```

[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 2346 Placed on Calendar Senate (PCS)]

                                                       Calendar No. 541

103d CONGRESS

  2d Session

                                S. 2346

_______________________________________________________________________

                                 A BILL

 To establish a fund for various programs to strengthen and expand the 
 capacity of State and local governments and other entities to improve 
                           the public health.

_______________________________________________________________________

                             August 5, 1994

            Read the second time and placed on the calendar

                                                       Calendar No. 541
103d CONGRESS
  2d Session
                                 S. 2346

 To establish a fund for various programs to strengthen and expand the 
 capacity of State and local governments and other entities to improve 
                           the public health.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

               August 1 (legislative day, July 20), 1994

Mr. Graham introduced the following bill; which was read the first time

                             August 5, 1994

            Read the second time and placed on the calendar

_______________________________________________________________________

                                 A BILL

 
 To establish a fund for various programs to strengthen and expand the 
 capacity of State and local governments and other entities to improve 
                           the public health.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Public Health 
Improvement Act of 1994''.
    (b) Table of Contents.--The table of titles and subtitles for this 
Act is as follows:

      TITLE I--PROGRAMS UNDER PUBLIC HEALTH IMPROVEMENT TRUST FUND

           Subtitle A--Programs of Public Health Service Act

           Subtitle B--Comprehensive School Health Education

      TITLE I--PROGRAMS UNDER PUBLIC HEALTH IMPROVEMENT TRUST FUND

           Subtitle A--Programs of Public Health Service Act

SEC. 101. TABLE OF CONTENTS REGARDING NEW TITLE XXVII OF PUBLIC HEALTH 
              SERVICE ACT.

    A table describing the contents of title XXVII of the Public Health 
Service Act, as added by section 102 of this Act, is as follows:

    TITLE XXVII--PROGRAMS UNDER PUBLIC HEALTH IMPROVEMENT TRUST FUND

         Subtitle A--Establishment of Fund; Advisory Commission

Sec. 2701. Public Health Improvement Trust Fund.
Sec. 2702. Public Health Advisory Commission.
          Subtitle B--Core Functions of Public Health Programs

                    Part 1--Formula Grants to States

Sec. 2711. Authorizations of appropriations from Fund.
Sec. 2712. Formula grants to States for core health functions.
Sec. 2713. Number of functions; planning.
Sec. 2714. Submission of information; reports.
Sec. 2715. Application for grant.
Sec. 2716. Determination of amount of allotment.
Sec. 2717. Allocations for certain activities.
   Part 2--Comprehensive Evaluation of Disease Prevention and Health 
                           Promotion Programs

Sec. 2718. Authorizations of appropriations from Fund.
Sec. 2719. Evaluation of programs.
 Subtitle C--Opportunities for Education and Training in Public Health

 Part 1--Scholarship and Loan Repayment Programs Regarding Service in 
                        Public Health Positions

Sec. 2721. Authorizations of appropriations from Fund.
Sec. 2722. Scholarship program.
Sec. 2723. Loan repayment program.
Sec. 2724. Approved public health positions.
Sec. 2725. Allocation of funds; special considerations.
        Part 2--Educational Institutions Regarding Public Health

Sec. 2731. Authorizations of appropriations from Fund.
Sec. 2732. Grants for expanding capacity of institutions.
Sec. 2733. Coordination of grant activities with national priorities.
Sec. 2734. Certain requirements for grants.
            Part 3--Expansion of Competency in Public Health

Sec. 2736. Authorizations of appropriations from Fund.
Sec. 2737. Grants to States.
      Part 4--General Provisions Regarding Education and Training
Sec. 2740. Underrepresented minorities regarding fields of public 
                            health.
Sec. 2740A. Coordination of programs.
              Subtitle D--Regional Poison Control Centers
Sec. 2741. Authorizations of appropriations from Fund.
Sec. 2742. Grants for regional centers.
Sec. 2743. Requirements regarding certification.
Sec. 2744. General provisions.
               Subtitle E--School-Related Health Services
               Part 1--Projects for Provision of Services
            subpart a--development and operation of projects
Sec. 2746. Authorizations of appropriations from Fund.
Sec. 2747. Eligibility for development and operation grants.
Sec. 2748. Preferences.
Sec. 2749. Grants for development of projects.
Sec. 2750. Grants for operation of projects.
Sec. 2751. Federal administrative costs.
            subpart b--capital costs of developing projects
Sec. 2753. Loans and loan guarantees regarding projects.
Sec. 2754. Funding.
Part 2--Scholarship and Loan Repayment Programs Regarding School Nurses
Sec. 2755. Authorizations of appropriations from Fund.
Sec. 2755A. Scholarship program regarding upgrade in skills.
Sec. 2755B. Loan repayment program.
Sec. 2755C. School-nurse positions.
           Subtitle F--Expansion of Access to Health Services
              Part 1--Community and Migrant Health Centers
Sec. 2756. Authorizations of appropriations from Fund.
Sec. 2757. Grants to community and migrant health centers.
     Part 2--Qualifiedsubpart a--funding; purposesPractice Networks
Sec. 2761. Authorizations of appropriations from Fund.
subpart b--development of qualified community health plans and practice 
                                networks
Sec. 2763. Grants and contracts for development of plans and networks.
Sec. 2764. Preferences in making awards of assistance.
Sec. 2765. Certain uses of awards.
Sec. 2766. Accessibility of services.
Sec. 2767. Additional agreements.
Sec. 2768. Submission of certain information.
Sec. 2769. Reports; audits.
Sec. 2770. Application for assistance.
Ssubpart c--capital cost of development of qualified community health 
                      plans and practice networks
Sec. 2773. Loans and loan guarantees regarding plans and networks.
Sec. 2774. Certain requirements.
Sec. 2775. Defaults; right of recovery.
Sec. 2776. Provisions regarding construction or expansion of 
                            facilities.
Sec. 2777. Application for assistance.
Sec. 2778. Administration of programs.
                       Part 3--Enabling Services

Sec. 2779. Authorizations of appropriations from Fund.
Sec. 2780. Grants and contracts for enabling services.
                 Part 4--National Health Service Corps

Sec. 2781. Authorizations of appropriations from Fund.
        Part 5--Satellite Clinics Regarding Primary Health Care

Sec. 2783. Authorizations of appropriations from Fund.
Sec. 2783A. Grants to States for development and operation of satellite 
                            clinics.
                   Part 6--Community Health Advisors

Sec. 2784. Authorizations of appropriations from Fund.
Sec. 2785. Formula grants regarding community health advisor programs.
Sec. 2786. Requirements regarding community health advisor programs.
Sec. 2787. Additional agreements.
Sec. 2788. Application for assistance; State plan.
Sec. 2789. Determination of amount of allotment.
Sec. 2790. Quality assurance; cost-effectiveness.
Sec. 2791. Evaluations; technical assistance.
Sec. 2792. Rule of construction regarding programs of Indian Health 
                            Service.
Sec. 2793. Definitions.
Sec. 2794. Effect of insufficient appropriations for minimum 
                            allotments.
                 Part 7--Mental Health; Substance Abuse

Sec. 2795. Authorizations of appropriations from Fund.
Sec. 2796. Supplemental formula grants for States regarding activities 
                            under part B of title XIX.
Sec. 2797. Capital costs of development of certain centers and clinics.
                     Subtitle E--General Provisions

Sec. 2798. Requirement regarding accreditation of schools, departments, 
                            and programs.
Sec. 2799. Definitions.

SEC. 102. ESTABLISHMENT OF NEW TITLE XXVII REGARDING PUBLIC HEALTH 
              PROGRAMS.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following title:

   ``TITLE XXVII--PROGRAMS UNDER PUBLIC HEALTH IMPROVEMENT TRUST FUND

        ``Subtitle A--Establishment of Fund; Advisory Commission

``SEC. 2701. PUBLIC HEALTH IMPROVEMENT TRUST FUND.

    ``(a) Establishment of Fund.--There is established in the Treasury 
of the United States a fund to be known as the Public Health 
Improvement Trust Fund (in this title referred to as the `Fund'), 
consisting of the amounts appropriated in subsection (b) and subsection 
(d)(3). Amounts in the Fund are available until expended.
    ``(b) Expenditures From Fund.--Amounts in the Fund are available 
for carrying out this title, and for carrying out subtitle B of title I 
of the Public Health Improvement Act of 1994 (relating to comprehensive 
school health education), subject to the extent of amounts made 
available in advance in appropriations Act pursuant to the 
authorizations of appropriations established in the other subtitles of 
this title and in section 2702. This section does not establish any 
authorization of appropriations.
    ``(c) Investment.--
            ``(1) In general.--The Secretary of the Treasury shall 
        invest such amounts of the Fund as such Secretary determines 
        are not required to meet current withdrawals from the Fund. 
        Such investments may be made only in interest-bearing 
        obligations of the United States. For such purpose, such 
        obligations may be acquired on original issue at the issue 
        price, or by purchase of outstanding obligations at the market 
        price.
            ``(2) Sale of obligations.--Any obligation acquired by the 
        Fund may be sold by the Secretary of the Treasury at the market 
        price.
            ``(3) Availability of income.--Any interest derived from 
        obligations acquired by the Fund, and proceeds from any sale or 
        redemption of such obligations, are hereby appropriated to the 
        Fund.

``SEC. 2702. PUBLIC HEALTH ADVISORY COMMISSION.

    ``(a) In General.--The Secretary shall establish within the Office 
of the Assistant Secretary for Health an advisory commission to be 
known as the National Public Health Advisory Commission (in this title 
referred to as the `Commission'). The first meeting of the Commission 
shall be held not later than 90 days after the date of the enactment of 
the Public Health Improvement Act of 1994.
    ``(b) Duties.--
            ``(1) In general.--The Commission shall provide to the 
        Secretary advice on carrying out this title (including advice 
        on the amount of funds that should be made available for each 
        of the programs of this title and including advice on improving 
        such programs) and advice on other Federal policies regarding 
        the public health (including the recommendations of the 
        Commission for changes in such policies). In carrying out the 
        preceding sentence, the Commission shall monitor the 
        development and operation of the programs of this title.
            ``(2) Certain activities.--The activities carried out under 
        paragraph (1) by the Commission shall include the following:
                    ``(A) Assessing the effectiveness and cost-
                effectiveness of public health programs on improving 
                health status of communities.
                    ``(B) Assessing the effectiveness and cost-
                effectiveness of public health interventions at the 
                community level.
                    ``(C) Assessing the impact of health care reform on 
                access to clinical preventive services, early detection 
                services, and health promotion services.
    ``(c) Composition.--
            ``(1) Ex officio members.--The heads of each of the 
        agencies of the Public Health Service (or the designees of such 
        heads) shall serve as nonvoting members of the Commission. The 
        Secretary may designate additional Federal officials to so 
        serve.
            ``(2) Appointed members.--The Secretary shall appoint to 
        the Commission 9 individuals who are not officers or employees 
        of the Federal Government, which individuals shall serve as 
        voting members of the Commission. Individuals appointed under 
        the preceding sentence shall include--
                    ``(A) individuals who are experienced or specially 
                trained in a field of public health;
                    ``(B) members of professional organizations 
                regarding the public health;
                    ``(C) members of the general public; and
                    ``(D) members of organizations representing the 
                general public.
            ``(3) Requirement regarding minority groups.--The Secretary 
        shall ensure that the membership of the Commission includes 
        individuals who are members of racial and ethnic minority 
        groups.
    ``(d) Chair.--From among the members of the Commission appointed 
under subsection (c)(2), the President shall designate an individual to 
serve as the chair of the Commission.
    ``(e) Terms.--
            ``(1) In general.--The term of a member of the Commission 
        appointed under subsection (c)(2) is 3 years, except that, of 
        such members first appointed to the Commission, the Secretary 
        shall specify varying terms of membership to achieve the result 
        that not more than \1/3\ of the terms of members so appointed 
        expire in any 1 year.
            ``(2) Service after expiration of term.--A member of the 
        Commission may continue to serve after the expiration of the 
        term of the member until a successor is appointed.
    ``(f) Vacancies.--
            ``(1) Authority of commission.--A vacancy in the membership 
        of the Commission does not affect the power of the remaining 
        members to carry out the duties under subsection (b).
            ``(2) Appointment of successors.--A vacancy in the 
        membership of the Commission shall be filled in the manner in 
        which the original appointment was made.
            ``(3) Incomplete term.--If a member of the Commission does 
        not serve the full term applicable to the member, the 
        individual appointed to fill the resulting vacancy shall be 
        appointed for the remainder of the term of the predecessor of 
        the individual.
    ``(g) Meetings.--The Commission shall meet at the call of the Chair 
or a majority of the members, except that the Commission shall meet not 
fewer than 3 times each fiscal year.
    ``(h) Compensation; Reimbursement of Expenses.--
            ``(1) Appointed members.--Members of the Commission 
        appointed under subsection (c)(2) shall receive compensation 
        for each day (including traveltime) engaged in carrying out the 
        duties of the Committee. Such compensation may not be in an 
        amount in excess of the maximum rate of basic pay payable under 
        the General Schedule for positions above GS-15.
            ``(2) Ex officio members.--Members of the Commission who 
        serve under subsection (c)(1) may not receive compensation for 
        service on the Commission in addition to the compensation 
        otherwise received for duties carried out as Federal officers 
        or employees.
            ``(3) Reimbursement.--Members of the Commission may, in 
        accordance with chapter 57 of title 5, United States Code, be 
        reimbursed for travel, subsistence, and other necessary 
        expenses incurred in carrying out the duties of the Commission.
    ``(i) Staff.--
            ``(1) In general.--The Commission may appoint and determine 
        the compensation of such staff as may be necessary to carry out 
        the duties of the Commission, including appointing an executive 
        director for the Commission. Such appointments and compensation 
        may be made without regard to the provisions of title 5, United 
        States Code, that govern appointments in the competitive 
        services, and the provisions of chapter 51 and subchapter III 
        of chapter 53 of such title that relate to classifications and 
        the General Schedule pay rates.
            ``(2) Limitation.--Staff appointed under paragraph (1) may 
        not be compensated in excess of the maximum rate of basic pay 
        payable for GS-15 under the General Schedule, except that the 
        executive director may be compensated in an amount not 
        exceeding the maximum rate of basic pay payable under such 
        Schedule for positions above GS-15.
    ``(j) Authorization of Appropriations From Fund.--For the purpose 
of carrying out this section, there are authorized to be appropriated 
from the Fund such sums as may be necessary for each of the fiscal 
years 1995 through 2002.

         ``Subtitle B--Core Functions of Public Health Programs

                   ``PART 1--Formula Grants to States

``SEC. 2711. AUTHORIZATIONS OF APPROPRIATIONS FROM FUND.

    ``For the purpose of carrying out this subtitle, there are 
authorized to be appropriated from the Fund $150,000,000 for fiscal 
year 1995, $400,000,000 for fiscal year 1996, $550,000,000 for fiscal 
year 1997, $650,000,000 for fiscal year 1998, $750,000,000 for fiscal 
year 1999, $850,000,000 for fiscal year 2000, $900,000,000 for fiscal 
year 2001, and $900,000,000 for fiscal year 2002.

``SEC. 2712. FORMULA GRANTS TO STATES FOR CORE HEALTH FUNCTIONS.

    ``(a) In General.--In the case of each State that submits to the 
Secretary an application in accordance with section 2715 for a fiscal 
year, the Secretary of Health and Human Services, acting through the 
Director of the Centers for Disease Control and Prevention, shall make 
a grant to the State for carrying out the activities described in 
subsection (c). The award shall consist of the allotment determined 
under section 2716 for the State.
    ``(b) General Purpose.--The purpose of this subtitle is to provide 
for improvements in the health status of the public through carrying 
out the activities described in subsection (b) toward attaining the 
Healthy People 2000 Objectives (as defined in section 2799). A funding 
agreement for a grant under subsection (a) is that--
            ``(1) the grant will be expended for such activities; and
            ``(2) the activities will be carried out by the State in 
        collaboration with local public health departments, health 
        education and training centers, neighborhood health centers, 
        and other community health providers.
    ``(c) Core Functions of Public Health Programs.--Subject to the 
purpose described in subsection (b), the activities referred to in 
subsection (a) are the following:
            ``(1) Data collection, and analytical activities, related 
        to population-based status and outcomes monitoring, including 
        the following:
                    ``(A) The regular collection and analysis of public 
                health data (including the 10 leading causes of death 
                and their costs to society).
                    ``(B) Vital statistics.
                    ``(C) Personal health services data.
                    ``(D) The supply and distribution of health 
                professionals.
            ``(2) Activities to reduce environmental risk and to assure 
        the safety of housing, schools, workplaces, day-care centers, 
        food and water, including the following activities:
                    ``(A) Monitoring the overall public health status 
                and safety of communities.
                    ``(B) Assessing exposure to high lead levels and 
                other environmental contaminants; and activities for 
                abatement of toxicant hazards, including lead-related 
                hazards.
                    ``(C) Monitoring the quality of community water 
                supplies used for consumption or for recreational 
                purposes.
                    ``(D) Monitoring sewage and solid waste disposal, 
                radiation exposure, radon exposure, and noise levels.
                    ``(E) Monitoring indoor and ambient air quality and 
                related risks to vulnerable populations.
                    ``(F) Assuring recreation, worker, and school 
                safety.
                    ``(G) Enforcing public health safety and sanitary 
                codes.
                    ``(H) Monitoring community access to appropriate 
                health services.
                    ``(I) Other activities relating to promoting and 
                protecting the public health of communities.
            ``(3) Investigation, control, and public-awareness 
        activities regarding adverse health conditions (such as 
        emergency treatment preparedness, community efforts to reduce 
        violence, outbreaks of communicable diseases within 
        communities, chronic disease and dysfunction exposure-related 
        conditions, toxic environmental pollutants, occupational and 
        recreational hazards, motor vehicle accidents, and other 
        threats to the health status of individuals).
            ``(4) Public information and education programs to reduce 
        risks to health (such as use of tobacco;, alcohol and other 
        drugs; unintentional injury from accidents, including motor 
        vehicle accidents; sexual activities that increase the risk to 
        HIV transmission and sexually transmitted diseases; poor diet; 
        physical inactivity; stress-related illness; mental health 
        problems; genetic disorders; and low childhood immunization 
        levels).
            ``(5) Provision of public health laboratory services to 
        complement private clinical laboratory services and that screen 
        for diseases and conditions (such as metabolic diseases in 
        newborns, provide assessments of blood lead levels and other 
        environmental toxicants, diagnose and contact tracing of 
        sexually transmitted diseases, tuberculosis and other diseases 
        requiring partner notification, test for infectious and food-
        borne diseases, and monitor the safety of water and food 
        supplies).
