II

105TH CONGRESS

2D SESSION S. 1754

To amend the Public Health Service Act to consolidate and reauthorize

health professions and minority and disadvantaged health education programs, and for other purposes.

IN THE SENATE OF THE UNITED STATES

MARCH 12, 1998

Mr. FRIST (for himself, Mr. KENNEDY, Mr. JEFFORDS, Mr. BINGAMAN, Mr.

COCHRAN, and Mr. INOUYE) introduced the following bill; which was read

twice and referred to the Committee on Labor and Human Resources

A BILL

To amend the Public Health Service Act to consolidate and

reauthorize health professions and minority and disadvantaged health education programs, and for other

purposes.

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

5 ‘‘Health Professions Education Partnerships Act of

6 1998’’.

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

8 this Act is as follows:
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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.

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. Reauthorization.

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

poisoning.

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

Sec. 406. Certain authorities of Centers for Disease Control and Prevention.

Sec. 407. Community programs on domestic violence.

Sec. 408. State loan repayment program.

Sec. 409. Construction of regional centers for research on primates.

Sec. 410. Peer review.

Sec. 411. Funding for trauma care.

Sec. 412. Health information and health promotion.

Sec. 413. Emergency medical services for children.

Sec. 414. Administration of certain requirements.

Sec. 415. Aids drug assistance program.

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

10 to 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 designated health professions schools described in sub16 section (c) for the purpose of assisting the schools in sup17 porting programs of excellence in health professions edu18 cation for under-represented minority individuals.
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1 ‘‘(b) REQUIRED USE OF FUNDS.—The Secretary

2 may not make a grant under subsection (a) unless the des3 ignated health professions school involved agrees, subject

4 to subsection (c)(1)(C), to expend the grant—

5 ‘‘(1) to develop a large competitive applicant

6 pool through linkages with institutions of higher

7 education, local school districts, and other commu8 nity-based entities and establish an education pipe9 line for health professions careers;

10 ‘‘(2) to establish, strengthen, or expand pro11 grams to enhance the academic performance of

12 under-represented minority students attending the

13 school;

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

15 train, recruit, and retain under-represented minority

16 faculty including the payment of such stipends and

17 fellowships as the Secretary may determine appro18 priate;

19 ‘‘(4) to carry out activities to improve the infor20 mation resources, clinical education, curricula and

21 cultural competence of the graduates of the school,

22 as it relates to minority health issues;

23 ‘‘(5) to facilitate faculty and student research

24 on health issues particularly affecting under-rep-
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1 resented minority groups, including research on

2 issues relating to the delivery of health care; and

3 ‘‘(6) to carry out a program to train students

4 of the school in providing health services to a signifi5 cant number of under-represented minority individ6 uals through training provided to such students at

7 community-based health facilities that—

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

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

10 main site of the teaching facilities of the school.

11 ‘‘(c) CENTERS OF EXCELLENCE.—

12 ‘‘(1) DESIGNATED SCHOOLS.—

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

14 professions schools referred to in subsection (a)

15 are such schools that meet each of the condi16 tions specified in subparagraphs (B) and (C),

17 and that—

18 ‘‘(i) meet each of the conditions speci19 fied in paragraph (2)(A);

20 ‘‘(ii) meet each of the conditions spec21 ified in paragraph (3);

22 ‘‘(iii) meet each of the conditions

23 specified in paragraph (4); or

24 ‘‘(iv) meet each of the conditions spec25 ified 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

5 under-represented minority individuals en6 rolled in the school, including individuals

7 accepted 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 edu11 cation 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 under23 represented minority individuals serving in

24 faculty or administrative positions at the

25 school.
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1 ‘‘(C) CONSORTIUM.—The condition speci2 fied in this subparagraph is that, in accordance

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

4 profession school involved has with other health

5 profession schools (designated or otherwise)

6 formed a consortium to carry out the purposes

7 described in subsection (b) at the schools of the

8 consortium.

9 ‘‘(D) APPLICATION OF CRITERIA TO

10 OTHER PROGRAMS.—In the case of any criteria

11 established by the Secretary for purposes of de12 termining whether schools meet the conditions

13 described in subparagraph (B), this section may

14 not, with respect to racial and ethnic minorities,

15 be construed to authorize, require, or prohibit

16 the use of such criteria in any program other

17 than the program established in this section.

18 ‘‘(2) CENTERS OF EXCELLENCE AT CERTAIN

19 HISTORICALLY BLACK COLLEGES AND UNIVER20 SITIES.—

21 ‘‘(A) CONDITIONS.—The conditions speci22 fied in this subparagraph are that a designated

23 health professions school—

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

25 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 pro13 fessions education for under-represented

14 minority 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.—

23 The conditions specified in this paragraph are

24 that—
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1 ‘‘(A) with respect to Hispanic individuals,

2 each of clauses (i) through (iv) of paragraph

3 (1)(B) applies to the designated health profes4 sions school involved;

5 ‘‘(B) the school agrees, as a condition of

6 receiving a grant under subsection (a), that the

7 school will, in carrying out the duties described

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

9 the duties with respect to Hispanic individuals;

10 and

11 ‘‘(C) the school agrees, as a condition of

12 receiving a grant under subsection (a), that—

13 ‘‘(i) the school will establish an ar14 rangement with 1 or more public or non15 profit community based Hispanic serving

16 organizations, or public or nonprofit pri17 vate institutions of higher education, in18 cluding schools of nursing, whose enroll19 ment of students has traditionally included

20 a significant number of Hispanic individ21 uals, the purposes of which will be to carry

22 out a program—

23 ‘‘(I) to identify Hispanic students

24 who are interested in a career in the

25 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

5 recruit Hispanic students, including stu6 dents who have participated in the under7 graduate or other matriculation program

8 carried out under arrangements established

9 by the school pursuant to clause (i)(II) and

10 will assist Hispanic students regarding the

11 completion of the educational requirements

12 for a degree from the school.

13 ‘‘(4) NATIVE AMERICAN CENTERS OF EXCEL14 LENCE.—Subject to subsection (e), the conditions

15 specified in this paragraph are that—

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

17 each of clauses (i) through (iv) of paragraph

18 (1)(B) applies to the designated health profes19 sions school involved;

20 ‘‘(B) the school agrees, as a condition of

21 receiving 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;

25 and
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1 ‘‘(C) the school agrees, as a condition of

2 receiving 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

13 higher education referred to in clause

14 (i), who are interested in health pro15 fessions careers; and

16 ‘‘(II) to facilitate the educational

17 preparation of such students to enter

18 the designated health professions

19 school; 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

24 program carried out under arrangements

25 established by the school pursuant to
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1 clause (i) and will assist Native American

2 students regarding the completion of the

3 educational requirements for a degree from

4 the designated 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

17 (a) and meeting the conditions described in para18 graph (2) or (5) of subsection (c) shall, for purposes

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

20 Center of Excellence in Under-Represented Minority

21 Health Professions Education.

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

23 Any designated health professions school receiving a

24 grant under subsection (a) and meeting the condi25 tions described in subsection (c)(3) shall, for pur-
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1 poses of this section, be designated by the Secretary

2 as a Hispanic Center of Excellence in Health Profes3 sions Education.

4 ‘‘(3) NATIVE AMERICAN CENTERS OF EXCEL5 LENCE.—Any designated health professions school

6 receiving a grant under subsection (a) and meeting

7 the conditions described in subsection (c)(4) shall,

8 for purposes of this section, be designated by the

9 Secretary as a Native American Center of Excellence

10 in Health Professions Education. Any consortium

11 receiving such a grant pursuant to subsection (e)

12 shall, for purposes of this section, be so designated.

13 ‘‘(e) AUTHORITY REGARDING NATIVE AMERICAN

14 CENTERS OF EXCELLENCE.—With respect to meeting the

15 conditions specified in subsection (c)(4), the Secretary

16 may make a grant under subsection (a) to a designated

17 health professions school that does not meet such condi18 tions if—

19 ‘‘(1) the school has formed a consortium in ac20 cordance with subsection (d)(1); and

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

22 meet such conditions, without regard to whether the

23 schools individually meet such conditions.

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

25 which payments are made under a grant under subsection
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1 (a) may not exceed 5 years. Such payments shall be sub2 ject to annual approval by the Secretary and to the avail3 ability of appropriations for the fiscal year involved to

4 make the payments.

