Calendar No. 327

103D CONGRESS

2D SESSION S. 1569

[Report No. 103–200]

A BILL

To amend the Public Health Service Act to estabNbackgrounds, and for other purposes. the health of individuals from disadvantaged lish, reauthorize and revise provisions to improve OVEMBER 20 (legislative day, NOVEMBER 2), 1993

Reported with an amendment
II

★(Star Print)

Calendar No. 327

103D CONGRESS

2D SESSION S. 1569

[Report No. 103–200]

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.

IN THE SENATE OF THE UNITED STATES

OCTOBER 19 (legislative day, OCTOBER 13), 1993

Mr. KENNEDY (for himself and Mr. HATCH) introduced the following bill;

which was read twice and referred to the Committee on Labor and

Human Resources

NOVEMBER 20 (legislative day, NOVEMBER 2), 1993

Reported by Mr. KENNEDY, with an amendment

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

A BILL

To amend the Public Health Service Act to 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,
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1 SECTION 1. SHORT TITLE; REFERENCE; TABLE OF CON2 TENTS.

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

4 ‘‘Preventive Health Services and Health Professions

5 Amendments Act of 1993’’.

6 (b) REFERENCE.—Except as otherwise expressly pro7 vided, whenever in this Act an amendment or a repeal is

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

9 a section or other provision, the reference shall be consid10 ered to be made to a section or other provision of the Pub11 lic Health Service Act (42 U.S.C. 201 et seq.).

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

13 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. Community scholarship programs.

Sec. 202. Health services for residents of public housing.

Sec. 203. Issuance of regulations regarding language as impediment to receipt

of services.

Sec. 204. Health services for Pacific Islanders.

TITLE III—HEALTH PROFESSIONS

Sec. 301. Loans for disadvantaged students.

Sec. 302. Cesar Chavez 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.
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TITLE IV—RESEARCH AND DATA COLLECTION

Sec. 401. Office of Research on Minority Health.

Sec. 402. National Center for Health Statistics.

Sec. 403. Activities of Agency for Health Care Policy and Research.

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.

Sec. 505. Medically underserved area study.

Sec. 506. Programs regarding birth defects.

TITLE VI—GENERAL PROVISIONS

Sec. 601. 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 Department of Health and Human Serv24 ices that relate to disease prevention, health pro25 motion, service delivery, and research concerning
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1 such individuals. The heads of the operating divi2 sions of the Department of Health and Human

3 Services and the heads of Public Health Service

4 agencies shall consult with the Deputy Assistant

5 Secretary for Minority Health to assist in the coordi6 nation of all activities within the Department as

7 they relate to disease prevention, health promotion,

8 service delivery, and research concerning such indi9 viduals.

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

11 by entering into interagency agreements with other

12 agencies of the public health service:

13 ‘‘(A) Support research, demonstrations and

14 evaluations to test new and innovative models.

15 ‘‘(B) Increase knowledge and understand16 ing of health risk factors.

17 ‘‘(C) Develop mechanisms that support

18 better information dissemination, education,

19 prevention, and service delivery to individuals

20 from disadvantaged backgrounds, including ra21 cial and ethnic minorities.

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

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

2 services, and education in the appropriate use

3 of health care.

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

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

6 problems relating to such matters.

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

10 for such technical assistance).

11 ‘‘(4) Establish a national center that shall carry

12 out programs to improve access to health care serv13 ices for individuals with limited English proficiency

14 by facilitating the removal of impediments to the re15 ceipt of health care that result from such limitation.

16 ‘‘(5) With respect to awards of grants and con17 tracts that are available under certain minority

18 health programs, establish a program—

19 ‘‘(A) to inform entities, as appropriate,

20 that the entities may be eligible for the awards;

21 ‘‘(B) to provide technical assistance to

22 such entities in the process of preparing and

23 submitting applications for the awards in ac24 cordance with the policies of the Secretary re25 garding such application; and
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1 ‘‘(C) to inform populations, as appropriate,

2 that members of the populations may be eligible

3 to receive services or otherwise participate in

4 the activities carried out with such awards.

5 ‘‘(c) ADVISORY COMMITTEE.—

6 ‘‘(1) IN GENERAL.—The Secretary shall estab7 lish an advisory committee to be known as the Advi8 sory Committee on Minority Health (in this sub9 section referred to as the ‘Committee’).

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

11 advice to the Secretary on carrying out this section,

12 including advice on the development of goals and

13 specific program activities under subsection (b)(1)

14 for each racial and ethnic group.

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

16 Secretary for Minority Health shall serve as the

17 Chairperson of the Committee.

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

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

20 18 individuals, who are not officers or employees of

21 the Federal Government. The Secretary shall ap22 point the members of the Committee from among in23 dividuals with expertise regarding issues of minority

24 health. The membership of the Committee shall be

25 equitably representative of the various racial and
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1 ethnic groups. The Secretary may appoint represent2 atives from selected Federal agencies to serve as ex

3 officio, non-voting members of the Committee.

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

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

6 Secretary shall initially appoint a portion of the

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

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

9 Committee, a new member shall be appointed by the

10 Secretary within 90 days from the date that the va11 cancy occurs, and serve for the remainder of the

12 term for which the predecessor of such member was

13 appointed. The vacancy shall not affect the power of

14 the remaining members to execute the duties of the

15 Committee.

16 ‘‘(7) COMPENSATION.—Members of the Com17 mittee who are officers or employees of the United

18 States shall serve without compensation. Members of

19 the Committee who are not officers or employees of

20 the United States shall receive, for each day (includ21 ing travel time) they are engaged in the performance

22 of the functions of the Committee, compensation at

23 rates that do not exceed the daily equivalent of the

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

25 Schedule under title 5, United States Code.
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1 ‘‘(d) CERTAIN REQUIREMENTS REGARDING DU2 TIES.—

3 ‘‘(1) RECOMMENDATIONS REGARDING LAN4 GUAGE AS IMPEDIMENT TO HEALTH CARE.—The

5 Secretary, acting through the Director of the Office

6 of Refugee Health, the Director of the Office of Civil

7 Rights, and the Director of the Office of Minority

8 Health of the Health Resources and Services Admin9 istration, shall make recommendations regarding ac10 tivities under subsection (b)(4).

11 ‘‘(2) EQUITABLE ALLOCATION REGARDING AC12 TIVITIES.—In awarding grants or contracts under

13 section 340A, 724, 737, 738, or 1707, the Secretary

14 shall ensure that such awards are equitably allocated

15 with respect to the various racial and ethnic popu16 lations.

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

18 The Secretary shall ensure that information and

19 services provided pursuant to subsection (b) are pro20 vided in the language and cultural context that is

21 most appropriate for the individuals for whom the

22 information and services are intended.

23 ‘‘(4) PEER REVIEW.—The Secretary shall en24 sure that each application for a grant, contract or
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1 cooperative agreement under section 340A, 724,

2 737, or 1707 undergoes appropriate peer review.

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

4 year 1995 and of each second year thereafter, the Sec5 retary shall submit to the Congress a report describing

6 the activities carried out under this section during the pre7 ceding 2 fiscal years and evaluating the extent to which

8 such activities have been effective in improving the health

9 of racial and ethnic minorities.

10 ‘‘(f) GRANTS AND CONTRACTS REGARDING DU11 TIES.—

12 ‘‘(1) AUTHORITY.—In carrying out subsection

13 (b), the Secretary may enter into contracts with

14 public and nonprofit private entities for activities de15 scribed in paragraphs (3) and (4) of subsection (b).

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

17 Secretary shall, directly or through contracts with

18 public and private entities, provide for evaluations of

19 projects carried out with financial assistance pro20 vided under paragraph (1) during the preceding 2

21 fiscal years. The report shall be included in the re22 port required under subsection (e) for the fiscal year

23 involved.

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

25 ‘racial and ethnic minority group’ means Hispanics,
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1 Blacks, Asian Americans, Pacific Islanders, Native Ameri2 cans, and Alaskan Natives. The term ‘Hispanic’ means in3 dividuals whose origin is Mexican, Puerto Rican, Cuban,

4 Central or South American, or any other Spanish-speak5 ing country, including Spain or the Caribbean Islands, and

6 individuals identifying themselves as Hispanic, Latino,

7 Spanish, or Spanish-American.

8 ‘‘(h) FUNDING.—

9 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

10 For the purpose of carrying out this section, there

11 is authorized to be appropriated $20,500,000 for fis12 cal year 1994, and such sums as may be necessary

13 for each of the fiscal years 1995 through 1998.

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

15 Of the amounts appropriated under paragraph (1)

16 for a fiscal year in excess of $15,000,000, the Sec17 retary shall make available not less than $3,000,000

18 for activities to improve access to health care serv19 ices for individuals with limited English proficiency,

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

21 SEC. 102. AGENCY OFFICES OF MINORITY HEALTH.

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

23 adding at the end the following new section:
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1 ‘‘SEC. 1709. AGENCY OFFICES OF MINORITY HEALTH.

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

3 the Deputy Assistant Secretary for Minority Health, shall

4 ensure that an Office of Minority Health is established

5 and operating at the Centers for Disease Control and Pre6 vention, the Health Resources and Services Administra7 tion, the Substance Abuse and Mental Health Administra8 tion, and the Agency for Health Care Policy and Research.

9 Such Offices shall be established to ensure that services

10 and programs carried out within each such respective

11 agency or office—

12 ‘‘(1) are equitably delivered with respect to ra13 cial and ethnic groups;

14 ‘‘(2) provide culturally competent services; and

15 ‘‘(3) utilize racial and ethnic minority commu16 nity-based organizations to deliver services.

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

18 within the Department of Health and Human Services

19 shall submit a report, not later than May 1 of each year,

20 to the Deputy Assistant Secretary for Minority Health (as

21 provided for in section 1707(a)) describing the accom22 plishments or programs of the plan, the budget allocation

23 and expenditures for, and the development and implemen24 tation of, such health programs targeting racial and ethnic

25 minority populations. The Secretary shall ensure the par-
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1 ticipation and cooperation of each Agency in the develop2 ment of the annual report.’’.

3 SEC. 103. STATE OFFICES OF MINORITY HEALTH.

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

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

6 following new section:

7 ‘‘SEC. 1710. GRANTS TO STATES FOR OPERATION OF OF8 FICES OF MINORITY HEALTH.

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

10 the Deputy Assistant Secretary for Minority Health (as

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

12 for the purpose of improving the health status in minority

13 communities, through the operation of State offices of mi14 nority health established to monitor and facilitate the

15 achievement of the Health Objectives for the Year 2000

16 as they affect minority populations.

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

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

19 unless such State agrees that the program carried out by

20 the State with amounts received under the grant will be

21 administered directly by a single State agency.

22 ‘‘(c) CERTAIN REQUIRED ACTIVITIES.—The Sec23 retary may not make a grant to a State under subsection

24 (a) unless such State agrees that activities carried out by
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1 an office operated under the grant received pursuant to

2 such subsection will—

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

4 clearinghouse for collecting and disseminating infor5 mation on—

6 ‘‘(A) minority health care issues;

7 ‘‘(B) research findings relating to minority

8 health care; and

9 ‘‘(C) innovative approaches to the delivery

10 of health care and social services in minority

11 communities;

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

13 State that relate to minority health care, including

14 providing coordination for the purpose of avoiding

15 redundancy in such activities;

16 ‘‘(3) identify Federal and State programs re17 garding minority health, and providing technical as18 sistance to public and nonprofit entities regarding

19 participation in such program; and

20 ‘‘(4) develop additional Health People 2000 ob21 jectives for the State that are necessary to address

22 the most prevalent morbidity and mortality concerns

23 for racial and ethnic minority groups in the State.

24 ‘‘(d) REQUIREMENT REGARDING ANNUAL BUDGET

25 OFFICE.—The Secretary may not make a grant to a State
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1 under subsection (a) unless such State agrees that, for any

2 fiscal year for which the State receives such a grant, the

3 office operated under such grant will be provided with an

4 annual budget of not less than $75,000.

5 ‘‘(e) CERTAIN USES OF FUNDS.—

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

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

8 such State agrees that—

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

10 health is conducted pursuant to the grant, not

11 more than 10 percent of the amount received

12 under the grant will be expended for such re13 search; and

14 ‘‘(B) amounts provided under the grant

15 will not be expended—

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

17 providing cash payments regarding such

18 care);

19 ‘‘(ii) to conduct activities for which

20 Federal funds are expended—

21 ‘‘(I) within the State to provide

22 technical and other nonfinancial as23 sistance under subsection (m) of sec24 tion 340A;
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1 ‘‘(II) under a memorandum of

2 agreement entered into with the State

3 under subsection (h) of such section;

4 or

5 ‘‘(III) under a grant under sec6 tion 388I;

7 ‘‘(iii) to purchase medical equipment,

8 to purchase ambulances, aircraft, or other

9 vehicles, or to purchase major communica10 tions equipment;

11 ‘‘(iv) to purchase or improve real

12 property; or

13 ‘‘(v) to carry out any activity regard14 ing a certificate of need.