            ``(6) Training and education of new and existing health 
        professionals in the field of public health, with special 
        emphasis on epidemiology, biostatistics, health education, 
        public health administration, public health nursing and 
        dentistry, environmental and occupational health sciences, 
        public health nutrition, social and behavioral health sciences, 
        operations research, and laboratory technology.
            ``(7) Leadership, policy development and administration 
        activities, including assessing needs and the supply and 
        distribution of health professionals; the setting of public 
        health standards; the development of community public health 
        policies; and the development of community public health 
        coalitions.
    ``(d) Restrictions on Use of Grant.--
             ``(1) In general.--A funding agreement for a grant under 
        subsection (a) for a State is that the grant will not be 
        expended--
                    ``(A) to provide inpatient services;
                    ``(B) to make cash payments to intended recipients 
                of health services;
                    ``(C) to purchase or improve land, purchase, 
                construct, or permanently improve (other than minor 
                remodeling) any building or other facility, or purchase 
                major medical equipment;
                    ``(D) to satisfy any requirement for the 
                expenditure of non-Federal funds as a condition for the 
                receipt of Federal funds; or
                    ``(E) to provide financial assistance to any entity 
                other than a public or nonprofit private entity.
            ``(2) Limitation on administrative expenses.--A funding 
        agreement for a grant under subsection (a) is that the State 
        involved will not expend more than 20 percent of the grant for 
        administrative expenses with respect to the grant.
    ``(e) Maintenance of Effort.--A funding agreement for a grant under 
subsection (a) is that the State involved will maintain expenditures of 
non-Federal amounts for core health functions at a level that is not 
less than the level of such expenditures maintained by the State for 
the fiscal year preceding the first fiscal year for which the State 
receives such a grant.

``SEC. 2713. NUMBER OF FUNCTIONS; PLANNING.

    ``(a) Number of Functions.--Subject to subsection (b), a funding 
agreement for a grant under section 2712 is that the State involved 
will carry out each of the activities described in subsection (c) of 
such section.
    ``(b) Planning.--In making grants under section 2712, the Secretary 
shall for each State designate a period during which the State is to 
engage in planning to meet the responsibilities of the State under 
subsection (a). The period so designated may not exceed 18 months. With 
respect to such period for a State, a funding agreement for a grant 
under section 2712 for any fiscal year containing any portion of the 
period is that, during the period, the State will expend the grant only 
for such planning.

``SEC. 2714. SUBMISSION OF INFORMATION; REPORTS.

    ``(a) Submission of Information.--The Secretary may make a grant 
under section 2712 only if the State involved submits to the Secretary 
the following information:
            ``(1) A description of the relationship between community 
        health providers, public and private health plans, and the 
        public health system of the State.
            ``(2) A description of existing deficiencies in the public 
        health system at the State level and the local level, using 
        standards under the Healthy People 2000 Objectives.
            ``(3) A description of public health priorities identified 
        at the State level and local levels, including the 10 leading 
        causes of death and their respective direct and indirect costs 
        to the State and the Federal Government.
            ``(4) Measurable outcomes and process objectives (using 
        criteria under the Healthy People 2000 Objectives) which 
        indicate improvements in health status as a result of the 
        activities carried out under section 2712(c).
            ``(5) Information regarding each such activity, which--
                    ``(A) identifies the amount of State and local 
                funding expended on each such activity for the fiscal 
                year preceding the fiscal year for which the grant is 
                sought; and
                    ``(B) provides a detailed description of how 
                additional Federal funding will improve each such 
                activity by both the State and local public health 
                agencies.
            ``(6) A description of activities under section 2712(c) to 
        be carried out at the local level, and a specification for each 
        such activity of--
                    ``(A) the communities in which the activity will be 
                carried out and any collaborating agencies;
                    ``(B) the amount of the grant to be expended for 
                the activity in each community so specified; and
                    ``(C) the integration of community health advisors 
                (as defined in 2786(d)) with such activities under 
                section 2712(c).
            ``(7) A description of how such activities have been 
        coordinated with activities supported under title V of the 
        Social Security Act (relating to maternal and child health).
    ``(b) Reports.--A funding agreement for a grant under section 2712 
is that the States involved will, not later than the date specified by 
the Secretary, submit to the Secretary a report describing--
            ``(1) the purposes for which the grant was expended;
            ``(2) the health status of the population of the State, as 
        measured by criteria under the Healthy People 2000 Objectives; 
        and
            ``(3) the progress achieved and obstacles encountered in 
        using uniform data sets under such Objectives.

``SEC. 2715. APPLICATION FOR GRANT.

    ``The Secretary may make a grant under section 2712 only if an 
application for the grant is submitted to the Secretary, the 
application contains each agreement described in this part, the 
application contains the information required in section 205, and the 
application is in such form, is made in such manner, and contains such 
agreements, assurances, and information as the Secretary determines to 
be necessary to carry out this part.

``SEC. 2716. DETERMINATION OF AMOUNT OF ALLOTMENT.

    ``For purposes of section 2712, the allotment under this section 
for a State for a fiscal year shall be determined through a formula 
established by the Secretary on the basis of the population, economic 
indicators, and health status of each State. Such allotment shall be 
the product of--
            ``(1) a percentage determined under the formula; and
            ``(2) the amount appropriated under section 2711 for the 
        fiscal year, less any amounts reserved under section 2717.

``SEC. 2717. ALLOCATIONS FOR CERTAIN ACTIVITIES.

    ``Of the amounts made available under section 2711 for a fiscal 
year for carrying out this part, the Secretary may reserve not more 
than 15 percent for carrying out the following activities:
            ``(1) Technical assistance with respect to planning, 
        development, and operation of activities under section 2712(b), 
        including provision of biostatistical and epidemiological 
        expertise, provision of laboratory expertise, and the 
        development of uniform data sets under the Health People 2000 
        Objectives.
            ``(2) Development and operation of a national information 
        network among State and local health agencies for utilizing 
        such uniform data sets.
            ``(3) Program monitoring and evaluation of activities 
        carried out under section 2712(b).
            ``(4) Development of a unified electronic reporting 
        mechanism to improve the efficiency of administrative 
        management requirements regarding the provision of Federal 
        grants to State public health agencies.

  ``PART 2--COMPREHENSIVE EVALUATION OF DISEASE PREVENTION AND HEALTH 
                           PROMOTION PROGRAMS

``SEC. 2718. AUTHORIZATIONS OF APPROPRIATIONS FROM FUND.

    ``For the purpose of carrying out this part, there are authorized 
to be appropriated from the Fund $100,000,000 for fiscal year 1995, 
$150,000,000 for each of the fiscal years 1996 through 1999, and 
$100,000,000 for fiscal year 2000.

``SEC. 2719. EVALUATION OF PROGRAMS.

    ``(a) Grants.--The Secretary may make grants to, or enter into 
cooperative agreements or contracts with, eligible entities for the 
purpose of enabling such entities to carry out evaluations of the type 
described in subsection (c). The Secretary shall carry out this section 
acting through the Director of the Centers for Disease Control and 
Prevention, subject to subsection (g).
    ``(b) Requirements.--
            ``(1) Eligible entities.--To be eligible to receive an 
        award of a grant, cooperative agreement, or contract under 
        subsection (a), an entity must--
                    ``(A) be a public, nonprofit, or private entity or 
                a university;
                    ``(B) prepare and submit to the Secretary an 
                application at such time, in such form, and containing 
                such information as the Secretary may require, 
                including a plan for the conduct of the evaluation 
                under the grant;
                    ``(C) provide assurances that any information 
                collected while conducting evaluations under this 
                section will be maintained in a confidential manner 
                with respect to the identities of the individuals from 
                which such information is obtained; and
                    ``(D) meet any other requirements that the 
                Secretary determines to be appropriate.
            ``(2) Types of entities.--In making awards under subsection 
        (a), the Secretary shall consider applications from entities 
        proposing to conduct evaluations using community programs, 
        managed care programs, State and county health departments, 
        public education campaigns, school programs, and other 
        appropriate programs. The Secretary shall ensure that not less 
        than 25 percent of the amounts appropriated under section 2718 
        for a fiscal year are used for making such awards to entities 
        that will use the amounts to conduct evaluations in the 
        workplace.
    ``(c) Use of Funds.--
            ``(1) Evaluations.--An award under subsection (a) shall be 
        used to--
                    ``(A) conduct evaluations to determine the extent 
                to which clinical preventive services, health promotion 
                and unintentional injury prevention activities, and 
                interpersonal and community violence prevention 
                activities, achieve short-term and long-term health 
                care cost reductions and health status improvement with 
                respect to the Healthy People 2000 Objectives; and
                    ``(B) evaluate other areas determined appropriate 
                by the Secretary.
            ``(2) Inclusion of certain population groups.--In carrying 
        out this section, the Secretary shall ensure that data 
        concerning women, children, minorities, older individuals with 
        different income levels, retirees, and individuals from diverse 
        geographical backgrounds, are obtained.
            ``(3) Minimum services.--The evaluations that the Secretary 
        may provide for under this section include (but are not limited 
        to) evaluations of programs that provide one or more of the 
        following services:
                    ``(A) Blood pressure screening and control (to 
                detect and control hypertension and coronary health 
                disease).
                    ``(B) Early cancer screening.
                    ``(C) Blood cholesterol screening and control.
                    ``(D) Smoking cessation programs.
                    ``(E) Substance abuse programs.
                    ``(F) Dietary and nutrition counseling, including 
                nutrition.
                    ``(G) Physical fitness counseling.
                    ``(H) Stress management.
                    ``(I) Diabetes education and screening.
                    ``(J) Intraocular pressure screening.
                    ``(K) Monitoring of prescription drug use.
                    ``(L) Violence and injury prevention programs.
                    ``(M) Health education.
                    ``(N) Immunization rates.
            ``(4) Environmental data.--Evaluations conducted under this 
        section may consider the health effects and cost-effectiveness 
        of certain environmental programs, including fluoridation 
        programs, traffic safety programs, pollution control programs, 
        accident prevention programs, and antismoking programs.
            ``(5) Public policies.--Evaluations conducted under this 
        section may consider the effects of prevention-oriented social 
        and economic policies on improvement of health status and their 
        long-term cost effectiveness.
            ``(6) Use of existing data.--In conducting evaluations 
        under this section, entities shall use existing data and health 
        promotion and screening programs where practicable.
            ``(7) Cooperation.--In providing for an evaluation under 
        this section, the Secretary shall encourage the recipient of 
        the award and public and private entities with relevant 
        expertise (including State and local agencies) to collaborate 
        for purposes of conducting the evaluation.
    ``(d) Sites.--Recipients of awards under subsection (a) shall 
select evaluation sites under the award that present the greatest 
potential for new and relevant knowledge. Such recipients, in selecting 
such sites, shall ensure that--
            ``(1) the sites provide evidence of pilot testing, process 
        evaluation, formative evaluation, availability assessment 
        strategies and results;
            ``(2) the sites provide evidence of a clear definition of 
        the program and protocols for the implementation of the 
        evaluation; and
            ``(3) the sites provide evidence of valid, appropriate and 
        feasible assessment methods and tools and a willingness to use 
        common data items and instruments across such sites.
    ``(e) Reporting Requirements.--Not later than 1 year after an 
entity first receives an award under subsection (a), and not less than 
once during each 1-year period thereafter for which such an award is 
made to the entity, the entity shall prepare and submit to the 
Secretary a report containing a description of the activities under 
this section conducted during the period for which the report is 
prepared, and the findings derived as a result of such activities.
    ``(f) Term of Evaluations.--Evaluations conducted under this 
section shall be for a period of not less than 3 years and may continue 
as necessary to permit the grantee to adequately measure the full 
benefit of the evaluations.
    ``(g) Dissemination and Guidelines.--
            ``(1) Consultation.--The Secretary shall carry out this 
        subsection acting through the Director of the Centers for 
        Disease Control and Prevention and the Administrator for Health 
        Care Policy and Research.
            ``(2) Guidelines.--The Secretary shall, where feasible and 
        practical, develop and issue practice guidelines that are based 
        on the results of evaluations conducted under this section. The 
        practice guidelines shall be developed by the Secretary 
        utilizing expert practitioners to assist in the development and 
        implementation of these guidelines.
            ``(3) Data.--
                    ``(A) In general.--The Secretary shall collect, 
                store, analyze, and make available data related to the 
                formulation of the guidelines that is provided to the 
                Centers for Disease Control and Prevention by entities 
                conducting evaluations under this section.
                    ``(B) Use of data.--The Secretary shall--
                            ``(i) identify activities that prevent 
                        disease, illness, injury and disability, and 
                        promote good health practices; ascertain their 
                        cost-effectiveness; and identify their 
                        potential to overall health status with respect 
                        to Healthy People 2000 Objectives;
                            ``(ii) disseminate practice guidelines to 
                        State and county health departments, State 
                        insurance departments, insurance companies, 
                        employers, professional medical organizations, 
                        and others determined appropriate by the 
                        Secretary; and
                            ``(iii) provide information with respect to 
                        recidivism rates of participation in the 
                        evaluations.
            ``(4) Dissemination.--The Secretary may disseminate 
        information collected from evaluations under this section.
    ``(h) Limitation.--Amounts appropriated for carrying out this 
section shall not be utilized to provide services.

``Subtitle C--Opportunities for Education and Training in Public Health

``Part 1--SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS REGARDING SERVICE IN 
                        PUBLIC HEALTH POSITIONS

``SEC. 2721. AUTHORIZATIONS OF APPROPRIATIONS FROM FUND.

    ``For the purpose of carrying out this part, there are authorized 
to be appropriated from the Fund $100,000,000 for fiscal year 1995, 
$125,000,000 for fiscal year 1996, $150,000,000 for fiscal year 1997, 
$150,000,000 for fiscal year 1998, $150,000,000 for fiscal year 1999, 
and $175,000,000 for each of the fiscal years 2000 through 2002.

``SEC. 2722. SCHOLARSHIP PROGRAM.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration and in consultation 
with the Director of the Centers for Disease Control and Prevention, 
shall carry out a program under which the Secretary awards scholarships 
to individuals described in subsection (b) for the purpose of assisting 
the individuals with the costs of attending public and nonprofit 
private schools of public health (or other public or nonprofit private 
institutions providing graduate or specialized training in public 
health).
    ``(b) Eligible Individuals.--An individual referred to in 
subsection (a) is any individual meeting the following conditions:
            ``(1) The individual is enrolled (or accepted for 
        enrollment) at a school or other institution referred to in 
        subsection (a) as a full-time or part-time student in a program 
        providing training in a health profession in a field of public 
        health (including the fields of epidemiology, biostatistics, 
        environmental health, health administration and planning, 
        behavioral sciences, maternal and child health, occupational 
        safety, public health nursing, nutrition, and toxicology).
            ``(2) The individual enters into the contract required 
        pursuant to subsection (d) as a condition of receiving the 
        scholarship (relating to an agreement to provide services in 
        approved public health positions, as defined in section 2724).
    ``(c) Eligible Schools.--For fiscal year 1997 and subsequent fiscal 
years, the Secretary may make an award of a scholarship under 
subsection (a) only if the Secretary determines that--
            ``(1) the school or other institution with respect to which 
        the award is to be provided has coordinated the activities of 
        the school or institution with relevant activities of the 
        Health Resources and Services Administration and the Centers 
        for Disease Control and Prevention; and
            ``(2) not fewer than 60 percent of the graduates of the 
        school or institution are in public health positions determined 
        by the Secretary to be consistent with the needs of the United 
        States regarding such professionals.
    ``(d) Applicability of Certain Provisions.--Except as inconsistent 
with this section or section 2724, the provisions of subpart III of 
part D of title III (relating to the Scholarship and Loan Repayment 
Programs of the National Health Service Corps) apply to an award of a 
scholarship under subsection (a) to the same extent and in the same 
manner as such provisions apply to an award of a scholarship under 
section 338A.

``SEC. 2723. LOAN REPAYMENT PROGRAM.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration and in consultation 
with the Director of the Centers for Disease Control and Prevention, 
shall carry out a program under which the Federal Government enters 
into agreements to repay all or part of the educational loans of 
individuals meeting the following conditions:
            ``(1) The individual involved is a graduate of a school or 
        other institution described in section 2722(a).
            ``(2) The individual meets the applicable legal 
        requirements to provide services as a public health 
        professional (including a professional in any of the fields 
        specified in section 2722(b)(1)).
            ``(3) The individual enters into the contract required 
        pursuant to subsection (b) as a condition of the Federal 
        Government repaying such loans (relating to an agreement to 
        provide services in approved public health positions, as 
        defined in section 2724).
    ``(b) Applicability of Certain Provisions.--Except as inconsistent 
with this section or section 2724, the provisions of subpart III of 
part D of title III (relating to the Scholarship and Loan Repayment 
Programs of the National Health Service Corps) apply to an agreement 
regarding repayment under subsection (a) to the same extent and in the 
same manner as such provisions apply to an agreement regarding 
repayment under section 338B.
    ``(c) Amount of Repayments.--For each year for which an individual 
contracts to serve in an approved public health position pursuant to 
subsection (b), the Secretary may repay not more than $20,000 of the 
principal and interest of the educational loans of the individual.

``SEC. 2724. APPROVED PUBLIC HEALTH POSITIONS.

    ``(a) Position Regarding Populations With Significant Need for 
Services.--
            ``(1) In general.--With respect to the programs under this 
        part, the obligated service of a program participant pursuant 
        to sections 2722(d) and 2723(b) shall be provided through an 
        assignment, to an entity described in subsection (b), for a 
        position in which the participant provides services as a public 
        health professional to a population determined by the Secretary 
        to have a significant unmet need for the services of such a 
        professional.
            ``(2) Period of service.--For purposes of sections 2722(d) 
        and 2723(d), the period of obligated service is the following, 
        as applicable to the program participant involved:
                    ``(A) In the case of scholarships under section 
                2722 for full-time students, the greater of--
                            ``(i) 1 year for each year for which such a 
                        scholarship is provided; or
                            ``(ii) 2 years.
                    ``(B) In the case of scholarships under section 
                2722 for part-time students, a period determined by the 
                Secretary on the basis of the number of hours of 
                education or training received under the scholarship, 
                considering the percentage constituted by the ratio of 
                such number to the number of hours for a full-time 
                student in the program involved.
                    ``(C) In the case of the loan repayments under 
                section 2723, such period as the Secretary and the 
                participant may agree, except that the period may not 
                be less than 2 years.