5 ‘‘(g) DEFINITIONS.—In this section:

6 ‘‘(1) DESIGNATED HEALTH PROFESSIONS

7 SCHOOL.—

8 ‘‘(A) IN GENERAL.—The term ‘health pro9 fessions school’ means, except as provided in

10 subparagraph (B), a school of medicine, a

11 school of osteopathic medicine, a school of den12 tistry, a school of pharmacy, or a graduate pro13 gram in behavioral or mental health.

14 ‘‘(B) EXCEPTION.—The definition estab15 lished in subparagraph (A) shall not apply to

16 the use of the term ‘designated health profes17 sions school’ for purposes of subsection (c)(2).

18 ‘‘(2) PROGRAM OF EXCELLENCE.—The term

19 ‘program of excellence’ means any program carried

20 out by a designated health professions school with a

21 grant made under subsection (a), if the program is

22 for purposes for which the school involved is author23 ized in subsection (b) or (c) to expend the grant.
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1 ‘‘(3) NATIVE AMERICANS.—The term ‘Native

2 Americans’ means American Indians, Alaskan Na3 tives, Aleuts, and Native Hawaiians.

4 ‘‘(h) FUNDING.—

5 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

6 For the purpose of making grants under subsection

7 (a), there authorized to be appropriated $26,000,000

8 for fiscal year 1998, and such sums as may be nec9 essary for each of the fiscal years 1999 through

10 2002.

11 ‘‘(2) ALLOCATIONS.—Based on the amount ap12 propriated under paragraph (1) for a fiscal year, one

13 of the following subparagraphs shall apply:

14 ‘‘(A) IN GENERAL.—If the amounts appro15 priated under paragraph (1) for a fiscal year

16 are less than $24,000,000—

17 ‘‘(i) the Secretary shall make available

18 $12,000,000 for grants under subsection

19 (a) to health professions schools that meet

20 the conditions described in subsection

21 (c)(2)(A); and

22 ‘‘(ii) and available after grants are

23 made with funds under clause (i), the Sec24 retary shall make available—
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1 ‘‘(I) 60 percent of such amount

2 for grants under subsection (a) to

3 health professions schools that meet

4 the conditions described in paragraph

5 (3) or (4) of subsection (c) (including

6 meeting the conditions under sub7 section (e)); and

8 ‘‘(II) 40 percent of such amount

9 for grants under subsection (a) to

10 health professions schools that meet

11 the conditions described in subsection

12 (c)(5).

13 ‘‘(B) FUNDING IN EXCESS OF

14 $24,000,000.—If amounts appropriated under

15 paragraph (1) for a fiscal year exceed

16 $24,000,000 but are less than $30,000,000—

17 ‘‘(i) 80 percent of such excess

18 amounts shall be made available for grants

19 under subsection (a) to health professions

20 schools that meet the requirements de21 scribed in paragraph (3) or (4) of sub22 section (c) (including meeting conditions

23 pursuant to subsection (e)); and

24 ‘‘(ii) 20 percent of such excess

25 amount shall be made available for grants
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1 under subsection (a) to health professions

2 schools that meet the conditions described

3 in subsection (c)(5).

4 ‘‘(C) FUNDING IN EXCESS OF

5 $30,000,000.—If amounts appropriated under

6 paragraph (1) for a fiscal year exceed

7 $30,000,000, the Secretary shall make avail8 able—

9 ‘‘(i) not less than $12,000,000 for

10 grants under subsection (a) to health pro11 fessions schools that meet the conditions

12 described in subsection (c)(2)(A);

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

14 grants under subsection (a) to health pro15 fessions schools that meet the conditions

16 described in paragraph (3) or (4) of sub17 section (c) (including meeting conditions

18 pursuant to subsection (e));

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

20 grants under subsection (a) to health pro21 fessions schools that meet the conditions

22 described in subsection (c)(5); and

23 ‘‘(iv) after grants are made with

24 funds under clauses (i) through (iii), any

25 remaining funds for grants under sub-
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1 section (a) to health professions schools

2 that meet the conditions described in para3 graph (2)(A), (3), (4), or (5) of subsection

4 (c).

5 ‘‘(3) NO LIMITATION.—Nothing in this sub6 section shall be construed as limiting the centers of

7 excellence referred to in this section to the des8 ignated amount, or to preclude such entities from

9 competing for other grants under this section.

10 ‘‘(4) MAINTENANCE OF EFFORT.—

11 ‘‘(A) IN GENERAL.—With respect to activi12 ties for which a grant made under this part are

13 authorized to be expended, the Secretary may

14 not make such a grant to a center of excellence

15 for any fiscal year unless the center agrees to

16 maintain expenditures of non-Federal amounts

17 for such activities at a level that is not less

18 than the level of such expenditures maintained

19 by the center for the fiscal year preceding the

20 fiscal year for which the school receives such a

21 grant.

22 ‘‘(B) USE OF FEDERAL FUNDS.—With re23 spect to any Federal amounts received by a cen24 ter of excellence and available for carrying out

25 activities for which a grant under this part is
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1 authorized to be expended, the Secretary may

2 not make such a grant to the center for any fis3 cal year unless the center agrees that the center

4 will, before expending the grant, expend the

5 Federal amounts obtained from sources other

6 than the grant.

7 ‘‘SEC. 737. SCHOLARSHIPS FOR DISADVANTAGED STU8 DENTS.

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

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

11 this section for the awarding of scholarships by schools

12 to any full-time student who is an eligible individual as

13 defined in subsection (d). Such scholarships may be ex14 pended only for tuition expenses, other reasonable edu15 cational expenses, and reasonable living expenses incurred

16 in the attendance of such school.

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

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

19 subsection (a) unless the health professions and nursing

20 schools involved agree that, in providing scholarships pur21 suant to the grant, the schools will give preference to stu22 dents for whom the costs of attending the schools would

23 constitute a severe financial hardship and, notwithstand24 ing other provisions of this section, to former recipients

25 of scholarships under sections 736 and 740(d)(2)(B) (as
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1 such sections existed on the day before the date of enact2 ment of this section).

3 ‘‘(c) AMOUNT OF AWARD.—In awarding grants to eli4 gible entities that are health professions and nursing

5 schools, the Secretary shall give priority to eligible entities

6 based on the proportion of graduating students going into

7 primary care, the proportion of underrepresented minority

8 students, and the proportion of graduates working in

9 medically underserved communities.

10 ‘‘(d) DEFINITIONS.—In this section:

11 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible

12 entities’ means an entity that—

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

14 medicine, dentistry, nursing (as defined in sec15 tion 801), pharmacy, podiatric medicine, optom16 etry, veterinary medicine, public health, or al17 lied health, a school offering a graduate pro18 gram in behavioral and mental health practice,

19 or an entity providing programs for the training

20 of physician assistants; and

21 ‘‘(B) is carrying out a program for recruit22 ing and retaining students from disadvantaged

23 backgrounds, including students who are mem24 bers of racial and ethnic minority groups.
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1 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible

2 individual’ means an individual who—

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

4 ‘‘(B) has a financial need for a scholar5 ship; and

6 ‘‘(C) is enrolled (or accepted for enroll7 ment) at an eligible health professions or nurs8 ing school as a full-time student in a program

9 leading to a degree in a health profession or

10 nursing.

11 ‘‘SEC. 738. LOAN REPAYMENTS AND FELLOWSHIPS REGARD12 ING FACULTY POSITIONS.

13 ‘‘(a) LOAN REPAYMENTS.—

14 ‘‘(1) ESTABLISHMENT OF PROGRAM.—The Sec15 retary shall establish a program of entering into con16 tracts with individuals described in paragraph (2)

17 under which the individuals agree to serve as mem18 bers of the faculties of schools described in para19 graph (3) in consideration of the Federal Govern20 ment agreeing to pay, for each year of such service,

21 not more than $20,000 of the principal and interest

22 of the educational loans of such individuals.

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

24 referred to in paragraph (1) are individuals from

25 disadvantaged backgrounds who—
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1 ‘‘(A) have a degree in medicine, osteo2 pathic medicine, dentistry, nursing, or another

3 health profession;

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

5 training program in medicine, osteopathic medi6 cine, dentistry, nursing, or other health profes7 sion; or

8 ‘‘(C) are enrolled as full-time students—

9 ‘‘(i) in an accredited (as determined

10 by the Secretary) school described in para11 graph (3); and

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

13 a study or program, offered by such insti14 tution and approved by the Secretary, lead15 ing to a degree from such a school.

