In the House of Representatives, U. S.,

May 23, 1994.

Resolved, That the bill from the Senate (S. 1569) entitled ‘‘An Act to amend the Public Health Service Act to establish, reauthorize and revise provisions to improve the

health of individuals from disadvantaged backgrounds, and

for other purposes’’, do pass with the following

AMENDMENTS:

Strike out all after the enacting clause, and insert:

1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

2 (a) SHORT TITLE.—This Act may be cited as the ‘‘Mi3 nority Health Improvement Act of 1994’’.

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

5 this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I—OFFICE OF MINORITY HEALTH

Sec. 101. Revision and extension of programs of Office of Minority Health.

Sec. 102. Establishment of individual offices of minority health within agencies

of Public Health Service.

TITLE II—PRIMARY HEALTH SERVICES

Sec. 201. Migrant health centers; community health centers.

Sec. 202. Health services for the homeless.

Sec. 203. Health services for residents of public housing.

Sec. 204. Grants to States for loan repayment programs regarding obligated service of health professionals.

Sec. 205. Grants to States for operation of State offices of rural health.

Sec. 206. Demonstration grants to States for community scholarship programs regarding obligated service of health professionals.

Sec. 207. Programs regarding birth defects.

Sec. 208. Healthy start for infants.

Sec. 209. Demonstration projects regarding diabetic-retinopathy.
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TITLE III—HEALTH PROFESSIONS PROGRAMS

Sec. 301. Primary care scholarships for students from disadvantaged backgrounds.

Sec. 302. Scholarships generally; certain other purposes.

Sec. 303. Loan repayments and fellowships regarding faculty positions.

Sec. 304. Centers of Excellence.

Sec. 305. Educational assistance regarding undergraduates.

Sec. 306. Student loans regarding schools of nursing.

Sec. 307. Federally-supported student loans funds.

TITLE IV—RESEARCH

Sec. 401. Office of Research on Minority Health.

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

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

TITLE V—NATIVE HAWAIIAN HEALTH CARE

Sec. 501. Clarification of 1992 amendments.

Sec. 502. Amendment of Native Hawaiian Health Care Improvement Act to reflect 1992 agreement.

Sec. 503. Repeal of Public Health Service Act provision.

TITLE VI—WOMEN’S HEALTH

Sec. 601. Establishment of Office of Women’s Health.

Sec. 602. Women’s scientific employment regarding National Institutes of Health.

Sec. 603. Information and education regarding female genital mutilation.

Sec. 604. Study regarding curricula of medical schools and women’s health conditions.

TITLE VII—TRAUMATIC BRAIN INJURY

Sec. 701. Programs of Centers for Disease Control and Prevention.

Sec. 702. Programs of National Institutes of Health.

Sec. 703. Programs of Health Resources and Services Administration.

Sec. 704. Study; consensus conference.

TITLE VIII—MISCELLANEOUS PROVISIONS

Sec. 801. Technical amendment to Indian Health Care Improvement Act.

Sec. 802. Health services for Pacific Islanders.

Sec. 803. Technical corrections regarding Public Law 103–183.

Sec. 804. Certain authorities of Centers for Disease Control and Prevention.

Sec. 805. Establishment of public health analytical laboratory.

Sec. 806. Administration of certain requirements.

Sec. 807. Revisions to eligibility requirements for entities subject to drug pricing

limitations.

TITLE IX—GENERAL PROVISIONS

Sec. 901. Effective date.
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1 TITLE I—OFFICE OF MINORITY

2 HEALTH

3 SEC. 101. REVISION AND EXTENSION OF PROGRAMS OF OF4 FICE OF MINORITY HEALTH.

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

6 Service Act (42 U.S.C. 300u–6) is amended by striking sub7 section (b) and all that follows and inserting the following:

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

9 of minority groups, the Secretary shall carry out the follow10 ing:

11 ‘‘(1) In consultation with the advisory council

12 under subsection (c), establish goals and objectives re13 garding disease prevention, health promotion, service

14 delivery, and research, and coordinate all activities

15 within the Department of Health and Human Serv16 ices that relate to such goals and objectives.

17 ‘‘(2) In consultation with such council, enter

18 into interagency agreements with other agencies of the

19 Service, and under such agreements provide amounts

20 to such agencies, to carry out the following:

21 ‘‘(A) Support research, demonstrations and

22 evaluations to test new and innovative models of

23 delivering services.

24 ‘‘(B) Increase knowledge and understanding

25 of health risk factors.
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1 ‘‘(C) Ensure that the National Center for

2 Health Statistics collects data on the health sta3 tus of each minority group.

4 ‘‘(D) With respect to individuals who lack

5 proficiency in speaking the English language,

6 enter into contracts with public and nonprofit

7 private providers of primary health services for

8 the purpose of increasing the access of the indi9 viduals to such services by developing and carry10 ing out programs to provide bilingual or inter11 pretive services.

12 ‘‘(3) Establish by contract a center to carry out

13 the following:

14 ‘‘(A) Facilitate the exchange of information

15 regarding matters relating to health information

16 and health promotion, preventive health services,

17 and education in the appropriate use of health

18 care.

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

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

21 problems relating to such matters.

22 ‘‘(D) Provide technical assistance with re23 spect to the exchange of such information (in24 cluding facilitating the development of materials

25 for such technical assistance).
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1 ‘‘(4)(A) Establish by contract a center for the

2 purpose of carrying out programs to improve access

3 to health care services for individuals who lack pro4 ficiency in speaking the English language by develop5 ing and carrying out programs to provide bilingual

6 or interpretive services.

7 ‘‘(B) In carrying out subparagraph (A), ensure

8 that—

9 ‘‘(i) the center under such subparagraph

10 conducts research, develops and evaluates model

11 projects, and provides technical assistance to

12 health care providers; and

13 ‘‘(ii) such center is not operated by the en14 tity that operates the center established under

15 paragraph (3).

16 ‘‘(c) ADVISORY COMMITTEE.—

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

18 an advisory committee to be known as the Advisory

19 Committee on Minority Health (in this subsection re20 ferred to as the ‘Committee’).

21 ‘‘(2) DUTIES.—The Committee shall provide ad22 vice to the Secretary on carrying out this section, in23 cluding advice on carrying out paragraphs (1) and

24 (2) of subsection (b) for each minority group.

25 ‘‘(3) COMPOSITION.—
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1 ‘‘(A) The Committee shall be composed of 12

2 voting members appointed in accordance with

3 subparagraph (B) and the nonvoting, ex officio

4 members designated under subparagraph (C).

5 ‘‘(B) The voting members of the Committee

6 shall be appointed from among individuals who

7 have expertise regarding the health status of mi8 nority groups and the access of such groups to

9 health services, which individuals are not officers

10 or employees of the Federal Government. The ap11 pointed membership of the Committee shall be

12 broadly representative of the various minority

13 groups.

14 ‘‘(C) The Secretary shall designate as ex

15 officio members of the Committee the heads of the

16 minority health offices referred to in section

17 1707A.

18 ‘‘(d) APPROPRIATE CONTEXT OF SERVICES.—The Sec19 retary shall ensure that information and services provided

20 pursuant to subsection (b) are provided in the language and

21 cultural context that is most appropriate for the individuals

22 for whom the information and services are intended.

23 ‘‘(e) EQUITABLE ALLOCATION OF SERVICES.—The Sec24 retary shall ensure that services provided under subsection
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1 (b) are equitably allocated among the various minority

2 groups.

3 ‘‘(f) CONSULTATION WITH INDIVIDUAL MINORITY

4 HEALTH OFFICES.—In carrying out subsection (b) regard5 ing a specified agency, the Secretary shall consult with the

6 head of the minority health office of the agency. For pur7 poses of the preceding sentence, the terms ‘specified agency’

8 and ‘minority health office’ have the meaning given such

9 terms in section 1707A(f).

10 ‘‘(g) BIENNIAL REPORTS.—Not later than February 1

11 of fiscal year 1996 and of each second year thereafter, the

12 Secretary shall submit to the Committee on Energy and

13 Commerce of the House of Representatives, and to the Com14 mittee on Labor and Human Resources of the Senate, a

15 report describing the activities carried out under this sec16 tion during the preceding 2 fiscal years and evaluating the

17 extent to which such activities have been effective in improv18 ing the health of minority groups. Each such report shall

19 include the biennial reports submitted to the Secretary

20 under section 1707A(e) for such years by the heads of the

21 minority health offices.

22 ‘‘(h) DEFINITION.—For purposes of this section, the

23 term ‘minority groups’ means African Americans, Amer24 ican Indians, Asian Americans, Hispanics, and Pacific Is25 landers.
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1 ‘‘(i) FUNDING.—

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

3 the purpose of carrying out this section, there is au4 thorized to be appropriated $21,000,000 for each of

5 the fiscal years 1995 through 1997.

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

7 the amounts appropriated under paragraph (1) for a

8 fiscal year, the Secretary shall make available not less

9 than $3,000,000 for carrying out subsection

10 (b)(2)(D).’’.

11 (b) MISCELLANEOUS AMENDMENT.—Section 1707 of

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

13 amended in the heading for the section by striking ‘‘ESTAB14 LISHMENT OF’’.

15 SEC. 102. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MI16 NORITY HEALTH WITHIN AGENCIES OF PUB17 LIC HEALTH SERVICE.

18 Title XVII of the Public Health Service Act (42 U.S.C.

19 300u et seq.) is amended by inserting after section 1707

20 the following section:

21 ‘‘INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN

22 PUBLIC HEALTH SERVICE

23 ‘‘SEC. 1707A. (a) IN GENERAL.—The head of each

24 agency specified in subsection (b)(1) shall establish within

25 the agency an office to be known as the Office of Minority

26 Health. Each such Office shall be headed by a director, who
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1 shall be appointed by the head of the agency within which

2 the Office is established, and who shall report directly to

3 the head of the agency. The head of such agency shall carry

4 out this section (as this section relates to the agency) acting

5 through such Director.

6 ‘‘(b) SPECIFIED AGENCIES.—

7 ‘‘(1) IN GENERAL.—The agencies referred to in

8 subsection (a) are the following:

9 ‘‘(A) The Centers for Disease Control and

10 Prevention.

11 ‘‘(B) The Agency for Health Care Policy

12 and Research.

13 ‘‘(C) The Health Resources and Services Ad14 ministration.

15 ‘‘(D) The Substance Abuse and Mental

16 Health Services Administration.

17 ‘‘(2) NATIONAL INSTITUTES OF HEALTH.—For

18 purposes of subsection (c) and the subsequent provi19 sions of this section, the term ‘minority health office’

20 includes the Office of Research on Minority Health es21 tablished within the National Institutes of Health.

22 The Director of the National Institutes of Health shall

23 carry out this section (as this section relates to the

24 agency) acting through the Director of such Office.
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1 ‘‘(c) COMPOSITION.—The head of each specified agency

2 shall ensure that the officers and employees of the minority

3 health office of the agency are, collectively, experienced in

4 carrying out community-based health programs for each of

5 the various minority groups that are present in significant

6 numbers in the United States. The head of such agency shall

7 ensure that, of such officers and employees who are members

8 of minority groups, no such group is disproportionately

9 represented.

10 ‘‘(d) DUTIES.—Each Director of a minority health of11 fice shall monitor the programs of the specified agency of

12 such office in order to—

13 ‘‘(1) determine the extent to which the purposes

14 of the programs are being carried out with respect to

15 minority groups;

16 ‘‘(2) determine the extent to which members of

17 such groups are represented among the Federal offi18 cers and employees who administer the programs; and

19 ‘‘(3) make recommendations to the head of such

20 agency on carrying out the programs with respect to

21 such groups.

22 ‘‘(e) BIENNIAL REPORTS TO SECRETARY.—The head of

23 each specified agency shall submit to the Secretary for in24 clusion in each biennial report under section 1707(g) (with25 out change) a biennial report describing—
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1 ‘‘(1) the extent to which the minority health of2 fice of the agency employs individuals who are mem3 bers of minority groups, including a specification by

4 minority group of the number of such individuals em5 ployed by such office; and

6 ‘‘(2) the manner in which the agency is comply7 ing with Public Law 94–311 (relating to data on

8 Americans of Spanish origin or descent).

9 ‘‘(f) DEFINITIONS.—For purposes of this section:

10 ‘‘(1) The term ‘minority health office’ means an

11 office established under subsection (a), subject to sub12 section (b)(2).

13 ‘‘(2) The term ‘minority group’ has the meaning

14 given such term in section 1707(h).

15 ‘‘(3) The term ‘specified agency’ means—

16 ‘‘(A) an agency specified in subsection

17 (b)(1); and

18 ‘‘(B) the National Institutes of Health.

19 ‘‘(g) FUNDING.—

20 ‘‘(1) ALLOCATIONS.—Of the amounts appro21 priated for a specified agency for a fiscal year, the

22 Secretary may reserve not more than 0.5 percent for

23 the purpose of carrying out activities under this sec24 tion through the minority health office of the agency.

25 In reserving an amount under the preceding sentence
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1 for a minority health office for a fiscal year, the Sec2 retary shall reduce, by substantially the same percent3 age, the amount that otherwise would be available for

4 each of the programs of the designated agency in5 volved.

6 ‘‘(2) AVAILABILITY OF FUNDS FOR STAFFING.—

7 The purposes for which amounts made available

8 under paragraph (1) may be expended by a minority

9 health office include the costs of employing staff for

10 such office.’’.

11 TITLE II—PRIMARY HEALTH

12 SERVICES

13 SEC. 201. MIGRANT HEALTH CENTERS; COMMUNITY

14 HEALTH CENTERS.

15 (a) MIGRANT HEALTH CENTERS.—

16 (1) TREATMENT OF PREGNANT WOMEN FOR SUB17 STANCE ABUSE.—Section 329(a) of the Public Health

18 Service Act (42 U.S.C. 254b(a)) is amended—

19 (A) in paragraph (1)(C)—

20 (i) by inserting ‘‘(i)’’ after ‘‘(C)’’;

21 (ii) in clause (i) (as so designated), by

22 adding ‘‘and’’ after the comma at the end;

23 and

24 (iii) by adding at the end the following

25 clause:
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1 ‘‘(ii) to the State official responsible for carrying

2 out programs under subpart II of part B of title XIX,

3 and in accordance with the provisions of section 543

4 regarding the disclosure of information, a notification

5 if a pregnant woman is provided a referral for the

6 treatment of substance abuse but the entity involved

7 does not have the capacity to admit additional indi8 viduals for treatment,’’; and

9 (B) in paragraph (7)—

10 (i) in subparagraph (L), by striking

11 ‘‘and’’ at the end;

12 (ii) by redesignating subparagraph

13 (M) as subparagraph (N); and

14 (iii) by inserting after subparagraph

15 (L) the following subparagraph:

16 ‘‘(M) treatment of pregnant women for substance

17 abuse; and’’.

18 (2) OVERLAP IN CATCHMENT AREAS.—Section

19 329(a) of the Public Health Service Act (42 U.S.C.

20 254b(a)) is amended by adding at the end the follow21 ing paragraph:

22 ‘‘(8) In making grants under subsections (c)(1) and

23 (d)(1), the Secretary may provide for the development and

24 operation of more than one migrant health center in a

25 catchment area in any case in which the Secretary deter-
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1 mines that in such area there are workers or other individ2 uals described in subsection (a)(1) (in the matter after and

3 below subparagraph (H)) who otherwise will have a short4 age of personal health services. The preceding sentence may

5 not be construed as requiring that, in such a case, the

6 catchment areas of the centers involved be identical.’’.

7 (3) OFFSITE ACTIVITIES.—Section 329(a) of the

8 Public Health Service Act, as amended by paragraph

9 (2) of this subsection, is amended by adding at the

10 end the following paragraph:

11 ‘‘(9) In making grants under this section, the Sec12 retary may, to the extent determined by the Secretary to

13 be appropriate, authorize migrant health centers to provide

14 services at locations other than the center.’’.

15 (4) AMOUNT OF GRANT; USE OF CERTAIN

16 FUNDS.—Section 329(d)(4) of the Public Health Serv17 ice Act (42 U.S.C. 254b(d)(4)) is amended to read as

18 follows:

19 ‘‘(4)(A) The amount of a grant under paragraph (1)

20 or under subsection (c) for a migrant health center shall

21 be determined by the Secretary, taking into account (for

22 the period for which the grant is made)—

23 ‘‘(i) the costs that the center may reasonably be

24 expected to incur in carrying out the plan approved
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1 by the Secretary pursuant to subsection (f)(3)(H),

2 and

3 ‘‘(ii) the amounts that the center may reasonably

4 be expected to receive as State, local, and other oper5 ational funding (exclusive of amounts to be provided

6 in the grant under this section) and as fees, pre7 miums, and third-party reimbursements.

8 ‘‘(B)(i) Subject to clause (ii), the Secretary may not

9 restrict the purposes for which a migrant health center ex10 pends the amounts described in subparagraph (A)(ii) (in11 cluding restrictions imposed pursuant to Federal cost prin12 ciples).

13 ‘‘(ii) The Secretary may require that amounts de14 scribed in subparagraph (A)(ii) be expended for purposes

15 that are consistent with the purposes specified in this sec16 tion.

17 ‘‘(C)(i) Payments under a grant under this section

18 shall be made in advance or by way of reimbursement and

19 in such installments as the Secretary finds necessary. Ad20 justments in such payments may be made for overpayments

21 or underpayments, subject to clause (ii).

22 ‘‘(ii) If, for the period for which a grant is made under

23 paragraph (1) to a migrant health center, the sum of the

24 amount of the grant and the amounts described in subpara25 graph (A)(ii) that the center actually received exceeded the
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1 costs of the center in carrying out the plan approved by

2 the Secretary pursuant to subsection (f)(3)(H), then the cen3 ter is entitled to retain such excess amount if the center

4 agrees to expend such amount only for the following pur5 poses:

6 ‘‘(I) To expand and improve services.

7 ‘‘(II) To increase the number of persons served.

8 ‘‘(III) To acquire, modernize, or expand facili9 ties, or to construct facilities.

10 ‘‘(IV) To improve the administration of service

11 programs.

12 ‘‘(V) To establish financial reserves.

13 ‘‘(D) With respect to funds that are amounts described

14 in subparagraph (A)(ii) or excess amounts described in sub15 paragraph (C)(ii), this paragraph may not be construed as

16 limiting the authority of the Secretary to require the sub17 mission of such plans, budgets, and other information as

18 may be necessary to ensure that the funds are expended in

19 accordance with subparagraph (B)(ii), or clauses (I)

20 through (V) of subparagraph (C)(ii), respectively.’’.

21 (5) AUTHORIZATION OF APPROPRIATIONS.—Sec22 tion 329(h) of the Public Health Service Act (42

23 U.S.C. 254b(h)) is amended—

24 (A) in paragraph (1)(A), by striking

25 ‘‘1994’’ and inserting ‘‘1998’’; and
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1 (B) in paragraph (2)(A), by striking

2 ‘‘1994’’ and inserting ‘‘1998’’.