    ``(b) Approval of Entities for Assignment of Program 
Participants.--The entities referred to in subsection (a) are public 
and nonprofit private entities approved by the Secretary as meeting 
such requirements for the assignment of a program participant as the 
Secretary may establish. The entities that the Secretary may so approve 
include State and local departments of health, public hospitals, 
community and neighborhood health clinics, migrant health clinics, 
community-based health-related organizations, certified regional poison 
control centers, purchasing cooperatives regarding health insurance, 
and any other public or nonprofit private entity.
    ``(c) Definitions.--For purposes of this part:
            ``(1) The term `approved public health position', with 
        respect to a program participant, means a position to which the 
        participant is assigned pursuant to subsection (a).
            ``(2) The term `program participant' means an individual 
        who enters into a contract pursuant to section 2722(b)(2) or 
        2723(a)(3).

``SEC. 2725. ALLOCATION OF FUNDS; SPECIAL CONSIDERATIONS.

    ``(a) Allocations Regarding New Participants in Scholarship 
Program.--Of the amounts appropriated under section 2721 for a fiscal 
year, the Secretary shall obligate not less than 30 percent for the 
purpose of providing awards for scholarships under section 2722 to 
individuals who have not previously received such scholarships.
    ``(b) Special Consideration for Certain Individuals.--In making 
awards of scholarships under section 2722 and making repayments under 
section 2723, the Secretary shall give special consideration to 
individuals who are in the armed forces of the United States or who are 
veterans of the armed forces.
    ``(c) School Health Education Programs.--The Secretary shall ensure 
that the approved public health positions to which the Secretary 
assigns program participants under this part include positions in 
programs that provide education on the promotion of health and the 
prevention of diseases and that are carried out on the premises of 
public or nonprofit private elementary and secondary schools, including 
comprehensive school health education programs under subtitle B of 
title I of the Public Health Improvement Act of 1994.

       ``PART 2--EDUCATIONAL INSTITUTIONS REGARDING PUBLIC HEALTH

``SEC. 2731. AUTHORIZATIONS OF APPROPRIATIONS FROM FUND.

    ``For the purpose of carrying out this part, there are authorized 
to be appropriated from the Fund $100,000,000 for fiscal year 1995, 
$125,000,000 for fiscal year 1996, $150,000,000 for each of the fiscal 
years 1997 through 2000, and $175,000,000 for each of the fiscal years 
2001 and 2002.

``SEC. 2732. GRANTS FOR EXPANDING CAPACITY OF INSTITUTIONS.

    ``(a) In General.--The Secretary may make grants to institutions 
described in subsection (b) for the purpose of expanding the 
educational capacities of the institutions through recruiting and 
retaining faculty, curriculum development, and coordinating the 
activities of the institutions regarding education, training, and field 
placements.
    ``(b) Relevant Institutions.--The institutions referred to in 
subsection (a) are public and nonprofit private--
            ``(1) schools of public health;
            ``(2) departments of community and preventive medicine 
        that--
                    ``(A) are within schools of medicine and schools of 
                osteopathic medicine; and
                    ``(B) have established formal arrangements with 
                schools of public health in order to award joint 
                degrees in public health and another health profession; 
                and
            ``(3) schools of nursing or dentistry that have established 
        formal arrangements with schools of public health in order to 
        carry out educational programs in public health at the schools 
        of nursing or dentistry, respectively.
    ``(c) Requirements Regarding Curriculum Development.--A funding 
agreement for a grant under subsection (a) for an institution is that, 
to the extent determined to be appropriate by the Secretary, the 
curriculum of institution will include the following:
            ``(1) Subject to subsection (d)(1), part-time nondegree 
        programs for public health professionals who need further 
        training in fields of public health.
            ``(2) With respect to the program of community health 
        advisors established in part 5 of subtitle F, a program to 
        train individuals to serve as supervisors under such part 
        (including training and evaluating the community health 
        advisors), which program is carried out in collaboration with 
        local public health departments and health education and 
        training centers.
            ``(3) A program under which the institution collaborates 
        with health departments and elementary and secondary schools to 
        develop a health education curriculum for use in the program 
        established under subtitle B of title I of the Public Health 
        Improvement Act of 1964.
    ``(d) Additional Requirements.--Funding agreements for a grant 
under subsection (a) for an institution are as follows:
            ``(1) In developing the curriculum under the grant, the 
        institution will consult with the health departments in the 
        State involved, and will follow the relevant priorities of such 
        departments.
            ``(2) The institution will, as appropriate in the 
        determination of the Secretary, coordinate the activities of 
        the institution under the grant with relevant activities of the 
        Health Resources and Services Administration and the Centers 
        for Disease Control and Prevention.

``SEC. 2733. COORDINATION OF GRANT ACTIVITIES WITH NATIONAL PRIORITIES.

    ``The Secretary shall--
            ``(1) determine the needs of the United States regarding 
        the education and geographic distribution of public health 
        professionals;
            ``(2) determine priorities among such needs; and
            ``(3) in making grants under section 2732, ensure that the 
        curricula developed under such section, and the expertise of 
        the faculty recruited and retained under such section, are 
        consistent with such priorities.

``SEC. 2734. CERTAIN REQUIREMENTS FOR GRANTS.

    ``For fiscal year 1997 and subsequent fiscal years, the Secretary 
may make a grant under section 2732 only if the institution involved is 
in compliance with the following:
            ``(1) The institution has coordinated the activities of the 
        school or institution with relevant activities of the Health 
        Resources and Services Administration and the Centers for 
        Disease Control and Prevention.
            ``(2) A significant number of the faculty of the 
        institution has served as practitioners in public health.
            ``(3) The institution has consulted with public health 
        departments and public hospital systems in the State involved 
        in order to develop a curriculum that reflects the needs and 
        priorities of the State regarding the public health.
            ``(4) The institution has coordinated the activities of the 
        institution with the activities of the health departments and 
        of community groups.
            ``(5) The institution carries out a program for part-time 
        students to receive training in fields of public health.
            ``(6) Not less than 60 percent of the graduates of the 
        school or institution are in public health positions determined 
        by the Secretary to be consistent with the needs of the United 
        States regarding such professionals.

           ``PART 3--EXPANSION OF COMPETENCY IN PUBLIC HEALTH

``SEC. 2736. AUTHORIZATIONS OF APPROPRIATIONS FROM FUND.

    ``For the purpose of carrying out this section, there is authorized 
to be appropriated from the Fund $60,000,000 for each of the fiscal 
years 1995 through 2002.

``SEC. 2737. GRANTS TO STATES.

    ``(a) States Lacking Adequate Training Programs.--
            ``(1) In general.--The Secretary may make grants to States 
        in which there is one or no program of training in a field of 
        public health but in which there are 1 or more schools of 
        medicine, osteopathic medicine, nursing, dentistry, social 
        work, pharmacy, or health administration. A funding agreement 
        for such a grant is that the purpose of the grant is for the 
        State involved to assist 1 or more of such schools in 
        developing and integrating public health curricula for the 
        schools.
            ``(2) Special considerations in making grants.--In making 
        grants under paragraph (1), the Secretary shall give special 
        consideration to States that agree to consult with 1 or more 
        schools of public health in carrying out the purpose described 
        in such subsection.
    ``(b) States With Nonaccredited Schools.--The Secretary may make 
grants to States in which there are 1 or more nonaccredited schools of 
public health. A funding agreement for such a grant is that the purpose 
of the grant is for the State involved to assist 1 or more of such 
schools in improving the schools.
    ``(c) Amount of Grant; Limitation Regarding Individual Educational 
Entities.--
            ``(1) Amount.--The amount of a grant under this section to 
        a State may not exceed $6,000,000.
            ``(2) Limitation.--A funding agreement for a grant under 
        this section for a State is that, with respect to the school 
        involved, the State will not provide more than 2 years of 
        assistance to the school from grants under this section.

 ``PART 4--GENERAL PROVISIONS REGARDING EDUCATION AND TRAINING PROGRAMS

``SEC. 2740. UNDERREPRESENTED MINORITIES REGARDING FIELDS OF PUBLIC 
              HEALTH.

    ``In providing for the education and training of individuals in a 
field of public health through the programs of this subtitle, the 
Secretary shall give special consideration to individuals who are 
members of a racial or ethnic minority group that is underrepresented 
in the field.

``SEC. 2740A. COORDINATION OF PROGRAMS.

    ``The Secretary shall ensure that activities under each program of 
this subtitle are coordinated with activities under each other such 
program, including activities regarding the number and variety of 
public health professionals educated or trained pursuant to this 
subtitle.

             ``Subtitle D--Regional Poison Control Centers

``SEC. 2741. AUTHORIZATIONS OF APPROPRIATIONS FROM FUND.

    ``For the purpose of carrying out this subtitle, there is 
authorized to be appropriated from the Fund $50,000,000 for each of the 
fiscal years 1995 through 1997.

``SEC. 2742. GRANTS FOR REGIONAL CENTERS.

    ``(a) In General.--The Secretary may make grants to public and 
nonprofit private entities for centers to carry out activities 
regarding--
            ``(1) the prevention and treatment of poisoning; and
            ``(2) such other activities regarding the control of 
        poisons as the Secretary determines to be appropriate.
    ``(b) Regional Considerations.--In making grants under subsection 
(a), the Secretary shall determine the need in each of the principal 
geographic regions of the United States for a center under such 
subsection, and shall make the grants according to priorities 
established by the Secretary on the basis of the extent of such need in 
each of the regions. In carrying out the preceding sentence, the 
Secretary shall ensure that no two centers receive grants for the same 
geographic service area.
    ``(c) Matching Funds.--
            ``(1) In general.--With respect to the costs of an entity 
        in providing for centers under subsection (a), the Secretary 
        may make a grant under such subsection only if the State in 
        which the center is to operate, or other public entities in the 
        State, agree to make available (directly or through donations 
        from public or private entities) non-Federal contributions 
        toward such costs in an amount determined by the Secretary.
            ``(2) Determination of amount contributed.--Non-Federal 
        contributions required under paragraph (1) may be in cash or in 
        kind, fairly evaluated, including plant, equipment, or 
        services. Amounts provided by the Federal Government, or 
        services assisted or subsidized to any significant extent by 
        the Federal Government, may not be included in determining the 
        amount of such non-Federal contributions.

``SEC. 2743. REQUIREMENTS REGARDING CERTIFICATION.

    ``(a) In General.--Subject to subsection (b), the Secretary may 
make a grant under section 2742 only if the center involved has been 
certified by a professional organization in the field of poison 
control, and the Secretary has approved the organization as having in 
effect standards for certification that reasonably provide for the 
protection of the public health with respect to poisoning. In carrying 
out the preceding sentence, the Secretary shall consider the standards 
established by the American Association of Poison Control Centers.
    ``(b) Temporary Waiver.--The Secretary may waive the requirement of 
subsection (a) for a center for a period not exceeding 1 year.

``SEC. 2744. GENERAL PROVISIONS.

    ``(a) Duration of Grant.--The period during which payments are made 
under a grant under section 2742 may not exceed 3 years. The provision 
of such payments is subject to annual approval by the Secretary of the 
payments and subject to the availability of appropriations for the 
fiscal year involved to make the payments. The preceding sentence may 
not be construed as establishing a limitation on the number of such 
grants that may be made to an entity.
    ``(b) Study Regarding Need for Centers.--
            ``(1) In general.--The Secretary shall conduct a study of 
        each of the centers for which a grant under section 2742 has 
        been provided. The purpose of the study shall be to determine 
        the effectiveness of the centers in carrying out the activities 
        described in such section and the extent to which the 
        activities have been carried out in a cost-effective manner.
            ``(2) Alternatives to centers.--In carrying out the study 
        under paragraph (1), the Secretary shall determine the extent 
        to which the activities described in section 2742 can be 
        effectively carried out through means other than centers under 
        such section. The alternative means considered by the Secretary 
        under the preceding sentence shall include the alternative of 
        requiring public and private health plans to carry out such 
        activities.
            ``(3) Date certain for completion.--Not later than November 
        1, 1996, the Secretary shall submit to the Congress a report 
        describing the findings made in the study under paragraph (1).
            ``(4) Notice to centers.--Not later than February 1, 1997, 
        the Secretary shall notify each grantee under section 2742 
        whether the Secretary considers the continued operation of the 
        center involved to be necessary in meeting the needs of the 
        geographic region involved for the activities described in such 
        section.

              ``Subtitle E--School-Related Health Services

              ``PART 1--PROJECTS FOR PROVISION OF SERVICES

           ``Subpart A--Development and Operation of Projects

``SEC. 2746. AUTHORIZATIONS OF APPROPRIATIONS FROM FUND.

    ``For the purpose of carrying out this part, there are authorized 
to be appropriated from the Fund $100,000,000 for fiscal year 1996, 
$275,000,000 for fiscal year 1997, $350,000,000 for fiscal year 1998, 
and $400,000,000 for fiscal year 1999, $450,000,000 for each of the 
fiscal years 2000 through 2002.

``SEC. 2747. ELIGIBILITY FOR DEVELOPMENT AND OPERATION GRANTS.

    ``(a) In General.--Entities eligible to apply for and receive 
grants under section 2749 or 2750 are the following:
            ``(1) State health agencies that apply on behalf of local 
        community partnerships for communities in need of health 
        services within the State.
            ``(2) Local community partnerships in States in which 
        health agencies have not applied.
    ``(b) Local Community Partnerships.--
            ``(1) In general.--A local community partnership under 
        subsection (a)(2) is an entity that, at a minimum, includes--
                    ``(A) a local health care provider with experience 
                in delivering services to pre-adolescents and 
                adolescents;
                    ``(B) one or more local public schools; and
                    ``(C) at least one community based organization 
                located in the community to be served that has a 
                history of providing services to at-risk youth in the 
                community.
            ``(2) Participation.--A partnership described in paragraph 
        (1) shall, to the maximum extent feasible, involve broad based 
        community participation from parents and youth to be served, 
        health and social service providers (including regional 
        alliance health plans and corporate alliance health plans in 
        which families in the community are enrolled), teachers and 
        other public school and school board personnel, youth 
        development and service organizations, and interested business 
        leaders. Such participation may be evidenced through an 
        expanded partnership, or an advisory board to such partnership.

``SEC. 2748. PREFERENCES.

    ``(a) In General.--In making grants under sections 2749 and 2750, 
the Secretary shall give preference to applicants whose communities to 
be served show the most substantial level of need for such services 
among individuals who are between the ages of 10 and 19 (inclusive), as 
measured by indicators of community health including the following:
            ``(1) High levels of poverty.
            ``(2) The presence of a medically underserved area or 
        population (as defined under section 330(a)).
            ``(3) A health professional shortage area, as designated 
        under section 332.
            ``(4) High rates of indicators of health risk among 
        children and youth, including a high proportion of children 
        receiving services through the Individuals with Disabilities 
        Education Act; adolescent pregnancy, sexually transmitted 
        disease (including infection with the human immunodeficiency 
        virus), preventable disease, communicable disease, intentional 
        and unintentional injuries among children and youth (including 
        motor vehicle injuries); interpersonal, community, and gang 
        violence; rape; youth unemployment; juvenile justice 
        involvement; and high rates of drug and alcohol exposure.
    ``(b) Linkage to Qualified Community Health Groups.--In making 
grants under sections 2749 and 2750, the Secretary shall give 
preference to applicants that demonstrate a linkage to qualified 
community health groups (as defined in section 2763(a)).

``SEC. 2749. GRANTS FOR DEVELOPMENT OF PROJECTS.

    ``(a) In General.--The Secretary may make grants to State health 
agencies or to local community partnerships to develop school health 
service sites. The locations at which such sites may be developed 
include any public or nonprofit private school.
    ``(b) Use of Funds.--A project for which a grant may be made under 
subsection (a) may include but not be limited to the cost of the 
following:
            ``(1) Planning for the provision of school health services.
            ``(2) Recruitment, compensation, and training of health and 
        administrative staff.
            ``(3) The development of agreements with regional and 
        corporate alliance health plans and the acquisition and 
        development of equipment and information services necessary to 
        support information exchange between school health service 
        sites and health plans, health providers, and other entities 
        authorized to collect information under this Act.
            ``(4) In the case of communities described in subsection 
        (d)(2)(B), funds to aid in the establishment of local community 
        partnerships.
            ``(5) Other activities necessary to assume operational 
        status.
    ``(c) Application for Grant.--
            ``(1) In general.--Applicants shall submit applications in 
        a form and manner prescribed by the Secretary.
            ``(2) Applications by state health agencies.--
                    ``(A) In the case of applicants that are State 
                health agencies, the application shall contain 
                assurances that the State health agency is applying for 
                funds--
                            ``(i) on behalf of at least one local 
                        community partnership; and
                            ``(ii) on behalf of at least one other 
                        community identified by the State as in need of 
                        the services funded under this subpart but 
                        without a local community partnership.
                    ``(B) In the case of communities identified in 
                applications submitted by State health agencies that do 
                not yet have local community partnerships, the State 
                shall describe the steps that will be taken to aid the 
                community in developing a local community partnership.
                    ``(C) A State applying on behalf of local community 
                partnerships and other communities may retain not more 
                than 10 percent of grants awarded under this subpart 
                for administrative costs.
    ``(d) Contents of Application.--In order to receive a grant under 
this section, an applicant must include in the application the 
following information:
            ``(1) An assessment of the need for school health services 
        in the communities to be served, using the latest available 
        health data and health goals and objectives established by the 
        Secretary.
            ``(2) A description of how the applicant will design the 
        proposed school health services to reach the maximum number of 
        school-aged children and youth at risk for poor health outcome.
            ``(3) An explanation of how the applicant will integrate 
        its services with those of other health and social service 
        programs within the community.
            ``(4) An explanation of how the applicant will link its 
        activities to health plans serving the communities in which the 
        applicant's program is to be located.
            ``(5) A description of outcome measures to be used to 
        evaluate the effectiveness of the program.
            ``(6) A description of a quality assurance program which 
        complies with standards that the Secretary may prescribe.
    ``(e) Number of Grants.--Not more than one planning grant may be 
made to a single applicant. A planning grant may not exceed two years 
in duration.

``SEC. 2750. GRANTS FOR OPERATION OF PROJECTS.

    ``(a) In General.--The Secretary may make grants to State health 
agencies or to local community partnerships for the cost of operating 
school health service sites. The locations at which such sites may be 
operated include any public or nonprofit private school.
    ``(b) Use of Grant.--The costs for which a grant may be made under 
this section include but are not limited to the following:
            ``(1) The cost of furnishing health services that are not 
        covered under title I of this Act or by any other public or 
        private insurer.
            ``(2) The cost of furnishing enabling services, as defined 
        in section 2780(g).