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

16 State may expend amounts received under a grant

17 under subsection (a) include—

18 ‘‘(A) paying the costs of establishing an of19 fice of minority health for purposes of sub20 section (a);

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

22 paying the costs of any activity carried out with

23 respect to recruiting and retaining health pro24 fessionals to serve in minority communities or

25 underserved areas in the State; and
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1 ‘‘(C) providing grants and contracts to

2 public and nonprofit entities to carry out activi3 ties authorized in this section.

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

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

6 agrees—

7 ‘‘(1) to submit to the Secretary reports contain8 ing such information as the Secretary may require

9 regarding activities carried out under this section by

10 the State; and

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

12 10 of each fiscal year immediately following any fis13 cal year for which the State has received such a

14 grant.

15 ‘‘(g) REIMBURSEMENT OF APPLICATION.—The Sec16 retary may not make a grant to a State under subsection

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

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

19 such manner, and contains such agreements, assurances,

20 and information as the Secretary determines to be nec21 essary to carry out such subsection.

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

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

24 fiscal year subsequent to the first fiscal year of such pay25 ments unless the Secretary determines that, for the imme-
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1 diately preceding fiscal year, the State has complied with

2 each of the agreements made by the State under this sec3 tion.

4 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—

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

6 grants under subsection (a) there are authorized to

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

8 $4,000,000 for fiscal year 1996, and $3,000,000 for

9 fiscal year 1997.

10 ‘‘(2) AVAILABILITY.—Amounts appropriated

11 under paragraph (1) shall remain available until ex12 pended.

13 ‘‘(j) TERMINATION OF PROGRAM.—No grant may be

14 made under this section after the aggregate amounts ap15 propriated under subsection (i)(1) are equal to

16 $10,000,000.’’.

17 SEC. 104. ASSISTANT SECRETARY OF HEALTH AND HUMAN

18 SERVICES FOR CIVIL RIGHTS.

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

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

21 43, is amended by adding at the end the following new

22 section:

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

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

25 in the Department of Health and Human Services an As-
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1 sistant Secretary for Civil Rights, who shall be appointed

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

3 the Senate.

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

5 shall perform such functions relating to civil rights as the

6 Secretary may assign.’’.

7 (b) CONFORMING AMENDMENT.—Section 5315 of

8 title 5, United States Code, is amended, in the item relat9 ing to Assistant Secretaries of Health and Human Serv10 ices, by striking ‘‘(5)’’ and inserting ‘‘(6)’’.

11 TITLE II—HEALTH SERVICES

12 SEC. 201. COMMUNITY SCHOLARSHIP PROGRAMS.

13 Section 338L (42 U.S.C. 254t) is amended—

14 (1) in subsection (a), by striking ‘‘health man15 power shortage areas’’ and inserting ‘‘Federally-des16 ignated health professional shortage areas’’;

17 (2) in subsection (c)—

18 (A) by striking ‘‘health manpower shortage

19 areas’’ and inserting ‘‘Federally-designated

20 health professional shortage areas’’ in the mat21 ter preceding paragraph (1); and

22 (B) by striking ‘‘in the health manpower

23 shortage areas in which the community organi24 zations are located,’’ and inserting ‘‘in a Feder25 ally-designated health professional shortage
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1 area that is served by the community organiza2 tion awarding the scholarship,’’ in paragraph

3 (2);

4 (3) in subsection (e)(1)—

5 (A) by striking ‘‘health manpower shortage

6 area’’ and inserting ‘‘Federally-designated

7 health professional shortage area’’; and

8 (B) by striking ‘‘in which the community’’

9 and all that follows through ‘‘located’’;

10 (4) in subsection (k)(2), by striking ‘‘internal

11 medicine’’ and all that follows through the end

12 thereof and inserting ‘‘general internal medicine,

13 general pediatrics, obstetrics and gynecology, den14 tistry, or mental health, that are provided by physi15 cians or other health professionals.’’; and

16 (5) in subsection (l)(1), by striking

17 ‘‘$5,000,000’’ and all that follows through ‘‘1993’’

18 and inserting ‘‘$1,000,000 for fiscal year 1994, and

19 such sums as may be necessary for each of the fiscal

20 years 1995 and 1996’’.

21 SEC. 202. HEALTH SERVICES FOR RESIDENTS OF PUBLIC

22 HOUSING.

23 Section 340A(p)(1) (42 U.S.C. 256a(p)(1)) is amend24 ed—
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1 (1) by striking ‘‘$35,000,000 for fiscal year

2 1991’’ and inserting ‘‘$12,000,000 for fiscal year

3 1994’’; and

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

5 ‘‘1995 and 1996’’.

6 SEC. 203. ISSUANCE OF REGULATIONS REGARDING LAN7 GUAGE AS IMPEDIMENT TO RECEIPT OF

8 SERVICES.

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

10 of the 90-day period beginning on the date of the enact11 ment of this Act, the Secretary of Health and Human

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

13 shall issue a proposed rule regarding policies to reduce the

14 extent to which having limited English proficiency con15 stitutes a significant impediment to individuals in estab16 lishing the eligibility of the individuals for participation

17 in health programs under the Public Health Service Act

18 or in receiving services under such programs.

19 (b) FINAL RULE.—

20 (1) IN GENERAL.—Not later than the expira21 tion of the 1-year period beginning on the date of

22 the enactment of this Act, the Secretary shall issue

23 a final rule regarding the policies described in sub24 section (a).
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1 (2) FAILURE TO ISSUE BY DATE CERTAIN.—If

2 the Secretary fails to issue a final rule under para3 graph (1) before the expiration of the period speci4 fied in such paragraph, the proposed rule issued

5 under subsection (a) is upon such expiration deemed

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

7 remain in effect until the Secretary issues a final

8 rule under such paragraph).

9 SEC. 204. HEALTH SERVICES FOR PACIFIC ISLANDERS.

10 Section 10 of the Disadvantaged Minority Health Im11 provement Act of 1990 (42 U.S.C. 254c–1) is amended—

12 (1) in subsection (b)—

13 (A) in paragraph (2)—

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

15 after ‘‘availability of health’’; and

16 (ii) by striking ‘‘, including improved

17 health data systems’’;

18 (B) in paragraph (3)—

19 (i) by striking ‘‘manpower’’ and in20 serting ‘‘care providers’’; and

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

22 follows through the end thereof and insert23 ing a semicolon;

24 (C) by striking paragraphs (5) and (6);
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1 (D) by redesignating paragraphs (7), and

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

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

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

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

6 by striking the period and inserting a semi7 colon; and

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

9 redesignated), the following new paragraphs:

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

11 health care, and related training to American Sa12 moan health care professionals; and

13 ‘‘(8) to improve access to health promotion and

14 disease prevention services for rural American

15 Samoa;

16 (2) in subsection (f)—

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

18 ‘‘there are’’; and

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

20 follows through ‘‘1993’’ and inserting

21 ‘‘$3,000,000 for each of the fiscal years 1994

22 through 1996’’; and

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

24 new subsection:

25 ‘‘(g) STUDY AND REPORT.—
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1 ‘‘(1) STUDY.—Not later than 180 days after

2 the date of enactment of this subsection, the Sec3 retary, acting through the Administrator of the

4 Health Resources and Services Administration, shall

5 enter into a contract with a public or nonprofit pri6 vate entity for the conduct of a study to determine

7 the effectiveness of projects funded under this sec8 tion.

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

10 the Secretary shall prepare and submit to the Com11 mittee on Labor and Human Resources of the Sen12 ate and the Committee on Energy and Commerce of

13 the House of Representatives a report describing the

14 findings made with respect to the study conducted

15 under paragraph (1).’’.

16 TITLE III—HEALTH

17 PROFESSIONS

18 SEC. 301. LOANS FOR DISADVANTAGED STUDENTS.

19 Section 724(f)(1) (42 U.S.C. 292t(f)(1)) is amend20 ed—

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

22 are’’; and

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

24 1993’’ and inserting ‘‘$8,000,000 for fiscal year
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1 1994, and such sums as may be necessary for each

2 of the fiscal years 1995 and 1996’’.

3 SEC. 302. CESAR CHAVEZ SCHOLARSHIP PROGRAM.

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

5 (1) by striking the section heading and insert6 ing the following:

7 ‘‘SEC. 736. CESAR CHAVEZ SCHOLARSHIP PROGRAM.

8 (2) in subsection (c)—

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

10 ‘‘there are’’; and

11 (B) by striking ‘‘$11,000,000 for fiscal

12 year 1993’’ and inserting ‘‘$10,500,000 for fis13 cal year 1994, and such sums as may be nec14 essary for each of the fiscal years 1995 and

15 1996’’.

16 SEC. 303. THURGOOD MARSHALL SCHOLARSHIP PROGRAM.

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

18 (1) by striking the section heading and insert19 ing the following:

20 ‘‘SEC. 737. THURGOOD MARSHALL SCHOLARSHIP PRO21 GRAM.’’;

22 (2) in subsection (a)—

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

24 known as Thurgood Marshall Scholars)’’ after

25 ‘‘providing scholarships to individuals’’; and
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1 (B) in paragraph (3), by inserting after

2 ‘‘public health,’’ schools offering programs for

3 the training of physician assistants,’’.

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

5 and inserting the following new paragraph:

6 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

7 For the purpose of carrying out this section, there

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

9 fiscal year 1994, and such sums as may be nec10 essary for each of the fiscal years 1995 and 1996.’’.

11 SEC. 304. LOAN REPAYMENTS AND FELLOWSHIPS REGARD12 ING FACULTY POSITIONS AT HEALTH PRO13 FESSIONS SCHOOLS.

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

15 (1) in subsection (a)—

16 (A) in paragraph (2), by striking ‘‘dis17 advantaged backgrounds who—’’ and inserting

18 ‘‘racial or ethnic groups that are

19 underrepresented in the health professions

20 who—’’

21 (B) in paragraph (5)—

22 (i) by striking ‘‘; and’’ in subpara23 graph (A) and inserting a period;

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

25 that follows through ‘‘the individual in-
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1 volved’’ in subparagraph (A) and inserting

2 ‘‘unless the individual involved’’; and

3 (iii) striking subparagraph (B);

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

5 (D) by redesignating paragraph (7) as

6 paragraph (6); and

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

8 ‘‘$30,000’’ and inserting ‘‘$50,000’’;

9 (3) in subsection (c)—

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

11 ‘‘there are’’; and

12 (B) by striking ‘‘$4,000,000 for fiscal year

13 1993’’ and inserting ‘‘$1,100,000 for fiscal year

14 1994, and such sums as may be necessary for

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

16 SEC. 305. CENTERS OF EXCELLENCE.

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

18 (1) in subsection (b)—

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

20 the semicolon the following: ‘‘through collabora21 tion with public and nonprofit private entities

22 to carry out community-based programs to pre23 pare students in secondary schools and institu24 tions of higher education for attendance at the

25 health professions school’’;
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1 (B) in paragraph (4), by striking ‘‘and’’ at

2 the end thereof;

3 (C) in paragraph (5), by striking the pe4 riod and inserting ‘‘; and’’; and

5 (D) by adding at the end thereof the fol6 lowing new paragraph:

7 ‘‘(6) to carry out a program to provide training

8 to the students of the school to enable such students

9 to provide health services to minority individuals at

10 community-based health facilities that provide such

11 services to a significant number of minority individ12 uals and that are located at a site remote from the

13 main site of the teaching facilities of the school.’’;

14 (2) in subsection (e)—

15 (A) by striking the subsection heading and

16 inserting ‘‘AUTHORITY REGARDING CONSOR17 TIA.—’’;

18 (B) by striking paragraph (1) and insert19 ing the following new paragraph:

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

21 grant under subsection (a) to any school of medi22 cine, osteopathic medicine, dentistry, clinical psy23 chology, or pharmacy that has in accordance with

24 paragraph (2) formed a consortium of schools.’’;
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1 (C) in paragraph (2), by striking subpara2 graphs (A) through (D) and inserting the fol3 lowing new subparagraphs:

4 ‘‘(A) the consortium consists of—

5 ‘‘(i) the health professions school

6 seeking the grant under subsection (a);

7 and

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

9 osteopathic medicine, dentistry, pharmacy,

10 nursing, allied health, public health, clini11 cal psychology, or graduate programs in

12 mental health practice;

13 ‘‘(B) the schools of the consortium have

14 entered into an agreement for the allocation of

15 such grant among the schools; and

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

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

18 (D) by adding at the end the following

19 paragraph:

20 ‘‘(3) AUTHORITY FOR COLLECTIVELY MEETING

21 RELEVANT REQUIREMENTS IN CERTAIN CASES.—

22 With respect to meeting the conditions specified in

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

24 Excellence, the Secretary may make a grant to any

25 school that has in accordance with paragraphs (1)
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1 and (2) formed a consortium of schools that meets

2 such conditions (without regard to whether the

3 schools of the consortium individually meet such

4 conditions).’’; and

5 (3) in subsection (i)—

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

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

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

9 1994, and such sums as may be necessary for

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

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

12 end the following: ‘‘Health professions schools

13 described in subsection (c)(2)(A) shall be eligi14 ble for grants under this subparagraph in a fis15 cal year if the amount appropriated for the fis16 cal year under paragraph (1) is greater than

17 $23,500,000. Such schools shall be eligible to

18 apply only for grants made from the portion of

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

20 SEC. 306. EDUCATIONAL ASSISTANCE REGARDING UNDER21 GRADUATES.

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

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

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

25 a grant, a school shall have in place a program to
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1 assist individuals from disadvantaged backgrounds

2 in gaining entry into a health professions school or

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

4 (2) in subsection (d)(1)—

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

6 ‘‘there are’’; and

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

8 ‘‘1994, and such sums as may be necessary for

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

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

11 end thereof the following new sentence: ‘‘Scholarship

12 recipients under this section shall be known as

13 ‘Cesar Chavez Primary Care Scholars.’’.