16 ‘‘(3) ELIGIBLE HEALTH PROFESSIONS

17 SCHOOLS.—The schools described in this paragraph

18 are schools of medicine, nursing (as schools of nurs19 ing are defined in section 801), osteopathic medi20 cine, dentistry, pharmacy, allied health, podiatric

21 medicine, optometry, veterinary medicine, or public

22 health, or schools offering graduate programs in be23 havioral and mental health.
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1 ‘‘(4) REQUIREMENTS REGARDING FACULTY PO2 SITIONS.—The Secretary may not enter into a con3 tract under paragraph (1) unless—

4 ‘‘(A) the individual involved has entered

5 into a contract with a school described in para6 graph (3) to serve as a member of the faculty

7 of the school for not less than 2 years; and

8 ‘‘(B) the contract referred to in subpara9 graph (A) provides that—

10 ‘‘(i) the school will, for each year for

11 which the individual will serve as a mem12 ber of the faculty under the contract with

13 the school, make payments of the principal

14 and interest due on the educational loans

15 of the individual for such year in an

16 amount equal to the amount of such pay17 ments made by the Secretary for the year;

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

19 pursuant to clause (i) on behalf of the indi20 vidual will be in addition to the pay that

21 the individual would otherwise receive for

22 serving as a member of such faculty; and

23 ‘‘(iii) the school, in making a deter24 mination of the amount of compensation to

25 be provided by the school to the individual
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1 for serving as a member of the faculty, will

2 make the determination without regard to

3 the amount of payments made (or to be

4 made) to the individual by the Federal

5 Government under paragraph (1).

6 ‘‘(5) APPLICABILITY OF CERTAIN PROVI7 SIONS.—The provisions of sections 338C, 338G, and

8 338I shall apply to the program established in para9 graph (1) to the same extent and in the same man10 ner as such provisions apply to the National Health

11 Service Corps Loan Repayment Program established

12 in subpart III of part D of title III, including the

13 applicability of provisions regarding reimbursements

14 for increased tax liability and regarding bankruptcy.

15 ‘‘(6) WAIVER REGARDING SCHOOL CONTRIBU16 TIONS.—The Secretary may waive the requirement

17 established in paragraph (4)(B) if the Secretary de18 termines that the requirement will impose an undue

19 financial hardship on the school involved.

20 ‘‘(b) FELLOWSHIPS.—

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

22 grants to and enter into contracts with eligible enti23 ties to assist such entities in increasing the number

24 of underrepresented minority individuals who are

25 members of the faculty of such schools.
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1 ‘‘(2) APPLICATIONS.—To be eligible to receive a

2 grant or contract under this subsection, an entity

3 shall provide an assurance, in the application sub4 mitted by the entity, that—

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

6 or contract will be used to award a fellowship

7 to an individual only if the individual meets the

8 requirements of paragraphs (3) and (4); and

9 ‘‘(B) each fellowship awarded pursuant to

10 the grant or contract will include—

11 ‘‘(i) a stipend in an amount not ex12 ceeding 50 percent of the regular salary of

13 a similar faculty member for not to exceed

14 3 years of training; and

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

16 such as travel to professional meetings and

17 costs related to specialized training.

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

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

20 shall demonstrate to the Secretary that such appli21 cant has or will have the ability to—

22 ‘‘(A) identify, recruit and select underrep23 resented minority individuals who have the po24 tential for teaching, administration, or conduct25 ing research at a health professions institution;
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1 ‘‘(B) provide such individuals with the

2 skills necessary to enable them to secure a

3 tenured faculty position at such institution,

4 which may include training with respect to ped5 agogical skills, program administration, the de6 sign and conduct of research, grants writing,

7 and the preparation of articles suitable for pub8 lication in peer reviewed journals;

9 ‘‘(C) provide services designed to assist

10 such individuals in their preparation for an aca11 demic career, including the provision of coun12 selors; and

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

14 medically underserved populations.

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

16 a grant or contract under paragraph (1) an appli17 cant shall—

18 ‘‘(A) provide an assurance that such appli19 cant will make available (directly through cash

20 donations) $1 for every $1 of Federal funds re21 ceived under this section for the fellowship;

22 ‘‘(B) provide an assurance that institu23 tional support will be provided for the individ24 ual for the second and third years at a level

25 that is equal to the total amount of institutional
27

•S 1754 IS

1 funds provided in the year in which the grant

2 or contract was awarded;

3 ‘‘(C) provide an assurance that the individ4 ual that will receive the fellowship will be a

5 member of the faculty of the applicant school;

6 and

7 ‘‘(D) provide an assurance that the individ8 ual that will receive the fellowship will have, at

9 a minimum, appropriate advanced preparation

10 (such as a master’s or doctoral degree) and spe11 cial skills necessary to enable such individual to

12 teach and practice.

13 ‘‘(5) DEFINITION.—For purposes of this sub14 section, the term ‘underrepresented minority individ15 uals’ means individuals who are members of racial

16 or ethnic minority groups that are underrepresented

17 in the health professions including nursing.

18 ‘‘SEC. 739. EDUCATIONAL ASSISTANCE IN THE HEALTH

19 PROFESSIONS REGARDING INDIVIDUALS

20 FROM DISADVANTAGED BACKGROUNDS.

21 ‘‘(a) IN GENERAL.—

22 ‘‘(1) AUTHORITY FOR GRANTS.—For the pur23 pose of assisting individuals from disadvantaged

24 backgrounds, as determined in accordance with cri25 teria prescribed by the Secretary, to undertake edu-
28

•S 1754 IS

1 cation to enter a health profession, the Secretary

2 may make grants to and enter into contracts with

3 schools of medicine, osteopathic medicine, public

4 health, dentistry, veterinary medicine, optometry,

5 pharmacy, allied health, chiropractic, and podiatric

6 medicine, public and nonprofit private schools that

7 offer graduate programs in behavioral and mental

8 health, programs for the training of physician assist9 ants, and other public or private nonprofit health or

10 educational entities to assist in meeting the costs de11 scribed in paragraph (2).

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

13 contract under paragraph (1) may be used by the

14 entity to meet the cost of—

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

16 individuals from disadvantaged backgrounds, as

17 so determined, for education and training in a

18 health profession;

19 ‘‘(B) facilitating the entry of such individ20 uals into such a school;

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

22 other services designed to assist such individ23 uals to complete successfully their education at

24 such a school;
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•S 1754 IS

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

2 entry of such individuals into the regular course

3 of education of such a school, preliminary edu4 cation and health research training designed to

5 assist them to complete successfully such regu6 lar course of education at such a school, or re7 ferring such individuals to institutions providing

8 such preliminary education;

9 ‘‘(E) publicizing existing sources of finan10 cial aid available to students in the education

11 program of such a school or who are undertak12 ing training necessary to qualify them to enroll

13 in such a program;

14 ‘‘(F) paying such scholarships as the Sec15 retary may determine for such individuals for

16 any period of health professions education at a

17 health professions school;

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

19 may approve for such individuals for any period

20 of education in student-enhancement programs

21 (other than regular courses) at any health pro22 fessions school, except that such a stipend may

23 not be provided to an individual for more than

24 12 months, and such a stipend shall be in an

25 amount determined appropriate by the Sec-
30

•S 1754 IS

1 retary (notwithstanding any other provision of

2 law regarding the amount of stipends);

3 ‘‘(H) carrying out programs under which

4 such individuals gain experience regarding a ca5 reer in a field of primary health care through

6 working at facilities of public or private non7 profit community-based providers of primary

8 health services; and

9 ‘‘(I) conducting activities to develop a larg10 er and more competitive applicant pool through

11 partnerships with institutions of higher edu12 cation, school districts, and other community13 based entities.

14 ‘‘(3) DEFINITION.—In this section, the term

15 ‘regular course of education of such a school’ as

16 used in subparagraph (D) includes a graduate pro17 gram in behavioral or mental health.

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

19 awards to eligible entities under subsection (a)(1), the

20 Secretary shall give preference to approved applications

21 for programs that involve a comprehensive approach by

22 several public or nonprofit private health or educational

23 entities to establish, enhance and expand educational pro24 grams that will result in the development of a competitive

25 applicant pool of individuals from disadvantaged back-
31

•S 1754 IS

1 grounds who desire to pursue health professions careers.

2 In considering awards for such a comprehensive partner3 ship approach, the following shall apply with respect to

4 the entity involved:

5 ‘‘(1) The entity shall have a demonstrated com6 mitment to such approach through formal agree7 ments that have common objectives with institutions

8 of higher education, school districts, and other com9 munity-based entities.