3 (b) COMMUNITY HEALTH CENTERS.—

4 (1) TREATMENT OF PREGNANT WOMEN FOR SUB5 STANCE ABUSE.—Section 330 of the Public Health

6 Service Act (42 U.S.C. 254c) is amended—

7 (A) in subsection (a)(3)—

8 (i) by inserting ‘‘(A)’’ after ‘‘(3)’’;

9 (ii) in subparagraph (A) (as so des10 ignated), by adding ‘‘and’’ after the comma

11 at the end; and

12 (iii) by adding at the end the following

13 subparagraph:

14 ‘‘(B) to the State official responsible for carrying

15 out programs under subpart II of part B of title XIX,

16 and in accordance with the provisions of section 543

17 regarding the disclosure of information, a notification

18 if a pregnant woman is provided a referral for the

19 treatment of substance abuse but the entity involved

20 does not have the capacity to admit additional indi21 viduals for treatment,’’; and

22 (B) in subsection (b)(2)—

23 (i) in subparagraph (L), by striking

24 ‘‘and’’ at the end;
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1 (ii) by redesignating subparagraph

2 (M) as subparagraph (N); and

3 (iii) by inserting after subparagraph

4 (L) the following subparagraph:

5 ‘‘(M) treatment of pregnant women for substance

6 abuse; and’’.

7 (2) OVERLAP IN CATCHMENT AREAS.—Section

8 330(b) of the Public Health Service Act (42 U.S.C.

9 254c(b)) is amended by adding at the end the follow10 ing paragraph:

11 ‘‘(7) In making grants under subsections (c)(1) and

12 (d)(1), the Secretary may provide for the development and

13 operation of more than one community health center in a

14 catchment area in any case in which the Secretary deter15 mines that there is a population group in such area that

16 otherwise will have a shortage of personal health services.

17 The preceding sentence may not be construed as requiring

18 that, in such a case, the catchment areas of the centers in19 volved be identical.’’.

20 (3) OFFSITE ACTIVITIES.—Section 330(b) of the

21 Public Health Service Act, as amended by paragraph

22 (2) of this subsection, is amended by adding at the

23 end the following paragraph:

24 ‘‘(8) In making grants under this section, the Sec25 retary may, to the extent determined by the Secretary to
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1 be appropriate, authorize community health centers to pro2 vide services at locations other than the center.’’.

3 (4) AMOUNT OF GRANT; USE OF CERTAIN

4 FUNDS.—Section 330(d)(4) of the Public Health Serv5 ice Act (42 U.S.C. 254c(d)(4)) is amended to read as

6 follows:

7 ‘‘(4)(A) The amount of a grant under paragraph (1)

8 or under subsection (c) for a community health center shall

9 be determined by the Secretary, taking into account (for

10 the period for which the grant is made)—

11 ‘‘(i) the costs that the center may reasonably be

12 expected to incur in carrying out the plan approved

13 by the Secretary pursuant to subsection (e)(3)(H),

14 and

15 ‘‘(ii) the amounts that the center may reasonably

16 be expected to receive as State, local, and other oper17 ational funding (exclusive of amounts to be provided

18 in the grant under this section) and as fees, pre19 miums, and third-party reimbursements.

20 ‘‘(B)(i) Subject to clause (ii), the Secretary may not

21 restrict the purposes for which a community health center

22 expends the amounts described in subparagraph (A)(ii) (in23 cluding restrictions imposed pursuant to Federal cost prin24 ciples).
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1 ‘‘(ii) The Secretary may require that amounts de2 scribed in subparagraph (A)(ii) be expended for purposes

3 that are consistent with the purposes specified in this sec4 tion.

5 ‘‘(C)(i) Payments under a grant under this section

6 shall be made in advance or by way of reimbursement and

7 in such installments as the Secretary finds necessary. Ad8 justments in such payments may be made for overpayments

9 or underpayments, subject to clause (ii).

10 ‘‘(ii) If, for the period for which a grant is made under

11 paragraph (1) to a community health center, the sum of

12 the amount of the grant and the amounts described in sub13 paragraph (A)(ii) that the center actually received exceeded

14 the costs of the center in carrying out the plan approved

15 by the Secretary pursuant to subsection (e)(3)(H), then the

16 center is entitled to retain such excess amount if the center

17 agrees to expend such amount only for the following pur18 poses:

19 ‘‘(I) To expand and improve services.

20 ‘‘(II) To increase the number of persons served.

21 ‘‘(III) To acquire, modernize, or expand facili22 ties, or to construct facilities.

23 ‘‘(IV) To improve the administration of service

24 programs.

25 ‘‘(V) To establish financial reserves.
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1 ‘‘(D) With respect to funds that are amounts described

2 in subparagraph (A)(ii) or excess amounts described in sub3 paragraph (C)(ii), this paragraph may not be construed as

4 limiting the authority of the Secretary to require the sub5 mission of such plans, budgets, and other information as

6 may be necessary to ensure that the funds are expended in

7 accordance with subparagraph (B)(ii), or clauses (I)

8 through (V) of subparagraph (C)(ii), respectively.’’.

9 (5) AUTHORIZATION OF APPROPRIATIONS.—Sec10 tion 330(g) of the Public Health Service Act (42

11 U.S.C. 254c(g)) is amended—

12 (A) in paragraph (1)(A), by striking

13 ‘‘1994’’ and inserting ‘‘1998’’; and

14 (B) in paragraph (2)(A), by striking

15 ‘‘1994’’ and inserting ‘‘1998’’.

16 SEC. 202. HEALTH SERVICES FOR THE HOMELESS.

17 Section 340(q)(1) of the Public Health Service Act (42

18 U.S.C. 256(q)(1)) is amended by striking ‘‘and 1994’’ and

19 inserting ‘‘through 1998’’.

20 SEC. 203. HEALTH SERVICES FOR RESIDENTS OF PUBLIC

21 HOUSING.

22 Section 340A(p)(1) of the Public Health Service Act

23 (42 U.S.C. 256a(p)(1)) is amended by striking ‘‘and 1993’’

24 and inserting ‘‘through 1998’’.
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1 SEC. 204. GRANTS TO STATES FOR LOAN REPAYMENT PRO2 GRAMS REGARDING OBLIGATED SERVICE OF

3 HEALTH PROFESSIONALS.

4 Section 338I(c) of the Public Health Service Act (42

5 U.S.C. 254q–1(c)) is amended by adding at the end the fol6 lowing paragraph:

7 ‘‘(4) PRIVATE PRACTICE.—

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

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

10 waive the requirement of paragraph (1) regard11 ing the assignment of a health professional if,

12 subject to subparagraph (B), the health profes13 sional enters into an agreement with the State to

14 provide primary health services in a full-time

15 private clinical practice in a health professional

16 shortage area.

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

18 under subsection (a) unless the State involved

19 agrees that, if the State provides a waiver under

20 subparagraph (A) for a health professional, sec21 tion 338D(b)(1) will apply to the agreement

22 under such subparagraph between the State and

23 the health professional to the same extent and in

24 the same manner as such section applies to an

25 agreement between the Secretary and a health
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1 professional regarding a full-time private clini2 cal practice.’’.

3 SEC. 205. GRANTS TO STATES FOR OPERATION OF STATE

4 OFFICES OF RURAL HEALTH.

5 Section 338J of the Public Health Service Act (42

6 U.S.C. 254r) is amended—

7 (1) in subsection (b)(1), in the matter preceding

8 subparagraph (A), by striking ‘‘in cash’’; and

9 (2) in subsection (j)(1)—

10 (A) by striking ‘‘and’’ after ‘‘1992,’’; and

11 (B) by inserting before the period the follow12 ing: ‘‘, and such sums as may be necessary for

13 each of the fiscal years 1995 through 1997’’.

14 SEC. 206. DEMONSTRATION GRANTS TO STATES FOR COM15 MUNITY SCHOLARSHIP PROGRAMS REGARD16 ING OBLIGATED SERVICE OF HEALTH PRO17 FESSIONALS.

18 Section 338L of the Public Health Service Act (42

19 U.S.C. 254t) is amended—

20 (1) by striking ‘‘health manpower shortage’’ each

21 place such term appears and inserting ‘‘health profes22 sional shortage’’;

23 (2) in subsection (e)—

24 (A) by striking paragraph (1);
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1 (B) by redesignating paragraphs (2)

2 through (6) as paragraphs (1) through (5), re3 spectively; and

4 (C) in paragraph (1) (as so redesignated),

5 by inserting after ‘‘the individual’’ the following:

6 ‘‘who is to receive the scholarship under the con7 tract’’;

8 (3) in subsection (k)(2), by striking ‘‘internal

9 medicine, pediatrics,’’ and inserting ‘‘general internal

10 medicine, general pediatrics,’’; and

11 (4) in subsection (l)(1)—

12 (A) by striking ‘‘and’’ after ‘‘1992,’’; and

13 (B) by inserting before the period the follow14 ing: ‘‘, and such sums as may be necessary for

15 each of the fiscal years 1995 through 1997’’.

16 SEC. 207. PROGRAMS REGARDING BIRTH DEFECTS.

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

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

19 ‘‘PROGRAMS REGARDING BIRTH DEFECTS

20 ‘‘SEC. 317C. (a) The Secretary, acting through the Di21 rector of the Centers for Disease Control and Prevention,

22 shall carry out programs—

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

24 on birth defects (in a manner that facilitates compli25 ance with subsection (d)(2)), including data on the
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1 causes of such defects and on the incidence and preva2 lence of such defects;

3 ‘‘(2) to support primary birth-defect prevention,

4 including information and education to the public on

5 the prevention of such defects;

6 ‘‘(3) to improve the education, training, and

7 clinical skills of health professionals with respect to

8 the prevention of such defects;

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

10 prevention of such defects; and

11 ‘‘(5) to operate regional centers for the conduct

12 of applied epidemiological research on the prevention

13 of such defects.

14 ‘‘(b) ADDITIONAL PROVISIONS REGARDING COLLEC15 TION OF DATA.—

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

17 (a)(1), the Secretary—

18 ‘‘(A) shall collect and analyze data by gen19 der and by racial and ethnic group, including

20 Hispanics, non-Hispanic whites, African Ameri21 cans, Native Americans, Asian Americans, and

22 Pacific Islanders;

23 ‘‘(B) shall collect data under subparagraph

24 (A) from birth certificates, death certificates, hos-
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1 pital records, and such other sources as the Sec2 retary determines to be appropriate; and

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

4 improve programs for the collection and analysis

5 of epidemiological data on birth defects, and to

6 make the data available.

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

8 out subsection (a)(1), the Secretary shall establish and

9 maintain a National Information Clearinghouse on

10 Birth Defects to collect and disseminate to health pro11 fessionals and the general public information on birth

12 defects, including the prevention of such defects.

13 ‘‘(c) GRANTS AND CONTRACTS.—

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

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

16 contracts with public and nonprofit private entities.

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

18 AWARD FUNDS.—

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

20 award of a grant or contract under paragraph

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

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

23 for the purpose of aiding the recipient in carry24 ing out the purposes for which the award is

25 made and, for such purposes, may detail to the
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1 recipient any officer or employee of the Depart2 ment of Health and Human Services.

3 ‘‘(B) With respect to a request described in

4 subparagraph (A), the Secretary shall reduce the

5 amount of payments under the award involved

6 by an amount equal to the costs of detailing per7 sonnel and the fair market value of any supplies,

8 equipment, or services provided by the Secretary.

9 The Secretary shall, for the payment of expenses

10 incurred in complying with such request, expend

11 the amounts withheld.

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

13 may make an award of a grant or contract under

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

15 is submitted to the Secretary and the application is

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

17 such agreements, assurances, and information as the

18 Secretary determines to be necessary to carry out the

19 purposes for which the award is to be made.

20 ‘‘(d) BIENNIAL REPORT.—Not later than February 1

21 of fiscal year 1995 and of every second such year thereafter,

22 the Secretary shall submit to the Committee on Energy and

23 Commerce of the House of Representatives, and the Commit24 tee on Labor and Human Resources of the Senate, a report

25 that, with respect to the preceding 2 fiscal years—
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1 ‘‘(1) contains information regarding the inci2 dence and prevalence of birth defects and the extent

3 to which birth defects have contributed to the inci4 dence and prevalence of infant mortality;

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

6 that is specific to various racial and ethnic groups

7 (including Hispanics, non-Hispanic whites, African

8 Americans, Native Americans, and Asian Americans);

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

10 which various approaches of preventing birth defects

11 have been effective;

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

13 this section; and

14 ‘‘(5) contains any recommendations of the Sec15 retary regarding this section.

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

17 purpose of carrying out this section, there are authorized

18 to be appropriated such sums as may be necessary for each

19 of the fiscal years 1995 through 1997.’’.

20 SEC. 208. HEALTHY START FOR INFANTS.

21 (a) TECHNICAL CORRECTION REGARDING AMEND22 ATORY INSTRUCTIONS.—Part D of title III of the Public

23 Health Service Act (42 U.S.C 254b et seq.), as amended

24 by section 104 of Public Law 103–183 (107 Stat. 2230),

25 is amended in the heading for subpart VIII by striking
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1 ‘‘Bulk’’ and all that follows and inserting the following:

2 ‘‘Miscellaneous Provisions Regarding Primary Health

3 Care’’. The amendment made by the preceding sentence is

4 deemed to have taken effect immediately after the enactment

5 of Public Law 103–183.

6 (b) HEALTHY START FOR INFANTS.—Part D of title

7 III of the Public Health Service Act, as amended by sub8 section (a) of this section, is amended by adding at the end

9 of subpart VIII the following section:

10 ‘‘HEALTHY START FOR INFANTS

11 ‘‘SEC. 340E. (a) GRANTS FOR COMPREHENSIVE SERV12 ICES.—

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

14 grants for the operation of not more than 19 dem15 onstration projects to provide the services described in

16 subsection (b) for the purpose of reducing, in the geo17 graphic areas in which the projects are carried out—

18 ‘‘(A) the incidence of infant mortality and

19 morbidity;

20 ‘‘(B) the incidence of fetal deaths;

21 ‘‘(C) the incidence of maternal mortality;

22 ‘‘(D) the incidence of fetal alcohol syn23 drome; and

24 ‘‘(E) the incidence of low-birthweight births.

25 ‘‘(2) ACHIEVEMENT OF YEAR 2000 HEALTH STA26 TUS OBJECTIVES.—With respect to the objectives es-
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1 tablished by the Secretary for the health status of the

2 population of the United States for the year 2000, the

3 Secretary shall, in providing for a demonstration

4 project under paragraph (1) in a geographic area,

5 seek to meet the objectives that are applicable to the

6 purpose described in such paragraph and the popu7 lations served by the project.

8 ‘‘(b) AUTHORIZED SERVICES.—

9 ‘‘(1) IN GENERAL.—Subject to subsection (h), the

10 services referred to in this subsection are comprehen11 sive services (including preventive and primary

12 health services for pregnant women and infants and

13 childhood immunizations in accordance with the

14 schedule recommended by the Secretary) for carrying

15 out the purpose described in subsection (a), including

16 services other than health services.

17 ‘‘(2) CERTAIN PROVIDERS.—The Secretary may

18 make a grant under subsection (a) only if the appli19 cant involved agrees that, in making any arrange20 ments under which other entities provide authorized

21 services in the demonstration project involved, the ap22 plicant will include among the entities with which the

23 arrangements are made grantees under any of sec24 tions 329, 330, 340, and 340A, if such grantees are

25 providing services in the service area of such project
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1 and the grantees are willing to make such arrange2 ments with the applicant.

3 ‘‘(c) ELIGIBLE GEOGRAPHIC AREAS.—The Secretary

4 may make a grant under subsection (a) only if—

5 ‘‘(1) the applicant for the grant specifies the geo6 graphic area in which the demonstration project

7 under such subsection is to be carried out and agrees

8 that the project will not be carried out in other areas;

9 and

10 ‘‘(2) for the fiscal year preceding the first fiscal

11 year for which the applicant is to receive such a

12 grant, the rate of infant mortality in the geographic

13 area equals or exceeds 150 percent of the national av14 erage in the United States of such rates.

15 ‘‘(d) MINIMUM QUALIFICATIONS OF GRANTEES.—

16 ‘‘(1) PUBLIC OR NONPROFIT PRIVATE ENTI17 TIES.—The Secretary may make a grant under sub18 section (a) only if the applicant for the grant is a

19 State or local department of health, or other public or

20 nonprofit private entity, or a consortium of public or

21 nonprofit private entities.

22 ‘‘(2) APPROVAL OF POLITICAL SUBDIVISIONS.—

23 With respect to a proposed demonstration project

24 under subsection (a), the Secretary may make a grant

25 under such subsection only if—
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1 ‘‘(A) the chief executive officer of each polit2 ical subdivision in the service area of such

3 project approves the applicant for the grant as

4 being qualified to carry out the project; and

5 ‘‘(B) the leadership of any Indian tribe or

6 tribal organization with jurisdiction over any

7 portion of such area so approves the applicant.

8 ‘‘(3) STATUS AS MEDICAID PROVIDER.—

9 ‘‘(A) In the case of any service described in

10 subsection (b) that is available pursuant to the

11 State plan approved under title XIX of the So12 cial Security Act for a State in which a dem13 onstration project under subsection (a) is carried

14 out, the Secretary may make a grant under such

15 subsection for the project only if, subject to sub16 paragraph (B)—

17 ‘‘(i) the applicant for the grant will

18 provide the service directly, and the appli19 cant has entered into a participation agree20 ment under the State plan and is qualified

21 to receive payments under such plan; or

22 ‘‘(ii) the applicant will enter into an

23 agreement with a public or private entity

24 under which the entity will provide the

25 service, and the entity has entered into such
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1 a participation agreement under the State

2 plan and is qualified to receive such pay3 ments.

4 ‘‘(B)(i) In the case of an entity making an

5 agreement pursuant to subparagraph (A)(ii) re6 garding the provision of services, the requirement

7 established in such subparagraph regarding a

8 participation agreement shall be waived by the

9 Secretary if the entity does not, in providing

10 health care services, impose a charge or accept

11 reimbursement available from any third-party

12 payor, including reimbursement under any in13 surance policy or under any Federal or State

14 health benefits plan.

15 ‘‘(ii) A determination by the Secretary of

16 whether an entity referred to in clause (i) meets

17 the criteria for a waiver under such clause shall

18 be made without regard to whether the entity ac19 cepts voluntary donations regarding the provi20 sion of services to the public.