14 SEC. 307. AREA HEALTH EDUCATION CENTERS.

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

16 amended by inserting ‘‘and minority health’’ after ‘‘dis17 ease prevention’’.

18 TITLE IV—RESEARCH AND DATA

19 COLLECTION

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

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

22 151 of Public Law 103–43, is amended by adding at the

23 end the following subsections:

24 ‘‘(c) PLAN.—The Director of the Office, shall collabo25 rate with the Deputy Assistant Secretary for Minority
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1 Health (as provided for in section 1707), to develop and

2 implement a plan for carrying out the duties required by

3 subsection (b). The Director, in consultation with the Dep4 uty Assistant Secretary for Minority Health, shall review

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

6 as appropriate.

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

8 Director of the Office shall ensure that activities under

9 subsection (b) address equitably all minority groups.

10 ‘‘(e) ADVISORY COMMITTEE.—

11 ‘‘(1) ESTABLISHMENT.—In carrying out sub12 section (b), the Secretary shall establish an advisory

13 committee to be known as the Advisory Committee

14 on Research on Minority Health (in this subsection

15 referred to as the ‘Advisory Committee’).

16 ‘‘(2) COMPOSITION.—

17 ‘‘(A) VOTING AND NONVOTING MEM18 BERS.—The Advisory Committee shall be com19 posed of voting members appointed in accord20 ance with subparagraph (B) and the ex officio

21 nonvoting members described in subparagraph

22 (C).

23 ‘‘(B) VOTING MEMBERS.—The Advisory

24 Committee shall include not fewer than 12, and

25 not more than 18, voting members who are not
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1 officers or employees of the Federal Govern2 ment. The Director of the Office shall appoint

3 such members to the Advisory Committee from

4 among physicians, practitioners, scientists, con5 sumers and other health professionals, whose

6 clinical practices, research specialization, or

7 professional expertise includes a significant

8 focus on research on minority health or on the

9 barriers that minorities must overcome to par10 ticipate in clinical trials. The membership of the

11 Advisory Committee shall be equitably rep12 resentative of the minority groups served by the

13 Office.

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

15 The Deputy Assistant Secretary for Minority

16 Health and the Directors of each of the na17 tional research entities shall serve as ex officio

18 nonvoting members of the Advisory Committee

19 (except that any of such Directors may des20 ignate an official of the institute involved to

21 serve as such member of the Committee in lieu

22 of the Director).

23 ‘‘(3) CHAIRPERSON.—The Director of the Of24 fice shall serve as the chairperson of the Advisory

25 Committee.
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1 ‘‘(4) DUTIES.—The Advisory Committee

2 shall—

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

4 appropriate research activities to be undertaken

5 by the national research institutes with respect

6 to—

7 ‘‘(i) research on minority health;

8 ‘‘(ii) research on racial and ethnic dif9 ferences in clinical drug trials, including

10 responses to pharmacological drugs;

11 ‘‘(iii) research on racial and ethnic

12 differences in disease etiology, course, and

13 treatment; and

14 ‘‘(iv) research on minority health con15 ditions which require a multidisciplinary

16 approach;

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

18 on such research;

19 ‘‘(C) provide recommendations to such Di20 rector regarding activities of the Office (includ21 ing recommendations on priorities in carrying

22 out research described in subparagraph (A));

23 and
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1 ‘‘(D) assist in monitoring compliance with

2 section 492B regarding the inclusion of minori3 ties in clinical research.

4 ‘‘(5) BIENNIAL REPORT.—

5 ‘‘(A) PREPARATION.—The Advisory Com6 mittee shall prepare a biennial report describing

7 the activities of the Committee, including find8 ings made by the Committee regarding—

9 ‘‘(i) compliance with section 492B;

10 ‘‘(ii) the extent of expenditures made

11 for research on minority health by the

12 agencies of the National Institutes of

13 Health; and

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

15 such research.

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

17 subparagraph (A) shall be submitted to the Di18 rector of the National Institutes of Health for

19 inclusion in the report required in section 403.

20 ‘‘(f) REPRESENTATIVES OF MINORITIES AMONG RE21 SEARCHERS.—The Secretary, acting through the Assist22 ant Secretary for Personnel Administration and in collabo23 ration with the Director of the Office, shall determine the

24 extent to which minorities are represented among senior

25 physicians and scientists of the national research insti-
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1 tutes and among physicians and scientists conducting re2 search with funds provided by such institutes, and as ap3 propriate, carry out activities to increase the extent of

4 such representation.

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

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

7 term ‘minority health conditions’, with respect to in8 dividuals who are members of minority groups,

9 means all diseases, disorders, and conditions (includ10 ing with respect to mental health)—

11 ‘‘(A) unique to, more serious, or more

12 prevalent in such individuals;

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

14 or types of medical intervention are different

15 for such individuals, or for which it is unknown

16 whether such factors or types are different for

17 such individuals; or

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

19 insufficient research involving such individuals

20 as subjects or insufficient data on such individ21 uals.

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

23 term ‘research on minority health’ means research

24 on minority health conditions, including research on

25 preventing such conditions.
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1 ‘‘(3) MINORITY GROUPS.—The term ‘minority

2 groups’ means Blacks, American Indians, Alaskan

3 Natives, Asian/Pacific Islanders, and Hispanics, in4 cluding subpopulations of such groups.’’.

5 SEC. 402. NATIONAL CENTER FOR HEALTH STATISTICS.

6 (a) IN GENERAL.—Section 306 (42 U.S.C. 242k) is

7 amended—

8 (1) in subsection (c), by striking ‘‘Committee on

9 Human Resources’’ and inserting ‘‘Committee on

10 Labor and Human Resources’’;

11 (2) in subsection (g), by striking ‘‘data which

12 shall be published’’ and all that follows and inserting

13 ‘‘data.’’;

14 (3) in subsection (k)(2)—

15 (A) in subparagraph (A)—

16 (i) by striking the subparagraph des17 ignation; and

18 (ii) by striking ‘‘Except as provided in

19 subparagraph (B), members’’ and inserting

20 ‘‘Members’’; and

21 (B) by striking subparagraph (B);

22 (4) in subsection (l)—

23 (A) by striking paragraph (3);

24 (B) by redesignating paragraph (4) as

25 paragraph (3); and
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1 (C) in paragraph (3) (as so redesignated),

2 by striking ‘‘paragraphs (1), (2), and (3),’’ and

3 inserting ‘‘paragraphs (1) and (2),’’; and

4 (5) in subsection (o)—

5 (A) in paragraph (1), by striking ‘‘1991

6 through 1993’’ and inserting ‘‘1994 through

7 1997’’; and

8 (B) in paragraph (2), by striking

9 ‘‘$5,000,000’’ and all that follows through

10 ‘‘1993’’ and inserting ‘‘$1,100,000 for fiscal

11 year 1994, and such sums as may be necessary

12 for each of the fiscal years 1995 through

13 1997’’.

14 (b) GENERAL AUTHORITY RESPECTING RESEARCH,

15 EVALUATIONS, AND DEMONSTRATIONS.—Section 304 (42

16 U.S.C. 242b) is amended by striking subsection (d).

17 (c) GENERAL PROVISIONS RESPECTING EFFECTIVE18 NESS, EFFICIENCY, AND QUALITY OF HEALTH SERV19 ICES.—Section 308 (42 U.S.C. 242m) is amended—

20 (1) in subsection (a)—

21 (A) in paragraph (1)—

22 (i) by striking subparagraph (A); and

23 (ii) by redesignating subparagraphs

24 (B) through (E) as subparagraphs (A)

25 through (D), respectively; and
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1 (B) in paragraph (2), by striking ‘‘reports

2 required by subparagraphs’’ and all that follows

3 through ‘‘Center’’ and inserting the following:

4 ‘‘reports required in paragraph (1) shall be pre5 pared through the National Center’’;

6 (2)(A) by striking subsection (c);

7 (B) by transferring paragraph (2) of subsection

8 (g) from the current location of the paragraph;

9 (C) by redesignating such paragraph as sub10 section (c);

11 (D) by inserting subsection (c) (as so redesig12 nated) after subsection (b); and

13 (E) by striking the remainder of subsection (g);

14 (3) in subsection (c) (as so redesignated)—

15 (A) by striking ‘‘shall (A) take’’ and in16 serting ‘‘shall take’’; and

17 (B) by striking ‘‘and (B) publish’’ and in18 serting ‘‘and shall publish’’;

19 (4) in subsection (f), by striking ‘‘sections

20 3648’’ and all that follows and inserting ‘‘section

21 3324 of title 31, United States Code, and section

22 3709 of the Revised Statutes (41 U.S.C. 5).’’; and

23 (5) by striking subsection (h).
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1 SEC. 403. ACTIVITIES OF AGENCY FOR HEALTH CARE POL2 ICY AND RESEARCH.

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

4 read as follows:

5 ‘‘(b) REQUIREMENTS WITH RESPECT TO CERTAIN

6 POPULATIONS.—In carrying out subsection (a), the Ad7 ministrator shall undertake and support research, dem8 onstration projects, and evaluations with respect to the

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

10 ‘‘(1) the populations of medically underserved

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

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

13 the elderly.’’.

14 TITLE V—MISCELLANEOUS

15 SEC. 501. REVISION AND EXTENSION OF PROGRAM FOR

16 STATE OFFICES OF RURAL HEALTH.

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

18 254r(b)) is amended to read as follows:

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

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

21 be incurred by a State in carrying out the purpose

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

23 make a grant under such subsection unless the State

24 agrees to provide non-Federal contributions toward

25 such costs, in cash, in an amount that is not less
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1 than $1 for each $1 of Federal funds provided in the

2 grant.

3 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB4 UTED.—In determining the amount of non-Federal

5 contributions in cash that a State has provided pur6 suant to paragraph (1), the Secretary may not in7 clude any amounts provided to the State by the Fed8 eral Government.’’.

9 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

10 338J(j)(1) (42 U.S.C. 254r(j)(1)) is amended—

11 (1) by striking ‘‘and’’ after ‘‘1992,’’; and

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

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

14 through 1996’’.

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

16 (42 U.S.C. 254r(k)) is amended by striking $10,000,000’’

17 and inserting ‘‘$20,000,000’’.

18 SEC. 502. TECHNICAL CORRECTIONS RELATING TO HEALTH

19 PROFESSIONS.

20 (a) HEALTH EDUCATION ASSISTANCE LOAN

21 DEFERMENT FOR BORROWERS PROVIDING HEALTH

22 SERVICES TO INDIANS.—

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

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

25 not in excess of three years, during which the bor-
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1 rower is providing health care services to Indians

2 through an Indian health program (as defined in

3 section 108(a)(2)(A) of the Indian Health Care Im4 provement Act (25 U.S.C. 1616a(a)(2)(A)); and

5 (xi)’’.

6 (2) CONFORMING AMENDMENTS.—Section

7 705(a)(2)(C) is further amended—

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

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

10 (B) in the matter following such clause

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

12 (3) EFFECTIVE DATE.—The amendments made

13 by this subsection shall apply with respect to serv14 ices provided on or after the first day of the third

15 month that begins after the date of enactment of

16 this Act.

17 (b) MAXIMUM STUDENT LOAN PROVISION.—Section

18 722(a)(1) (42 U.S.C. 292r(a)(1)), as amended by section

19 2014(b)(1) of Public Law 103–43, is amended by striking

20 ‘‘the sum of’’ and all that follows through the end thereof

21 and inserting ‘‘the cost of attendance (including tuition,

22 other reasonable educational expenses, and reasonable liv23 ing costs) for that year at the educational institution at24 tended by the student (as determined by such educational

25 institution).’’.
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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.—Section 791 (42 U.S.C. 295j) is

14 amended by adding at the end thereof the following sub15 section:

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
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1 the capability to provide the information necessary

2 to qualify the program for the general funding pref3 erences described in subsection (a).

