105TH CONGRESS

2D SESSION S. 1754

AMENDMENT
In the House of Representatives, U. S.,

October 13, 1998.

Resolved, That the bill from the Senate (S. 1754) entitled ‘‘An Act to amend the Public Health Service Act to consolidate and reauthorize health professions and minority and

disadvantaged health education programs, and for other purposes’’, do pass with the following

AMENDMENT:

Strike out all after the enacting clause and insert:

1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

3 ‘‘Health Professions Education Partnerships Act of 1998’’.

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

5 Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I—HEALTH PROFESSIONS EDUCATION AND FINANCIAL

ASSISTANCE PROGRAMS

Subtitle A—Health Professions Education Programs

Sec. 101. Under-represented minority health professions grant program.

Sec. 102. Training in primary care medicine and dentistry.

Sec. 103. Interdisciplinary, community-based linkages.

Sec. 104. Health professions workforce information and analysis.

Sec. 105. Public health workforce development.

Sec. 106. General provisions.

Sec. 107. Preference in certain programs.

Sec. 108. Definitions.

Sec. 109. Technical amendment on National Health Service Corps.

Sec. 110. Savings provision.
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Subtitle B—Nursing Workforce Development

Sec. 121. Short title.

Sec. 122. Purpose.

Sec. 123. Amendments to Public Health Service Act.

Sec. 124. Savings provision.

Subtitle C—Financial Assistance

CHAPTER 1—SCHOOL-BASED REVOLVING LOAN FUNDS

Sec. 131. Primary care loan program.

Sec. 132. Loans for disadvantaged students.

Sec. 133. Student loans regarding schools of nursing.

Sec. 134. General provisions.

CHAPTER 2—INSURED HEALTH EDUCATION ASSISTANCE LOANS TO

GRADUATE STUDENTS

Sec. 141. Health Education Assistance Loan Program.

Sec. 142. HEAL lender and holder performance standards.

Sec. 143. Insurance Program.

Sec. 144. HEAL bankruptcy.

Sec. 145. HEAL refinancing.

TITLE II—OFFICE OF MINORITY HEALTH

Sec. 201. Revision and extension of programs of Office of Minority Health.

TITLE III—SELECTED INITIATIVES

Sec. 301. State offices of rural health.

Sec. 302. Demonstration projects regarding Alzheimer’s Disease.

Sec. 303. Project grants for immunization services.

TITLE IV—MISCELLANEOUS PROVISIONS

Sec. 401. Technical corrections regarding Public Law 103–183.

Sec. 402. Miscellaneous amendments regarding PHS commissioned officers.

Sec. 403. Clinical traineeships.

Sec. 404. Project grants for screenings, referrals, and education regarding lead

poisoning.

Sec. 405. Project grants for preventive health services regarding tuberculosis.

Sec. 406. CDC loan repayment program.

Sec. 407. Community programs on domestic violence.

Sec. 408. State loan repayment program.

Sec. 409. Authority of the director of NIH.

Sec. 410. Raise in maximum level of loan repayments.

Sec. 411. Construction of regional centers for research on primates.

Sec. 412. Peer review.

Sec. 413. Funding for trauma care.

Sec. 414. Health information and health promotion.

Sec. 415. Emergency medical services for children.

Sec. 416. Administration of certain requirements.

Sec. 417. Aids drug assistance program.

Sec. 418. National Foundation for Biomedical Research.

Sec. 419. Fetal Alcohol Syndrome prevention and services.
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1 TITLE I—HEALTH PROFESSIONS

2 EDUCATION AND FINANCIAL

3 ASSISTANCE PROGRAMS

4 Subtitle A—Health Professions

5 Education Programs

6 SEC. 101. UNDER-REPRESENTED MINORITY HEALTH PRO7 FESSIONS GRANT PROGRAM.

8 (a) IN GENERAL.—Part B of title VII of the Public

9 Health Service Act (42 U.S.C. 293 et seq.) is amended to

10 read as follows:

11 ‘‘PART B—HEALTH PROFESSIONS TRAINING FOR

12 DIVERSITY

13 ‘‘SEC. 736. CENTERS OF EXCELLENCE.

14 ‘‘(a) IN GENERAL.—The Secretary shall make grants

15 to, and enter into contracts with, designated health profes16 sions schools described in subsection (c), and other public

17 and nonprofit health or educational entities, for the purpose

18 of assisting the schools in supporting programs of excellence

19 in health professions education for under-represented mi20 nority individuals.

21 ‘‘(b) REQUIRED USE OF FUNDS.—The Secretary may

22 not make a grant under subsection (a) unless the designated

23 health professions school involved agrees, subject to sub24 section (c)(1)(C), to expend the grant—
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1 ‘‘(1) to develop a large competitive applicant

2 pool through linkages with institutions of higher edu3 cation, local school districts, and other community4 based entities and establish an education pipeline for

5 health professions careers;

6 ‘‘(2) to establish, strengthen, or expand programs

7 to enhance the academic performance of under-rep8 resented minority students attending the school;

9 ‘‘(3) to improve the capacity of such school to

10 train, recruit, and retain under-represented minority

11 faculty including the payment of such stipends and

12 fellowships as the Secretary may determine appro13 priate;

14 ‘‘(4) to carry out activities to improve the infor15 mation resources, clinical education, curricula and

16 cultural competence of the graduates of the school, as

17 it relates to minority health issues;

18 ‘‘(5) to facilitate faculty and student research on

19 health issues particularly affecting under-represented

20 minority groups, including research on issues relating

21 to the delivery of health care;

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

23 the school in providing health services to a significant

24 number of under-represented minority individuals
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1 through training provided to such students at commu2 nity-based health facilities that—

3 ‘‘(A) provide such health services; and

4 ‘‘(B) are located at a site remote from the

5 main site of the teaching facilities of the school;

6 and

7 ‘‘(7) to provide stipends as the Secretary deter8 mines appropriate, in amounts as the Secretary de9 termines appropriate.

10 ‘‘(c) CENTERS OF EXCELLENCE.—

11 ‘‘(1) DESIGNATED SCHOOLS.—

12 ‘‘(A) IN GENERAL.—The designated health

13 professions schools referred to in subsection (a)

14 are such schools that meet each of the conditions

15 specified in subparagraphs (B) and (C), and

16 that—

17 ‘‘(i) meet each of the conditions speci18 fied in paragraph (2)(A);

19 ‘‘(ii) meet each of the conditions speci20 fied in paragraph (3);

21 ‘‘(iii) meet each of the conditions speci22 fied in paragraph (4); or

23 ‘‘(iv) meet each of the conditions speci24 fied in paragraph (5).
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1 ‘‘(B) GENERAL CONDITIONS.—The condi2 tions specified in this subparagraph are that a

3 designated health professions school—

4 ‘‘(i) has a significant number of under5 represented minority individuals enrolled in

6 the school, including individuals accepted

7 for enrollment in the school;

8 ‘‘(ii) has been effective in assisting

9 under-represented minority students of the

10 school to complete the program of education

11 and receive the degree involved;

12 ‘‘(iii) has been effective in recruiting

13 under-represented minority individuals to

14 enroll in and graduate from the school, in15 cluding providing scholarships and other fi16 nancial assistance to such individuals and

17 encouraging under-represented minority

18 students from all levels of the educational

19 pipeline to pursue health professions ca20 reers; and

21 ‘‘(iv) has made significant recruitment

22 efforts to increase the number of under-rep23 resented minority individuals serving in

24 faculty or administrative positions at the

25 school.
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1 ‘‘(C) CONSORTIUM.—The condition specified

2 in this subparagraph is that, in accordance with

3 subsection (e)(1), the designated health profession

4 school involved has with other health profession

5 schools (designated or otherwise) formed a con6 sortium to carry out the purposes described in

7 subsection (b) at the schools of the consortium.

8 ‘‘(D) APPLICATION OF CRITERIA TO OTHER

9 PROGRAMS.—In the case of any criteria estab10 lished by the Secretary for purposes of determin11 ing whether schools meet the conditions described

12 in subparagraph (B), this section may not, with

13 respect to racial and ethnic minorities, be con14 strued to authorize, require, or prohibit the use

15 of such criteria in any program other than the

16 program established in this section.

17 ‘‘(2) CENTERS OF EXCELLENCE AT CERTAIN HIS18 TORICALLY BLACK COLLEGES AND UNIVERSITIES.—

19 ‘‘(A) CONDITIONS.—The conditions specified

20 in this subparagraph are that a designated

21 health professions school—

22 ‘‘(i) is a school described in section

23 799B(1); and
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1 ‘‘(ii) received a contract under section

2 788B for fiscal year 1987, as such section

3 was in effect for such fiscal year.

4 ‘‘(B) USE OF GRANT.—In addition to the

5 purposes described in subsection (b), a grant

6 under subsection (a) to a designated health pro7 fessions school meeting the conditions described

8 in subparagraph (A) may be expended—

9 ‘‘(i) to develop a plan to achieve insti10 tutional improvements, including financial

11 independence, to enable the school to sup12 port programs of excellence in health profes13 sions education for under-represented mi14 nority individuals; and

15 ‘‘(ii) to provide improved access to the

16 library and informational resources of the

17 school.

18 ‘‘(C) EXCEPTION.—The requirements of

19 paragraph (1)(C) shall not apply to a histori20 cally black college or university that receives

21 funding under paragraphs (2) or (5).

22 ‘‘(3) HISPANIC CENTERS OF EXCELLENCE.—The

23 conditions specified in this paragraph are that—

24 ‘‘(A) with respect to Hispanic individuals,

25 each of clauses (i) through (iv) of paragraph
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1 (1)(B) applies to the designated health profes2 sions school involved;

3 ‘‘(B) the school agrees, as a condition of re4 ceiving a grant under subsection (a), that the

5 school will, in carrying out the duties described

6 in subsection (b), give priority to carrying out

7 the duties with respect to Hispanic individuals;

8 and

9 ‘‘(C) the school agrees, as a condition of re10 ceiving a grant under subsection (a), that—

11 ‘‘(i) the school will establish an ar12 rangement with 1 or more public or non13 profit community based Hispanic serving

14 organizations, or public or nonprofit pri15 vate institutions of higher education, in16 cluding schools of nursing, whose enrollment

17 of students has traditionally included a sig18 nificant number of Hispanic individuals,

19 the purposes of which will be to carry out

20 a program—

21 ‘‘(I) to identify Hispanic students

22 who are interested in a career in the

23 health profession involved; and
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1 ‘‘(II) to facilitate the educational

2 preparation of such students to enter

3 the health professions school; and

4 ‘‘(ii) the school will make efforts to re5 cruit Hispanic students, including students

6 who have participated in the undergraduate

7 or other matriculation program carried out

8 under arrangements established by the

9 school pursuant to clause (i)(II) and will

10 assist Hispanic students regarding the com11 pletion of the educational requirements for

12 a degree from the school.

13 ‘‘(4) NATIVE AMERICAN CENTERS OF EXCEL14 LENCE.—Subject to subsection (e), the conditions spec15 ified in this paragraph are that—

16 ‘‘(A) with respect to Native Americans, each

17 of clauses (i) through (iv) of paragraph (1)(B)

18 applies to the designated health professions

19 school involved;

20 ‘‘(B) the school agrees, as a condition of re21 ceiving a grant under subsection (a), that the

22 school will, in carrying out the duties described

23 in subsection (b), give priority to carrying out

24 the duties with respect to Native Americans; and
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1 ‘‘(C) the school agrees, as a condition of re2 ceiving a grant under subsection (a), that—

3 ‘‘(i) the school will establish an ar4 rangement with 1 or more public or non5 profit private institutions of higher edu6 cation, including schools of nursing, whose

7 enrollment of students has traditionally in8 cluded a significant number of Native

9 Americans, the purpose of which arrange10 ment will be to carry out a program—

11 ‘‘(I) to identify Native American

12 students, from the institutions of high13 er education referred to in clause (i),

14 who are interested in health professions

15 careers; and

16 ‘‘(II) to facilitate the educational

17 preparation of such students to enter

18 the designated health professions school;

19 and

20 ‘‘(ii) the designated health professions

21 school will make efforts to recruit Native

22 American students, including students who

23 have participated in the undergraduate pro24 gram carried out under arrangements estab25 lished by the school pursuant to clause (i)
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1 and will assist Native American students

2 regarding the completion of the educational

3 requirements for a degree from the des4 ignated health professions school.

5 ‘‘(5) OTHER CENTERS OF EXCELLENCE.—The

6 conditions specified in this paragraph are—

7 ‘‘(A) with respect to other centers of excel8 lence, the conditions described in clauses (i)

9 through (iv) of paragraph (1)(B); and

10 ‘‘(B) that the health professions school in11 volved has an enrollment of under-represented

12 minorities above the national average for such

13 enrollments of health professions schools.

14 ‘‘(d) DESIGNATION AS CENTER OF EXCELLENCE.—

15 ‘‘(1) IN GENERAL.—Any designated health pro16 fessions school receiving a grant under subsection (a)

17 and meeting the conditions described in paragraph

18 (2) or (5) of subsection (c) shall, for purposes of this

19 section, be designated by the Secretary as a Center of

20 Excellence in Under-Represented Minority Health

21 Professions Education.

22 ‘‘(2) HISPANIC CENTERS OF EXCELLENCE.—Any

23 designated health professions school receiving a grant

24 under subsection (a) and meeting the conditions de25 scribed in subsection (c)(3) shall, for purposes of this
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1 section, be designated by the Secretary as a Hispanic

2 Center of Excellence in Health Professions Education.

3 ‘‘(3) NATIVE AMERICAN CENTERS OF EXCEL4 LENCE.—Any designated health professions school re5 ceiving a grant under subsection (a) and meeting the

6 conditions described in subsection (c)(4) shall, for

7 purposes of this section, be designated by the Sec8 retary as a Native American Center of Excellence in

9 Health Professions Education. Any consortium receiv10 ing such a grant pursuant to subsection (e) shall, for

11 purposes of this section, be so designated.

12 ‘‘(e) AUTHORITY REGARDING NATIVE AMERICAN CEN13 TERS OF EXCELLENCE.—With respect to meeting the condi14 tions specified in subsection (c)(4), the Secretary may make

15 a grant under subsection (a) to a designated health profes16 sions school that does not meet such conditions if—

17 ‘‘(1) the school has formed a consortium in ac18 cordance with subsection (d)(1); and

19 ‘‘(2) the schools of the consortium collectively

20 meet such conditions, without regard to whether the

21 schools individually meet such conditions.

22 ‘‘(f) DURATION OF GRANT.—The period during which

23 payments are made under a grant under subsection (a)

24 may not exceed 5 years. Such payments shall be subject to

25 annual approval by the Secretary and to the availability
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1 of appropriations for the fiscal year involved to make the

2 payments.

3 ‘‘(g) DEFINITIONS.—In this section:

4 ‘‘(1) DESIGNATED HEALTH PROFESSIONS

5 SCHOOL.—

6 ‘‘(A) IN GENERAL.—The term ‘health profes7 sions school’ means, except as provided in sub8 paragraph (B), a school of medicine, a school of

9 osteopathic medicine, a school of dentistry, a

10 school of pharmacy, or a graduate program in

11 behavioral or mental health.

12 ‘‘(B) EXCEPTION.—The definition estab13 lished in subparagraph (A) shall not apply to

14 the use of the term ‘designated health professions

15 school’ for purposes of subsection (c)(2).

16 ‘‘(2) PROGRAM OF EXCELLENCE.—The term ‘pro17 gram of excellence’ means any program carried out

18 by a designated health professions school with a grant

19 made under subsection (a), if the program is for pur20 poses for which the school involved is authorized in

21 subsection (b) or (c) to expend the grant.

22 ‘‘(3) NATIVE AMERICANS.—The term ‘Native

23 Americans’ means American Indians, Alaskan Na24 tives, Aleuts, and Native Hawaiians.

25 ‘‘(h) FUNDING.—
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1 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—For

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

3 there authorized to be appropriated $26,000,000 for

4 fiscal year 1998, and such sums as may be necessary

5 for each of the fiscal years 1999 through 2002.

6 ‘‘(2) ALLOCATIONS.—Based on the amount ap7 propriated under paragraph (1) for a fiscal year, one

8 of the following subparagraphs shall apply:

9 ‘‘(A) IN GENERAL.—If the amounts appro10 priated under paragraph (1) for a fiscal year

11 are $24,000,000 or less—

12 ‘‘(i) the Secretary shall make available

13 $12,000,000 for grants under subsection (a)

14 to health professions schools that meet the

15 conditions described in subsection (c)(2)(A);

16 and

17 ‘‘(ii) and available after grants are

18 made with funds under clause (i), the Sec19 retary shall make available—

20 ‘‘(I) 60 percent of such amount

21 for grants under subsection (a) to

22 health professions schools that meet the

23 conditions described in paragraph (3)

24 or (4) of subsection (c) (including
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1 meeting the conditions under sub2 section (e)); and

3 ‘‘(II) 40 percent of such amount

4 for grants under subsection (a) to

5 health professions schools that meet the

6 conditions described in subsection

7 (c)(5).

8 ‘‘(B) FUNDING IN EXCESS OF

9 $24,000,000.—If amounts appropriated under

10 paragraph (1) for a fiscal year exceed

11 $24,000,000 but are less than $30,000,000—

12 ‘‘(i) 80 percent of such excess amounts

13 shall be made available for grants under

14 subsection (a) to health professions schools

15 that meet the requirements described in

16 paragraph (3) or (4) of subsection (c) (in17 cluding meeting conditions pursuant to sub18 section (e)); and

19 ‘‘(ii) 20 percent of such excess amount

20 shall be made available for grants under

21 subsection (a) to health professions schools

22 that meet the conditions described in sub23 section (c)(5).

24 ‘‘(C) FUNDING IN EXCESS OF

25 $30,000,000.—If amounts appropriated under
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1 paragraph (1) for a fiscal year are $30,000,000

2 or more, the Secretary shall make available—

3 ‘‘(i) not less than $12,000,000 for

4 grants under subsection (a) to health profes5 sions schools that meet the conditions de6 scribed in subsection (c)(2)(A);

7 ‘‘(ii) not less than $12,000,000 for

8 grants under subsection (a) to health profes9 sions schools that meet the conditions de10 scribed in paragraph (3) or (4) of sub11 section (c) (including meeting conditions

12 pursuant to subsection (e));

13 ‘‘(iii) not less than $6,000,000 for

14 grants under subsection (a) to health profes15 sions schools that meet the conditions de16 scribed in subsection (c)(5); and

17 ‘‘(iv) after grants are made with funds

18 under clauses (i) through (iii), any remain19 ing funds for grants under subsection (a) to

20 health professions schools that meet the con21 ditions described in paragraph (2)(A), (3),

22 (4), or (5) of subsection (c).

23 ‘‘(3) NO LIMITATION.—Nothing in this subsection

24 shall be construed as limiting the centers of excellence

25 referred to in this section to the designated amount,
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1 or to preclude such entities from competing for other

2 grants under this section.

3 ‘‘(4) MAINTENANCE OF EFFORT.—

4 ‘‘(A) IN GENERAL.—With respect to activi5 ties for which a grant made under this part are

6 authorized to be expended, the Secretary may not

7 make such a grant to a center of excellence for

8 any fiscal year unless the center agrees to main9 tain expenditures of non-Federal amounts for

10 such activities at a level that is not less than the

11 level of such expenditures maintained by the cen12 ter for the fiscal year preceding the fiscal year

13 for which the school receives such a grant.

14 ‘‘(B) USE OF FEDERAL FUNDS.—With re15 spect to any Federal amounts received by a cen16 ter of excellence and available for carrying out

17 activities for which a grant under this part is

18 authorized to be expended, the Secretary may not

19 make such a grant to the center for any fiscal

20 year unless the center agrees that the center will,

21 before expending the grant, expend the Federal

22 amounts obtained from sources other than the

23 grant.
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1 ‘‘SEC. 737. SCHOLARSHIPS FOR DISADVANTAGED STU2 DENTS.

3 ‘‘(a) IN GENERAL.—The Secretary may make a grant

4 to an eligible entity (as defined in subsection (d)(1)) under

5 this section for the awarding of scholarships by schools to

6 any full-time student who is an eligible individual as de7 fined in subsection (d). Such scholarships may be expended

8 only for tuition expenses, other reasonable educational ex9 penses, and reasonable living expenses incurred in the at10 tendance of such school.

11 ‘‘(b) PREFERENCE IN PROVIDING SCHOLARSHIPS.—

12 The Secretary may not make a grant to an entity under

13 subsection (a) unless the health professions and nursing

14 schools involved agree that, in providing scholarships pur15 suant to the grant, the schools will give preference to stu16 dents for whom the costs of attending the schools would con17 stitute a severe financial hardship and, notwithstanding

18 other provisions of this section, to former recipients of schol19 arships under sections 736 and 740(d)(2)(B) (as such sec20 tions existed on the day before the date of enactment of this

21 section).

22 ‘‘(c) AMOUNT OF AWARD.—In awarding grants to eli23 gible entities that are health professions and nursing

24 schools, the Secretary shall give priority to eligible entities

25 based on the proportion of graduating students going into

26 primary care, the proportion of underrepresented minority
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1 students, and the proportion of graduates working in medi2 cally underserved communities.

3 ‘‘(d) DEFINITIONS.—In this section:

4 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible en5 tities’ means an entity that—

6 ‘‘(A) is a school of medicine, osteopathic

7 medicine, dentistry, nursing (as defined in sec8 tion 801), pharmacy, podiatric medicine, optom9 etry, veterinary medicine, public health, chiro10 practic, or allied health, a school offering a grad11 uate program in behavioral and mental health

12 practice, or an entity providing programs for the

13 training of physician assistants; and

14 ‘‘(B) is carrying out a program for recruit15 ing and retaining students from disadvantaged

16 backgrounds, including students who are mem17 bers of racial and ethnic minority groups.

18 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible

19 individual’ means an individual who—

20 ‘‘(A) is from a disadvantaged background;

21 ‘‘(B) has a financial need for a scholarship;

22 and

23 ‘‘(C) is enrolled (or accepted for enrollment)

24 at an eligible health professions or nursing school
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1 as a full-time student in a program leading to

2 a degree in a health profession or nursing.

3 ‘‘SEC. 738. LOAN REPAYMENTS AND FELLOWSHIPS REGARD4 ING FACULTY POSITIONS.

5 ‘‘(a) LOAN REPAYMENTS.—

6 ‘‘(1) ESTABLISHMENT OF PROGRAM.—The Sec7 retary shall establish a program of entering into con8 tracts with individuals described in paragraph (2)

9 under which the individuals agree to serve as mem10 bers of the faculties of schools described in paragraph

11 (3) in consideration of the Federal Government agree12 ing to pay, for each year of such service, not more

13 than $20,000 of the principal and interest of the edu14 cational loans of such individuals.

15 ‘‘(2) ELIGIBLE INDIVIDUALS.—The individuals

16 referred to in paragraph (1) are individuals from dis17 advantaged backgrounds who—

18 ‘‘(A) have a degree in medicine, osteopathic

19 medicine, dentistry, nursing, or another health

20 profession;

21 ‘‘(B) are enrolled in an approved graduate

22 training program in medicine, osteopathic medi23 cine, dentistry, nursing, or other health profes24 sion; or

25 ‘‘(C) are enrolled as full-time students—
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1 ‘‘(i) in an accredited (as determined by

2 the Secretary) school described in para3 graph (3); and

4 ‘‘(ii) in the final year of a course of a

5 study or program, offered by such institu6 tion and approved by the Secretary, leading

7 to a degree from such a school.

8 ‘‘(3) ELIGIBLE HEALTH PROFESSIONS

9 SCHOOLS.—The schools described in this paragraph

10 are schools of medicine, nursing (as schools of nursing

11 are defined in section 801), osteopathic medicine, den12 tistry, pharmacy, allied health, podiatric medicine,

13 optometry, veterinary medicine, or public health, or

14 schools offering graduate programs in behavioral and

15 mental health.

16 ‘‘(4) REQUIREMENTS REGARDING FACULTY POSI17 TIONS.—The Secretary may not enter into a contract

18 under paragraph (1) unless—

19 ‘‘(A) the individual involved has entered

20 into a contract with a school described in para21 graph (3) to serve as a member of the faculty of

22 the school for not less than 2 years; and

23 ‘‘(B) the contract referred to in subpara24 graph (A) provides that—
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1 ‘‘(i) the school will, for each year for

2 which the individual will serve as a member

3 of the faculty under the contract with the

4 school, make payments of the principal and

5 interest due on the educational loans of the

6 individual for such year in an amount

7 equal to the amount of such payments made

8 by the Secretary for the year;

9 ‘‘(ii) the payments made by the school

10 pursuant to clause (i) on behalf of the indi11 vidual will be in addition to the pay that

12 the individual would otherwise receive for

13 serving as a member of such faculty; and

14 ‘‘(iii) the school, in making a deter15 mination of the amount of compensation to

16 be provided by the school to the individual

17 for serving as a member of the faculty, will

18 make the determination without regard to

19 the amount of payments made (or to be

20 made) to the individual by the Federal Gov21 ernment under paragraph (1).

22 ‘‘(5) APPLICABILITY OF CERTAIN PROVISIONS.—

23 The provisions of sections 338C, 338G, and 338I shall

24 apply to the program established in paragraph (1) to

25 the same extent and in the same manner as such pro-
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1 visions apply to the National Health Service Corps

2 Loan Repayment Program established in subpart III

3 of part D of title III, including the applicability of

4 provisions regarding reimbursements for increased tax

5 liability and regarding bankruptcy.

6 ‘‘(6) WAIVER REGARDING SCHOOL CONTRIBU7 TIONS.—The Secretary may waive the requirement es8 tablished in paragraph (4)(B) if the Secretary deter9 mines that the requirement will impose an undue fi10 nancial hardship on the school involved.

