II

103D CONGRESS

1ST SESSION S. 1569

To amend the Public Health Service Act to establish, reauthorize and revise

provisions to improve the health of individuals from disadvantaged backgrounds, and for other purposes.

IN THE SENATE OF THE UNITED STATES

OCTOBER 19 (legislative day, OCTOBER 13), 1993

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

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

Human Resources

A BILL

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

individuals from disadvantaged backgrounds, and for

other purposes.

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

3 SECTION 1. SHORT TITLE; REFERENCE; TABLE OF CON4 TENTS.

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

6 ‘‘Preventive Health Services and Health Professions

7 Amendments Act of 1993’’.
2

•S 1569 IS

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

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

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

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

8 as follows:

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

Sec. 2. Findings.

TITLE I—HEALTH POLICY

Sec. 101. Office of Minority Health.

Sec. 102. Agency Offices of Minority Health.

Sec. 103. State Offices of Minority Health.

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

TITLE II—HEALTH SERVICES

Sec. 201. Community scholarship programs.

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

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

of services.

Sec. 204. Health services for Pacific Islanders.

TITLE III—HEALTH PROFESSIONS

Sec. 301. Loans for disadvantaged students.

Sec. 302. Cesar Chavez scholarship program.

Sec. 303. Thurgood Marshall scholarship program.

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

health professions schools.

Sec. 305. Centers of excellence.

Sec. 306. Educational assistance regarding undergraduates.

Sec. 307. Area health education centers.

TITLE IV—RESEARCH AND DATA COLLECTION

Sec. 401. Office of Research on Minority Health.

Sec. 402. National Center for Health Statistics.

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

TITLE V—MISCELLANEOUS

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

Sec. 502. Technical corrections relating to health professions.

Sec. 503. Clinical traineeships.
3

•S 1569 IS

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

Sec. 505. Medically underserved area study.

Sec. 506. Programs regarding birth defects.

TITLE VI—GENERAL PROVISIONS

Sec. 601. Effective date.

1 SEC. 2. FINDINGS.

2 Section 1(b) of the Disadvantaged Minority Health

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

4 amended to read as follows—

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

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

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

9 population and has not improved significantly since

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

11 the Secretary’s Task Force on Black and Minority

12 Health’’;

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

15 ‘‘(3) racial and ethnic minorities suffer dis16 proportionately high rates of cancer, heart disease,

17 diabetes, substance abuse, acquired immune defi18 ciency syndrome, and other diseases and disorders;

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

20 African Americans is almost double that for the gen21 eral population;
4

•S 1569 IS

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

2 adults have diabetes rates twice that of non-His3 panic whites;

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

5 before the age of 45;

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

7 Americans, Hispanics, American Indians, and Asian/

8 Pacific Islanders constitute approximately 12.1 per9 cent, 9 percent, 0.08 percent, and 2.9 percent, re10 spectively, of the population of the United States;

11 ‘‘(8) minority health professionals have histori12 cally tended to practice in low-income areas, medi13 cally underserved areas, and to serve racial and eth14 nic minorities;

15 ‘‘(9) minority health professionals have histori16 cally tended to engage in the general practice of

17 medicine and specialties providing primary care;

18 ‘‘(10) reports published in leading medical jour19 nals indicate that access to health care among mi20 norities can be substantially improved by increasing

21 the number of minority professionals;

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

23 of health professions schools enhances the quality of

24 education for all students attending the schools; and
5

•S 1569 IS

1 ‘‘(12) health professionals need greater access

2 to continuing medical education programs to enable

3 such professionals to upgrade their skills (including

4 linguistic and cultural competence skills) and im5 prove the quality of medical care rendered in minor6 ity communities.’’.

7 TITLE I—HEALTH POLICY

8 SEC. 101. OFFICE OF MINORITY HEALTH.

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

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

11 the following:

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

13 of racial and ethnic minorities, the Secretary, acting

14 through the Deputy Assistant Secretary for Minority

15 Health, shall carry out the following:

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

17 and objectives and coordinate all other activities

18 within the Department of Health and Human Serv19 ices that relate to disease prevention, health pro20 motion, service delivery, and research concerning

21 such individuals. The heads of the operating divi22 sions of the Department of Health and Human

23 Services and the heads of Public Health Service

24 agencies shall consult with the Deputy Assistant

25 Secretary for Minority Health to assist in the coordi-
6

•S 1569 IS

1 nation of all activities within the Department as

2 they relate to disease prevention, health promotion,

3 service delivery, and research concerning such indi4 viduals.

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

6 by entering into interagency agreements with other

7 agencies of the public health service:

8 ‘‘(A) Support research, demonstrations and

9 evaluations to test new and innovative models.