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

5 paragraph (1) are the following:

6 ‘‘(A) The mission statement of the pro7 gram identifies a specific purpose of the pro8 gram as being the preparation of health profes9 sionals to serve underserved populations.

10 ‘‘(B) The curriculum of the program in11 cludes content which will help to prepare practi12 tioners to serve underserved populations.

13 ‘‘(C) Substantial clinical training experi14 ence is required under the program in medically

15 underserved communities.

16 ‘‘(D) A minimum of 20 percent of the fac17 ulty of the program spend at least 50 percent

18 of their time providing or supervising care in

19 medically underserved communities.

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

21 portion of the program is physically located in

22 a medically underserved community.

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

24 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 (f) PREFERENCES IN MAKING AWARDS.—

7 (1) TITLE VII.—Section 791(a)(1)(A) (42

8 U.S.C. 295j(a)(1)(A)) is amended by striking ‘‘com9 munities; or’’ and inserting ‘‘communities includ10 ing—

11 ‘‘(i) ambulatory practice sites des12 ignated by State Governors as shortage

13 areas or medically underserved commu14 nities for purposes of State scholarships or

15 loan repayment or related programs; and

16 ‘‘(ii) practices or facilities in which

17 not less than 50 percent of the patients are

18 recipients of aid under title XIX of the So19 cial Security Act or eligible and uninsured;

20 or’’.

21 (2) TITLE VIII.—Section 860(e)(1)(A)(i) (42

22 U.S.C. 298b–7(e)(1)(A)(i)) is amended by striking

23 ‘‘communities; or’’ and inserting ‘‘communities in24 cluding—
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1 ‘‘(i) ambulatory practice sites des2 ignated by State Governors as shortage

3 areas or medically underserved commu4 nities for purposes of State scholarships or

5 loan repayment or related programs; and

6 ‘‘(ii) practices or facilities in which

7 not less than 50 percent of the patients are

8 recipients of aid under title XIX of the So9 cial Security Act or eligible and uninsured;

10 or’’.

11 (g) GENERALLY APPLICABLE MODIFICATIONS RE12 GARDING OBLIGATED SERVICE.—

13 (1) IN GENERAL.—Section 795 (42 U.S.C.

14 295n), is amended—

15 (A) in subsection (a)(2)—

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

17 ‘‘speciality in’’ and inserting ‘‘field of’’;

18 and

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

20 ‘‘speciality’’ and inserting ‘‘field’’; and

21 (B) in subsection (b)(1), in each of sub22 paragraphs (A) and (B), by striking ‘‘interest

23 on such amount at the maximum legal prevail24 ing rate’’ and inserting ‘‘interest on such
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1 amount at the rate of 12 percent per year

2 (compounded annually)’’.

3 (2) EFFECTIVE DATE.—Each amendment made

4 by paragraph (1) shall take effect as if such sub5 section had been enacted immediately after the en6 actment of the Health Professions Education Exten7 sion Amendments of 1992.

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

9 et seq.) is amended by inserting after section 795, the fol10 lowing new section:

11 ‘‘SEC. 796. RECOVERY.

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

13 (or within such shorter period as the Secretary may pre14 scribe by regulation for an interim facility) after the com15 pletion of construction of a facility with respect to which

16 funds have been paid under section 720(a) (as such sec17 tion existed one day prior to the date of enactment of the

18 Health Professions Education Extension Amendments of

19 1992 (Public Law 102–408)—

20 ‘‘(1)(A) in case of a facility which was an affili21 ated hospital or outpatient facility with respect to

22 which funds have been paid under such section

23 720(a)(1), the owner of the facility ceases to be a

24 public or other nonprofit agency that would have
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1 been qualified to file an application under section

2 605;

3 ‘‘(B) in case of a facility which was not an af4 filiated hospital or outpatient facility but was a facil5 ity with respect to which funds have been paid under

6 paragraph (1) or (3) of such section 720(a), the

7 owner of the facility ceases to be a public or non8 profit school, or

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

10 with respect to which funds have been paid under

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

12 ceases to be a public or nonprofit entity,

13 ‘‘(2) the facility ceases to be used for the teach14 ing or training purposes (or other purposes per15 mitted under section 722 (as such section existed

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

17 Professions Education Extension Amendments of

18 1992 (Public Law 102–408)) for which it was con19 structed, or

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

21 or as a place for religious worship,

22 the United States shall be entitled to recover from the

23 owner of the facility the base amount prescribed by sub24 section (c)(1) plus the interest (if any) prescribed by sub25 section (c)(2).
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1 ‘‘(b) NOTICE.—The owner of a facility which ceases

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

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

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

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

6 of subsection (a), shall provide the Secretary written no7 tice of such cessation or change of use within 10 days after

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

9 or within 30 days after the date of enactment of this sub10 section, whichever is later.

11 ‘‘(c) AMOUNT.—

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

13 the United States is entitled to recover under sub14 section (a) is the amount bearing the same ratio to

15 the then value (as determined by the agreement of

16 the parties or in an action brought in the district

17 court of the United States for the district in which

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

19 of the Federal participation bore to the cost of con20 struction.

21 ‘‘(2) INTEREST.—

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

23 United States is entitled to recover under sub24 section (a) is the interest for the period (if any)

25 described in subparagraph (B) at a rate (deter-
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1 mined by the Secretary) based on the average

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

3 Treasury bills auctioned during that period.

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

5 subparagraph (A) is the period beginning—

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

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

8 on which the owner of the facility ceases to

9 be a public or nonprofit agency, school, or

10 entity as described in subparagraph (A),

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

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

13 which the use of the facility changes as de14 scribed in paragraph (2) or (3) of sub15 section (a), or

16 ‘‘(ii) if notice is not provided as pre17 scribed by subsection (b), 11 days after the

18 date on which such cessation or change of

19 use occurs,

20 and ending on the date the amount the United

21 States is entitled to recover is collected.

22 ‘‘(d) WAIVER.—The Secretary may waive the recov23 ery rights of the United States under subsection (a)(2)

24 with respect to a facility (under such conditions as the
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1 Secretary may establish by regulation) if the Secretary de2 termines that there is good cause for waiving such rights.

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

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

5 constitute a lien on any facility.’’.

6 SEC. 503. CLINICAL TRAINEESHIPS.

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

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

9 SEC. 504. DEMONSTRATION PROJECT GRANTS TO STATES

10 FOR ALZHEIMER’S DISEASE.

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

12 3(a)) is amended—

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

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

15 (2) in paragraph (2)—

16 (A) by inserting after ‘‘disorders’’ the fol17 lowing: ‘‘who are living in single family homes

18 or in congregate settings’’; and

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

20 (3) by redesignating paragraph (3) as para21 graph (4); and

22 (4) by inserting after paragraph (2) the follow23 ing:

24 ‘‘(3) to improve access for individuals with Alz25 heimer’s disease or related disorders, particularly
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1 such individuals from ethnic, cultural, or language

2 minorities and such individuals who are living in iso3 lated rural areas, to services that—

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

5 long-term care services; and

6 ‘‘(B) exist on the date of enactment of this

7 paragraph; and’’.

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

9 is amended—

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

11 ON’’;

12 (2) in subsection (a)—

13 (A) in the heading, by striking ‘‘LIMITA14 TION ON’’; and

15 (B) by striking ‘‘may not exceed’’ and in16 serting ‘‘may exceed’’; and

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

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

19 after ‘‘third year’’.

20 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

21 398B(e) (42 U.S.C. 280c–5(e)) is amended by striking

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

23 SEC. 505. MEDICALLY UNDERSERVED AREA STUDY.

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

25 Human Services shall conduct a study concerning the fea-
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1 sibility and desirability of, and the criteria to be used for,

2 combining the designations of ‘‘health professional short3 age area’’ and ‘‘medically underserved area’’ into a single

4 health professional shortage area designation.

5 (b) REQUIREMENTS.—As part of the study conducted

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

7 Services, in considering the statutory and regulatory re8 quirements necessary for the creation of a single health

9 professional shortage area designation, shall—

10 (1) review and report on the application of cur11 rent statutory and regulatory criteria used—

12 (A) in designating an area as a health pro13 fessional shortage area;

14 (B) in designating an area as a medically

15 underserved area; and

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

17 health professional shortage area designations

18 of such State; and

19 (2) review the suggestions of public health and

20 primary care experts.

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

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

23 Human Services shall prepare and submit to the appro24 priate committees of Congress a report concerning the
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1 findings of the study conducted under subsection (a) to2 gether with the recommendations of the Secretary.

3 (d) RECOMMENDATIONS.—In making recommenda4 tions under subsection (c), the Secretary of Health and

5 Human Services shall give special consideration to (and

6 describe in the report) the unique impact of designation

7 criteria on different rural and urban populations, and eth8 nic and racial minorities, including—

9 (1) rational service areas, and their application

10 to frontier areas and inner-city communities;

11 (2) indicators of high medical need, including

12 fertility rates, infant mortality rates, pediatric popu13 lation, elderly population, poverty rates, and physi14 cian to population ratios; and

15 (3) indicators of insufficient service capacity,

16 including language proficiency criteria for ethnic

17 populations, annual patient visits per physician,

18 waiting times for appointments, waiting times in a

19 primary care physician office, excessive use of emer20 gency facilities, low annual office visit rate, and de21 mand on physicians in contiguous rural or urban

22 areas.
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1 SEC. 506. PROGRAMS REGARDING BIRTH DEFECTS.

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

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

4 102–531 (106 Stat. 3494), is amended to read as follows:

5 ‘‘PROGRAMS REGARDING BIRTH DEFECTS

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

7 Director of the Centers for Disease Control and Preven8 tion, shall carry out programs—

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

10 on birth defects, including data on the causes of

11 such defects and on the incidence and prevalence of

12 such defects;

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

14 the public on the prevention of such defects;

15 ‘‘(3) to operate regional centers for the conduct

16 of epidemiologic research and study of such defects,

17 and to improve the education, training, and clinical

18 skills of health professionals with respect to the pre19 vention of such defects; and

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

21 prevention of such defects.

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

23 subsection (a)(1), the Secretary shall establish and main24 tain a National Information Clearinghouse on Birth De25 fects to collect and disseminate to health professionals and
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1 the general public information on birth defects, including

2 the prevention of such defects.

3 ‘‘(c) GRANTS AND CONTRACTS.—

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

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

6 into contracts with public and nonprofit private enti7 ties. Recipients of assistance under this subsection

8 shall collect and analyze demographic data utilizing

9 appropriate sources as determined by the Secretary.

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

11 AWARD FUNDS.—

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

13 award of a grant or contract under paragraph

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

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

16 for the purpose of aiding the recipient in carry17 ing out the purposes for which the award is

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

19 recipient any officer or employee of the Depart20 ment of Health and Human Services.

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

22 in subparagraph (A), the Secretary shall reduce

23 the amount of payments under the award in24 volved by an amount equal to the costs of de25 tailing personnel and the fair market value of
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1 any supplies, equipment, or services provided by

2 the Secretary. The Secretary shall, for the pay3 ment of expenses incurred in complying with

4 such request, expend the amounts withheld.

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

6 may make an award of a grant or contract under

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

8 is submitted to the Secretary and the application is

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

10 such agreements, assurances, and information as the

11 Secretary determines to be necessary to carry out

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

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

14 1 of fiscal year 1995 and of every second such year there15 after, the Secretary shall submit to the Committee on En16 ergy and Commerce of the House of Representatives, and

17 the Committee on Labor and Human Resources of the

18 Senate, a report that, with respect to the preceding 2 fis19 cal years—

20 ‘‘(1) contains information regarding the inci21 dence and prevalence of birth defects and the extent

22 to which birth defects have contributed to the inci23 dence and prevalence of infant mortality;
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1 ‘‘(2) contains information under paragraph (1)

2 that is specific to various racial and ethnic groups;

3 and

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

5 which each approach to preventing birth defects has

6 been effective, including a description of effective7 ness in relation to cost;

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

13 purpose of carrying out this section, there are authorized

14 to be appropriated such sums as may be necessary for

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

16 TITLE VI—GENERAL

17 PROVISIONS

18 SEC. 601. EFFECTIVE DATE.

19 This Act and the amendments made by this Act shall

20 take effect October 1, 1993, or upon the date of the enact21 ment of this Act, whichever occurs later.

22 SECTION 1. SHORT TITLE; REFERENCE; TABLE OF CON23 TENTS.

24 (a) SHORT TITLE.—This Act may be cited as the ‘‘Dis25 advantaged Minority Health Improvement Act of 1993’’.
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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, a

4 section or other provision, the reference shall be considered

5 to be made to a section or other provision of the Public

6 Health Service Act (42 U.S.C. 201 et seq.).

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

8 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. Community scholarship programs.