11 ‘‘(b) FELLOWSHIPS.—

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

13 grants to and enter into contracts with eligible enti14 ties to assist such entities in increasing the number

15 of underrepresented minority individuals who are

16 members of the faculty of such schools.

17 ‘‘(2) APPLICATIONS.—To be eligible to receive a

18 grant or contract under this subsection, an entity

19 shall provide an assurance, in the application sub20 mitted by the entity, that—

21 ‘‘(A) amounts received under such a grant

22 or contract will be used to award a fellowship to

23 an individual only if the individual meets the

24 requirements of paragraphs (3) and (4); and
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1 ‘‘(B) each fellowship awarded pursuant to

2 the grant or contract will include—

3 ‘‘(i) a stipend in an amount not ex4 ceeding 50 percent of the regular salary of

5 a similar faculty member for not to exceed

6 3 years of training; and

7 ‘‘(ii) an allowance for other expenses,

8 such as travel to professional meetings and

9 costs related to specialized training.

10 ‘‘(3) ELIGIBILITY.—To be eligible to receive a

11 grant or contract under paragraph (1), an applicant

12 shall demonstrate to the Secretary that such applicant

13 has or will have the ability to—

14 ‘‘(A) identify, recruit and select underrep15 resented minority individuals who have the po16 tential for teaching, administration, or conduct17 ing research at a health professions institution;

18 ‘‘(B) provide such individuals with the

19 skills necessary to enable them to secure a

20 tenured faculty position at such institution,

21 which may include training with respect to ped22 agogical skills, program administration, the de23 sign and conduct of research, grants writing,

24 and the preparation of articles suitable for publi25 cation in peer reviewed journals;
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1 ‘‘(C) provide services designed to assist such

2 individuals in their preparation for an academic

3 career, including the provision of counselors; and

4 ‘‘(D) provide health services to rural or

5 medically underserved populations.

6 ‘‘(4) REQUIREMENTS.—To be eligible to receive a

7 grant or contract under paragraph (1) an applicant

8 shall—

9 ‘‘(A) provide an assurance that such appli10 cant will make available (directly through cash

11 donations) $1 for every $1 of Federal funds re12 ceived under this section for the fellowship;

13 ‘‘(B) provide an assurance that institu14 tional support will be provided for the individ15 ual for the second and third years at a level that

16 is equal to the total amount of institutional

17 funds provided in the year in which the grant or

18 contract was awarded;

19 ‘‘(C) provide an assurance that the individ20 ual that will receive the fellowship will be a

21 member of the faculty of the applicant school;

22 and

23 ‘‘(D) provide an assurance that the individ24 ual that will receive the fellowship will have, at

25 a minimum, appropriate advanced preparation
27

•S 1754 EAH

1 (such as a master’s or doctoral degree) and spe2 cial skills necessary to enable such individual to

3 teach and practice.

4 ‘‘(5) DEFINITION.—For purposes of this sub5 section, the term ‘underrepresented minority individ6 uals’ means individuals who are members of racial or

7 ethnic minority groups that are underrepresented in

8 the health professions including nursing.

9 ‘‘SEC. 739. EDUCATIONAL ASSISTANCE IN THE HEALTH PRO10 FESSIONS REGARDING INDIVIDUALS FROM

11 DISADVANTAGED BACKGROUNDS.

12 ‘‘(a) IN GENERAL.—

13 ‘‘(1) AUTHORITY FOR GRANTS.—For the purpose

14 of assisting individuals from disadvantaged back15 grounds, as determined in accordance with criteria

16 prescribed by the Secretary, to undertake education to

17 enter a health profession, the Secretary may make

18 grants to and enter into contracts with schools of

19 medicine, osteopathic medicine, public health, den20 tistry, veterinary medicine, optometry, pharmacy, al21 lied health, chiropractic, and podiatric medicine, pub22 lic and nonprofit private schools that offer graduate

23 programs in behavioral and mental health, programs

24 for the training of physician assistants, and other

25 public or private nonprofit health or educational enti-
28

•S 1754 EAH

1 ties to assist in meeting the costs described in para2 graph (2).

3 ‘‘(2) AUTHORIZED EXPENDITURES.—A grant or

4 contract under paragraph (1) may be used by the en5 tity to meet the cost of—

6 ‘‘(A) identifying, recruiting, and selecting

7 individuals from disadvantaged backgrounds, as

8 so determined, for education and training in a

9 health profession;

10 ‘‘(B) facilitating the entry of such individ11 uals into such a school;

12 ‘‘(C) providing counseling, mentoring, or

13 other services designed to assist such individuals

14 to complete successfully their education at such a

15 school;

16 ‘‘(D) providing, for a period prior to the

17 entry of such individuals into the regular course

18 of education of such a school, preliminary edu19 cation and health research training designed to

20 assist them to complete successfully such regular

21 course of education at such a school, or referring

22 such individuals to institutions providing such

23 preliminary education;

24 ‘‘(E) publicizing existing sources of finan25 cial aid available to students in the education
29

•S 1754 EAH

1 program of such a school or who are undertaking

2 training necessary to qualify them to enroll in

3 such a program;

4 ‘‘(F) paying such scholarships as the Sec5 retary may determine for such individuals for

6 any period of health professions education at a

7 health professions school;

8 ‘‘(G) paying such stipends as the Secretary

9 may approve for such individuals for any period

10 of education in student-enhancement programs

11 (other than regular courses), except that such a

12 stipend may not be provided to an individual for

13 more than 12 months, and such a stipend shall

14 be in an amount determined appropriate by the

15 Secretary (notwithstanding any other provision

16 of law regarding the amount of stipends);

17 ‘‘(H) carrying out programs under which

18 such individuals gain experience regarding a ca19 reer in a field of primary health care through

20 working at facilities of public or private non21 profit community-based providers of primary

22 health services; and

23 ‘‘(I) conducting activities to develop a larg24 er and more competitive applicant pool through

25 partnerships with institutions of higher edu-
30

•S 1754 EAH

1 cation, school districts, and other community2 based entities.

3 ‘‘(3) DEFINITION.—In this section, the term ‘reg4 ular course of education of such a school’ as used in

5 subparagraph (D) includes a graduate program in be6 havioral or mental health.

7 ‘‘(b) REQUIREMENTS FOR AWARDS.—In making

8 awards to eligible entities under subsection (a)(1), the Sec9 retary shall give preference to approved applications for

10 programs that involve a comprehensive approach by several

11 public or nonprofit private health or educational entities

12 to establish, enhance and expand educational programs that

13 will result in the development of a competitive applicant

14 pool of individuals from disadvantaged backgrounds who

15 desire to pursue health professions careers. In considering

16 awards for such a comprehensive partnership approach, the

17 following shall apply with respect to the entity involved:

18 ‘‘(1) The entity shall have a demonstrated com19 mitment to such approach through formal agreements

20 that have common objectives with institutions of high21 er education, school districts, and other community22 based entities.

23 ‘‘(2) Such formal agreements shall reflect the co24 ordination of educational activities and support serv-
31

•S 1754 EAH

1 ices, increased linkages, and the consolidation of re2 sources within a specific geographic area.

3 ‘‘(3) The design of the educational activities in4 volved shall provide for the establishment of a com5 petitive health professions applicant pool of individ6 uals from disadvantaged backgrounds by enhancing

7 the total preparation (academic and social) of such

8 individuals to pursue a health professions career.

9 ‘‘(4) The programs or activities under the award

10 shall focus on developing a culturally competent

11 health care workforce that will serve the unserved and

12 underserved populations within the geographic area.

13 ‘‘(c) EQUITABLE ALLOCATION OF FINANCIAL ASSIST14 ANCE.—The Secretary, to the extent practicable, shall en15 sure that services and activities under subsection (a) are

16 adequately allocated among the various racial and ethnic

17 populations who are from disadvantaged backgrounds.

18 ‘‘(d) MATCHING REQUIREMENTS.—The Secretary may

19 require that an entity that applies for a grant or contract

20 under subsection (a), provide non-Federal matching funds,

21 as appropriate, to ensure the institutional commitment of

22 the entity to the projects funded under the grant or contract.

23 As determined by the Secretary, such non-Federal matching

24 funds may be provided directly or through donations from
32

•S 1754 EAH

1 public or private entities and may be in cash or in-kind,

2 fairly evaluated, including plant, equipment, or services.

3 ‘‘SEC. 740. AUTHORIZATION OF APPROPRIATION.

4 ‘‘(a) SCHOLARSHIPS.—There are authorized to be ap5 propriated to carry out section 737, $37,000,000 for fiscal

6 year 1998, and such sums as may be necessary for each

7 of the fiscal years 1999 through 2002. Of the amount appro8 priated in any fiscal year, the Secretary shall ensure that

9 not less than 16 percent shall be distributed to schools of

10 nursing.

11 ‘‘(b) LOAN REPAYMENTS AND FELLOWSHIPS.—For the

12 purpose of carrying out section 738, there is authorized to

13 be appropriated $1,100,000 for fiscal year 1998, and such

14 sums as may be necessary for each of the fiscal years 1999

15 through 2002.

16 ‘‘(c) EDUCATIONAL ASSISTANCE IN HEALTH PROFES17 SIONS REGARDING INDIVIDUALS FOR DISADVANTAGED

18 BACKGROUNDS.—For the purpose of grants and contracts

19 under section 739(a)(1), there is authorized to be appro20 priated $29,400,000 for fiscal year 1998, and such sums

21 as may be necessary for each of the fiscal years 1999

22 through 2002. The Secretary may use not to exceed 20 per23 cent of the amount appropriated for a fiscal year under

24 this subsection to provide scholarships under section

25 739(a)(2)(F).
33

•S 1754 EAH

1 ‘‘(d) REPORT.—Not later than 6 months after the date

2 of enactment of this part, the Secretary shall prepare and

3 submit to the appropriate committees of Congress a report

4 concerning the efforts of the Secretary to address the need

5 for a representative mix of individuals from historically mi6 nority health professions schools, or from institutions or

7 other entities that historically or by geographic location

8 have a demonstrated record of training or educating under9 represented minorities, within various health professions

10 disciplines, on peer review councils.’’.

11 (b) REPEAL.—

12 (1) IN GENERAL.—Section 795 of the Public

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

14 (2) NONTERMINATION OF AUTHORITY.—The

15 amendments made by this section shall not be con16 strued to terminate agreements that, on the day before

17 the date of enactment of this Act, are in effect pursu18 ant to section 795 of the Public Health Service Act

19 (42 U.S.C. 795) as such section existed on such date.

20 Such agreements shall continue in effect in accord21 ance with the terms of the agreements. With respect

22 to compliance with such agreements, any period of

23 practice as a provider of primary health services shall

24 be counted towards the satisfaction of the requirement

25 of practice pursuant to such section 795.
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•S 1754 EAH

1 (c) CONFORMING AMENDMENTS.—Section

2 481A(c)(3)(D)(i) of the Public Health Service Act (42

3 U.S.C. 287a–2(c)(3)(D)(i)) is amended by striking ‘‘section

4 739’’ and inserting ‘‘part B of title VII’’.

5 SEC. 102. TRAINING IN PRIMARY CARE MEDICINE AND DEN6 TISTRY.

7 Part C of title VII of the Public Health Service Act

8 (42 U.S.C. 293 et seq.) is amended—

9 (1) in the part heading by striking ‘‘PRI10 MARY HEALTH CARE’’ and inserting ‘‘FAM11 ILY MEDICINE, GENERAL INTERNAL

12 MEDICINE, GENERAL PEDIATRICS,

13 PHYSICIAN ASSISTANTS, GENERAL

14 DENTISTRY, AND PEDIATRIC DEN15 TISTRY’’;

16 (2) by repealing section 746 (42 U.S.C. 293j);

17 (3) in section 747 (42 U.S.C. 293k)—

18 (A) by striking the section heading and in19 serting the following:

20 ‘‘SEC. 747. FAMILY MEDICINE, GENERAL INTERNAL MEDI21 CINE, GENERAL PEDIATRICS, GENERAL DEN22 TISTRY, PEDIATRIC DENTISTRY, AND PHYSI23 CIAN ASSISTANTS.’’;

24 (B) in subsection (a)—

25 (i) in paragraph (1)—
35

•S 1754 EAH

1 (I) by inserting ‘‘, internal medi2 cine, or pediatrics’’ after ‘‘family med3 icine’’; and

4 (II) by inserting before the semi5 colon the following: ‘‘that emphasizes

6 training for the practice of family

7 medicine, general internal medicine, or

8 general pediatrics (as defined by the

9 Secretary)’’;

10 (ii) in paragraph (2), by inserting ‘‘,

11 general internal medicine, or general pedi12 atrics’’ before the semicolon;

13 (iii) in paragraphs (3) and (4), by in14 serting ‘‘(including geriatrics), general in15 ternal medicine or general pediatrics’’ after

16 ‘‘family medicine’’;

17 (iv) in paragraph (3), by striking

18 ‘‘and’’ at the end thereof;

19 (v) in paragraph (4), by striking the

20 period and inserting a semicolon; and

21 (vii) by adding at the end thereof the

22 following new paragraphs:

23 ‘‘(5) to meet the costs of projects to plan, develop,

24 and operate or maintain programs for the training of

25 physician assistants (as defined in section 799B), and
36

•S 1754 EAH

1 for the training of individuals who will teach in pro2 grams to provide such training; and

3 ‘‘(6) to meet the costs of planning, developing, or

4 operating programs, and to provide financial assist5 ance to residents in such programs, of general den6 tistry or pediatric dentistry.

7 For purposes of paragraph (6), entities eligible for such

8 grants or contracts shall include entities that have pro9 grams in dental schools, approved residency programs in

10 the general or pediatric practice of dentistry, approved ad11 vanced education programs in the general or pediatric

12 practice of dentistry, or approved residency programs in

13 pediatric dentistry.’’;

14 (C) in subsection (b)—

15 (i) in paragraphs (1) and (2)(A), by

16 inserting ‘‘, general internal medicine, or

17 general pediatrics’’ after ‘‘family medicine’’;

18 (ii) in paragraph (2)—

19 (I) in subparagraph (A), by strik20 ing ‘‘or’’ at the end; and

21 (II) in subparagraph (B), by

22 striking the period and inserting ‘‘;

23 or’’; and

24 (iii) by adding at the end the follow25 ing:
37

•S 1754 EAH

1 ‘‘(3) PRIORITY IN MAKING AWARDS.—In making

2 awards of grants and contracts under paragraph (1),

3 the Secretary shall give priority to any qualified ap4 plicant for such an award that proposes a collabo5 rative project between departments of primary care.’’;

6 (D) by redesignating subsections (c) and (d)

7 as subsections (d) and (e), respectively;

8 (E) by inserting after subsection (b), the fol9 lowing new subsection:

10 ‘‘(c) PRIORITY.—

11 ‘‘(1) IN GENERAL.—With respect to programs for

12 the training of interns or residents, the Secretary

13 shall give priority in awarding grants under this sec14 tion to qualified applicants that have a record of

15 training the greatest percentage of providers, or that

16 have demonstrated significant improvements in the

17 percentage of providers, which enter and remain in

18 primary care practice or general or pediatric den19 tistry.

20 ‘‘(2) DISADVANTAGED INDIVIDUALS.—With re21 spect to programs for the training of interns, resi22 dents, or physician assistants, the Secretary shall give

23 priority in awarding grants under this section to

24 qualified applicants that have a record of training in25 dividuals who are from disadvantaged backgrounds
38

•S 1754 EAH

1 (including racial and ethnic minorities underrep2 resented among primary care practice or general or

3 pediatric dentistry).

4 ‘‘(3) SPECIAL CONSIDERATION.—In awarding

5 grants under this section the Secretary shall give spe6 cial consideration to projects which prepare practi7 tioners to care for underserved populations and other

8 high risk groups such as the elderly, individuals with

9 HIV-AIDS, substance abusers, homeless, and victims

10 of domestic violence.’’; and

11 (F) in subsection (e) (as so redesignated by

12 subparagraph (D))—

13 (i) in paragraph (1), by striking

14 ‘‘$54,000,000’’ and all that follows and in15 serting ‘‘$78,300,000 for fiscal year 1998,

16 and such sums as may be necessary for each

17 of the fiscal years 1999 through 2002.’’; and

18 (ii) by striking paragraph (2) and in19 serting the following:

20 ‘‘(2) ALLOCATION.—

21 ‘‘(A) IN GENERAL.—Of the amounts appro22 priated under paragraph (1) for a fiscal year,

23 the Secretary shall make available—

24 ‘‘(i) not less than $49,300,000 for

25 awards of grants and contracts under sub-
39

•S 1754 EAH

1 section (a) to programs of family medicine,

2 of which not less than $8,600,000 shall be

3 made available for awards of grants and

4 contracts under subsection (b) for family

5 medicine academic administrative units;

6 ‘‘(ii) not less than $17,700,000 for

7 awards of grants and contracts under sub8 section (a) to programs of general internal

9 medicine and general pediatrics;

10 ‘‘(iii) not less than $6,800,000 for

11 awards of grants and contracts under sub12 section (a) to programs relating to physi13 cian assistants; and

14 ‘‘(iv) not less than $4,500,000 for

15 awards of grants and contracts under sub16 section (a) to programs of general or pedi17 atric dentistry.

18 ‘‘(B) RATABLE REDUCTION.—If amounts

19 appropriated under paragraph (1) for any fiscal

20 year are less than the amount required to com21 ply with subparagraph (A), the Secretary shall

22 ratably reduce the amount to be made available

23 under each of clauses (i) through (iv) of such

24 subparagraph accordingly.’’; and
40

•S 1754 EAH

1 (4) by repealing sections 748 through 752 (42

2 U.S.C. 293l through 293p) and inserting the follow3 ing:

4 ‘‘SEC. 748. ADVISORY COMMITTEE ON TRAINING IN PRI5 MARY CARE MEDICINE AND DENTISTRY.

6 ‘‘(a) ESTABLISHMENT.—The Secretary shall establish

7 an advisory committee to be known as the Advisory Com8 mittee on Training in Primary Care Medicine and Den9 tistry (in this section referred to as the ‘Advisory Commit10 tee’).

11 ‘‘(b) COMPOSITION.—

12 ‘‘(1) IN GENERAL.—The Secretary shall deter13 mine the appropriate number of individuals to serve

14 on the Advisory Committee. Such individuals shall

15 not be officers or employees of the Federal Govern16 ment.

17 ‘‘(2) APPOINTMENT.—Not later than 90 days

18 after the date of enactment of this Act, the Secretary

19 shall appoint the members of the Advisory Committee

20 from among individuals who are health professionals.

21 In making such appointments, the Secretary shall en22 sure a fair balance between the health professions,

23 that at least 75 percent of the members of the Advi24 sory Committee are health professionals, a broad geo25 graphic representation of members and a balance be-
41

•S 1754 EAH

1 tween urban and rural members. Members shall be

2 appointed based on their competence, interest, and

3 knowledge of the mission of the profession involved.

4 ‘‘(3) MINORITY REPRESENTATION.—In appoint5 ing the members of the Advisory Committee under

6 paragraph (2), the Secretary shall ensure the ade7 quate representation of women and minorities.

8 ‘‘(c) TERMS.—

9 ‘‘(1) IN GENERAL.—A member of the Advisory

10 Committee shall be appointed for a term of 3 years,

11 except that of the members first appointed—

‘‘(A) 1 12 ⁄3 of such members shall serve for a

13 term of 1 year;

‘‘(B) 1 14 ⁄3 of such members shall serve for a

15 term of 2 years; and

‘‘(C) 1 16 ⁄3 of such members shall serve for a

17 term of 3 years.

18 ‘‘(2) VACANCIES.—

19 ‘‘(A) IN GENERAL.—A vacancy on the Advi20 sory Committee shall be filled in the manner in

21 which the original appointment was made and

22 shall be subject to any conditions which applied

23 with respect to the original appointment.

24 ‘‘(B) FILLING UNEXPIRED TERM.—An indi25 vidual chosen to fill a vacancy shall be ap-
42

•S 1754 EAH

1 pointed for the unexpired term of the member re2 placed.

3 ‘‘(d) DUTIES.—The Advisory Committee shall—

4 ‘‘(1) provide advice and recommendations to the

5 Secretary concerning policy and program develop6 ment and other matters of significance concerning the

7 activities under section 747; and

8 ‘‘(2) not later than 3 years after the date of en9 actment of this section, and annually thereafter, pre10 pare and submit to the Secretary, and the Committee

11 on Labor and Human Resources of the Senate, and

12 the Committee on Commerce of the House of Rep13 resentatives, a report describing the activities of the

14 Committee, including findings and recommendations

15 made by the Committee concerning the activities

16 under section 747.

17 ‘‘(e) MEETINGS AND DOCUMENTS.—

18 ‘‘(1) MEETINGS.—The Advisory Committee shall

19 meet not less than 2 times each year. Such meetings

20 shall be held jointly with other related entities estab21 lished under this title where appropriate.

22 ‘‘(2) DOCUMENTS.—Not later than 14 days prior

23 to the convening of a meeting under paragraph (1),

24 the Advisory Committee shall prepare and make

25 available an agenda of the matters to be considered by
43

•S 1754 EAH

1 the Advisory Committee at such meeting. At any such

2 meeting, the Advisory Council shall distribute mate3 rials with respect to the issues to be addressed at the

4 meeting. Not later than 30 days after the adjourning

5 of such a meeting, the Advisory Committee shall pre6 pare and make available a summary of the meeting

7 and any actions taken by the Committee based upon

8 the meeting.

9 ‘‘(f) COMPENSATION AND EXPENSES.—

10 ‘‘(1) COMPENSATION.—Each member of the Advi11 sory Committee shall be compensated at a rate equal

12 to the daily equivalent of the annual rate of basic pay

13 prescribed for level IV of the Executive Schedule

14 under section 5315 of title 5, United States Code, for

15 each day (including travel time) during which such

16 member is engaged in the performance of the duties

17 of the Committee.

18 ‘‘(2) EXPENSES.—The members of the Advisory

19 Committee shall be allowed travel expenses, including

20 per diem in lieu of subsistence, at rates authorized for

21 employees of agencies under subchapter I of chapter

22 57 of title 5, United States Code, while away from

23 their homes or regular places of business in the per24 formance of services for the Committee.
44

•S 1754 EAH

1 ‘‘(g) FACA.—The Federal Advisory Committee Act

2 shall apply to the Advisory Committee under this section

3 only to the extent that the provisions of such Act do not

4 conflict with the requirements of this section.’’.

5 SEC. 103. INTERDISCIPLINARY, COMMUNITY-BASED LINK6 AGES.

7 Part D of title VII of the Public Health Service Act

8 (42 U.S.C. 294 et seq.) is amended to read as follows:

9 ‘‘PART D—INTERDISCIPLINARY, COMMUNITY10 BASED LINKAGES

11 ‘‘SEC. 750. GENERAL PROVISIONS.

12 ‘‘(a) COLLABORATION.—To be eligible to receive assist13 ance under this part, an academic institution shall use such

14 assistance in collaboration with 2 or more disciplines.

15 ‘‘(b) ACTIVITIES.—An entity shall use assistance under

16 this part to carry out innovative demonstration projects for

17 strategic workforce supplementation activities as needed to

18 meet national goals for interdisciplinary, community-based

19 linkages. Such assistance may be used consistent with this

20 part—

21 ‘‘(1) to develop and support training programs;

22 ‘‘(2) for faculty development;

23 ‘‘(3) for model demonstration programs;

24 ‘‘(4) for the provision of stipends for fellowship

25 trainees;
45

•S 1754 EAH

1 ‘‘(5) to provide technical assistance; and

2 ‘‘(6) for other activities that will produce out3 comes consistent with the purposes of this part.

4 ‘‘SEC. 751. AREA HEALTH EDUCATION CENTERS.

5 ‘‘(a) AUTHORITY FOR PROVISION OF FINANCIAL AS6 SISTANCE.—

7 ‘‘(1) ASSISTANCE FOR PLANNING, DEVELOPMENT,

8 AND OPERATION OF PROGRAMS.—

9 ‘‘(A) IN GENERAL.—The Secretary shall

10 award grants to and enter into contracts with

11 schools of medicine and osteopathic medicine,

12 and incorporated consortia made up of such

13 schools, or the parent institutions of such schools,

14 for projects for the planning, development and

15 operation of area health education center pro16 grams that—

17 ‘‘(i) improve the recruitment, distribu18 tion, supply, quality and efficiency of per19 sonnel providing health services in under20 served rural and urban areas and personnel

21 providing health services to populations

22 having demonstrated serious unmet health

23 care needs;

24 ‘‘(ii) increase the number of primary

25 care physicians and other primary care
46

•S 1754 EAH

1 providers who provide services in under2 served areas through the offering of an edu3 cational continuum of health career recruit4 ment through clinical education concerning

5 underserved areas in a comprehensive

6 health workforce strategy;

7 ‘‘(iii) carry out recruitment and health

8 career awareness programs to recruit indi9 viduals from underserved areas and under10 represented populations, including minority

11 and other elementary or secondary students,

12 into the health professions;

13 ‘‘(iv) prepare individuals to more effec14 tively provide health services to underserved

15 areas or underserved populations through

16 field placements, preceptorships, the conduct

17 of or support of community-based primary

18 care residency programs, and agreements

19 with community-based organizations such

20 as community health centers, migrant

21 health centers, Indian health centers, public

22 health departments and others;

23 ‘‘(v) conduct health professions edu24 cation and training activities for students
47

•S 1754 EAH

1 of health professions schools and medical

2 residents;

3 ‘‘(vi) conduct at least 10 percent of

4 medical student required clinical education

5 at sites remote to the primary teaching fa6 cility of the contracting institution; and

7 ‘‘(vii) provide information dissemina8 tion and educational support to reduce pro9 fessional isolation, increase retention,

10 enhance the practice environment, and im11 prove health care through the timely dis12 semination of research findings using rel13 evant resources.