10 ‘‘(B) Increase knowledge and understand11 ing of health risk factors.

12 ‘‘(C) Develop mechanisms that support

13 better information dissemination, education,

14 prevention, and service delivery to individuals

15 from disadvantaged backgrounds, including ra16 cial and ethnic minorities.

17 ‘‘(3) Establish a national minority health re18 source center to carry out the following:

19 ‘‘(A) Facilitate the exchange of informa20 tion regarding matters relating to health infor21 mation and health promotion, preventive health

22 services, and education in the appropriate use

23 of health care.

24 ‘‘(B) Facilitate access to such information.
7

•S 1569 IS

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

2 problems relating to such matters.

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

6 for such technical assistance).

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

8 out programs to improve access to health care serv9 ices for individuals with limited English proficiency

10 by facilitating the removal of impediments to the re11 ceipt of health care that result from such limitation.

12 ‘‘(5) With respect to awards of grants and con13 tracts that are available under certain minority

14 health programs, establish a program—

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

16 that the entities may be eligible for the awards;

17 ‘‘(B) to provide technical assistance to

18 such entities in the process of preparing and

19 submitting applications for the awards in ac20 cordance with the policies of the Secretary re21 garding such application; and

22 ‘‘(C) to inform populations, as appropriate,

23 that members of the populations may be eligible

24 to receive services or otherwise participate in

25 the activities carried out with such awards.
8

•S 1569 IS

1 ‘‘(c) ADVISORY COMMITTEE.—

2 ‘‘(1) IN GENERAL.—The Secretary shall estab3 lish an advisory committee to be known as the Advi4 sory Committee on Minority Health (in this sub5 section referred to as the ‘Committee’).

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

7 advice to the Secretary on carrying out this section,

8 including advice on the development of goals and

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

10 for each racial and ethnic group.

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

12 Secretary for Minority Health shall serve as the

13 Chairperson of the Committee.

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

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

16 18 individuals, who are not officers or employees of

17 the Federal Government. The Secretary shall ap18 point the members of the Committee from among in19 dividuals with expertise regarding issues of minority

20 health. The membership of the Committee shall be

21 equitably representative of the various racial and

22 ethnic groups. The Secretary may appoint represent23 atives from selected Federal agencies to serve as ex

24 officio, non-voting members of the Committee.
9

•S 1569 IS

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

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

3 Secretary shall initially appoint a portion of the

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

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

6 Committee, a new member shall be appointed by the

7 Secretary within 90 days from the date that the va8 cancy occurs, and serve for the remainder of the

9 term for which the predecessor of such member was

10 appointed. The vacancy shall not affect the power of

11 the remaining members to execute the duties of the

12 Committee.

13 ‘‘(7) COMPENSATION.—Members of the Com14 mittee who are officers or employees of the United

15 States shall serve without compensation. Members of

16 the Committee who are not officers or employees of

17 the United States shall receive, for each day (includ18 ing travel time) they are engaged in the performance

19 of the functions of the Committee, compensation at

20 rates that do not exceed the daily equivalent of the

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

22 Schedule under title 5, United States Code.

23 ‘‘(d) CERTAIN REQUIREMENTS REGARDING DU24 TIES.—
10

•S 1569 IS

1 ‘‘(1) RECOMMENDATIONS REGARDING LAN2 GUAGE AS IMPEDIMENT TO HEALTH CARE.—The

3 Secretary, acting through the Director of the Office

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

5 Rights, and the Director of the Office of Minority

6 Health of the Health Resources and Services Admin7 istration, shall make recommendations regarding ac8 tivities under subsection (b)(4).

9 ‘‘(2) EQUITABLE ALLOCATION REGARDING AC10 TIVITIES.—In awarding grants or contracts under

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

12 shall ensure that such awards are equitably allocated

13 with respect to the various racial and ethnic popu14 lations.

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

16 The Secretary shall ensure that information and

17 services provided pursuant to subsection (b) are pro18 vided in the language and cultural context that is

19 most appropriate for the individuals for whom the

20 information and services are intended.

21 ‘‘(4) PEER REVIEW.—The Secretary shall en22 sure that each application for a grant, contract or

23 cooperative agreement under section 340A, 724,

24 737, or 1707 undergoes appropriate peer review.
11

•S 1569 IS

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

2 year 1995 and of each second year thereafter, the Sec3 retary shall submit to the Congress a report describing

4 the activities carried out under this section during the pre5 ceding 2 fiscal years and evaluating the extent to which

6 such activities have been effective in improving the health

7 of racial and ethnic minorities.

8 ‘‘(f) GRANTS AND CONTRACTS REGARDING DU9 TIES.—

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

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

12 public and nonprofit private entities for activities de13 scribed in paragraphs (3) and (4) of subsection (b).