Sec. 202. Health services for residents of public housing.

Sec. 203. Issuance of regulations regarding language as impediment to receipt of

services.

Sec. 204. 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. National Center for Health Statistics.

Sec. 403. Activities of Agency for Health Care Policy and Research.

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.
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Sec. 504. Demonstration project grants to States for alzheimer’s disease.

Sec. 505. Medically underserved area study.

Sec. 506. Programs regarding birth defects.

TITLE VI—GENERAL PROVISIONS

Sec. 601. 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 pop9 ulation and has not improved significantly since the

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

11 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, di17 abetes, substance abuse, acquired immune deficiency

18 syndrome, and other diseases and disorders;

19 ‘‘(4) the incidence of infant mortality among Af20 rican Americans is almost double that for the general

21 population;
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1 ‘‘(5) Mexican-American and Puerto Rican adults

2 have diabetes rates twice that of non-Hispanic whites;

3 ‘‘(6) a third of American Indian deaths occur be4 fore the age of 45;

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

6 Americans, Hispanics, American Indians, and Asian/

7 Pacific Islanders constitute approximately 12.1 per8 cent, 9 percent, 0.08 percent, and 2.9 percent, respec9 tively, of the population of the United States;

10 ‘‘(8) minority health professionals have histori11 cally tended to practice in low-income areas, medi12 cally underserved areas, and to serve racial and eth13 nic minorities;

14 ‘‘(9) minority health professionals have histori15 cally tended to engage in the general practice of medi16 cine and specialties providing primary care;

17 ‘‘(10) reports published in leading medical jour18 nals indicate that access to health care among mi19 norities can be substantially improved by increasing

20 the number of minority professionals;

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

22 of health professions schools enhances the quality of

23 education for all students attending the schools; and

24 ‘‘(12) health professionals need greater access to

25 continuing medical education programs to enable
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1 such professionals to upgrade their skills (including

2 linguistic and cultural competence skills) and im3 prove the quality of medical care rendered in minor4 ity communities.’’.

5 TITLE I—HEALTH POLICY

6 SEC. 101. OFFICE OF MINORITY HEALTH.

7 Section 1707 (42 U.S.C. 300u–6) is amended by strik8 ing subsection (b) and all that follows and inserting the

9 following:

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

11 of racial and ethnic minorities, the Secretary, acting

12 through the Deputy Assistant Secretary for Minority

13 Health, shall carry out the following:

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

15 and objectives and coordinate all other activities with16 in the Public Health Service that relate to disease

17 prevention, health promotion, service delivery, and re18 search concerning such individuals. The Director of

19 the Centers for Disease Control and Prevention, the

20 Administrator of the Health Resources and Services

21 Administration, the Director of the Agency for Health

22 Care Policy and Research, the Administrator of the

23 Substance Abuse and Mental Health Services Admin24 istration and the Director of the National Institutes

25 of Health shall consult with the Deputy Assistant Sec-
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1 retary for Minority Health to ensure the coordination

2 of all activities within the Public Health Service as

3 they relate to disease prevention, health promotion,

4 service delivery, and research concerning such indi5 viduals.

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

7 by entering into interagency agreements with other

8 agencies of the Public Health Service:

9 ‘‘(A) Support research, demonstrations and

10 evaluations to test new and innovative models.

11 ‘‘(B) Increase knowledge and understanding

12 of health risk factors.

13 ‘‘(C) Develop mechanisms that support bet14 ter information dissemination, education, pre15 vention, and service delivery to individuals from

16 disadvantaged backgrounds, including racial and

17 ethnic minorities.

18 ‘‘(3) Support a national minority health re19 source center to carry out the following:

20 ‘‘(A) Facilitate the exchange of information

21 regarding matters relating to health information

22 and health promotion, preventive health services,

23 and education in the appropriate use of health

24 care.

25 ‘‘(B) Facilitate access to such information.
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1 ‘‘(C) Assist in the analysis of issues and

2 problems relating to such matters.

3 ‘‘(D) Provide technical assistance with re4 spect to the exchange of such information (in5 cluding facilitating the development of materials

6 for such technical assistance).

7 ‘‘(4) Establish a national center that shall carry

8 out programs to improve access to health care services

9 for individuals with limited English proficiency by

10 facilitating the removal of impediments to the receipt

11 of health care that result from such limitation.

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

13 are available under certain minority health pro14 grams, the Secretary shall ensure that the agencies of

15 the Public Health Service—

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

17 the entities may be eligible for the awards;

18 ‘‘(B) provide technical assistance to such

19 entities in the process of preparing and submit20 ting applications for the awards in accordance

21 with the policies of the Secretary regarding such

22 application; and

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

24 that members of the populations may be eligible
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1 to receive services or otherwise participate in the

2 activities carried out with such awards.

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

4 Deputy Assistant Secretary of Minority Health shall

5 prepare and submit to the Secretary a report summa6 rizing the activities of each Office of Minority Health

7 within the Public Health Service, including the Office

8 of Research on Minority Health at the National Insti9 tutes of Health.

10 ‘‘(c) ADVISORY COMMITTEE.—

11 ‘‘(1) IN GENERAL.—The Secretary shall establish

12 an advisory committee to be known as the Advisory

13 Committee on Minority Health (in this subsection re14 ferred to as the ‘Committee’).

15 ‘‘(2) DUTIES.—The Committee shall provide ad16 vice to the Secretary on carrying out this section, in17 cluding advice on the development of goals and spe18 cific program activities under subsection (b)(1) for

19 each racial and ethnic group.

20 ‘‘(3) CHAIRPERSON.—The Deputy Assistant Sec21 retary for Minority Health shall serve as the Chair22 person of the Committee.

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

24 composed of no fewer than 12, and not more than 18

25 individuals, who are not officers or employees of the
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1 Federal Government. The Secretary shall appoint the

2 members of the Committee from among individuals

3 with expertise regarding issues of minority health.

4 The membership of the Committee shall be equitably

5 representative of the various racial and ethnic groups.

6 The Secretary may appoint representatives from se7 lected Federal agencies to serve as ex officio, non-vot8 ing members of the Committee.

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

10 shall serve for a term of 4 years, except that the Sec11 retary shall initially appoint a portion of the mem12 bers to terms of 1 year, 2 years, and 3 years.

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

14 Committee, a new member shall be appointed by the

15 Secretary within 90 days from the date that the va16 cancy occurs, and serve for the remainder of the term

17 for which the predecessor of such member was ap18 pointed. The vacancy shall not affect the power of the

19 remaining members to execute the duties of the Com20 mittee.

21 ‘‘(7) COMPENSATION.—Members of the Commit22 tee who are officers or employees of the United States

23 shall serve without compensation. Members of the

24 Committee who are not officers or employees of the

25 United States shall receive, for each day (including
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1 travel time) they are engaged in the performance of

2 the functions of the Committee, compensation at rates

3 that do not exceed the daily equivalent of the annual

4 rate in effect for grade GS–18 of the General Schedule

5 under title 5, United States Code.

6 ‘‘(d) CERTAIN REQUIREMENTS REGARDING DUTIES.—

7 ‘‘(1) RECOMMENDATIONS REGARDING LANGUAGE

8 AS IMPEDIMENT TO HEALTH CARE.—The Secretary,

9 acting through the Director of the Office of Refugee

10 Health, the Director of the Office of Civil Rights, and

11 the Director of the Office of Minority Health of the

12 Health Resources and Services Administration, shall

13 make recommendations regarding activities under

14 subsection (b)(4).

15 ‘‘(2) EQUITABLE ALLOCATION REGARDING AC16 TIVITIES.—In awarding grants or contracts under

17 section 338A, 338B, 340A, 724, 737, 738, or 1707, the

18 Secretary shall ensure that such awards are equitably

19 allocated with respect to the various racial and ethnic

20 populations.

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

22 The Secretary shall ensure that information and serv23 ices provided pursuant to subsection (b) are provided

24 in the language and cultural context that is most ap-
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1 propriate for the individuals for whom the informa2 tion and services are intended.

3 ‘‘(4) PEER REVIEW.—The Secretary shall ensure

4 that each application for a grant, contract or cooper5 ative agreement under this section undergoes appro6 priate peer review.

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

8 year 1995 and of each second year thereafter, the Secretary

9 shall submit to the Congress a report describing the activi10 ties carried out under this section during the preceding 2

11 fiscal years and evaluating the extent to which such activi12 ties have been effective in improving the health of racial

13 and ethnic minorities.

14 ‘‘(f) GRANTS AND CONTRACTS REGARDING DUTIES.—

15 ‘‘(1) AUTHORITY.—In carrying out subsection

16 (b), the Secretary may enter into grants and con17 tracts with public and nonprofit private entities.

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

19 Secretary shall, directly or through contracts with

20 public and private entities, provide for evaluations of

21 projects carried out with financial assistance pro22 vided under paragraph (1) during the preceding 2 fis23 cal years. The report shall be included in the report

24 required under subsection (e) for the fiscal year in25 volved.
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1 ‘‘(g) DEFINITION.—As used in this section, the term

2 ‘racial and ethnic minority group’ means Hispanics,

3 Blacks, Asian Americans, Pacific Islanders, Native Ameri4 cans, and Alaskan Natives. The term ‘Hispanic’ means in5 dividuals whose origin is Mexican, Puerto Rican, Cuban,

6 Central or South American, or any other Spanish-speaking

7 country, including Spain or the Caribbean Islands, and in8 dividuals identifying themselves as Hispanic, Latino,

9 Spanish, or Spanish-American.

10 ‘‘(h) FUNDING.—

11 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—For

12 the purpose of carrying out this section, there is au13 thorized to be appropriated $20,500,000 for fiscal

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

15 each of the fiscal years 1995 through 1998.

16 ‘‘(2) ALLOCATION OF FUNDS BY SECRETARY.—Of

17 the amounts appropriated under paragraph (1) for a

18 fiscal year in excess of $15,000,000, the Secretary

19 shall make available not less than $3,000,000 for ac20 tivities to improve access to health care services for

21 individuals with limited English proficiency, includ22 ing activities identified in subsection (b)(4).’’.

23 SEC. 102. AGENCY OFFICES OF MINORITY HEALTH.

24 Title XVII (42 U.S.C. 300u et seq.) is amended by add25 ing at the end the following new section:
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1 ‘‘SEC. 1709. AGENCY OFFICES OF MINORITY HEALTH.

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

3 Office of Minority Health is operating at the Centers for

4 Disease Control and Prevention, the Health Resources and

5 Services Administration, the Substance Abuse and Mental

6 Health Services Administration, and the Agency for Health

7 Care Policy and Research. Such Offices shall ensure that

8 services and programs carried out within each such respec9 tive agency or office—

10 ‘‘(1) are equitably delivered with respect to ra11 cial and ethnic groups;

12 ‘‘(2) provide culturally and linguistically com13 petent services; and

14 ‘‘(3) utilize racial and ethnic minority commu15 nity-based organizations to deliver services.

16 ‘‘(b) REPORTS.—Each Office of Minority Health with17 in the Public Health Service, including the Office of Re18 search on Minority Health at the National Institutes of

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

20 year, to the Deputy Assistant Secretary for Minority Health

21 (as provided for in section 1707(b)) describing the accom22 plishments or programs of the plan, the budget allocation

23 and expenditures for, and the development and implementa24 tion of, such health programs targeting racial and ethnic

25 minority populations. The Secretary shall ensure the par-
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1 ticipation and cooperation of each Agency in the develop2 ment of the annual report.’’.

3 SEC. 103. STATE OFFICES OF MINORITY HEALTH.

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

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

6 following new section:

7 ‘‘SEC. 1710. GRANTS TO STATES FOR OPERATION OF OF8 FICES OF MINORITY HEALTH.

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

10 Deputy Assistant Secretary for Minority Health (as pro11 vided for in section 1707), may make grants to States for

12 the purpose of improving the health status in minority com13 munities, through the operation of State offices of minority

14 health established to monitor and facilitate the achievement

15 of the Health Objectives for the Year 2000 as they affect

16 minority populations.

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

18 may not make a grant to a State under subsection (a) un19 less such State agrees that the program carried out by the

20 State with amounts received under the grant will be admin21 istered directly by a single State agency.

22 ‘‘(c) CERTAIN REQUIRED ACTIVITIES.—The Secretary

23 may not make a grant to a State under subsection (a) un24 less such State agrees that activities carried out by an office
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1 operated under the grant received pursuant to such sub2 section will—

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

4 clearinghouse for collecting and disseminating infor5 mation on—

6 ‘‘(A) minority health care issues;

7 ‘‘(B) research findings relating to minority

8 health care; and

9 ‘‘(C) innovative approaches to the delivery

10 of health care and social services in minority

11 communities;

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

13 State that relate to minority health care, including

14 providing coordination for the purpose of avoiding re15 dundancy in such activities;

16 ‘‘(3) identify Federal and State programs re17 garding minority health, and providing technical as18 sistance to public and nonprofit entities regarding

19 participation in such program; and

20 ‘‘(4) develop additional Healthy People 2000 ob21 jectives for the State that are necessary to address the

22 most prevalent morbidity, mortality and disability

23 concerns for racial and ethnic minority groups in the

24 State.
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1 ‘‘(d) REQUIREMENT REGARDING ANNUAL BUDGET

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

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

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

5 a grant, the office operated under such grant will be pro6 vided with an annual budget of not less than $75,000.