            ``(3) Training, recruitment and compensation of health 
        professionals and other staff.
            ``(4) Outreach services to at-risk youth and to parents.
            ``(5) Linkage of individuals to health plans, community 
        health services and social services.
            ``(6) Other activities deemed necessary by the Secretary.
    ``(c) Application for Grant.--Applicants shall submit applications 
in a form and manner prescribed by the Secretary. In order to receive a 
grant under this section, an applicant must include in the application 
the following information:
            ``(1) A description of the services to be furnished by the 
        applicant.
            ``(2) The amounts and sources of funding that the applicant 
        will expend, including estimates of the amount of payments the 
        applicant will receive from alliance health plans and from 
        other sources.
            ``(3) Such other information as the Secretary determines to 
        be appropriate.
    ``(d) Additional Contents of Application.--In order to receive a 
grant under this section, an applicant must meet the following 
conditions:
            ``(1) The applicant furnishes the following services:
                    ``(A) Diagnosis and treatment of acute illnesses 
                and minor injuries.
                    ``(B) Clinical preventive health services, 
                including health screenings and early detection 
                services.
                    ``(C) Enabling services, as defined in section 
                2780(g).
                    ``(D) Referrals and followups in situations 
                involving illness or injury.
                    ``(E) Health and social services, counseling 
                services, and necessary referrals, including referrals 
                regarding mental health, substance abuse, and 
                interpersonal violence, including rape.
                    ``(F) Such other services as the Secretary 
                determines to be appropriate.
            ``(2) The applicant maintains agreements with health plans 
        offering services in the applicant's service area.
            ``(3) The applicant is a participating provider in the 
        State's program for medical assistance under title XIX of the 
        Social Security Act.
            ``(4) The applicant does not impose charges on students or 
        their families for services (including collection of any cost-
        sharing for services under the comprehensive benefit package 
        that otherwise would be required).
            ``(5) The applicant has reviewed and will periodically 
        review the needs of the population served by the applicant in 
        order to ensure that its services are accessible to the maximum 
        number of school age children and youth in the area, and that, 
        to the maximum extent possible, barriers to access to services 
        of the applicant are removed (including barriers resulting from 
        the area's physical characteristics, its economic, social and 
        cultural grouping, the health care utilization patterns of 
        children and youth, and available transportation).
            ``(6) In the case of an applicant which serves a population 
        that includes a substantial proportion of individuals of 
        limited English speaking ability, the applicant has developed a 
        plan to meet the needs of such population to the extent 
        practicable in the language and cultural context most 
        appropriate to such individuals.
            ``(7) The applicant will provide non-Federal contributions 
        toward the cost of the project in an amount determined by the 
        Secretary.
            ``(8) The applicant will operate a quality assurance 
        program consistent with section 2754(e)(6).
    ``(e) Duration of Grant.--A grant under this section shall be for a 
period determined by the Secretary.
    ``(f) Reports.--A recipient of funding under this section shall 
provide such reports and information as are required in regulations of 
the Secretary.

``SEC. 2751. FEDERAL ADMINISTRATIVE COSTS.

    ``Of the amounts made available under section 2751, the Secretary 
may reserve not more than 5 percent for administrative expenses 
regarding this subpart.

           ``Subpart B--Capital Costs of Developing Projects

``SEC. 2753. LOANS AND LOAN GUARANTEES REGARDING PROJECTS.

    ``(a) In General.--The Secretary may make loans to, and guarantee 
the payment of principal and interest to Federal and non-Federal 
lenders on behalf of, State health agencies and local community 
partnerships for the capital costs of developing projects in accordance 
with subpart A.
    ``(b) Applicability of Certain Provisions.--The provisions of 
subpart A apply to loans and loan guarantees under subsection (a) to 
the same extent and in the same manner as such provisions apply to 
grants under subpart A. Except for any provision inconsistent with the 
purpose described in subsection (a), the provisions of subpart C of 
part 2 of subtitle F apply to loans and loan guarantees under 
subsection (a) to the same extent and in the same manner as such 
provisions apply to loans and loan guarantees under section 2773.

``SEC. 2754. FUNDING.

    ``Amounts available to the Secretary under section 2761 for the 
purpose of carrying out part 2 of subtitle F are, in addition to such 
purpose, available to the Secretary for the purpose of carrying out 
this subpart.

  ``PART 2--SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS REGARDING SCHOOL 
                                 NURSES

``SEC. 2755. AUTHORIZATIONS OF APPROPRIATIONS FROM FUND.

    ``For the purpose of carrying out this part, there is authorized to 
be appropriated from the Fund $10,000,000 for each of the fiscal years 
1995 through 2002.

``SEC. 2755A. SCHOLARSHIP PROGRAM REGARDING UPGRADE IN SKILLS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration and in consultation 
with the Director of the Centers for Disease Control and Prevention, 
shall carry out a program under which the Secretary awards scholarships 
to individuals described in subsection (b) for the purpose of assisting 
the individuals with the costs of attending programs of education in 
professional nursing (exclusive of graduate programs in nursing).
    ``(b) Eligible Individuals.--An individual referred to in 
subsection (a) is any individual meeting the following conditions:
            ``(1) The individual is serving or has served as a school 
        nurse in public or nonprofit private elementary or secondary 
        school, and the individual is not a professional nurse.
            ``(2) The individual is enrolled (or accepted for 
        enrollment) at a program referred to in subsection (a) as a 
        full-time or part-time student.
            ``(3) The individual enters into the contract required 
        pursuant to subsection (d) as a condition of receiving the 
        scholarship (relating to an agreement to provide services as a 
        school nurse).
    ``(c) Applicability of Certain Provisions.--Except as inconsistent 
with this section or section 2755C, the provisions of subpart III of 
part D of title III (relating to the Scholarship and Loan Repayment 
Programs of the National Health Service Corps) apply to an award of a 
scholarship under subsection (a) to the same extent and in the same 
manner as such provisions apply to an award of a scholarship under 
section 338A.

``SEC. 2755B. LOAN REPAYMENT PROGRAM.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration and in consultation 
with the Director of the Centers for Disease Control and Prevention, 
shall carry out a program under which the Federal Government enters 
into agreements to repay all or part of the educational loans of 
individuals meeting the following conditions:
            ``(1) The individual is a professional nurse and meets the 
        applicable legal requirements to serve as a school nurse.
            ``(2) The individual enters into the contract required 
        pursuant to subsection (b) as a condition of the Federal 
        Government repaying such loans (relating to an agreement to 
        provide services as a school nurse).
    ``(b) Applicability of Certain Provisions.--Except as inconsistent 
with this section or section 2755C, the provisions of subpart III of 
part D of title III (relating to the Scholarship and Loan Repayment 
Programs of the National Health Service Corps) apply to an agreement 
regarding repayment under subsection (a) to the same extent and in the 
same manner as such provisions apply to an agreement regarding 
repayment under section 338B.
    ``(c) Amount of Repayments.--For each year for which an individual 
contracts to serve as school nurse pursuant to subsection (b), the 
Secretary may repay not more than $20,000 of the principal and interest 
of the educational loans of the individual.

``SEC. 2755C. SCHOOL-NURSE POSITIONS.

    ``(a) Position Regarding Students With Significant Need for 
Services.--
            ``(1) In general.--With respect to the programs under this 
        part, the obligated service of a program participant pursuant 
        to sections 2755A(d) and 2755B(b) shall be provided through an 
        assignment to a school described in subsection (b) for a 
        position as a school nurse.
            ``(2) Period of service.--For purposes of sections 2755A(d) 
        and 2755B(d), the period of obligated service is the following, 
        as applicable to the program participant involved:
                    ``(A) In the case of scholarships under section 
                2755A for full-time students, the greater of--
                            ``(i) 1 year for each year for which such a 
                        scholarship is provided; or
                            ``(ii) 2 years.
                    ``(B) In the case of scholarships under section 
                2755A for part-time students, a period determined by 
                the Secretary on the basis of the number of hours of 
                education or training received under the scholarship, 
                considering the percentage constituted by the ratio of 
                such number to the number of hours for a full-time 
                student in the program involved.
                    ``(C) In the case of the loan repayments under 
                section 2755B, such period as the Secretary and the 
                participant may agree, except that the period may not 
                be less than 2 years.
    ``(b) Approval of Schools for Assignment of Program Participants.--
The schools referred to in subsection (a) are public or nonprofit 
private elementary or secondary schools whose students include a 
significant number of students with an unmet need for health services 
that are provided by school nurses.
    ``(c) Definitions.--For purposes of this subpart:
            ``(1) The term `professional nurse' has the meaning given 
        such term under title VIII.
            ``(2) The term `program participant' means an individual 
        who enters into a contract pursuant to section 2755A(b)(3) or 
        2755B(a)(2).
            ``(3) The term `school nurse' means a nurse who provides 
        health services on the premises of an elementary or secondary 
        school and meets such criteria as the Secretary may establish.

          ``Subtitle F--Expansion of Access to Health Services

             ``PART 1--COMMUNITY AND MIGRANT HEALTH CENTERS

``SEC. 2756. AUTHORIZATIONS OF APPROPRIATIONS FROM FUND.

    ``(a) In General.--For the purpose of carrying out this part, there 
is authorized to be appropriated from the Fund $100,000,000 for each of 
the fiscal years 1995 through 2000.
    ``(b) Relation to Other Funds.--The authorizations of 
appropriations established in subsection (a) for the purpose described 
in such subsection are in addition to any other authorizations of 
appropriations that are available for such purpose.

``SEC. 2757. GRANTS TO COMMUNITY AND MIGRANT HEALTH CENTERS.

    ``(a) In General.--The Secretary shall make grants in accordance 
with this section to migrant health centers and community health 
centers.
    ``(b) Use of Funds.--
            ``(1) Development, operation, and other purposes regarding 
        centers.--Subject to paragraph (2), grants under subsection (a) 
        to migrant health centers and community health centers may be 
        made only in accordance with the conditions upon which grants 
        are made under sections 329 and 330, respectively.
            ``(2) Required financial reserves.--The Secretary may 
        authorize migrant health centers and community health centers 
        to expend a grant under subsection (a) to establish and 
        maintain financial reserves required for purposes of health 
        plans.
    ``(c) Definitions.--For purposes of this subtitle, the terms 
`migrant health center' and `community health center' have the meanings 
given such terms in sections 329(a)(1) and 330(a), respectively.

    ``PART 2--QUALIFIED COMMUNITY HEALTH PLANS AND PRACTICE NETWORKS

                     ``Subpart A--Funding; Purposes

``SEC. 2761. AUTHORIZATIONS OF APPROPRIATIONS FROM FUND.

    ``(a) Development of Qualified Community Health Plans and Practice 
Groups.--For the purpose of carrying out this part, there are 
authorized to be appropriated from the Fund $200,000,000 for fiscal 
year 1995, $500,000,000 for fiscal year 1996, $600,000,000 for fiscal 
year 1997, $650,000,000 for fiscal year 1998, $500,000,000 for fiscal 
year 1999, and $200,000,000 for fiscal year 2000.
    ``(b) Relation to Other Funds.--The authorizations of 
appropriations established in subsection (a) are in addition to any 
other authorizations of appropriations that are available for the 
purpose described in such subsection.
    ``(c) Relationship to Program Regarding School-Related Health 
Services.--This section is subject to section 2754.

``SEC. 2762. PURPOSES.

    ``Subject to the provisions of this part, the purposes of this part 
are as follows:
            ``(1) To improve access to health services for urban and 
        rural medically-underserved populations through a program of 
        flexible grants, contracts, and loans.
            ``(2) To facilitate transition to a system in which 
        medically-underserved populations have an adequate choice of 
        community-oriented providers and health plans.
            ``(3) To promote the development of community practice 
        networks and community health plans that integrate health 
        professionals and health care organizations supported through 
        public funding with other providers in medically underserved 
        areas.
            ``(4) To support linkages between providers of health care 
        for medically-underserved populations and health plans.
            ``(5) To expand the capacity of community practice networks 
        and community health plans in underserved areas by increasing 
        the number of practice sites and by renovating and converting 
        substandard inpatient and outpatient facilities.
            ``(6) To link providers in underserved areas with each 
        other and with public and private health care institutions and 
        academic health centers, through information systems and 
        telecommunications.
            ``(7) To support activities that enable medically 
        underserved populations to gain access to the health care 
        system and use it effectively.

   ``Subpart B--Development of Qualified Community Health Plans and 
                           Practice Networks

``SEC. 2763. GRANTS AND CONTRACTS FOR DEVELOPMENT OF PLANS AND 
              NETWORKS.

    ``(a) In General.--The Secretary may make grants to and enter into 
contracts with consortia of public or private health care providers for 
the development of qualified community health plans and qualified 
community practice networks. For purposes of this subtitle, the term 
`qualified community health group' means such a health plan or such a 
practice network.
    ``(b) Qualified Community Health Plans.--For purposes of this 
subtitle, the term `qualified community health plan' means a health 
plan that meets the following conditions:
            ``(1) The health plan is a public or nonprofit private 
        entity whose principal purpose is to provide comprehensive 
        health services, including clinical preventive services, in 1 
        or more medically underserved communities (as defined in 
        section 2799).
            ``(2) Two or more of the categories specified in subsection 
        (d) are represented among the entities providing health 
        services through the health plan.
    ``(c) Qualified Community Practice Networks.--For purposes of this 
subtitle, the term `qualified community practice network' means a 
consortium of health care providers meeting the following conditions:
            ``(1) The consortium is a public or nonprofit private 
        entity whose principal purpose is the purpose described in 
        subsection (b)(1).
            ``(2) The consortium has an agreement with one or more 
        health plans.
            ``(3) The participation of health care providers in the 
        consortium is governed by a written agreement to which each of 
        the participating providers is a party.
            ``(4) Two or more of the categories described in subsection 
        (d) are represented among the entities participating in the 
        consortium.
    ``(d) Relevant Categories of Entities.--For purposes of subsections 
(b)(3) and (c)(4), the categories described in this subsection are the 
following categories of entities:
            ``(1) Physicians, other health professionals, or health 
        care institutions that provide health services in one or more 
        health professional shortage areas or provide such services to 
        a significant number of individuals who are members of a 
        medically underserved population, and that do not provide 
        health services under any of the programs specified in 
        paragraphs (2) through (7) or as employees of public entities.
            ``(2) Entities providing health services under grants under 
        sections 329 and 330.
            ``(3) Entities providing health services under grants under 
        sections 340 and 340A.
            ``(4) Entities providing health services under grants under 
        section 1001 or title XXVI.
            ``(5) Entities providing health services under title V of 
        the Social Security Act.
            ``(6) Entities providing health services through rural 
        health clinics and other federally qualified health centers.
            ``(7) Entities providing health services in urban areas 
        through programs under title V of the Indian Health Care 
        Improvement Act, and entities providing outpatient health 
        services through programs under the Indian Self-Determination 
        Act.
            ``(8) Programs providing personal health services and 
        operating through State or local public health agencies.
    ``(e) Rule of Construction.--The consortia to which the Secretary 
may make an award of financial assistance under subsection (a) for the 
development of qualified community practice networks include any health 
plan that meets applicable requirements regarding financial solvency 
and professional credentials, without regard to whether the health plan 
is a qualified health plan.
    ``(f) Service Area.--In making an award of financial assistance 
under subsection (a), the Secretary shall designate the geographic area 
with respect to which the qualified community health group involved is 
to provide health services. A funding agreement for such an award is 
that the qualified community health group involved will provide such 
services in the area so designated.
    ``(g) Definitions.--For purposes of this subtitle:
            ``(1) The term `health professional shortage areas' means 
        health professional shortage areas designated under section 
        332.
            ``(2) The term `medically underserved population' means a 
        medically underserved population designated under section 330.
            ``(3) The term `rural health clinic' has the meaning given 
        such term in section 1861(aa)(2) of the Social Security Act.
            ``(4) The term `federally qualified health centers' has the 
        meaning given such term in section 1861(aa)(4) of the Social 
        Security Act.
            ``(5) The term `service area', with respect to a qualified 
        community health group, means the geographic area designated 
        under subsection (f).
            ``(6) The term `funding agreement', with respect to an 
        award of financial assistance under this section, means that 
        the Secretary may make the award only if the applicant for the 
        award makes the agreement involved.
            ``(7) The term `financial assistance', with respect to 
        awards under subsection (a), means a grant or contract.

``SEC. 2764. PREFERENCES IN MAKING AWARDS OF ASSISTANCE.

    ``In making awards of financial assistance under section 2763, the 
Secretary shall give preference to applicants in accordance with the 
following:
            ``(1) The Secretary shall give preference if 3 or more of 
        the categories described in subsection (d) of such section will 
        be represented in the qualified community health group involved 
        (pursuant to subsection (b)(3) or (c)(4) of such section, as 
        the case may be).
            ``(2) Of applicants receiving preference under paragraph 
        (1), the Secretary shall give a greater degree of preference 
        according to the extent to which a greater number of categories 
        are represented.
            ``(3) Of applicants receiving preference under paragraph 
        (1), the Secretary shall give a greater degree of preference if 
        one of the categories represented is the category described in 
        subsection (d)(1) of such section.

``SEC. 2765. CERTAIN USES OF AWARDS.

    ``(a) In General.--Subject to subsections (b) and (c), the purposes 
for which an award of financial assistance under section 2763 may be 
expended in developing a qualified community health group include the 
following:
            ``(1) Planning such group, including entering into 
        contracts between the recipient of the award and health care 
        providers who are to participate in the group.
            ``(2) Recruitment, compensation, and training of health 
        professionals (including public health professionals) and 
        administrative staff.
            ``(3) Acquisition, expansion, modernization, and conversion 
        of facilities, including for purposes of providing for sites at 
        which health services are to be provided through such group.
            ``(4) Acquisition and development of information systems 
        (exclusive of systems that the Secretary determines are 
        information highways).
            ``(5) Such other expenditures as the Secretary determines 
        to be appropriate.
    ``(b) Priorities and Limitations Regarding Capital Costs.--
            ``(1) Priorities regarding use of funds.--In authorizing 
        recipients of awards under section 2763 to use the awards for 
        capital costs, the Secretary shall give priority to authorizing 
        expenditures for projects for the renovation and modernization 
        of medical facilities necessary to prevent or eliminate safety 
        hazards, avoid noncompliance with licensure or accreditation 
        standards, or projects to replace obsolete facilities.
            ``(2) Limitation.--The Secretary may authorize the use of 
        awards under section 2763 for the construction of new buildings 
        only if the Secretary determines that appropriate facilities 
        are not available through acquiring, modernizing, expanding or 
        converting existing buildings, or that construction of new 
        buildings will cost less.