14 ‘‘(B) OTHER ELIGIBLE ENTITIES.—With re15 spect to a State in which no area health edu16 cation center program is in operation, the Sec17 retary may award a grant or contract under

18 subparagraph (A) to a school of nursing.

19 ‘‘(C) PROJECT TERMS.—

20 ‘‘(i) IN GENERAL.—Except as provided

21 in clause (ii), the period during which pay22 ments may be made under an award under

23 subparagraph (A) may not exceed—

24 ‘‘(I) in the case of a project, 12

25 years or
48

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1 ‘‘(II) in the case of a center with2 in a project, 6 years.

3 ‘‘(ii) EXCEPTION.—The periods de4 scribed in clause (i) shall not apply to

5 projects that have completed the initial pe6 riod of Federal funding under this section

7 and that desire to compete for model awards

8 under paragraph (2)(A).

9 ‘‘(2) ASSISTANCE FOR OPERATION OF MODEL

10 PROGRAMS.—

11 ‘‘(A) IN GENERAL.—In the case of any en12 tity described in paragraph (1)(A) that—

13 ‘‘(i) has previously received funds

14 under this section;

15 ‘‘(ii) is operating an area health edu16 cation center program; and

17 ‘‘(iii) is no longer receiving financial

18 assistance under paragraph (1);

19 the Secretary may provide financial assistance

20 to such entity to pay the costs of operating and

21 carrying out the requirements of the program as

22 described in paragraph (1).

23 ‘‘(B) MATCHING REQUIREMENT.—With re24 spect to the costs of operating a model program

25 under subparagraph (A), an entity, to be eligible
49

•S 1754 EAH

1 for financial assistance under subparagraph (A),

2 shall make available (directly or through con3 tributions from State, county or municipal gov4 ernments, or the private sector) recurring non5 Federal contributions in cash toward such costs

6 in an amount that is equal to not less than 50

7 percent of such costs.

8 ‘‘(C) LIMITATION.—The aggregate amount

9 of awards provided under subparagraph (A) to

10 entities in a State for a fiscal year may not ex11 ceed the lesser of—

12 ‘‘(i) $2,000,000; or

13 ‘‘(ii) an amount equal to the product

14 of $250,000 and the aggregate number of

15 area health education centers operated in

16 the State by such entities.

17 ‘‘(b) REQUIREMENTS FOR CENTERS.—

18 ‘‘(1) GENERAL REQUIREMENT.—Each area

19 health education center that receives funds under this

20 section shall encourage the regionalization of health

21 professions schools through the establishment of part22 nerships with community-based organizations.

23 ‘‘(2) SERVICE AREA.—Each area health edu24 cation center that receives funds under this section

25 shall specifically designate a geographic area or medi-
50

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1 cally underserved population to be served by the cen2 ter. Such area or population shall be in a location re3 moved from the main location of the teaching facili4 ties of the schools participating in the program with

5 such center.

6 ‘‘(3) OTHER REQUIREMENTS.—Each area health

7 education center that receives funds under this section

8 shall—

9 ‘‘(A) assess the health personnel needs of the

10 area to be served by the center and assist in the

11 planning and development of training programs

12 to meet such needs;

13 ‘‘(B) arrange and support rotations for stu14 dents and residents in family medicine, general

15 internal medicine or general pediatrics, with at

16 least one center in each program being affiliated

17 with or conducting a rotating osteopathic intern18 ship or medical residency training program in

19 family medicine (including geriatrics), general

20 internal medicine (including geriatrics), or gen21 eral pediatrics in which no fewer than 4 individ22 uals are enrolled in first-year positions;

23 ‘‘(C) conduct and participate in inter24 disciplinary training that involves physicians

25 and other health personnel including, where
51

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1 practicable, public health professionals, physi2 cian assistants, nurse practitioners, nurse mid3 wives, and behavioral and mental health provid4 ers; and

5 ‘‘(D) have an advisory board, at least 75

6 percent of the members of which shall be individ7 uals, including both health service providers and

8 consumers, from the area served by the center.

9 ‘‘(c) CERTAIN PROVISIONS REGARDING FUNDING.—

10 ‘‘(1) ALLOCATION TO CENTER.—Not less than 75

11 percent of the total amount of Federal funds provided

12 to an entity under this section shall be allocated by

13 an area health education center program to the area

14 health education center. Such entity shall enter into

15 an agreement with each center for purposes of specify16 ing the allocation of such 75 percent of funds.

17 ‘‘(2) OPERATING COSTS.—With respect to the op18 erating costs of the area health education center pro19 gram of an entity receiving funds under this section,

20 the entity shall make available (directly or through

21 contributions from State, county or municipal gov22 ernments, or the private sector) non-Federal contribu23 tions in cash toward such costs in an amount that is

24 equal to not less than 50 percent of such costs, except

25 that the Secretary may grant a waiver for up to 75
52

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1 percent of the amount of the required non-Federal

2 match in the first 3 years in which an entity receives

3 funds under this section.

4 ‘‘SEC. 752. HEALTH EDUCATION AND TRAINING CENTERS.

5 ‘‘(a) IN GENERAL.—To be eligible for funds under this

6 section, a health education training center shall be an en7 tity otherwise eligible for funds under section 751 that—

8 ‘‘(1) addresses the persistent and severe unmet

9 health care needs in States along the border between

10 the United States and Mexico and in the State of

11 Florida, and in other urban and rural areas with

12 populations with serious unmet health care needs;

13 ‘‘(2) establishes an advisory board comprised of

14 health service providers, educators and consumers

15 from the service area;

16 ‘‘(3) conducts training and education programs

17 for health professions students in these areas;

18 ‘‘(4) conducts training in health education serv19 ices, including training to prepare community health

20 workers; and

21 ‘‘(5) supports health professionals (including

22 nursing) practicing in the area through educational

23 and other services.

24 ‘‘(b) ALLOCATION OF FUNDS.—The Secretary shall

25 make available 50 percent of the amounts appropriated for
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1 each fiscal year under section 752 for the establishment or

2 operation of health education training centers through

3 projects in States along the border between the United

4 States and Mexico and in the State of Florida.

5 ‘‘SEC. 753. EDUCATION AND TRAINING RELATING TO GERI6 ATRICS.

7 ‘‘(a) GERIATRIC EDUCATION CENTERS.—

8 ‘‘(1) IN GENERAL.—The Secretary shall award

9 grants or contracts under this section to entities de10 scribed in paragraphs (1), (3), or (4) of section 799B,

11 and section 853(2), for the establishment or operation

12 of geriatric education centers.

13 ‘‘(2) REQUIREMENTS.—A geriatric education

14 center is a program that—

15 ‘‘(A) improves the training of health profes16 sionals in geriatrics, including geriatric

17 residencies, traineeships, or fellowships;

18 ‘‘(B) develops and disseminates curricula

19 relating to the treatment of the health problems

20 of elderly individuals;

21 ‘‘(C) supports the training and retraining

22 of faculty to provide instruction in geriatrics;

23 ‘‘(D) supports continuing education of

24 health professionals who provide geriatric care;

25 and
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•S 1754 EAH

1 ‘‘(E) provides students with clinical train2 ing in geriatrics in nursing homes, chronic and

3 acute disease hospitals, ambulatory care centers,

4 and senior centers.

5 ‘‘(b) GERIATRIC TRAINING REGARDING PHYSICIANS

6 AND DENTISTS.—

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

8 grants to, and enter into contracts with, schools of

9 medicine, schools of osteopathic medicine, teaching

10 hospitals, and graduate medical education programs,

11 for the purpose of providing support (including

12 residencies, traineeships, and fellowships) for geriatric

13 training projects to train physicians, dentists and be14 havioral and mental health professionals who plan to

15 teach geriatric medicine, geriatric behavioral or men16 tal health, or geriatric dentistry.

17 ‘‘(2) REQUIREMENTS.—Each project for which a

18 grant or contract is made under this subsection

19 shall—

20 ‘‘(A) be staffed by full-time teaching physi21 cians who have experience or training in geri22 atric medicine or geriatric behavioral or mental

23 health;

24 ‘‘(B) be staffed, or enter into an agreement

25 with an institution staffed by full-time or part-
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•S 1754 EAH

1 time teaching dentists who have experience or

2 training in geriatric dentistry;

3 ‘‘(C) be staffed, or enter into an agreement

4 with an institution staffed by full-time or part5 time teaching behavioral mental health profes6 sionals who have experience or training in geri7 atric behavioral or mental health;

8 ‘‘(D) be based in a graduate medical edu9 cation program in internal medicine or family

10 medicine or in a department of geriatrics or be11 havioral or mental health;

12 ‘‘(E) provide training in geriatrics and ex13 posure to the physical and mental disabilities of

14 elderly individuals through a variety of service

15 rotations, such as geriatric consultation services,

16 acute care services, dental services, geriatric be17 havioral or mental health units, day and home

18 care programs, rehabilitation services, extended

19 care facilities, geriatric ambulatory care and

20 comprehensive evaluation units, and community

21 care programs for elderly mentally retarded in22 dividuals; and

23 ‘‘(F) provide training in geriatrics through

24 one or both of the training options described in

25 subparagraphs (A) and (B) of paragraph (3).
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1 ‘‘(3) TRAINING OPTIONS.—The training options

2 referred to in subparagraph (F) of paragraph (2)

3 shall be as follows:

4 ‘‘(A) A 1-year retraining program in geri5 atrics for—

6 ‘‘(i) physicians who are faculty mem7 bers in departments of internal medicine,

8 family medicine, gynecology, geriatrics, and

9 behavioral or mental health at schools of

10 medicine and osteopathic medicine;

11 ‘‘(ii) dentists who are faculty members

12 at schools of dentistry or at hospital depart13 ments of dentistry; and

14 ‘‘(iii) behavioral or mental health pro15 fessionals who are faculty members in de16 partments of behavioral or mental health;

17 and

18 ‘‘(B) A 2-year internal medicine or family

19 medicine fellowship program providing emphasis

20 in geriatrics, which shall be designed to provide

21 training in clinical geriatrics and geriatrics re22 search for—

23 ‘‘(i) physicians who have completed

24 graduate medical education programs in in25 ternal medicine, family medicine, behav-
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•S 1754 EAH

1 ioral or mental health, neurology, gyne2 cology, or rehabilitation medicine;

3 ‘‘(ii) dentists who have demonstrated a

4 commitment to an academic career and who

5 have completed postdoctoral dental training,

6 including postdoctoral dental education pro7 grams or who have relevant advanced train8 ing or experience; and

9 ‘‘(iii) behavioral or mental health pro10 fessionals who have completed graduate

11 medical education programs in behavioral

12 or mental health.

13 ‘‘(4) DEFINITIONS.—For purposes of this sub14 section:

15 ‘‘(A) The term ‘graduate medical education

16 program’ means a program sponsored by a

17 school of medicine, a school of osteopathic medi18 cine, a hospital, or a public or private institu19 tion that—

20 ‘‘(i) offers postgraduate medical train21 ing in the specialties and subspecialties of

22 medicine; and

23 ‘‘(ii) has been accredited by the Accred24 itation Council for Graduate Medical Edu25 cation or the American Osteopathic Associa-
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•S 1754 EAH

1 tion through its Committee on Postdoctoral

2 Training.

3 ‘‘(B) The term ‘post-doctoral dental edu4 cation program’ means a program sponsored by

5 a school of dentistry, a hospital, or a public or

6 private institution that—

7 ‘‘(i) offers post-doctoral training in the

8 specialties of dentistry, advanced education

9 in general dentistry, or a dental general

10 practice residency; and

11 ‘‘(ii) has been accredited by the Com12 mission on Dental Accreditation.

13 ‘‘(c) GERIATRIC FACULTY FELLOWSHIPS.—

14 ‘‘(1) ESTABLISHMENT OF PROGRAM.—The Sec15 retary shall establish a program to provide Geriatric

16 Academic Career Awards to eligible individuals to

17 promote the career development of such individuals as

18 academic geriatricians.

19 ‘‘(2) ELIGIBLE INDIVIDUALS.—To be eligible to

20 receive an Award under paragraph (1), an individual

21 shall—

22 ‘‘(A) be board certified or board eligible in

23 internal medicine, family practice, or psychia24 try;
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•S 1754 EAH

1 ‘‘(B) have completed an approved fellowship

2 program in geriatrics; and

3 ‘‘(C) have a junior faculty appointment at

4 an accredited (as determined by the Secretary)

5 school of medicine or osteopathic medicine.

6 ‘‘(3) LIMITATIONS.—No Award under paragraph

7 (1) may be made to an eligible individual unless the

8 individual—

9 ‘‘(A) has submitted to the Secretary an ap10 plication, at such time, in such manner, and

11 containing such information as the Secretary

12 may require, and the Secretary has approved

13 such application; and

14 ‘‘(B) provides, in such form and manner as

15 the Secretary may require, assurances that the

16 individual will meet the service requirement de17 scribed in subsection (e).

18 ‘‘(4) AMOUNT AND TERM.—

19 ‘‘(A) AMOUNT.—The amount of an Award

20 under this section shall equal $50,000 for fiscal

21 year 1998, adjusted for subsequent fiscal years to

22 reflect the increase in the Consumer Price Index.

23 ‘‘(B) TERM.—The term of any Award made

24 under this subsection shall not exceed 5 years.
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•S 1754 EAH

1 ‘‘(5) SERVICE REQUIREMENT.—An individual

2 who receives an Award under this subsection shall

3 provide training in clinical geriatrics, including the

4 training of interdisciplinary teams of health care pro5 fessionals. The provision of such training shall con6 stitute at least 75 percent of the obligations of such

7 individual under the Award.

8 ‘‘SEC. 754. QUENTIN N. BURDICK PROGRAM FOR RURAL

9 INTERDISCIPLINARY TRAINING.

10 ‘‘(a) GRANTS.—The Secretary may make grants or

11 contracts under this section to help entities fund authorized

12 activities under an application approved under subsection

13 (c).

14 ‘‘(b) USE OF AMOUNTS.—

15 ‘‘(1) IN GENERAL.—Amounts provided under

16 subsection (a) shall be used by the recipients to fund

17 interdisciplinary training projects designed to—

18 ‘‘(A) use new and innovative methods to

19 train health care practitioners to provide services

20 in rural areas;

21 ‘‘(B) demonstrate and evaluate innovative

22 interdisciplinary methods and models designed

23 to provide access to cost-effective comprehensive

24 health care;
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•S 1754 EAH

1 ‘‘(C) deliver health care services to individ2 uals residing in rural areas;

3 ‘‘(D) enhance the amount of relevant re4 search conducted concerning health care issues in

5 rural areas; and

6 ‘‘(E) increase the recruitment and retention

7 of health care practitioners from rural areas and

8 make rural practice a more attractive career

9 choice for health care practitioners.

10 ‘‘(2) METHODS.—A recipient of funds under sub11 section (a) may use various methods in carrying out

12 the projects described in paragraph (1), including—

13 ‘‘(A) the distribution of stipends to students

14 of eligible applicants;

15 ‘‘(B) the establishment of a post-doctoral fel16 lowship program;

17 ‘‘(C) the training of faculty in the economic

18 and logistical problems confronting rural health

19 care delivery systems; or

20 ‘‘(D) the purchase or rental of transpor21 tation and telecommunication equipment where

22 the need for such equipment due to unique char23 acteristics of the rural area is demonstrated by

24 the recipient.

25 ‘‘(3) ADMINISTRATION.—
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•S 1754 EAH

1 ‘‘(A) IN GENERAL.—An applicant shall not

2 use more than 10 percent of the funds made

3 available to such applicant under subsection (a)

4 for administrative expenses.

5 ‘‘(B) TRAINING.—Not more than 10 percent

6 of the individuals receiving training with funds

7 made available to an applicant under subsection

8 (a) shall be trained as doctors of medicine or

9 doctors of osteopathy.

10 ‘‘(C) LIMITATION.—An institution that re11 ceives a grant under this section shall use

12 amounts received under such grant to supple13 ment, not supplant, amounts made available by

14 such institution for activities of the type de15 scribed in subsection (b)(1) in the fiscal year

16 preceding the year for which the grant is re17 ceived.

18 ‘‘(c) APPLICATIONS.—Applications submitted for as19 sistance under this section shall—

20 ‘‘(1) be jointly submitted by at least two eligible

21 applicants with the express purpose of assisting indi22 viduals in academic institutions in establishing long23 term collaborative relationships with health care pro24 viders in rural areas; and
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•S 1754 EAH

1 ‘‘(2) designate a rural health care agency or

2 agencies for clinical treatment or training, including

3 hospitals, community health centers, migrant health

4 centers, rural health clinics, community behavioral

5 and mental health centers, long-term care facilities,

6 Native Hawaiian health centers, or facilities operated

7 by the Indian Health Service or an Indian tribe or

8 tribal organization or Indian organization under a

9 contract with the Indian Health Service under the In10 dian Self-Determination Act.

11 ‘‘(d) DEFINITIONS.—For the purposes of this section,

12 the term ‘rural’ means geographic areas that are located

13 outside of standard metropolitan statistical areas.

14 ‘‘SEC. 755. ALLIED HEALTH AND OTHER DISCIPLINES.

15 ‘‘(a) IN GENERAL.—The Secretary may make grants

16 or contracts under this section to help entities fund activi17 ties of the type described in subsection (b).

18 ‘‘(b) ACTIVITIES.—Activities of the type described in

19 this subsection include the following:

20 ‘‘(1) Assisting entities in meeting the costs asso21 ciated with expanding or establishing programs that

22 will increase the number of individuals trained in al23 lied health professions. Programs and activities fund24 ed under this paragraph may include—
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•S 1754 EAH

1 ‘‘(A) those that expand enrollments in allied

2 health professions with the greatest shortages or

3 whose services are most needed by the elderly;

4 ‘‘(B) those that provide rapid transition

5 training programs in allied health fields to indi6 viduals who have baccalaureate degrees in

7 health-related sciences;

8 ‘‘(C) those that establish community-based

9 allied health training programs that link aca10 demic centers to rural clinical settings;

11 ‘‘(D) those that provide career advancement

12 training for practicing allied health profes13 sionals;

14 ‘‘(E) those that expand or establish clinical

15 training sites for allied health professionals in

16 medically underserved or rural communities in

17 order to increase the number of individuals

18 trained;

19 ‘‘(F) those that develop curriculum that will

20 emphasize knowledge and practice in the areas of

21 prevention and health promotion, geriatrics,

22 long-term care, home health and hospice care,

23 and ethics;

24 ‘‘(G) those that expand or establish inter25 disciplinary training programs that promote the
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•S 1754 EAH

1 effectiveness of allied health practitioners in geri2 atric assessment and the rehabilitation of the el3 derly;

4 ‘‘(H) those that expand or establish dem5 onstration centers to emphasize innovative mod6 els to link allied health clinical practice, edu7 cation, and research;

8 ‘‘(I) those that provide financial assistance

9 (in the form of traineeships) to students who are

10 participants in any such program; and

11 ‘‘(i) who plan to pursue a career in an

12 allied health field that has a demonstrated

13 personnel shortage; and

14 ‘‘(ii) who agree upon completion of the

15 training program to practice in a medically

16 underserved community;

17 that shall be utilized to assist in the payment of

18 all or part of the costs associated with tuition,

19 fees and such other stipends as the Secretary

20 may consider necessary; and

21 ‘‘(J) those to meet the costs of projects to

22 plan, develop, and operate or maintain graduate

23 programs in behavioral and mental health prac24 tice.
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•S 1754 EAH

1 ‘‘(2) Planning and implementing projects in pre2 ventive and primary care training for podiatric phy3 sicians in approved or provisionally approved resi4 dency programs that shall provide financial assist5 ance in the form of traineeships to residents who par6 ticipate in such projects and who plan to specialize

7 in primary care.

8 ‘‘(3) Carrying out demonstration projects in

9 which chiropractors and physicians collaborate to

10 identify and provide effective treatment for spinal

11 and lower-back conditions.

12 ‘‘SEC. 756. ADVISORY COMMITTEE ON INTERDISCIPLINARY,

13 COMMUNITY-BASED LINKAGES.

14 ‘‘(a) ESTABLISHMENT.—The Secretary shall establish

15 an advisory committee to be known as the Advisory Com16 mittee on Interdisciplinary, Community-Based Linkages

17 (in this section referred to as the ‘Advisory Committee’).

18 ‘‘(b) COMPOSITION.—

19 ‘‘(1) IN GENERAL.—The Secretary shall deter20 mine the appropriate number of individuals to serve

21 on the Advisory Committee. Such individuals shall

22 not be officers or employees of the Federal Govern23 ment.

24 ‘‘(2) APPOINTMENT.—Not later than 90 days

25 after the date of enactment of this Act, the Secretary
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•S 1754 EAH

1 shall appoint the members of the Advisory Committee

2 from among individuals who are health professionals

3 from schools of the types described in sections

4 751(a)(1)(A), 751(a)(1)(B), 753(b), 754(3)(A), and

5 755(b). In making such appointments, the Secretary

6 shall ensure a fair balance between the health profes7 sions, that at least 75 percent of the members of the

8 Advisory Committee are health professionals, a broad

9 geographic representation of members and a balance

10 between urban and rural members. Members shall be

11 appointed based on their competence, interest, and

12 knowledge of the mission of the profession involved.

13 ‘‘(3) MINORITY REPRESENTATION.—In appoint14 ing the members of the Advisory Committee under

15 paragraph (2), the Secretary shall ensure the ade16 quate representation of women and minorities.

17 ‘‘(c) TERMS.—

18 ‘‘(1) IN GENERAL.—A member of the Advisory

19 Committee shall be appointed for a term of 3 years,

20 except that of the members first appointed—

‘‘(A) 1 21 ⁄3 of the members shall serve for a

22 term of 1 year;

‘‘(B) 1 23 ⁄3 of the members shall serve for a

24 term of 2 years; and
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‘‘(C) 1 1 ⁄3 of the members shall serve for a

2 term of 3 years.

3 ‘‘(2) VACANCIES.—

4 ‘‘(A) IN GENERAL.—A vacancy on the Advi5 sory Committee shall be filled in the manner in

6 which the original appointment was made and

7 shall be subject to any conditions which applied

8 with respect to the original appointment.

9 ‘‘(B) FILLING UNEXPIRED TERM.—An indi10 vidual chosen to fill a vacancy shall be ap11 pointed for the unexpired term of the member re12 placed.

13 ‘‘(d) DUTIES.—The Advisory Committee shall—

14 ‘‘(1) provide advice and recommendations to the

15 Secretary concerning policy and program develop16 ment and other matters of significance concerning the

17 activities under this part; and

18 ‘‘(2) not later than 3 years after the date of en19 actment of this section, and annually thereafter, pre20 pare and submit to the Secretary, and the Committee

21 on Labor and Human Resources of the Senate, and

22 the Committee on Commerce of the House of Rep23 resentatives, a report describing the activities of the

24 Committee, including findings and recommendations
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1 made by the Committee concerning the activities

2 under this part.

3 ‘‘(e) MEETINGS AND DOCUMENTS.—

4 ‘‘(1) MEETINGS.—The Advisory Committee shall

5 meet not less than 3 times each year. Such meetings

6 shall be held jointly with other related entities estab7 lished under this title where appropriate.

8 ‘‘(2) DOCUMENTS.—Not later than 14 days prior

9 to the convening of a meeting under paragraph (1),

10 the Advisory Committee shall prepare and make

11 available an agenda of the matters to be considered by

12 the Advisory Committee at such meeting. At any such

13 meeting, the Advisory Council shall distribute mate14 rials with respect to the issues to be addressed at the

15 meeting. Not later than 30 days after the adjourning

16 of such a meeting, the Advisory Committee shall pre17 pare and make available a summary of the meeting

18 and any actions taken by the Committee based upon

19 the meeting.

20 ‘‘(f) COMPENSATION AND EXPENSES.—

21 ‘‘(1) COMPENSATION.—Each member of the Advi22 sory Committee shall be compensated at a rate equal

23 to the daily equivalent of the annual rate of basic pay

24 prescribed for level IV of the Executive Schedule

25 under section 5315 of title 5, United States Code, for
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1 each day (including travel time) during which such

2 member is engaged in the performance of the duties

3 of the Committee.

4 ‘‘(2) EXPENSES.—The members of the Advisory

5 Committee shall be allowed travel expenses, including

6 per diem in lieu of subsistence, at rates authorized for

7 employees of agencies under subchapter I of chapter

8 57 of title 5, United States Code, while away from

9 their homes or regular places of business in the per10 formance of services for the Committee.

11 ‘‘(g) FACA.—The Federal Advisory Committee Act

12 shall apply to the Advisory Committee under this section

13 only to the extent that the provisions of such Act do not

14 conflict with the requirements of this section.

15 ‘‘SEC. 757. AUTHORIZATION OF APPROPRIATIONS.

16 ‘‘(a) IN GENERAL.—There are authorized to be appro17 priated to carry out this part, $55,600,000 for fiscal year

18 1998, and such sums as may be necessary for each of the

19 fiscal years 1999 through 2002.

20 ‘‘(b) ALLOCATION.—

21 ‘‘(1) IN GENERAL.—Of the amounts appro22 priated under subsection (a) for a fiscal year, the Sec23 retary shall make available—

24 ‘‘(A) not less than $28,587,000 for awards

25 of grants and contracts under section 751;
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1 ‘‘(B) not less than $3,765,000 for awards of

2 grants and contracts under section 752, of which

3 not less than 50 percent of such amount shall be

4 made available for centers described in sub5 section (a)(1) of such section; and

6 ‘‘(C) not less than $22,631,000 for awards

7 of grants and contracts under sections 753, 754,

8 and 755.