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

15 Secretary shall, directly or through contracts with

16 public and private entities, provide for evaluations of

17 projects carried out with financial assistance pro18 vided under paragraph (1) during the preceding 2

19 fiscal years. The report shall be included in the re20 port required under subsection (e) for the fiscal year

21 involved.

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

23 ‘racial and ethnic minority group’ means Hispanics,

24 Blacks, Asian Americans, Pacific Islanders, Native Ameri25 cans, and Alaskan Natives. The term ‘Hispanic’ means in-
12

•S 1569 IS

1 dividuals whose origin is Mexican, Puerto Rican, Cuban,

2 Central or South American, or any other Spanish-speak3 ing country, including Spain or the Caribbean Islands, and

4 individuals identifying themselves as Hispanic, Latino,

5 Spanish, or Spanish-American.

6 ‘‘(h) FUNDING.—

7 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

8 For the purpose of carrying out this section, there

9 is authorized to be appropriated $20,500,000 for fis10 cal year 1994, and such sums as may be necessary

11 for each of the fiscal years 1995 through 1998.

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

13 Of the amounts appropriated under paragraph (1)

14 for a fiscal year in excess of $15,000,000, the Sec15 retary shall make available not less than $3,000,000

16 for activities to improve access to health care serv17 ices for individuals with limited English proficiency,

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

19 SEC. 102. AGENCY OFFICES OF MINORITY HEALTH.

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

21 adding at the end the following new section:

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

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

24 the Deputy Assistant Secretary for Minority Health, shall

25 ensure that an Office of Minority Health is established
13

•S 1569 IS

1 and operating at the Centers for Disease Control and Pre2 vention, the Health Resources and Services Administra3 tion, the Substance Abuse and Mental Health Administra4 tion, and the Agency for Health Care Policy and Research.

5 Such Offices shall be established to ensure that services

6 and programs carried out within each such respective

7 agency or office—

8 ‘‘(1) are equitably delivered with respect to ra9 cial and ethnic groups;

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

11 ‘‘(3) utilize racial and ethnic minority commu12 nity-based organizations to deliver services.

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

14 within the Department of Health and Human Services

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

16 to the Deputy Assistant Secretary for Minority Health (as

17 provided for in section 1707(a)) describing the accom18 plishments or programs of the plan, the budget allocation

19 and expenditures for, and the development and implemen20 tation of, such health programs targeting racial and ethnic

21 minority populations. The Secretary shall ensure the par22 ticipation and cooperation of each Agency in the develop23 ment of the annual report.’’.
14

•S 1569 IS

1 SEC. 103. STATE OFFICES OF MINORITY HEALTH.

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

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

4 following new section:

5 ‘‘SEC. 1710. GRANTS TO STATES FOR OPERATION OF OF6 FICES OF MINORITY HEALTH.

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

8 the Deputy Assistant Secretary for Minority Health (as

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

10 for the purpose of improving the health status in minority

11 communities, through the operation of State offices of mi12 nority health established to monitor and facilitate the

13 achievement of the Health Objectives for the Year 2000

14 as they affect minority populations.

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

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

17 unless such State agrees that the program carried out by

18 the State with amounts received under the grant will be

19 administered directly by a single State agency.

20 ‘‘(c) CERTAIN REQUIRED ACTIVITIES.—The Sec21 retary may not make a grant to a State under subsection

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

23 an office operated under the grant received pursuant to

24 such subsection will—
15

•S 1569 IS

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

2 clearinghouse for collecting and disseminating infor3 mation on—

4 ‘‘(A) minority health care issues;

5 ‘‘(B) research findings relating to minority

6 health care; and

7 ‘‘(C) innovative approaches to the delivery

8 of health care and social services in minority

9 communities;

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

11 State that relate to minority health care, including

12 providing coordination for the purpose of avoiding

13 redundancy in such activities;

14 ‘‘(3) identify Federal and State programs re15 garding minority health, and providing technical as16 sistance to public and nonprofit entities regarding

17 participation in such program; and

18 ‘‘(4) develop additional Health People 2000 ob19 jectives for the State that are necessary to address

20 the most prevalent morbidity and mortality concerns

21 for racial and ethnic minority groups in the State.