21 ‘‘(e) STATE APPROVAL OF PROJECT.—With respect to

22 a proposed demonstration project under subsection (a), the

23 Secretary may make a grant under such subsection to the

24 applicant involved only if—
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1 ‘‘(1) the chief executive officer of the State in

2 which the project is to be carried out approves the

3 proposal of the applicant for carrying out the project;

4 and

5 ‘‘(2) the leadership of any Indian tribe or tribal

6 organization with jurisdiction over any portion of the

7 service area of the project so approves the proposal.

8 ‘‘(f) ELIGIBILITY FOR SERVICES PROVIDED WITH

9 GRANT FUNDS.—The Secretary may make a grant under

10 subsection (a) only if the applicant involved agrees as fol11 lows:

12 ‘‘(1) With respect to any authorized service

13 under subsection (b), if the service is a service that the

14 State involved is required or has elected to provide

15 under title XIX of the Social Security Act, the grant

16 will not be expended to provide the service to any in17 dividual to whom the State is required or has elected

18 under such title to provide the service.

19 ‘‘(2) The grant will not be expended to make

20 payment for any item or service to the extent that

21 payment has been made, or can reasonably be ex22 pected to be made, with respect to such item or serv23 ice—
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1 ‘‘(A) under a health insurance policy or

2 plan (including a group health plan or a pre3 paid health plan);

4 ‘‘(B) under any Federal or State health ben5 efits program, including any program under

6 title V, XVIII, or XIX of the Social Security Act;

7 or

8 ‘‘(C) under subpart II of part B of title XIX

9 of this Act.

10 ‘‘(g) MAINTENANCE OF EFFORT.—

11 ‘‘(1) GRANTEE.—With respect to authorized serv12 ices under subsection (b), the Secretary may make a

13 grant under subsection (a) only if the applicant in14 volved agrees to maintain expenditures of non-Federal

15 amounts for such services at a level that is not less

16 than the level of such expenditures maintained by the

17 applicant for fiscal year 1991.

18 ‘‘(2) RELEVANT POLITICAL SUBDIVISIONS.—With

19 respect to authorized services under subsection (b), the

20 Secretary may make a grant under subsection (a)

21 only if each political subdivision in the service area

22 of the demonstration project involved agrees to main23 tain expenditures of non-Federal amounts for such

24 services at a level that is not less than the level of
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1 such expenditures maintained by the political sub2 division for fiscal year 1991.

3 ‘‘(h) RESTRICTIONS ON EXPENDITURE OF GRANT.—

4 ‘‘(1) IN GENERAL.—Except as provided in para5 graph (3), the Secretary may make a grant under

6 subsection (a) only if the applicant involved agrees

7 that the grant will not be expended—

8 ‘‘(A) to provide inpatient services, except

9 with respect to residential treatment for sub10 stance abuse provided in settings other than hos11 pitals;

12 ‘‘(B) to make cash payments to intended re13 cipients of health services or mental health serv14 ices; or

15 ‘‘(C) to purchase or improve real property

16 (other than minor remodeling of existing im17 provements to real property) or to purchase

18 major medical equipment (other than mobile

19 medical units for providing ambulatory prenatal

20 services).

21 ‘‘(2) ADMINISTRATIVE EXPENSES; DATA COLLEC22 TION.—The Secretary may make a grant under sub23 section (a) only if the applicant involved agrees that

24 not more than an aggregate 10 percent of the grant
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1 will be expended for administering the grant and the

2 collection and analysis of data.

3 ‘‘(3) WAIVER.—If the Secretary finds that the

4 purpose described in subsection (a) cannot otherwise

5 be carried out, the Secretary may, with respect to an

6 otherwise qualified applicant, waive the restriction es7 tablished in paragraph (1)(C).

8 ‘‘(i) DETERMINATION OF CAUSE OF INFANT

9 DEATHS.—The Secretary may make a grant under sub10 section (a) only if the applicant involved—

11 ‘‘(1) agrees to provide for a determination of the

12 cause of each infant death in the service area of the

13 demonstration project involved; and

14 ‘‘(2) the applicant has made such arrangements

15 with public entities as may be necessary to carry out

16 paragraph (1).

17 ‘‘(j) ANNUAL REPORTS TO SECRETARY.—The Sec18 retary may make a grant under subsection (a) only if the

19 applicant involved agrees that, for each fiscal year for

20 which the applicant operates a demonstration project under

21 such subsection the applicant will, not later than April 1

22 of the subsequent fiscal year, submit to the Secretary a re23 port providing the following information with respect to the

24 project:
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1 ‘‘(1) The number of individuals that received au2 thorized services, and the demographic characteristics

3 of the population of such individuals.

4 ‘‘(2) The types of authorized services provided,

5 including the types of ambulatory prenatal services

6 provided and the trimester of the pregnancy in which

7 the services were provided.

8 ‘‘(3) The sources of payment for the authorized

9 services provided.

10 ‘‘(4) The extent to which children under age 2 re11 ceiving authorized services have received the appro12 priate number and variety of immunizations against

13 vaccine-preventable diseases.

14 ‘‘(5) An analysis of the causes of death deter15 mined under subsection (i).

16 ‘‘(6) The extent of progress being made toward

17 meeting the health status objectives specified in sub18 section (a)(2).

19 ‘‘(7) The extent to which, in the service area in20 volved, progress is being made toward meeting the

21 participation goals established for the State by the

22 Secretary under section 1905(r) of the Social Security

23 Act (relating to early periodic screening, diagnostic,

24 and treatment services for children under the age of

25 21).
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1 ‘‘(k) COMMUNITY PARTICIPATION.—The Secretary may

2 make a grant under subsection (a) only if the applicant

3 involved agrees that, in preparing the proposal of the appli4 cant for the demonstration project involved, and in the op5 eration of the project, the applicant will consult with the

6 residents of the service area for the project and with public

7 and nonprofit private entities that provide authorized serv8 ices to such residents.

9 ‘‘(l) APPLICATION FOR GRANT.—The Secretary may

10 make a grant under subsection (a) only if an application

11 for the grant is submitted to the Secretary and the applica12 tion is in such form, is made in such manner, and contains

13 such agreements, assurances, and information as the Sec14 retary determines to be necessary to carry out this sub15 section.

16 ‘‘(m) REPORT TO CONGRESS.—Not later than Feb17 ruary 1, 1998, the Secretary shall submit to the Committee

18 on Energy and Commerce of the House of Representatives,

19 and the Committee on Labor and Human Resources of the

20 Senate, a report—

21 ‘‘(1) summarizing the reports received by the

22 Secretary under subsection (j);

23 ‘‘(2) describing the extent to which the Secretary

24 has, in the service areas of such projects, been success-
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1 ful in meeting the health status objectives specified in

2 subsection (a)(2); and

3 ‘‘(3) describing the extent to which demonstra4 tion projects under subsection (a) have been cost effec5 tive.

6 ‘‘(n) LIMITATION ON CERTAIN EXPENSES OF SEC7 RETARY.—Of the amounts appropriated under subsection

8 (p) for a fiscal year, the Secretary may not obligate more

9 than an aggregate 5 percent for the administrative costs

10 of the Secretary in carrying out this section, for the provi11 sion of technical assistance regarding demonstration

12 projects under subsection (a), and for evaluations of such

13 projects.

14 ‘‘(o) DEFINITIONS.—For purposes of this section:

15 ‘‘(1) The term ‘authorized services’ means the

16 services specified in subsection (b).

17 ‘‘(2) The terms ‘Indian tribe’ and ‘tribal organi18 zation’ have the meaning given such terms in section

19 4(b) and section 4(c) of the Indian Self-Determina20 tion and Education Assistance Act.

21 ‘‘(3) The term ‘service area’, with respect to a

22 demonstration project under subsection (a), means the

23 geographic area specified in subsection (c).

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

25 purpose of carrying out this section, there are authorized
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1 to be appropriated such sums as may be necessary for each

2 of the fiscal years 1995 through 1997.

3 ‘‘(q) SUNSET.—Effective October 1, 1997, this section

4 is repealed.’’.

5 (b) CERTAIN PROVISIONS REGARDING REPORTS.—

6 (1) FISCAL YEAR 1995.—With respect to grants

7 under section 340E of the Public Health Service Act

8 (as added by subsection (b) of this section), the Sec9 retary of Health and Human Services may make a

10 grant under such section for fiscal year 1995 only if

11 the applicant for the grant agrees to submit to the

12 Secretary, not later than April 1 of such year, a re13 port on any federally-supported project of the appli14 cant that is substantially similar to the demonstra15 tion projects authorized in such section 340E, which

16 report provides, to the extent practicable, the informa17 tion described in subsection (j) of such section.

18 (2) FISCAL YEAR 1997.—With respect to grants

19 for fiscal year 1997 under section 340E of the Public

20 Health Service Act (as added by subsection (b) of this

21 section), the requirement under subsection (j) of such

22 section that a report be submitted not later than

23 April 1, 1998, remains in effect notwithstanding the

24 repeal of such section pursuant to subsection (q) of

25 such section.
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1 (c) LAPSE OF FUNDS.—Effective October 1, 1997, all

2 unexpended portions of amounts appropriated for grants

3 under 340E of the Public Health Service Act (as added by

4 subsection (b) of this section) are unavailable for obligation

5 or expenditure, without regard to whether the amounts have

6 been received by the grantees involved.

7 (d) USE OF GENERAL AUTHORITY UNDER PUBLIC

8 HEALTH SERVICE ACT.—With respect to the program es9 tablished in section 340E of the Public Health Service Act

10 (as added by subsection (b) of this section), section 301 of

11 such Act may not be construed as providing to the Secretary

12 of Health and Human Services any authority to carry out,

13 during any fiscal year in which such program is in oper14 ation, any demonstration project to provide any of the serv15 ices specified in subsection (b) of such section 340E.

16 SEC. 209. DEMONSTRATION PROJECTS REGARDING DIA17 BETIC-RETINOPATHY.

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

19 Human Services, acting through the Director of the Centers

20 for Disease Control and Prevention and in consultation

21 with the Director of the National Eye Institute, may make

22 grants to public and nonprofit private entities for dem23 onstration projects to serve the populations specified in sub24 section (b) by carrying out, with respect to the eye disorder

25 known as diabetic retinopathy, activities regarding infor-
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1 mation, identification, dissemination, education, and pre2 vention.

3 (b) RELEVANT POPULATIONS.—The populations re4 ferred to in subsection (a) are minority populations that

5 are at significant risk of contracting diabetes mellitus.

6 (c) AUTHORIZATION OF APPROPRIATIONS.—For the

7 purpose of carrying out this section, there is authorized to

8 be appropriated $1,000,000 for each of the fiscal years 1995

9 through 1997.

10 TITLE III—HEALTH

11 PROFESSIONS PROGRAMS

12 SEC. 301. PRIMARY CARE SCHOLARSHIPS FOR STUDENTS

13 FROM DISADVANTAGED BACKGROUNDS.

14 (a) IN GENERAL.—Section 736 of the Public Health

15 Service Act (42 U.S.C. 293) is amended to read as follows:

16 ‘‘SEC. 736. PRIMARY CARE SCHOLARSHIPS FOR STUDENTS

17 FROM DISADVANTAGED BACKGROUNDS.

18 ‘‘(a) IN GENERAL.—The Secretary may in accordance

19 with this section award scholarships to individuals de20 scribed in subsection (b) for the purpose of assisting the in21 dividuals with the costs of attending schools of medicine or

22 osteopathic medicine, schools of dentistry, schools of nursing

23 (as defined in section 853), graduate programs in mental

24 health practice, and programs for the training of physician

25 assistants.
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1 ‘‘(b) ELIGIBLE INDIVIDUALS.—An individual referred

2 to in subsection (a) is any individual meeting the following

3 conditions:

4 ‘‘(1) The individual is from a disadvantaged

5 background.

6 ‘‘(2) The individual is enrolled (or accepted for

7 enrollment) at an eligible school as a full-time student

8 in a program leading to a degree in a health profes9 sion.

10 ‘‘(3) The individual enters into the contract re11 quired pursuant to subsection (d) as a condition of

12 receiving the scholarship (relating to an agreement to

13 provide primary health services in a health profes14 sional shortage area designated under section 332).

15 ‘‘(c) PREFERENCES REGARDING AWARDS; SPECIAL

16 CONSIDERATION.—In awarding scholarships under sub17 section (a), the Secretary shall—

18 ‘‘(1) give preference to eligible individuals for

19 whom the costs of attending the school involved would

20 constitute a severe financial hardship; and

21 ‘‘(2) give special consideration to eligible indi22 viduals who received scholarships pursuant to this

23 section, section 737, or section 740(d)(2) for fiscal

24 year 1993 or 1994 and are seeking scholarships for

25 attendance at eligible schools that received a grant
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1 under any of such sections for any of such fiscal

2 years.

3 ‘‘(d) APPLICABILITY OF CERTAIN PROVISIONS.—Ex4 cept as inconsistent with this section, the provisions of sub5 part III of part D of title III apply to an award of a schol6 arship under subsection (a) to the same extent and in the

7 same manner as such provisions apply to an award of a

8 scholarship under section 338A. This section shall be car9 ried out by the bureau that administers such subpart III.

10 ‘‘(e) DEFINITIONS.—For purposes of this section:

11 ‘‘(1) The term ‘eligible individual’ means an in12 dividual described in subsection (b).

13 ‘‘(2) The term ‘eligible school’ means a school or

14 program specified in subsection (a).

15 ‘‘(f) FUNDING.—

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

17 the purpose of carrying out this section, there are au18 thorized to be appropriated $28,000,000 for fiscal

19 year 1995, $38,000,000 for fiscal year 1996, and

20 $48,000,000 for fiscal year 1997. Such authorization

21 is in addition to the authorization of appropriations

22 established in section 740(e).

23 ‘‘(2) ALLOCATIONS BY SECRETARY.—Of the

24 amounts appropriated for a fiscal year under para25 graph (1), the Secretary shall make available—
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1 ‘‘(A) 20 percent for scholarships under sub2 section (a) for attendance at schools of nursing;

3 and

4 ‘‘(B) 15 percent for scholarships under such

5 subsection for attendance at graduate programs

6 in mental health practice.’’.

7 (b) CERTAIN PROGRAMS OF OBLIGATED SERVICE.—

8 (1) REPEAL.—Section 795 of the Public Health

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

10 (2) RULE OF CONSTRUCTION.—Paragraph (1)

11 does not terminate agreements that, on the day before

12 the effective date under section 901, are in effect pur13 suant to section 795 of the Public Health Service Act.

14 Such agreements continue in effect in accordance with

15 the terms of the agreements. With respect to compli16 ance with such agreements, any period of practice as

17 a provider of primary health services (whether pro18 vided pursuant to other agreements with the Federal

19 Government or whether provided otherwise) counts to20 ward satisfaction of the requirement of practice pur21 suant to such section 795.
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1 SEC. 302. SCHOLARSHIPS GENERALLY; CERTAIN OTHER

2 PURPOSES.

3 (a) RELEVANT HEALTH PROFESSIONS SCHOOLS.—

4 Section 737(a)(3) of the Public Health Service Act (42

5 U.S.C. 293a(a)(3)) is amended—

6 (1) by striking ‘‘medicine,’’ and all that follows

7 through ‘‘dentistry,’’; and

8 (2) by striking ‘‘allied health,’’ and all that fol9 lows and inserting ‘‘allied health.’’.

10 (b) ELIGIBLE INDIVIDUALS.—

11 (1) IN GENERAL.—Section 737(a)(2) of the Pub12 lic Health Service Act (42 U.S.C. 293a(a)(2)) is

13 amended to read as follows:

14 ‘‘(2) ELIGIBLE INDIVIDUALS.—An individual re15 ferred to in paragraph (1) is any individual meeting

16 the following conditions:

17 ‘‘(A) The individual is from a disadvan18 taged background.

19 ‘‘(B) The individual is enrolled (or accepted

20 for enrollment) as a full-time student in a health

21 professions school specified in paragraph (3).

22 ‘‘(C) The individual enters into the contract

23 required pursuant to subsection (e) as a condi24 tion of receiving the scholarship under para25 graph (1) (relating to an agreement to provide

26 services).’’.
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1 (2) CERTAIN REQUIREMENT.—Section 737 of the

2 Public Health Service Act (42 U.S.C. 293a) is

3 amended—

4 (A) in subsection (a)(1), by striking ‘‘sub5 section (e)’’ and inserting ‘‘subsection (f)’’;

6 (B) by redesignating subsections (e) through

7 (h) as subsections (f) through (i), respectively;

8 and

9 (C) by inserting after subsection (d) the fol10 lowing subsection:

11 ‘‘(e) APPLICABILITY OF CERTAIN PROVISIONS.—

12 ‘‘(1) IN GENERAL.—Except as inconsistent with

13 this section, and subject to paragraph (2), the provi14 sions of subpart III of part D of title III apply to

15 an award of a scholarship under subsection (a) to the

16 same extent and in the same manner as such provi17 sions apply to an award of a scholarship under sec18 tion 338A. This section shall be carried out by the bu19 reau that administers such subpart III.

20 ‘‘(2) CERTAIN INDIVIDUALS.—

21 ‘‘(A) In the case of an individual who re22 ceives a scholarship under subsection (a) for at23 tendance at a school of veterinary medicine, the

24 contract referred to in subsection (a)(2)(C) is a

25 contract under which the individual agrees that,
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1 after completing training in such medicine, the

2 individual will, in accordance with requirements

3 established under subparagraph (B), conduct or

4 assist in the conduct of research regarding

5 human health or safety. Except as inconsistent

6 with this section, the provisions specified in

7 paragraph (1) with respect to title III apply to

8 such a scholarship to the same extent and in the

9 same manner as such provisions apply to an

10 award of a scholarship under section 338A.

11 ‘‘(B) The Secretary shall establish require12 ments regarding contracts under subparagraph

13 (A).’’.

14 (c) FUNDING.—Section 737(i) of the Public Health

15 Service Act, as redesignated by subsection (b)(2) of this sec16 tion, is amended—

17 (1) in paragraph (1), by inserting before the pe18 riod the following: ‘‘, and $6,000,000 for each of the

19 fiscal years 1994 through 1997’’; and

20 (2) in paragraph (2)(A), by striking ‘‘30 per21 cent’’ and all that follows and inserting the following:

22 ‘‘50 percent for such grants to schools of allied health;

23 and’’.
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1 SEC. 303. LOAN REPAYMENTS AND FELLOWSHIPS REGARD2 ING FACULTY POSITIONS.

3 (a) LOAN REPAYMENTS.—Section 738(a) of the Public

4 Health Service Act (42 U.S.C. 293b(a)) is amended—

5 (1) by striking paragraphs (4) and (6);

6 (2) by redesignating paragraphs (5) and (7) as

7 paragraphs (4) and (5), respectively; and

8 (3) in paragraph (4) (as so redesignated), by

9 amending subparagraph (B) to read as follows:

10 ‘‘(B) the contract referred to in subpara11 graph (A) provides that the school, in making a

12 determination of the amount of compensation to

13 be provided by the school to the individual for

14 serving as a member of the faculty, will make the

15 determination without regard to the amount of

16 payments made (or to be made) to the individual

17 by the Federal Government under paragraph

18 (1).’’.