    ``(c) Twenty-year Obligation Regarding Significant Capital 
Expenditures; Right of Recovery.--
            ``(1) In general.--With respect to a facility for which 
        substantial capital costs are to paid from an award of 
        financial assistance under section 2763, the Secretary may make 
        the award only if the applicant involved agrees that the 
        applicant will be liable to the United States for the amount of 
        the award expended for such costs, together with an amount 
        representing interest, if at any time during the 20-period 
        beginning on the date of completion of the activities involved, 
        the facility--
                    ``(A) ceases to be a facility utilized by a 
                qualified community health group, or by another public 
                or nonprofit private entity that provides health 
                services in one or more health professional shortage 
                areas or that provides such services to a significant 
                number of individuals who are members of a medically 
                underserved population; or
                    ``(B) is sold or transferred to any entity other 
                than an entity that is--
                            ``(i) a qualified community health group or 
                        other entity described in subparagraph (A); and
                            ``(ii) approved by the Secretary as a 
                        purchaser or transferee regarding the facility.
            ``(2) Subordination; waivers.--The Secretary may 
        subordinate or waive the right of recovery under paragraph (1), 
        and any other Federal interest that may be derived by virtue of 
        an award of financial assistance under section 2763 from which 
        substantial capital costs are to be paid, if the Secretary 
        determines that subordination or waiver will further the 
        objectives of this part.

``SEC. 2766. ACCESSIBILITY OF SERVICES.

    ``(a) Services for Certain Individuals.--A funding agreement for an 
award of financial assistance under section 2763 is that the qualified 
community health group involved will ensure that the services of the 
group will be accessible to all individuals in the service area of the 
group, directly or through formal contractual arrangements with its 
participating providers.
    ``(b) Use of Third-Party Payors.--A funding agreement for an award 
of financial assistance under section 2763 is that the qualified 
community health group involved will ensure that the health care 
providers of the group are all approved by the Secretary as providers 
under title XVIII of the Social Security Act and by the appropriate 
State agency as providers under title XIX of the Social Security Act, 
and the applicant has made or will make every reasonable effort to 
collect appropriate reimbursement for its costs in providing health 
services to individuals who are entitled to insurance benefits under 
title XVIII of the Social Security Act, to medical assistance under a 
State plan approved under title XIX of the Social Security Act, or to 
assistance for medical expenses under any other public assistance 
program or private health insurance program.
    ``(c) Schedule of Fees.--A funding agreement for an award of 
financial assistance under section 2763 is that the qualified community 
health group involved will--
            ``(1) prepare a schedule of fees or payments for the 
        provision of health services that is consistent with locally 
        prevailing rates or charges and designed to cover its 
        reasonable costs of operation and has prepared a corresponding 
        schedule of discounts to be applied to the payment of such fees 
        or payments (or payments of cost sharing amounts owed in the 
        case of covered benefits) which discounts are applied on the 
        basis of the patient's ability to pay; and
            ``(2) make every reasonable effort to secure from patients 
        payment in accordance with such schedules, and to collect 
        reimbursement for services to persons entitled to public or 
        private insurance benefits or other medical assistance on the 
        basis of full fees without application of discounts, except 
        that the applicant will ensure that no person is denied service 
        based on the person's inability to pay therefor.
    ``(d) Barriers Within Service Area.--A funding agreement for an 
award of financial assistance under section 2763 is that the qualified 
community health group involved will ensure that the following 
conditions are met:
            ``(1) In the service area of the group, the group will 
        ensure that--
                    ``(A) the services of the group are accessible to 
                all residents; and
                    ``(B) to the maximum extent possible, barriers to 
                access to the services of the group are eliminated, 
                including barriers resulting from the area's physical 
                characteristics, its residential patterns, its 
                economic, social and cultural groupings, and available 
                transportation.
            ``(2) The group will periodically conduct reviews within 
        the service area of the group to determine whether the 
        conditions described in paragraph (1) are being met.
    ``(e) Limited Ability to Speak English Language.--A funding 
agreement for an award of financial assistance under section 2763 is 
that, if the service area of the qualified community health group 
involved includes a substantial number of individuals who have a 
limited ability to speak the English language, the applicant will--
            ``(1) maintain arrangements responsive to the needs of such 
        individuals for providing services to the extent practicable in 
        the language and cultural context most appropriate to such 
        individuals; and
            ``(2) maintain a sufficient number of staff members who are 
        fluent in both English and the languages spoken by such 
        individuals, and will ensure that the responsibilities of the 
        employees include providing guidance and assistance to such 
        individuals and to other staff members of the group.

``SEC. 2767. ADDITIONAL AGREEMENTS.

    ``(a) Required Services.--A funding agreement for an award of 
financial assistance under section 2763 is that the qualified community 
health group involved will provide enabling services (as defined in 
section 2780(g)) and all of the items and services identified by the 
Secretary in rules regarding qualified community health plans and 
practice networks.
    ``(b) Quality Control System.--A funding agreement for an award of 
financial assistance under section 2763 is that the qualified community 
health group involved will maintain a community-oriented, patient 
responsive, quality control system under which the group, in accordance 
with regulations prescribed by the Secretary--
            ``(1) conducts an ongoing quality assurance program for the 
        health services delivered by participating provider entities;
            ``(2) maintains a continuous community health status 
        improvement process that is based on outcomes reporting by the 
        State, including any such reports available pursuant to the 
        Healthy People 2000 Objectives; and
            ``(3) maintains a system for development, compilation, 
        evaluation and reporting of information to the public and to 
        the State and local health departments involved regarding the 
        costs of operation, service utilization patterns, availability, 
        accessibility and acceptability of services, developments in 
        the health status of the populations served, uniform health and 
        clinical performance measures and financial performance of the 
        network or plan.
    ``(c) Use of Existing Resources.--A funding agreement for an award 
of financial assistance under section 2763 is that the applicant will, 
in developing the qualified community health group involved, utilize 
existing resources to the maximum extent practicable.

``SEC. 2768. SUBMISSION OF CERTAIN INFORMATION.

    ``(a) Assessment of Need.--The Secretary may make an award of 
financial assistance under section 2763 only if the applicant involved 
submits to the Secretary an assessment of the need that the medically 
underserved population or populations proposed to be served by the 
applicant have for health services and for enabling services (as 
defined in section 2780(g)).
    ``(b) Description of Intended Expenditures; Related Information.--
The Secretary may make an award of financial assistance under section 
2763 only if the applicant involved submits to the Secretary the 
following information:
            ``(1) A description of how the applicant will design the 
        proposed quality community health plan or practice network 
        (including the service sites involved) for such populations 
        based on the assessment of need.
            ``(2) A description of efforts to secure, within the 
        proposed service area of such health plan or practice network 
        (including the service sites involved), financial and 
        professional assistance and support for the project.
            ``(3) Evidence of significant community involvement in the 
        initiation, development and ongoing operation of the project.

``SEC. 2769. REPORTS; AUDITS.

    ``A funding agreement for an award of financial assistance under 
section 2763 is that the applicant involved will--
            ``(1) provide such reports and information on activities 
        carried out under this section in a manner and form required by 
        the Secretary; and
            ``(2) provide an annual organization-wide audit that meets 
        applicable standards of the Secretary.

``SEC. 2770. APPLICATION FOR ASSISTANCE.

    ``The Secretary may make an award of financial assistance under 
section 2763 only if an application for the award is submitted to the 
Secretary, the application contains each funding agreement described in 
this subpart, the application contains the information required in 
section 2768, and the application is in such form, is made in such 
manner, and contains such agreements, assurances, and information as 
the Secretary determines to be necessary to carry out this subpart.

``SEC. 2771. GENERAL PROVISIONS.

    ``(a) Limitation on Number of Awards.--The Secretary may not make 
more than two awards of financial assistance under section 2763 for the 
same project.
    ``(b) Amount.--The amount of any award of financial assistance 
under section 2763 for any project shall be determined by the 
Secretary.

``Subpart C--Capital Cost of Development of Qualified Community Health 
                      Plans and Practice Networks

``SEC. 2773. LOANS AND LOAN GUARANTEES REGARDING PLANS AND NETWORKS.

    ``(a) In General.--The Secretary may make loans to, and guarantee 
the payment of principal and interest to Federal and non-Federal 
lenders on behalf of, public and private entities for the capital costs 
of developing qualified community health groups (as defined in section 
2763(a)).
    ``(b) Preferences; Accessibility of Services; Certain Other 
Provisions.--The provisions of subpart B apply to loans and loan 
guarantees under subsection (a) to the same extent and in the same 
manner as such provisions apply to awards of grants and contracts under 
section 2763.
    ``(c) Use of Assistance.--
            ``(1) In general.--With respect to the development of 
        qualified community health groups, the capital costs for which 
        loans made pursuant to subsection (a) may be expended are, 
        subject to paragraphs (2) and (3), the following:
                    ``(A) The acquisition, modernization, expansion or 
                construction of facilities, or the conversion of 
                unneeded hospital facilities to facilities that will 
                assure or enhance the provision and accessibility of 
                health care and enabling services to medically 
                underserved populations.
                    ``(B) The purchase of major equipment, including 
                equipment necessary for the support of external and 
                internal information systems.
                    ``(C) The establishment of reserves required for 
                furnishing services on a prepaid basis.
                    ``(D) Such other capital costs as the Secretary may 
                determine are necessary to achieve the objectives of 
                this section.
            ``(2) Priorities regarding use of funds.--In providing 
        loans or loan guarantees under subsection (a) for an entity, 
        the Secretary shall give priority to authorizing the use of 
        amounts for projects for the renovation and modernization of 
        medical facilities necessary to prevent or eliminate safety 
        hazards, avoid noncompliance with licensure or accreditation 
        standards, or projects to replace obsolete facilities.
            ``(3) Limitation.--The Secretary may authorize the use of 
        amounts under subsection (a) for the construction of new 
        buildings only if the Secretary determines that appropriate 
        facilities are not available through acquiring, modernizing, 
        expanding or converting existing buildings, or that 
        construction of new buildings will cost less.
    ``(d) Amount of Assistance.--The principal amount of loans or loan 
guarantees under subsection (a) may, when added to any other assistance 
under this section, cover up to 100 percent of the costs involved.

``SEC. 2774. CERTAIN REQUIREMENTS.

    ``(a) Loans.--
            ``(1) In general.--The Secretary may approve a loan under 
        section 2773 only if--
                    ``(A) the Secretary is reasonably satisfied that 
                the applicant for the project for which the loan would 
                be made will be able to make payments of principal and 
                interest thereon when due; and
                    ``(B) the applicant provides the Secretary with 
                reasonable assurances that there will be available to 
                it such additional funds as may be necessary to 
                complete the project or undertaking with respect to 
                which such loan is requested.
            ``(2) Terms and conditions.--Any loan made under section 
        2773 shall, subject to the Federal Credit Reform Act of 1990, 
        meet such terms and conditions (including provisions for 
        recovery in case of default) as the Secretary, in consultation 
        with the Secretary of the Treasury, determines to be necessary 
        to carry out the purposes of such section while adequately 
        protecting the financial interests of the United States. Terms 
        and conditions for such loans shall include provisions 
        regarding the following:
                    ``(A) Security.
                    ``(B) Maturity date.
                    ``(C) Amount and frequency of installments.
                    ``(D) Rate of interest, which shall be at a rate 
                comparable to the rate of interest prevailing on the 
                date the loan is made.
    ``(b) Loan Guarantees.--The Secretary may not approve a loan 
guarantee under section 2773 unless the Secretary determines that the 
terms, conditions, security (if any), schedule and amount of repayments 
with respect to the loan are sufficient to protect the financial 
interests of the United States and are otherwise reasonable. Such loan 
guarantees shall be subject to such further terms and conditions as the 
Secretary determines, in consultation with the Secretary of the 
Treasury, and subject to the Federal Credit Reform Act of 1990, to be 
necessary to ensure that the purposes of this section will be achieved.
    ``(c) Use of Existing Resources.--The Secretary may provide a loan 
or loan guarantee under section 2773 only if the applicant involved 
agrees that, in developing the qualified community health group 
involved, the applicant will utilize existing resources to the maximum 
extent practicable.

``SEC. 2775. DEFAULTS; RIGHT OF RECOVERY.

    ``(a) Defaults.--
            ``(1) In general.--The Secretary may take such action as 
        may be necessary to prevent a default on loans or loan 
        guarantees under section 2773, including the waiver of 
        regulatory conditions, deferral of loan payments, renegotiation 
        of loans, and the expenditure of funds for technical and 
        consultative assistance, for the temporary payment of the 
        interest and principal on such a loan, and for other purposes.
            ``(2) Foreclosure.--The Secretary may take such action, 
        consistent with State law respecting foreclosure procedures, as 
        the Secretary deems appropriate to protect the interest of the 
        United States in the event of a default on a loan made pursuant 
        to section 2773, including selling real property pledged as 
        security for such a loan or loan guarantee and for a reasonable 
        period of time taking possession of, holding, and using real 
        property pledged as security for such a loan or loan guarantee.
            ``(3) Waivers.--The Secretary may, for good cause, but with 
        due regard to the financial interests of the United States, 
        waive any right of recovery which the Secretary has by reasons 
        of the failure of a borrower to make payments of principal of 
        and interest on a loan made pursuant to section 2773, except 
        that if such loan is sold and guaranteed, any such waiver shall 
        have no effect upon the Secretary's guarantee of timely payment 
        of principal and interest.
    ``(b) Twenty-year Obligation; Right of Recovery.--
            ``(1) In general.--With respect to a facility for which a 
        loan is to be made pursuant to section 2773, the Secretary may 
        provide the loan or loan guarantee only if the applicant 
        involved agrees that the applicant will be liable to the United 
        States for the amount of the loan or loan guarantee, together 
        with an amount representing interest, if at any time during the 
        20-period beginning on the date of completion of the activities 
        involved, the facility--
                    ``(A) ceases to be a facility utilized by a 
                qualified community health group, or by another public 
                or nonprofit private entity that provides health 
                services in one or more health professional shortage 
                areas or that provides such services to a significant 
                number of individuals who are members of a medically 
                underserved population; or
                    ``(B) is sold or transferred to any entity other 
                than an entity that is--
                            ``(i) a qualified community health group or 
                        other entity described in subparagraph (A); and
                            ``(ii) approved by the Secretary as a 
                        purchaser or transferee regarding the facility.
            ``(2) Subordination; waivers.--The Secretary may 
        subordinate or waive the right of recovery under paragraph (1), 
        and any other Federal interest that may be derived by virtue of 
        a loan or loan guarantee under subsection (a), if the Secretary 
        determines that subordination or waiver will further the 
        objectives of this part.

``SEC. 2776. PROVISIONS REGARDING CONSTRUCTION OR EXPANSION OF 
              FACILITIES.

    ``(a) Submission of Information.--In the case of a project for 
construction, conversion, expansion or modernization of a facility, the 
Secretary may provide loans or loan guarantees under section 2773 only 
if the applicant submits to the Secretary the following:
            ``(1) A description of the site.
            ``(2) Plans and specifications which meet requirements 
        prescribed by the Secretary.
            ``(3) Information reasonably demonstrating that title to 
        such site is vested in one or more of the entities filing the 
        application (unless the agreement described in subsection 
        (b)(1) is made).
            ``(4) A specification of the type of assistance being 
        requested under section 2773.
    ``(b) Agreements.--In the case of a project for construction, 
conversion, expansion or modernization of a facility, the Secretary may 
provide loans or loan guarantees under section 2773 only if the 
applicant makes the following agreements:
            ``(1) Title to such site will be vested in one or more of 
        the entities filing the application (unless the assurance 
        described in subsection (a)(3) has been submitted under such 
        subsection).
            ``(2) Adequate financial support will be available for 
        completion of the project and for its maintenance and operation 
        when completed.
            ``(3) All laborers and mechanics employed by contractors or 
        subcontractors in the performance of work on a project will be 
        paid wages at rates not less than those prevailing on similar 
        construction in the locality as determined by the Secretary of 
        Labor in accordance with the Act of March 3, 1931 (40 U.S.C. 
        276a et seq; commonly known as the Davis-Bacon Act), and the 
        Secretary of Labor shall have with respect to such labor 
        standards the authority and functions set forth in 
        Reorganization Plan Numbered 14 of 1950 (15 FR 3176; 5 U.S.C. 
        Appendix) and section 276c of title 40.
            ``(4) The facility will be made available to all persons 
        seeking service regardless of their ability to pay.

``SEC. 2777. APPLICATION FOR ASSISTANCE.

    ``The Secretary may provide loans or loan guarantees under section 
2773 only if an application for such assistance is submitted to the 
Secretary, the application contains each agreement described in this 
subpart, the application contains the information required in section 
2781(a), and the application is in such form, is made in such manner, 
and contains such agreements, assurances, and information as the 
Secretary determines to be necessary to carry out this subpart.

``SEC. 2778. ADMINISTRATION OF PROGRAMS.

    ``This subpart, and any other program of the Secretary that 
provides loans or loan guarantees, shall be carried out by a 
centralized loan unit established within the Department of Health and 
Human Services.

                      ``PART 3--ENABLING SERVICES

``SEC. 2779. AUTHORIZATIONS OF APPROPRIATIONS FROM FUND.

    ``(a) Enabling Services.--For the purpose of carrying out this 
part, there are authorized to be appropriated from the Fund 
$200,000,000 for each of the fiscal year 1996 through 1999, and 
$100,000,000 for fiscal year 2000.
    ``(b) Relation to Other Funds.--The authorizations of 
appropriations established in subsection (a) are in addition to any 
other authorizations of appropriations that are available for the 
purpose described in such subsection.

``SEC. 2780. GRANTS AND CONTRACTS FOR ENABLING SERVICES.

    ``(a) In General.--
            ``(1) Grants and contracts.--The Secretary may make grants 
        to and enter into contracts with entities described in 
        paragraph (2) to assist such entities in providing the services 
        described in subsection (b) for the purpose of increasing the 
        extent to which individuals appropriately utilize health 
        services that are available to the individuals, including 
        health services for which the individuals are eligible under 
        Federal and State programs.
            ``(2) Relevant entities.--For purposes of paragraph (1), 
        the entities described in this paragraph are qualified 
        community health groups (as defined in section 2763(a)), and 
        other public or nonprofit private entities, that--
                    ``(A) provide health services in one or more health 
                professional shortage areas or that provide such 
                services to a significant number of individuals who are 
                members of a medically underserved population; and
                    ``(B) are experienced in providing services to 
                increase the extent to which individuals appropriately 
                utilize health services that are available to the 
                individuals.