22 ‘‘(d) REQUIREMENT REGARDING ANNUAL BUDGET

23 OFFICE.—The Secretary may not make a grant to a State

24 under subsection (a) unless such State agrees that, for any

25 fiscal year for which the State receives such a grant, the
16

•S 1569 IS

1 office operated under such grant will be provided with an

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

3 ‘‘(e) CERTAIN USES OF FUNDS.—

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

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

6 such State agrees that—

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

8 health is conducted pursuant to the grant, not

9 more than 10 percent of the amount received

10 under the grant will be expended for such re11 search; and

12 ‘‘(B) amounts provided under the grant

13 will not be expended—

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

15 providing cash payments regarding such

16 care);

17 ‘‘(ii) to conduct activities for which

18 Federal funds are expended—

19 ‘‘(I) within the State to provide

20 technical and other nonfinancial as21 sistance under subsection (m) of sec22 tion 340A;

23 ‘‘(II) under a memorandum of

24 agreement entered into with the State
17

•S 1569 IS

1 under subsection (h) of such section;

2 or

3 ‘‘(III) under a grant under sec4 tion 388I;

5 ‘‘(iii) to purchase medical equipment,

6 to purchase ambulances, aircraft, or other

7 vehicles, or to purchase major communica8 tions equipment;

9 ‘‘(iv) to purchase or improve real

10 property; or

11 ‘‘(v) to carry out any activity regard12 ing a certificate of need.

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

14 State may expend amounts received under a grant

15 under subsection (a) include—

16 ‘‘(A) paying the costs of establishing an of17 fice of minority health for purposes of sub18 section (a);

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

20 paying the costs of any activity carried out with

21 respect to recruiting and retaining health pro22 fessionals to serve in minority communities or

23 underserved areas in the State; and
18

•S 1569 IS

1 ‘‘(C) providing grants and contracts to

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

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

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

6 agrees—

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

9 regarding activities carried out under this section by

10 the State; and

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

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

14 grant.

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

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

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

19 such manner, and contains such agreements, assurances,

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

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

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

24 fiscal year subsequent to the first fiscal year of such pay25 ments unless the Secretary determines that, for the imme-
19

•S 1569 IS

1 diately preceding fiscal year, the State has complied with

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

4 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—

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

6 grants under subsection (a) there are authorized to

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

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

9 fiscal year 1997.

10 ‘‘(2) AVAILABILITY.—Amounts appropriated

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

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

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

16 $10,000,000.’’.

17 SEC. 104. ASSISTANT SECRETARY OF HEALTH AND HUMAN

18 SERVICES FOR CIVIL RIGHTS.

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

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

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

22 section:

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

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

25 in the Department of Health and Human Services an As-
20

•S 1569 IS

1 sistant Secretary for Civil Rights, who shall be appointed

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

3 the Senate.

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

5 shall perform such functions relating to civil rights as the

6 Secretary may assign.’’.

7 (b) CONFORMING AMENDMENT.—Section 5315 of

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

11 TITLE II—HEALTH SERVICES

12 SEC. 201. COMMUNITY SCHOLARSHIP PROGRAMS.

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

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

17 (2) in subsection (c)—

18 (A) by striking ‘‘health manpower shortage

19 areas’’ and inserting ‘‘Federally-designated

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

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

23 shortage areas in which the community organi24 zations are located,’’ and inserting ‘‘in a Feder25 ally-designated health professional shortage
21

•S 1569 IS

1 area that is served by the community organiza2 tion awarding the scholarship,’’ in paragraph

3 (2);

4 (3) in subsection (e)(1)—

5 (A) by striking ‘‘health manpower shortage

6 area’’ and inserting ‘‘Federally-designated

7 health professional shortage area’’; and

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

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

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

11 medicine’’ and all that follows through the end

12 thereof and inserting ‘‘general internal medicine,

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

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

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

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

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

20 years 1995 and 1996’’.

21 SEC. 202. HEALTH SERVICES FOR RESIDENTS OF PUBLIC

22 HOUSING.

23 Section 340A(p)(1) (42 U.S.C. 256a(p)(1)) is amend24 ed—
22

•S 1569 IS

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

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

3 1994’’; and

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

5 ‘‘1995 and 1996’’.

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

8 SERVICES.

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

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

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

13 shall issue a proposed rule regarding policies to reduce the

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

17 in health programs under the Public Health Service Act

18 or in receiving services under such programs.

19 (b) FINAL RULE.—

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

22 the enactment of this Act, the Secretary shall issue

23 a final rule regarding the policies described in sub24 section (a).
23

•S 1569 IS

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

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

5 under subsection (a) is upon such expiration deemed

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

7 remain in effect until the Secretary issues a final

8 rule under such paragraph).

9 SEC. 204. HEALTH SERVICES FOR PACIFIC ISLANDERS.

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

12 (1) in subsection (b)—

13 (A) in paragraph (2)—

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

15 after ‘‘availability of health’’; and

16 (ii) by striking ‘‘, including improved

17 health data systems’’;

18 (B) in paragraph (3)—

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

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

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

24 (C) by striking paragraphs (5) and (6);
24

•S 1569 IS

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

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

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

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

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

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

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

9 redesignated), the following new paragraphs:

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

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

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

14 disease prevention services for rural American

15 Samoa;

16 (2) in subsection (f)—

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

18 ‘‘there are’’; and

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

20 follows through ‘‘1993’’ and inserting

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

22 through 1996’’; and

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

24 new subsection:

25 ‘‘(g) STUDY AND REPORT.—
25

•S 1569 IS

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

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

4 Health Resources and Services Administration, shall

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

7 the effectiveness of projects funded under this sec8 tion.