19 (b) AUTHORIZATION OF APPROPRIATIONS REGARDING

20 LOAN REPAYMENTS AND FELLOWSHIPS.—Section 738(c) of

21 the Public Health Service Act (42 U.S.C. 293b(c)) is

22 amended by striking ‘‘there is’’ and all that follows and in23 serting the following: ‘‘there is authorized to be appro24 priated $1,000,000 for each of the fiscal years 1995 through

25 1997.’’.
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1 SEC. 304. CENTERS OF EXCELLENCE.

2 (a) REFERENCES TO SCHOOLS.—Section 739 of the

3 Public Health Service Act (42 U.S.C. 293c) is amended—

4 (1) by striking ‘‘health professions schools’’ each

5 place such term appears and inserting ‘‘designated

6 health professions schools’’; and

7 (2) by striking ‘‘health professions school’’ each

8 place such term appears and inserting ‘‘designated

9 health professions school’’.

10 (b) REQUIRED USES OF FUNDS.—Section 739(b) of the

11 Public Health Service Act (42 U.S.C. 293c(b)), as amended

12 by subsection (a), is amended—

13 (1) by striking paragraph (2);

14 (2) by redesignating paragraph (1) as para15 graph (2);

16 (3) by inserting before paragraph (2) (as so re17 designated) the following paragraph:

18 ‘‘(1) to collaborate with public and nonprofit

19 private entities to carry out community-based pro20 grams to recruit students of secondary schools and in21 stitutions of higher education and to prepare the stu22 dents academically for pursuing a career in the

23 health professions;’’;

24 (4) in paragraph (5)—

25 (A) by striking ‘‘faculty and student re26 search’’ and inserting ‘‘student research’’; and
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1 (B) by inserting before the period the follow2 ing: ‘‘, including research on issues relating to

3 the delivery of health care’’; and

4 (5)(A) in paragraph (4), by striking ‘‘and’’ after

5 the semicolon at the end;

6 (B) in paragraph (5), by striking the period at

7 the end and inserting ‘‘; and’’; and

8 (C) by adding at the end the following para9 graph:

10 ‘‘(6) to carry out a program to train students of

11 the school in providing health services through train12 ing provided at community-based health facilities

13 that provide such services to a significant number of

14 disadvantaged individuals and that are located at a

15 site remote from the main site of the teaching facili16 ties of the school.’’.

17 (c) REQUIREMENTS REGARDING CONSORTIA.—

18 (1) IN GENERAL.—Section 739(c)(1) of the Pub19 lic Health Service Act (42 U.S.C. 293c(c)(1)), as

20 amended by subsection (a), is amended—

21 (A) in subparagraph (A), in the matter pre22 ceding clause (i), by striking ‘‘specified in sub23 paragraph (B)’’ and inserting ‘‘specified in sub24 paragraphs (B) and (C)’’;
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1 (B) by redesignating subparagraph (C) as

2 subparagraph (D); and

3 (C) by inserting after subparagraph (B) the

4 following subparagraph:

5 ‘‘(C) The condition specified in this sub6 paragraph is that, in accordance with subsection

7 (e)(1), the designated health professions school

8 involved has with other health profession schools

9 (designated or otherwise) formed a consortium to

10 carry out the purposes described in subsection

11 (b) at the schools of the consortium. The grant

12 involved may be expended with respect to the

13 other schools without regard to whether such

14 schools meet the conditions specified in subpara15 graph (B).’’.

16 (2) CERTAIN REQUIREMENTS.—Section 739(e) of

17 the Public Health Service Act (42 U.S.C. 293c(e)), as

18 amended by subsection (a), is amended to read as fol19 lows:

20 ‘‘(e) PROVISIONS REGARDING CONSORTIA.—

21 ‘‘(1) REQUIREMENTS.—For purposes of sub22 section (c)(1)(C), a consortium of schools has been

23 formed in accordance with this subsection if—

24 ‘‘(A) the consortium consists of—
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1 ‘‘(i) the designated health professions

2 school seeking the grant under subsection

3 (a); and

4 ‘‘(ii) 1 or more schools of medicine, os5 teopathic medicine, dentistry, pharmacy,

6 nursing, allied health, or public health, or

7 graduate programs in mental health prac8 tice;

9 ‘‘(B) the schools of the consortium have en10 tered into an agreement for the allocation of such

11 grant among the schools; and

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

13 grant in accordance with this section.

14 ‘‘(2) AUTHORITY REGARDING NATIVE AMERICANS

15 CENTERS OF EXCELLENCE.—With respect to meeting

16 the conditions specified in subsection (c)(4), the Sec17 retary may make a grant under subsection (a) to a

18 designated health professions school that does not meet

19 such conditions if—

20 ‘‘(A) the school has formed a consortium in

21 accordance with paragraph (1); and

22 ‘‘(B) the schools of the consortium collec23 tively meet such conditions, without regard to

24 whether the schools individually meet such condi25 tions.’’.
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1 (3) CONFORMING AMENDMENTS.—Section 739 of

2 the Public Health Service Act (42 U.S.C. 293c), as

3 amended by subsection (a), is amended—

4 (A) in subsection (b), in the matter preced5 ing paragraph (1), by inserting ‘‘, subject to sub6 section (c)(1)(C),’’ after ‘‘agrees’’; and

7 (B) in subsection (d)—

8 (i) in paragraph (3), by striking ‘‘(e)’’

9 and inserting ‘‘(e)(2)’’; and

10 (ii) by adding at the end the following

11 paragraph:

12 ‘‘(4) RULE OF CONSTRUCTION.—Except as pro13 vided in paragraph (3) regarding a consortium under

14 subsection (e)(2), a health professions school that does

15 not meet the conditions specified in subsection

16 (c)(1)(B) may not be designated as a center of excel17 lence for purposes of this section. The preceding sen18 tence applies without regard to whether a grant under

19 subsection (a) is, pursuant to subsection (c)(1)(C),

20 being expended with respect to the school.’’.

21 (d) DEFINITION OF HEALTH PROFESSIONS SCHOOL.—

22 (1) GRADUATE PROGRAMS IN MENTAL HEALTH

23 PRACTICE.—Section 739(h)(1)(A) of the Public Health

24 Service Act (42 U.S.C. 293c(h)(1)(A)), as amended by

25 subsection (a), is amended by—
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1 (A) by striking ‘‘or’’ after ‘‘dentistry’’; and

2 (B) by inserting before the period the follow3 ing: ‘‘, or a graduate program in mental health

4 practice’’.

5 (2) LIMITATION.—During the fiscal years 1995

6 through 1997, the Secretary of Health and Human

7 Services may not make more than one grant under

8 section 739 of the Public Health Service Act directly

9 to a graduate program in mental health practice (as

10 defined in section 799 of such Act).

11 (e) FUNDING.—Section 739(i) of the Public Health

12 Service Act (42 U.S.C. 293c(i)), as amended by subsection

13 (a), is amended to read as follows:

14 ‘‘(i) FUNDING.—

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

16 the purpose of making grants under subsection (a),

17 there are authorized to be appropriated $28,000,000

18 for fiscal year 1995, $30,000,000 for fiscal year 1996,

19 and $32,000,000 for fiscal year 1997.

20 ‘‘(2) ALLOCATIONS BY SECRETARY.—

21 ‘‘(A) Of the amounts appropriated under

22 paragraph (1) for a fiscal year, the Secretary

23 shall make available $12,000,000 for grants

24 under subsection (a) to health professions schools

25 that are eligible for such grants pursuant to
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1 meeting the conditions described in paragraph

2 (2)(A) of subsection (c).

3 ‘‘(B) Of the amounts appropriated under

4 paragraph (1) for a fiscal year and available

5 after compliance with subparagraph (A), the

6 Secretary shall make available 65 percent for

7 grants under subsection (a) to health professions

8 schools that are eligible for such grants pursuant

9 to meeting the conditions described in paragraph

10 (3) or (4) of subsection (c) (including meeting

11 conditions pursuant to subsection (e)(2)).

12 ‘‘(C)(i) Of the amounts appropriated under

13 paragraph (1) for a fiscal year and available

14 after compliance with subparagraph (A), the

15 Secretary shall make available 35 percent for

16 grants under subsection (a) to health professions

17 schools that are eligible for such grants pursuant

18 to meeting the conditions described in paragraph

19 (5) of subsection (c).

20 ‘‘(ii) With respect to a fiscal year, a grant

21 under subsection (a) that includes amounts

22 available under subparagraph (A) may not in23 clude amounts available under clause (i) unless

24 each of the following conditions is met:
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1 ‘‘(I) In the case of amounts available

2 under subparagraph (B) or clause (i) and

3 included in grants made pursuant to sub4 section (c)(3), the aggregate number of such

5 grants is not less than such aggregate num6 ber for the preceding fiscal year, and one or

7 more of such grants is made in an amount

8 that is not less than the lowest amount

9 among grants made from amounts available

10 under subparagraph (A).

11 ‘‘(II) In the case of amounts available

12 under subparagraph (B) or clause (i) and

13 included in grants made pursuant to sub14 section (c)(4), the aggregate number of such

15 grants is not less than such aggregate num16 ber for the preceding fiscal year, and one or

17 more of such grants is made in an amount

18 that is not less than the lowest amount

19 among grants made from amounts available

20 under subparagraph (A).

21 ‘‘(III) In the case of amounts available

22 under clause (i) and included in grants

23 made pursuant to subsection (c)(5) (exclu24 sive of grants that include amounts avail25 able under subparagraph (A) or (B)), the
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1 aggregate number of such grants is not less

2 than such aggregate number for the preced3 ing fiscal year, and one or more of such

4 grants is made in an amount that is not

5 less than the lowest amount among grants

6 made from amounts available under sub7 paragraph (A).

8 ‘‘(IV) The aggregate amount of grants

9 under subsection (a) made from amounts

10 available under subparagraph (B) and

11 clause (i) (other than grants that include

12 amounts available under subparagraph (A))

13 is, in the case of fiscal year 1995, not less

14 than the sum of such aggregate amount for

15 fiscal year 1994 and the total amount by

16 which grants are required under subclauses

17 (I) through (III) to be increased; and is, in

18 the case of fiscal year 1996 and each subse19 quent fiscal year, not less than such aggre20 gate amount for the preceding fiscal year.’’.

21 (f) CONFORMING AMENDMENTS.—Section 739(c) of the

22 Public Health Service Act (42 U.S.C. 293c(c)), as amended

23 by subsection (a), is amended—
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1 (1) in paragraph (3)(B), by striking ‘‘the des2 ignated health professions school’’ and inserting ‘‘the

3 school’’; and

4 (2) in paragraph (4), in each of subparagraphs

5 (B) and (C), by striking ‘‘the designated health pro6 fessions school’’ and inserting ‘‘the school’’.

7 (g) TRANSITIONAL AND SAVINGS PROVISIONS.—

8 (1) IN GENERAL.—In the case of any entity re9 ceiving a grant under section 739 of the Public

10 Health Service Act for fiscal year 1994, the Secretary

11 of Health and Human Services shall, during the pe12 riod specified in paragraph (2), waive any or all of

13 the additional requirements established pursuant to

14 this section for the receipt or expenditure of such a

15 grant, subject to the entity providing assurances satis16 factory to the Secretary that the entity is making

17 progress toward meeting such requirements.

18 (2) RELEVANT PERIOD.—In the case of any en19 tity receiving a grant under section 739 of the Public

20 Health Service Act for fiscal year 1994, the period re21 ferred to in paragraph (1) is the period that, in first

22 approving the grant, the Secretary specified as the

23 duration of the grant.
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1 SEC. 305. EDUCATIONAL ASSISTANCE REGARDING UNDER2 GRADUATES.

3 (a) IN GENERAL.—Section 740 of the Public Health

4 Service Act (42 U.S.C. 293d) is amended to read as follows:

5 ‘‘SEC. 740. ASSISTANCE REGARDING HEALTH PROFESSIONS

6 AS CAREER CHOICE.

7 ‘‘(a) IN GENERAL.—

8 ‘‘(1) ACADEMIC PREPARATION OF STUDENTS.—

9 Subject to the provisions of this section, the Secretary

10 may make grants and enter into contracts for pur11 poses of—

12 ‘‘(A) identifying individuals who—

13 ‘‘(i) are students of elementary schools,

14 or students or graduates of secondary

15 schools or of institutions of higher edu16 cation;

17 ‘‘(ii) are from disadvantaged back18 grounds; and

19 ‘‘(iii) are interested in a career in the

20 health professions; and

21 ‘‘(B) providing to such individuals aca22 demic assistance, counseling, and other services

23 to prepare the students to meet the academic re24 quirements for entry into health professions

25 schools.
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1 ‘‘(2) RECIPIENTS OF GRANTS AND CONTRACTS.—

2 The Secretary may make an award of a grant or con3 tract under paragraph (1) only if the applicant for

4 the award is a nonprofit private community-based or5 ganization or other public or nonprofit private entity.

6 Such other entities include schools of medicine, osteo7 pathic medicine, public health, dentistry, veterinary

8 medicine, optometry, pharmacy, allied health, chiro9 practic, and podiatric medicine, and include grad10 uate programs in mental health practice.

11 ‘‘(3) CERTAIN USES OF AWARDS.—The purposes

12 for which the Secretary may authorize an award

13 under paragraph (1) to be expended include the fol14 lowing:

15 ‘‘(A) Assisting elementary and secondary

16 schools and institutions of higher education in

17 developing or improving programs to prepare

18 students to meet the academic requirements for

19 entry into health professions schools.

20 ‘‘(B) Establishing arrangements with non21 profit private community-based providers of pri22 mary health services under which students are

23 provided with opportunities to visit or work at

24 facilities of such providers and gain experience
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1 regarding a career in a field of primary health

2 care.

3 ‘‘(C) Developing or improving programs to

4 enhance the academic preparation of advanced,

5 prehealth professions students or

6 postbaccalaureate individuals to successfully

7 enter a health professions school.

8 ‘‘(D) In the case of an award under para9 graph (1) that the Secretary has authorized to be

10 expended for the purpose described in subpara11 graph (B) or (C), paying such stipends as the

12 Secretary may approve for individuals from dis13 advantaged backgrounds for any period of edu14 cation in student-enhancement programs (other

15 than regular courses), except that such a stipend

16 may not be provided to an individual for more

17 than 12 months, and such a stipend shall be in

18 an amount of $25 per day (notwithstanding any

19 other provision of law regarding the amount of

20 stipends).

21 ‘‘(b) MINIMUM REQUIREMENTS FOR AWARDS.—

22 ‘‘(1) ASSURANCES REGARDING FINANCIAL CAPAC23 ITY.—The Secretary may make an award of a grant

24 or contract under subsection (a) only if the applicant

25 provides assurances satisfactory to the Secretary that,
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1 with respect to the activities for which the award is

2 to be made, the applicant has or will have the finan3 cial capacity to continue the activities after the eligi4 bility of the applicant for such awards for such ac5 tivities is terminated pursuant to subsection (d).

6 ‘‘(2) COLLABORATION AMONG VARIOUS ENTI7 TIES.—The Secretary may make an award of a grant

8 or contract under subsection (a) only if the applicant

9 for the award has entered into an agreement with any

10 schools, institutions, community-based organizations,

11 or other entities with which the applicant will col12 laborate in carrying out activities under the award,

13 and the agreement specifies whether and to what ex14 tent the award will be allocated among the applicant

15 and the entities.

16 ‘‘(3) MATCHING FUNDS.—

17 ‘‘(A) With respect to the costs of the activi18 ties to be carried out under subsection (a) by an

19 applicant, the Secretary may make an award of

20 a grant or contract under such subsection only

21 if the applicant agrees to make available (di22 rectly or through donations from public or pri23 vate entities), in cash, non-Federal contributions

24 toward such costs in an amount that—
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1 ‘‘(i) for any second fiscal year for

2 which the applicant receives such a grant,

3 is not less than 20 percent of such costs;

4 ‘‘(ii) for any third such fiscal year, is

5 not less than 20 percent of such costs;

6 ‘‘(iii) for any fourth such fiscal year,

7 is not less than 40 percent of such costs;

8 ‘‘(iv) for any fifth such fiscal year, is

9 not less than 60 percent of such costs; and

10 ‘‘(v) for any sixth or subsequent such

11 fiscal year, is not less than 80 percent of

12 such costs.

13 ‘‘(B) Amounts provided by the Federal Gov14 ernment may not be included in determining the

15 amount of non-Federal contributions required in

16 subparagraph (A).

17 ‘‘(C) The Secretary may not require non18 Federal contributions for the first fiscal year for

19 which an applicant receives a grant under sub20 section (a).

21 ‘‘(c) PREFERENCE IN MAKING AWARDS.—

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

23 making awards of grants and contracts under sub24 section (a), the Secretary shall give preference to any

25 applicant that has made an arrangement with 1 or
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1 more elementary schools, an arrangement with 1 or

2 more secondary schools, an arrangement with 1 or

3 more institutions of higher education, an arrange4 ment with 1 or more health professions schools, and

5 an arrangement with 1 or more community-based or6 ganizations, the purpose of which arrangements is to

7 establish a program as follows:

8 ‘‘(A) With respect to the elementary schools

9 involved, the program carries out the purposes

10 described in subsection (a)(1).

11 ‘‘(B) After a student identified pursuant to

12 paragraph (1) enters the secondary school in13 volved, the program continues to carry out such

14 purposes with respect to the student.

15 ‘‘(C) After graduating from the secondary

16 school, the student enters the institution of higher

17 education involved, subject to meeting reasonable

18 academic requirements, and the program contin19 ues to carry out such purposes with respect to

20 the student.

21 ‘‘(D) After graduating from the institution

22 of higher education, the student enters the health

23 professions school involved, subject to meeting

24 reasonable academic requirements.
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1 ‘‘(2) REQUIREMENT REGARDING SCHOOLS AND

2 INSTITUTIONS.—For purposes of paragraph (1), an

3 applicant may not receive preference unless the

4 schools or institutions with which arrangements have

5 been made are schools or institutions whose enroll6 ment of students includes a significant number of in7 dividuals from disadvantaged backgrounds.

8 ‘‘(d) LIMITATION ON YEARS OF FUNDING FOR PAR9 TICULAR ACTIVITIES.—With respect to a particular activity

10 carried out under paragraph (1) or (3) of subsection (a)

11 by an entity, the Secretary may not, for the activity in12 volved, provide more than 6 years of financial assistance

13 under such subsection to the entity.