    ``(b) Enabling Services.--The services referred to in subsection 
(a)(1) are transportation, community and patient outreach, patient 
education, translation services, and such other services as the 
Secretary determines to be appropriate in carrying out the purpose 
described in such subsection.
    ``(c) Certain Requirements Regarding Project Area.--The Secretary 
may make an award of a grant or contract under subsection (a) only if 
the applicant involved--
            ``(1) submits to the Secretary--
                    ``(A) information demonstrating that the medically 
                underserved populations in the community to be served 
                under the award have a need for enabling services; and
                    ``(B) a proposed budget for providing such 
                services; and
            ``(2) the applicant for the award agrees that the residents 
        of the community will be significantly involved in the project 
        carried out with the award.
    ``(d) Imposition of Fees.--The Secretary may make an award of a 
grant or contract under subsection (a) only if the applicant involved 
agrees that, in the project carried out under such subsection, enabling 
services will be provided without charge to the recipients of the 
services.
    ``(e) Use of Existing Resources.--The Secretary may make an award 
of a grant or contract under subsection (a) only if the applicant 
involved agrees that, in carrying out the project under such 
subsection, the applicant will utilize existing resources to the 
maximum extent practicable.
    ``(f) Application for Awards of Assistance.--The Secretary may make 
an award of a grant or contract under subsection (a) only if an 
application for the award is submitted to the Secretary, the 
application contains each agreement described in this subpart, the 
application contains the information required in subsection (d)(1), and 
the application is in such form, is made in such manner, and contains 
such agreements, assurances, and information as the Secretary 
determines to be necessary to carry out this subpart.
    ``(g) Definition.--For purposes of this section, the term `enabling 
services' means services described in subsection (b) that are provided 
for the purpose described in subsection (a)(1).

                ``PART 4--NATIONAL HEALTH SERVICE CORPS

``SEC. 2781. AUTHORIZATIONS OF APPROPRIATIONS FROM FUND.

    ``(a) Additional Funding; General Corps Program; Allocations 
Regarding Nurses.--For the purpose of carrying out subpart II of part D 
of title III, and for the purpose of carrying out subsection (c), there 
are authorized to be appropriated from the Fund $50,000,000 for fiscal 
year 1995, $100,000,000 for fiscal year 1996, and $200,000,000 for each 
of the fiscal years 1997 through 2000.
    ``(b) Relation to Other Funds.--The authorizations of 
appropriations established in subsection (a) are in addition to any 
other authorizations of appropriations that are available for the 
purpose described in such subsection.
    ``(c) Allocation for Participation of Nurses in Scholarship and 
Loan Repayment Programs.--Of the amounts appropriated under subsection 
(a), the Secretary shall reserve such amounts as may be necessary to 
ensure that, of the aggregate number of individuals who are 
participants in the Scholarship Program under section 338A, or in the 
Loan Repayment Program under section 338B, the total number who are 
being educated as nurses or are serving as nurses, respectively, is 
increased to 30 percent.
    ``(d) Availability of Funds.--An appropriation under this section 
for any fiscal year may be made at any time before that fiscal year and 
may be included in an Act making an appropriation under an 
authorization under subsection (a) for another fiscal year; but no 
funds may be made available from any appropriation under this section 
for obligation under sections 331 through 335, section 336A, and 
section 337 before the fiscal year involved.

       ``PART 5--SATELLITE CLINICS REGARDING PRIMARY HEALTH CARE

``SEC. 2783. AUTHORIZATION OF APPROPRIATIONS FORM FUND.

    ``For the purpose of carrying out this part, there is authorized to 
be appropriated from the Fund $50,000,000 for each of the fiscal years 
1995 through 2000.

``SEC. 2783A. GRANTS TO STATES FOR DEVELOPMENT AND OPERATION OF 
              SATELLITE CLINICS.

    ``(a) In General.--With respect to outpatient health centers that 
are providers of comprehensive health services, the Secretary may make 
grants to States for the purpose of assisting such centers in 
developing or operating facilities that--
            ``(1) provide clinical preventive services, treatment of 
        minor illnesses and injuries, family planning services, and 
        referrals for health services, mental health services, and 
        health-related social services; and
            ``(2) are located at a distance from the center sufficient 
        to increase the extent to which individuals in the geographic 
        area involved have access to the services specified in 
        paragraph (1).
    ``(b) Certain Requirements.--The Secretary may make a grant under 
subsection (a) only if the State agrees that the health facility for 
which the grant is made, once in operation, will meet the following 
conditions:
            ``(1) The clinical preventive services provided by the 
        facility will include routine preventive services, including 
        family planning services, for pregnant and postpartum women and 
        for children, including health screenings and immunizations.
            ``(2) The principal providers of health services at the 
        facility, and the principal managers of the facility, will be 
        nurse practitioners or nurse clinicians, subject to applicable 
        law.
            ``(3) The outpatient health center operating the facility 
        will serve as a referral center for physician services and will 
        provide for the ongoing monitoring of the activities of the 
        facility.
    ``(c) Matching Funds.--The Secretary may make a grant under 
subsection (a) only if the State involved agrees to make non-Federal 
contributions toward the costs of developing and operating the health 
facilities involved.
    ``(d) Application for Grant.--The Secretary may make a grant under 
subsection (a) only if an application for the grant is submitted to the 
Secretary and the application is in such form, is made in such manner, 
and contains such agreements, assurances, and information as the 
Secretary determines to be necessary to carry out this part.
    ``(e) Limitation on Amount of Assistance Per Facility.--With 
respect to a health facility for which one or more grants under 
subsection (a) are made, the Secretary may not provide more than an 
aggregate $250,000 for the development and operation of the facility.

                  ``PART 6--COMMUNITY HEALTH ADVISORS

``SEC. 2784. AUTHORIZATION OF APPROPRIATIONS FORM FUND.

    ``For the purpose of carrying out this part, there is authorized to 
be appropriated from the Fund $100,000,000 for fiscal year 1995, 
$125,000,000 for fiscal year 1996, $150,000,000 for fiscal year 1997, 
$175,000,000 for fiscal year 1998, $175,000,000 for fiscal year 1999, 
and $175,000,000 for fiscal year 2000.

``SEC. 2785. FORMULA GRANTS REGARDING COMMUNITY HEALTH ADVISOR 
              PROGRAMS.

    ``(a) Formula Grants.--
            ``(1) In general.--In the case of each State (or entity 
        designated by a State under subsection (b)) that submits to the 
        Secretary an application in accordance with section 2788 for a 
        fiscal year, the Secretary of Health and Human Services, acting 
        through the Director of the Centers for Disease Control and 
        Prevention and in coordination with the heads of the agencies 
        specified in paragraph (2), shall make an award of financial 
        assistance to the State or entity for the development and 
        operation of community health advisor programs under section 
        2786(b). The award shall consist of the allotment determined 
        under section 2789 with respect to the State, subject to 
        section 2794.
            ``(2) Coordination with other agencies.--The agencies 
        referred to in paragraph (1) regarding coordination are the 
        Health Resources and Services Administration, the National 
        Institutes of Health, and the Substance Abuse and Mental Health 
        Services Administration.
    ``(b) Designated Entities.--With respect to the State involved, an 
entity other than the State may receive an award under subsection (a) 
only if the entity--
            ``(1) is a public or nonprofit private academic 
        organization (or other public or nonprofit private entity); and
            ``(2) has been designated by the State to carry out the 
        purpose described in such subsection in the State and to 
        receive amounts under such subsection in lieu of the State.
    ``(c) Role of State Agency for Public Health.--A funding agreement 
for an award under subsection (a) is that--
            ``(1) if the applicant is a State, the award will be 
        administered by the State agency with the principal 
        responsibility for carrying out public health programs; and
            ``(2) if the applicant is an entity designated under 
        subsection (b), the award will be administered in consultation 
        with such State agency.
    ``(d) Statewide Responsibilities; Limitation on Expenditures.--
            ``(1) Statewide responsibilities.--A funding agreement for 
        an award under subsection (a) is that the applicant involved 
        will--
                    ``(A) operate a clearinghouse to maintain and 
                disseminate information on community health advisor 
                programs (and similar programs) in the State, including 
                information on developing and operating such programs, 
                on training individuals to participate in the programs, 
                and on evaluation of the programs;
                    ``(B) collaborate with schools of public health to 
                provide to community health advisor programs in the 
                State technical assistance in training and supervising 
                community health advisors under section 2787(g)(1); and
                    ``(C) coordinate the activities carried out in the 
                State under the award, including coordination between 
                the various community health advisor programs and 
                coordination between such programs and related 
                activities of the State and of other public or private 
                entities.
            ``(2) Limitation.--A funding agreement for an award under 
        subsection (a) is that the applicant involved will not expend 
        more than 15 percent of the award in the aggregate for carrying 
        out paragraph (1) and for the expenses of administering the 
        award with respect to the State involved, including the process 
        of receiving payments from the Secretary under the award, 
        allocating the payments among the entities that are to develop 
        and operate the community health advisor programs involved, and 
        monitoring compliance with the funding agreements made under 
        this subtitle by the applicant.

``SEC. 2786. REQUIREMENTS REGARDING COMMUNITY HEALTH ADVISOR PROGRAMS.

    ``(a) Purpose of Award; Healthy People 2000 Objectives.--
            ``(1) In general.--Subject to paragraph (2), a funding 
        agreement for an award under section 2785 for an applicant is 
        that the purpose of the award is, through community health 
        advisor programs under subsection (b), to assist the State 
        involved in attaining the Healthy People 2000 Objectives.
            ``(2) Authority regarding selection of priority 
        objectives.--With respect to compliance with the agreement made 
        under paragraph (1), an applicant receiving an award under 
        section 2785 may, from among the various Healthy People 2000 
        Objectives, select one or more Objectives to be given priority 
        in the operation of a community health advisor program of the 
        applicant, subject to the applicant selecting such priorities 
        in consultation with the entity that is to carry out the 
        program and the local health department involved.
    ``(b) Requirements for Programs.--
            ``(1) In general.--A funding agreement for an award under 
        section 2785 for an applicant is that, in expending the award, 
        the purpose described in subsection (a)(1) will be carried out 
        in accordance with the following:
                    ``(A) For each community for which the purpose is 
                to be carried out, the applicant will establish a 
                program in accordance with this subsection.
                    ``(B) The program will be carried out in a 
                community only if the applicant has, under section 
                2787(a), identified the community as having a 
                significant need for the program.
                    ``(C) The program will be operated by a public or 
                nonprofit private entity with experience in providing 
                health or health-related social services to individuals 
                who are underserved with respect to such services.
                    ``(D) The services of the program, as specified in 
                paragraph (2), will be provided principally by 
                community health advisors (as defined in subsection 
                (d)).
            ``(2) Authorized program services.--For purposes of 
        paragraph (1)(D), the services specified in this paragraph for 
        a program are as follows:
                    ``(A) The program will collaborate with health care 
                providers and related entities in order to facilitate 
                the provision of health services and health-related 
                social services (including collaborating with local 
                health departments, community health centers, public 
                hospital systems, migrant health centers, rural health 
                clinics, hospitals, physicians and nurses, providers of 
                health education, pre-school facilities for children, 
                elementary and secondary schools, and providers of 
                social services).
                    ``(B) The program will provide public education on 
                health promotion and on the prevention of diseases, 
                illnesses, injuries, and disabilities, and will 
                facilitate the appropriate use of available health 
                services and health-related social services.
                    ``(C) The program will provide health-related 
                counseling.
                    ``(D) The program will provide referrals for 
                available health services and health-related social 
                services.
                    ``(E) For the purpose of increasing the capacity of 
                individuals to utilize health services and health-
                related social services under Federal, State, and local 
                programs, the following conditions will be met:
                            ``(i) The program will assist individuals 
                        in establishing eligibility under the programs 
                        and in receiving the services or other benefits 
                        of the programs.
                            ``(ii) The program will provide such other 
                        services as the Secretary determines to be 
                        appropriate, which services may include (but 
                        are not limited to) transportation and 
                        translation services.
                    ``(F) The program will provide outreach services to 
                inform the community of the availability of the 
                services of the program.
    ``(c) Priority for Medically Underserved Communities.--A funding 
agreement for an award under section 2785 is that the applicant 
involved will give priority to developing and operating community 
health advisor programs for medically underserved communities.
    ``(d) Definition of Community Health Advisor.--For purposes of this 
part, the term `community health advisor' means an individual--
            ``(1) who has demonstrated the capacity to carry out one or 
        more of the authorized program services;
            ``(2) who, for not less than 1 year, has been a resident of 
        the community in which the community health advisor program 
        involved is to be operated; and
            ``(3) is a member of a socioeconomic group to be served by 
        the program.

``SEC. 2787. ADDITIONAL AGREEMENTS.

    ``(a) Identification of Community Needs.--A funding agreement for 
an award under section 2785 is that the applicant involved will--
            ``(1) identify the needs of the community involved for the 
        authorized program services, including the identifying the 
        resources of the community that are available for carrying out 
        the program;
            ``(2) in identifying such needs, consult with members of 
        the community, with individuals and programs that provide 
        health services in the community, and with individuals and 
        programs that provide health-related social services in the 
        community; and
            ``(3) consider such needs in carrying out a community 
        health advisor program for the community.
    ``(b) Matching Funds.--
            ``(1) In general.--With respect to the cost of carrying out 
        a community health advisor program, a funding agreement for an 
        award under section 2785 is that the applicant involved will 
        make available (directly or through donations from public or 
        private entities) non-Federal contributions toward such cost in 
        an amount that is not less than 25 percent of such cost.
            ``(2) Determination of amount contributed.--
                    ``(A) Non-Federal contributions required in 
                paragraph (1) may be in cash or in kind, fairly 
                evaluated, including plant, equipment, or services. 
                Amounts provided by the Federal Government, or services 
                assisted or subsidized to any significant extent by the 
                Federal Government, may not be included in determining 
                the amount of such non-Federal contributions.
                    ``(B) With respect to the State in which the 
                community health advisor program involved is to be 
                carried out, amounts provided by the State in 
                compliance with subsection (c) shall be included in 
                determining the amount of non-Federal contributions 
                under paragraph (1).
    ``(c) Maintenance of Effort.--With respect to the purposes for 
which an award under section 2785 is authorized in this subtitle to be 
expended, the Secretary may make such an award only if the State 
involved agrees to maintain expenditures of non-Federal amounts for 
such purposes at a level that is not less than the level of such 
expenditures maintained by the State for the fiscal year preceding the 
first fiscal year for which such an award is made with respect to the 
State.
    ``(d) Cultural Context of Services.--A funding agreement for an 
award under section 2785 for an applicant is that the services of the 
community health advisor program involved will be provided in the 
language and cultural context most appropriate for the individuals 
served by the program, and that for such purpose the community health 
advisors of the program will include an appropriate number of advisors 
who are fluent in both English and not less than one of the other 
relevant languages.
    ``(e) Number of Programs Per Award; Programs for Urban and Rural 
Areas.--A funding agreement for an award under section 2785 for an 
applicant is that the number of community health advisor programs 
operated in the State with the award will be determined by the 
Secretary, except that (subject to section 2786(b)(1)(B)) such a 
program will be carried out in not less than one urban area of the 
State, and in not less than one rural area of the State.
    ``(f) Ongoing Supervision of Advisors.--A funding agreement for an 
award under section 2785 is that the applicant involved will ensure 
that each community health advisor program operated with the award 
provides for the ongoing supervision of the community health advisors 
of the program, and that the individuals serving as supervisors in the 
program will include 1 or more public health nurses with field 
experience and managerial experience.
    ``(g) Certain Expenditures.--
            ``(1) Training; continuing education.--Funding agreements 
        for an award under section 2785 include the following:
                    ``(A) The applicant involved will ensure that, for 
                each community health advisor program operated with the 
                award, a program is carried out to train community 
                health advisors to provide the authorized program 
                services, including practical experiences in providing 
                services for health promotion and disease prevention.
                    ``(B) The program of training will provide for the 
                continuing education of the community health advisors.
                    ``(C) Not more than 15 percent of the award will be 
                expended for the program of training.
            ``(2) Compensation.--With respect to compliance with the 
        agreements made under this subtitle, the purposes for which an 
        award under section 2785 may be expended include providing 
        compensation for the services of community health advisors.
    ``(h) Reports to Secretary; Assessment of Effectiveness.--Funding 
agreements for an award under section 2785 for an applicant include the 
following:
            ``(1) The applicant will ensure that, for each fiscal year 
        for which a community health advisor program receives amounts 
        from the award, the program will prepare a report describing 
        the activities of the program for such year, including--
                    ``(A) a specification of the number of individuals 
                served by the program;
                    ``(B) a specification of the entities with which 
                the program has collaborated in carrying out the 
                purpose described in section 2786(a)(1); and
                    ``(C) an assessment of the extent of the 
                effectiveness of the program in carrying out such 
                purpose.
            ``(2) Such reports will include such additional information 
        regarding the applicant and the programs as the Secretary may 
        require.
            ``(3) The applicant will prepare the reports as a single 
        document and will submit the document to the Secretary not 
        later than February 1 of the fiscal year following the fiscal 
        year for which the reports were prepared.

``SEC. 2788. APPLICATION FOR ASSISTANCE; STATE PLAN.

    ``For purposes of section 2785, an application is in accordance 
with this section if--
            ``(1) the application is submitted not later than the date 
        specified by the Secretary;
            ``(2) the application contains each funding agreement 
        described in this subtitle;
            ``(3) the application contains a State plan describing the 
        purposes for which the award is to be expended in the State, 
        including a description of the manner in which the applicant 
        will comply with each such funding agreement; and
            ``(4) the application is in such form, is made in such 
        manner, and contains such agreements, assurances, and 
        information as the Secretary determines to be necessary to 
        carry out this subtitle.

``SEC. 2789. DETERMINATION OF AMOUNT OF ALLOTMENT.

    ``(a) In General.--For purposes of section 2785, the allotment 
under this section with respect to a State for a fiscal year is the sum 
of the respective amounts determined for the State under subsection (b) 
and subsection (c).
    ``(b) Amount Relating to Population.--For purposes of subsection 
(a), the amount determined under this subsection is the product of--
            ``(1) an amount equal to 50 percent of the amount 
        appropriated under section 2784 for the fiscal year and 
        available for awards under section 2785; and
            ``(2) the percentage constituted by the ratio of--
                    ``(A) the number of individuals residing in the 
                State involved; to
                    ``(B) the sum of the respective amounts determined 
                for each State under subparagraph (A).