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

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

13 the House of Representatives a report describing the

14 findings made with respect to the study conducted

15 under paragraph (1).’’.

16 TITLE III—HEALTH

17 PROFESSIONS

18 SEC. 301. LOANS FOR DISADVANTAGED STUDENTS.

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

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

22 are’’; and

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

24 1993’’ and inserting ‘‘$8,000,000 for fiscal year
26

•S 1569 IS

1 1994, and such sums as may be necessary for each

2 of the fiscal years 1995 and 1996’’.

3 SEC. 302. CESAR CHAVEZ SCHOLARSHIP PROGRAM.

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

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

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

8 (2) in subsection (c)—

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

10 ‘‘there are’’; and

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

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

15 1996’’.

16 SEC. 303. THURGOOD MARSHALL SCHOLARSHIP PROGRAM.

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

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

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

22 (2) in subsection (a)—

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

24 known as Thurgood Marshall Scholars)’’ after

25 ‘‘providing scholarships to individuals’’; and
27

•S 1569 IS

1 (B) in paragraph (3), by inserting after

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

3 the training of physician assistants,’’.

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

5 and inserting the following new paragraph:

6 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

7 For the purpose of carrying out this section, there

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

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

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

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

15 (1) in subsection (a)—

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

18 ‘‘racial or ethnic groups that are

19 underrepresented in the health professions

20 who—’’

21 (B) in paragraph (5)—

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

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

25 that follows through ‘‘the individual in-
28

•S 1569 IS

1 volved’’ in subparagraph (A) and inserting

2 ‘‘unless the individual involved’’; and

3 (iii) striking subparagraph (B);

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

5 (D) by redesignating paragraph (7) as

6 paragraph (6); and

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

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

9 (3) in subsection (c)—

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

11 ‘‘there are’’; and

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

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

14 1994, and such sums as may be necessary for

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

16 SEC. 305. CENTERS OF EXCELLENCE.

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

18 (1) in subsection (b)—

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

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

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

25 health professions school’’;
29

•S 1569 IS

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

2 the end thereof;

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

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

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

8 to the students of the school to enable such students

9 to provide health services to minority individuals at

10 community-based health facilities that provide such

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

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

14 (2) in subsection (e)—

15 (A) by striking the subsection heading and

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

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

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

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

24 paragraph (2) formed a consortium of schools.’’;
30

•S 1569 IS

1 (C) in paragraph (2), by striking subpara2 graphs (A) through (D) and inserting the fol3 lowing new subparagraphs:

4 ‘‘(A) the consortium consists of—

5 ‘‘(i) the health professions school

6 seeking the grant under subsection (a);

7 and

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

9 osteopathic medicine, dentistry, pharmacy,

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

12 mental health practice;

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

14 entered into an agreement for the allocation of

15 such grant among the schools; and

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

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

18 (D) by adding at the end the following

19 paragraph:

20 ‘‘(3) AUTHORITY FOR COLLECTIVELY MEETING

21 RELEVANT REQUIREMENTS IN CERTAIN CASES.—

22 With respect to meeting the conditions specified in

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

24 Excellence, the Secretary may make a grant to any

25 school that has in accordance with paragraphs (1)
31

•S 1569 IS

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

2 such conditions (without regard to whether the

3 schools of the consortium individually meet such

4 conditions).’’; and

5 (3) in subsection (i)—

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

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

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

9 1994, and such sums as may be necessary for

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

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

12 end the following: ‘‘Health professions schools

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

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

18 apply only for grants made from the portion of

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

20 SEC. 306. EDUCATIONAL ASSISTANCE REGARDING UNDER21 GRADUATES.

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

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

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

25 a grant, a school shall have in place a program to
32

•S 1569 IS

1 assist individuals from disadvantaged backgrounds

2 in gaining entry into a health professions school or

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

4 (2) in subsection (d)(1)—

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

6 ‘‘there are’’; and

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

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

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

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

11 end thereof the following new sentence: ‘‘Scholarship

12 recipients under this section shall be known as

13 ‘Cesar Chavez Primary Care Scholars.’’.

14 SEC. 307. AREA HEALTH EDUCATION CENTERS.

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

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

18 TITLE IV—RESEARCH AND DATA

19 COLLECTION

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

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

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

23 end the following subsections:

24 ‘‘(c) PLAN.—The Director of the Office, shall collabo25 rate with the Deputy Assistant Secretary for Minority
33

•S 1569 IS

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

2 implement a plan for carrying out the duties required by

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

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

6 as appropriate.