14 ‘‘(e) FUNDING.—

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

16 the purpose of carrying out this section and section

17 736, there are authorized to be appropriated

18 $32,000,000 for fiscal year 1995, $36,000,000 for fis19 cal year 1996, and $38,000,000 for fiscal year 1997.

20 ‘‘(2) ALLOCATIONS.—Of the amounts appro21 priated under paragraph (1) for a fiscal year, the

22 Secretary shall obligate not less than 20 percent for

23 carrying out subsection (a)(3)(B) and not less than

24 20 percent for providing scholarships under section

25 736.’’.
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1 (b) TRANSITIONAL AND SAVINGS PROVISION.—In the

2 case of an entity that received an award of a grant or con3 tract for fiscal year 1994 under section 740 of the Public

4 Health Service Act, the Secretary of Health and Human

5 Services may continue in effect the award in accordance

6 with the terms of the award, subject to the duration of the

7 award not exceeding the period determined by the Secretary

8 in first approving the award. The preceding sentence ap9 plies notwithstanding the amendment made by subsection

10 (a) of this section.

11 SEC. 306. STUDENT LOANS REGARDING SCHOOLS OF NURS12 ING.

13 Section 836(b) of the Public Health Service Act (42

14 U.S.C. 297b(b)) is amended—

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

16 the end and inserting a semicolon;

17 (2) in paragraph (2)—

18 (A) in subparagraph (A), by striking ‘‘and’’

19 at the end; and

20 (B) by inserting before the semicolon at the

21 end the following: ‘‘, and (C) such additional pe22 riods under the terms of paragraph (8) of this

23 subsection’’;

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

25 the end and inserting ‘‘; and’’; and
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1 (4) by adding at the end the following para2 graph:

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

4 the Secretary, the repayment period established under

5 paragraph (2) for any student borrower who during

6 the repayment period failed to make consecutive pay7 ments and who, during the last 12 months of the re8 payment period, has made at least 12 consecutive

9 payments may be extended for a period not to exceed

10 10 years.’’.

11 SEC. 307. FEDERALLY-SUPPORTED STUDENT LOAN FUNDS.

12 (a) AUTHORIZATION OF APPROPRIATIONS REGARDING

13 CERTAIN MEDICAL SCHOOLS.—

14 (1) IN GENERAL.—Subpart II of part A of title

15 VII of the Public Health Service Act (42 U.S.C. 292q

16 et seq.) is amended—

17 (A) by transferring subsection (f) of section

18 735 from the current placement of the subsection;

19 (B) by adding the subsection at the end of

20 section 723;

21 (C) by redesignating the subsection as sub22 section (e); and

23 (D) in subsection (e)(1) of section 723 (as

24 so redesignated), by striking ‘‘1996’’ and insert25 ing ‘‘1997’’.
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1 (2) CONFORMING AMENDMENTS.—Section 723 of

2 the Public Health Service Act (42 U.S.C. 292s), as

3 amended by paragraph (1) of this subsection, is

4 amended in subsection (e)(2)(A)—

5 (A) by striking ‘‘section 723(b)(2)’’ and in6 serting ‘‘subsection (b)(2)’’; and

7 (B) by striking ‘‘such section’’ and inserting

8 ‘‘such subsection’’.

9 (b) AUTHORIZATION OF APPROPRIATIONS REGARDING

10 INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.—Sec11 tion 724(f)(1) of the Public Health Service Act (42 U.S.C.

12 292t(f)(1)) is amended to read as follows:

13 ‘‘(1) IN GENERAL.—With respect to making Fed14 eral capital contributions to student loan funds for

15 purposes of subsection (a), other than the student loan

16 fund of any school of medicine or osteopathic medi17 cine, there is authorized to be appropriated

18 $5,000,000 for each of the fiscal years 1995 through

19 1997.’’.

20 TITLE IV—RESEARCH

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

22 Section 404 of the Public Health Service Act (42

23 U.S.C. 283(b)) is amended by adding at the end the follow24 ing subsections:
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1 ‘‘(c) PLAN.—Subject to applicable law, the Director of

2 the Office, in consultation with the advisory committee es3 tablished under subsection (d), shall develop and implement

4 a plan for carrying out the duties established in subsection

5 (b). The Director shall review the plan not less than annu6 ally, and revise the plan as appropriate.

7 ‘‘(d) ADVISORY COMMITTEE.—

8 ‘‘(1) In carrying out subsection (b), the Director

9 of the Office shall establish an advisory committee to

10 be known as the Advisory Committee on Research on

11 Minority Health (in this subsection referred to as the

12 ‘Committee’).

13 ‘‘(2)(A) The Committee shall be composed of

14 nonvoting, ex officio members designated in accord15 ance with subparagraph (B) and voting members ap16 pointed in accordance with subparagraph (C).

17 ‘‘(B) The Secretary shall designate as ex officio

18 members of the Committee the Directors of each of the

19 national research institutes and the Deputy Assistant

20 Secretary for Minority Health (except that any of

21 such officials may designate another officer or em22 ployee of the office or agency involved to serve as a

23 member of the Committee in lieu of the official).

24 ‘‘(C) The Director of the Office shall appoint as

25 voting members of the Committee not fewer than 12
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1 and not more than 18 individuals who are not offi2 cers or employees of the Federal Government. The ap3 pointments shall be made from among scientists and

4 health professionals whose clinical practice, research

5 specialization, or professional expertise includes sig6 nificant expertise in research on minority health. The

7 appointed membership of the Advisory Committee

8 shall be broadly representative of the various minority

9 groups.

10 ‘‘(3) The Director of the Office shall serve as the

11 chair of the Committee.

12 ‘‘(4) The Committee shall—

13 ‘‘(A) advise the Director of the Office on ap14 propriate research activities to be undertaken by

15 the national research institutes with respect to—

16 ‘‘(i) research on minority health;

17 ‘‘(ii) research on racial and ethnic dif18 ferences in clinical drug trials, including

19 responses to pharmacological drugs;

20 ‘‘(iii) research on racial and ethnic

21 differences in disease etiology, course, and

22 treatment; and

23 ‘‘(iv) research on minority health con24 ditions which require a multidisciplinary

25 approach;
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1 ‘‘(B) report to the Director of the Office on

2 such research;

3 ‘‘(C) provide recommendations to such Di4 rector regarding activities of the Office (includ5 ing recommendations on priorities in carrying

6 out research described in subparagraph (A)); and

7 ‘‘(D) assist in monitoring compliance with

8 section 492B regarding the inclusion of minori9 ties in clinical research.

10 ‘‘(5)(A) The Advisory Committee shall prepare

11 biennial reports describing the activities of the Com12 mittee, including findings made by the Committee re13 garding—

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

15 ‘‘(ii) the extent of expenditures made for re16 search on minority health by the agencies of the

17 National Institutes of Health; and

18 ‘‘(iii) the level of funding needed for such

19 research.

20 ‘‘(B) Each report under subparagraph (A) shall

21 be submitted to the Director of NIH for inclusion in

22 the report required in section 403 for the period in23 volved.

24 ‘‘(e) REPRESENTATION OF MINORITIES AMONG RE25 SEARCHERS.—The Secretary, acting through the Assistant
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1 Secretary for Personnel and in collaboration with the Di2 rector of the Office, shall determine the extent to which the

3 various minority groups are represented among adminis4 trators, senior physicians, and scientists of the national re5 search institutes and among physicians and scientists con6 ducting research with funds provided by such institutes,

7 and as appropriate, carry out activities to increase the ex8 tent of such representation.

9 ‘‘(f) REQUIREMENT REGARDING GRANTS AND CON10 TRACTS.—Any award of a grant, cooperative agreement, or

11 contract that the Director of the Office is authorized to make

12 shall be made only on a competitive basis.

13 ‘‘(g) DEFINITIONS.—For purposes of this section:

14 ‘‘(1) The term ‘minority health conditions’, with

15 respect to individuals who are members of minority

16 groups, means all diseases, disorders, and conditions

17 (including with respect to mental health)—

18 ‘‘(A) unique to, more serious, or more prev19 alent in such individuals;

20 ‘‘(B) for which the factors of medical risk or

21 types of medical intervention are different for

22 such individuals, or for which it is unknown

23 whether such factors or types are different for

24 such individuals; or
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1 ‘‘(C) with respect to which there has been

2 insufficient clinical research involving such indi3 viduals as subjects or insufficient clinical data

4 on such individuals.

5 ‘‘(2) The term ‘research on minority health’

6 means research on minority health conditions, includ7 ing research on preventing such conditions.

8 ‘‘(3) The term ‘minority groups’ has the meaning

9 given such term in section 1707(h).’’.

10 SEC. 402. ACTIVITIES OF AGENCY FOR HEALTH CARE POL11 ICY AND RESEARCH.

12 Title IX of the Public Health Service Act (42 U.S.C.

13 299 et seq.) is amended—

14 (1) in section 902, by amending subsection (b) to

15 read as follows:

16 ‘‘(b) REQUIREMENTS WITH RESPECT TO CERTAIN

17 POPULATIONS.—In carrying out subsection (a), the Admin18 istrator shall undertake and support research, demonstra19 tion projects, and evaluations with respect to the health sta20 tus of, and the delivery of health care to—

21 ‘‘(1) the populations of medically underserved

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

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

24 the elderly.’’; and
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1 (2) in section 926(a), by adding at the end the

2 following sentence: ‘‘Of the amounts appropriated

3 under the preceding sentence for a fiscal year, the Ad4 ministrator shall reserve not less than 8 percent for

5 carrying out section 902(b)(2).’’.

6 SEC. 403. DATA COLLECTION BY NATIONAL CENTER FOR

7 HEALTH STATISTICS.

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

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

10 Public Law 103–183 (107 Stat. 2237), is amended to read

11 as follows:

12 ‘‘(n)(1) For health statistical and epidemiological ac13 tivities undertaken or supported under this section, there

14 are authorized to be appropriated such sums as may be nec15 essary for each of the fiscal years 1995 through 1998.

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

17 (1) for a fiscal year, the Secretary shall obligate not less

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

19 (h), (l), and (m) with respect to particular racial and eth20 nic population groups.’’.

21 TITLE V—NATIVE HAWAIIAN

22 HEALTH CARE

23 SEC. 501. CLARIFICATION OF 1992 AMENDMENTS.

24 (a) CLARIFICATION OF DATE OF PASSAGE.—Section

25 9168 of the Department of Defense Appropriations Act,
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1 1993 (106 Stat. 1948) is amended by striking ‘‘September

2 12, 1992,’’ and inserting ‘‘August 7, 1992,’’.

3 (b) EFFECTIVE DATE.—The amendment made by sub4 section (a) shall take effect as of October 6, 1992.

5 SEC. 502. AMENDMENT OF NATIVE HAWAIIAN HEALTH CARE

6 IMPROVEMENT ACT TO REFLECT 1992 AGREE7 MENT.

8 Effective on the date of enactment of this Act, the Na9 tive Hawaiian Health Care Improvement Act (42 U.S.C.

10 11701 et seq.) is amended to read as follows:

11 ‘‘SECTION 1. SHORT TITLE.

12 ‘‘This Act may be cited as the ‘Native Hawaiian

13 Health Care Improvement Act’.

14 ‘‘SEC. 2. FINDINGS; DECLARATION OF POLICY; INTENT OF

15 CONGRESS.

16 ‘‘(a) FINDINGS.—The Congress finds that—

17 ‘‘(1) the United States retains the legal respon18 sibility to enforce the administration of the public

19 trust responsibility of the State of Hawaii for the bet20 terment of the conditions of Native Hawaiians under

21 section 5(f) of Public Law 86–3 (73 Stat. 6; com22 monly referred to as the ‘Hawaii Statehood Admis23 sions Act’);

24 ‘‘(2) in furtherance of the State of Hawaii’s pub25 lic trust responsibility for the betterment of the condi-
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1 tions of Native Hawaiians, contributions by the Unit2 ed States to the provision of comprehensive health

3 promotion and disease prevention services to main4 tain and improve the health status of Native Hawai5 ians are consistent with the historical and unique

6 legal relationship of the United States with the gov7 ernment that represented the indigenous native people

8 of Hawaii; and

9 ‘‘(3) it is the policy of the United States to raise

10 the health status of Native Hawaiians to the highest

11 possible level and to encourage the maximum partici12 pation of Native Hawaiians in order to achieve this

13 objective.

14 ‘‘(b) DECLARATION OF POLICY.—The Congress hereby

15 declares that it is the policy of the United States in fulfill16 ment of its special responsibilities and legal obligations to

17 the indigenous people of Hawaii resulting from the unique

18 and historical relationship between the United States and

19 the Government of the indigenous people of Hawaii—

20 ‘‘(1) to raise the health status of Native Hawai21 ians to the highest possible health level; and

22 ‘‘(2) to provide existing Native Hawaiian health

23 care programs with all resources necessary to effec24 tuate this policy.
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1 ‘‘(c) INTENT OF CONGRESS.—It is the intent of the

2 Congress that the Nation meet the following health objectives

3 with respect to Native Hawaiians by the year 2000:

4 ‘‘(1) Reduce coronary heart disease deaths to no

5 more than 100 per 100,000.

6 ‘‘(2) Reduce stroke deaths to no more than 20 per

7 100,000.

8 ‘‘(3) Increase control of high blood pressure to at

9 least 50 percent of people with high blood pressure.

10 ‘‘(4) Reduce blood cholesterol to an average of no

11 more than 200 mg/dl.

12 ‘‘(5) Slow the rise in lung cancer deaths to

13 achieve a rate of no more than 42 per 100,000.

14 ‘‘(6) Reduce breast cancer deaths to no more

15 than 20.6 per 100,000 women.

16 ‘‘(7) Increase Pap tests every 1 to 3 years to at

17 least 85 percent of women age 18 and older.

18 ‘‘(8) Increase fecal occult blood testing every 1 to

19 2 years to at least 50 percent of people age 50 and

20 older.

21 ‘‘(9) Reduce diabetes-related deaths to no more

22 than 34 per 100,000.

23 ‘‘(10) Reduce the most severe complications of di24 abetes as follows:
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1 ‘‘(A) End-stage renal disease to no more

2 than 1.4 in 1,000.

3 ‘‘(B) Blindness to no more than 1.4 in

4 1,000.

5 ‘‘(C) Lower extremity amputation to no

6 more than 4.9 in 1,000.

7 ‘‘(D) Perinatal mortality to no more than 2

8 percent.

9 ‘‘(E) Major congenital malformations to no

10 more than 4 percent.

11 ‘‘(11) Reduce infant mortality to no more than

12 7 deaths per 1,000 live births.

13 ‘‘(12) Reduce low birth weight to no more than

14 5 percent of live births.

15 ‘‘(13) Increase first trimester prenatal care to at

16 least 90 percent of live births.

17 ‘‘(14) Reduce teenage pregnancies to no more

18 than 50 per 1,000 girls age 17 and younger.

19 ‘‘(15) Reduce unintended pregnancies to no more

20 than 30 percent of pregnancies.

21 ‘‘(16) Increase to at least 60 percent the propor22 tion of primary care providers who provide age-ap23 propriate preconception care and counseling.

24 ‘‘(17) Increase years of healthy life to at least 65

25 years.
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1 ‘‘(18) Eliminate financial barriers to clinical

2 preventive services.

3 ‘‘(19) Increase childhood immunization levels to

4 at least 90 percent of 2-year-olds.

5 ‘‘(20) Reduce the prevalence of dental caries to

6 no more than 35 percent of children by age 8.

7 ‘‘(21) Reduce untreated dental caries so that the

8 proportion of children with untreated caries (in per9 manent or primary teeth) is no more than 20 percent

10 among children age 6 through 8 and no more than 15

11 percent among adolescents age 15.

12 ‘‘(22) Reduce edentulism to no more than 20 per13 cent in people age 65 and older.

14 ‘‘(23) Increase moderate daily physical activity

15 to at least 30 percent of the population.

16 ‘‘(24) Reduce sedentary lifestyles to no more than

17 15 percent of the population.

18 ‘‘(25) Reduce overweight to a prevalence of no

19 more than 20 percent of the population.

20 ‘‘(26) Reduce dietary fat intake to an average of

21 30 percent of calories or less.

22 ‘‘(27) Increase to at least 75 percent the propor23 tion of primary care providers who provide nutrition

24 assessment and counseling or referral to qualified nu25 tritionists or dieticians.
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1 ‘‘(28) Reduce cigarette smoking prevalence to no

2 more than 15 percent of adults.

3 ‘‘(29) Reduce initiation of smoking to no more

4 than 15 percent by age 20.

5 ‘‘(30) Reduce alcohol-related motor vehicle crash

6 deaths to no more than 8.5 per 100,000 adjusted for

7 age.

8 ‘‘(31) Reduce alcohol use by school children age

9 12 to 17 to less than 13 percent.

10 ‘‘(32) Reduce marijuana use by youth age 18 to

11 25 to less than 8 percent.

12 ‘‘(33) Reduce cocaine use by youth age 18 to 25

13 to less than 3 percent.

14 ‘‘(34) Confine HIV infection to no more than

15 800 per 100,000.

16 ‘‘(35) Reduce gonorrhea infections to no more

17 than 225 per 100,000.

18 ‘‘(36) Reduce syphilis infections to no more that

19 10 per 100,000.

20 ‘‘(37) Reduce significant hearing impairment to

21 a prevalance of no more than 82 per 1,000.

22 ‘‘(38) Reduce acute middle ear infections among

23 children age 4 and younger, as measured by days of

24 restricted activity or school absenteeism, to no more

25 than 105 days per 100 children.
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1 ‘‘(39) Reduce indigenous cases of vaccine-pre2 ventable diseases as follows:

3 ‘‘(A) Diphtheria among individuals age 25

4 and younger to 0.

5 ‘‘(B) Tetanus among individuals age 25

6 and younger to 0.

7 ‘‘(C) Polio (wild-type virus) to 0.

8 ‘‘(D) Measles to 0.

9 ‘‘(E) Rubella to 0.

10 ‘‘(F) Congenital Rubella Syndrome to 0.

11 ‘‘(G) Mumps to 500.

12 ‘‘(H) Pertussis to 1,000.

13 ‘‘(40) Reduce significant visual impairment to a

14 prevalence of no more than 30 per 1,000.

15 ‘‘(d) REPORT.—The Secretary shall submit to the

16 President, for inclusion in each report required to be trans17 mitted to the Congress under section 9, a report on the

18 progress made toward meeting each of the objectives de19 scribed in subsection (c).

20 ‘‘SEC. 3. COMPREHENSIVE HEALTH CARE MASTER PLAN

21 FOR NATIVE HAWAIIANS.

22 ‘‘The Secretary may make a grant to, or enter into

23 a contract with, Papa Ola Lokahi for the purpose of coordi24 nating, implementing, and updating a Native Hawaiian

25 comprehensive health care master plan designed to promote
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1 comprehensive health promotion and disease prevention

2 services and to maintain and improve the health status of

3 Native Hawaiians. The master plan shall be based upon

4 an assessment of the health care status and health care

5 needs of Native Hawaiians. To the extent practicable, as6 sessments made as of the date of such grant or contract shall

7 be used by Papa Ola Lokahi, except that any such assess8 ment shall be updated as appropriate.