9 ‘‘(2) RATABLE REDUCTION.—If amounts appro10 priated under subsection (a) for any fiscal year are

11 less than the amount required to comply with para12 graph (1), the Secretary shall ratably reduce the

13 amount to be made available under each of subpara14 graphs (A) through (C) of such paragraph accord15 ingly.

16 ‘‘(3) INCREASE IN AMOUNTS.—If amounts appro17 priated for a fiscal year under subsection (a) exceed

18 the amount authorized under such subsection for such

19 fiscal year, the Secretary may increase the amount to

20 be made available for programs and activities under

21 this part without regard to the amounts specified in

22 each of subparagraphs (A) through (C) of paragraph

23 (2).

24 ‘‘(c) OBLIGATION OF CERTAIN AMOUNTS.—
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1 ‘‘(1) AREA HEALTH EDUCATION CENTER PRO2 GRAMS.—Of the amounts made available under sub3 section (b)(1)(A) for each fiscal year, the Secretary

4 may obligate for awards under section 751(a)(2)—

5 ‘‘(A) not less than 23 percent of such

6 amounts in fiscal year 1998;

7 ‘‘(B) not less than 30 percent of such

8 amounts in fiscal year 1999;

9 ‘‘(C) not less than 35 percent of such

10 amounts in fiscal year 2000;

11 ‘‘(D) not less than 40 percent of such

12 amounts in fiscal year 2001; and

13 ‘‘(E) not less than 45 percent of such

14 amounts in fiscal year 2002.

15 ‘‘(2) SENSE OF CONGRESS.—It is the sense of the

16 Congress that—

17 ‘‘(A) every State have an area health edu18 cation center program in effect under this sec19 tion; and

20 ‘‘(B) the ratio of Federal funding for the

21 model program under section 751(a)(2) should

22 increase over time and that Federal funding for

23 other awards under this section shall decrease so

24 that the national program will become entirely
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1 comprised of programs that are funded at least

2 50 percent by State and local partners.’’.

3 SEC. 104. HEALTH PROFESSIONS WORKFORCE INFORMA4 TION AND ANALYSIS.

5 (a) IN GENERAL.—Part E of title VII of the Public

6 Health Service Act (42 U.S.C. 294n et seq.) is amended to

7 read as follows:

8 ‘‘PART E—HEALTH PROFESSIONS AND PUBLIC

9 HEALTH WORKFORCE

10 ‘‘Subpart 1—Health Professions Workforce

11 Information and Analysis

12 ‘‘SEC. 761. HEALTH PROFESSIONS WORKFORCE INFORMA13 TION AND ANALYSIS.

14 ‘‘(a) PURPOSE.—It is the purpose of this section to—

15 ‘‘(1) provide for the development of information

16 describing the health professions workforce and the

17 analysis of workforce related issues; and

18 ‘‘(2) provide necessary information for decision19 making regarding future directions in health profes20 sions and nursing programs in response to societal

21 and professional needs.

22 ‘‘(b) GRANTS OR CONTRACTS.—The Secretary may

23 award grants or contracts to State or local governments,

24 health professions schools, schools of nursing, academic

25 health centers, community-based health facilities, and other
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1 appropriate public or private nonprofit entities to provide

2 for—

3 ‘‘(1) targeted information collection and analysis

4 activities related to the purposes described in sub5 section (a);

6 ‘‘(2) research on high priority workforce ques7 tions;

8 ‘‘(3) the development of a non-Federal analytic

9 and research infrastructure related to the purposes de10 scribed in subsection (a); and

11 ‘‘(4) the conduct of program evaluation and as12 sessment.

13 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—

14 ‘‘(1) IN GENERAL.—There are authorized to be

15 appropriated to carry out this section, $750,000 for

16 fiscal year 1998, and such sums as may be necessary

17 for each of the fiscal years 1999 through 2002.

18 ‘‘(2) RESERVATION.—Of the amounts appro19 priated under subsection (a) for a fiscal year, the Sec20 retary shall reserve not less than $600,000 for con21 ducting health professions research and for carrying

22 out data collection and analysis in accordance with

23 section 792.

24 ‘‘(3) AVAILABILITY OF ADDITIONAL FUNDS.—

25 Amounts otherwise appropriated for programs or ac-
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1 tivities under this title may be used for activities

2 under subsection (b) with respect to the programs or

3 activities from which such amounts were made avail4 able.’’.

5 (b) COUNCIL ON GRADUATE MEDICAL EDUCATION.—

6 Section 301 of the Health Professions Education Extension

7 Amendments of 1992 (Public Law 102–408) is amended—

8 (1) in subsection (j), by striking ‘‘1995’’ and in9 serting ‘‘2002’’;

10 (2) in subsection (k), by striking ‘‘1995’’ and in11 serting ‘‘2002’’;

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

13 new subsection:

14 ‘‘(l) FUNDING.—Amounts otherwise appropriated

15 under this title may be utilized by the Secretary to support

16 the activities of the Council.’’;

17 (4) by transferring such section to part E of title

18 VII of the Public Health Service Act (as amended by

19 subsection (a));

20 (5) by redesignating such section as section 762;

21 and

22 (6) by inserting such section after section 761.
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1 SEC. 105. PUBLIC HEALTH WORKFORCE DEVELOPMENT.

2 Part E of title VII of the Public Health Service Act

3 (as amended by section 104) is further amended by adding

4 at the end the following:

5 ‘‘Subpart 2—Public Health Workforce

6 ‘‘SEC. 765. GENERAL PROVISIONS.

7 ‘‘(a) IN GENERAL.—The Secretary may award grants

8 or contracts to eligible entities to increase the number of

9 individuals in the public health workforce, to enhance the

10 quality of such workforce, and to enhance the ability of the

11 workforce to meet national, State, and local health care

12 needs.

13 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant

14 or contract under subsection (a) an entity shall—

15 ‘‘(1) be—

16 ‘‘(A) a health professions school, including

17 an accredited school or program of public health,

18 health administration, preventive medicine, or

19 dental public health or a school providing health

20 management programs;

21 ‘‘(B) an academic health center;

22 ‘‘(C) a State or local government; or

23 ‘‘(D) any other appropriate public or pri24 vate nonprofit entity; and
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1 ‘‘(2) prepare and submit to the Secretary an ap2 plication at such time, in such manner, and contain3 ing such information as the Secretary may require.

4 ‘‘(c) PREFERENCE.—In awarding grants or contracts

5 under this section the Secretary may grant a preference to

6 entities—

7 ‘‘(1) serving individuals who are from disadvan8 taged backgrounds (including underrepresented racial

9 and ethnic minorities); and

10 ‘‘(2) graduating large proportions of individuals

11 who serve in underserved communities.

12 ‘‘(d) ACTIVITIES.—Amounts provided under a grant or

13 contract awarded under this section may be used for—

14 ‘‘(1) the costs of planning, developing, or operat15 ing demonstration training programs;

16 ‘‘(2) faculty development;

17 ‘‘(3) trainee support;

18 ‘‘(4) technical assistance;

19 ‘‘(5) to meet the costs of projects—

20 ‘‘(A) to plan and develop new residency

21 training programs and to maintain or improve

22 existing residency training programs in preven23 tive medicine and dental public health, that have

24 available full-time faculty members with train-
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1 ing and experience in the fields of preventive

2 medicine and dental public health; and

3 ‘‘(B) to provide financial assistance to resi4 dency trainees enrolled in such programs;

5 ‘‘(6) the retraining of existing public health

6 workers as well as for increasing the supply of new

7 practitioners to address priority public health, pre8 ventive medicine, public health dentistry, and health

9 administration needs;

10 ‘‘(7) preparing public health professionals for

11 employment at the State and community levels; or

12 ‘‘(8) other activities that may produce outcomes

13 that are consistent with the purposes of this section

14 ‘‘(e) TRAINEESHIPS.—

15 ‘‘(1) IN GENERAL.—With respect to amounts

16 used under this section for the training of health pro17 fessionals, such training programs shall be designed

18 to—

19 ‘‘(A) make public health education more ac20 cessible to the public and private health work21 force;

22 ‘‘(B) increase the relevance of public health

23 academic preparation to public health practice

24 in the future;
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1 ‘‘(C) provide education or training for stu2 dents from traditional on-campus programs in

3 practice-based sites; or

4 ‘‘(D) develop educational methods and dis5 tance-based approaches or technology that ad6 dress adult learning requirements and increase

7 knowledge and skills related to community-based

8 cultural diversity in public health education.

9 ‘‘(2) SEVERE SHORTAGE DISCIPLINES.—Amounts

10 provided under grants or contracts under this section

11 may be used for the operation of programs designed

12 to award traineeships to students in accredited

13 schools of public health who enter educational pro14 grams in fields where there is a severe shortage of

15 public health professionals, including epidemiology,

16 biostatistics, environmental health, toxicology, public

17 health nursing, nutrition, preventive medicine, mater18 nal and child health, and behavioral and mental

19 health professions.

20 ‘‘SEC. 766. PUBLIC HEALTH TRAINING CENTERS.

21 ‘‘(a) IN GENERAL.—The Secretary may make grants

22 or contracts for the operation of public health training cen23 ters.

24 ‘‘(b) ELIGIBLE ENTITIES.—
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1 ‘‘(1) IN GENERAL.—A public health training cen2 ter shall be an accredited school of public health, or

3 another public or nonprofit private institution ac4 credited for the provision of graduate or specialized

5 training in public health, that plans, develops, oper6 ates, and evaluates projects that are in furtherance of

7 the goals established by the Secretary for the year

8 2000 in the areas of preventive medicine, health pro9 motion and disease prevention, or improving access to

10 and quality of health services in medically under11 served communities.

12 ‘‘(2) PREFERENCE.—In awarding grants or con13 tracts under this section the Secretary shall give pref14 erence to accredited schools of public health.

15 ‘‘(c) CERTAIN REQUIREMENTS.—With respect to a

16 public health training center, an award may not be made

17 under subsection (a) unless the program agrees that it—

18 ‘‘(1) will establish or strengthen field placements

19 for students in public or nonprofit private health

20 agencies or organizations;

21 ‘‘(2) will involve faculty members and students

22 in collaborative projects to enhance public health serv23 ices to medically underserved communities;

24 ‘‘(3) will specifically designate a geographic area

25 or medically underserved population to be served by
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1 the center that shall be in a location removed from the

2 main location of the teaching facility of the school

3 that is participating in the program with such center;

4 and

5 ‘‘(4) will assess the health personnel needs of the

6 area to be served by the center and assist in the plan7 ning and development of training programs to meet

8 such needs.

9 ‘‘SEC. 767. PUBLIC HEALTH TRAINEESHIPS.

10 ‘‘(a) IN GENERAL.—The Secretary may make grants

11 to accredited schools of public health, and to other public

12 or nonprofit private institutions accredited for the provi13 sion of graduate or specialized training in public health,

14 for the purpose of assisting such schools and institutions

15 in providing traineeships to individuals described in sub16 section (b)(3).

17 ‘‘(b) CERTAIN REQUIREMENTS.—

18 ‘‘(1) AMOUNT.—The amount of any grant under

19 this section shall be determined by the Secretary.

20 ‘‘(2) USE OF GRANT.—Traineeships awarded

21 under grants made under subsection (a) shall provide

22 for tuition and fees and such stipends and allowances

23 (including travel and subsistence expenses and de24 pendency allowances) for the trainees as the Secretary

25 may deem necessary.
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1 ‘‘(3) ELIGIBLE INDIVIDUALS.—The individuals

2 referred to in subsection (a) are individuals who are

3 pursuing a course of study in a health professions

4 field in which there is a severe shortage of health pro5 fessionals (which fields include the fields of epidemiol6 ogy, environmental health, biostatistics, toxicology,

7 nutrition, and maternal and child health).

8 ‘‘SEC. 768. PREVENTIVE MEDICINE; DENTAL PUBLIC

9 HEALTH.

10 ‘‘(a) IN GENERAL.—The Secretary may make grants

11 to and enter into contracts with schools of medicine, osteo12 pathic medicine, public health, and dentistry to meet the

13 costs of projects—

14 ‘‘(1) to plan and develop new residency training

15 programs and to maintain or improve existing resi16 dency training programs in preventive medicine and

17 dental public health; and

18 ‘‘(2) to provide financial assistance to residency

19 trainees enrolled in such programs.

20 ‘‘(b) ADMINISTRATION.—

21 ‘‘(1) AMOUNT.—The amount of any grant under

22 subsection (a) shall be determined by the Secretary.

23 ‘‘(2) ELIGIBILITY.—To be eligible for a grant

24 under subsection (a), the applicant must demonstrate

25 to the Secretary that it has or will have available full-
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1 time faculty members with training and experience in

2 the fields of preventive medicine or dental public

3 health and support from other faculty members

4 trained in public health and other relevant specialties

5 and disciplines.

6 ‘‘(3) OTHER FUNDS.—Schools of medicine, osteo7 pathic medicine, dentistry, and public health may use

8 funds committed by State, local, or county public

9 health officers as matching amounts for Federal grant

10 funds for residency training programs in preventive

11 medicine.

12 ‘‘SEC. 769. HEALTH ADMINISTRATION TRAINEESHIPS AND

13 SPECIAL PROJECTS.

14 ‘‘(a) IN GENERAL.—The Secretary may make grants

15 to State or local governments (that have in effect preventive

16 medical and dental public health residency programs) or

17 public or nonprofit private educational entities (including

18 graduate schools of social work and business schools that

19 have health management programs) that offer a program

20 described in subsection (b)—

21 ‘‘(1) to provide traineeships for students enrolled

22 in such a program; and

23 ‘‘(2) to assist accredited programs health admin24 istration in the development or improvement of pro-
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1 grams to prepare students for employment with pub2 lic or nonprofit private entities.

3 ‘‘(b) RELEVANT PROGRAMS.—The program referred to

4 in subsection (a) is an accredited program in health admin5 istration, hospital administration, or health policy analysis

6 and planning, which program is accredited by a body or

7 bodies approved for such purpose by the Secretary of Edu8 cation and which meets such other quality standards as the

9 Secretary of Health and Human Services by regulation

10 may prescribe.

11 ‘‘(c) PREFERENCE IN MAKING GRANTS.—In making

12 grants under subsection (a), the Secretary shall give pref13 erence to qualified applicants that meet the following condi14 tions:

15 ‘‘(1) Not less than 25 percent of the graduates of

16 the applicant are engaged in full-time practice set17 tings in medically underserved communities.

18 ‘‘(2) The applicant recruits and admits students

19 from medically underserved communities.

20 ‘‘(3) For the purpose of training students, the

21 applicant has established relationships with public

22 and nonprofit providers of health care in the commu23 nity involved.
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1 ‘‘(4) In training students, the applicant empha2 sizes employment with public or nonprofit private en3 tities.

4 ‘‘(d) CERTAIN PROVISIONS REGARDING

5 TRAINEESHIPS.—

6 ‘‘(1) USE OF GRANT.—Traineeships awarded

7 under grants made under subsection (a) shall provide

8 for tuition and fees and such stipends and allowances

9 (including travel and subsistence expenses and de10 pendency allowances) for the trainees as the Secretary

11 may deem necessary.

12 ‘‘(2) PREFERENCE FOR CERTAIN STUDENTS.—

13 Each entity applying for a grant under subsection (a)

14 for traineeships shall assure to the satisfaction of the

15 Secretary that the entity will give priority to award16 ing the traineeships to students who demonstrate a

17 commitment to employment with public or nonprofit

18 private entities in the fields with respect to which the

19 traineeships are awarded.

20 ‘‘SEC. 770. AUTHORIZATION OF APPROPRIATIONS.

21 ‘‘(a) IN GENERAL.—For the purpose of carrying out

22 this subpart, there is authorized to be appropriated

23 $9,100,000 for fiscal year 1998, and such sums as may be

24 necessary for each of the fiscal years 1999 through 2002.
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1 ‘‘(b) LIMITATION REGARDING CERTAIN PROGRAM.—In

2 obligating amounts appropriated under subsection (a), the

3 Secretary may not obligate more than 30 percent for carry4 ing out section 767.’’.

5 SEC. 106. GENERAL PROVISIONS.

6 (a) IN GENERAL.—

7 (1) Part F of title VII of the Public Health Serv8 ice Act (42 U.S.C. 295 et seq.) is repealed.

9 (2) Part G of title VII of the Public Health Serv10 ice Act (42 U.S.C. 295j et seq.) is amended—

11 (A) by redesignating such part as part F;

12 (B) in section 791 (42 U.S.C. 295j)—

13 (i) by striking subsection (b); and

14 (ii) redesignating subsection (c) as sub15 section (b);

16 (C) by repealing section 793 (42 U.S.C.

17 295l);

18 (D) by repealing section 798;

19 (E) by redesignating section 799 as section

20 799B; and

21 (F) by inserting after section 794, the fol22 lowing new sections:

23 ‘‘SEC. 796. APPLICATION.

24 ‘‘(a) IN GENERAL.—To be eligible to receive a grant

25 or contract under this title, an eligible entity shall prepare
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1 and submit to the Secretary an application that meets the

2 requirements of this section, at such time, in such manner,

3 and containing such information as the Secretary may re4 quire.

5 ‘‘(b) PLAN.—An application submitted under this sec6 tion shall contain the plan of the applicant for carrying

7 out a project with amounts received under this title. Such

8 plan shall be consistent with relevant Federal, State, or re9 gional health professions program plans.

10 ‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An ap11 plication submitted under this section shall contain a speci12 fication by the applicant entity of performance outcome

13 standards that the project to be funded under the grant or

14 contract will be measured against. Such standards shall ad15 dress relevant health workforce needs that the project will

16 meet. The recipient of a grant or contract under this section

17 shall meet the standards set forth in the grant or contract

18 application.

19 ‘‘(d) LINKAGES.—An application submitted under this

20 section shall contain a description of the linkages with rel21 evant educational and health care entities, including train22 ing programs for other health professionals as appropriate,

23 that the project to be funded under the grant or contract

24 will establish. To the extent practicable, grantees under this

25 section shall establish linkages with health care providers
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1 who provide care for underserved communities and popu2 lations.

3 ‘‘SEC. 797. USE OF FUNDS.

4 ‘‘(a) IN GENERAL.—Amounts provided under a grant

5 or contract awarded under this title may be used for train6 ing program development and support, faculty develop7 ment, model demonstrations, trainee support including tui8 tion, books, program fees and reasonable living expenses

9 during the period of training, technical assistance, work10 force analysis, dissemination of information, and exploring

11 new policy directions, as appropriate to meet recognized

12 health workforce objectives, in accordance with this title.

13 ‘‘(b) MAINTENANCE OF EFFORT.—With respect to ac14 tivities for which a grant awarded under this title is to

15 be expended, the entity shall agree to maintain expenditures

16 of non-Federal amounts for such activities at a level that

17 is not less than the level of such expenditures maintained

18 by the entity for the fiscal year preceding the fiscal year

19 for which the entity receives such a grant.

20 ‘‘SEC. 798. MATCHING REQUIREMENT.

21 ‘‘The Secretary may require that an entity that ap22 plies for a grant or contract under this title provide non23 Federal matching funds, as appropriate, to ensure the insti24 tutional commitment of the entity to the projects funded

25 under the grant. As determined by the Secretary, such non-
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1 Federal matching funds may be provided directly or

2 through donations from public or private entities and may

3 be in cash or in-kind, fairly evaluated, including plant,

4 equipment, or services.

5 ‘‘SEC. 799. GENERALLY APPLICABLE PROVISIONS.

6 ‘‘(a) AWARDING OF GRANTS AND CONTRACTS.—The

7 Secretary shall ensure that grants and contracts under this

8 title are awarded on a competitive basis, as appropriate,

9 to carry out innovative demonstration projects or provide

10 for strategic workforce supplementation activities as needed

11 to meet health workforce goals and in accordance with this

12 title. Contracts may be entered into under this title with

13 public or private entities as may be necessary.

14 ‘‘(b) ELIGIBLE ENTITIES.—Unless specifically re15 quired otherwise in this title, the Secretary shall accept ap16 plications for grants or contracts under this title from

17 health professions schools, academic health centers, State or

18 local governments, or other appropriate public or private

19 nonprofit entities for funding and participation in health

20 professions and nursing training activities. The Secretary

21 may accept applications from for-profit private entities if

22 determined appropriate by the Secretary.

23 ‘‘(c) INFORMATION REQUIREMENTS.—
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1 ‘‘(1) IN GENERAL.—Recipients of grants and

2 contracts under this title shall meet information re3 quirements as specified by the Secretary.

4 ‘‘(2) DATA COLLECTION.—The Secretary shall es5 tablish procedures to ensure that, with respect to any

6 data collection required under this title, such data is

7 collected in a manner that takes into account age, sex,

8 race, and ethnicity.

9 ‘‘(3) USE OF FUNDS.—The Secretary shall estab10 lish procedures to permit the use of amounts appro11 priated under this title to be used for data collection

12 purposes.

13 ‘‘(4) EVALUATIONS.—The Secretary shall estab14 lish procedures to ensure the annual evaluation of

15 programs and projects operated by recipients of

16 grants or contracts under this title. Such procedures

17 shall ensure that continued funding for such pro18 grams and projects will be conditioned upon a dem19 onstration that satisfactory progress has been made

20 by the program or project in meeting the objectives of

21 the program or project.

22 ‘‘(d) TRAINING PROGRAMS.—Training programs con23 ducted with amounts received under this title shall meet ap24 plicable accreditation and quality standards.

25 ‘‘(e) DURATION OF ASSISTANCE.—
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1 ‘‘(1) IN GENERAL.—Subject to paragraph (2), in

2 the case of an award to an entity of a grant, coopera3 tive agreement, or contract under this title, the period

4 during which payments are made to the entity under

5 the award may not exceed 5 years. The provision of

6 payments under the award shall be subject to annual

7 approval by the Secretary of the payments and sub8 ject to the availability of appropriations for the fiscal

9 year involved to make the payments. This paragraph

10 may not be construed as limiting the number of

11 awards under the program involved that may be

12 made to the entity.

13 ‘‘(2) LIMITATION.—In the case of an award to

14 an entity of a grant, cooperative agreement, or con15 tract under this title, paragraph (1) shall apply only

16 to the extent not inconsistent with any other provi17 sion of this title that relates to the period during

18 which payments may be made under the award.

19 ‘‘(f) PEER REVIEW REGARDING CERTAIN PRO20 GRAMS.—

21 ‘‘(1) IN GENERAL.—Each application for a grant

22 under this title, except any scholarship or loan pro23 gram, including those under sections 701, 721, or 723,

24 shall be submitted to a peer review group for an eval25 uation of the merits of the proposals made in the ap-
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1 plication. The Secretary may not approve such an

2 application unless a peer review group has rec3 ommended the application for approval.

4 ‘‘(2) COMPOSITION.—Each peer review group

5 under this subsection shall be composed principally of

6 individuals who are not officers or employees of the

7 Federal Government. In providing for the establish8 ment of peer review groups and procedures, the Sec9 retary shall ensure sex, racial, ethnic, and geographic

10 balance among the membership of such groups.

11 ‘‘(3) ADMINISTRATION.—This subsection shall be

12 carried out by the Secretary acting through the Ad13 ministrator of the Health Resources and Services Ad14 ministration.

15 ‘‘(g) PREFERENCE OR PRIORITY CONSIDERATIONS.—

16 In considering a preference or priority for funding which

17 is based on outcome measures for an eligible entity under

18 this title, the Secretary may also consider the future ability

19 of the eligible entity to meet the outcome preference or prior20 ity through improvements in the eligible entity’s program

21 design.

22 ‘‘(h) ANALYTIC ACTIVITIES.—The Secretary shall en23 sure that—
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1 ‘‘(1) cross-cutting workforce analytical activities

2 are carried out as part of the workforce information

3 and analysis activities under section 761; and

4 ‘‘(2) discipline-specific workforce information

5 and analytical activities are carried out as part of—

6 ‘‘(A) the community-based linkage program

7 under part D; and

8 ‘‘(B) the health workforce development pro9 gram under subpart 2 of part E.

10 ‘‘(i) OSTEOPATHIC SCHOOLS.—For purposes of this

11 title, any reference to—

12 ‘‘(1) medical schools shall include osteopathic

13 medical schools; and

14 ‘‘(2) medical students shall include osteopathic

15 medical students.

16 ‘‘SEC. 799A. TECHNICAL ASSISTANCE.

17 ‘‘Funds appropriated under this title may be used by

18 the Secretary to provide technical assistance in relation to

19 any of the authorities under this title.’’.

20 (b) PROFESSIONAL COUNSELORS AS MENTAL HEALTH

21 PROFESSIONALS.—Section 792(a) of the Public Health

22 Service Act (42 U.S.C. 295k(a)) is amended by inserting

23 ‘‘professional counselors,’’ after ‘‘clinical psychologists,’’.
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1 SEC. 107. PREFERENCE IN CERTAIN PROGRAMS.

2 (a) IN GENERAL.—Section 791 of the Public Health

3 Service Act (42 U.S.C. 295j), as amended by section

4 105(a)(2)(B), is further amended by adding at the end

5 thereof the following subsection:

6 ‘‘(c) EXCEPTIONS FOR NEW PROGRAMS.—

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

8 compete equitably for funding under this section,

9 those new programs that meet at least 4 of the cri10 teria described in paragraph (3) shall qualify for a

11 funding preference under this section.

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

13 the term ‘new program’ means any program that has

14 graduated less than three classes. Upon graduating at

15 least three classes, a program shall have the capabil16 ity to provide the information necessary to qualify the

17 program for the general funding preferences described

18 in subsection (a).

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

20 paragraph (1) are the following:

21 ‘‘(A) The mission statement of the program

22 identifies a specific purpose of the program as

23 being the preparation of health professionals to

24 serve underserved populations.
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1 ‘‘(B) The curriculum of the program in2 cludes content which will help to prepare practi3 tioners to serve underserved populations.