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

8 Director of the Office shall ensure that activities under

9 subsection (b) address equitably all minority groups.

10 ‘‘(e) ADVISORY COMMITTEE.—

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

13 committee to be known as the Advisory Committee

14 on Research on Minority Health (in this subsection

15 referred to as the ‘Advisory Committee’).

16 ‘‘(2) COMPOSITION.—

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

21 nonvoting members described in subparagraph

22 (C).

23 ‘‘(B) VOTING MEMBERS.—The Advisory

24 Committee shall include not fewer than 12, and

25 not more than 18, voting members who are not
34

•S 1569 IS

1 officers or employees of the Federal Govern2 ment. The Director of the Office shall appoint

3 such members to the Advisory Committee from

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

6 clinical practices, research specialization, or

7 professional expertise includes a significant

8 focus on research on minority health or on the

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

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

13 Office.

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

15 The Deputy Assistant Secretary for Minority

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

18 nonvoting members of the Advisory Committee

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

21 serve as such member of the Committee in lieu

22 of the Director).

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

25 Committee.
35

•S 1569 IS

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

2 shall—

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

4 appropriate research activities to be undertaken

5 by the national research institutes with respect

6 to—

7 ‘‘(i) research on minority health;

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

10 responses to pharmacological drugs;

11 ‘‘(iii) research on racial and ethnic

12 differences in disease etiology, course, and

13 treatment; and

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

16 approach;

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

18 on such research;

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

22 out research described in subparagraph (A));

23 and
36

•S 1569 IS

1 ‘‘(D) assist in monitoring compliance with

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

4 ‘‘(5) BIENNIAL REPORT.—

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

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

9 ‘‘(i) compliance with section 492B;

10 ‘‘(ii) the extent of expenditures made

11 for research on minority health by the

12 agencies of the National Institutes of

13 Health; and

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

15 such research.

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

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

19 inclusion in the report required in section 403.

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

24 extent to which minorities are represented among senior

25 physicians and scientists of the national research insti-
37

•S 1569 IS

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

4 such representation.

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

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

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

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

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

12 prevalent in such individuals;

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

14 or types of medical intervention are different

15 for such individuals, or for which it is unknown

16 whether such factors or types are different for

17 such individuals; or

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

19 insufficient research involving such individuals

20 as subjects or insufficient data on such individ21 uals.

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

23 term ‘research on minority health’ means research

24 on minority health conditions, including research on

25 preventing such conditions.
38

•S 1569 IS

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

2 groups’ means Blacks, American Indians, Alaskan

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

5 SEC. 402. NATIONAL CENTER FOR HEALTH STATISTICS.

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

7 amended—

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

9 Human Resources’’ and inserting ‘‘Committee on

10 Labor and Human Resources’’;

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

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

13 ‘‘data.’’;

14 (3) in subsection (k)(2)—

15 (A) in subparagraph (A)—

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

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

19 subparagraph (B), members’’ and inserting

20 ‘‘Members’’; and

21 (B) by striking subparagraph (B);

22 (4) in subsection (l)—

23 (A) by striking paragraph (3);

24 (B) by redesignating paragraph (4) as

25 paragraph (3); and
39

•S 1569 IS

1 (C) in paragraph (3) (as so redesignated),

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

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

4 (5) in subsection (o)—

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

6 through 1993’’ and inserting ‘‘1994 through

7 1997’’; and

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

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

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

11 year 1994, and such sums as may be necessary

12 for each of the fiscal years 1995 through

13 1997’’.

14 (b) GENERAL AUTHORITY RESPECTING RESEARCH,

15 EVALUATIONS, AND DEMONSTRATIONS.—Section 304 (42

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

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

20 (1) in subsection (a)—

21 (A) in paragraph (1)—

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

23 (ii) by redesignating subparagraphs

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

25 through (D), respectively; and
40

•S 1569 IS

1 (B) in paragraph (2), by striking ‘‘reports

2 required by subparagraphs’’ and all that follows

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

23 (5) by striking subsection (h).
41

•S 1569 IS

1 SEC. 403. ACTIVITIES OF AGENCY FOR HEALTH CARE POL2 ICY AND RESEARCH.

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

4 read as follows:

5 ‘‘(b) REQUIREMENTS WITH RESPECT TO CERTAIN

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

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

10 ‘‘(1) the populations of medically underserved

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

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

13 the elderly.’’.