10 ‘‘(2) Such formal agreements shall reflect the

11 coordination of educational activities and support

12 services, increased linkages, and the consolidation of

13 resources within a specific geographic area.

14 ‘‘(3) The design of the educational activities in15 volved shall provide for the establishment of a com16 petitive health professions applicant pool of individ17 uals from disadvantaged backgrounds by enhancing

18 the total preparation (academic and social) of such

19 individuals to pursue a health professions career.

20 ‘‘(4) The programs or activities under the

21 award shall focus on developing a culturally com22 petent health care workforce that will serve the

23 unserved and underserved populations within the ge24 ographic area.
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1 ‘‘(c) EQUITABLE ALLOCATION OF FINANCIAL AS2 SISTANCE.—The Secretary, to the extent practicable, shall

3 ensure that services and activities under subsection (a) are

4 adequately allocated among the various racial and ethnic

5 populations who are from disadvantaged backgrounds.

6 ‘‘(d) MATCHING REQUIREMENTS.—The Secretary

7 may require that an entity that applies for a grant or con8 tract under subsection (a), provide non-Federal matching

9 funds, as appropriate, to ensure the institutional commit10 ment of the entity to the projects funded under the grant

11 or contract. As determined by the Secretary, such non12 Federal matching funds may be provided directly or

13 through donations from public or private entities and may

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

15 equipment, or services.

16 ‘‘SEC. 740. AUTHORIZATION OF APPROPRIATION.

17 ‘‘(a) SCHOLARSHIPS.—There are authorized to be ap18 propriated to carry out section 737, $37,000,000 for fiscal

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

20 of the fiscal years 1999 through 2002. Of the amount ap21 propriated in any fiscal year, the Secretary shall ensure

22 that not less than 16 percent shall be distributed to

23 schools of nursing.

24 ‘‘(b) LOAN REPAYMENTS AND FELLOWSHIPS.—For

25 the purpose of carrying out section 738, there is author-
33

•S 1754 IS

1 ized to be appropriated $1,100,000 for fiscal year 1998,

2 and such sums as may be necessary for each of the fiscal

3 years 1999 through 2002.

4 ‘‘(c) UNDERGRADUATE ASSISTANCE.—For the pur5 pose of grants and contracts under section 739(a)(1),

6 there is authorized to be appropriated $29,400,000 for fis7 cal year 1998, and such sums as may be necessary for

8 each of the fiscal years 1999 through 2002. The Secretary

9 may use not to exceed 20 percent of the amount appro10 priated for a fiscal year under this subsection to provide

11 scholarships under section 739(a)(2)(F).

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

13 date of enactment of this part, the Secretary shall prepare

14 and submit to the appropriate committees of Congress a

15 report concerning the efforts of the Secretary to address

16 the need for a representative mix of individuals from his17 torically minority health professions schools, or from insti18 tutions or other entities that historically or by geographic

19 location have a demonstrated record of training or educat20 ing underrepresented minorities, within various health

21 professions disciplines, on peer review councils.’’.

22 (b) REPEAL.—

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

24 Health Service Act (42 U.S.C. 295n) is repealed.
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•S 1754 IS

1 (2) NONTERMINATION OF AUTHORITY.—The

2 amendments made by this section shall not be con3 strued to terminate agreements that, on the day be4 fore the date of enactment of this Act, are in effect

5 pursuant to section 795 of the Public Health Service

6 Act (42 U.S.C. 795) as such section existed on such

7 date. Such agreements shall continue in effect in ac8 cordance with the terms of the agreements. With re9 spect to compliance with such agreements, any pe10 riod of practice as a provider of primary health serv11 ices shall be counted towards the satisfaction of the

12 requirement of practice pursuant to such section

13 795.

14 (c) CONFORMING AMENDMENTS.—Section

15 481A(c)(3)(D)(i) of the Public Health Service Act (42

16 U.S.C. 287a–2(c)(3)(D)(i)) is amended by striking ‘‘sec17 tion 739’’ and inserting ‘‘part B of title VII’’.

18 SEC. 102. TRAINING IN PRIMARY CARE MEDICINE AND DEN19 TISTRY.

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

21 (42 U.S.C. 293 et seq.) is amended—

22 (1) in the part heading by striking ‘‘PRI23 MARY HEALTH CARE’’ and inserting ‘‘FAM24 ILY MEDICINE, GENERAL INTERNAL

25 MEDICINE, GENERAL PEDIATRICS,
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•S 1754 IS

1 PHYSICIAN ASSISTANTS, GENERAL

2 DENTISTRY, AND PEDIATRIC DEN3 TISTRY’’;

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

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

6 (A) by striking the section heading and in7 serting the following:

8 ‘‘SEC. 747. FAMILY MEDICINE, GENERAL INTERNAL MEDI9 CINE, GENERAL PEDIATRICS, GENERAL DEN10 TISTRY, PEDIATRIC DENTISTRY, AND PHYSI11 CIAN ASSISTANTS.’’;

12 (B) in subsection (a)—

13 (i) in paragraph (1)—

14 (I) by inserting ‘‘, internal medi15 cine, or pediatrics’’ after ‘‘family med16 icine’’; and

17 (II) by inserting before the semi18 colon the following: ‘‘that emphasizes

19 training for the practice of family

20 medicine, general internal medicine,

21 or general pediatrics (as defined by

22 the Secretary)’’;

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

24 general internal medicine, or general pedi25 atrics’’ before the semicolon;
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•S 1754 IS

1 (iii) in paragraphs (3) and (4), by in2 serting ‘‘, general internal medicine or gen3 eral pediatrics’’ after ‘‘family medicine’’;

4 (iv) in paragraphs (3) and (4), by in5 serting ‘‘(including geriatrics) after ‘‘fam6 ily medicine’’;

7 (v) in paragraph (3), by striking

8 ‘‘and’’ at the end thereof;

9 (vi) in paragraph (4), by striking the

10 period and inserting a semicolon; and

11 (vii) by adding at the end thereof the

12 following new paragraphs:

13 ‘‘(5) to meet the costs of projects to plan, de14 velop, and operate or maintain programs for the

15 training of physician assistants (as defined in sec16 tion 799B), and for the training of individuals who

17 will teach in programs to provide such training; and

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

19 or operating programs, and to provide financial as20 sistance to residents in such programs, of general

21 dentistry or pediatric dentistry.

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

23 grants or contracts shall include entities that have pro24 grams in dental schools, approved residency programs in

25 the general or pediatric practice of dentistry, approved ad-
37

•S 1754 IS

1 vanced education programs in the general or pediatric

2 practice of dentistry, or approved residency programs in

3 pediatric dentistry.’’;

4 (C) in subsection (b)—

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

6 inserting ‘‘, general internal medicine, or

7 general pediatrics’’ after ‘‘family medi8 cine’’;

9 (ii) in paragraph (2)—

10 (I) in subparagraph (A), by strik11 ing ‘‘or’’ at the end; and

12 (II) in subparagraph (B), by

13 striking the period and inserting ‘‘;

14 or’’; and

15 (iii) by adding at the end the follow16 ing:

17 ‘‘(3) PRIORITY IN MAKING AWARDS.—In mak18 ing awards of grants and contracts under paragraph

19 (1), the Secretary shall give priority to any qualified

20 applicant for such an award that proposes a collabo21 rative project between departments of primary

22 care.’’;

23 (D) by redesignating subsections (c) and

24 (d) as subsections (d) and (e), respectively;
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•S 1754 IS

1 (E) by inserting after subsection (b), the

2 following new subsection:

3 ‘‘(c) PRIORITY.—

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

5 for the training of interns or residents, the Secretary

6 shall give priority in awarding grants under this sec7 tion to qualified applicants that have a record of

8 training the greatest percentage of providers, or that

9 have demonstrated significant improvements in the

10 percentage of providers, which enter and remain in

11 primary care practice or general or pediatric den12 tistry.

13 ‘‘(2) DISADVANTAGED INDIVIDUALS.—With re14 spect to programs for the training of interns, resi15 dents, or physician assistants, the Secretary shall

16 give priority in awarding grants under this section

17 to qualified applicants that have a record of training

18 individuals who are from disadvantaged backgrounds

19 (including racial and ethnic minorities underrep20 resented among primary care practice or general or

21 pediatric dentistry).