4 ‘‘(C) Substantial clinical training experi5 ence is required under the program in medically

6 underserved communities.

7 ‘‘(D) A minimum of 20 percent of the clini8 cal faculty of the program spend at least 50 per9 cent of their time providing or supervising care

10 in medically underserved communities.

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

12 portion of the program is physically located in

13 a medically underserved community.

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

15 service in medically underserved communities

16 following graduation, is available to the students

17 in the program.

18 ‘‘(G) The program provides a placement

19 mechanism for deploying graduates to medically

20 underserved communities.’’.

21 (b) CONFORMING AMENDMENTS.—Section 791(a) of

22 the Public Health Service Act (42 U.S.C. 295j(a)) is amend23 ed—
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1 (1) in paragraph (1), by striking ‘‘sections 747’’

2 and all that follows through ‘‘767’’ and inserting ‘‘sec3 tions 747 and 750’’; and

4 (2) in paragraph (2), by striking ‘‘under section

5 798(a)’’.

6 SEC. 108. DEFINITIONS.

7 (a) GRADUATE PROGRAM IN BEHAVIORAL AND MEN8 TAL HEALTH PRACTICE.—Section 799B(1)(D) of the Public

9 Health Service Act (42 U.S.C. 295p(1)(D)) (as so redesig10 nated by section 106(a)(2)(E)) is amended—

11 (1) by inserting ‘‘behavioral health and’’ before

12 ‘‘mental’’; and

13 (2) by inserting ‘‘behavioral health and mental

14 health practice,’’ before ‘‘clinical’’.

15 (b) PROFESSIONAL COUNSELING AS A BEHAVIORAL

16 AND MENTAL HEALTH PRACTICE.—Section 799B of the

17 Public Health Service Act (42 U.S.C. 295p) (as so redesig18 nated by section 106(a)(2)(E)) is amended—

19 (1) in paragraph (1)—

20 (A) in subparagraph (C)—

21 (i) by inserting ‘‘and ‘graduate pro22 gram in professional counseling’ ’’ after

23 ‘‘graduate program in marriage and family

24 therapy’ ’’; and
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1 (ii) by inserting before the period the

2 following: ‘‘and a concentration leading to a

3 graduate degree in counseling’’;

4 (B) in subparagraph (D), by inserting

5 ‘‘professional counseling,’’ after ‘‘social work,’’;

6 and

7 (C) in subparagraph (E), by inserting ‘‘pro8 fessional counseling,’’ after ‘‘social work,’’; and

9 (2) in paragraph (5)(C), by inserting before the

10 period the following: ‘‘or a degree in counseling or an

11 equivalent degree’’.

12 (c) MEDICALLY UNDERSERVED COMMUNITY.—Section

13 799B(6) of the Public Health Service Act (42 U.S.C.

14 295p(6)) (as so redesignated by section 105(a)(2)(E)) is

15 amended—

16 (1) in subparagraph (B), by striking ‘‘or’’ at the

17 end thereof;

18 (2) in subparagraph (C), by striking the period

19 and inserting ‘‘; or’’; and

20 (3) by adding at the end the following:

21 ‘‘(D) is designated by a State Governor (in

22 consultation with the medical community) as a

23 shortage area or medically underserved commu24 nity.’’.
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1 (d) PROGRAMS FOR THE TRAINING OF PHYSICIAN AS2 SISTANTS.—Paragraph (3) of section 799B of the Public

3 Health Service Act (42 U.S.C. 295p) (as so redesignated

4 by section 105(a)(2)(E)) is amended to read as follows:

5 ‘‘(3) The term ‘program for the training of phy6 sician assistants’ means an educational program

7 that—

8 ‘‘(A) has as its objective the education of in9 dividuals who will, upon completion of their

10 studies in the program, be qualified to provide

11 primary care under the supervision of a physi12 cian;

13 ‘‘(B) extends for at least one academic year

14 and consists of—

15 ‘‘(i) supervised clinical practice; and

16 ‘‘(ii) at least four months (in the ag17 gregate) of classroom instruction, directed

18 toward preparing students to deliver health

19 care;

20 ‘‘(C) has an enrollment of not less than

21 eight students; and

22 ‘‘(D) trains students in primary care, dis23 ease prevention, health promotion, geriatric med24 icine, and home health care.’’.
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1 (e) PSYCHOLOGIST.—Section 799B of the Public

2 Health Service Act (42 U.S.C. 295p) (as so redesignated

3 by section 105(a)(2)(E)) is amended by adding at the end

4 the following:

5 ‘‘(11) The term ‘psychologist’ means an individ6 ual who—

7 ‘‘(A) holds a doctoral degree in psychology;

8 and

9 ‘‘(B) is licensed or certified on the basis of

10 the doctoral degree in psychology, by the State in

11 which the individual practices, at the independ12 ent practice level of psychology to furnish diag13 nostic, assessment, preventive, and therapeutic

14 services directly to individuals.’’.

15 SEC. 109. TECHNICAL AMENDMENT ON NATIONAL HEALTH

16 SERVICE CORPS.

17 Section 338B(b)(1)(B) of the Public Health Service Act

18 (42 U.S.C. 254l–1(b)(1)(B)) is amended by striking ‘‘or

19 other health profession’’ and inserting ‘‘behavioral and

20 mental health, or other health profession’’.

21 SEC. 110. SAVINGS PROVISION.

22 In the case of any authority for making awards of

23 grants or contracts that is terminated by the amendments

24 made by this subtitle, the Secretary of Health and Human

25 Services may, notwithstanding the termination of the au-
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1 thority, continue in effect any grant or contract made under

2 the authority that is in effect on the day before the date

3 of the enactment of this Act, subject to the duration of any

4 such grant or contract not exceeding the period determined

5 by the Secretary in first approving such financial assist6 ance, or in approving the most recent request made (before

7 the date of such enactment) for continuation of such assist8 ance, as the case may be.

9 Subtitle B—Nursing Workforce

10 Development

11 SEC. 121. SHORT TITLE.

12 This subtitle may be cited as the ‘‘Nursing Education

13 and Practice Improvement Act of 1998’’.

14 SEC. 122. PURPOSE.

15 It is the purpose of this subtitle to restructure the nurse

16 education authorities of title VIII of the Public Health Serv17 ice Act to permit a comprehensive, flexible, and effective ap18 proach to Federal support for nursing workforce develop19 ment.

20 SEC. 123. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.

21 Title VIII of the Public Health Service Act (42 U.S.C.

22 296k et seq.) is amended—

23 (1) by striking the title heading and all that fol24 lows except for subpart II of part B and sections 846

25 and 855; and inserting the following:
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1 ‘‘TITLE VIII—NURSING

2 WORKFORCE DEVELOPMENT’’;

3 (2) in subpart II of part B, by striking the sub4 part heading and inserting the following:

5 ‘‘PART E—STUDENT LOANS’’;

6 (3) by striking section 837;

7 (4) by inserting after the title heading the follow8 ing new parts:

9 ‘‘PART A—GENERAL PROVISIONS

10 ‘‘SEC. 801. DEFINITIONS.

11 ‘‘As used in this title:

12 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible en13 tities’ means schools of nursing, nursing centers, aca14 demic health centers, State or local governments, and

15 other public or private nonprofit entities determined

16 appropriate by the Secretary that submit to the Sec17 retary an application in accordance with section 802.

18 ‘‘(2) SCHOOL OF NURSING.—The term ‘school of

19 nursing’ means a collegiate, associate degree, or di20 ploma school of nursing in a State.

21 ‘‘(3) COLLEGIATE SCHOOL OF NURSING.—The

22 term ‘collegiate school of nursing’ means a depart23 ment, division, or other administrative unit in a col24 lege or university which provides primarily or exclu25 sively a program of education in professional nursing
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1 and related subjects leading to the degree of bachelor

2 of arts, bachelor of science, bachelor of nursing, or to

3 an equivalent degree, or to a graduate degree in nurs4 ing, or to an equivalent degree, and including ad5 vanced training related to such program of education

6 provided by such school, but only if such program, or

7 such unit, college or university is accredited.

8 ‘‘(4) ASSOCIATE DEGREE SCHOOL OF NURS9 ING.—The term ‘associate degree school of nursing’

10 means a department, division, or other administra11 tive unit in a junior college, community college, col12 lege, or university which provides primarily or exclu13 sively a two-year program of education in profes14 sional nursing and allied subjects leading to an asso15 ciate degree in nursing or to an equivalent degree, but

16 only if such program, or such unit, college, or univer17 sity is accredited.

18 ‘‘(5) DIPLOMA SCHOOL OF NURSING.—The term

19 ‘diploma school of nursing’ means a school affiliated

20 with a hospital or university, or an independent

21 school, which provides primarily or exclusively a pro22 gram of education in professional nursing and allied

23 subjects leading to a diploma or to equivalent indicia

24 that such program has been satisfactorily completed,

25 but only if such program, or such affiliated school or
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1 such hospital or university or such independent school

2 is accredited.

3 ‘‘(6) ACCREDITED.—

4 ‘‘(A) IN GENERAL.—Except as provided in

5 subparagraph (B), the term ‘accredited’ when

6 applied to any program of nurse education

7 means a program accredited by a recognized

8 body or bodies, or by a State agency, approved

9 for such purpose by the Secretary of Education

10 and when applied to a hospital, school, college,

11 or university (or a unit thereof) means a hos12 pital, school, college, or university (or a unit

13 thereof) which is accredited by a recognized body

14 or bodies, or by a State agency, approved for

15 such purpose by the Secretary of Education. For

16 the purpose of this paragraph, the Secretary of

17 Education shall publish a list of recognized ac18 crediting bodies, and of State agencies, which the

19 Secretary of Education determines to be reliable

20 authority as to the quality of education offered.

21 ‘‘(B) NEW PROGRAMS.—A new program of

22 nursing that, by reason of an insufficient period

23 of operation, is not, at the time of the submission

24 of an application for a grant or contract under

25 this title, eligible for accreditation by such a rec-
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1 ognized body or bodies or State agency, shall be

2 deemed accredited for purposes of this title if the

3 Secretary of Education finds, after consultation

4 with the appropriate accreditation body or bod5 ies, that there is reasonable assurance that the

6 program will meet the accreditation standards of

7 such body or bodies prior to the beginning of the

8 academic year following the normal graduation

9 date of students of the first entering class in such

10 a program.

11 ‘‘(7) NONPROFIT.—The term ‘nonprofit’ as ap12 plied to any school, agency, organization, or institu13 tion means one which is a corporation or association,

14 or is owned and operated by one or more corporations

15 or associations, no part of the net earnings of which

16 inures, or may lawfully inure, to the benefit of any

17 private shareholder or individual.

18 ‘‘(8) STATE.—The term ‘State’ means a State,

19 the Commonwealth of Puerto Rico, the District of Co20 lumbia, the Commonwealth of the Northern Mariana

21 Islands, Guam, American Samoa, the Virgin Islands,

22 or the Trust Territory of the Pacific Islands.

23 ‘‘SEC. 802. APPLICATION.

24 ‘‘(a) IN GENERAL.—To be eligible to receive a grant

25 or contract under this title, an eligible entity shall prepare
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1 and submit to the Secretary an application that meets the

2 requirements of this section, at such time, in such manner,

3 and containing such information as the Secretary may re4 quire.

5 ‘‘(b) PLAN.—An application submitted under this sec6 tion shall contain the plan of the applicant for carrying

7 out a project with amounts received under this title. Such

8 plan shall be consistent with relevant Federal, State, or re9 gional program plans.

10 ‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An ap11 plication submitted under this section shall contain a speci12 fication by the applicant entity of performance outcome

13 standards that the project to be funded under the grant or

14 contract will be measured against. Such standards shall ad15 dress relevant national nursing needs that the project will

16 meet. The recipient of a grant or contract under this section

17 shall meet the standards set forth in the grant or contract

18 application.

19 ‘‘(d) LINKAGES.—An application submitted under this

20 section shall contain a description of the linkages with rel21 evant educational and health care entities, including train22 ing programs for other health professionals as appropriate,

23 that the project to be funded under the grant or contract

24 will establish.
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1 ‘‘SEC. 803. USE OF FUNDS.

2 ‘‘(a) IN GENERAL.—Amounts provided under a grant

3 or contract awarded under this title may be used for train4 ing program development and support, faculty develop5 ment, model demonstrations, trainee support including tui6 tion, books, program fees and reasonable living expenses

7 during the period of training, technical assistance, work8 force analysis, and dissemination of information, as appro9 priate to meet recognized nursing objectives, in accordance

10 with this title.

11 ‘‘(b) MAINTENANCE OF EFFORT.—With respect to ac12 tivities for which a grant awarded under this title is to

13 be expended, the entity shall agree to maintain expenditures

14 of non-Federal amounts for such activities at a level that

15 is not less than the level of such expenditures maintained

16 by the entity for the fiscal year preceding the fiscal year

17 for which the entity receives such a grant.

18 ‘‘SEC. 804. MATCHING REQUIREMENT.

19 ‘‘The Secretary may require that an entity that ap20 plies for a grant or contract under this title provide non21 Federal matching funds, as appropriate, to ensure the insti22 tutional commitment of the entity to the projects funded

23 under the grant. Such non-Federal matching funds may be

24 provided directly or through donations from public or pri25 vate entities and may be in cash or in-kind, fairly evalu26 ated, including plant, equipment, or services.
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1 ‘‘SEC. 805. PREFERENCE.

2 ‘‘In awarding grants or contracts under this title, the

3 Secretary shall give preference to applicants with projects

4 that will substantially benefit rural or underserved popu5 lations, or help meet public health nursing needs in State

6 or local health departments.

7 ‘‘SEC. 806. GENERALLY APPLICABLE PROVISIONS.

8 ‘‘(a) AWARDING OF GRANTS AND CONTRACTS.—The

9 Secretary shall ensure that grants and contracts under this

10 title are awarded on a competitive basis, as appropriate,

11 to carry out innovative demonstration projects or provide

12 for strategic workforce supplementation activities as needed

13 to meet national nursing service goals and in accordance

14 with this title. Contracts may be entered into under this

15 title with public or private entities as determined necessary

16 by the Secretary.

17 ‘‘(b) INFORMATION REQUIREMENTS.—

18 ‘‘(1) IN GENERAL.—Recipients of grants and

19 contracts under this title shall meet information re20 quirements as specified by the Secretary.

21 ‘‘(2) EVALUATIONS.—The Secretary shall estab22 lish procedures to ensure the annual evaluation of

23 programs and projects operated by recipients of

24 grants under this title. Such procedures shall ensure

25 that continued funding for such programs and

26 projects will be conditioned upon a demonstration
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1 that satisfactory progress has been made by the pro2 gram or project in meeting the objectives of the pro3 gram or project.

4 ‘‘(c) TRAINING PROGRAMS.—Training programs con5 ducted with amounts received under this title shall meet ap6 plicable accreditation and quality standards.

7 ‘‘(d) DURATION OF ASSISTANCE.—

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

9 the case of an award to an entity of a grant, coopera10 tive agreement, or contract under this title, the period

11 during which payments are made to the entity under

12 the award may not exceed 5 years. The provision of

13 payments under the award shall be subject to annual

14 approval by the Secretary of the payments and sub15 ject to the availability of appropriations for the fiscal

16 year involved to make the payments. This paragraph

17 may not be construed as limiting the number of

18 awards under the program involved that may be

19 made to the entity.

20 ‘‘(2) LIMITATION.—In the case of an award to

21 an entity of a grant, cooperative agreement, or con22 tract under this title, paragraph (1) shall apply only

23 to the extent not inconsistent with any other provi24 sion of this title that relates to the period during

25 which payments may be made under the award.
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1 ‘‘(e) PEER REVIEW REGARDING CERTAIN PRO2 GRAMS.—

3 ‘‘(1) IN GENERAL.—Each application for a grant

4 under this title, except advanced nurse traineeship

5 grants under section 811(a)(2), shall be submitted to

6 a peer review group for an evaluation of the merits

7 of the proposals made in the application. The Sec8 retary may not approve such an application unless a

9 peer review group has recommended the application

10 for approval.

11 ‘‘(2) COMPOSITION.—Each peer review group

12 under this subsection shall be composed principally of

13 individuals who are not officers or employees of the

14 Federal Government. In providing for the establish15 ment of peer review groups and procedures, the Sec16 retary shall, except as otherwise provided, ensure sex,

17 racial, ethnic, and geographic representation among

18 the membership of such groups.

19 ‘‘(3) ADMINISTRATION.—This subsection shall be

20 carried out by the Secretary acting through the Ad21 ministrator of the Health Resources and Services Ad22 ministration.

23 ‘‘(f) ANALYTIC ACTIVITIES.—The Secretary shall en24 sure that—
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1 ‘‘(1) cross-cutting workforce analytical activities

2 are carried out as part of the workforce information

3 and analysis activities under this title; and

4 ‘‘(2) discipline-specific workforce information is

5 developed and analytical activities are carried out as

6 part of—

7 ‘‘(A) the advanced education nursing activi8 ties under part B;

9 ‘‘(B) the workforce diversity activities under

10 part C; and

11 ‘‘(C) basic nursing education and practice

12 activities under part D.

13 ‘‘(g) STATE AND REGIONAL PRIORITIES.—Activities

14 under grants or contracts under this title shall, to the extent

15 practicable, be consistent with related Federal, State, or re16 gional nursing professions program plans and priorities.

17 ‘‘(h) FILING OF APPLICATIONS.—

18 ‘‘(1) IN GENERAL.—Applications for grants or

19 contracts under this title may be submitted by health

20 professions schools, schools of nursing, academic

21 health centers, State or local governments, or other

22 appropriate public or private nonprofit entities as de23 termined appropriate by the Secretary in accordance

24 with this title.
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1 ‘‘(2) FOR PROFIT ENTITIES.—Notwithstanding

2 paragraph (1), a for-profit entity may be eligible for

3 a grant or contract under this title as determined ap4 propriate by the Secretary.

5 ‘‘SEC. 807. TECHNICAL ASSISTANCE.

6 ‘‘Funds appropriated under this title may be used by

7 the Secretary to provide technical assistance in relation to

8 any of the authorities under this title.

9 ‘‘PART B—NURSE PRACTITIONERS, NURSE MID10 WIVES, NURSE ANESTHETISTS, AND OTHER

11 ADVANCED EDUCATION NURSES

12 ‘‘SEC. 811. ADVANCED EDUCATION NURSING GRANTS.

13 ‘‘(a) IN GENERAL.—The Secretary may award grants

14 to and enter into contracts with eligible entities to meet the

15 costs of—

16 ‘‘(1) projects that support the enhancement of ad17 vanced nursing education and practice; and

18 ‘‘(2) traineeships for individuals in advanced

19 nursing education programs.

20 ‘‘(b) DEFINITION OF ADVANCED EDUCATION

21 NURSES.—For purposes of this section, the term ‘advanced

22 education nurses’ means individuals trained in advanced

23 degree programs including individuals in combined R.N./

24 Master’s degree programs, post-nursing master’s certificate

25 programs, or, in the case of nurse midwives, in certificate
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1 programs in existence on the date that is one day prior

2 to the date of enactment of this section, to serve as nurse

3 practitioners, clinical nurse specialists, nurse midwives,

4 nurse anesthetists, nurse educators, nurse administrators,

5 or public health nurses, or in other nurse specialties deter6 mined by the Secretary to require advanced education.

7 ‘‘(c) AUTHORIZED NURSE PRACTITIONER AND NURSE8 MIDWIFERY PROGRAMS.—Nurse practitioner and nurse

9 midwifery programs eligible for support under this section

10 are educational programs for registered nurses (irrespective

11 of the type of school of nursing in which the nurses received

12 their training) that—

13 ‘‘(1) meet guidelines prescribed by the Secretary;

14 and

15 ‘‘(2) have as their objective the education of

16 nurses who will upon completion of their studies in

17 such programs, be qualified to effectively provide pri18 mary health care, including primary health care in

19 homes and in ambulatory care facilities, long-term

20 care facilities, acute care, and other health care set21 tings.

22 ‘‘(d) AUTHORIZED NURSE ANESTHESIA PROGRAMS.—

23 Nurse anesthesia programs eligible for support under this

24 section are education programs that—
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1 ‘‘(1) provide registered nurses with full-time an2 esthetist education; and

3 ‘‘(2) are accredited by the Council on Accredita4 tion of Nurse Anesthesia Educational Programs.

5 ‘‘(e) OTHER AUTHORIZED EDUCATIONAL PRO6 GRAMS.—The Secretary shall prescribe guidelines as appro7 priate for other advanced nurse education programs eligible

8 for support under this section.

9 ‘‘(f) TRAINEESHIPS.—

10 ‘‘(1) IN GENERAL.—The Secretary may not

11 award a grant to an applicant under subsection (a)

12 unless the applicant involved agrees that traineeships

13 provided with the grant will only pay all or part of

14 the costs of—

15 ‘‘(A) the tuition, books, and fees of the pro16 gram of advanced nurse education with respect

17 to which the traineeship is provided; and

18 ‘‘(B) the reasonable living expenses of the

19 individual during the period for which the

20 traineeship is provided.

21 ‘‘(2) DOCTORAL PROGRAMS.—The Secretary may

22 not obligate more than 10 percent of the traineeships

23 under subsection (a) for individuals in doctorate de24 gree programs.
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1 ‘‘(3) SPECIAL CONSIDERATION.—In making

2 awards of grants and contracts under subsection

3 (a)(2), the Secretary shall give special consideration

4 to an eligible entity that agrees to expend the award

5 to train advanced education nurses who will practice

6 in health professional shortage areas designated under

7 section 332.

8 ‘‘PART C—INCREASING NURSING WORKFORCE

9 DIVERSITY

10 ‘‘SEC. 821. WORKFORCE DIVERSITY GRANTS.

11 ‘‘(a) IN GENERAL.—The Secretary may award grants

12 to and enter into contracts with eligible entities to meet the

13 costs of special projects to increase nursing education op14 portunities for individuals who are from disadvantaged

15 backgrounds (including racial and ethnic minorities under16 represented among registered nurses) by providing student

17 scholarships or stipends, pre-entry preparation, and reten18 tion activities.

19 ‘‘(b) GUIDANCE.—In carrying out subsection (a), the

20 Secretary shall take into consideration the recommenda21 tions of the First, Second and Third Invitational Congresses

22 for Minority Nurse Leaders on ‘Caring for the Emerging

23 Majority,’ in 1992, 1993 and 1997, and consult with nurs24 ing associations including the American Nurses Associa25 tion, the National League for Nursing, the American Asso-
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1 ciation of Colleges of Nursing, the National Black Nurses

2 Association, the National Association of Hispanic Nurses,

3 the Association of Asian American and Pacific Islander

4 Nurses, the Native American Indian and Alaskan Nurses

5 Association, and the National Council of State Boards of

6 Nursing.

7 ‘‘(c) REQUIRED INFORMATION AND CONDITIONS FOR

8 AWARD RECIPIENTS.—

9 ‘‘(1) IN GENERAL.—Recipients of awards under

10 this section may be required, where requested, to re11 port to the Secretary concerning the annual admis12 sion, retention, and graduation rates for individuals

13 from disadvantaged backgrounds and ethnic and ra14 cial minorities in the school or schools involved in the

15 projects.

16 ‘‘(2) FALLING RATES.—If any of the rates re17 ported under paragraph (1) fall below the average of

18 the two previous years, the grant or contract recipient

19 shall provide the Secretary with plans for imme20 diately improving such rates.

21 ‘‘(3) INELIGIBILITY.—A recipient described in

22 paragraph (2) shall be ineligible for continued fund23 ing under this section if the plan of the recipient fails

24 to improve the rates within the 1-year period begin25 ning on the date such plan is implemented.
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1 ‘‘PART D—STRENGTHENING CAPACITY FOR BASIC

2 NURSE EDUCATION AND PRACTICE

3 ‘‘SEC. 831. BASIC NURSE EDUCATION AND PRACTICE

4 GRANTS.

5 ‘‘(a) IN GENERAL.—The Secretary may award grants

6 to and enter into contracts with eligible entities for projects

7 to strengthen capacity for basic nurse education and prac8 tice.

9 ‘‘(b) PRIORITY AREAS.—In awarding grants or con10 tracts under this section the Secretary shall give priority

11 to entities that will use amounts provided under such a

12 grant or contract to enhance the educational mix and utili13 zation of the basic nursing workforce by strengthening pro14 grams that provide basic nurse education, such as

15 through—

16 ‘‘(1) establishing or expanding nursing practice

17 arrangements in noninstitutional settings to dem18 onstrate methods to improve access to primary health

19 care in medically underserved communities;

20 ‘‘(2) providing care for underserved populations

21 and other high-risk groups such as the elderly, indi22 viduals with HIV-AIDS, substance abusers, the home23 less, and victims of domestic violence;

24 ‘‘(3) providing managed care, quality improve25 ment, and other skills needed to practice in existing

26 and emerging organized health care systems;
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1 ‘‘(4) developing cultural competencies among

2 nurses;

3 ‘‘(5) expanding the enrollment in baccalaureate

4 nursing programs;

5 ‘‘(6) promoting career mobility for nursing per6 sonnel in a variety of training settings and cross

7 training or specialty training among diverse popu8 lation groups;

9 ‘‘(7) providing education in informatics, includ10 ing distance learning methodologies; or

11 ‘‘(8) other priority areas as determined by the

12 Secretary.’’;

13 (5) by adding at the end the following:

14 ‘‘PART F—FUNDING

15 ‘‘SEC. 841. FUNDING.

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

17 purpose of carrying out parts B, C, and D (subject to sec18 tion 845(g)), there are authorized to be appropriated

19 $65,000,000 for fiscal year 1998, and such sums as may

20 be necessary for each of the fiscal years 1999 through 2002.