14 TITLE V—MISCELLANEOUS

15 SEC. 501. REVISION AND EXTENSION OF PROGRAM FOR

16 STATE OFFICES OF RURAL HEALTH.

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

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

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

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

21 be incurred by a State in carrying out the purpose

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

23 make a grant under such subsection unless the State

24 agrees to provide non-Federal contributions toward

25 such costs, in cash, in an amount that is not less
42

•S 1569 IS

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

2 grant.

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

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

9 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

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

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

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

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

14 through 1996’’.

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

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

17 and inserting ‘‘$20,000,000’’.

18 SEC. 502. TECHNICAL CORRECTIONS RELATING TO HEALTH

19 PROFESSIONS.

20 (a) HEALTH EDUCATION ASSISTANCE LOAN

21 DEFERMENT FOR BORROWERS PROVIDING HEALTH

22 SERVICES TO INDIANS.—

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

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

25 not in excess of three years, during which the bor-
43

•S 1569 IS

1 rower is providing health care services to Indians

2 through an Indian health program (as defined in

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

5 (xi)’’.

6 (2) CONFORMING AMENDMENTS.—Section

7 705(a)(2)(C) is further amended—

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

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

10 (B) in the matter following such clause

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

12 (3) EFFECTIVE DATE.—The amendments made

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

15 month that begins after the date of enactment of

16 this Act.

17 (b) MAXIMUM STUDENT LOAN PROVISION.—Section

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

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

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

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

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

25 institution).’’.
44

•S 1569 IS

1 (c) REQUIREMENT FOR SCHOOLS.—Section

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

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

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

5 years before’’.

6 (d) SERVICE REQUIREMENT FOR PRIMARY CARE

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

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

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

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

12 (e) PREFERENCE AND REQUIRED INFORMATION IN

13 CERTAIN PROGRAMS.—Section 791 (42 U.S.C. 295j) is

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

16 ‘‘(d) EXCEPTIONS.—

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

18 compete equitably for funding under this section,

19 those new programs that meet the criteria described

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

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

23 the term ‘new program’ means any program that

24 has graduated less than three classes. Upon grad25 uating at least three classes, a program shall have
45

•S 1569 IS

1 the capability to provide the information necessary

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

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

5 paragraph (1) are the following:

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

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

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

15 underserved communities.

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

18 of their time providing or supervising care in

19 medically underserved communities.

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

21 portion of the program is physically located in

22 a medically underserved community.

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

24 service in medically underserved communities
46

•S 1569 IS

1 following graduation, is available to the stu2 dents in the program.

3 ‘‘(G) The program provides a placement

4 mechanism for deploying graduates to medically

5 underserved communities.’’.

6 (f) PREFERENCES IN MAKING AWARDS.—

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

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

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

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

15 loan repayment or related programs; and

16 ‘‘(ii) practices or facilities in which

17 not less than 50 percent of the patients are

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

20 or’’.

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

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

23 ‘‘communities; or’’ and inserting ‘‘communities in24 cluding—
47

•S 1569 IS

1 ‘‘(i) ambulatory practice sites des2 ignated by State Governors as shortage

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

5 loan repayment or related programs; and

6 ‘‘(ii) practices or facilities in which

7 not less than 50 percent of the patients are

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

10 or’’.

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

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

14 295n), is amended—

15 (A) in subsection (a)(2)—

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

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

18 and

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

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

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

23 on such amount at the maximum legal prevail24 ing rate’’ and inserting ‘‘interest on such
48

•S 1569 IS

1 amount at the rate of 12 percent per year

2 (compounded annually)’’.

3 (2) EFFECTIVE DATE.—Each amendment made

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

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

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

11 ‘‘SEC. 796. RECOVERY.

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

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

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

18 Health Professions Education Extension Amendments of

19 1992 (Public Law 102–408)—

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

22 which funds have been paid under such section

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

24 public or other nonprofit agency that would have
49

•S 1569 IS

1 been qualified to file an application under section

2 605;

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

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

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

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

10 with respect to which funds have been paid under

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

12 ceases to be a public or nonprofit entity,

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

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

17 Professions Education Extension Amendments of

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

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

21 or as a place for religious worship,

22 the United States shall be entitled to recover from the

23 owner of the facility the base amount prescribed by sub24 section (c)(1) plus the interest (if any) prescribed by sub25 section (c)(2).
50

•S 1569 IS

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

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

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

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

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

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

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

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

11 ‘‘(c) AMOUNT.—

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

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

15 the then value (as determined by the agreement of

16 the parties or in an action brought in the district

17 court of the United States for the district in which

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

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

21 ‘‘(2) INTEREST.—

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

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

25 described in subparagraph (B) at a rate (deter-
51

•S 1569 IS

1 mined by the Secretary) based on the average

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

3 Treasury bills auctioned during that period.

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

5 subparagraph (A) is the period beginning—

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

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

8 on which the owner of the facility ceases to

9 be a public or nonprofit agency, school, or

10 entity as described in subparagraph (A),

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

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

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

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

18 date on which such cessation or change of

19 use occurs,

20 and ending on the date the amount the United

21 States is entitled to recover is collected.

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

24 with respect to a facility (under such conditions as the
52

•S 1569 IS

1 Secretary may establish by regulation) if the Secretary de2 termines that there is good cause for waiving such rights.

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

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

5 constitute a lien on any facility.’’.