7 ‘‘(e) CERTAIN USES OF FUNDS.—

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

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

10 such State agrees that—

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

12 health is conducted pursuant to the grant, not

13 more than 10 percent of the amount received

14 under the grant will be expended for such re15 search; and

16 ‘‘(B) amounts provided under the grant will

17 not be expended—

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

19 providing cash payments regarding such

20 care);

21 ‘‘(ii) to conduct activities for which

22 Federal funds are expended—

23 ‘‘(I) within the State to provide

24 technical and other nonfinancial as-
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1 sistance under subsection (m) of section

2 340A;

3 ‘‘(II) under a memorandum of

4 agreement entered into with the State

5 under subsection (h) of such section; or

6 ‘‘(III) under a grant under sec7 tion 388I;

8 ‘‘(iii) to purchase medical equipment,

9 to purchase ambulances, aircraft, or other

10 vehicles, or to purchase major communica11 tions equipment;

12 ‘‘(iv) to purchase or improve real prop13 erty; or

14 ‘‘(v) to carry out any activity regard15 ing a certificate of need.

16 ‘‘(2) AUTHORITIES.—Activities for which a State

17 may expend amounts received under a grant under

18 subsection (a) include—

19 ‘‘(A) paying the costs of establishing an of20 fice of minority health for purposes of subsection

21 (a);

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

23 paying the costs of any activity carried out with

24 respect to recruiting and retaining health profes-
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1 sionals to serve in minority communities or un2 derserved areas in the State; and

3 ‘‘(C) providing grants and contracts to pub4 lic and nonprofit entities to carry out activities

5 authorized in this section.

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

7 to a State under subsection (a) unless such State agrees—

8 ‘‘(1) to submit to the Secretary reports contain9 ing such information as the Secretary may require re10 garding activities carried out under this section by

11 the State; and

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

13 10 of each fiscal year immediately following any fis14 cal year for which the State has received such a

15 grant.

16 ‘‘(g) REIMBURSEMENT OF APPLICATION.—The Sec17 retary may not make a grant to a State under subsection

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

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

20 manner, and contains such agreements, assurances, and in21 formation as the Secretary determines to be necessary to

22 carry out such subsection.

23 ‘‘(h) NONCOMPLIANCE.—The Secretary may not make

24 payments under subsection (a) to a State for any fiscal year

25 subsequent to the first fiscal year of such payments unless
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1 the Secretary determines that, for the immediately preced2 ing fiscal year, the State has complied with each of the

3 agreements made by the State under this section.

4 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—

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

6 grants under subsection (a) there are authorized to be

7 appropriated $3,000,000 for fiscal year 1995,

8 $4,000,000 for fiscal year 1996, and $3,000,000 for

9 fiscal year 1997.

10 ‘‘(2) AVAILABILITY.—Amounts appropriated

11 under paragraph (1) shall remain available until ex12 pended.

13 ‘‘(j) TERMINATION OF PROGRAM.—No grant may be

14 made under this section after the aggregate amounts appro15 priated under subsection (i)(1) are equal to $10,000,000.’’.

16 SEC. 104. ASSISTANT SECRETARY OF HEALTH AND HUMAN

17 SERVICES FOR CIVIL RIGHTS.

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

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

20 43, is amended by adding at the end the following new

21 section:

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

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

24 the Department of Health and Human Services an Assist25 ant Secretary for Civil Rights, who shall be appointed by
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1 the President, by and with the advice and consent of the

2 Senate.

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

4 shall perform such functions relating to civil rights as the

5 Secretary may assign.’’.

6 (b) CONFORMING AMENDMENT.—Section 5315 of title

7 5, United States Code, is amended, in the item relating to

8 Assistant Secretaries of Health and Human Services, by

9 striking ‘‘(5)’’ and inserting ‘‘(6)’’.

10 TITLE II—HEALTH SERVICES

11 SEC. 201. COMMUNITY SCHOLARSHIP PROGRAMS.

12 Section 338L (42 U.S.C. 254t) is amended—

13 (1) in subsection (a), by striking ‘‘health man14 power shortage areas’’ and inserting ‘‘a Federally-des15 ignated health professional shortage areas’’;

16 (2) in subsection (c)—

17 (A) by striking ‘‘health manpower shortage

18 areas’’ and inserting ‘‘Federally-designated

19 health professional shortage areas’’ in the matter

20 preceding paragraph (1); and

21 (B) by striking ‘‘in the health manpower

22 shortage areas in which the community organi23 zations are located,’’ and inserting ‘‘in a Feder24 ally-designated health professional shortage area
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1 that is served by the community organization

2 awarding the scholarship,’’ in paragraph (2);

3 (3) in subsection (e)(1)—

4 (A) by striking ‘‘health manpower shortage

5 area’’ and inserting ‘‘a Federally-designated

6 health professional shortage area’’; and

7 (B) by striking ‘‘in which the community’’

8 and all that follows through ‘‘located’’;

9 (4) in subsection (k)(2), by striking ‘‘internal

10 medicine’’ and all that follows through the end thereof

11 and inserting ‘‘general internal medicine, general pe12 diatrics, obstetrics and gynecology, dentistry, or men13 tal health, that are provided by physicians or other

14 health professionals.’’; and

15 (5) in subsection (l)(1), by striking ‘‘$5,000,000’’

16 and all that follows through ‘‘1993’’ and inserting

17 ‘‘$1,000,000 for fiscal year 1994, and such sums as

18 may be necessary for each of the fiscal years 1995 and

19 1996’’.

20 SEC. 202. HEALTH SERVICES FOR RESIDENTS OF PUBLIC

21 HOUSING.

22 Section 340A(p)(1) (42 U.S.C. 256a(p)(1)) is amend23 ed—
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1 (1) by striking ‘‘$35,000,000 for fiscal year

2 1991’’ and inserting ‘‘$12,000,000 for fiscal year

3 1994’’; and

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

5 ‘‘1995 and 1996’’.

6 SEC. 203. ISSUANCE OF REGULATIONS REGARDING LAN7 GUAGE AS IMPEDIMENT TO RECEIPT OF

8 SERVICES.

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

10 of the 90-day period beginning on the date of the enactment

11 of this Act, the Secretary of Health and Human Services

12 (in this section referred to as the ‘‘Secretary’’) shall issue

13 a proposed rule regarding policies to reduce the extent to

14 which having limited English proficiency constitutes a sig15 nificant impediment to individuals in establishing the eligi16 bility of the individuals for—

17 (1) participation in health programs under the

18 Public Health Service Act;

19 (2) the receipt of services under such programs

20 and under programs under titles XVIII and XIX of

21 the Social Security Act; or

22 (3) participation in programs or activities other23 wise receiving financial assistance from the Secretary

24 or receiving services under such programs or activi25 ties.
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1 (b) FINAL RULE.—

2 (1) IN GENERAL.—Not later than the expiration

3 of the 1-year period beginning on the date of the en4 actment of this Act, the Secretary shall issue a final

5 rule regarding the policies described in subsection (a).

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

7 the Secretary fails to issue a final rule under para8 graph (1) before the expiration of the period specified

9 in such paragraph, the proposed rule issued under

10 subsection (a) is upon such expiration deemed to be

11 the final rule under paragraph (1) (and shall remain

12 in effect until the Secretary issues a final rule under

13 such paragraph).

14 SEC. 204. 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 semicolon;

11 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 1994, and such sums
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1 as may be necessary for each of the fiscal years

2 1995 and 1996’’; 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 the

7 date of enactment of this subsection, the Secretary,

8 acting through the Administrator of the Health Re9 sources and Services Administration, shall enter into

10 a contract with a public or nonprofit private entity

11 for the conduct of a study to determine the effective12 ness of projects funded under this section.

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

14 Secretary shall prepare and submit to the Committee

15 on Labor and Human Resources of the Senate and

16 the Committee on Energy and Commerce of the House

17 of Representatives a report describing the findings

18 made with respect to the study conducted under para19 graph (1).’’.

20 TITLE III—HEALTH

21 PROFESSIONS

22 SEC. 301. LOANS FOR DISADVANTAGED STUDENTS.

23 Section 724(f)(1) (42 U.S.C. 292t(f)(1)) is amended—

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

25 are’’; and
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1 (2) by striking ‘‘$15,000,000 for fiscal year

2 1993’’ and inserting ‘‘$8,000,000 for fiscal year 1994,

3 and such sums as may be necessary for each of the

4 fiscal years 1995 and 1996’’.

5 SEC. 302. CESAR CHAVEZ PRIMARY CARE SCHOLARSHIP

6 PROGRAM.

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

8 (1) by striking the section heading and inserting

9 the following:

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

11 PROGRAM.’’;

12 (2) in subsection (c)—

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

14 ‘‘there are’’; and

15 (B) by striking ‘‘$11,000,000 for fiscal year

16 1993’’ and inserting ‘‘$10,500,000 for fiscal year

17 1994, and such sums as may be necessary for

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

19 SEC. 303. THURGOOD MARSHALL SCHOLARSHIP PROGRAM.

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

21 (1) by striking the section heading and inserting

22 the following:

23 ‘‘SEC. 737. THURGOOD MARSHALL SCHOLARSHIP PRO24 GRAM.’’;

25 (2) in subsection (a)—
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1 (A) in paragraph (1), by inserting ‘‘(to be

2 known as Thurgood Marshall Scholars)’’ after

3 ‘‘providing scholarships to individuals’’; and

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

5 offering programs for the training of physician

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

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

8 and inserting the following new paragraph:

9 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—For

10 the purpose of carrying out this section, there are au11 thorized to be appropriated $17,100,000 for fiscal

12 year 1994, and such sums as may be necessary for

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

14 SEC. 304. LOAN REPAYMENTS AND FELLOWSHIPS REGARD15 ING FACULTY POSITIONS AT HEALTH PRO16 FESSIONS SCHOOLS.

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

18 (1) in subsection (a)—

19 (A) in paragraph (2), by striking ‘‘dis20 advantaged backgrounds who—’’ and inserting

21 ‘‘racial or ethnic groups that are under22 represented in the health professions who—’’

23 (B) in paragraph (5)—

24 (i) by striking ‘‘; and’’ in subpara25 graph (A) and inserting a period;
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1 (ii) by striking ‘‘unless—’’ and all that

2 follows through ‘‘the individual involved’’ in

3 subparagraph (A) and inserting ‘‘unless the

4 individual involved’’; and

5 (iii) striking subparagraph (B);

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

7 (D) by redesignating paragraph (7) as

8 paragraph (6); and

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

10 ‘‘$30,000’’ and inserting ‘‘$50,000’’;

11 (3) in subsection (c)—

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

13 ‘‘there are’’; and

14 (B) by striking ‘‘$4,000,000 for fiscal year

15 1993’’ and inserting ‘‘$1,100,000 for fiscal year

16 1994, and such sums as may be necessary for

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

18 SEC. 305. CENTERS OF EXCELLENCE.

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

20 (1) in subsection (b)—

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

22 the semicolon the following: ‘‘through collabora23 tion with public and nonprofit private entities to

24 carry out community-based programs to prepare

25 students in secondary schools and institutions of
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1 higher education for attendance at the health

2 professions school’’;

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

4 the end thereof;

5 (C) in paragraph (5), by striking the period

6 and inserting ‘‘; and’’; and

7 (D) by adding at the end thereof the follow8 ing new paragraph:

9 ‘‘(6) to train the students of the school at com10 munity-based health facilities that provide health

11 services to a significant number of minority individ12 uals and that are located at a site remote from the

13 main site of the teaching facilities of the school.’’;

14 (2) in subsection (e)—

15 (A) by striking the subsection heading and

16 inserting ‘‘AUTHORITY REGARDING CONSOR17 TIA.—’’;

18 (B) by striking paragraph (1) and inserting

19 the following new paragraph:

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

21 grant under subsection (a) to any school of medicine,

22 osteopathic medicine, dentistry, clinical psychology,

23 or pharmacy that has in accordance with paragraph

24 (2) formed a consortium of schools.’’;
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1 (C) in paragraph (2), by striking subpara2 graphs (A) through (D) and inserting the follow3 ing new subparagraphs:

4 ‘‘(A) the consortium consists of—

5 ‘‘(i) the health professions school seek6 ing the grant under subsection (a); and