9 ‘‘SEC. 4. NATIVE HAWAIIAN HEALTH CARE SYSTEMS.

10 ‘‘(a) COMPREHENSIVE HEALTH PROMOTION, DISEASE

11 PREVENTION, AND PRIMARY HEALTH SERVICES.—(1)(A)

12 The Secretary, in consultation with Papa Ola Lokahi, may

13 make grants to, or enter into contracts with, any qualified

14 entity for the purpose of providing comprehensive health

15 promotion and disease prevention services as well as pri16 mary health services to Native Hawaiians.

17 ‘‘(B) In making grants and entering into contracts

18 under this paragraph, the Secretary shall give preference

19 to Native Hawaiian health care systems and Native Hawai20 ian organizations, and, to the extent feasible, health pro21 motion and disease prevention services shall be performed

22 through Native Hawaiian health care systems.

23 ‘‘(2) In addition to paragraph (1), the Secretary may

24 make a grant to, or enter into a contract with, Papa Ola

25 Lokahi for the purpose of planning Native Hawaiian health
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1 care systems to serve the health needs of Native Hawaiian

2 communities on the islands of O’ahu, Moloka’i, Maui, Ha3 wai’i, Lana’i, Kaua’i, and Ni’ihau in the State of Hawaii.

4 ‘‘(b) QUALIFIED ENTITY.—An entity is a qualified en5 tity for purposes of subsection (a)(1) if the entity is a Na6 tive Hawaiian health care system.

7 ‘‘(c) SERVICES TO BE PROVIDED.—(1) Each recipient

8 of funds under subsection (a)(1) shall provide the following

9 services:

10 ‘‘(A) Outreach services to inform Native Hawai11 ians of the availability of health services.

12 ‘‘(B) Education in health promotion and disease

13 prevention of the Native Hawaiian population by

14 (wherever possible) Native Hawaiian health care

15 practitioners, community outreach workers, coun16 selors, and cultural educators.

17 ‘‘(C) Services of physicians, physicians’ assist18 ants, or nurse practitioners.

19 ‘‘(D) Immunizations.

20 ‘‘(E) Prevention and control of diabetes, high

21 blood pressure, and otitis media.

22 ‘‘(F) Pregnancy and infant care.

23 ‘‘(G) Improvement of nutrition.
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1 ‘‘(2) In addition to the mandatory services under

2 paragraph (1), the following services may be provided pur3 suant to subsection (a)(1):

4 ‘‘(A) Identification, treatment, control, and re5 duction of the incidence of preventable illnesses and

6 conditions endemic to Native Hawaiians.

7 ‘‘(B) Collection of data related to the prevention

8 of diseases and illnesses among Native Hawaiians.

9 ‘‘(C) Services within the meaning of the terms

10 ‘health promotion’, ‘disease prevention’, and ‘primary

11 health services’, as such terms are defined in section

12 10, which are not specifically referred to in para13 graph (1) of this subsection.

14 ‘‘(3) The health care services referred to in paragraphs

15 (1) and (2) which are provided under grants or contracts

16 under subsection (a)(1) may be provided by traditional Na17 tive Hawaiian healers.

18 ‘‘(d) LIMITATION ON NUMBER OF ENTITIES.—During

19 a fiscal year, the Secretary under this Act may make a

20 grant to, or hold a contract with, not more than 5 Native

21 Hawaiian health care systems.

22 ‘‘(e) MATCHING FUNDS.—(1) The Secretary may not

23 make a grant or provide funds pursuant to a contract under

24 subsection (a)(1) to an entity—
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1 ‘‘(A) in an amount exceeding 75 percent of the

2 costs of providing health services under the grant or

3 contract; and

4 ‘‘(B) unless the entity agrees that the entity will

5 make available, directly or through donations to the

6 entity, non-Federal contributions toward such costs in

7 an amount equal to not less than $1 (in cash or in

8 kind under paragraph (2)) for each $3 of Federal

9 funds provided in such grant or contract.

10 ‘‘(2) Non-Federal contributions required in paragraph

11 (1) may be in cash or in kind, fairly evaluated, including

12 plant, equipment, or services. Amounts provided by the Fed13 eral Government or services assisted or subsidized to any

14 significant extent by the Federal Government may not be

15 included in determining the amount of such non-Federal

16 contributions.

17 ‘‘(3) The Secretary may waive the requirement estab18 lished in paragraph (1) if—

19 ‘‘(A) the entity involved is a nonprofit private

20 entity described in subsection (b); and

21 ‘‘(B) the Secretary, in consultation with Papa

22 Ola Lokahi, determines that it is not feasible for the

23 entity to comply with such requirement.

24 ‘‘(f) RESTRICTION ON USE OF GRANT AND CONTRACT

25 FUNDS.—The Secretary may not make a grant to, or enter
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1 into a contract with, an entity under subsection (a)(1) un2 less the entity agrees that amounts received pursuant to

3 such subsection will not, directly or through contract, be

4 expended—

5 ‘‘(1) for any purpose other than the purposes de6 scribed in subsection (c);

7 ‘‘(2) to provide inpatient services;

8 ‘‘(3) to make cash payments to intended recipi9 ents of health services; or

10 ‘‘(4) to purchase or improve real property (other

11 than minor remodeling of existing improvements to

12 real property) or to purchase major medical equip13 ment.

14 ‘‘(g) LIMITATION ON CHARGES FOR SERVICES.—The

15 Secretary may not make a grant, or enter into a contract

16 with, an entity under subsection (a)(1) unless the entity

17 agrees that, whether health services are provided directly or

18 through contract—

19 ‘‘(1) health services under the grant or contract

20 will be provided without regard to ability to pay for

21 the health services; and

22 ‘‘(2) the entity will impose a charge for the deliv23 ery of health services, and such charge—
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1 ‘‘(A) will be made according to a schedule

2 of charges that is made available to the public,

3 and

4 ‘‘(B) will be adjusted to reflect the income

5 of the individual involved.

6 ‘‘SEC. 5. FUNCTIONS OF, AND GRANTS TO, PAPA OLA

7 LOKAHI.

8 ‘‘(a) FUNCTIONS.—Papa Ola Lokahi shall—

9 ‘‘(1) coordinate, implement, and update, as ap10 propriate, the comprehensive health care master plan

11 developed pursuant to section 3;

12 ‘‘(2) to the maximum extent possible, coordinate

13 and assist the health care programs and services pro14 vided to Native Hawaiians;

15 ‘‘(3) provide for the training of the persons de16 scribed in section 4(c)(1)(B);

17 ‘‘(4) develop an action plan outlining the con18 tributions that each member organization of Papa

19 Ola Lokahi will make in carrying out this Act;

20 ‘‘(5) serve as a clearinghouse for—

21 ‘‘(A) the collection and maintenance of data

22 associated with the health status of Native Ha23 waiians;

24 ‘‘(B) the identification of and research into

25 diseases affecting Native Hawaiians;
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1 ‘‘(C) the availability of Native Hawaiian

2 project funds, research projects, and publications;

3 and

4 ‘‘(D) the timely dissemination of informa5 tion relating to Native Hawaiian health care

6 systems;

7 ‘‘(6) perform the recognition and certification

8 functions specified in sections 10(6)(F) and 10(6)(G);

9 and

10 ‘‘(7) provide technical support and coordination

11 of training and technical assistance to Native Hawai12 ian health care systems.

13 ‘‘(b) SPECIAL PROJECT FUNDS.—Papa Ola Lokahi

14 may receive project funds that may be appropriated for the

15 purpose of research on the health status of Native Hawai16 ians or for the purpose of addressing the health care needs

17 of Native Hawaiians.

18 ‘‘(c) GRANTS.—In addition to any other grant or con19 tract under this Act, the Secretary may make grants to,

20 or enter into contracts with, Papa Ola Lokahi for—

21 ‘‘(1) carrying out the functions described in sub22 section (a); and

23 ‘‘(2) administering any special project funds re24 ceived under the authority of subsection (b).
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1 ‘‘(d) RELATIONSHIPS WITH OTHER AGENCIES.—Papa

2 Ola Lokahi may enter into agreements or memoranda of

3 understanding with relevant agencies or organizations that

4 are capable of providing resources or services to Native Ha5 waiian health care systems.

6 ‘‘SEC. 6. ADMINISTRATION OF GRANTS AND CONTRACTS.

7 ‘‘(a) TERMS AND CONDITIONS.—The Secretary shall

8 include in any grant made or contract entered into under

9 this Act such terms and conditions as the Secretary consid10 ers necessary or appropriate to ensure that the objectives

11 of such grant or contract are achieved.

12 ‘‘(b) PERIODIC REVIEW.—The Secretary shall periodi13 cally evaluate the performance of, and compliance with,

14 grants and contracts under this Act.

15 ‘‘(c) ADMINISTRATIVE REQUIREMENTS.—The Sec16 retary may not make a grant or enter into a contract under

17 this Act with an entity unless the entity—

18 ‘‘(1) agrees to establish such procedures for fiscal

19 control and fund accounting as may be necessary to

20 ensure proper disbursement and accounting with re21 spect to the grant or contract;

22 ‘‘(2) agrees to ensure the confidentiality of

23 records maintained on individuals receiving health

24 services under the grant or contract;
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1 ‘‘(3) with respect to providing health services to

2 any population of Native Hawaiians a substantial

3 portion of which has a limited ability to speak the

4 English language—

5 ‘‘(A) has developed and has the ability to

6 carry out a reasonable plan to provide health

7 services under the grant or contract through in8 dividuals who are able to communicate with the

9 population involved in the language and cultural

10 context that is most appropriate; and

11 ‘‘(B) has designated at least one individual,

12 fluent in both English and the appropriate lan13 guage, to assist in carrying out the plan;

14 ‘‘(4) with respect to health services that are cov15 ered in the plan of the State of Hawaii approved

16 under title XIX of the Social Security Act—

17 ‘‘(A) if the entity will provide under the

18 grant or contract any such health services di19 rectly—

20 ‘‘(i) the entity has entered into a par21 ticipation agreement under such plan; and

22 ‘‘(ii) the entity is qualified to receive

23 payments under such plan; and
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1 ‘‘(B) if the entity will provide under the

2 grant or contract any such health services

3 through a contract with an organization—

4 ‘‘(i) the organization has entered into

5 a participation agreement under such plan;

6 and

7 ‘‘(ii) the organization is qualified to

8 receive payments under such plan; and

9 ‘‘(5) agrees to submit to the Secretary and to

10 Papa Ola Lokahi an annual report that describes the

11 utilization and costs of health services provided under

12 the grant or contract (including the average cost of

13 health services per user) and that provides such other

14 information as the Secretary determines to be appro15 priate.

16 ‘‘(d) CONTRACT EVALUATION.—(1) If, as a result of

17 evaluations conducted by the Secretary, the Secretary deter18 mines that an entity has not complied with or satisfactorily

19 performed a contract entered into under section 4, the Sec20 retary shall, prior to renewing such contract, attempt to

21 resolve the areas of noncompliance or unsatisfactory per22 formance and modify such contract to prevent future occur23 rences of such noncompliance or unsatisfactory perform24 ance. If the Secretary determines that such noncompliance

25 or unsatisfactory performance cannot be resolved and pre-
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1 vented in the future, the Secretary shall not renew such con2 tract with such entity and is authorized to enter into a con3 tract under section 4 with another entity referred to in sec4 tion 4(b) that provides services to the same population of

5 Native Hawaiians which is served by the entity whose con6 tract is not renewed by reason of this subsection.

7 ‘‘(2) In determining whether to renew a contract en8 tered into with an entity under this Act, the Secretary shall

9 consider the results of evaluation under this section.

10 ‘‘(3) All contracts entered into by the Secretary under

11 this Act shall be in accordance with all Federal contracting

12 laws and regulations except that, in the discretion of the

13 Secretary, such contracts may be negotiated without adver14 tising and may be exempted from the provisions of the Act

15 of August 24, 1935 (40 U.S.C. 270a et seq.).

16 ‘‘(4) Payments made under any contract entered into

17 under this Act may be made in advance, by means of reim18 bursement, or in installments and shall be made on such

19 conditions as the Secretary deems necessary to carry out

20 the purposes of this Act.

21 ‘‘(e) LIMITATION ON USE OF FUNDS FOR ADMINISTRA22 TIVE EXPENSES.—Except for grants and contracts under

23 section 5(c), the Secretary may not make a grant to, or

24 enter into a contract with, an entity under this Act unless

25 the entity agrees that the entity will not expend more than
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1 10 percent of amounts received pursuant to this Act for the

2 purpose of administering the grant or contract.

3 ‘‘(f) REPORT.—(1) For each fiscal year during which

4 an entity receives or expends funds pursuant to a grant

5 or contract under this Act, such entity shall submit to the

6 Secretary and to Papa Ola Lokahi a quarterly report on—

7 ‘‘(A) activities conducted by the entity under the

8 grant or contract;

9 ‘‘(B) the amounts and purposes for which Fed10 eral funds were expended; and

11 ‘‘(C) such other information as the Secretary

12 may request.

13 ‘‘(2) The reports and records of any entity which con14 cern any grant or contract under this Act shall be subject

15 to audit by the Secretary, the Inspector General of Health

16 and Human Services, and the Comptroller General of the

17 United States.

18 ‘‘(g) ANNUAL PRIVATE AUDIT.—The Secretary shall

19 allow as a cost of any grant made or contract entered into

20 under this Act the cost of an annual private audit con21 ducted by a certified public accountant.

22 ‘‘SEC. 7. ASSIGNMENT OF PERSONNEL.

23 ‘‘(a) IN GENERAL.—The Secretary is authorized to

24 enter into an agreement with any entity under which the

25 Secretary is authorized to assign personnel of the Depart-
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1 ment of Health and Human Services with expertise identi2 fied by such entity to such entity on detail for the purposes

3 of providing comprehensive health promotion and disease

4 prevention services to Native Hawaiians.

5 ‘‘(b) APPLICABLE FEDERAL PERSONNEL PROVI6 SIONS.—Any assignment of personnel made by the Sec7 retary under any agreement entered into under the author8 ity of subsection (a) shall be treated as an assignment of

9 Federal personnel to a local government that is made in

10 accordance with subchapter VI of chapter 33 of title 5,

11 United States Code.

12 ‘‘SEC. 8. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.

13 ‘‘(a) ELIGIBILITY.—The Secretary is authorized to

14 make scholarship grants to students who—

15 ‘‘(1) meet the requirements of section 338A(b) of

16 the Public Health Service Act (42 U.S.C. 254l(b));

17 and

18 ‘‘(2) are Native Hawaiians.

19 ‘‘(b) TERMS AND CONDITIONS.—(1) Scholarship grants

20 provided under subsection (a) shall be provided under the

21 same terms and subject to the same conditions, regulations,

22 and rules that apply to scholarship grants provided under

23 section 338A of the Public Health Service Act (42 U.S.C.

24 254l), except that—
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1 ‘‘(A) the provision of scholarships in each type

2 of health care profession training shall correspond to

3 the need for each type of health care professional to

4 serve Native Hawaiian health care systems, as identi5 fied by Papa Ola Lokahi;

6 ‘‘(B) in selecting scholarship recipients, the Sec7 retary shall give priority to individuals included on

8 a list of eligible applicants submitted by the Kameha9 meha Schools/Bishop Estate; and

10 ‘‘(C) the obligated service requirement for each

11 scholarship recipient shall be fulfilled through service,

12 in order of priority, in—

13 ‘‘(i) any one of the five Native Hawaiian

14 health care systems which, during the fiscal year

15 in which the obligated service requirement is as16 signed, has received a grant or entered into a

17 contract pursuant to section 4; or

18 ‘‘(ii) health professions shortage areas,

19 medically underserved areas, or geographic areas

20 or facilities similarly designated by the United

21 States Public Health Service in the State of Ha22 waii.

23 ‘‘(2) The Secretary shall enter into a cooperative agree24 ment with the Kamehameha Schools/Bishop Estate under

25 which such organization shall provide recruitment, reten-
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1 tion, counseling, and other support services intended to im2 prove the operation of the scholarship program established

3 under this section.

4 ‘‘(3) The Native Hawaiian Health Scholarship pro5 gram shall not be administered by or through the Indian

6 Health Service.

7 ‘‘SEC. 9. REPORT.

8 ‘‘The President shall, at the time the budget is submit9 ted under section 1105 of title 31, United States Code, for

10 each fiscal year transmit to the Congress the report required

11 pursuant to section 2(d).

12 ‘‘SEC. 10. DEFINITIONS.

13 ‘‘For purposes of this Act:

14 ‘‘(1) DISEASE PREVENTION.—The term ‘disease

15 prevention’ includes—

16 ‘‘(A) immunizations,

17 ‘‘(B) control of high blood pressure,

18 ‘‘(C) control of sexually transmittable dis19 eases,

20 ‘‘(D) prevention and control of diabetes,

21 ‘‘(E) control of toxic agents,

22 ‘‘(F) occupational safety and health,

23 ‘‘(G) accident prevention,

24 ‘‘(H) fluoridation of water,

25 ‘‘(I) control of infectious agents, and
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1 ‘‘(J) provision of mental health care.

2 ‘‘(2) HEALTH PROMOTION.—The term ‘health

3 promotion’ includes—

4 ‘‘(A) pregnancy and infant care, including

5 prevention of fetal alcohol syndrome,

6 ‘‘(B) cessation of tobacco smoking,

7 ‘‘(C) reduction in the misuse of alcohol and

8 drugs,

9 ‘‘(D) improvement of nutrition,

10 ‘‘(E) improvement in physical fitness,

11 ‘‘(F) family planning, and

12 ‘‘(G) control of stress.

13 ‘‘(3) NATIVE HAWAIIAN.—The term ‘Native Ha14 waiian’ means any individual who is—

15 ‘‘(A) a citizen of the United States; and

16 ‘‘(B) a descendant of the aboriginal people,

17 who prior to 1778, occupied and exercised sov18 ereignty in the area that now constitutes the

19 State of Hawaii, as evidenced by—

20 ‘‘(i) genealogical records;

21 ‘‘(ii) Kupuna (elders) or Kama’aina

22 (long-term community residents) verifica23 tion; or

24 ‘‘(iii) birth records of the State of Ha25 waii.
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1 ‘‘(4) NATIVE HAWAIIAN HEALTH CENTER.—The

2 term ‘Native Hawaiian health center’ means an en3 tity—

4 ‘‘(A) which is organized under the laws of

5 the State of Hawaii,

6 ‘‘(B) which provides or arranges for health

7 care services through practitioners licensed by

8 the State of Hawaii, where licensure require9 ments are applicable,

10 ‘‘(C) which is a public or nonprofit private

11 entity, and

12 ‘‘(D) in which Native Hawaiian health

13 practitioners significantly participate in the

14 planning, management, monitoring, and evalua15 tion of health services.