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

23 grants under this section the Secretary shall give

24 special consideration to projects which prepare prac25 titioners to care for underserved populations and
39

•S 1754 IS

1 other high risk groups such as the elderly, individ2 uals with HIV-AIDS, substance abusers, homeless,

3 and victims of domestic violence.’’; and

4 (F) in subsection (e) (as so redesignated

5 by subparagraph (D))—

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

7 ‘‘$54,000,000’’ and all that follows and in8 serting ‘‘$78,300,000 for fiscal year 1998,

9 and such sums as may be necessary for

10 each of the fiscal years 1999 through

11 2002.’’; and

12 (ii) by striking paragraph (2) and in13 serting the following:

14 ‘‘(2) ALLOCATION.—

15 ‘‘(A) IN GENERAL.—Of the amounts ap16 propriated under paragraph (1) for a fiscal

17 year, the Secretary shall make available—

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

19 awards of grants and contracts under sub20 section (a) to programs of family medicine,

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

22 made available for awards of grants and

23 contracts under subsection (b) for family

24 medicine academic administrative units;
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•S 1754 IS

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

2 awards of grants and contracts under sub3 section (a) to programs of general internal

4 medicine and general pediatrics;

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

6 awards of grants and contracts under sub7 section (a) to programs relating to physi8 cian assistants; and

9 ‘‘(iv) not less than $4,500,000 for

10 awards of grants and contracts under sub11 section (a) to programs of general or pedi12 atric dentistry.

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

14 appropriated under paragraph (1) for any fiscal

15 year are less than the amount required to com16 ply with subparagraph (A), the Secretary shall

17 ratably reduce the amount to be made available

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

19 subparagraph accordingly.’’; and

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

21 U.S.C. 293l through 293p) and inserting the follow22 ing:
41

•S 1754 IS

1 ‘‘SEC. 748. ADVISORY COMMITTEE ON TRAINING IN PRI2 MARY CARE MEDICINE AND DENTISTRY.

3 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab4 lish an advisory committee to be known as the Advisory

5 Committee on Training in Primary Care Medicine and

6 Dentistry (in this section referred to as the ‘Advisory

7 Committee’).

8 ‘‘(b) COMPOSITION.—

9 ‘‘(1) IN GENERAL.—The Secretary shall deter10 mine the appropriate number of individuals to serve

11 on the Advisory Committee. Such individuals shall

12 not be officers or employees of the Federal Govern13 ment.

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

15 after the date of enactment of this Act, the Sec16 retary shall appoint the members of the Advisory

17 Committee from among individuals who are health

18 professionals. In making such appointments, the

19 Secretary shall ensure a fair balance between the

20 health professions, that at least 75 percent of the

21 members of the Advisory Committee are health pro22 fessionals, a broad geographic representation of

23 members and a balance between urban and rural

24 members. Members shall be appointed based on their

25 competence, interest, and knowledge of the mission

26 of the profession involved.
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•S 1754 IS

1 ‘‘(3) MINORITY REPRESENTATION.—In appoint2 ing the members of the Advisory Committee under

3 paragraph (2), the Secretary shall ensure the ade4 quate representation of women and minorities.

5 ‘‘(c) TERMS.—

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

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

8 except that of the members first appointed—

‘‘(A) 1 9 ⁄3 of such members shall serve for a

10 term of 1 year;

‘‘(B) 1 11 ⁄3 of such members shall serve for a

12 term of 2 years; and

‘‘(C) 1 13 ⁄3 of such members shall serve for a

14 term of 3 years.

15 ‘‘(2) VACANCIES.—

16 ‘‘(A) IN GENERAL.—A vacancy on the Ad17 visory Committee shall be filled in the manner

18 in which the original appointment was made

19 and shall be subject to any conditions which ap20 plied with respect to the original appointment.

21 ‘‘(B) FILLING UNEXPIRED TERM.—An in22 dividual chosen to fill a vacancy shall be ap23 pointed for the unexpired term of the member

24 replaced.

25 ‘‘(d) DUTIES.—The Advisory Committee shall—
43

•S 1754 IS

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

2 Secretary concerning policy and program develop3 ment and other matters of significance concerning

4 the activities under section 747; and

5 ‘‘(2) not later than 3 years after the date of en6 actment of this section, and annually thereafter, pre7 pare and submit to the Secretary, and the Commit8 tee on Labor and Human Resources of the Senate,

9 and the Committee on Commerce of the House of

10 Representatives, a report describing the activities of

11 the Committee, including findings and recommenda12 tions made by the Committee concerning the activi13 ties under section 747.

14 ‘‘(e) MEETINGS AND DOCUMENTS.—

15 ‘‘(1) MEETINGS.—The Advisory Committee

16 shall meet not less than 2 times each year. Such

17 meetings shall be held jointly with other related enti18 ties established under this title where appropriate.

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

20 prior to the convening of a meeting under paragraph

21 (1), the Advisory Committee shall prepare and make

22 available an agenda of the matters to be considered

23 by the Advisory Committee at such meeting. At any

24 such meeting, the Advisory Council shall distribute

25 materials with respect to the issues to be addressed
44

•S 1754 IS

1 at the meeting. Not later than 30 days after the ad2 journing of such a meeting, the Advisory Committee

3 shall prepare and make available a summary of the

4 meeting and any actions taken by the Committee

5 based upon the meeting.

6 ‘‘(f) COMPENSATION AND EXPENSES.—

7 ‘‘(1) COMPENSATION.—Each member of the

8 Advisory Committee shall be compensated at a rate

9 equal to the daily equivalent of the annual rate of

10 basic pay prescribed for level IV of the Executive

11 Schedule under section 5315 of title 5, United

12 States Code, for each day (including travel time)

13 during which such member is engaged in the per14 formance of the duties of the Committee.

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

16 Committee shall be allowed travel expenses, includ17 ing per diem in lieu of subsistence, at rates author18 ized for employees of agencies under subchapter I of

19 chapter 57 of title 5, United States Code, while

20 away from their homes or regular places of business

21 in the performance of services for the Committee.

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

23 shall apply to the Advisory Committee under this section

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

25 conflict with the requirements of this section.’’.
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1 SEC. 103. INTERDISCIPLINARY, COMMUNITY-BASED LINK2 AGES.

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

4 (42 U.S.C. 294 et seq.) is amended to read as follows:

5 ‘‘PART D—INTERDISCIPLINARY, COMMUNITY6 BASED LINKAGES

7 ‘‘SEC. 750. GENERAL PROVISIONS.

8 ‘‘(a) COLLABORATION.—To be eligible to receive as9 sistance under this part, an academic institution shall use

10 such assistance in collaboration with 2 or more disciplines.

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

12 under this part to carry out innovative demonstration

13 projects for strategic workforce supplementation activities

14 as needed to meet national goals for interdisciplinary,

15 community-based linkages. Such assistance may be used

16 consistent with this part—

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

18 ‘‘(2) for faculty development;

19 ‘‘(3) for model demonstration programs;

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

21 trainees;

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

23 ‘‘(6) for other activities that will produce out24 comes consistent with the purposes of this part.
46

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

2 ‘‘(a) AUTHORITY FOR PROVISION OF FINANCIAL AS3 SISTANCE.—

4 ‘‘(1) ASSISTANCE FOR PLANNING, DEVELOP5 MENT, AND OPERATION OF PROGRAMS.—

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

7 award grants to and enter into contracts with

8 schools of medicine and osteopathic medicine,

9 and incorporated consortia made up of such

10 schools, or the parent institutions of such

11 schools, for projects for the planning, develop12 ment and operation of area health education

13 center programs that—

14 ‘‘(i) improve the recruitment, distribu15 tion, supply, quality and efficiency of per16 sonnel providing health services in under17 served rural and urban areas and person18 nel providing health services to populations

19 having demonstrated serious unmet health

20 care needs;

21 ‘‘(ii) increase the number of primary

22 care physicians and other primary care

23 providers who provide services in under24 served areas through the offering of an

25 educational continuum of health career re26 cruitment through clinical education con-
47

•S 1754 IS

1 cerning underserved areas in a comprehen2 sive health workforce strategy;

3 ‘‘(iii) carry out recruitment and health

4 career awareness programs to recruit indi5 viduals from underserved areas and under6 represented populations, including minority

7 and other elementary or secondary stu8 dents, into the health professions;

9 ‘‘(iv) prepare individuals to more ef10 fectively provide health services to under11 served areas or underserved populations

12 through field placements, preceptorships,

13 the conduct of or support of community14 based primary care residency programs,

15 and agreements with community-based or16 ganizations such as community health cen17 ters, migrant health centers, Indian health

18 centers, public health departments and

19 others;

20 ‘‘(v) conduct health professions edu21 cation and training activities for students

22 of health professions schools and medical

23 residents;

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

25 medical student required clinical education
48

•S 1754 IS

1 at sites remote to the primary teaching fa2 cility of the contracting institution; and

3 ‘‘(vii) provide information dissemina4 tion and educational support to reduce pro5 fessional isolation, increase retention,

6 enhance the practice environment, and im7 prove health care through the timely dis8 semination of research findings using rel9 evant resources.