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

8 osteopathic medicine, dentistry, pharmacy,

9 nursing, allied health, or public health, or

10 graduate programs in mental health prac11 tice;

12 ‘‘(B) the schools of the consortium have en13 tered into an agreement for the allocation of such

14 grant among the schools; and

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

16 grant in accordance with this section.’’; and

17 (D) by adding at the end the following

18 paragraph:

19 ‘‘(3) AUTHORITY FOR COLLECTIVELY MEETING

20 RELEVANT REQUIREMENTS IN CERTAIN CASES.—With

21 respect to meeting the conditions specified in sub22 section (c)(4) for Native American Centers of Excel23 lence, the Secretary may make a grant to any school

24 that has in accordance with paragraphs (1) and (2)

25 formed a consortium of schools that meets such condi-
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1 tions (without regard to whether the schools of the

2 consortium individually meet such conditions).’’; and

3 (3) in subsection (i)—

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

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

6 and inserting ‘‘$25,000,000 for fiscal year 1994,

7 and such sums as may be necessary for each of

8 the fiscal years 1995 and 1996’’; and

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

10 end the following: ‘‘Health professions schools de11 scribed in subsection (c)(2)(A) shall be eligible

12 for grants under this subparagraph in a fiscal

13 year if the amount appropriated for the fiscal

14 year under paragraph (1) is greater than

15 $23,500,000. Such schools shall be eligible to

16 apply only for grants made from the portion of

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

18 SEC. 306. EDUCATIONAL ASSISTANCE REGARDING UNDER19 GRADUATES.

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

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

22 following new sentence: ‘‘To be eligible for such a

23 grant, a school shall have in place a program to assist

24 individuals from disadvantaged backgrounds in gain-
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1 ing entry into a health professions school or complet2 ing the course of study at such a school.’’;

3 (2) in subsection (d)(1)—

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

5 ‘‘there are’’; and

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

7 ‘‘1994, and such sums as may be necessary for

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

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

10 thereof the following new sentence: ‘‘Scholarship re11 cipients under this section shall be known as ‘Cesar

12 Chavez Primary Care Scholars’.’’.

13 SEC. 307. AREA HEALTH EDUCATION CENTERS.

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

15 amended by inserting ‘‘and minority health’’ after ‘‘disease

16 prevention’’.

17 TITLE IV—RESEARCH AND DATA

18 COLLECTION

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

20 Section 404 (42 U.S.C. 283b), as added by section 151

21 of Public Law 103–43, is amended by adding at the end

22 the following subsections:

23 ‘‘(c) PLAN.—The Director of the Office, shall collabo24 rate with the Deputy Assistant Secretary for Minority

25 Health (as provided for in section 1707), to develop and
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1 implement a plan for carrying out the duties required by

2 subsection (b). The Director, in consultation with the Dep3 uty Assistant Secretary for Minority Health, shall review

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

5 as appropriate.

6 ‘‘(d) EQUITY REGARDING VARIOUS GROUPS.—The Di7 rector of the Office shall ensure that activities under sub8 section (b) address equitably all minority groups.

9 ‘‘(e) ADVISORY COMMITTEE.—

10 ‘‘(1) ESTABLISHMENT.—In carrying out sub11 section (b), the Secretary shall establish an advisory

12 committee to be known as the Advisory Committee on

13 Research on Minority Health (in this subsection re14 ferred to as the ‘Advisory Committee’).

15 ‘‘(2) COMPOSITION.—

16 ‘‘(A) VOTING AND NONVOTING MEMBERS.—

17 The Advisory Committee shall be composed of

18 voting members appointed in accordance with

19 subparagraph (B) and the ex officio nonvoting

20 members described in subparagraph (C).

21 ‘‘(B) VOTING MEMBERS.—The Advisory

22 Committee shall include not fewer than 12, and

23 not more than 18, voting members who are not

24 officers or employees of the Federal Government.

25 The Director of the Office shall appoint such
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1 members to the Advisory Committee from among

2 physicians, practitioners, scientists, consumers

3 and other health professionals, whose clinical

4 practices, research specialization, or professional

5 expertise includes a significant focus on research

6 on minority health or on the barriers that mi7 norities must overcome to participate in clinical

8 trials. The membership of the Advisory Commit9 tee shall be equitably representative of the minor10 ity groups served by the Office.

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

12 The Deputy Assistant Secretary for Minority

13 Health and the Directors of each of the national

14 research entities shall serve as ex officio

15 nonvoting members of the Advisory Committee

16 (except that any of such Directors may designate

17 an official of the institute involved to serve as

18 such member of the Committee in lieu of the Di19 rector).

20 ‘‘(3) CHAIRPERSON.—The Director of the Office

21 shall serve as the chairperson of the Advisory Com22 mittee.

23 ‘‘(4) DUTIES.—The Advisory Committee shall—
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1 ‘‘(A) advise the Director of the Office on ap2 propriate research activities to be undertaken by

3 the national research institutes with respect to—

4 ‘‘(i) research on minority health;

5 ‘‘(ii) research on racial and ethnic dif6 ferences in clinical drug trials, including

7 responses to pharmacological drugs;

8 ‘‘(iii) research on racial and ethnic

9 differences in disease etiology, course, and

10 treatment; and

11 ‘‘(iv) research on minority health con12 ditions which require a multidisciplinary

13 approach;

14 ‘‘(B) report to the Director of the Office on

15 such research;

16 ‘‘(C) provide recommendations to such Di17 rector regarding activities of the Office (includ18 ing recommendations on priorities in carrying

19 out research described in subparagraph (A)); and

20 ‘‘(D) assist in monitoring compliance with

21 section 492B regarding the inclusion of minori22 ties in clinical research.

23 ‘‘(5) BIENNIAL REPORT.—

24 ‘‘(A) PREPARATION.—The Advisory Com25 mittee shall prepare a biennial report describing
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1 the activities of the Committee, including find2 ings made by the Committee regarding—

3 ‘‘(i) compliance with section 492B;

4 ‘‘(ii) the extent of expenditures made

5 for research on minority health by the agen6 cies of the National Institutes of Health;

7 and

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

9 such research.

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

11 subparagraph (A) shall be submitted to the Di12 rector of the National Institutes of Health for in13 clusion in the report required in section 403.

14 ‘‘(f) REPRESENTATIVES OF MINORITIES AMONG RE15 SEARCHERS.—The Secretary, acting through the Assistant

16 Secretary for Personnel Administration and in collabora17 tion with the Director of the Office, shall determine the ex18 tent to which minorities are represented among senior phy19 sicians and scientists of the national research institutes and

20 among physicians and scientists conducting research with

21 funds provided by such institutes, and as appropriate,

22 carry out activities to increase the extent of such representa23 tion.

24 ‘‘(g) DEFINITIONS.—For purposes of this part:
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1 ‘‘(1) MINORITY HEALTH CONDITIONS.—The term

2 ‘minority health conditions’, with respect to individ3 uals who are members of minority groups, means all

4 diseases, disorders, and conditions (including with re5 spect to mental health)—

6 ‘‘(A) unique to, more serious, or more prev7 alent in such individuals;

8 ‘‘(B) for which the factors of medical risk or

9 types of medical intervention are different for

10 such individuals, or for which it is unknown

11 whether such factors or types are different for

12 such individuals; or

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

14 insufficient research involving such individuals

15 as subjects or insufficient data on such individ16 uals.

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

18 term ‘research on minority health’ means research on

19 minority health conditions, including research on pre20 venting such conditions.

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

22 groups’ means Blacks, American Indians, Alaskan

23 Natives, Asian/Pacific Islanders, and Hispanics, in24 cluding subpopulations of such groups.’’.
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1 SEC. 402. NATIONAL CENTER FOR HEALTH STATISTICS.

2 (a) IN GENERAL.—Section 306 (42 U.S.C. 242k) is

3 amended—

4 (1) in subsection (c), by striking ‘‘Committee on

5 Human Resources’’ and inserting ‘‘Committee on

6 Labor and Human Resources’’;

7 (2) in subsection (g), by striking ‘‘data which

8 shall be published’’ and all that follows and inserting

9 ‘‘data.’’;

10 (3) in subsection (k)(2)—

11 (A) in subparagraph (A)—

12 (i) by striking the subparagraph des13 ignation; and

14 (ii) by striking ‘‘Except as provided in

15 subparagraph (B), members’’ and inserting

16 ‘‘Members’’; and

17 (B) by striking subparagraph (B);

18 (4) in subsection (l)—

19 (A) by striking paragraph (3);

20 (B) by redesignating paragraph (4) as

21 paragraph (3); and

22 (C) in paragraph (3) (as so redesignated),

23 by striking ‘‘paragraphs (1), (2), and (3),’’ and

24 inserting ‘‘paragraphs (1) and (2),’’; and

25 (5) in subsection (o)—
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1 (A) in paragraph (1), by striking ‘‘1991

2 through 1993’’ and inserting ‘‘1994 through

3 1997’’; and

4 (B) in paragraph (2), by striking

5 ‘‘$5,000,000’’ and all that follows through

6 ‘‘1993’’ and inserting ‘‘$1,100,000 for fiscal year

7 1994, and such sums as may be necessary for

8 each of the fiscal years 1995 through 1997’’.

9 (b) GENERAL AUTHORITY RESPECTING RESEARCH,

10 EVALUATIONS, AND DEMONSTRATIONS.—Section 304 (42

11 U.S.C. 242b) is amended by striking subsection (d).

12 (c) GENERAL PROVISIONS RESPECTING EFFECTIVE13 NESS, EFFICIENCY, AND QUALITY OF HEALTH SERVICES.—

14 Section 308 (42 U.S.C. 242m) is amended—

15 (1) in subsection (a)—

16 (A) in paragraph (1)—

17 (i) by striking subparagraph (A); and

18 (ii) by redesignating subparagraphs

19 (B) through (E) as subparagraphs (A)

20 through (D), respectively; and

21 (B) in paragraph (2), by striking ‘‘reports

22 required by subparagraphs’’ and all that follows

23 through ‘‘Center’’ and inserting the following:

24 ‘‘reports required in paragraph (1) shall be pre25 pared through the National Center’’;
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1 (2)(A) by striking subsection (c);

2 (B) by transferring paragraph (2) of subsection

3 (g) from the current location of the paragraph;

4 (C) by redesignating such paragraph as sub5 section (c);

6 (D) by inserting subsection (c) (as so redesig7 nated) after subsection (b); and

8 (E) by striking the remainder of subsection (g);

9 (3) in subsection (c) (as so redesignated)—

10 (A) by striking ‘‘shall (A) take’’ and insert11 ing ‘‘shall take’’; and

12 (B) by striking ‘‘and (B) publish’’ and in13 serting ‘‘and shall publish’’;

14 (4) in subsection (f), by striking ‘‘sections 3648’’

15 and all that follows and inserting ‘‘section 3324 of

16 title 31, United States Code, and section 3709 of the

17 Revised Statutes (41 U.S.C. 5).’’; and

18 (5) by striking subsection (h).

19 SEC. 403. ACTIVITIES OF AGENCY FOR HEALTH CARE POL20 ICY AND RESEARCH.

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

22 as follows:

23 ‘‘(b) REQUIREMENTS WITH RESPECT TO CERTAIN

24 POPULATIONS.—In carrying out subsection (a), the Admin25 istrator shall undertake and support research, demonstra-
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1 tion projects, and evaluations with respect to the health sta2 tus of, and the delivery of health care to—

3 ‘‘(1) the populations of medically underserved

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

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

6 the elderly.’’.

7 TITLE V—MISCELLANEOUS

8 SEC. 501. REVISION AND EXTENSION OF PROGRAM FOR

9 STATE OFFICES OF RURAL HEALTH.

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

11 254r(b)) is amended to read as follows:

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

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

14 be incurred by a State in carrying out the purpose

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

16 make a grant under such subsection unless the State

17 agrees to provide non-Federal contributions toward

18 such costs, in cash, in an amount that is not less than

19 $1 for each $1 of Federal funds provided in the grant.

20 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB21 UTED.—In determining the amount of non-Federal

22 contributions in cash that a State has provided pur23 suant to paragraph (1), the Secretary may not in24 clude any amounts provided to the State by the Fed25 eral Government.’’.
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1 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

2 338J(j)(1) (42 U.S.C. 254r(j)(1)) is amended—

3 (1) by striking ‘‘and’’ after ‘‘1992,’’; and

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

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

6 through 1996’’.

7 (c) TERMINATION OF PROGRAM.—Section 338J(k) (42

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

9 inserting ‘‘$20,000,000’’.