16 ‘‘(5) NATIVE HAWAIIAN ORGANIZATION.—The

17 term ‘Native Hawaiian organization’ means any or18 ganization—

19 ‘‘(A) which serves the interests of Native

20 Hawaiians,

21 ‘‘(B) which is—

22 ‘‘(i) recognized by Papa Ola Lokahi for

23 the purpose of planning, conducting, or ad24 ministering programs (or portions of pro-
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1 grams) authorized under this Act for the

2 benefit of Native Hawaiians, and

3 ‘‘(ii) certified by Papa Ola Lokahi as

4 having the qualifications and capacity to

5 provide the services, and meet the require6 ments, under the contract the organization

7 enters into with, or grant the organization

8 receives from, the Secretary under this Act,

9 ‘‘(C) in which Native Hawaiian health

10 practitioners significantly participate in the

11 planning, management, monitoring, and evalua12 tion of health services, and

13 ‘‘(D) which is a public or nonprofit private

14 entity.

15 ‘‘(6) NATIVE HAWAIIAN HEALTH CARE SYSTEM.—

16 The term ‘Native Hawaiian health care system’

17 means an entity—

18 ‘‘(A) which is organized under the laws of

19 the State of Hawaii;

20 ‘‘(B) which provides or arranges for health

21 care services through practitioners licensed by

22 the State of Hawaii, where licensure require23 ments are applicable;

24 ‘‘(C) which is a public or nonprofit private

25 entity;
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1 ‘‘(D) in which Native Hawaiian health

2 practitioners significantly participate in the

3 planning, management, monitoring, and evalua4 tion of health care services;

5 ‘‘(E) which may be composed of as many

6 Native Hawaiian health centers as necessary to

7 meet the health care needs of Native Hawaiians

8 residing on the island or islands served by such

9 entity;

10 ‘‘(F) which is recognized by Papa Ola

11 Lokahi for the purpose of providing comprehen12 sive health promotion and disease prevention

13 services as well as primary health services to Na14 tive Hawaiians under this Act; and

15 ‘‘(G) which is certified by Papa Ola Lokahi

16 as having the qualifications and the capacity to

17 provide the services and meet the requirements of

18 a contract entered into, or a grant received,

19 under section 4.

20 ‘‘(7) PAPA OLA LOKAHI.—(A) Subject to sub21 paragraph (B), the term ‘Papa Ola Lokahi’ means an

22 organization composed of—

23 ‘‘(i) E Ola Mau;

24 ‘‘(ii) the Office of Hawaiian Affairs of the

25 State of Hawaii;
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1 ‘‘(iii) Alu Like Inc.;

2 ‘‘(iv) the University of Hawaii;

3 ‘‘(v) the Office of Hawaiian Health of the

4 Hawaii State Department of Health;

5 ‘‘(vi) Ho’ola Lahui Hawaii, or a health

6 care system serving the islands of Kaua’i and

7 Ni’ihau;

8 ‘‘(vii) Ke Ola Mamo, or a health care sys9 tem serving the island of O’ahu;

10 ‘‘(viii) Na Pu’uwai or a health care system

11 serving the islands of Moloka’i and Lana’i;

12 ‘‘(ix) Hui No Ke Ola Pono, or a health care

13 system serving the island of Maui;

14 ‘‘(x) Hui Malama Ola Ha’Oiwi or a health

15 care system serving the island of Hawaii; and

16 ‘‘(xi) such other member organizations as

17 the Board of Papa Ola Lokahi may admit from

18 time to time, based upon satisfactory demonstra19 tion of a record of contribution to the health and

20 well-being of Native Hawaiians, and upon satis21 factory development of a mission statement in

22 relation to this Act, including clearly defined

23 goals and objectives, a 5-year action plan outlin24 ing the contributions that each organization will
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1 make in carrying out the policy of this Act, and

2 an estimated budget.

3 ‘‘(B) Such term does not include any organiza4 tion identified in subparagraph (A) if the Secretary

5 determines that such organization does not have a

6 mission statement with clearly defined goals and ob7 jectives for the contributions the organization will

8 make to Native Hawaiian health care systems and an

9 action plan for carrying out such goals and objectives.

10 ‘‘(8) PRIMARY HEALTH SERVICES.—The term

11 ‘primary health services’ means—

12 ‘‘(A) services of physicians, physicians’ as13 sistants and nurse practitioners;

14 ‘‘(B) diagnostic laboratory and radiologic

15 services;

16 ‘‘(C) preventive health services (including

17 children’s eye and ear examinations to determine

18 the need for vision and hearing correction,

19 perinatal services, well child services, and family

20 planning services);

21 ‘‘(D) emergency medical services;

22 ‘‘(E) transportation services as required for

23 adequate patient care;

24 ‘‘(F) preventive dental services; and
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1 ‘‘(G) pharmaceutical services, as may be

2 appropriate for particular health centers.

3 ‘‘(9) SECRETARY.—The term ‘Secretary’ means

4 the Secretary of Health and Human Services.

5 ‘‘(10) TRADITIONAL NATIVE HAWAIIAN HEAL6 ER.—The term ‘traditional Native Hawaiian healer’

7 means a practitioner—

8 ‘‘(A) who—

9 ‘‘(i) is of Hawaiian ancestry, and

10 ‘‘(ii) has the knowledge, skills, and ex11 perience in direct personal health care of

12 individuals, and

13 ‘‘(B) whose knowledge, skills, and experience

14 are based on a demonstrated learning of Native

15 Hawaiian healing practices acquired by—

16 ‘‘(i) direct practical association with

17 Native Hawaiian elders, and

18 ‘‘(ii) oral traditions transmitted from

19 generation to generation.

20 ‘‘SEC. 11. RULE OF CONSTRUCTION.

21 ‘‘Nothing in this Act shall be construed to restrict the

22 authority of the State of Hawaii to license health practi23 tioners.
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1 ‘‘SEC. 12. COMPLIANCE WITH BUDGET ACT.

2 ‘‘Any new spending authority (described in subsection

3 (c)(2) (A) or (B) of section 401 of the Congressional Budget

4 Act of 1974) which is provided under this Act shall be effec5 tive for any fiscal year only to such extent or in such

6 amounts as are provided in appropriation Acts.

7 ‘‘SEC. 13. SEVERABILITY.

8 ‘‘If any provision of this Act, or the application of any

9 such provision to any person or circumstances is held to

10 be invalid, the remainder of this Act, and the application

11 of such provision or amendment to persons or circumstances

12 other than those to which it is held invalid, shall not be

13 affected thereby.

14 ‘‘SEC. 14. AUTHORIZATION OF APPROPRIATIONS.

15 ‘‘There is authorized to be appropriated for each of the

16 fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000

17 such sums as may be necessary to carry out the purposes

18 of this Act.

19 ‘‘SEC. 15. PROHIBITION AGAINST EXCLUSION FROM PAR20 TICIPATION.

21 ‘‘Notwithstanding any other provision of this Act, no

22 person shall, on the basis of race, color, or national origin,

23 be excluded from participation in, or be denied the benefits

24 of, or be subjected to discrimination under, any program

25 or activity receiving Federal financial assistance under this

26 Act.’’.
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1 SEC. 503. REPEAL OF PUBLIC HEALTH SERVICE ACT PROVI2 SION.

3 (a) IN GENERAL.—The Public Health Service Act (42

4 U.S.C. 201 et seq.), as amended by section 206 of this Act,

5 is amended by repealing section 338K and redesignating

6 section 338L as section 338K. Such repeal shall not be con7 strued to terminate contracts in effect under such section

8 on the date of the enactment of this Act. Any such contracts

9 shall continue according to the terms and conditions of such

10 contracts.

11 (b) EFFECTIVE DATE.—Subsection (a) takes effect on

12 the date of the enactment of this Act.

13 TITLE VI—WOMEN’S HEALTH

14 SEC. 601. ESTABLISHMENT OF OFFICE OF WOMEN’S

15 HEALTH.

16 Title XVII of the Public Health Service Act (42 U.S.C.

17 300u et seq.), as amended by section 704 of Public Law

18 103–183 (107 Stat. 2240), is amended by adding at the

19 end the following section:

20 ‘‘OFFICE OF WOMEN’S HEALTH

21 ‘‘SEC. 1710. (a) IN GENERAL.—There is established an

22 Office of Women’s Health within the Office of the Assistant

23 Secretary for Health. There shall be in the Department of

24 Health and Human Services a Deputy Assistant Secretary

25 for Women’s Health, who shall be the head of the Office of
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1 Women’s Health. The Secretary, acting through such Dep2 uty Assistant Secretary, shall carry out this section.

3 ‘‘(b) DUTIES.—

4 ‘‘(1) IN GENERAL.—The Secretary may conduct

5 or support programs and activities regarding wom6 en’s health conditions. In carrying out the preceding

7 sentence, the Secretary shall—

8 ‘‘(A) monitor the programs and activities of

9 the agencies specified in paragraph (2) in order

10 to determine the extent to which the purposes of

11 the programs and activities are being carried out

12 with respect to women’s health conditions (as de13 fined in section 486);

14 ‘‘(B) provide advice to the heads of such

15 agencies on improving programs and activities

16 that relate to such conditions; and

17 ‘‘(C) coordinate such programs and activi18 ties of the agencies.

19 ‘‘(2) SPECIFIED AGENCIES.—For purposes of

20 paragraph (1), the agencies referred to in this para21 graph are the following:

22 ‘‘(A) The Centers for Disease Control and

23 Prevention.

24 ‘‘(B) The National Institutes of Health.
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1 ‘‘(C) The Agency for Health Care Policy

2 and Research.

3 ‘‘(D) The Health Resources and Services

4 Administration.

5 ‘‘(E) The Substance Abuse and Mental

6 Health Services Administration.

7 ‘‘(F) The Food and Drug Administration.

8 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the

9 purpose of carrying out this section, there are authorized

10 to be appropriated $5,000,000 for fiscal year 1995, and

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

12 1996 and 1997.’’.

13 SEC. 602. WOMEN’S SCIENTIFIC EMPLOYMENT REGARDING

14 NATIONAL INSTITUTES OF HEALTH.

15 (a) IN GENERAL.—Part A of title IV of the Public

16 Health Service Act (42 U.S.C. 281 et seq.) is amended by

17 adding at the end the following section:

18 ‘‘WOMEN’S SCIENTIFIC EMPLOYMENT

19 ‘‘SEC. 404F. (a) IN GENERAL.—The Director of NIH

20 shall—

21 ‘‘(1) establish policies for the National Institutes

22 of Health on matters relating to the employment by

23 such Institutes of women as scientists;

24 ‘‘(2) monitor the extent of compliance with such

25 policies, including through the implementation of an
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1 accountability system under the Federal Equal Op2 portunity Recruitment Program; and

3 ‘‘(3) establish and maintain a process for re4 sponding to incidents of noncompliance with such

5 policies.

6 ‘‘(b) CERTAIN POLICIES.—In establishing policies

7 under subsection (a)(1), the Director of NIH shall provide

8 for the following policies regarding the employment of

9 women as scientists at the National Institutes of Health:

10 ‘‘(1) A policy on the granting of tenured status.

11 ‘‘(2) A policy on family leave.

12 ‘‘(3) A policy on the recruitment of minority

13 women.

14 ‘‘(4) A policy on the inclusion of women sci15 entists in intramural and extramural conferences,

16 workshops, international congresses, and similar

17 events funded or sponsored by such Institutes.

18 ‘‘(c) AVAILABILITY OF POLICIES.—The Director of

19 NIH shall ensure that copies of policies established under

20 subsection (a) are available to scientists of the National In21 stitutes of Health.

22 ‘‘(d) DEFINITION.—For purposes of this section, the

23 term ‘Federal Equal Opportunity Recruitment Program’

24 means the program carried out under part 720 of title 5,

25 Code of Federal Regulations (5 CFR 720).’’.
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1 (b) STUDIES.—

2 (1) PAY EQUITY.—The Director of the National

3 Institutes of Health shall provide for a study to iden4 tify any pay differences among men and women sci5 entists employed (both tenured and untenured) by the

6 National Institutes of Health. The study shall include

7 recommendations on measures to adjust any inequi8 ties, and on making available information on salary

9 ranges to all scientists of such Institutes.

10 (2) STUDY ON TERMINATION OF EMPLOYMENT.—

11 The Comptroller General of the United States shall

12 conduct a study for the purpose of determining the

13 reasons underlying the employment termination of

14 scientists of the National Institutes of Health. The

15 study shall be carried out with respect to male and

16 female scientists, and with respect to voluntary and

17 involuntary terminations.

18 (3) REPORTS.—Not later than 240 days after the

19 date of the enactment of this Act, the studies required

20 in this subsection shall be completed, and reports de21 scribing the findings and recommendations of the

22 studies shall be submitted to the Committee on En23 ergy and Commerce of the House of Representatives

24 and the Committee on Labor and Human Resources

25 of the Senate.
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1 SEC. 603. INFORMATION AND EDUCATION REGARDING FE2 MALE GENITAL MUTILATION.

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

4 Human Services shall ensure that the Deputy Assistant Sec5 retary for Women’s Health and the Deputy Assistant Sec6 retary for Minority Health collaborate for the purpose of

7 carrying out the following activities:

8 (1) Compile data on the number of females liv9 ing in the United States who have been subjected to

10 female genital mutilation (whether in the United

11 States or in their countries of origin), including a

12 specification of the number of girls under the age of

13 18 who have been subjected to such mutilation.

14 (2) Identify communities in the United States

15 that practice female genital mutilation, and design

16 and carry out outreach activities to educate individ17 uals in the communities on the physical and psycho18 logical health effects of such practice. Such outreach

19 activities shall be designed and implemented in col20 laboration with representatives of the ethnic groups

21 practicing such mutilation and with representatives

22 of organizations with expertise in preventing such

23 practice.

24 (3) Develop recommendations for the education

25 of students of schools of medicine and osteopathic

26 medicine regarding female genital mutilation and
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1 complications arising from such mutilation. Such rec2 ommendations shall be disseminated to such schools.

3 (b) DEFINITION.—For purposes of this section, the

4 term ‘‘female genital mutilation’’ means the removal or

5 infibulation (or both) of the whole or part of the clitoris,

6 the labia minor, or the labia major.

7 SEC. 604. STUDY REGARDING CURRICULA OF MEDICAL

8 SCHOOLS AND WOMEN’S HEALTH CONDI9 TIONS.

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

11 Human Services, acting through the Administrator of the

12 Health Resources and Services Administration, shall con13 duct a study for the purpose of determining the contents

14 of the curriculum of schools of medicine and osteopathic

15 medicine and whether such curriculum provides adequate

16 education to students on women’s health conditions.

17 (b) CONSULTATIONS.—The Secretary shall carry out

18 subsection (a) in consultation with the Deputy Assistant

19 Secretary for Women’s Health and the Director of the Office

20 of Research on Women’s Health (of the National Institutes

21 of Health).

22 (c) REPORT.—Not later than April 1, 1995, the Sec23 retary shall complete the study required in subsection (a)

24 and submit to the Committee on Energy and Commerce of

25 the House of Representatives, and to the Committee on
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1 Labor and Human Resources of the Senate, a report de2 scribing the findings made as a result of the study and con3 taining any recommendations of the Secretary regarding

4 such findings.

5 (d) DEFINITIONS.—For purposes of this section:

6 (1) The term ‘‘Secretary’’ means the Secretary of

7 Health and Human Services.

8 (2) The term ‘‘women’s health conditions’’ has

9 the meaning given such term in section 486 of the

10 Public Health Service Act.

11 TITLE VII—TRAUMATIC BRAIN

12 INJURY

13 SEC. 701. PROGRAMS OF CENTERS FOR DISEASE CONTROL

14 AND PREVENTION.

15 (a) TECHNICAL CORRECTION REGARDING AMEND16 ATORY INSTRUCTIONS.—Section 301(a) of Public Law 103–

17 183 (107 Stat. 2233) is amended by striking ‘‘(42 U.S.C.

18 242 et seq.)’’ and inserting ‘‘(42 U.S.C. 243 et seq.)’’. The

19 amendment made by the preceding sentence is deemed to

20 have taken effect immediately after the enactment of Public

21 Law 103–183.

22 (b) PROGRAMS OF CENTERS FOR DISEASE CONTROL

23 AND PREVENTION.—Part B of title III of the Public Health

24 Service Act (42 U.S.C. 243 et seq.), as amended pursuant

25 to subsection (a) and as amended by section 703 of Public
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1 Law 103–183 (107 Stat. 2240), is amended by inserting

2 after section 317F the following section:

3 ‘‘PREVENTION OF TRAUMATIC BRAIN INJURY

4 ‘‘SEC. 317G. (a) The Secretary, acting through the Di5 rector of the Centers for Disease Control and Prevention,

6 may carry out projects to reduce the incidence of traumatic

7 brain injury. Such projects may be carried out by the Sec8 retary directly or through awards of grants or contracts to

9 public or nonprofit private entities. The Secretary may di10 rectly or through such awards provide technical assistance

11 with respect to the planning, development, and operation

12 of such projects.

13 ‘‘(b) CERTAIN ACTIVITIES.—Activities under sub14 section (a) may include—

15 ‘‘(1) the conduct of research into identifying ef16 fective strategies for the prevention of traumatic brain

17 injury; and

18 ‘‘(2) the implementation of public information

19 and education programs for the prevention of such in20 jury and for broadening the awareness of the public

21 concerning the public health consequences of such in22 jury.

23 ‘‘(c) COORDINATION OF ACTIVITIES.—The Secretary

24 shall ensure that activities under this section are coordi25 nated as appropriate with other agencies of the Public
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1 Health Service that carry out activities regarding trau2 matic brain injury.

3 ‘‘(d) DEFINITION.—For purposes of this section, the

4 term ‘traumatic brain injury’ means an acquired injury

5 to the brain. Such term does not include brain dysfunction

6 caused by congenital or degenerative disorders, nor birth

7 trauma, but may include brain injuries caused by anoxia

8 due to near drowning.’’.