10 ‘‘(B) OTHER ELIGIBLE ENTITIES.—With

11 respect to a State in which no area health edu12 cation center program is in operation, the Sec13 retary may award a grant or contract under

14 subparagraph (A) to a school of nursing.

15 ‘‘(C) PROJECT TERMS.—

16 ‘‘(i) IN GENERAL.—Except as pro17 vided in clause (ii), the period during

18 which payments may be made under an

19 award under subparagraph (A) may not

20 exceed—

21 ‘‘(I) in the case of a project, 12

22 years or

23 ‘‘(II) in the case of a center with24 in a project, 6 years.
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•S 1754 IS

1 ‘‘(ii) EXCEPTION.—The periods de2 scribed in clause (i) shall not apply to

3 projects that have completed the initial pe4 riod of Federal funding under this section

5 and that desire to compete for model

6 awards under paragraph (2)(A).

7 ‘‘(2) ASSISTANCE FOR OPERATION OF MODEL

8 PROGRAMS.—

9 ‘‘(A) IN GENERAL.—In the case of any en10 tity described in paragraph (1)(A) that—

11 ‘‘(i) has previously received funds

12 under this section;

13 ‘‘(ii) is operating an area health edu14 cation center program; and

15 ‘‘(iii) is no longer receiving financial

16 assistance under paragraph (1);

17 the Secretary may provide financial assistance

18 to such entity to pay the costs of operating and

19 carrying out the requirements of the program

20 as described in paragraph (1).

21 ‘‘(B) MATCHING REQUIREMENT.—With re22 spect to the costs of operating a model program

23 under subparagraph (A), an entity, to be eligi24 ble for financial assistance under subparagraph

25 (A), shall make available (directly or through
50

•S 1754 IS

1 contributions from State, county or municipal

2 governments, or the private sector) recurring

3 non-Federal contributions in cash toward such

4 costs in an amount that is equal to not less

5 than 50 percent of such costs.

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

7 of awards provided under subparagraph (A) to

8 entities in a State for a fiscal year may not ex9 ceed the lesser of—

10 ‘‘(i) $2,000,000; or

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

12 of $250,000 and the aggregate number of

13 area health education centers operated in

14 the State by such entities.

15 ‘‘(b) REQUIREMENTS FOR CENTERS.—

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

17 health education center that receives funds under

18 this section shall encourage the regionalization of

19 health professions schools through the establishment

20 of partnerships with community-based organizations.

21 ‘‘(2) SERVICE AREA.—Each area health edu22 cation center that receives funds under this section

23 shall specifically designate a geographic area or

24 medically underserved population to be served by the

25 center. Such area or population shall be in a location
51

•S 1754 IS

1 removed from the main location of the teaching fa2 cilities of the schools participating in the program

3 with such center.

4 ‘‘(3) OTHER REQUIREMENTS.—Each area

5 health education center that receives funds under

6 this section shall—

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

8 the area to be served by the center and assist

9 in the planning and development of training

10 programs to meet such needs;

11 ‘‘(B) arrange and support rotations for

12 students and residents in family medicine, gen13 eral internal medicine or general pediatrics,

14 with at least one center in each program being

15 affiliated with or conducting a rotating osteo16 pathic internship or medical residency training

17 program in family medicine (including geri18 atrics), general internal medicine (including

19 geriatrics), or general pediatrics in which no

20 fewer than 4 individuals are enrolled in first21 year positions;

22 ‘‘(C) conduct and participate in inter23 disciplinary training that involves physicians

24 and other health personnel including, where

25 practicable, public health professionals, physi-
52

•S 1754 IS

1 cian assistants, nurse practitioners, nurse mid2 wives, and behavioral and mental health provid3 ers; and

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

5 percent of the members of which shall be indi6 viduals, including both health service providers

7 and consumers, from the area served by the

8 center.

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

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

11 75 percent of the total amount of Federal funds pro12 vided to an entity under this section shall be allo13 cated by an area health education center program to

14 the area health education center. Such entity shall

15 enter into an agreement with each center for pur16 poses of specifying the allocation of such 75 percent

17 of funds.

18 ‘‘(2) OPERATING COSTS.—With respect to the

19 operating costs of the area health education center

20 program of an entity receiving funds under this sec21 tion, the entity shall make available (directly or

22 through contributions from State, county or munici23 pal governments, or the private sector) non-Federal

24 contributions in cash toward such costs in an

25 amount that is equal to not less than 50 percent of
53

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1 such costs, except that the Secretary may grant a

2 waiver for up to 75 percent of the amount of the

3 required non-Federal match in the first 3 years in

4 which an entity receives funds under this section.

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

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

7 this section, an health education training center shall be

8 an entity otherwise eligible for funds under section 751

9 that—

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

11 health care needs in States along the border between

12 the United States and Mexico and in the State of

13 Florida, and in other urban and rural areas with

14 populations with serious unmet health care needs;

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

16 health service providers, educators and consumers

17 from the service area;

18 ‘‘(3) conducts training and education programs

19 for health professions students in these areas;

20 ‘‘(4) conducts training in health education serv21 ices, including training to prepare community health

22 workers; and

23 ‘‘(5) supports health professionals (including

24 nursing) practicing in the area through educational

25 and other services.
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•S 1754 IS

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

2 make available 50 percent of the amounts appropriated

3 for each fiscal year under section 752 for the establish4 ment or operation of health education training centers

5 through projects in States along the border between the

6 United States and Mexico and in the State of Florida.

7 ‘‘SEC. 753. EDUCATION AND TRAINING RELATING TO GERI8 ATRICS.

9 ‘‘(a) GERIATRIC EDUCATION CENTERS.—

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

11 grants or contracts under this section to entities de12 scribed in paragraphs (1), (3), or (4) of section

13 799B, and section 853(2), for the establishment or

14 operation of geriatric education centers.

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

16 center is a program that—

17 ‘‘(A) improves the training of health pro18 fessionals in geriatrics, including geriatric

19 residencies, traineeships, or fellowships;

20 ‘‘(B) develops and disseminates curricula

21 relating to the treatment of the health problems

22 of elderly individuals;

23 ‘‘(C) supports the training and retraining

24 of faculty to provide instruction in geriatrics;
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•S 1754 IS

1 ‘‘(D) supports continuing education of

2 health professionals who provide geriatric care;

3 and

4 ‘‘(E) provides students with clinical train5 ing in geriatrics in nursing homes, chronic and

6 acute disease hospitals, ambulatory care cen7 ters, and senior centers.

8 ‘‘(b) GERIATRIC TRAINING REGARDING PHYSICIANS

9 AND DENTISTS.—

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

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

12 medicine, schools of osteopathic medicine, teaching

13 hospitals, and graduate medical education programs,

14 for the purpose of providing support (including

15 residencies, traineeships, and fellowships) for geri16 atric training projects to train physicians, dentists

17 and behavioral and mental health professionals who

18 plan to teach geriatric medicine, geriatric behavioral

19 or mental health, or geriatric dentistry.

20 ‘‘(2) REQUIREMENTS.—Each project for which

21 a grant or contract is made under this subsection

22 shall—

23 ‘‘(A) be staffed by full-time teaching physi24 cians who have experience or training in geri-
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•S 1754 IS

1 atric medicine or geriatric behavioral or mental

2 health;

3 ‘‘(B) be staffed, or enter into an agree4 ment with an institution staffed by full-time or

5 part-time teaching dentists who have experience

6 or training in geriatric dentistry;

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

8 with an institution staffed by full-time or part9 time teaching behavioral mental health profes10 sionals who have experience or training in geri11 atric behavioral or mental health;

12 ‘‘(D) be based in a graduate medical edu13 cation program in internal medicine or family

14 medicine or in a department of geriatrics or be15 havioral or mental health;

16 ‘‘(E) provide training in geriatrics and ex17 posure to the physical and mental disabilities of

18 elderly individuals through a variety of service

19 rotations, such as geriatric consultation serv20 ices, acute care services, dental services, geri21 atric behavioral or mental health units, day and

22 home care programs, rehabilitation services, ex23 tended care facilities, geriatric ambulatory care

24 and comprehensive evaluation units, and com-
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•S 1754 IS

1 munity care programs for elderly mentally re2 tarded individuals; and

3 ‘‘(F) provide training in geriatrics through

4 one or both of the training options described in

5 subparagraphs (A) and (B) of paragraph (3).