10 SEC. 502. TECHNICAL CORRECTIONS RELATING TO HEALTH

11 PROFESSIONS.

12 (a) HEALTH EDUCATION ASSISTANCE LOAN

13 DEFERMENT FOR BORROWERS PROVIDING HEALTH SERV14 ICES TO INDIANS.—

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

16 amended by striking ‘‘and (x)’’ and inserting ‘‘(x) not

17 in excess of three years, during which the borrower is

18 providing health care services to Indians through an

19 Indian health program (as defined in section

20 108(a)(2)(A) of the Indian Health Care Improvement

21 Act (25 U.S.C. 1616a(a)(2)(A)); and (xi)’’.

22 (2) CONFORMING AMENDMENTS.—Section

23 705(a)(2)(C) is further amended—

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

25 striking ‘‘(ix)’’ and inserting ‘‘(x)’’; and
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1 (B) in the matter following such clause (xi),

2 by striking ‘‘(x)’’ and inserting ‘‘(xi)’’.

3 (3) EFFECTIVE DATE.—The amendments made

4 by this subsection shall apply with respect to services

5 provided on or after the first day of the third month

6 that begins after the date of enactment of this Act.

7 (b) MAXIMUM STUDENT LOAN PROVISION.—

8 (1) IN GENERAL.—Section 722(a)(1) (42 U.S.C.

9 292r(a)(1)), as amended by section 2014(b)(1) of Pub10 lic Law 103–43, is amended by striking ‘‘the sum of’’

11 and all that follows through the end thereof and in12 serting ‘‘the cost of attendance (including tuition,

13 other reasonable educational expenses, and reasonable

14 living costs) for that year at the educational institu15 tion attended by the student (as determined by such

16 educational institution).’’.

17 (2) THIRD AND FOURTH YEARS.—Section

18 722(a)(2) (42 U.S.C. 292r(a)(2)), as amended by sec19 tion 2014(b)(1) of Public Law 103–43, is amended by

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

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

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

23 fourth year of a student at school of medicine or os24 teopathic medicine, be increased to the extent nec25 essary’’.
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1 (c) REQUIREMENT FOR SCHOOLS.—Section 723(b)(1)

2 (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), is

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

5 years before’’.

6 (d) SERVICE REQUIREMENT FOR PRIMARY CARE LOAN

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

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

9 ‘‘through the date on which the loan is repaid in full’’ and

10 inserting ‘‘for 5 years after completing the residency pro11 gram’’.

12 (e) PREFERENCE AND REQUIRED INFORMATION IN

13 CERTAIN PROGRAMS.—

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

15 amended by adding at the end thereof the following

16 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 has

25 graduated less than three classes. Upon graduating at
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1 least three classes, a program shall have the capabil2 ity to provide the information necessary to qualify the

3 program for the general funding preferences described

4 in subsection (a).

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

6 paragraph (1) are the following:

7 ‘‘(A) The mission statement of the program

8 identifies a specific purpose of the program as

9 being the preparation of health professionals to

10 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 of

19 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 students

2 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. 298b-7)

7 is amended by adding at the end thereof the following

8 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 has

17 graduated less than three classes. Upon graduating at

18 least three classes, a program shall have the capabil19 ity to provide the information necessary to qualify the

20 program for the general funding preferences described

21 in subsection (a).

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

23 paragraph (1) are the following:

24 ‘‘(A) The mission statement of the program

25 identifies a specific purpose of the program as
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1 being the preparation of health professionals to

2 serve underserved populations.

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

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

8 underserved communities.

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

11 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 students

19 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. 295p(6))

24 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 less

12 than 50 percent of the patients are recipients of

13 aid under title XIX of the Social Security Act or

14 eligible and uninsured.’’.

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

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

18 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 enact-
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1 ment of the Health Professions Education Extension

2 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 follow5 ing 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 section

12 existed one day prior to the date of enactment of the Health

13 Professions Education Extension Amendments of 1992

14 (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 pub19 lic or other nonprofit agency that would have been

20 qualified to file an application under section 605;

21 ‘‘(B) in case of a facility which was not an af22 filiated hospital or outpatient facility but was a facil23 ity with respect to which funds have been paid under

24 paragraph (1) or (3) of such section 720(a), the owner
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1 of the facility ceases to be a public or nonprofit

2 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 ceases

6 to be a public or nonprofit entity,

7 ‘‘(2) the facility ceases to be used for the teaching

8 or training purposes (or other purposes permitted

9 under section 722 (as such section existed one day

10 prior to the date of enactment of the Health Profes11 sions Education Extension Amendments of 1992

12 (Public Law 102–408)) for which it was constructed,

13 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 owner

17 of the facility the base amount prescribed by subsection

18 (c)(1) plus the interest (if any) prescribed by subsection

19 (c)(2).

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

21 be a public or nonprofit agency, school, or entity as de22 scribed 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 notice
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1 of such cessation or change of use within 10 days after the

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

3 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 the

7 United States is entitled to recover under subsection

8 (a) is the amount bearing the same ratio to the then

9 value (as determined by the agreement of the parties

10 or in an action brought in the district court of the

11 United States for the district in which the facility is

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

13 participation bore to the cost of construction.

14 ‘‘(2) INTEREST.—

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

16 United States is entitled to recover under sub17 section (a) is the interest for the period (if any)

18 described in subparagraph (B) at a rate (deter19 mined by the Secretary) based on the average of

20 the bond equivalent rates of ninety-one-day

21 Treasury bills auctioned during that period.

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

23 subparagraph (A) is the period beginning—

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

25 by subsection (b), 191 days after the date on
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1 which the owner of the facility ceases to be

2 a public or nonprofit agency, school, or en3 tity as described in subparagraph (A), (B),

4 or (C) of subsection (a)(1), as the case may

5 be, or 191 days after the date on which the

6 use of the facility changes as described in

7 paragraph (2) or (3) of subsection (a), or

8 ‘‘(ii) if notice is not provided as pre9 scribed by subsection (b), 11 days after the

10 date on which such cessation or change of

11 use occurs,

12 and ending on the date the amount the United

13 States is entitled to recover is collected.

14 ‘‘(d) WAIVER.—The Secretary may waive the recovery

15 rights of the United States under subsection (a)(2) with re16 spect to a facility (under such conditions as the Secretary

17 may establish by regulation) if the Secretary determines

18 that there is good cause for waiving such rights.

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

20 under subsection (a) shall not, prior to judgment, constitute

21 a lien on any facility.’’.

22 SEC. 503. CLINICAL TRAINEESHIPS.

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

24 by inserting ‘‘counseling’’ after ‘‘family therapy,’’.
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1 SEC. 504. DEMONSTRATION PROJECT GRANTS TO STATES

2 FOR ALZHEIMER’S DISEASE.

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

4 3(a)) is amended—

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

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

7 (2) in paragraph (2)—

8 (A) by inserting after ‘‘disorders’’ the fol9 lowing: ‘‘who are living in single family homes

10 or in congregate settings’’; and

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

12 (3) by redesignating paragraph (3) as para13 graph (4); and

14 (4) by inserting after paragraph (2) the follow15 ing:

16 ‘‘(3) to improve access for individuals with Alz17 heimer’s disease or related disorders, particularly

18 such individuals from ethnic, cultural, or language

19 minorities and such individuals who are living in

20 isolated rural areas, to services that—

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

22 long-term care services; and

23 ‘‘(B) exist on the date of enactment of this

24 paragraph; and’’.

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

26 amended—
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1 (1) in the title, by striking ‘‘LIMITATION

2 ON’’;

3 (2) in subsection (a)—

4 (A) in the heading, by striking ‘‘LIMITA5 TION ON’’; and

6 (B) by striking ‘‘may not exceed’’ and in7 serting ‘‘may exceed’’; and

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

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

10 after ‘‘third year’’.

11 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

12 398B(e) (42 U.S.C. 280c–5(e)) is amended by striking ‘‘and

13 1993’’ and inserting ‘‘through 1998’’.

14 SEC. 505. MEDICALLY UNDERSERVED AREA STUDY.

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

16 Human Services shall conduct a study concerning the fea17 sibility and desirability of, and the criteria to be used for,

18 combining the designations of ‘‘health professional shortage

19 area’’ and ‘‘medically underserved area’’ into a single

20 health professional shortage area designation.

21 (b) REQUIREMENTS.—As part of the study conducted

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

23 Services, in considering the statutory and regulatory re24 quirements necessary for the creation of a single health pro25 fessional shortage area designation, shall—
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1 (1) review and report on the application of cur2 rent statutory and regulatory criteria used—

3 (A) in designating an area as a health pro4 fessional shortage area;

5 (B) in designating an area as a medically

6 underserved area; and

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

8 health professional shortage area designations of

9 such State; and

10 (2) review the suggestions of public health and

11 primary care experts.

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

13 enactment of this Act, the Secretary of Health and Human

14 Services shall prepare and submit to the appropriate com15 mittees of Congress a report concerning the findings of the

16 study conducted under subsection (a) together with the rec17 ommendations of the Secretary.

18 (d) RECOMMENDATIONS.—In making recommenda19 tions under subsection (c), the Secretary of Health and

20 Human Services shall give special consideration to (and de21 scribe in the report) the unique impact of designation cri22 teria on different rural and urban populations, and ethnic

23 and racial minorities, including—

24 (1) rational service areas, and their application

25 to frontier areas and inner-city communities;
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1 (2) indicators of high medical need, including

2 fertility rates, infant mortality rates, pediatric popu3 lation, elderly population, poverty rates, and physi4 cian to population ratios; and

5 (3) indicators of insufficient service capacity, in6 cluding language proficiency criteria for ethnic popu7 lations, annual patient visits per physician, waiting

8 times for appointments, waiting times in a primary

9 care physician office, excessive use of emergency fa10 cilities, low annual office visit rate, and demand on

11 physicians in contiguous rural or urban areas.

12 SEC. 506. PROGRAMS REGARDING BIRTH DEFECTS.

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

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

15 102–531 (106 Stat. 3494), is amended to read as follows:

16 ‘‘PROGRAMS REGARDING BIRTH DEFECTS

17 ‘‘SEC. 317C. (a) The Secretary, acting through the Di18 rector of the Centers for Disease Control and Prevention,

19 shall carry out programs—

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

21 on birth defects, including data on the causes of such

22 defects and on the incidence and prevalence of such

23 defects;

24 ‘‘(2) to provide information and education to the

25 public on the prevention of such defects;
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1 ‘‘(3) to operate centers for the conduct of applied

2 epidemiologic research and study of such defects, and

3 to improve the education, training, and clinical skills

4 of health professionals with respect to the prevention

5 of such defects; and

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

7 prevention of such defects.

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

9 subsection (a)(1), the Secretary shall establish and main10 tain a National Information Clearinghouse on Birth De11 fects to collect and disseminate to health professionals and

12 the general public information on birth defects, including

13 the prevention of such defects.

14 ‘‘(c) GRANTS AND CONTRACTS.—

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

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

17 contracts with public and nonprofit private entities.

18 Recipients of assistance under this subsection shall

19 collect and analyze demographic data utilizing appro20 priate sources as determined by the Secretary.

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

22 AWARD FUNDS.—

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

24 award of a grant or contract under paragraph

25 (1), the Secretary may, subject to subparagraph
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1 (B), provide supplies, equipment, and services

2 for the purpose of aiding the recipient in carry3 ing out the purposes for which the award is

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

5 recipient any officer or employee of the Depart6 ment of Health and Human Services.

7 ‘‘(B) With respect to a request described in

8 subparagraph (A), the Secretary shall reduce the

9 amount of payments under the award involved

10 by an amount equal to the costs of detailing per11 sonnel and the fair market value of any supplies,

12 equipment, or services provided by the Secretary.

13 The Secretary shall, for the payment of expenses

14 incurred in complying with such request, expend

15 the amounts withheld.

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

17 may make an award of a grant or contract under

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

19 is submitted to the Secretary and the application is

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

21 such agreements, assurances, and information as the

22 Secretary determines to be necessary to carry out the

23 purposes for which the award is to be made.

24 ‘‘(d) BIENNIAL REPORT.—Not later than February 1

25 of fiscal year 1995 and of every second such year thereafter,
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1 the Secretary shall submit to the Committee on Energy and

2 Commerce of the House of Representatives, and the Commit3 tee on Labor and Human Resources of the Senate, a report

4 that, with respect to the preceding 2 fiscal years—

5 ‘‘(1) contains information regarding the inci6 dence and prevalence of birth defects and the extent

7 to which birth defects have contributed to the inci8 dence and prevalence of infant mortality;

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

10 that is specific to various racial and ethnic groups;

11 and

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

13 which each approach to preventing birth defects has

14 been effective, including a description of effectiveness

15 in relation to cost;

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

17 this section; and

18 ‘‘(5) contains any recommendations of the Sec19 retary regarding this section.

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

21 purpose of carrying out this section, there are authorized

22 to be appropriated such sums as may be necessary for each

23 of the fiscal years 1994 through 1997.’’.
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1 TITLE VI—GENERAL PROVISIONS

2 SEC. 601. EFFECTIVE DATE.

3 This Act and the amendments made by this Act shall

4 take effect October 1, 1993, or upon the date of the enact5 ment of this Act, whichever occurs later.

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