    ``(c) Amount Relating to Poverty Level.--For purposes of subsection 
(a), the amount determined under this subsection is the product of--
            ``(1) the amount determined under subsection (b)(1); and
            ``(2) the percentage constituted by the ratio of--
                    ``(A) the number of individuals residing in the 
                State whose income is at or below an amount equal to 
                200 percent of the official poverty line; to
                    ``(B) the sum of the respective amounts determined 
                for each State under subparagraph (A).

``SEC. 2790. QUALITY ASSURANCE; COST-EFFECTIVENESS.

    ``The Secretary shall establish guidelines for assuring the quality 
of community health advisor programs (including quality in the training 
of community health advisors) and for assuring the cost-effectiveness 
of the programs. A funding agreement for an award under section 2785 is 
that the applicant involved will carry out such programs in accordance 
with the guidelines.

``SEC. 2791. EVALUATIONS; TECHNICAL ASSISTANCE.

    ``(a) Evaluations.--The Secretary shall conduct evaluations of 
community health advisor programs and disseminate information developed 
as result of the evaluations to the States. In conducting such 
evaluations, the Secretary shall determine whether the programs are in 
compliance with the guidelines established under section 2790.
    ``(b) Technical Assistance.--The Secretary may provide technical 
assistance to recipients of awards under section 2785 with respect to 
the planning, development, and operation of community health advisor 
programs.
    ``(c) Grants and Contracts.--The Secretary may carry out this 
section directly or through grants, cooperative agreements, or 
contracts.
    ``(d) Limitation on Expenditures.--Of the amounts appropriated 
under section 2784 for a fiscal year, the Secretary may reserve not 
more than 10 percent for carrying out this section.

``SEC. 2792. RULE OF CONSTRUCTION REGARDING PROGRAMS OF INDIAN HEALTH 
              SERVICE.

    ``This subtitle may not be construed as requiring the Secretary to 
modify or terminate the program carried out by the Director of the 
Indian Health Service and designated by such Director as the Community 
Health Representative Program. The Secretary shall ensure that support 
for such Program is not supplanted by awards under section 2785. In 
communities in which both such Program and a community health advisor 
program are being carried out, the Secretary shall ensure that the 
community health advisor program works in cooperation with, and as a 
complement to, the Community Health Representative Program.

``SEC. 2793. DEFINITIONS.

    ``For purposes of this subtitle:
            ``(1) The term `authorized program services', with respect 
        to a community health advisor program, means the services 
        specified in section 2786(b)(2).
            ``(2) The term `community health advisor' has the meaning 
        given such term in section 2786(d).
            ``(3) The term `community health advisor program' means a 
        program carried out under section 2786(b).
            ``(4) The term `financial assistance', with respect to an 
        award under section 2785, means a grant, cooperative agreement, 
        or a contract.
            ``(5) The term `funding agreement' means an agreement 
        required as a condition of receiving an award under section 
        2785.
            ``(6) The term `official poverty line' means the official 
        poverty line established by the Director of the Office of 
        Management and Budget and revised by the Secretary in 
        accordance with section 673(2) of the Omnibus Budget 
        Reconciliation Act of 1981, which poverty line is applicable 
        the size of the family involved.
            ``(7) The term `State involved', with respect to an 
        applicant for an award under section 2785, means the State in 
        which the applicant is to carry out a community health advisor 
        program.

``SEC. 2794. EFFECT OF INSUFFICIENT APPROPRIATIONS FOR MINIMUM 
              ALLOTMENTS.

    ``(a) In General.--If the amounts made available under section 2784 
for a fiscal year are insufficient for providing each State (or entity 
designated by the State pursuant to section 2785, as the case may be) 
with an award under section 2785 in an amount equal to or greater than 
the amount specified in section 2789(a)(2), the Secretary shall, from 
such amounts as are made available under subsection (a), make such 
awards on a discretionary basis.
    ``(b) Rule of Construction.--For purposes of subsection (a), awards 
under section 2785 are made on a discretionary basis if the Secretary 
determines which States (or entities designated by States pursuant to 
such section, as the case may be) are to receive such awards, subject 
to meeting the requirements of this subtitle for such an award, and the 
Secretary determines the amount of such awards.

                ``PART 7--MENTAL HEALTH; SUBSTANCE ABUSE

``SEC. 2795. AUTHORIZATIONS OF APPROPRIATIONS FROM FUND.

    ``(a) In General.--For the purpose of carrying out this part, there 
are authorized to be appropriated from the Fund $100,000,000 for fiscal 
year 1995, $150,000,000 for fiscal year 1996, $200,000,000 for fiscal 
year 1997, and $250,000,000 for each of the fiscal years 1998 through 
2000.
    ``(b) Allocation Among Programs.--Of the amounts made available 
under subsection (a) for a fiscal year--
            ``(1) the Secretary may reserve for carrying out section 
        2797 such amounts as the Secretary determines to be 
        appropriate; and
            ``(2) the Secretary shall, of the remaining amounts, 
        reserve 50 percent for carrying out subsection (a) of section 
        2796 and 50 percent for carrying out subsection (b) of such 
        section.
    ``(c) Relation to Other Funds.--The authorizations of 
appropriations established in subsection (a) are in addition to any 
other authorizations of appropriations that are available for the 
purpose described in such subsection.

``SEC. 2796. SUPPLEMENTAL FORMULA GRANTS FOR STATES REGARDING 
              ACTIVITIES UNDER PART B OF TITLE XIX.

    ``(a) Mental Health.--
            ``(1) In general.--In the case of any State that submits to 
        the Secretary an application in accordance with subsection (e) 
        for a fiscal year with respect to mental health, the Secretary 
        shall make a grant to the State for the purposes authorized in 
        subsection (c) with respect to mental health. The grant shall 
        consist of the allotment determined under paragraph (2) for the 
        State for such year.
            ``(2) Determination of allotment.--For purposes of 
        paragraph (1), the allotment under this paragraph for a State 
        for a fiscal year shall be determined as follows: With respect 
        to the amount reserved under section 2795(b)(2) for carrying 
        out this subsection, section 1918 shall be applied to such 
        amount to the same extent and in the same manner as section 
        1918 is applied to the amount determined under section 
        1918(a)(2).
    ``(b) Substance Abuse.--
            ``(1) In general.--In the case of any State that submits to 
        the Secretary an application in accordance with subsection (e) 
        for a fiscal year with respect to substance abuse, the 
        Secretary shall make a grant to the State for the purposes 
        authorized in subsection (c) with respect to substance abuse. 
        The grant shall consist of the allotment determined under 
        paragraph (2) for the State for such year.
            ``(2) Determination of allotment.--For purposes of 
        paragraph (1), the allotment under this paragraph for a State 
        for a fiscal year shall be determined as follows: With respect 
        to the amount reserved under section 2795(b)(2) for carrying 
        out this subsection, section 1933 shall be applied to such 
        amount to the same extent and in the same manner as section 
        1933 is applied to the amount determined pursuant to sections 
        1933(a)(1)(B)(i).
    ``(c) Use of Grants.--
            ``(1) In general.--With respect to the expenditure of a 
        grant to a State under subsection (a) or (b), the Secretary, 
        subject to paragraph (3)--
                    ``(A) shall designate as authorized expenditures 
                such of the activities described in paragraph (2) with 
                respect to mental health and substance abuse, 
                respectively, as the Secretary determines to be 
                appropriate; and
                    ``(B) may make the grant only if the State agrees 
                to expend the grant in accordance with the activities 
                so designated.
            ``(2) Description of activities.--The activities referred 
        to in paragraph (1) are (as applicable to the grant involved) 
        the following:
                    ``(A) For the purpose of increasing the access of 
                individuals to services relating to mental health and 
                substance abuse, the following services: 
                Transportation, community and patient outreach, patient 
                education, translation services, and such other 
                services as the Secretary determines to be appropriate 
                regarding such purpose.
                    ``(B) Improving the capacity of State and local 
                service systems to coordinate and monitor mental health 
                and substance abuse services, including improvement of 
                management information systems, and establishment of 
                linkages between public and private providers of mental 
                health and substance abuse services and primary care 
                providers and health plans.
                    ``(C) Providing incentives to integrate public and 
                private systems for the treatment of mental health and 
                substance abuse disorders.
                    ``(D) Any activity for which a grant under section 
                1911 or section 1921 is authorized to be expended.
            ``(3) Reports on integration of services into health care 
        delivery system.--
                    ``(A) The Secretary may make a grant under 
                subsection (a) or (b) for a fiscal year only if the 
                State involved agrees to report to the Secretary for 
                the fiscal year, in accordance with criteria under 
                subparagraph (B), information on--
                            ``(i) any activities carried out by the 
                        State toward integrating the provision of 
                        mental health and substance abuse services in 
                        the State into the general health care delivery 
                        system in the State;
                            ``(ii) the extent to which the activities 
                        have been effective;
                            ``(iii) the difficulties encountered in 
                        carrying out such activities; and
                            ``(iv) the recommendations of the State 
                        regarding such activities.
                    ``(B) The Secretary shall establish criteria for 
                the uniform collecting and reporting of data under 
                subparagraph (A).
                    ``(C) The Secretary shall disseminate to the States 
                the information by the Secretary under subparagraph 
                (A), as appropriate.
                    ``(D) A State may expend a grant under subsection 
                (a) or (b) for the costs of complying with subparagraph 
                (A).
    ``(d) Maintenance of Effort.--
            ``(1) In general.--With respect to the activities for which 
        a grant under subsection (a) or (b) is to be made, the 
        Secretary may make the grant only if the State involved agrees 
        to maintain expenditures of non-Federal amounts for such 
        activities at a level that is not less than the level of such 
        expenditures maintained by the State for the fiscal year 
        preceding the first fiscal year for which the State receives 
        such a grant.
            ``(2) Waiver.--The Secretary may waive all or part of the 
        requirement established for a State under paragraph (1) if--
                    ``(A) the State agrees that the amounts that 
                otherwise would have been subject to such requirement 
                will be expended for the purpose of developing 
                community-based systems of care to promote the eventual 
                integration of the public and private systems for 
                treatment of mental health, or substance abuse, as 
                applicable to the grant;
                    ``(B) the State submits to the Secretary a request 
                for the waiver and a description of the manner in which 
                the State will carry out such purpose; and
                    ``(C) the Secretary approves the waiver.
    ``(e) Application for Grant.--For purposes of subsection (a)(1) and 
(b)(1), an application for a grant under this section regarding mental 
health or substance abuse, respectively, is in accordance with this 
subsection if the State involved submits the application not later than 
the date specified by the Secretary, the application contains each 
applicable agreement described in this section, and the application 
otherwise is in such form, is made in such manner, and contains such 
agreements, assurances, and information as the Secretary determines to 
be necessary to carry out the purpose involved.

``SEC. 2797. CAPITAL COSTS OF DEVELOPMENT OF CERTAIN CENTERS AND 
              CLINICS.

    ``(a) In General.--The Secretary may make loans to, and guarantee 
the payment of principal and interest to Federal and non-Federal 
lenders on behalf of, public and private entities for the capital costs 
to be incurred by the entities in the development of non-acute, 
residential treatment centers and community-based ambulatory clinics.
    ``(b) Priorities Regarding Use of Funds.--In providing loans or 
loan guarantees under subsection (a), the Secretary shall give priority 
to authorizing the use of amounts for projects in health professional 
shortage areas or in geographic area in which there resides a 
significant number of individuals who are members of a medically 
underserved population.
    ``(c) Applicability of Certain Provisions.--The Secretary may 
provide loans or loan guarantees under subsection (a) only if the 
applicant involved agrees that, except to the extent inconsistent with 
the purpose described in subsection (a), subpart C of part 2 applies to 
such assistance to the same extent and in the same manner as such 
subpart applies to loans and loan guarantees under section 2773.

                    ``Subtitle G--General Provisions

``SEC. 2798. REQUIREMENT REGARDING ACCREDITATION OF SCHOOLS, 
              DEPARTMENTS, AND PROGRAMS.

    ``Except as indicated otherwise in this title:
            ``(1) A reference in this title to a school of public 
        health, a school of nursing, or any other entity providing 
        education or training in a health profession (whether a school, 
        department, program, or other entity) is a reference to the 
        entity as defined under section 799 or 853.
            ``(2) If an entity is not defined in either of such 
        sections, the reference in this title to the entity has the 
        meaning provided by the Secretary, except that the Secretary 
        shall require for purposes of this title that the entity be 
        accredited for the provision of the education or training 
        involved.

``SEC. 2799. DEFINITIONS.

    ``(a) In General.--For purposes of this title:
            ``(1) The term `Healthy People 2000 Objectives' means the 
        objectives established by the Secretary toward the goals of 
        increasing the span of healthy life, reducing health 
        disparities among various populations, and providing access to 
        preventive services, which objectives apply to the health 
        status of the population of the United States for the year 
        2000.
            ``(2) The term `medically underserved community' means--
                    ``(A) a community that has a substantial number of 
                individuals who are members of a medically underserved 
                population, as defined in section 330; or
                    ``(B) a community a significant portion of which is 
                a health professional shortage area designated under 
                section 332.''.

           Subtitle B--Comprehensive School Health Education

                       PART 1--GENERAL PROVISIONS

SEC. 111. TABLE OF CONTENTS FOR SUBTITLE.

    The table of contents for this subtitle is as follows:

           Subtitle B--Comprehensive School Health Education

                       Part 1--General Provisions

Sec. 111. Table of contents for subtitle.
Sec. 112. Authorizations of appropriations from Fund.
Sec. 113. Definitions.
                            Part 2--Purposes

Sec. 121. Purposes.
        subpart a--planning grants for state education agencies
Sec. 131. Application for grant.
Sec. 132. Approval of Secretary.
Sec. 133. Amount of grant.
Sec. subpart b--implementation grants for state education agencies
Sec. 141. Application for grant.
Sec. 142. Selection of grantees.
Sec. 143. Amount of grant.
Sec. 144. Authorized activities; limitation on administrative costs.
Sec. 145. Subgrantssubpart c--state and local reports
Sec. 151. State and local reports.
          Part 4--Grants subpart a--eligibilitytional Agencies
Sec. 161subpart b--planning grants for local education agencies
Sec. 171. Application for grant.
Sec. 172. Selection of grantees.
Sec. 173. Amount of grant.
Sec.subpart c--implementation grants for local educational agencies
Sec. 181. Application for grant.
Sec. 182. Selection of grantees.
Sec. 183. Amount of grant.
Sec. 184. Authorized activities.
Sec. 185. Reports.

SEC. 112. AUTHORIZATIONS OF APPROPRIATIONS FROM FUND.

    (a) Funding for School Health Education.--For the purpose of 
carrying out this subtitle, there are authorized to be appropriated 
from the Fund $100,000,000 for fiscal year 1995, $125,000,000 for 
fiscal year 1996, $150,000,000 for fiscal year 1997, $175,000,000 for 
fiscal year 1998, $200,000,000 for fiscal year 1999, and $200,000,000 
for fiscal year 2000.
    (b) Allocations.--Of the amounts appropriated under subsection (a) 
for a fiscal year--
            (1) the Secretary may reserve not more than $13,000,000 for 
        carrying out part 4;
            (2) the Secretary may reserve not more than $5,000,000 to 
        support national leadership activities, such as research and 
        demonstration, evaluation, and training and technical 
        assistance in comprehensive school health education; and
            (3) the Secretary may reserve not more than 5 percent for 
        administrative expenses regarding parts 3 and 4.
    (c) Relation to Other Funds.--The authorizations of appropriations 
established in subsection (a) are in addition to any other 
authorizations of appropriations that are available for the purpose 
described in such subsection.

SEC. 113. DEFINITIONS.

    (a) Comprehensive School Health Education Program.--For purposes of 
this subtitle, the term ``comprehensive school health education 
program'' means a program that addresses locally relevant priorities 
and meets the following conditions:
            (1) The program is sequential, and age and developmentally 
        appropriate.
            (2) The program is provided, in the area served by the 
        program, every year for all students from kindergarten through 
        grade 12.
            (3) The program provides comprehensive health education, 
        including the following components:
                    (A) Community health.
                    (B) Environmental health.
                    (C) Personal health.
                    (D) Family life.
                    (E) Growth and development.
                    (F) Nutritional health.
                    (G) Prevention and control of diseases, 
                disabilities, and genetic disorders.
                    (H) Safety, prevention, and treatment of injuries, 
                including motor vehicle injuries.
                    (I) Substance abuse, including tobacco and alcohol 
                use.
                    (J) Consumer health, including education to ensure 
                that students understand the benefits and appropriate 
                use of medical services, including immunizations and 
                other clinical preventive services.
                    (K) Mental health.
            (4) The program promotes personal responsibility for a 
        healthy lifestyle and provides the knowledge and skills 
        necessary to adopt a healthy lifestyle, including teaching the 
        legal, social, and health consequences of behaviors that pose 
        health risks.
            (5) The program is sensitive to cultural and ethnic issues 
        in the content of instructional materials and approaches.
            (6) The program includes activities that support 
        instruction.
            (7) The program includes activities to promote involvement 
        by parents, families, community organizations, and other 
        appropriate entities.
            (8) The program is coordinated with other Federal, State, 
        and local health education and prevention programs, including 
        such programs under title XXVII of the Public Health Service 
        Act, and with other Federal, State and local education 
        programs, including those carried out under title I of the 
        Elementary and Secondary Education Act of 1965.
            (9) The program focuses on the particular health concerns 
        of the students in the State, school district, or school, as 
        the case may be.
    (b) Other Definitions.--For purposes of this subtitle:
            (1) The term ``local educational agency'' has the meaning 
        given such term in section 1471(12) of the Elementary and 
        Secondary Education Act of 1965.
            (2) The term ``State educational agency'' has the meaning 
        given such term in section 1471(23) of the Elementary and 
        Secondary Education Act of 1965.

                            PART 2--PURPOSES

SEC. 121. PURPOSES.

    Subject to the subsequent provisions of this subtitle, the purposes 
of this subtitle are as follows:
            (1) To support the provision in kindergarten through grade 
        12 of sequential, age-appropriate, comprehensive health 
        education programs that address locally relevant priorities.
            (2) To establish a national framework within which States 
        can create comprehensive school health education programs 
        that--
                    (A) target the health risk behaviors accounting for 
                the majority of the morbidity and mortality among youth 
                and adults, including the following: Tobacco use; 
                alcohol and other drug abuse; sexual behaviors 
                resulting in infection with the human immunodeficiency 
                virus, in other sexually transmitted diseases or in 
                unintended pregnancy; behaviors resulting in 
                intentional and unintentional injuries; dietary 
                patterns resulting in disease; and sedentary 
                lifestyles; and
                    (B) are integrated with plans and programs in the 
                State, if any, under title III of the Goals 2000: 
                Educate America Act and those targeting health 
                promotion and disease prevention goals related to the 
                national health objectives set forth in Healthy People 
                2000.