6 ‘‘(3) TRAINING OPTIONS.—The training options

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

8 shall be as follows:

9 ‘‘(A) A 1-year retraining program in geri10 atrics for—

11 ‘‘(i) physicians who are faculty mem12 bers in departments of internal medicine,

13 family medicine, gynecology, geriatrics, and

14 behavioral or mental health at schools of

15 medicine and osteopathic medicine;

16 ‘‘(ii) dentists who are faculty members

17 at schools of dentistry or at hospital de18 partments of dentistry; and

19 ‘‘(iii) behavioral or mental health pro20 fessionals who are faculty members in de21 partments of behavioral or mental health;

22 and

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

24 medicine fellowship program providing emphasis

25 in geriatrics, which shall be designed to provide
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•S 1754 IS

1 training in clinical geriatrics and geriatrics re2 search for—

3 ‘‘(i) physicians who have completed

4 graduate medical education programs in

5 internal medicine, family medicine, behav6 ioral or mental health, neurology, gyne7 cology, or rehabilitation medicine;

8 ‘‘(ii) dentists who have demonstrated

9 a commitment to an academic career and

10 who have completed postdoctoral dental

11 training, including postdoctoral dental edu12 cation programs or who have relevant ad13 vanced training or experience; and

14 ‘‘(iii) behavioral or mental health pro15 fessionals who have completed graduate

16 medical education programs in behavioral

17 or mental health.

18 ‘‘(4) DEFINITIONS.—For purposes of this sub19 section:

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

21 program’ means a program sponsored by a

22 school of medicine, a school of osteopathic med23 icine, a hospital, or a public or private institu24 tion that—
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•S 1754 IS

1 ‘‘(i) offers postgraduate medical train2 ing in the specialties and subspecialties of

3 medicine; and

4 ‘‘(ii) has been accredited by the Ac5 creditation Council for Graduate Medical

6 Education or the American Osteopathic

7 Association through its Committee on

8 Postdoctoral Training.

9 ‘‘(B) The term ‘post-doctoral dental edu10 cation program’ means a program sponsored by

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

12 private institution that—

13 ‘‘(i) offers post-doctoral training in

14 the specialties of dentistry, advanced edu15 cation in general dentistry, or a dental

16 general practice residency; and

17 ‘‘(ii) has been accredited by the Com18 mission on Dental Accreditation.

19 ‘‘(c) GERIATRIC FACULTY FELLOWSHIPS.—

20 ‘‘(1) ESTABLISHMENT OF PROGRAM.—The Sec21 retary shall establish a program to provide Geriatric

22 Academic Career Awards to eligible individuals to

23 promote the career development of such individuals

24 as academic geriatricians.
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•S 1754 IS

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

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

3 shall—

4 ‘‘(A) have a degree in internal medicine,

5 family practice, or behavioral or mental health

6 science;

7 ‘‘(B) have completed an approved fellow8 ship program in geriatrics; and

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

10 an accredited (as determined by the Secretary)

11 school of medicine or osteopathic medicine.

12 ‘‘(3) LIMITATIONS.—No Award under para13 graph (1) may be made to an eligible individual un14 less the individual—

15 ‘‘(A) has submitted to the Secretary an ap16 plication, at such time, in such manner, and

17 containing such information as the Secretary

18 may require, and the Secretary has approved

19 such application; and

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

21 the Secretary may require, assurances that the

22 individual will meet the service requirement de23 scribed in subsection (e).

24 ‘‘(4) AMOUNT AND TERM.—
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•S 1754 IS

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

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

3 year 1998, adjusted for subsequent fiscal years

4 to reflect the increase in the Consumer Price

5 Index.

6 ‘‘(B) TERM.—The term of any Award

7 made under this subsection shall not exceed 5

8 years.

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

10 who receives an Award under this subsection shall

11 provide training in clinical geriatrics, including the

12 training of interdisciplinary teams of health care

13 professionals. The provision of such training shall

14 constitute at least 75 percent of the obligations of

15 such individual under the Award.

16 ‘‘SEC. 754. RURAL INTERDISCIPLINARY TRAINING GRANTS.

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

18 contracts under this section to help entities fund author19 ized activities under an application approved under sub20 section (c).

21 ‘‘(b) USE OF AMOUNTS.—

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

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

24 interdisciplinary training projects designed to—
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•S 1754 IS

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

2 train health care practitioners to provide serv3 ices in rural areas;

4 ‘‘(B) demonstrate and evaluate innovative

5 interdisciplinary methods and models designed

6 to provide access to cost-effective comprehensive

7 health care;

8 ‘‘(C) deliver health care services to individ9 uals residing in rural areas;

10 ‘‘(D) enhance the amount of relevant re11 search conducted concerning health care issues

12 in rural areas; and

13 ‘‘(E) increase the recruitment and reten14 tion of health care practitioners from rural

15 areas and make rural practice a more attractive

16 career choice for health care practitioners.

17 ‘‘(2) METHODS.—A recipient of funds under

18 subsection (a) may use various methods in carrying

19 out the projects described in paragraph (1), includ20 ing—

21 ‘‘(A) the distribution of stipends to stu22 dents of eligible applicants;

23 ‘‘(B) the establishment of a post-doctoral

24 fellowship program;
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•S 1754 IS

1 ‘‘(C) the training of faculty in the eco2 nomic and logistical problems confronting rural

3 health care delivery systems; or

4 ‘‘(D) the purchase or rental of transpor5 tation and telecommunication equipment where

6 the need for such equipment due to unique

7 characteristics of the rural area is demonstrated

8 by the recipient.

9 ‘‘(3) ADMINISTRATION.—

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

11 use more than 10 percent of the funds made

12 available to such applicant under subsection (a)

13 for administrative expenses.

14 ‘‘(B) TRAINING.—Not more than 10 per15 cent of the individuals receiving training with

16 funds made available to an applicant under sub17 section (a) shall be trained as doctors of medi18 cine or doctors of osteopathy.

19 ‘‘(C) LIMITATION.—An institution that re20 ceives a grant under this section shall use

21 amounts received under such grant to supple22 ment, not supplant, amounts made available by

23 such institution for activities of the type de24 scribed in subsection (b)(1) in the fiscal year
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•S 1754 IS

1 preceding the year for which the grant is re2 ceived.

3 ‘‘(c) APPLICATIONS.—Applications submitted for as4 sistance under this section shall—

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

6 applicants with the express purpose of assisting indi7 viduals in academic institutions in establishing long8 term collaborative relationships with health care pro9 viders in rural areas; and

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

11 agencies for clinical treatment or training, including

12 hospitals, community health centers, migrant health

13 centers, rural health clinics, community behavioral

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

15 Native Hawaiian health centers, or facilities oper16 ated by the Indian Health Service or an Indian tribe

17 or tribal organization or Indian organization under

18 a contract with the Indian Health Service under the

19 Indian Self-Determination Act.

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

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

22 outside of standard metropolitan statistical areas.
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1 ‘‘SEC. 755. ALLIED HEALTH AND OTHER DISCIPLINES.

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

3 or contracts under this section to help entities fund activi4 ties of the type described in subsection (b).