9 SEC. 702. PROGRAMS OF NATIONAL INSTITUTES OF

10 HEALTH.

11 Section 1261 of the Public Health Service Act (42

12 U.S.C. 300d-61) is amended—

13 (1) in subsection (d)—

14 (A) in paragraph (2), by striking ‘‘and’’

15 after the semicolon at the end;

16 (B) in paragraph (3), by striking the period

17 and inserting ‘‘; and’’; and

18 (C) by adding at the end the following

19 paragraph:

20 ‘‘(4) the authority to make awards of grants or

21 contracts to public or nonprofit private entities for

22 the conduct of basic and applied research regarding

23 traumatic brain injury, which research may in24 clude—
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1 ‘‘(A) the development of new methods and

2 modalities for the more effective diagnosis, meas3 urement of degree of injury, post-injury monitor4 ing and prognostic assessment of head injury for

5 acute, subacute and later phases of care;

6 ‘‘(B) the development, modification and

7 evaluation of therapies that retard, prevent or

8 reverse brain damage after acute head injury,

9 that arrest further deterioration following injury

10 and that provide the restitution of function for

11 individuals with long-term injuries;

12 ‘‘(C) the development of research on a con13 tinuum of care from acute care through rehabili14 tation, designed, to the extent practicable, to in15 tegrate rehabilitation and long-term outcome

16 evaluation with acute care research; and

17 ‘‘(D) the development of programs that in18 crease the participation of academic centers of

19 excellence in head injury treatment and rehabili20 tation research and training.’’; and

21 (2) in subsection (h), by adding at the end the

22 following paragraph:

23 ‘‘(4) The term ‘traumatic brain injury’ means

24 an acquired injury to the brain. Such term does not

25 include brain dysfunction caused by congenital or de-
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1 generative disorders, nor birth trauma, but may in2 clude brain injuries caused by anoxia due to near

3 drowning.’’.

4 SEC. 703. PROGRAMS OF HEALTH RESOURCES AND SERV5 ICES ADMINISTRATION.

6 Part E of title XII of the Public Health Service Act

7 (42 U.S.C. 300d-51 et seq.) is amended by adding at the

8 end the following section:

9 ‘‘SEC. 1252. STATE GRANTS FOR DEMONSTRATION

10 PROJECTS REGARDING TRAUMATIC BRAIN

11 INJURY.

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

13 Administrator of the Health Resources and Services Admin14 istration, may make grants to States for the purpose of car15 rying out demonstration projects to improve the availabil16 ity of health services regarding traumatic brain injury.

17 ‘‘(b) STATE ADVISORY BOARD.—

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

19 grant under subsection (a) only if the State involved

20 agrees to establish an advisory board within the ap21 propriate health department of the State or within

22 another department as designated by the chief execu23 tive officer of the State.

24 ‘‘(2) FUNCTIONS.—An advisory board established

25 under paragraph (1) shall be cognizant of findings
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1 and concerns of Federal, State and local agencies,

2 citizens groups, and private industry (such as insur3 ance, health care, automobile, and other industry en4 tities). Such advisory boards shall encourage citizen

5 participation through the establishment of public

6 hearings and other types of community outreach pro7 grams.

8 ‘‘(3) COMPOSITION.—An advisory board estab9 lished under paragraph (1) shall be composed of—

10 ‘‘(A) representatives of—

11 ‘‘(i) the corresponding State agencies

12 involved;

13 ‘‘(ii) public and nonprofit private

14 health related organizations;

15 ‘‘(iii) other disability advisory or

16 planning groups within the State;

17 ‘‘(iv) members of an organization or

18 foundation representing traumatic brain in19 jury survivors in that State; and

20 ‘‘(v) injury control programs at the

21 State or local level if such programs exist;

22 and

23 ‘‘(B) a substantial number of individuals

24 who are survivors of traumatic brain injury, or

25 the family members of such individuals.
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1 ‘‘(c) MATCHING FUNDS.—

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

3 be incurred by a State in carrying out the purpose

4 described in subsection (a), the Secretary may make

5 a grant under such subsection only if the State agrees

6 to make available, in cash, non-Federal contributions

7 toward such costs in an amount that is not less than

8 $1 for each $2 of Federal funds provided under the

9 grant.

10 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB11 UTED.—In determining the amount of non-Federal

12 contributions in cash that a State has provided pur13 suant to paragraph (1), the Secretary may not in14 clude any amounts provided to the State by the Fed15 eral Government.

16 ‘‘(d) APPLICATION FOR GRANT.—The Secretary may

17 make a grant under subsection (a) only if an application

18 for the grant is submitted to the Secretary and the applica19 tion is in such form, is made in such manner, and contains

20 such agreements, assurances, and information as the Sec21 retary determines to be necessary to carry out this section.

22 ‘‘(e) COORDINATION OF ACTIVITIES.—The Secretary

23 shall ensure that activities under this section are coordi24 nated as appropriate with other agencies of the Public
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1 Health Service that carry out activities regarding trau2 matic brain injury.

3 ‘‘(f) REPORT.—Not later than 2 years after the effec4 tive date under section 901 of the Minority Health Improve5 ment Act of 1994, the Secretary shall submit to the Commit6 tee on Energy and Commerce of the House of Representa7 tives, and to the Committee on Labor and Human Re8 sources of the Senate, a report describing the findings and

9 results of the programs established under this section, in10 cluding measures of outcomes and consumer and surrogate

11 satisfaction.

12 ‘‘(g) DEFINITION.—For purposes of this section, the

13 term ‘traumatic brain injury’ means an acquired injury

14 to the brain. Such term does not include brain dysfunction

15 caused by congenital or degenerative disorders, nor birth

16 trauma, but may include brain injuries caused by anoxia

17 due to near drowning.

18 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There

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

20 $5,000,000 for fiscal year 1995, and such sums as may be

21 necessary for each of the fiscal years 1996 and 1997.’’.

22 SEC. 704. STUDY; CONSENSUS CONFERENCE.

23 (a) STUDY.—

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

25 Human Services (in this section referred to as the
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1 ‘‘Secretary’’), acting through the appropriate agencies

2 of the Public Health Service, shall conduct a study for

3 the purpose of carrying out the following with respect

4 to traumatic brain injury:

5 (A) In collaboration with appropriate State

6 and local health-related agencies—

7 (i) determine the incidence and preva8 lence of traumatic brain injury; and

9 (ii) develop a uniform reporting sys10 tem under which States report incidences of

11 traumatic brain injury, if the Secretary de12 termines that such a system is appropriate.

13 (B) Identify common therapeutic interven14 tions which are used for the rehabilitation of in15 dividuals with such injuries, and shall, subject to

16 the availability of information, include an anal17 ysis of—

18 (i) the effectiveness of each such inter19 vention in improving the functioning of in20 dividuals with brain injuries;

21 (ii) the comparative effectiveness of

22 interventions employed in the course of re23 habilitation of individuals with brain inju24 ries to achieve the same or similar clinical

25 outcome; and
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1 (iii) the adequacy of existing measures

2 of outcomes and knowledge of factors influ3 encing differential outcomes.

4 (C) Develop practice guidelines for the reha5 bilitation of traumatic brain injury at such time

6 as appropriate scientific research becomes avail7 able.

8 (2) DATES CERTAIN FOR REPORTS.—

9 (A) Not later than 18 months after the effec10 tive date under section 901, the Secretary shall

11 submit to the Committee on Energy and Com12 merce of the House of Representatives, and to the

13 Committee on Labor and Human Resources of

14 the Senate, a report describing the findings made

15 as a result of carrying out paragraph (1)(A).

16 (B) Not later than 3 years after the effective

17 date under section 901, the Secretary shall sub18 mit to the Committees specified in subparagraph

19 (A) a report describing the findings made as a

20 result of carrying out subparagraphs (B) and

21 (C) of paragraph (1).

22 (b) CONSENSUS CONFERENCE.—The Secretary, acting

23 through the Director of the National Center for Medical Re24 habilitation Research within the National Institute for

25 Child Health and Human Development, shall conduct a na-
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1 tional consensus conference on managing traumatic brain

2 injury and related rehabilitation concerns.

3 (c) DEFINITION.—For purposes of this section, the

4 term ‘‘traumatic brain injury’’ means an acquired injury

5 to the brain. Such term does not include brain dysfunction

6 caused by congenital or degenerative disorders, nor birth

7 trauma, but may include brain injuries caused by anoxia

8 due to near drowning.

9 TITLE VIII—MISCELLANEOUS

10 PROVISIONS

11 SEC. 801. TECHNICAL AMENDMENT TO INDIAN HEALTH

12 CARE IMPROVEMENT ACT.

13 The last sentence of section 818(e)(3) of the Indian

14 Health Care Improvement Act (25 U.S.C. 1680h(e)(3)) is

15 amended—

16 (1) by striking ‘‘services,’’ and inserting ‘‘serv17 ices’’; and

18 (2) by striking ‘‘, shall be recoverable.’’ and in19 serting a period.

20 SEC. 802. HEALTH SERVICES FOR PACIFIC ISLANDERS.

21 Section 10 of the Disadvantaged Minority Health Im22 provement Act of 1990 (42 U.S.C. 254c–1) is amended—

23 (1) in subsection (b)—

24 (A) by striking paragraphs (5) and (6);
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1 (B) by redesignating paragraphs (7) and

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

3 (C) in paragraph (2)—

4 (i) by inserting ‘‘substance abuse’’ after

5 ‘‘availability of health’’; and

6 (ii) by striking ‘‘, including improved

7 health data systems’’; and

8 (D) in paragraph (3)—

9 (i) by striking ‘‘manpower’’ and in10 serting ‘‘care providers’’; and

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

12 follows through the end and inserting a

13 semicolon; and

14 (2) in subsection (f)—

15 (A) by striking ‘‘There is’’ and inserting

16 ‘‘There are’’; and

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

18 follows through ‘‘1993’’ and inserting

19 ‘‘$3,000,000 for each of the fiscal years 1995

20 through 1997’’.

21 SEC. 803. TECHNICAL CORRECTIONS REGARDING PUBLIC

22 LAW 103–183.

23 (a) AMENDATORY INSTRUCTIONS.—Public Law 103–

24 183 is amended—

25 (1) in section 601—
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1 (A) in subsection (b), in the matter preced2 ing paragraph (1), by striking ‘‘Section 1201 of

3 the Public Health Service Act (42 U.S.C. 300d)’’

4 and inserting ‘‘Title XII of the Public Health

5 Service Act (42 U.S.C. 300d et seq.)’’; and

6 (B) in subsection (f)(1), by striking ‘‘in sec7 tion 1204(c)’’ and inserting ‘‘in section 1203(c)

8 (as redesignated by subsection (b)(2) of this sec9 tion)’’;

10 (2) in section 602, by striking ‘‘for the purpose’’

11 and inserting ‘‘For the purpose’’; and

12 (3) in section 705(b), by striking ‘‘317D((l)(1)’’

13 and inserting ‘‘317D(l)(1)’’.

14 (b) PUBLIC HEALTH SERVICE ACT.—The Public

15 Health Service Act, as amended by Public Law 103–183

16 and by subsection (a) of this section, is amended—

17 (1) in section 317E(g)(2), by striking ‘‘making

18 grants under subsection (b)’’ and inserting ‘‘carrying

19 out subsection (b)’’;

20 (2) in section 318, in subsection (e) as in effect

21 on the day before the date of the enactment of Public

22 Law 103–183, by redesignating the subsection as sub23 section (f);

24 (3) in subpart 6 of part C of title IV—
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1 (A) by transferring the first section 447

2 (added by section 302 of Public Law 103–183)

3 from the current placement of the section;

4 (B) by redesignating the section as section

5 447A; and

6 (C) by inserting the section after section

7 447;

8 (4) in section 1213(a)(8), by striking ‘‘provides

9 for for’’ and inserting ‘‘provides for’’;

10 (5) in section 1501, by redesignating the second

11 subsection (c) (added by section 101(f) of Public Law

12 103–183) as subsection (d); and

13 (6) in section 1505(3), by striking ‘‘nonprofit’’.

14 (c) MISCELLANEOUS CORRECTION.—Section 401(c)(3)

15 of Public Law 103–183 is amended in the matter preceding

16 subparagraph (A) by striking ‘‘(d)(5)’’ and inserting

17 ‘‘(e)(5)’’.

18 (d) EFFECTIVE DATE.—This section is deemed to have

19 taken effect immediately after the enactment of Public Law

20 103–183.

21 SEC. 804. CERTAIN AUTHORITIES OF CENTERS FOR DIS22 EASE CONTROL AND PREVENTION.

23 (a) IN GENERAL.—Part B of title III of the Public

24 Health Service Act, as amended by section 701 of this Act,
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1 is amended by inserting after section 317G the following

2 section:

3 ‘‘MISCELLANEOUS AUTHORITIES REGARDING CENTERS FOR

4 DISEASE CONTROL AND PREVENTION

5 ‘‘SEC. 317H. (a) TECHNICAL AND SCIENTIFIC PEER

6 REVIEW GROUPS.—The Secretary, acting through the Di7 rector of the Centers for Disease Control and Prevention,

8 may, without regard to the provisions of title 5, United

9 States Code, governing appointments in the competitive

10 service, and without regard to the provisions of chapter 51

11 and subchapter III of chapter 53 of such title relating to

12 classification and General Schedule pay rates, establish

13 such technical and scientific peer review groups and sci14 entific program advisory committees as are needed to carry

15 out the functions of such Centers and appoint and pay the

16 members of such groups, except that officers and employees

17 of the United States shall not receive additional compensa18 tion for service as members of such groups. The Federal Ad19 visory Committee Act shall not apply to the duration of

20 such peer review groups. Not more than one-fourth of the

21 members of any such group shall be officers or employees

22 of the United States.

23 ‘‘(b) FELLOWSHIP AND TRAINING PROGRAMS.—The

24 Secretary, acting through the Director of the Centers for

25 Disease Control and Prevention, shall establish fellowship

26 and training programs to be conducted by such Centers to
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1 train individuals to develop skills in epidemiology, surveil2 lance, laboratory analysis, and other disease detection and

3 prevention methods. Such programs shall be designed to en4 able health professionals and health personnel trained under

5 such programs to work, after receiving such training, in

6 local, State, national, and international efforts toward the

7 prevention and control of diseases, injuries, and disabilities.

8 Such fellowships and training may be administered through

9 the use of either appointment or nonappointment proce10 dures.’’.

11 (b) EFFECTIVE DATE.—This section takes effect July

12 1, 1994.

13 SEC. 805. ESTABLISHMENT OF PUBLIC HEALTH ANALYT14 ICAL LABORATORY.

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

16 Human Services, acting as appropriate through the Direc17 tor of the Centers for Disease Control and Prevention or

18 through other agencies, may make a grant for the establish19 ment and operation of a laboratory to protect the public

20 health through analyzing human, wildlife, air, water, and

21 soil samples. The laboratory shall be established within the

22 United States at the central point of the international bor23 der between the United States and Mexico (as determined

24 by such Secretary), and the laboratory shall serve the border

25 region.
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1 (b) AUTHORIZATION OF APPROPRIATIONS.—For the

2 purpose of carrying out subsection (a), there are authorized

3 to be appropriated such sums as may be necessary for fiscal

4 year 1995 and each subsequent fiscal year.

5 SEC. 806. ADMINISTRATION OF CERTAIN REQUIREMENTS.

6 (a) IN GENERAL.—Section 2004 of Public Law 103–

7 43 (107 Stat. 209) is amended by striking subsection (a).

8 (b) CONFORMING AMENDMENTS.—Section 2004 of

9 Public Law 103–43, as amended by subsection (a) of this

10 section, is amended—

11 (1) by striking ‘‘(b) SENSE’’ and all that follows

12 through ‘‘In the case’’ and inserting the following:

13 ‘‘(a) SENSE OF CONGRESS REGARDING PURCHASE OF

14 AMERICAN-MADE EQUIPMENT AND PRODUCTS.—In the

15 case’’;

16 (2) by striking ‘‘(2) NOTICE TO RECIPIENTS OF

17 ASSISTANCE’’ and inserting the following:

18 ‘‘(b) NOTICE TO RECIPIENTS OF ASSISTANCE’’; and

19 (3) in subsection (b), as redesignated by para20 graph (2) of this subsection, by striking ‘‘paragraph

21 (1)’’ and inserting ‘‘subsection (a)’’.

22 (c) EFFECTIVE DATE.—This section is deemed to have

23 taken effect immediately after the enactment of Public Law

24 103–43.
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1 SEC. 807. REVISIONS TO ELIGIBILITY REQUIREMENTS FOR

2 ENTITIES SUBJECT TO DRUG PRICING LIMI3 TATIONS.

4 (a) TREATMENT OF CERTAIN OUTPATIENT CLINICS AS

5 COVERED ENTITIES.—Section 340B(a)(4) of the Public

6 Health Service Act (42 U.S.C. 256b(a)(4)) is amended by

7 adding at the end the following subparagraph:

8 ‘‘(M) A diagnostic and treatment center

9 owned and operated by the New York City

10 Health and Hospitals Corporation.’’.

11 (b) LIMITATION ON EXCLUSION BASED ON PARTICIPA12 TION IN GROUP PURCHASING ORGANIZATION.—Section

13 340B(a)(4)(L) of the Public Health Service Act (42 U.S.C.

14 256b(a)(4)(L)) is amended—

15 (1) in clause (i), by striking ‘‘under this title’’

16 and inserting ‘‘under title XIX of such Act’’; and

17 (2) in clause (iii), by inserting before the period

18 at the end the following: ‘‘, other than the Health

19 Services Purchasing Group under the control of Los

20 Angeles County’’.

21 (c) CLARIFICATION OF EFFECTIVE DATE OF EXCLU22 SION BASED ON PARTICIPATION IN GROUP PURCHASING

23 ORGANIZATION.—The Secretary of Health and Human

24 Services may not find that the hospital system for the Dal25 las County Hospital District of Texas (commonly known

26 as Parkland Memorial Hospital) fails to meet the require-
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1 ments for a covered entity under paragraph (4)(L) of sec2 tion 340B(a) of the Public Health Service Act solely because

3 the hospital used a group purchasing organization or other

4 group purchasing arrangement to obtain a covered out5 patient drug before the effective date of the entity guidelines

6 published by the Secretary pursuant to section 602 of the

7 Veterans Health Care Act of 1992 if, at the time the hospital

8 purchased the drug, the manufacturer of the drug did not

9 offer to furnish the drug to the hospital at the price required

10 to be paid for the drug under paragraph (1) of such section.

11 (d) EFFECTIVE DATES.—Subsections (a) and (b) take

12 effect as if included in the enactment of the Veterans Health

13 Care Act of 1992. Subsection (c) takes effect on the date

14 of the enactment of this Act.

15 TITLE IX—GENERAL PROVISIONS

16 SEC. 901. EFFECTIVE DATE.

17 Except as otherwise provided in this Act, this Act takes

18 effect October 1, 1994, or upon the date of the enactment

19 of this Act, whichever occurs later.

Agreed to amend the title so as to read: ‘‘An Act to

amend the Public Health Service Act to revise and extend
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programs relating to the health of individuals who are

members of minority groups, and for other purposes.’’.

Attest:

Clerk.
103D CONGRESS

2D SESSION S. 1569

AMENDMENTS