6 SEC. 503. CLINICAL TRAINEESHIPS.

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

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

9 SEC. 504. DEMONSTRATION PROJECT GRANTS TO STATES

10 FOR ALZHEIMER’S DISEASE.

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

12 3(a)) is amended—

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

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

15 (2) in paragraph (2)—

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

18 or in congregate settings’’; and

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

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

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

24 ‘‘(3) to improve access for individuals with Alz25 heimer’s disease or related disorders, particularly
53

•S 1569 IS

1 such individuals from ethnic, cultural, or language

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

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

5 long-term care services; and

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

7 paragraph; and’’.

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

9 is amended—

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

11 ON’’;

12 (2) in subsection (a)—

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

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

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

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

19 after ‘‘third year’’.

20 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

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

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

23 SEC. 505. MEDICALLY UNDERSERVED AREA STUDY.

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

25 Human Services shall conduct a study concerning the fea-
54

•S 1569 IS

1 sibility and desirability of, and the criteria to be used for,

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

4 health professional shortage area designation.

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

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

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

9 professional shortage area designation, shall—

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

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

14 (B) in designating an area as a medically

15 underserved area; and

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

17 health professional shortage area designations

18 of such State; and

19 (2) review the suggestions of public health and

20 primary care experts.

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

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

23 Human Services shall prepare and submit to the appro24 priate committees of Congress a report concerning the
55

•S 1569 IS

1 findings of the study conducted under subsection (a) to2 gether with the recommendations of the Secretary.

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

5 Human Services shall give special consideration to (and

6 describe in the report) the unique impact of designation

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

9 (1) rational service areas, and their application

10 to frontier areas and inner-city communities;

11 (2) indicators of high medical need, including

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

15 (3) indicators of insufficient service capacity,

16 including language proficiency criteria for ethnic

17 populations, annual patient visits per physician,

18 waiting times for appointments, waiting times in a

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

22 areas.
56

•S 1569 IS

1 SEC. 506. PROGRAMS REGARDING BIRTH DEFECTS.

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

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

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

5 ‘‘PROGRAMS REGARDING BIRTH DEFECTS

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

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

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

10 on birth defects, including data on the causes of

11 such defects and on the incidence and prevalence of

12 such defects;

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

14 the public on the prevention of such defects;

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

16 of epidemiologic research and study of such defects,

17 and to improve the education, training, and clinical

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

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

21 prevention of such defects.

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

23 subsection (a)(1), the Secretary shall establish and main24 tain a National Information Clearinghouse on Birth De25 fects to collect and disseminate to health professionals and
57

•S 1569 IS

1 the general public information on birth defects, including

2 the prevention of such defects.

3 ‘‘(c) GRANTS AND CONTRACTS.—

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

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

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

8 shall collect and analyze demographic data utilizing

9 appropriate sources as determined by the Secretary.

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

11 AWARD FUNDS.—

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

13 award of a grant or contract under paragraph

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

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

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

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

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

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

22 in subparagraph (A), the Secretary shall reduce

23 the amount of payments under the award in24 volved by an amount equal to the costs of de25 tailing personnel and the fair market value of
58

•S 1569 IS

1 any supplies, equipment, or services provided by

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

4 such request, expend the amounts withheld.

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

6 may make an award of a grant or contract under

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

8 is submitted to the Secretary and the application is

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

10 such agreements, assurances, and information as the

11 Secretary determines to be necessary to carry out

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

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

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

17 the Committee on Labor and Human Resources of the

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

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

22 to which birth defects have contributed to the inci23 dence and prevalence of infant mortality;
59

•S 1569 IS

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

2 that is specific to various racial and ethnic groups;

3 and

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

5 which each approach to preventing birth defects has

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

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

9 this section; and

10 ‘‘(5) contains any recommendations of the Sec11 retary regarding this section.

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

13 purpose of carrying out this section, there are authorized

14 to be appropriated such sums as may be necessary for

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

16 TITLE VI—GENERAL

17 PROVISIONS

18 SEC. 601. EFFECTIVE DATE.

19 This Act and the amendments made by this Act shall

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

Æ

S 1569 IS——2

S 1569 IS——3

S 1569 IS——4
60

•S 1569 IS

S 1569 IS——5