            (3) To pay the initial costs of planning and establishing 
        Statewide comprehensive school health education programs that 
        will be implemented and maintained with local, State, and other 
        Federal resources.
            (4) To support Federal activities such as research and 
        demonstrations, evaluations, and training and technical 
        assistance regarding comprehensive school health education.
            (5) To motivate youth, especially low-achieving youth, to 
        stay in school, avoid teen pregnancy, and strive for success by 
        providing intensive, high-quality health education programs 
        that include peer-teaching, family, and community involvement.
            (6) To improve the knowledge and skills of children and 
        youth by integrating academic and experiential learning in 
        health education with other elements of a comprehensive school 
        health program.
            (7) To further the National Education Goals set forth in 
        title I of the Goals 2000: Educate America Act and the national 
        health objectives set forth in Healthy People 2000.

               PART 3--GRANTS TO STATE EDUCATION AGENCIES

        Subpart A--Planning Grants for State Education Agencies

SEC. 131. APPLICATION FOR GRANT.

    (a) In General.--Any State educational agency that wishes to 
receive a planning grant under this part shall submit an application to 
the Secretary of Health and Human Services, at such time and in such 
manner as the Secretary may require.
    (b) Application; Joint Development; Contents.--An application under 
subsection (a) shall be jointly developed by the State educational 
agency and the State health agencies of the State involved, and shall 
contain the following:
            (1) An assessment of the State's need for comprehensive 
        school health education, using goals established by the 
        Department of Health and Human Services and the Department of 
        Education and the State's school improvement plan, if any, 
        under title III of Goals 2000: Educate America Act.
            (2) A description of how the State educational agency will 
        collaborate with the State public health agency in the 
        planning, development, and implementation of a comprehensive 
        school health education program in the State, including 
        coordination of existing health education programs and 
        resources.
            (3) A plan to build capacity at the State and local levels 
        to provide staff development and technical assistance to local 
        educational agency and local health agency personnel involved 
        with comprehensive school health education.
            (4) A preliminary plan for evaluating comprehensive school 
        health education activities.
            (5) Information demonstrating that the State has 
        established a State-level advisory council whose membership 
        includes representatives of the State agencies with principal 
        responsibilities for programs regarding health, education, and 
        mental health.
            (6) A timetable and proposed budget for the planning 
        process.
            (7) Such other information and assurances as the Secretary 
        may require.
    (c) Number of Grants.--States may receive one planning grant 
annually and no more than two planning grants may be awarded to any one 
State.

SEC. 132. APPROVAL OF SECRETARY.

    The Secretary may approve the application of a State under section 
131 if the Secretary determines that--
            (1) the application meets the requirements of this part; 
        and
            (2) there is a substantial likelihood that the State will 
        be able to develop and implement a comprehensive school health 
        education plan that complies with the requirements of part 2.

SEC. 133. AMOUNT OF GRANT.

    For any fiscal year, the minimum grant to any State under this part 
is an amount determined by the Secretary to be necessary to enable the 
State to conduct the planning process and the maximum such grant is 
$500,000.

SEC. 134. AUTHORIZED ACTIVITIES.

    A State may use funds received under this part only for the 
following:
            (1) To establish and carry out the State planning process.
            (2) To conduct Statewide or sub-State regional coordination 
        and collaboration activities for local educational agencies, 
        local health agencies, schools of public health, departments of 
        preventive health or community medicine, and other agencies and 
        organizations, as appropriate.
            (3) To conduct activities to build capacity to provide 
        staff development and technical assistance services to local 
        educational agency and local health agency personnel involved 
        with comprehensive school health education.
            (4) To develop student learning objectives and assessment 
        instruments.
            (5) To work with State and local health agencies and State 
        and local educational agencies to reduce barriers to the 
        implementation of comprehensive school health education 
        programs in schools.
            (6) To prepare the plan required to receive an 
        implementation grant under part 2.
            (7) To adopt, validate, and disseminate curriculum models 
        and program strategies, if the Secretary determines that such 
        activities are necessary to achieving the objectives of the 
        State's program.

     Subpart B--Implementation Grants for State Education Agencies

SEC. 141. APPLICATION FOR GRANT.

    (a) In General.--Any State that wishes to receive an implementation 
grant under this part shall submit an application to the Secretary of 
Health and Human Services, at such time, in such manner, and containing 
such information and assurances as the Secretary may require.
    (b) Application and State Plan; Joint Development; Contents.--An 
application under subsection (a) shall be jointly developed by the 
State educational agency and the State health agencies of the State 
involved, and shall include a State plan for comprehensive school 
health education programs (as defined in section 113) that describes 
the following:
            (1) The State's goals and objectives for those programs.
            (2) How the State will allocate funds to local educational 
        agencies in accordance with section 144.
            (3) How the State will coordinate programs under this part 
        with other local, State and Federal health education programs.
            (4) How comprehensive school health education programs will 
        be coordinated with other local, State and Federal education 
        programs, such as programs under title I of the Elementary and 
        Secondary Education Act of 1965, with the State's school 
        improvement plan, if any, under title III of the Goals 2000: 
        Educate America Act, and with any similar programs.
            (5) How the State has worked with State and local education 
        agencies and with State and local health agencies to reduce 
        barriers to implementing comprehensive school health education 
        programs.
            (6) How the State will monitor the implementation and 
        effectiveness of such programs by local educational agencies.
            (7) How the State will build capacity for professional 
        development of health educators and the regional deployment and 
        employment of such educators.
            (8) How the State will provide staff development and 
        technical assistance to local educational agencies.
            (9) The respective roles of the State educational agency, 
        local educational agencies, the State health agency, and the 
        local health agencies in developing and implementing such 
        school health education programs.
            (10) How such school health education programs will be 
        tailored to the extent practicable to be culturally and 
        linguistically sensitive and responsive to the various needs of 
        the students served, including individuals with disabilities, 
        and individuals from disadvantaged backgrounds (including 
        racial and ethnic minorities).
            (11) How the State will evaluate and report on the State's 
        progress toward attaining the goals and objectives described in 
        paragraph (1).

SEC. 142. SELECTION OF GRANTEES.

    (a) Selection of Grantees.--The Secretary shall establish criteria 
for the competitive selection of grantees under this part.
    (b) Opportunity for Planning Grant.--If the Secretary does not 
approve a State's application under this part and determines that the 
State could benefit from a planning grant under part 1, the Secretary 
shall inform the State of any planning grant funds that may be 
available to it under part 1, subject to section 131(c).

SEC. 143. AMOUNT OF GRANT.

    (a) In General.--For any fiscal year, the minimum grant to any 
State under this part is an amount determined by the Secretary to be 
necessary to enable the State to conduct the implementation process.
    (b) Criteria.--In determining the amount of any such grant, the 
Secretary may consider such factors as the number of children enrolled 
in schools in the State, the number of school-aged children living in 
poverty in the State, and the scope and quality of the State's plan.

SEC. 144. AUTHORIZED ACTIVITIES; LIMITATION ON ADMINISTRATIVE COSTS.

    (a) Subgrants to Local Educational Agencies.--Each State that 
receives funds under this part for any fiscal year shall retain not 
more than 75 percent of those funds in the first year, 50 percent of 
those funds in the second and third years, and 25 percent of those 
funds in each succeeding year. Those funds not retained by the State 
shall be used to make grants to local educational agencies in 
accordance with section 145.
    (b) State-level Activities.--Each State shall use retained funds 
for any fiscal year for the following purposes:
            (1) To conduct Statewide or sub-State regional coordination 
        and collaboration activities.
            (2) To adapt, validate, or disseminate program models or 
        strategies for comprehensive school health education.
            (3) To build capacity to deliver staff development and 
        technical assistance services to local educational agencies, 
        and State and local health agencies.
            (4) To promote program activities involving families and 
        coordinating program activities with community groups and 
        agencies.
            (5) To evaluate and report to the Secretary on the progress 
        made toward attaining the goals and objectives described in 
        section 131(b)(1).
            (6) To conduct such other activities to achieve the 
        objectives of this part as the Secretary may by regulation 
        authorize.
    (c) State Administration.--Of the amounts received by a State for a 
fiscal year under this part and remaining after any grants to local 
educational agencies made from such amounts, the State may use up to 10 
percent for the costs of administering such amounts, including the 
activities of the State advisory council and monitoring the performance 
of local educational agencies.

SEC. 145. SUBGRANTS TO LOCAL EDUCATIONAL AGENCIES.

    (a) Application for Grant.--Any local educational agency that 
wishes to receive a grant under this part shall submit an application 
to the State, containing such information and assurances as the State 
may require, including a description of the following:
            (1) The local educational agency's goals and objectives for 
        comprehensive school health education programs.
            (2) How the local educational agency will concentrate funds 
        in high-need schools and provide sufficient funds to targeted 
        schools to ensure the implementation of comprehensive programs.
            (3) How the local educational agency will monitor the 
        implementation of these programs.
            (4) How the local educational agency will ensure that 
        school health education programs are tailored to the extent 
        practicable to be culturally and linguistically sensitive and 
        responsive to the various needs of the students served, 
        including individuals with disabilities, and individuals from 
        disadvantaged backgrounds (including racial and ethnic 
        minorities).
            (5) How the local educational agency, in consultation with 
        the local health agency, will evaluate and report on its 
        progress toward attaining the goals and objectives described in 
        paragraph (1).
    (b) Selection of Subgrantees.--Each State shall give priority to 
applications from local educational agencies serving areas with high 
needs, as indicated by criteria developed by the State, which shall 
include, but need not be limited to, high rates of any of the 
following:
            (1) Poverty among school-aged youth.
            (2) Births to adolescents.
            (3) Sexually transmitted diseases among school-aged youth.
            (4) Drug and alcohol use among school-aged youth.
            (5) Violence among school-aged youth.
            (6) Obesity in school-aged youth.
    (c) Authorized Activities.--Each local educational agency that 
receives a grant under this part shall use the grant funds to implement 
comprehensive school health education programs, as defined in section 
113. The purposes for which the grant may be expended include 
compensating individuals who teach such programs.

                   Subpart C--State and Local Reports

SEC. 151. STATE AND LOCAL REPORTS.

    (a) State Reports.--Each State that receives a grant under this 
part shall collect and submit to the Secretary such data and other 
information on State and local programs as the Secretary may require.
    (b) In General.-- Each local educational agency that receives a 
grant under part 2 shall collect and report to the State such data and 
other information as the Secretary may require.

          PART 4--GRANTS TO CERTAIN LOCAL EDUCATIONAL AGENCIES

                         Subpart A--Eligibility

SEC. 161. SUBSTANTIAL NEED OF AREA SERVED BY AGENCY.

    Any local educational agency is eligible for a grant under this 
part for any fiscal year if--
            (1) the agency enrolls at least 25,000 students; and
            (2) the geographic area served by the agency has a 
        substantial need for such a grant, relative to other geographic 
        areas in the United States.

        Subpart B--Planning Grants for Local Education Agencies

SEC. 171. APPLICATION FOR GRANT.

    (a) In General.--Any local educational agency that wishes to 
receive a planning grant under this part shall submit an application to 
the Secretary of Health and Human Services at such time and in such 
manner as the Secretary may require.
    (b) State Educational Agency Review.--Each such local educational 
agency, before submitting its application to the Secretary, shall 
submit the application to the State educational agency for comment by 
such agency and by the State health agencies of the State.
    (c) Contents of Applications.--Each such application shall contain 
the following:
            (1) An assessment of the local educational agency's need 
        for comprehensive school health education, using goals 
        established by the Department of Health and Human Services and 
        the Department of Education, as well as local health and 
        education strategies, such as State school improvement plans, 
        if any, under title III of the Goals 2000: Educate America Act.
            (2) Information demonstrating that the local educational 
        agency has established or selected a community-level advisory 
        council, which shall include representatives of relevant 
        community agencies such as those that administer education, 
        child nutrition, health, and mental health programs.
            (3) A description of how the local educational agency will 
        collaborate with the State educational agency, the State health 
        agency, and the local health agency in the planning and 
        development of a comprehensive school health education program 
        in the local educational agency, including coordination of 
        existing health education programs and resources.
            (4) A plan to build capacity at the local educational 
        agency to provide staff development and technical assistance to 
        local educational agency and local health agency personnel 
        involved with comprehensive school health education.
            (5) A preliminary plan for evaluating comprehensive school 
        health education activities.
            (6) A timetable and proposed budget for the planning 
        process.
            (7) Such other information and assurances as the Secretary 
        may require.
    (d) Number of Grants.--Local educational agencies may receive at a 
maximum two annual planning grants.

SEC. 172. SELECTION OF GRANTEES.

    (a) Selection Criteria.--The Secretary shall establish criteria for 
the competitive selection of grantees under this part.
    (b) Limitation.--The Secretary shall not approve an application 
from a local educational agency in a State that has an approved plan 
under part 1 or 2 of subtitle C of this title unless the Secretary 
determines, after consultation with the State that the local 
application is consistent with the State plan, if one exists.

SEC. 173. AMOUNT OF GRANT.

    For any fiscal year, the minimum grant to any local educational 
agency under this part is an amount determined by the Secretary to be 
necessary to enable the local educational agency to conduct the 
planning process, and the maximum such grant is $500,000.

SEC. 174. AUTHORIZED ACTIVITIES.

    A local educational agency may use funds received under this part 
only for the following:
            (1) To establish and carry out the local educational agency 
        planning process.
            (2) To undertake joint training, staffing, administration, 
        and other coordination and collaboration activities for local 
        educational agencies, local health agencies, and other agencies 
        and organizations, as appropriate.
            (3) To conduct activities to build capacity to provide 
        staff development and technical assistance services to local 
        educational agency and local health agency personnel involved 
        with comprehensive school health education.
            (4) To develop student learning objectives and assessment 
        instruments.
            (5) To work with State and local health agencies and State 
        educational agencies to reduce barriers to the implementation 
        of comprehensive school health education programs in schools, 
        by, for example, ensuring that adequate time is available 
        during the school day for such programs.
            (6) To prepare the plan required to receive an 
        implementation grant under part 3.

    Subpart C--Implementation Grants for Local Educational Agencies

SEC. 181. APPLICATION FOR GRANT.

    (a) In General.--Any local educational agency that wishes to 
receive an implementation grant under this part shall submit an 
application to the Secretary of Health and Human Services, at such 
time, in such manner, and containing such information and assurances as 
the Secretary may require.
    (b) State Educational Agency Review.--Each such local educational 
agency shall submit its application to the State educational agency for 
comment before submitting it to the Secretary.
    (c) Local Educational Agency Plan.--Each such application shall 
include a local educational agency plan for comprehensive school health 
education programs (as defined in section 113) that describes the 
following:
            (1) The local educational agency's goals and objectives for 
        those programs.
            (2) How the local educational agency will coordinate 
        programs under this part with other local, State and Federal 
        health education programs.
            (3) How comprehensive school health education programs will 
        be coordinated with other local, State and Federal education 
        programs, such as programs under title I of the Elementary and 
        Secondary Education Act of 1965, and with State's school 
        improvement plan, if any, under title III of the Goals 2000: 
        Educate America Act.
            (4) How the local educational agency has worked with State 
        educational agencies and with State and local health agencies 
        to reduce barriers to implementing comprehensive school health 
        education programs.
            (5) How local educational agencies will monitor the 
        implementation of such programs.
            (6) How the local educational agency, in consultation with 
        the State educational agency and State and local health 
        agencies and in conjunction with other local professional 
        development activities, will build capacity for professional 
        development of health educators.
            (7) How the local educational agency, in consultation with 
        the State educational agency and State and local health 
        agencies, will provide staff development and technical 
        assistance.
            (8) The respective roles of the State educational agency, 
        local educational agencies, the State health agency, and the 
        local health agencies in developing and implementing such 
        school health education programs.
            (9) How such school health education programs will be 
        tailored to the extent practicable to be culturally and 
        linguistically sensitive and responsive to the various needs of 
        the students served, including individuals with disabilities, 
        and individuals from disadvantaged backgrounds (including 
        racial and ethnic minorities).
            (10) How the local educational agency, in consultation with 
        the local health agency, will evaluate and report on the local 
        educational agency's progress toward attaining the goals and 
        objectives described in paragraph (1).

SEC. 182. SELECTION OF GRANTEES.

    (a) Selection of Grantees.--The Secretary shall establish criteria 
for the competitive selection of grantees under this part.
    (b) Limitation.--The Secretary shall not approve an application 
from a local educational agency in a State that has an approved plan 
under part 1 or 2 of subtitle C unless the Secretary determines, after 
consultation with the State that the local application is consistent 
with such State plan.
    (c) Opportunity for Planning Grant.--If the Secretary does not 
approve a local educational agency's application under this part and 
determines that the local educational agency could benefit from a 
planning grant under part 2, the Secretary shall inform the local 
educational agency of any planning grant funds that may be available to 
it under part 2, subject to section 171(d).

SEC. 183. AMOUNT OF GRANT.

    (a) In General.--For any fiscal year, the minimum grant to any 
local educational agency under this part is an amount determined by the 
Secretary to be necessary to enable the local educational agency to 
conduct the implementation process.
    (b) Criteria.--In determining the amount of any such grant, the 
Secretary may consider such factors as the number of children enrolled 
in schools in the local educational agency, the number of school-aged 
children living in poverty in the local educational agency, and the 
scope and quality of the local educational agency's plan.

SEC. 184. AUTHORIZED ACTIVITIES.

    Each local educational agency that receives a grant under this part 
shall use the grant funds as follows:
            (1) To implement comprehensive school health education 
        programs, as defined in section 113.
            (2) To conduct local or regional coordination and 
        collaboration activities.
            (3) To provide staff development and technical assistance 
        to schools, local health agencies, and other community agencies 
        involved in providing comprehensive school health education 
        programs.
            (4) To administer the program and monitor program 
        implementation at the local level.
            (5) To evaluate and report to the Secretary on the local 
        educational agency's progress toward attaining the goals and 
        objectives described in section 181(c)(1).
            (6) To conduct such other activities as the Secretary may 
        by regulation authorize.

SEC. 185. REPORTS.

    Each local educational agency that receives a grant under this part 
shall collect and report to the Secretary and the State such data and 
other information as the Secretary may require.
S 2346 PCS----2
S 2346 PCS----3
S 2346 PCS----4
S 2346 PCS----5
S 2346 PCS----6
S 2346 PCS----7
S 2346 PCS----8
S 2346 PCS----9
S 2346 PCS----10
S 2346 PCS----11
```