21 ‘‘(b) ALLOCATIONS FOR FISCAL YEARS 1998 THROUGH

22 2002.—

23 ‘‘(1) NURSE PRACTITIONERS; NURSE MID24 WIVES.—
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1 ‘‘(A) FISCAL YEAR 1998.—Of the amount

2 appropriated under subsection (a) for fiscal year

3 1998, the Secretary shall reserve not less than

4 $17,564,000 for making awards of grants and

5 contracts under section 822 as such section was

6 in effect for fiscal year 1998.

7 ‘‘(B) FISCAL YEARS 1999 THROUGH 2002.—

8 Of the amount appropriated under subsection (a)

9 for fiscal year 1999 or any of the fiscal years

10 2000 through 2002, the Secretary, subject to sub11 section (d), shall reserve for the fiscal year in12 volved, for making awards of grants and con13 tracts under part B with respect to nurse practi14 tioners and nurse midwives, not less than the

15 percentage constituted by the ratio of the amount

16 appropriated under section 822 as such section

17 was in effect for fiscal year 1998 to the total of

18 the amounts appropriated under this title for

19 such fiscal year. For purposes of the preceding

20 sentence, the Secretary, in determining the

21 amount that has been reserved for the fiscal year

22 involved, shall include any amounts appro23 priated under subsection (a) for the fiscal year

24 that are obligated by the Secretary to continue
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1 in effect grants or contracts under section 822 as

2 such section was in effect for fiscal year 1998.

3 ‘‘(2) NURSE ANESTHETISTS.—

4 ‘‘(A) FISCAL YEAR 1998.—Of the amount

5 appropriated under subsection (a) for fiscal year

6 1998, the Secretary shall reserve not less than

7 $2,761,000 for making awards of grants and

8 contracts under section 831 as such section was

9 in effect for fiscal year 1998.

10 ‘‘(B) FISCAL YEARS 1999 THROUGH 2002.—

11 Of the amount appropriated under subsection (a)

12 for fiscal year 1999 or any of the fiscal years

13 2000 through 2002, the Secretary, subject to sub14 section (d), shall reserve for the fiscal year in15 volved, for making awards of grants and con16 tracts under part B with respect to nurse anes17 thetists, not less than the percentage constituted

18 by the ratio of the amount appropriated under

19 section 831 as such section was in effect for fiscal

20 year 1998 to the total of the amounts appro21 priated under this title for such fiscal year. For

22 purposes of the preceding sentence, the Secretary,

23 in determining the amount that has been re24 served for the fiscal year involved, shall include

25 any amounts appropriated under subsection (a)
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1 for the fiscal year that are obligated by the Sec2 retary to continue in effect grants or contracts

3 under section 831 as such section was in effect

4 for fiscal year 1998.

5 ‘‘(c) ALLOCATIONS AFTER FISCAL YEAR 2002.—

6 ‘‘(1) IN GENERAL.—For fiscal year 2003 and

7 subsequent fiscal years, amounts appropriated under

8 subsection (a) for the fiscal year involved shall be al9 located by the Secretary among parts B, C, and D

10 (and programs within such parts) according to a

11 methodology that is developed in accordance with

12 paragraph (2). The Secretary shall enter into a con13 tract with a public or private entity for the purpose

14 of developing the methodology. The contract shall re15 quire that the development of the methodology be com16 pleted not later than February 1, 2002.

17 ‘‘(2) USE OF CERTAIN FACTORS.—The contract

18 under paragraph (1) shall provide that the methodol19 ogy under such paragraph will be developed in ac20 cordance with the following:

21 ‘‘(A) The methodology will take into account

22 the need for and the distribution of health serv23 ices among medically underserved populations,

24 as determined according to the factors that apply

25 under section 330(b)(3).
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1 ‘‘(B) The methodology will take into ac2 count the need for and the distribution of health

3 services in health professional shortage areas, as

4 determined according to the factors that apply

5 under section 332(b).

6 ‘‘(C) The methodology will take into account

7 the need for and the distribution of mental

8 health services among medically underserved

9 populations and in health professional shortage

10 areas.

11 ‘‘(D) The methodology will be developed in

12 consultation with individuals in the field of

13 nursing, including registered nurses, nurse prac14 titioners, nurse midwives, nurse anesthetists,

15 clinical nurse specialists, nursing educators and

16 educational institutions, nurse executives, pedi17 atric nurse associates and practitioners, and

18 women’s health, obstetric, and neonatal nurses.

19 ‘‘(E) The methodology will take into ac20 count the following factors with respect to the

21 States:

22 ‘‘(i) A provider population ratio equiv23 alent to a managed care formula of 1/1,500

24 for primary care services.
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1 ‘‘(ii) The use of whole rather than frac2 tional counts in determining the number of

3 health care providers.

4 ‘‘(iii) The counting of only employed

5 health care providers in determining the

6 number of health care providers.

7 ‘‘(iv) The number of families whose in8 come is less than 200 percent of the official

9 poverty line (as established by the Director

10 of the Office of Management and Budget

11 and revised by the Secretary in accordance

12 with section 673(2) of the Omnibus Budget

13 Reconciliation Act of 1981).

14 ‘‘(v) The rate of infant mortality and

15 the rate of low-birthweight births.

16 ‘‘(vi) The percentage of the general

17 population constituted by individuals who

18 are members or racial or ethnic minority

19 groups, stated both by minority group and

20 in the aggregate.

21 ‘‘(vii) The percentage of the general

22 population constituted by individuals who

23 are of Hispanic ethnicity.

24 ‘‘(viii) The number of individuals re25 siding in health professional shortage areas,
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1 and the number of individuals who are

2 members of medically underserved popu3 lations.

4 ‘‘(ix) The percentage of the general

5 population constituted by elderly individ6 uals.

7 ‘‘(x) The extent to which the popu8 lations served have a choice of providers.

9 ‘‘(xi) The impact of care on hos10 pitalizations and emergency room use.

11 ‘‘(xii) The number of individuals who

12 lack proficiency in speaking the English

13 language.

14 ‘‘(xiii) Such additional factors as the

15 Secretary determines to be appropriate.

16 ‘‘(3) REPORT TO CONGRESS.—Not later than 30

17 days after the completion of the development of the

18 methodology required in paragraph (1), the Secretary

19 shall submit to the Committee on Commerce of the

20 House of Representatives, and to the Committee on

21 Labor and Human Resources of the Senate, a report

22 describing the methodology and explaining the effects

23 of the methodology on the allocation among parts B,

24 C, and D (and programs within such parts) of

25 amounts appropriated under subsection (a) for the
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1 first fiscal year for which the methodology will be in

2 effect. Such explanation shall include a comparison of

3 the allocation for such fiscal year with the allocation

4 made under this section for the preceding fiscal year.

5 ‘‘(d) USE OF METHODOLOGY BEFORE FISCAL YEAR

6 2003.—With respect to the fiscal years 1999 through 2002,

7 if the report required in subsection (c)(3) is submitted in

8 accordance with such subsection not later than 90 days be9 fore the beginning of such a fiscal year, the Secretary may

10 for such year implement the methodology described in the

11 report (rather than implementing the methodology in fiscal

12 year 2003), in which case subsection (b) ceases to be in ef13 fect. The authority under the preceding sentence is subject

14 to the condition that the fiscal year for which the methodol15 ogy is implemented be the same fiscal year identified in

16 such report as the fiscal year for which the methodology will

17 first be in effect.

18 ‘‘(e) AUTHORITY FOR USE OF ADDITIONAL FACTORS

19 IN METHODOLOGY.—

20 ‘‘(1) IN GENERAL.—The Secretary shall make the

21 determinations specified in paragraph (2). For any

22 fiscal year beginning after the first fiscal year for

23 which the methodology under subsection (c)(1) is in

24 effect, the Secretary may alter the methodology by in-
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1 cluding the information from such determinations as

2 factors in the methodology.

3 ‘‘(2) RELEVANT DETERMINATIONS.—The deter4 minations referred to in paragraph (1) are as follows:

5 ‘‘(A) The need for and the distribution of

6 health services among populations for which it is

7 difficult to determine the number of individuals

8 who are in the population, such as homeless in9 dividuals; migratory and seasonal agricultural

10 workers and their families; individuals infected

11 with the human immunodeficiency virus, and

12 individuals who abuse drugs.

13 ‘‘(B) In the case of a population for which

14 the determinations under subparagraph (A) are

15 made, the extent to which the population in16 cludes individuals who are members of racial or

17 ethnic minority groups and a specification of the

18 skills needed to provide health services to such

19 individuals in the language and the educational

20 and cultural context that is most appropriate to

21 the individuals.

22 ‘‘(C) Data, obtained from the Director of the

23 Centers for Disease Control and Prevention, on

24 rates of morbidity and mortality among various

25 populations (including data on the rates of ma-
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1 ternal and infant mortality and data on the

2 rates of low-birthweight births of living infants).

3 ‘‘(D) Data from the Health Plan Employer

4 Data and Information Set, as appropriate.

5 ‘‘PART G—NATIONAL ADVISORY COUNCIL ON

6 NURSE EDUCATION AND PRACTICE

7 ‘‘SEC. 845. NATIONAL ADVISORY COUNCIL ON NURSE EDU8 CATION AND PRACTICE.

9 ‘‘(a) ESTABLISHMENT.—The Secretary shall establish

10 an advisory council to be known as the National Advisory

11 Council on Nurse Education and Practice (in this section

12 referred to as the ‘Advisory Council’).

13 ‘‘(b) COMPOSITION.—

14 ‘‘(1) IN GENERAL.—The Advisory Council shall

15 be composed of

16 ‘‘(A) not less than 21, nor more than 23 in17 dividuals, who are not officers or employees of

18 the Federal Government, appointed by the Sec19 retary without regard to the Federal civil service

20 laws, of which—

21 ‘‘(i) 2 shall be selected from full-time

22 students enrolled in schools of nursing;

23 ‘‘(ii) 2 shall be selected from the gen24 eral public;
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1 ‘‘(iii) 2 shall be selected from practic2 ing professional nurses; and

3 ‘‘(iv) 9 shall be selected from among

4 the leading authorities in the various fields

5 of nursing, higher, secondary education,

6 and associate degree schools of nursing, and

7 from representatives of advanced education

8 nursing groups (such as nurse practitioners,

9 nurse midwives, and nurse anesthetists),

10 hospitals, and other institutions and orga11 nizations which provide nursing services;

12 and

13 ‘‘(B) the Secretary (or the delegate of the

14 Secretary (who shall be an ex officio member and

15 shall serve as the Chairperson)).

16 ‘‘(2) APPOINTMENT.—Not later than 90 days

17 after the date of enactment of this Act, the Secretary

18 shall appoint the members of the Advisory Council

19 and each such member shall serve a 4 year term. In

20 making such appointments, the Secretary shall ensure

21 a fair balance between the nursing professions, a

22 broad geographic representation of members and a

23 balance between urban and rural members. Members

24 shall be appointed based on their competence, interest,
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1 and knowledge of the mission of the profession in2 volved. A majority of the members shall be nurses.

3 ‘‘(3) MINORITY REPRESENTATION.—In appoint4 ing the members of the Advisory Council under para5 graph (1), the Secretary shall ensure the adequate

6 representation of minorities.

7 ‘‘(c) VACANCIES.—

8 ‘‘(1) IN GENERAL.—A vacancy on the Advisory

9 Council shall be filled in the manner in which the

10 original appointment was made and shall be subject

11 to any conditions which applied with respect to the

12 original appointment.

13 ‘‘(2) FILLING UNEXPIRED TERM.—An individual

14 chosen to fill a vacancy shall be appointed for the un15 expired term of the member replaced.

16 ‘‘(d) DUTIES.—The Advisory Council shall—

17 ‘‘(1) provide advice and recommendations to the

18 Secretary and Congress concerning policy matters

19 arising in the administration of this title, including

20 the range of issues relating to the nurse workforce,

21 education, and practice improvement;

22 ‘‘(2) provide advice to the Secretary and Con23 gress in the preparation of general regulations and

24 with respect to policy matters arising in the adminis25 tration of this title, including the range of issues re-
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1 lating to nurse supply, education and practice im2 provement; and

3 ‘‘(3) not later than 3 years after the date of en4 actment of this section, and annually thereafter, pre5 pare and submit to the Secretary, the Committee on

6 Labor and Human Resources of the Senate, and the

7 Committee on Commerce of the House of Representa8 tives, a report describing the activities of the Council,

9 including findings and recommendations made by the

10 Council concerning the activities under this title.

11 ‘‘(e) MEETINGS AND DOCUMENTS.—

12 ‘‘(1) MEETINGS.—The Advisory Council shall

13 meet not less than 2 times each year. Such meetings

14 shall be held jointly with other related entities estab15 lished under this title where appropriate.

16 ‘‘(2) DOCUMENTS.—Not later than 14 days prior

17 to the convening of a meeting under paragraph (1),

18 the Advisory Council shall prepare and make avail19 able an agenda of the matters to be considered by the

20 Advisory Council at such meeting. At any such meet21 ing, the Advisory Council shall distribute materials

22 with respect to the issues to be addressed at the meet23 ing. Not later than 30 days after the adjourning of

24 such a meeting, the Advisory Council shall prepare

25 and make available a summary of the meeting and
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1 any actions taken by the Council based upon the

2 meeting.

3 ‘‘(f) COMPENSATION AND EXPENSES.—

4 ‘‘(1) COMPENSATION.—Each member of the Advi5 sory Council shall be compensated at a rate equal to

6 the daily equivalent of the annual rate of basic pay

7 prescribed for level IV of the Executive Schedule

8 under section 5315 of title 5, United States Code, for

9 each day (including travel time) during which such

10 member is engaged in the performance of the duties

11 of the Council. All members of the Council who are

12 officers or employees of the United States shall serve

13 without compensation in addition to that received for

14 their services as officers or employees of the United

15 States.

16 ‘‘(2) EXPENSES.—The members of the Advisory

17 Council shall be allowed travel expenses, including

18 per diem in lieu of subsistence, at rates authorized for

19 employees of agencies under subchapter I of chapter

20 57 of title 5, United States Code, while away from

21 their homes or regular places of business in the per22 formance of services for the Council.

23 ‘‘(g) FUNDING.—Amounts appropriated under this

24 title may be utilized by the Secretary to support the nurse

25 education and practice activities of the Council.
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1 ‘‘(h) FACA.—The Federal Advisory Committee Act

2 shall apply to the Advisory Committee under this section

3 only to the extent that the provisions of such Act do not

4 conflict with the requirements of this section.’’; and

5 (6) by redesignating section 855 as section 810,

6 and transferring such section so as to appear after

7 section 809 (as added by the amendment made by

8 paragraph (5)).

9 SEC. 124. SAVINGS PROVISION.

10 In the case of any authority for making awards of

11 grants or contracts that is terminated by the amendment

12 made by section 123, the Secretary of Health and Human

13 Services may, notwithstanding the termination of the au14 thority, continue in effect any grant or contract made under

15 the authority that is in effect on the day before the date

16 of the enactment of this Act, subject to the duration of any

17 such grant or contract not exceeding the period determined

18 by the Secretary in first approving such financial assist19 ance, or in approving the most recent request made (before

20 the date of such enactment) for continuation of such assist21 ance, as the case may be.
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1 Subtitle C—Financial Assistance

2 CHAPTER 1—SCHOOL-BASED REVOLVING LOAN

3 FUNDS

4 SEC. 131. PRIMARY CARE LOAN PROGRAM.

5 (a) REQUIREMENT FOR SCHOOLS.—Section 723(b)(1)

6 of the Public Health Service Act (42 U.S.C. 292s(b)(1)), as

7 amended by section 2014(c)(2)(A)(ii) of Public Law 103–

8 43 (107 Stat. 216), is amended by striking ‘‘3 years before’’

9 and inserting ‘‘4 years before’’.

10 (b) NONCOMPLIANCE.—Section 723(a)(3) of the Public

11 Health Service Act (42 U.S.C. 292s(a)(3)) is amended to

12 read as follows:

13 ‘‘(3) NONCOMPLIANCE BY STUDENT.—Each

14 agreement entered into with a student pursuant to

15 paragraph (1) shall provide that, if the student fails

16 to comply with such agreement, the loan involved will

17 begin to accrue interest at a rate of 18 percent per

18 year beginning on the date of such noncompliance.’’.

19 (c) REPORT REQUIREMENT.—Section 723 of the Pub20 lic Health Service Act (42 U.S.C. 292s) is amended—

21 (1) by striking subsection (c); and

22 (2) by redesignating subsection (d) as subsection

23 (c).
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1 SEC. 132. LOANS FOR DISADVANTAGED STUDENTS.

2 (a) AUTHORIZATION OF APPROPRIATIONS.—Section

3 724(f)(1) of the Public Health Service Act (42 U.S.C.

4 292t(f)(1)) is amended by striking ‘‘$15,000,000 for fiscal

5 year 1993’’ and inserting ‘‘$8,000,000 for each of the fiscal

6 years 1998 through 2002’’.

7 (b) REPEAL.—Effective October 1, 2002, paragraph

8 (1) of section 724(f) of the Public Health Service Act (42

9 U.S.C. 292t(f)(1)) is repealed.

10 SEC. 133. STUDENT LOANS REGARDING SCHOOLS OF

11 NURSING.

12 (a) IN GENERAL.—Section 836(b) of the Public Health

13 Service Act (42 U.S.C. 297b(b)) is amended—

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

15 the end and inserting a semicolon;

16 (2) in paragraph (2)—

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

18 at the end; and

19 (B) by inserting before the semicolon at the

20 end the following: ‘‘, and (C) such additional pe21 riods under the terms of paragraph (8) of this

22 subsection’’;

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

24 the end and inserting ‘‘; and’’; and

25 (4) by adding at the end the following para26 graph:
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1 ‘‘(8) pursuant to uniform criteria established by

2 the Secretary, the repayment period established under

3 paragraph (2) for any student borrower who during

4 the repayment period failed to make consecutive pay5 ments and who, during the last 12 months of the re6 payment period, has made at least 12 consecutive

7 payments may be extended for a period not to exceed

8 10 years.’’.

9 (b) MINIMUM MONTHLY PAYMENTS.—Section 836(g) of

10 the Public Health Service Act (42 U.S.C. 297b(g)) is

11 amended by striking ‘‘$15’’ and inserting ‘‘$40’’.

12 (c) ELIMINATION OF STATUTE OF LIMITATION FOR

13 LOAN COLLECTIONS.—

14 (1) IN GENERAL.—Section 836 of the Public

15 Health Service Act (42 U.S.C. 297b) is amended by

16 adding at the end the following new subsection:

17 ‘‘(l) ELIMINATION OF STATUTE OF LIMITATION FOR

18 LOAN COLLECTIONS.—

19 ‘‘(1) PURPOSE.—It is the purpose of this sub20 section to ensure that obligations to repay loans

21 under this section are enforced without regard to any

22 Federal or State statutory, regulatory, or administra23 tive limitation on the period within which debts may

24 be enforced.
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1 ‘‘(2) PROHIBITION.—Notwithstanding any other

2 provision of Federal or State law, no limitation shall

3 terminate the period within which suit may be filed,

4 a judgment may be enforced, or an offset, garnish5 ment, or other action may be initiated or taken by a

6 school of nursing that has an agreement with the Sec7 retary pursuant to section 835 that is seeking the re8 payment of the amount due from a borrower on a

9 loan made under this subpart after the default of the

10 borrower on such loan.’’.

11 (2) EFFECTIVE DATE.—The amendment made by

12 paragraph (1) shall be effective with respect to actions

13 pending on or after the date of enactment of this Act.

14 (d) BREACH OF AGREEMENTS.—Section 846 of the

15 Public Health Service Act (42 U.S.C. 297n) is amended by

16 adding at the end thereof the following new subsection:

17 ‘‘(h) BREACH OF AGREEMENT.—

18 ‘‘(1) IN GENERAL.—In the case of any program

19 under this section under which an individual makes

20 an agreement to provide health services for a period

21 of time in accordance with such program in consider22 ation of receiving an award of Federal funds regard23 ing education as a nurse (including an award for the

24 repayment of loans), the following applies if the

25 agreement provides that this subsection is applicable:
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1 ‘‘(A) In the case of a program under this

2 section that makes an award of Federal funds for

3 attending an accredited program of nursing (in

4 this section referred to as a ‘nursing program’),

5 the individual is liable to the Federal Govern6 ment for the amount of such award (including

7 amounts provided for expenses related to such at8 tendance), and for interest on such amount at

9 the maximum legal prevailing rate, if the indi10 vidual—

11 ‘‘(i) fails to maintain an acceptable

12 level of academic standing in the nursing

13 program (as indicated by the program in

14 accordance with requirements established by

15 the Secretary);

16 ‘‘(ii) is dismissed from the nursing

17 program for disciplinary reasons; or

18 ‘‘(iii) voluntarily terminates the nurs19 ing program.

20 ‘‘(B) The individual is liable to the Federal

21 Government for the amount of such award (in22 cluding amounts provided for expenses related to

23 such attendance), and for interest on such

24 amount at the maximum legal prevailing rate, if

25 the individual fails to provide health services in
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1 accordance with the program under this section

2 for the period of time applicable under the pro3 gram.

4 ‘‘(2) WAIVER OR SUSPENSION OF LIABILITY.—In

5 the case of an individual or health facility making an

6 agreement for purposes of paragraph (1), the Sec7 retary shall provide for the waiver or suspension of

8 liability under such subsection if compliance by the

9 individual or the health facility, as the case may be,

10 with the agreements involved is impossible, or would

11 involve extreme hardship to the individual or facility,

12 and if enforcement of the agreements with respect to

13 the individual or facility would be unconscionable.

14 ‘‘(3) DATE CERTAIN FOR RECOVERY.—Subject to

15 paragraph (2), any amount that the Federal Govern16 ment is entitled to recover under paragraph (1) shall

17 be paid to the United States not later than the expi18 ration of the 3-year period beginning on the date the

19 United States becomes so entitled.

20 ‘‘(4) AVAILABILITY.—Amounts recovered under

21 paragraph (1) with respect to a program under this

22 section shall be available for the purposes of such pro23 gram, and shall remain available for such purposes

24 until expended.’’.
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1 (e) TECHNICAL AMENDMENTS.—Section 839 of the

2 Public Health Service Act (42 U.S.C. 297e) is amended—

3 (1) in subsection (a)—

4 (A) by striking the matter preceding para5 graph (1) and inserting the following:

6 ‘‘(a) If a school terminates a loan fund established

7 under an agreement pursuant to section 835(b), or if the

8 Secretary for good cause terminates the agreement with the

9 school, there shall be a capital distribution as follows:’’; and

10 (B) in paragraph (1), by striking ‘‘at the

11 close of September 30, 1999,’’ and inserting ‘‘on

12 the date of termination of the fund’’; and

13 (2) in subsection (b), to read as follows:

14 ‘‘(b) If a capital distribution is made under subsection

15 (a), the school involved shall, after such capital distribution,

16 pay to the Secretary, not less often than quarterly, the same

17 proportionate share of amounts received by the school in

18 payment of principal or interest on loans made from the

19 loan fund established under section 835(b) as determined

20 by the Secretary under subsection (a).’’.

21 SEC. 134. GENERAL PROVISIONS.

22 (a) MAXIMUM STUDENT LOAN PROVISIONS AND MINI23 MUM PAYMENTS.—

24 (1) IN GENERAL.—Section 722(a)(1) of the Pub25 lic Health Service Act (42 U.S.C. 292r(a)(1)), as
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1 amended by section 2014(b)(1) of Public Law 103–43,

2 is amended by striking ‘‘the sum of’’ and all that fol3 lows through the end thereof and inserting ‘‘the cost

4 of attendance (including tuition, other reasonable

5 educational expenses, and reasonable living costs) for

6 that year at the educational institution attended by

7 the student (as determined by such educational insti8 tution).’’.

9 (2) THIRD AND FOURTH YEARS.—Section

10 722(a)(2) of the Public Health Service Act (42 U.S.C.

11 292r(a)(2)), as amended by section 2014(b)(1) of Pub12 lic Law 103–43, is amended by striking ‘‘the amount

13 $2,500’’ and all that follows through ‘‘including such

14 $2,500)’’ and inserting ‘‘the amount of the loan may,

15 in the case of the third or fourth year of a student

16 at a school of medicine or osteopathic medicine, be in17 creased to the extent necessary’’.

18 (3) REPAYMENT PERIOD.—Section 722(c) of the

19 Public Health Service Act (42 U.S.C. 292r(c)), as

20 amended by section 2014(b)(1) of Public Law 103–43,

21 is amended—

22 (A) in the subsection heading by striking

23 ‘‘TEN-YEAR’’ and inserting ‘‘REPAYMENT’’;

24 (B) by striking ‘‘ten-year period which be25 gins’’ and inserting ‘‘period of not less than 10
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1 years nor more than 25 years, at the discretion

2 of the institution, which begins’’; and

3 (C) by striking ‘‘such ten-year period’’ and

4 inserting ‘‘such period’’.

5 (4) MINIMUM PAYMENTS.—Section 722(j) of the

6 Public Health Service Act (42 U.S.C. 292r(j)), as

7 amended by section 2014(b)(1) of Public Law 103–43,

8 is amended by striking ‘‘$15’’ and inserting $40’’.

9 (b) ELIMINATION OF STATUTE OF LIMITATION FOR

10 LOAN COLLECTIONS.—

11 (1) IN GENERAL.—Section 722 of the Public

12 Health Service Act (42 U.S.C. 292r), as amended by

13 section 2014(b)(1) of Public Law 103–43, is amended

14 by adding at the end the following new subsection:

15 ‘‘(m) ELIMINATION OF STATUTE OF LIMITATION FOR

16 LOAN COLLECTIONS.—

17 ‘‘(1) PURPOSE.—It is the purpose of this sub18 section to ensure that obligations to repay loans

19 under this section are enforced without regard to any

20 Federal or State statutory, regulatory, or administra21 tive limitation on the period within which debts may

22 be enforced.

