION OF APPROPRIATIONS.—For the

23 purpose of carrying out this section, there is authorized

24 to be appropriated $1,000,000 for each of the fiscal years

25 1995 through 1997.
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1 SEC. 508. MEXICAN BORDER STATE ANALYTICAL LABORA2 TORIES.

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

4 Human Services, acting through the Director of the Cen5 ters for Disease Control and Prevention, may make grants

6 to eligible entities to establish and operate State labora7 tories to analyze human, wildlife, air, water, and soil sam8 ples. The laboratories shall serve the border region.

9 (b) ELIGIBLE ENTITY.—To be eligible to receive a

10 grant under subsection (a), an entity shall be a State that

11 borders Mexico.

12 (c) APPLICATIONS REQUIREMENTS.—No grant may

13 be made under subsection (a) unless an application has

14 been submitted to and approved by the Secretary of

15 Health and Human Services.

16 (d) AUTHORIZATION OF APPROPRIATIONS.—For the

17 purpose of carrying out subsection (a), there are author18 ized to be appropriated such sums as may be necessary

19 for each of the fiscal years 1995 through 1997.

20 SEC. 509. CONSTRUCTION OF REGIONAL CENTERS FOR RE21 SEARCH ON PRIMATES.

22 Section 481B of the Public Health Service Act (42

23 U.S.C. 287a-3), as added by section 1503 of Public Law

24 103–43 (107 Stat. 178), is amended to read as follows:
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1 ‘‘CONSTRUCTION OF REGIONAL CENTERS FOR RESEARCH

2 ON PRIMATES

3 ‘‘SEC. 481B. With respect to activities carried out by

4 the National Center for Research Resources to support re5 gional centers for research on primates, the Director of

6 NIH may, for each of the fiscal years 1994 through 1996,

7 reserve from the amounts appropriated under section

8 481A(h) not more than $3,000,000 for the purpose of

9 making awards of grants and contracts to public and non10 profit private entities to construct, renovate, or otherwise

11 improve such regional centers. The reservation of such

12 amounts for any fiscal year is subject to the availability

13 of qualified applicants for such awards.’’.

14 TITLE VI—MULTIETHNIC

15 PLACEMENT

16 SEC. 601. SHORT TITLE.

17 This title may be cited as the ‘‘Multiethnic Placement

18 Act of 1994’’.

19 SEC. 602. FINDINGS AND PURPOSE.

20 (a) FINDINGS.—Congress finds that—

21 (1) nearly 500,000 children are in foster care in

22 the United States;

23 (2) tens of thousands of children in foster care

24 are waiting for adoption;
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1 (3) 2 years and 8 months is the median length

2 of time that children wait to be adopted;

3 (4) child welfare agencies should work to elimi4 nate racial, ethnic, and national origin discrimina5 tion and bias in adoption and foster care recruit6 ment, selection, and placement procedures; and

7 (5) active, creative, and diligent efforts are

8 needed to recruit parents, from every race and cul9 ture, for children needing foster care or adoptive

10 parents.

11 (b) PURPOSE.—It is the purpose of this Act to de12 crease the length of time that children wait to be adopted

13 and to prevent discrimination in the placement of children

14 on the basis of race, color, or national origin.

15 SEC. 603. MULTIETHNIC PLACEMENTS.

16 (a) ACTIVITIES.—

17 (1) PROHIBITION.—An agency, or entity, that

18 receives Federal assistance and is involved in adop19 tion or foster care placements may not—

20 (A) categorically deny to any person the

21 opportunity to become an adoptive or a foster

22 parent, solely on the basis of the race, color, or

23 national origin of the adoptive or foster parent,

24 or the child, involved; or
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1 (B) delay or deny the placement of a child

2 for adoption or into foster care, or otherwise

3 discriminate in making a placement decision,

4 solely on the basis of the race, color, or national

5 origin of the adoptive or foster parent, or the

6 child, involved.

7 (2) PERMISSIBLE CONSIDERATION.—An agency

8 or entity to which paragraph (1) applies may con9 sider the race, color, or national origin of a child as

10 a factor in making a placement decision if such fac11 tor is relevant to the best interests of the child in12 volved and is considered in conjunction with other

13 factors.

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

15 the term ‘‘placement decision’’ means the decision to

16 place, or to delay or deny the placement of, a child

17 in a foster care or an adoptive home, and includes

18 the decision of the agency or entity involved to seek

19 the termination of birth parent rights or otherwise

20 make a child legally available for adoptive place21 ment.

22 (b) LIMITATION.—The Secretary of Health and

23 Human Services shall not provide placement and adminis24 trative funds under section 474(a)(3) of the Social Secu25 rity Act (42 U.S.C. 674(a)(3)) to an agency or entity de-
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1 scribed in subsection (a) that is not in compliance with

2 subsection (a).

3 (c) EQUITABLE RELIEF.—Any individual who is ag4 grieved by an action in violation of subsection (a), taken

5 by an agency or entity described in subsection (a), shall

6 have the right to bring an action seeking relief in a United

7 States district court of appropriate jurisdiction.

8 (d) CONSTRUCTION.—Nothing in this section shall be

9 construed to affect the application of the Indian Child

10 Welfare Act of 1978 (25 U.S.C. 1901 et seq.).

11 TITLE VII—VOLUNTARY MUTUAL

12 REUNIONS

13 SEC. 701. FACILITATION OF REUNIONS.

14 The Secretary of Health and Human Services, in the

15 discretion of the Secretary and at no net expense to the

16 Federal Government, may use the facilities of the Depart17 ment of Health and Human Services to facilitate the vol18 untary, mutually requested reunion of an adult adopted

19 child who is 21 or older with—

20 (1) any birth parent of the adult child; or

21 (2) any adult adopted sibling, who is 21 or

22 older, of the adult child,

23 if all such persons involved in any such reunion have, on

24 their own initiative, expressed a desire for a reunion.
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1 TITLE VIII—GENERAL

2 PROVISIONS

3 SEC. 801. EFFECTIVE DATE.

4 This Act and the amendments made by this Act shall

5 take effect October 1, 1993, or upon the date of the enact6 ment of this Act, whichever occurs later.

Passed the Senate March 26 (legislative day, February 22), 1994.

Attest:

Secretary.
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