23 ‘‘(2) PROHIBITION.—Notwithstanding any other

24 provision of Federal or State law, no limitation shall

25 terminate the period within which suit may be filed,
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1 a judgment may be enforced, or an offset, garnish2 ment, or other action may be initiated or taken by a

3 school that has an agreement with the Secretary pur4 suant to section 721 that is seeking the repayment of

5 the amount due from a borrower on a loan made

6 under this subpart after the default of the borrower on

7 such loan.’’.

8 (2) EFFECTIVE DATE.—The amendment made by

9 paragraph (1) shall be effective with respect to actions

10 pending on or after the date of enactment of this Act.

11 (c) DATE CERTAIN FOR CONTRIBUTIONS.—Paragraph

12 (2) of section 735(e) of the Public Health Service Act (42

13 U.S.C. 292y(e)(2)) is amended to read as follows:

14 ‘‘(2) DATE CERTAIN FOR CONTRIBUTIONS.—

15 Amounts described in paragraph (1) that are re16 turned to the Secretary shall be obligated before the

17 end of the succeeding fiscal year.’’.

18 CHAPTER 2—INSURED HEALTH EDUCATION

19 ASSISTANCE LOANS TO GRADUATE STUDENTS

20 SEC. 141. HEALTH EDUCATION ASSISTANCE LOAN PRO21 GRAM.

22 (a) HEALTH EDUCATION ASSISTANCE LOAN

23 DEFERMENT FOR BORROWERS PROVIDING HEALTH SERV24 ICES TO INDIANS.—
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1 (1) IN GENERAL.—Section 705(a)(2)(C) of the

2 Public Health Service Act (42 U.S.C. 292d(a)(2)(C))

3 is amended by striking ‘‘and (x)’’ and inserting ‘‘(x)

4 not in excess of three years, during which the bor5 rower is providing health care services to Indians

6 through an Indian health program (as defined in sec7 tion 108(a)(2)(A) of the Indian Health Care Improve8 ment Act (25 U.S.C. 1616a(a)(2)(A)); and (xi)’’.

9 (2) CONFORMING AMENDMENTS.—Section

10 705(a)(2)(C) of the Public Health Service Act (42

11 U.S.C. 292d(a)(2)(C)) is further amended—

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

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

14 (B) in the matter following such clause (xi),

15 by striking ‘‘(x)’’ and inserting ‘‘(xi)’’.

16 (3) EFFECTIVE DATE.—The amendments made

17 by this subsection shall apply with respect to services

18 provided on or after the first day of the third month

19 that begins after the date of the enactment of this Act.

20 (b) REPORT REQUIREMENT.—Section 709(b) of the

21 Public Health Service Act (42 U.S.C. 292h(b)) is

22 amended—

23 (1) in paragraph (4)(B), by adding ‘‘and’’ after

24 the semicolon;
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1 (2) in paragraph (5), by striking ‘‘; and’’ and

2 inserting a period; and

3 (3) by striking paragraph (6).

4 (c) PROGRAM ELIGIBILITY.—

5 (1) LIMITATIONS ON LOANS.—Section 703(a) of

6 the Public Health Service Act (42 U.S.C. 292b(a)) is

7 amended by striking ‘‘or clinical psychology’’ and in8 serting ‘‘or behavioral and mental health practice, in9 cluding clinical psychology’’.

10 (2) DEFINITION OF ELIGIBLE INSTITUTION.—

11 Section 719(1) of the Public Health Service Act (42

12 U.S.C. 292o(1)) is amended by striking ‘‘or clinical

13 psychology’’ and inserting ‘‘or behavioral and mental

14 health practice, including clinical psychology’’.

15 SEC. 142. HEAL LENDER AND HOLDER PERFORMANCE

16 STANDARDS.

17 (a) GENERAL AMENDMENTS.—Section 707(a) of the

18 Public Health Service Act (42 U.S.C. 292f) is amended—

19 (1) by striking the last sentence;

20 (2) by striking ‘‘determined.’’ and inserting ‘‘de21 termined, except that, if the insurance beneficiary in22 cluding any servicer of the loan is not designated for

23 ‘exceptional performance’, as set forth in paragraph

24 (2), the Secretary shall pay to the beneficiary a sum
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1 equal to 98 percent of the amount of the loss sustained

2 by the insured upon that loan.’’;

3 (3) by striking ‘‘Upon’’ and inserting:

4 ‘‘(1) IN GENERAL.—Upon’’; and

5 (4) by adding at the end the following new para6 graph:

7 ‘‘(2) EXCEPTIONAL PERFORMANCE.—

8 ‘‘(A) AUTHORITY.—Where the Secretary de9 termines that an eligible lender, holder, or

10 servicer has a compliance performance rating

11 that equals or exceeds 97 percent, the Secretary

12 shall designate that eligible lender, holder, or

13 servicer, as the case may be, for exceptional per14 formance.

15 ‘‘(B) COMPLIANCE PERFORMANCE RAT16 ING.—For purposes of subparagraph (A), a com17 pliance performance rating is determined with

18 respect to compliance with due diligence in the

19 disbursement, servicing, and collection of loans

20 under this subpart for each year for which the

21 determination is made. Such rating shall be

22 equal to the percentage of all due diligence re23 quirements applicable to each loan, on average,

24 as established by the Secretary, with respect to
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1 loans serviced during the period by the eligible

2 lender, holder, or servicer.

3 ‘‘(C) ANNUAL AUDITS FOR LENDERS, HOLD4 ERS, AND SERVICERS.—Each eligible lender,

5 holder, or servicer desiring a designation under

6 subparagraph (A) shall have an annual finan7 cial and compliance audit conducted with re8 spect to the loan portfolio of such eligible lender,

9 holder, or servicer, by a qualified independent

10 organization from a list of qualified organiza11 tions identified by the Secretary and in accord12 ance with standards established by the Secretary.

13 The standards shall measure the lender’s, hold14 er’s, or servicer’s compliance with due diligence

15 standards and shall include a defined statistical

16 sampling technique designed to measure the per17 formance rating of the eligible lender, holder, or

18 servicer for the purpose of this section. Each eli19 gible lender, holder, or servicer shall submit the

20 audit required by this section to the Secretary.

21 ‘‘(D) SECRETARY’S DETERMINATIONS.—The

22 Secretary shall make the determination under

23 subparagraph (A) based upon the audits submit24 ted under this paragraph and any information

25 in the possession of the Secretary or submitted
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1 by any other agency or office of the Federal Gov2 ernment.

3 ‘‘(E) QUARTERLY COMPLIANCE AUDIT.—To

4 maintain its status as an exceptional performer,

5 the lender, holder, or servicer shall undergo a

6 quarterly compliance audit at the end of each

7 quarter (other than the quarter in which status

8 as an exceptional performer is established

9 through a financial and compliance audit, as de10 scribed in subparagraph (C)), and submit the re11 sults of such audit to the Secretary. The compli12 ance audit shall review compliance with due

13 diligence requirements for the period beginning

14 on the day after the ending date of the previous

15 audit, in accordance with standards determined

16 by the Secretary.

17 ‘‘(F) REVOCATION AUTHORITY.—The Sec18 retary shall revoke the designation of a lender,

19 holder, or servicer under subparagraph (A) if

20 any quarterly audit required under subpara21 graph (E) is not received by the Secretary by the

22 date established by the Secretary or if the audit

23 indicates the lender, holder, or servicer has failed

24 to meet the standards for designation as an ex25 ceptional performer under subparagraph (A). A
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1 lender, holder, or servicer receiving a compliance

2 audit not meeting the standard for designation

3 as an exceptional performer may reapply for

4 designation under subparagraph (A) at any

5 time.

6 ‘‘(G) DOCUMENTATION.—Nothing in this

7 section shall restrict or limit the authority of the

8 Secretary to require the submission of claims

9 documentation evidencing servicing performed on

10 loans, except that the Secretary may not require

11 exceptional performers to submit greater docu12 mentation than that required for lenders, holders,

13 and servicers not designated under subparagraph

14 (A).

15 ‘‘(H) COST OF AUDITS.—Each eligible lend16 er, holder, or servicer shall pay for all the costs

17 associated with the audits required under this

18 section.

19 ‘‘(I) ADDITIONAL REVOCATION AUTHOR20 ITY.—Notwithstanding any other provision of

21 this section, a designation under subparagraph

22 (A) may be revoked at any time by the Secretary

23 if the Secretary determines that the eligible lend24 er, holder, or servicer has failed to maintain an

25 overall level of compliance consistent with the
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1 audit submitted by the eligible lender, holder, or

2 servicer under this paragraph or if the Secretary

3 asserts that the lender, holder, or servicer may

4 have engaged in fraud in securing designation

5 under subparagraph (A) or is failing to service

6 loans in accordance with program requirements.

7 ‘‘(J) NONCOMPLIANCE.—A lender, holder, or

8 servicer designated under subparagraph (A) that

9 fails to service loans or otherwise comply with

10 applicable program regulations shall be consid11 ered in violation of the Federal False Claims

12 Act.’’.

13 (b) DEFINITION.—Section 707(e) of the Public Health

14 Service Act (42 U.S.C. 292f(e)) is amended by adding at

15 the end the following new paragraph:

16 ‘‘(4) The term ‘servicer’ means any agency act17 ing on behalf of the insurance beneficiary.’’.

18 (c) EFFECTIVE DATE.—The amendments made by sub19 sections (a) and (b) shall apply with respect to loans sub20 mitted to the Secretary for payment on or after the first

21 day of the sixth month that begins after the date of enact22 ment of this Act.

23 SEC. 143. INSURANCE PROGRAM.

24 Section 710(a)(2)(B) of the Public Health Service Act

25 (42 U.S.C. 292i(a)(2)(B)) is amended by striking ‘‘any of
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1 the fiscal years 1993 through 1996’’ and inserting ‘‘fiscal

2 year 1993 and subsequent fiscal years’’.

3 SEC. 144. HEAL BANKRUPTCY.

4 (a) IN GENERAL.—Section 707(g) of the Public Health

5 Service Act (42 U.S.C. 292f(g)) is amended in the first sen6 tence by striking ‘‘A debt which is a loan insured’’ and in7 serting ‘‘Notwithstanding any other provision of Federal or

8 State law, a debt that is a loan insured’’.

9 (b) APPLICATION.—The amendment made by sub10 section (a) shall apply to any loan insured under the au11 thority of subpart I of part A of title VII of the Public

12 Health Service Act (42 U.S.C. 292 et seq.) that is listed

13 or scheduled by the debtor in a case under title XI, United

14 States Code, filed—

15 (1) on or after the date of enactment of this Act;

16 or

17 (2) prior to such date of enactment in which a

18 discharge has not been granted.

19 SEC. 145. HEAL REFINANCING.

20 Section 706 of the Public Health Service Act (42

21 U.S.C. 292e) is amended—

22 (1) in subsection (d)—

23 (A) in the subsection heading, by striking

24 ‘‘CONSOLIDATION’’ and inserting ‘‘REFINANCING

25 OR CONSOLIDATION’’; and
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1 (B) in the first sentence, by striking ‘‘in2 debtedness’’ and inserting ‘‘indebtedness or the

3 refinancing of a single loan’’; and

4 (2) in subsection (e)—

5 (A) in the subsection heading, by striking

6 ‘‘DEBTS’’ and inserting ‘‘DEBTS AND REFINANC7 ING’’;

8 (B) in the first sentence, by striking ‘‘all of

9 the borrower’s debts into a single instrument’’

10 and inserting ‘‘all of the borrower’s loans insured

11 under this subpart into a single instrument (or,

12 if the borrower obtained only 1 loan insured

13 under this subpart, refinancing the loan 1

14 time)’’; and

15 (C) in the second sentence, by striking ‘‘con16 solidation’’ and inserting ‘‘consolidation or refi17 nancing’’.

18 TITLE II—OFFICE OF MINORITY

19 HEALTH

20 SEC. 201. REVISION AND EXTENSION OF PROGRAMS OF OF21 FICE OF MINORITY HEALTH.

22 (a) DUTIES AND REQUIREMENTS.—Section 1707 of the

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

24 by striking subsection (b) and all that follows and inserting

25 the following:
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1 ‘‘(b) DUTIES.—With respect to improving the health

2 of racial and ethnic minority groups, the Secretary, acting

3 through the Deputy Assistant Secretary for Minority

4 Health (in this section referred to as the ‘Deputy Assistant

5 Secretary’), shall carry out the following:

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

7 and objectives and coordinate all other activities with8 in the Public Health Service that relate to disease

9 prevention, health promotion, service delivery, and re10 search concerning such individuals. The heads of each

11 of the agencies of the Service shall consult with the

12 Deputy Assistant Secretary to ensure the coordination

13 of such activities.

14 ‘‘(2) Enter into interagency agreements with

15 other agencies of the Public Health Service.

16 ‘‘(3) Support research, demonstrations and eval17 uations to test new and innovative models.

18 ‘‘(4) Increase knowledge and understanding of

19 health risk factors.

20 ‘‘(5) Develop mechanisms that support better in21 formation dissemination, education, prevention, and

22 service delivery to individuals from disadvantaged

23 backgrounds, including individuals who are members

24 of racial or ethnic minority groups.
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1 ‘‘(6) Ensure that the National Center for Health

2 Statistics collects data on the health status of each

3 minority group.

4 ‘‘(7) With respect to individuals who lack pro5 ficiency in speaking the English language, enter into

6 contracts with public and nonprofit private providers

7 of primary health services for the purpose of increas8 ing the access of the individuals to such services by

9 developing and carrying out programs to provide bi10 lingual or interpretive services.

11 ‘‘(8) Support a national minority health re12 source center to carry out the following:

13 ‘‘(A) Facilitate the exchange of information

14 regarding matters relating to health information

15 and health promotion, preventive health services,

16 and education in the appropriate use of health

17 care.

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

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

20 problems relating to such matters.

21 ‘‘(D) Provide technical assistance with re22 spect to the exchange of such information (in23 cluding facilitating the development of materials

24 for such technical assistance).
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1 ‘‘(9) Carry out programs to improve access to

2 health care services for individuals with limited pro3 ficiency in speaking the English language. Activities

4 under the preceding sentence shall include developing

5 and evaluating model projects.

6 ‘‘(c) ADVISORY COMMITTEE.—

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

8 an advisory committee to be known as the Advisory

9 Committee on Minority Health (in this subsection re10 ferred to as the ‘Committee’).

11 ‘‘(2) DUTIES.—The Committee shall provide ad12 vice to the Deputy Assistant Secretary carrying out

13 this section, including advice on the development of

14 goals and specific program activities under para15 graphs (1) through (9) of subsection (b) for each ra16 cial and ethnic minority group.

17 ‘‘(3) CHAIR.—The chairperson of the Committee

18 shall be selected by the Secretary from among the

19 members of the voting members of the Committee. The

20 term of office of the chairperson shall be 2 years.

21 ‘‘(4) COMPOSITION.—

22 ‘‘(A) The Committee shall be composed of 12

23 voting members appointed in accordance with

24 subparagraph (B), and nonvoting, ex officio

25 members designated in subparagraph (C).
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1 ‘‘(B) The voting members of the Committee

2 shall be appointed by the Secretary from among

3 individuals who are not officers or employees of

4 the Federal Government and who have expertise

5 regarding issues of minority health. The racial

6 and ethnic minority groups shall be equally rep7 resented among such members.

8 ‘‘(C) The nonvoting, ex officio members of

9 the Committee shall be such officials of the De10 partment of Health and Human Services as the

11 Secretary determines to be appropriate.

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

13 shall serve for a term of 4 years, except that the Sec14 retary shall initially appoint a portion of the mem15 bers to terms of 1 year, 2 years, and 3 years.

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

17 Committee, a new member shall be appointed by the

18 Secretary within 90 days from the date that the va19 cancy occurs, and serve for the remainder of the term

20 for which the predecessor of such member was ap21 pointed. The vacancy shall not affect the power of the

22 remaining members to execute the duties of the Com23 mittee.

24 ‘‘(7) COMPENSATION.—Members of the Commit25 tee who are officers or employees of the United States
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1 shall serve without compensation. Members of the

2 Committee who are not officers or employees of the

3 United States shall receive compensation, for each

4 day (including travel time) they are engaged in the

5 performance of the functions of the Committee. Such

6 compensation may not be in an amount in excess of

7 the daily equivalent of the annual maximum rate of

8 basic pay payable under the General Schedule (under

9 title 5, United States Code) for positions above GS–

10 15.

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

12 ‘‘(1) RECOMMENDATIONS REGARDING LANGUAGE

13 AS IMPEDIMENT TO HEALTH CARE.—The Deputy As14 sistant Secretary for Minority Health shall consult

15 with the Director of the Office of International and

16 Refugee Health, the Director of the Office of Civil

17 Rights, and the Directors of other appropriate De18 partmental entities regarding recommendations for

19 carrying out activities under subsection (b)(9).

20 ‘‘(2) EQUITABLE ALLOCATION REGARDING AC21 TIVITIES.—In carrying out subsection (b), the Sec22 retary shall ensure that services provided under such

23 subsection are equitably allocated among all groups

24 served under this section by the Secretary.
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1 ‘‘(3) CULTURAL COMPETENCY OF SERVICES.—

2 The Secretary shall ensure that information and serv3 ices provided pursuant to subsection (b) are provided

4 in the language, educational, and cultural context

5 that is most appropriate for the individuals for whom

6 the information and services are intended.

7 ‘‘(e) GRANTS AND CONTRACTS REGARDING DUTIES.—

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

9 (b), the Secretary acting through the Deputy Assist10 ant Secretary may make awards of grants, coopera11 tive agreements, and contracts to public and non12 profit private entities.

13 ‘‘(2) PROCESS FOR MAKING AWARDS.—The Dep14 uty Assistant Secretary shall ensure that awards

15 under paragraph (1) are made, to the extent prac16 tical, only on a competitive basis, and that a grant

17 is awarded for a proposal only if the proposal has

18 been recommended for such an award through a proc19 ess of peer review.

20 ‘‘(3) EVALUATION AND DISSEMINATION.—The

21 Deputy Assistant Secretary, directly or through con22 tracts with public and private entities, shall provide

23 for evaluations of projects carried out with awards

24 made under paragraph (1) during the preceding 2 fis25 cal years. The report shall be included in the report
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1 required under subsection (f) for the fiscal year in2 volved.

3 ‘‘(f) REPORTS.—

4 ‘‘(1) IN GENERAL.—Not later than February 1 of

5 fiscal year 1999 and of each second year thereafter,

6 the Secretary shall submit to the Committee on En7 ergy and Commerce of the House of Representatives,

8 and to the Committee on Labor and Human Re9 sources of the Senate, a report describing the activi10 ties carried out under this section during the preced11 ing 2 fiscal years and evaluating the extent to which

12 such activities have been effective in improving the

13 health of racial and ethnic minority groups. Each

14 such report shall include the biennial reports submit15 ted under sections 201(e)(3) and 201(f)(2) for such

16 years by the heads of the Public Health Service agen17 cies.

18 ‘‘(2) AGENCY REPORTS.—Not later than Feb19 ruary 1, 1999, and biennially thereafter, the heads of

20 the Public Health Service agencies shall submit to the

21 Deputy Assistant Secretary a report summarizing the

22 minority health activities of each of the respective

23 agencies.

24 ‘‘(g) DEFINITION.—For purposes of this section:
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1 ‘‘(1) The term ‘racial and ethnic minority group’

2 means American Indians (including Alaska Natives,

3 Eskimos, and Aleuts); Asian Americans and Pacific

4 Islanders; Blacks; and Hispanics.

5 ‘‘(2) The term ‘Hispanic’ means individuals

6 whose origin is Mexican, Puerto Rican, Cuban, Cen7 tral or South American, or any other Spanish-speak8 ing country.

9 ‘‘(h) FUNDING.—

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

11 the purpose of carrying out this section, there are au12 thorized to be appropriated $30,000,000 for fiscal

13 year 1998, such sums as may be necessary for each

14 of the fiscal years 1999 through 2002.’’.

15 (b) AUTHORIZATION FOR NATIONAL CENTER FOR

16 HEALTH STATISTICS.—Section 306 of the Public Health

17 Service Act (42 U.S.C. 242k) is amended—

18 (1) in subsection (m), by adding at the end the

19 following:

20 ‘‘(4)(A) Subject to subparagraph (B), the Secretary,

21 acting through the Center, shall collect data on Hispanics

22 and major Hispanic subpopulation groups and American

23 Indians, and for developing special area population studies

24 on major Asian American and Pacific Islander popu25 lations.
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1 ‘‘(B) The provisions of subparagraph (A) shall be effec2 tive with respect to a fiscal year only to the extent that

3 funds are appropriated pursuant to paragraph (3) of sub4 section (n), and only if the amounts appropriated for such

5 fiscal year pursuant to each of paragraphs (1) and (2) of

6 subsection (n) equal or exceed the amounts so appropriated

7 for fiscal year 1997.’’;

8 (2) in subsection (n)(1), by striking ‘‘through

9 1998’’ and inserting ‘‘through 2003’’; and

10 (3) in subsection (n)

11 (A) in the first sentence of paragraph (2)—

12 (i) by striking ‘‘authorized in sub13 section (m)’’ and inserting ‘‘authorized in

14 paragraphs (1) through (3) of subsection

15 (m)’’; and

16 (ii) by striking ‘‘$5,000,000’’ and all

17 that follows through the period and insert18 ing ‘‘such sums as may be necessary for

19 each of the fiscal years 1999 through 2003.’’;

20 and

21 (B) by adding at the end the following:

22 ‘‘(3) For activities authorized in subsection (m)(4),

23 there are authorized to be appropriated $1,000,000 for fiscal

24 year 1998, and such sums as may be necessary for each

25 of the fiscal years 1999 through 2002.’’.
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1 (c) MISCELLANEOUS AMENDMENTS.—Section 1707 of

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

3 amended—

4 (1) in the heading for the section by striking

5 ‘‘ESTABLISHMENT OF’’; and

6 (2) in subsection (a), by striking ‘‘Office of the

7 Assistant Secretary for Health’’ and inserting ‘‘Office

8 of Public Health and Science’’.

9 TITLE III—SELECTED

10 INITIATIVES

11 SEC. 301. STATE OFFICES OF RURAL HEALTH.

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

13 U.S.C. 254r) is amended—

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

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

16 (2) in subsection (j)(1)—

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

18 (B) by inserting before the period the follow19 ing: ‘‘, and such sums as may be necessary for

20 each of the fiscal years 1998 through 2002’’; and

21 (3) in subsection (k), by striking ‘‘$10,000,000’’

22 and inserting ‘‘$36,000,000’’.
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1 SEC. 302. DEMONSTRATION PROJECTS REGARDING ALZ2 HEIMER’S DISEASE.

3 (a) IN GENERAL.—Section 398(a) of the Public Health

4 Service Act (42 U.S.C. 280c–3(a)) is amended—

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

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

7 (2) in paragraph (2)—

8 (A) by inserting after ‘‘disorders’’ the fol9 lowing: ‘‘who are living in single family homes

10 or in congregate settings’’; and

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

12 (3) by redesignating paragraph (3) as para13 graph (4); and

14 (4) by inserting after paragraph (2) the follow15 ing:

16 ‘‘(3) to improve the access of such individuals to

17 home-based or community-based long-term care serv18 ices (subject to the services being provided by entities

19 that were providing such services in the State in20 volved as of October 1, 1995), particularly such indi21 viduals who are members of racial or ethnic minority

22 groups, who have limited proficiency in speaking the

23 English language, or who live in rural areas; and’’.

24 (b) DURATION.—Section 398A of the Public Health

25 Service Act (42 U.S.C. 280c–4) is amended—
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1 (1) in the heading for the section, by striking

2 ‘‘LIMITATION’’ and all that follows and inserting

3 ‘‘REQUIREMENT OF MATCHING

4 FUNDS’’;

5 (2) by striking subsection (a);

6 (3) by redesignating subsections (b) and (c) as

7 subsections (a) and (b), respectively; and

8 (4) in subsection (a) (as so redesignated), in each

9 of paragraphs (1)(C) and (2)(C), by striking ‘‘third

10 year’’ and inserting ‘‘third or subsequent year’’.

11 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

12 398B(e) of the Public Health Service Act (42 U.S.C. 280c–

13 5(e)) is amended—

14 (1) by striking ‘‘and such sums’’ and inserting

15 ‘‘such sums’’; and

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

17 ‘‘, $8,000,000 for fiscal year 1998, and such sums as

18 may be necessary for each of the fiscal years 1999

19 through 2002’’.

20 SEC. 303. PROJECT GRANTS FOR IMMUNIZATION SERVICES.

21 Section 317(j) of the Public Health Service Act (42

22 U.S.C. 247b(j)) is amended—

23 (1) in paragraph (1), by striking ‘‘individuals

24 against vaccine-preventable diseases’’ and all that fol25 lows through the first period and inserting the follow-
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1 ing: ‘‘children, adolescents, and adults against vac2 cine-preventable diseases, there are authorized to be

3 appropriated such sums as may be necessary for each

4 of the fiscal years 1998 through 2002.’’; and

5 (2) in paragraph (2), by striking ‘‘1990’’ and in6 serting ‘‘1997’’.

7 TITLE IV—MISCELLANEOUS

8 PROVISIONS

9 SEC. 401. TECHNICAL CORRECTIONS REGARDING PUBLIC

10 LAW 103–183.

11 (a) AMENDATORY INSTRUCTIONS.—Public Law 103–

12 183 is amended—

13 (1) in section 601—

14 (A) in subsection (b), in the matter preced15 ing paragraph (1), by striking ‘‘Section 1201 of

16 the Public Health Service Act (42 U.S.C. 300d)’’

17 and inserting ‘‘Title XII of the Public Health

18 Service Act (42 U.S.C. 300d et seq.)’’; and

19 (B) in subsection (f)(1), by striking ‘‘in sec20 tion 1204(c)’’ and inserting ‘‘in section 1203(c)

21 (as redesignated by subsection (b)(2) of this sec22 tion)’’;

23 (2) in section 602, by striking ‘‘for the purpose’’

24 and inserting ‘‘For the purpose’’; and
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1 (3) in section 705(b), by striking ‘‘317D((l)(1)’’

2 and inserting ‘‘317D(l)(1)’’.

3 (b) PUBLIC HEALTH SERVICE ACT.—The Public

4 Health Service Act, as amended by Public Law 103–183

5 and by subsection (a) of this section, is amended—

6 (1) in section 317E(g)(2), by striking ‘‘making

7 grants under subsection (b)’’ and inserting ‘‘carrying

8 out subsection (b)’’;

9 (2) in section 318, in subsection (e) as in effect

10 on the day before the date of the enactment of Public

11 Law 103–183, by redesignating the subsection as sub12 section (f);

13 (3) in subpart 6 of part C of title IV—

14 (A) by transferring the first section 447

15 (added by section 302 of Public Law 103–183)

16 from the current placement of the section;

17 (B) by redesignating the section as section

18 447A; and

19 (C) by inserting the section after section

20 447;

21 (4) in section 1213(a)(8), by striking ‘‘provides

22 for for’’ and inserting ‘‘provides for’’;

23 (5) in section 1501, by redesignating the second

24 subsection (c) (added by section 101(f) of Public Law

25 103–183) as subsection (d); and
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1 (6) in section 1505(3), by striking ‘‘nonprofit’’.

2 (c) MISCELLANEOUS CORRECTION.—Section 401(c)(3)

3 of Public Law 103–183 is amended in the matter preceding

4 subparagraph (A) by striking ‘‘(d)(5)’’ and inserting

5 ‘‘(e)(5)’’.

6 (d) CONFORMING AMENDMENT.—Section 308(b) of the

7 Public Health Service Act (42 U.S.C. 242m(b)) is amend8 ed—

9 (1) in paragraph (2)(A), by striking ‘‘306(n)’’

10 and inserting ‘‘306(m)’’; and

11 (2) in paragraph (2)(C), by striking ‘‘306(n)’’

12 and inserting ‘‘306(m)’’.

13 (e) EFFECTIVE DATE.—This section is deemed to have

14 taken effect immediately after the enactment of Public Law

15 103–183.

16 SEC. 402. MISCELLANEOUS AMENDMENTS REGARDING PHS

17 COMMISSIONED OFFICERS.

18 (a) ANTI-DISCRIMINATION LAWS.—Amend section 212

19 of the Public Health Service Act (42 U.S.C. 213) by adding

20 the following new subsection at the end thereof:

21 ‘‘(f) Active service of commissioned officers of the Serv22 ice shall be deemed to be active military service in the

23 Armed Forces of the United States for purposes of all laws

24 related to discrimination on the basis of race, color, sex,

25 ethnicity, age, religion, and disability.’’
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1 (b) TRAINING IN LEAVE WITHOUT PAY STATUS.—Sec2 tion 218 of the Public Health Service Act (42 U.S.C. 218a)

3 is amended by adding at the end the following:

4 ‘‘(c) A commissioned officer may be placed in leave

5 without pay status while attending an educational institu6 tion or training program whenever the Secretary deter7 mines that such status is in the best interest of the Service.

8 For purposes of computation of basic pay, promotion, re9 tirement, compensation for injury or death, and the benefits

10 provided by sections 212 and 224, an officer in such status

11 pursuant to the preceding sentence shall be considered as

12 performing service in the Service and shall have an active

13 service obligation as set forth in subsection (b) of this sec14 tion.’’.

15 (c) UTILIZATION OF ALCOHOL AND DRUG ABUSE

16 RECORDS THAT APPLY TO THE ARMED FORCES.—Section

17 543(e) of the Public Health Service Act (42 U.S.C. 290dd–

18 2(e)) is amended by striking ‘‘Armed Forces’’ each place

19 that such term appears and inserting ‘‘Uniformed Serv20 ices’’.

21 SEC. 403. CLINICAL TRAINEESHIPS.

22 Section 303(d)(1) of the Public Health Service Act (42

23 U.S.C. 242a(d)(1)) is amended by inserting ‘‘counseling,’’

24 after ‘‘family therapy,’’.
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1 SEC. 404. PROJECT GRANTS FOR SCREENINGS, REFERRALS,

2 AND EDUCATION REGARDING LEAD POISON3 ING.

4 Section 317A(l)(1) of the Public Health Service Act

5 (42 U.S.C. 247b–1(l)(1)) is amended by striking ‘‘1998’’

6 and inserting ‘‘2002’’.

7 SEC. 405. PROJECT GRANTS FOR PREVENTIVE HEALTH

8 SERVICES REGARDING TUBERCULOSIS.

9 Section 317E(g) of the Public Health Service Act (42

10 U.S.C. 247b–6(g)(1)) is amended—

11 (1) in paragraph (1)—

12 (A) in subparagraph (A), by striking

13 ‘‘1998’’ and inserting ‘‘2002’’; and

14 (B) in subparagraph (B), by striking

15 ‘‘$50,000,000’’ and inserting ‘‘25 percent’’; and

16 (2) in paragraph (2), by striking ‘‘1998’’ and in17 serting ‘‘2002’’.

18 SEC. 406. CDC LOAN REPAYMENT PROGRAM.

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

20 U.S.C. 247b-7) is amended—

21 (1) in subsection (a)(1), by striking ‘‘$20,000’’

22 and inserting ‘‘$35,000’’;

23 (2) in subsection (c), by striking ‘‘1998’’ and in24 serting ‘‘2002’’; and

25 (3) by adding at the end the following:
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1 ‘‘(d) AVAILABILITY OF APPROPRIATIONS.—Amounts

2 appropriated for a fiscal year for contracts under subsection

3 (a) shall remain available until the expiration of the second

4 fiscal year beginning after the fiscal year for which the

5 amounts were appropriated.’’.

6 SEC. 407. COMMUNITY PROGRAMS ON DOMESTIC VIOLENCE.

7 (a) IN GENERAL.—Section 318(h)(2) of the Family Vi8 olence Prevention and Services Act (42 U.S.C. 10418(h)(2))

9 is amended by striking ‘‘fiscal year 1997’’ and inserting

10 ‘‘for each of the fiscal years 1997 through 2002’’.

11 (b) STUDY.—The Secretary of Health and Human

12 Services shall request that the Institute of Medicine conduct

13 a study concerning the training needs of health profes14 sionals with respect to the detection and referral of victims

15 of family or acquaintance violence. Not later than 2 years

16 after the date of enactment of this Act, the Institute of Medi17 cine shall prepare and submit to Congress a report concern18 ing the study conducted under this subsection.

19 SEC. 408. STATE LOAN REPAYMENT PROGRAM.

20 Section 338I(i)(1) of the Public Health Service Act (42

21 U.S.C. 254q–1(i)(1)) is amended by inserting before the pe22 riod ‘‘, and such sums as may be necessary for each of the

23 fiscal years 1998 through 2002’’.
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1 SEC. 409. AUTHORITY OF THE DIRECTOR OF NIH.

2 Section 402(b) of the Public Health Service Act (42

3 U.S.C. 282(b)) is amended—

4 (1) in paragraph (11), by striking ‘‘and’’ at the

5 end thereof;

6 (2) in paragraph (12), by striking the period

7 and inserting a semicolon; and

8 (3) by adding after paragraph (12), the follow9 ing new paragraphs:

10 ‘‘(13) may conduct and support research train11 ing—

12 ‘‘(A) for which fellowship support is not

13 provided under section 487; and

14 ‘‘(B) which does not consist of residency

15 training of physicians or other health profes16 sionals; and

17 ‘‘(14) may appoint physicians, dentists, and

18 other health care professionals, subject to the provi19 sions of title 5, United States Code, relating to ap20 pointments and classifications in the competitive

21 service, and may compensate such professionals sub22 ject to the provisions of chapter 74 of title 38, United

23 States Code.’’.
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1 SEC. 410. RAISE IN MAXIMUM LEVEL OF LOAN REPAY2 MENTS.

3 (a) REPAYMENT PROGRAMS WITH RESPECT TO

4 AIDS.—Section 487A of the Public Health Service Act (42

5 U.S.C. 288–1) is amended—

6 (1) in subsection (a), by striking ‘‘$20,000’’ and

7 inserting ‘‘$35,000’’; and

8 (2) in subsection (c), by striking ‘‘1996’’ and in9 serting ‘‘2001’’.

10 (b) REPAYMENT PROGRAMS WITH RESPECT TO CON11 TRACEPTION AND INFERTILITY.—Section 487B(a) of the

12 Public Health Service Act (42 U.S.C. 288–2(a)) is amended

13 by striking ‘‘$20,000’’ and inserting ‘‘$35,000’’.

14 (c) REPAYMENT PROGRAMS WITH RESPECT TO RE15 SEARCH GENERALLY.—Section 487C(a)(1) of the Public

16 Health Service Act (42 U.S.C. 288–3(a)(1)) is amended by

17 striking ‘‘$20,000’’ and inserting ‘‘$35,000’’.

18 (d) REPAYMENT PROGRAMS WITH RESPECT TO CLINI19 CAL RESEARCHERS FROM DISADVANTAGED BACK20 GROUNDS.—Section 487E(a) of the Public Health Service

21 Act (42 U.S.C. 288–5(a)) is amended—

22 (1) in paragraph (1), by striking ‘‘$20,000’’ and

23 inserting ‘‘$35,000’’; and

24 (2) in paragraph (3), by striking ‘‘338C’’ and

25 inserting ‘‘338B, 338C’’.
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1 SEC. 411. CONSTRUCTION OF REGIONAL CENTERS FOR RE2 SEARCH ON PRIMATES.

3 Section 481B(a) of the Public Health Service Act (42

4 U.S.C. 287a–3(a)) is amended—

5 (1) by striking ‘‘shall’’ and inserting ‘‘may’’;

6 and

7 (2) by striking ‘‘$5,000,000’’ and inserting ‘‘up

8 to $2,500,000’’.

9 SEC. 412. PEER REVIEW.

10 Section 504(d)(2) of the Public Health Service Act (42

11 U.S.C. 290aa–3(d)(2)) is amended by striking ‘‘cooperative

12 agreement, or contract’’ each place that such appears and

13 inserting ‘‘or cooperative agreement’’.

14 SEC. 413. FUNDING FOR TRAUMA CARE.

15 Section 1232(a) of the Public Health Service Act (42

16 U.S.C. 300d–32) is amended by striking ‘‘and 1996’’ and

17 inserting ‘‘through 2002’’.

18 SEC. 414. HEALTH INFORMATION AND HEALTH PRO19 MOTION.

20 Section 1701(b) of the Public Health Service Act (42

21 U.S.C. 300u(b)) is amended by striking ‘‘through 1996’’

22 and inserting ‘‘through 2002’’.

23 SEC. 415. EMERGENCY MEDICAL SERVICES FOR CHILDREN.

24 Section 1910 of the Public Health Service Act (42

25 U.S.C. 300w–9) is amended—

26 (1) in subsection (a)—
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1 (A) by striking ‘‘two-year period’’ and in2 serting ‘‘3-year period (with an optional 4th

3 year based on performance)’’; and

4 (B) by striking ‘‘one grant’’ and inserting

5 ‘‘3 grants’’; and

6 (2) in subsection (d), by striking ‘‘1997’’ and in7 serting ‘‘2005’’.

8 SEC. 416. ADMINISTRATION OF CERTAIN REQUIREMENTS.

9 (a) IN GENERAL.—Section 2004 of Public Law 103–

10 43 (107 Stat. 209) is amended by striking subsection (a).

11 (b) CONFORMING AMENDMENTS.—Section 2004 of

12 Public Law 103–43, as amended by subsection (a) of this

13 section, is amended—

14 (1) by striking ‘‘(b) SENSE’’ and all that follows

15 through ‘‘In the case’’ and inserting the following:

16 ‘‘(a) SENSE OF CONGRESS REGARDING PURCHASE OF

17 AMERICAN-MADE EQUIPMENT AND PRODUCTS.—In the

18 case’’;

19 (2) by striking ‘‘(2) NOTICE TO RECIPIENTS OF

20 ASSISTANCE’’ and inserting the following:

21 ‘‘(b) NOTICE TO RECIPIENTS OF ASSISTANCE’’; and

22 (3) in subsection (b), as redesignated by para23 graph (2) of this subsection, by striking ‘‘paragraph

24 (1)’’ and inserting ‘‘subsection (a)’’.
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1 (c) EFFECTIVE DATE.—This section is deemed to have

2 taken effect immediately after the enactment of Public Law

3 103–43.

4 SEC. 417. AIDS DRUG ASSISTANCE PROGRAM.

5 Section 2618(b)(3) of the Public Health Service Act

6 (42 U.S.C. 300ff–28(b)(3)) is amended—

7 (1) in subparagraph (A), by striking ‘‘and the

8 Commonwealth of Puerto Rico’’ and inserting ‘‘, the

9 Commonwealth of Puerto Rico, the Virgin Islands,

10 and Guam’’; and

11 (2) in subparagraph (B), by striking ‘‘the Virgin

12 Islands, Guam’’.

13 SEC. 418. NATIONAL FOUNDATION FOR BIOMEDICAL RE14 SEARCH.

15 Part I of title IV of the Public Health Service Act (42

16 U.S.C. 290b et seq.) is amended—

17 (1) by striking the part heading and inserting

18 the following:

19 ‘‘PART I—FOUNDATION FOR THE NATIONAL

20 INSTITUTES OF HEALTH’’;

21 and

22 (2) in section 499—

23 (A) in subsection (a), by striking ‘‘National

24 Foundation for Biomedical Research’’ and in-
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1 serting ‘‘Foundation for the National Institutes

2 of Health’’;

3 (B) in subsection (k)(10)—

4 (i) by striking ‘‘not’’; and

5 (ii) by adding at the end the following:

6 ‘‘Any funds transferred under this para7 graph shall be subject to all Federal limita8 tions relating to Federally-funded re9 search.’’; and

10 (C) in subsection (m)(1), by striking

11 ‘‘$200,000’’ and all that follows through ‘‘1995’’

12 and inserting ‘‘$500,000 for each fiscal year’’.

13 SEC. 419. FETAL ALCOHOL SYNDROME PREVENTION AND

14 SERVICES.

15 (a) SHORT TITLE.—This section may be cited as the

16 ‘‘Fetal Alcohol Syndrome and Fetal Alcohol Effect Preven17 tion and Services Act’’.

18 (b) FINDINGS.—Congress finds that—

19 (1) Fetal Alcohol Syndrome is the leading pre20 ventable cause of mental retardation, and it is 100

21 percent preventable;

22 (2) estimates on the number of children each

23 year vary, but according to some researchers, up to

24 12,000 infants are born in the United States with
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1 Fetal Alcohol Syndrome, suffering irreversible phys2 ical and mental damage;

3 (3) thousands more infants are born each year

4 with Fetal Alcohol Effect, also known as Alcohol Re5 lated Neurobehavioral Disorder (ARND), a related

6 and equally tragic syndrome;

7 (4) children of women who use alcohol while

8 pregnant have a significantly higher infant mortality

9 rate (13.3 per 1000) than children of those women

10 who do not use alcohol (8.6 per 1000);

11 (5) Fetal Alcohol Syndrome and Fetal Alcohol

12 Effect are national problems which can impact any

13 child, family, or community, but their threat to

14 American Indians and Alaska Natives is especially

15 alarming;

16 (6) in some American Indian communities,

17 where alcohol dependency rates reach 50 percent and

18 above, the chances of a newborn suffering Fetal Alco19 hol Syndrome or Fetal Alcohol Effect are up to 30

20 times greater than national averages;

21 (7) in addition to the immeasurable toll on chil22 dren and their families, Fetal Alcohol Syndrome and

23 Fetal Alcohol Effect pose extraordinary financial costs

24 to the Nation, including the costs of health care, edu-
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1 cation, foster care, job training, and general support

2 services for affected individuals;

3 (8) the total cost to the economy of Fetal Alcohol

4 Syndrome was approximately $2,500,000,000 in

5 1995, and over a lifetime, health care costs for one

6 Fetal Alcohol Syndrome child are estimated to be at

7 least $1,400,000;

8 (9) researchers have determined that the possibil9 ity of giving birth to a baby with Fetal Alcohol Syn10 drome or Fetal Alcohol Effect increases in proportion

11 to the amount and frequency of alcohol consumed by

12 a pregnant woman, and that stopping alcohol con13 sumption at any point in the pregnancy reduces the

14 emotional, physical, and mental consequences of alco15 hol exposure to the baby; and

16 (10) though approximately 1 out of every 5 preg17 nant women drink alcohol during their pregnancy, we

18 know of no safe dose of alcohol during pregnancy, or

19 of any safe time to drink during pregnancy, thus, it

20 is in the best interest of the Nation for the Federal

21 Government to take an active role in encouraging all

22 women to abstain from alcohol consumption during

23 pregnancy.

24 (c) PURPOSE.—It is the purpose of this section to es25 tablish, within the Department of Health and Human Serv-
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1 ices, a comprehensive program to help prevent Fetal Alcohol

2 Syndrome and Fetal Alcohol Effect nationwide and to pro3 vide effective intervention programs and services for chil4 dren, adolescents and adults already affected by these condi5 tions. Such program shall—

6 (1) coordinate, support, and conduct national,

7 State, and community-based public awareness, pre8 vention, and education programs on Fetal Alcohol

9 Syndrome and Fetal Alcohol Effect;

10 (2) coordinate, support, and conduct prevention

11 and intervention studies as well as epidemiologic re12 search concerning Fetal Alcohol Syndrome and Fetal

13 Alcohol Effect;

14 (3) coordinate, support and conduct research and

15 demonstration projects to develop effective develop16 mental and behavioral interventions and programs

17 that foster effective advocacy, educational and voca18 tional training, appropriate therapies, counseling,

19 medical and mental health, and other supportive serv20 ices, as well as models that integrate or coordinate

21 such services, aimed at the unique challenges facing

22 individuals with Fetal Alcohol Syndrome or Fetal Al23 cohol Effect and their families; and

24 (4) foster coordination among all Federal, State

25 and local agencies, and promote partnerships between
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1 research institutions and communities that conduct or

2 support Fetal Alcohol Syndrome and Fetal Alcohol

3 Effect research, programs, surveillance, prevention,

4 and interventions and otherwise meet the general

5 needs of populations already affected or at risk of

6 being impacted by Fetal Alcohol Syndrome and Fetal

7 Alcohol Effect.

8 (d) ESTABLISHMENT OF PROGRAM.—Title III of the

9 Public Health Service Act (42 U.S.C. 241 et seq.) is amend10 ed by adding at the end the following:

11 ‘‘PART O—FETAL ALCOHOL SYNDROME

12 PREVENTION AND SERVICES PROGRAM

13 ‘‘SEC. 399G. ESTABLISHMENT OF FETAL ALCOHOL SYN14 DROME PREVENTION AND SERVICES PRO15 GRAM.

16 ‘‘(a) FETAL ALCOHOL SYNDROME PREVENTION,

17 INTERVENTION AND SERVICES DELIVERY PROGRAM.—The

18 Secretary shall establish a comprehensive Fetal Alcohol

19 Syndrome and Fetal Alcohol Effect prevention, intervention

20 and services delivery program that shall include—

21 ‘‘(1) an education and public awareness program

22 to support, conduct, and evaluate the effectiveness

23 of—

24 ‘‘(A) educational programs targeting medi25 cal schools, social and other supportive services,
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•S 1754 EAH

1 educators and counselors and other service pro2 viders in all phases of childhood development,

3 and other relevant service providers, concerning

4 the prevention, identification, and provision of

5 services for children, adolescents and adults with

6 Fetal Alcohol Syndrome and Fetal Alcohol Ef7 fect;

8 ‘‘(B) strategies to educate school-age chil9 dren, including pregnant and high risk youth,

10 concerning Fetal Alcohol Syndrome and Fetal

11 Alcohol Effect;

12 ‘‘(C) public and community awareness pro13 grams concerning Fetal Alcohol Syndrome and

14 Fetal Alcohol Effect; and

15 ‘‘(D) strategies to coordinate information

16 and services across affected community agencies,

17 including agencies providing social services such

18 as foster care, adoption, and social work, medical

19 and mental health services, and agencies involved

20 in education, vocational training and civil and

21 criminal justice;

22 ‘‘(2) a prevention and diagnosis program to sup23 port clinical studies, demonstrations and other re24 search as appropriate to—
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1 ‘‘(A) develop appropriate medical diag2 nostic methods for identifying Fetal Alcohol Syn3 drome and Fetal Alcohol Effect; and

4 ‘‘(B) develop effective prevention services

5 and interventions for pregnant, alcohol-depend6 ent women; and

7 ‘‘(3) an applied research program concerning

8 intervention and prevention to support and conduct

9 service demonstration projects, clinical studies and

10 other research models providing advocacy, educational

11 and vocational training, counseling, medical and

12 mental health, and other supportive services, as well

13 as models that integrate and coordinate such services,

14 that are aimed at the unique challenges facing indi15 viduals with Fetal Alcohol Syndrome or Fetal Alcohol

16 Effect and their families.

17 ‘‘(b) GRANTS AND TECHNICAL ASSISTANCE.—The Sec18 retary may award grants, cooperative agreements and con19 tracts and provide technical assistance to eligible entities

20 described in section 399H to carry out subsection (a).

21 ‘‘(c) DISSEMINATION OF CRITERIA.—In carrying out

22 this section, the Secretary shall develop a procedure for dis23 seminating the Fetal Alcohol Syndrome and Fetal Alcohol

24 Effect diagnostic criteria developed pursuant to section 705

25 of the ADAMHA Reorganization Act (42 U.S.C. 485n note)
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1 to health care providers, educators, social workers, child

2 welfare workers, and other individuals.

3 ‘‘(d) NATIONAL TASK FORCE.—

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

5 a task force to be known as the National task force

6 on Fetal Alcohol Syndrome and Fetal Alcohol Effect

7 (referred to in this subsection as the ‘task force’) to

8 foster coordination among all governmental agencies,

9 academic bodies and community groups that conduct

10 or support Fetal Alcohol Syndrome and Fetal Alcohol

11 Effect research, programs, and surveillance, and oth12 erwise meet the general needs of populations actually

13 or potentially impacted by Fetal Alcohol Syndrome

14 and Fetal Alcohol Effect.

15 ‘‘(2) MEMBERSHIP.—The Task Force established

16 pursuant to paragraph (1) shall—

17 ‘‘(A) be chaired by an individual to be ap18 pointed by the Secretary and staffed by the Ad19 ministration; and

20 ‘‘(B) include the Chairperson of the Inter21 agency Coordinating Committee on Fetal Alcohol

22 Syndrome of the Department of Health and

23 Human Services, individuals with Fetal Alcohol

24 Syndrome and Fetal Alcohol Effect, and rep25 resentatives from advocacy and research organi-
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1 zation such as the Research Society on Alcohol2 ism, the FAS Family Resource Institute, the Na3 tional Organization of Fetal Alcohol Syndrome,

4 the Arc, the academic community, and Federal,

5 State and local government agencies and offices.

6 ‘‘(3) FUNCTIONS.—The Task Force shall—

7 ‘‘(A) advise Federal, State and local pro8 grams and research concerning Fetal Alcohol

9 Syndrome and Fetal Alcohol Effect, including

10 programs and research concerning education and

11 public awareness for relevant service providers,

12 school-age children, women at-risk, and the gen13 eral public, medical diagnosis, interventions for

14 women at-risk of giving birth to children with

15 Fetal Alcohol Syndrome and Fetal Alcohol Ef16 fect, and beneficial services for individuals with

17 Fetal Alcohol Syndrome and Fetal Alcohol Effect

18 and their families;

19 ‘‘(B) coordinate its efforts with the Inter20 agency Coordinating Committee on Fetal Alcohol

21 Syndrome of the Department of Health and

22 Human Services; and

23 ‘‘(C) report on a biennial basis to the Sec24 retary and relevant committees of Congress on
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1 the current and planned activities of the partici2 pating agencies.

3 ‘‘(4) TIME FOR APPOINTMENT.—The members of

4 the Task Force shall be appointed by the Secretary

5 not later than 6 months after the date of enactment

6 of this part.

7 ‘‘SEC. 399H. ELIGIBILITY.

8 ‘‘To be eligible to receive a grant, or enter into a coop9 erative agreement or contract under this part, an entity

10 shall—

11 ‘‘(1) be a State, Indian tribal government, local

12 government, scientific or academic institution, or

13 nonprofit organization; and

14 ‘‘(2) prepare and submit to the Secretary an ap15 plication at such time, in such manner, and contain16 ing such information as the Secretary may prescribe,

17 including a description of the activities that the en18 tity intends to carry out using amounts received

19 under this part.

20 ‘‘SEC. 399I. AUTHORIZATION OF APPROPRIATIONS.

21 ‘‘(a) IN GENERAL.—There are authorized to be appro22 priated to carry out this part, $27,000,000 for each of the

23 fiscal years 1999 through 2003.

24 ‘‘(b) TASK FORCE.—From amounts appropriate for a

25 fiscal year under subsection (a), the Secretary may use not
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1 to exceed $2,000,000 of such amounts for the operations of

2 the National Task Force under section 399G(d).

3 ‘‘SEC. 399J. SUNSET PROVISION.

4 ‘‘This part shall not apply on the date that is 7 years

5 after the date on which all members of the national task

6 force have been appointed under section 399G(d)(1).’’.

Attest:

Clerk.