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

6 this subsection include the following:

7 ‘‘(1) Assisting entities in meeting the costs as8 sociated with expanding or establishing programs

9 that will increase the number of individuals trained

10 in allied health professions. Programs and activities

11 funded under this paragraph may include—

12 ‘‘(A) those that expand enrollments in al13 lied health professions with the greatest short14 ages or whose services are most needed by the

15 elderly;

16 ‘‘(B) those that provide rapid transition

17 training programs in allied health fields to indi18 viduals who have baccalaureate degrees in

19 health-related sciences;

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

21 allied health training programs that link aca22 demic centers to rural clinical settings;

23 ‘‘(D) those that provide career advance24 ment training for practicing allied health pro25 fessionals;
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•S 1754 IS

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

2 training sites for allied health professionals in

3 medically underserved or rural communities in

4 order to increase the number of individuals

5 trained;

6 ‘‘(F) those that develop curriculum that

7 will emphasize knowledge and practice in the

8 areas of prevention and health promotion, geri9 atrics, long-term care, home health and hospice

10 care, and ethics;

11 ‘‘(G) those that expand or establish inter12 disciplinary training programs that promote the

13 effectiveness of allied health practitioners in

14 geriatric assessment and the rehabilitation of

15 the elderly;

16 ‘‘(H) those that expand or establish dem17 onstration centers to emphasize innovative mod18 els to link allied health clinical practice, edu19 cation, and research;

20 ‘‘(I) those that provide financial assistance

21 (in the form of traineeships) to students who

22 are participants in any such program; and

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

24 allied health field that has a demonstrated

25 personnel shortage; and
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•S 1754 IS

1 ‘‘(ii) who agree upon completion of

2 the training program to practice in a medi3 cally underserved community;

4 that shall be utilized to assist in the payment

5 of all or part of the costs associated with tui6 tion, fees and such other stipends as the Sec7 retary may consider necessary; and

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

9 plan, develop, and operate or maintain graduate

10 programs in behavioral and mental health prac11 tice.

12 ‘‘(2) Planning and implementing projects in

13 preventive and primary care training for podiatric

14 physicians in approved or provisionally approved

15 residency programs that shall provide financial as16 sistance in the form of traineeships to residents who

17 participate in such projects and who plan to special18 ize in primary care.

19 ‘‘(3) Carrying out demonstration projects in

20 which chiropractors and physicians collaborate to

21 identify and provide effective treatment for spinal

22 and lower-back conditions.
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•S 1754 IS

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

2 COMMUNITY-BASED LINKAGES.

3 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab4 lish an advisory committee to be known as the Advisory

5 Committee on Interdisciplinary, Community-Based Link6 ages (in this section referred to as the ‘Advisory Commit7 tee’).

8 ‘‘(b) COMPOSITION.—

9 ‘‘(1) IN GENERAL.—The Secretary shall deter10 mine the appropriate number of individuals to serve

11 on the Advisory Committee. Such individuals shall

12 not be officers or employees of the Federal Govern13 ment.

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

15 after the date of enactment of this Act, the Sec16 retary shall appoint the members of the Advisory

17 Committee from among individuals who are health

18 professionals from schools of the types described in

19 sections 751(a)(1)(A), 751(a)(1)(B), 753(b),

20 754(3)(A), and 755(b). In making such appoint21 ments, the Secretary shall ensure a fair balance be22 tween the health professions, that at least 75 per23 cent of the members of the Advisory Committee are

24 health professionals, a broad geographic representa25 tion of members and a balance between urban and

26 rural members. Members shall be appointed based
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•S 1754 IS

1 on their competence, interest, and knowledge of the

2 mission of the profession involved.

3 ‘‘(3) MINORITY REPRESENTATION.—In appoint4 ing the members of the Advisory Committee under

5 paragraph (2), the Secretary shall ensure the ade6 quate representation of women and minorities.

7 ‘‘(c) TERMS.—

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

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

10 except that of the members first appointed—

‘‘(A) 1 11 ⁄3 of the members shall serve for a

12 term of 1 year;

‘‘(B) 1 13 ⁄3 of the members shall serve for a

14 term of 2 years; and

‘‘(C) 1 15 ⁄3 of the members shall serve for a

16 term of 3 years.

17 ‘‘(2) VACANCIES.—

18 ‘‘(A) IN GENERAL.—A vacancy on the Ad19 visory Committee shall be filled in the manner

20 in which the original appointment was made

21 and shall be subject to any conditions which ap22 plied with respect to the original appointment.

23 ‘‘(B) FILLING UNEXPIRED TERM.—An in24 dividual chosen to fill a vacancy shall be ap-
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•S 1754 IS

1 pointed for the unexpired term of the member

2 replaced.

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

7 the activities under this part; 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 Commit11 tee on Labor and Human Resources of the Senate,

12 and the Committee on Commerce of the House of

13 Representatives, a report describing the activities of

14 the Committee, including findings and recommenda15 tions made by the Committee concerning the activi16 ties under this part.

17 ‘‘(e) MEETINGS AND DOCUMENTS.—

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

19 shall meet not less than 3 times each year. Such

20 meetings shall be held jointly with other related enti21 ties established under this title where appropriate.

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

23 prior to the convening of a meeting under paragraph

24 (1), the Advisory Committee shall prepare and make

25 available an agenda of the matters to be considered
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•S 1754 IS

1 by the Advisory Committee at such meeting. At any

2 such meeting, the Advisory Council shall distribute

3 materials with respect to the issues to be addressed

4 at the meeting. Not later than 30 days after the ad5 journing of such a meeting, the Advisory Committee

6 shall prepare and make available a summary of the

7 meeting and any actions taken by the Committee

8 based upon the meeting.

9 ‘‘(f) COMPENSATION AND EXPENSES.—

10 ‘‘(1) COMPENSATION.—Each member of the

11 Advisory Committee shall be compensated at a rate

12 equal to the daily equivalent of the annual rate of

13 basic pay prescribed for level IV of the Executive

14 Schedule under section 5315 of title 5, United

15 States Code, for each day (including travel time)

16 during which such member is engaged in the per17 formance of the duties of the Committee.

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

19 Committee shall be allowed travel expenses, includ20 ing per diem in lieu of subsistence, at rates author21 ized for employees of agencies under subchapter I of

22 chapter 57 of title 5, United States Code, while

23 away from their homes or regular places of business

24 in the performance of services for the Committee.
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•S 1754 IS

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. 757. AUTHORIZATION OF APPROPRIATIONS.

6 ‘‘(a) IN GENERAL.—There are authorized to be ap7 propriated to carry out this part, $55,600,000 for fiscal

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

9 of the fiscal years 1999 through 2002.

10 ‘‘(b) ALLOCATION.—

11 ‘‘(1) IN GENERAL.—Of the amounts appro12 priated under subsection (a) for a fiscal year, the

13 Secretary shall make available—

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

15 of grants and contracts under section 751;

16 ‘‘(B) not less than $3,765,000 for awards

17 of grants and contracts under section 752, of

18 which not less than 50 percent of such amount

19 shall be made available for centers described in

20 subsection (a)(1) of such section; and

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

22 of grants and contracts under sections 753,

23 754, and 755.

24 ‘‘(2) RATABLE REDUCTION.—If amounts appro25 priated under subsection (a) for any fiscal year are
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•S 1754 IS

1 less than the amount required to comply with para2 graph (1), the Secretary shall ratably reduce the

3 amount to be made available under each of subpara4 graphs (A) through (C) of such paragraph accord5 ingly.

6 ‘‘(c) OBLIGATION OF CERTAIN AMOUNTS.—

7 ‘‘(1) AREA HEALTH EDUCATION CENTER PRO8 GRAMS.—Of the amounts made available under sub9 section (b)(1)(A) for each fiscal year, the Secretary

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

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

12 amounts in fiscal year 1998;

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

14 amounts in fiscal year 1999;

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

16 amounts in fiscal year 2000;

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

18 amounts in fiscal year 2001; and

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

20 amounts in fiscal year 2002.

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

22 the Congress that—

23 ‘‘(A) every State have an area health edu24 cation center program in effect under this sec25 tion; and
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•S 1754 IS

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

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

3 increase over time and that Federal funding for

4 other awards under this section shall decrease

5 so that the national program will become en6 tirely comprised of programs that are funded at

7 least 50 percent by State and local partners.’’.

8 SEC. 104. HEALTH PROFESSIONS WORKFORCE INFORMA9 TION AND ANALYSIS.

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

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

12 to read as follows:

13 ‘‘PART E—HEALTH PROFESSIONS AND PUBLIC

14 HEALTH WORKFORCE

15 ‘‘Subpart 1—Health Professions Workforce

16 Information and Analysis

17 ‘‘SEC. 761. HEALTH PROFESSIONS WORKFORCE INFORMA18 TION AND ANALYSIS.

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

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

21 describing the health professions workforce and the

22 analysis of workforce related issues; and

23 ‘‘(2) provide necessary information for decision24 making regarding future directions in health profes-
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•S 1754 IS

1 sions and nursing programs in response to societal

2 and professional needs.

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

4 award grants or contracts to State or local governments,

5 health professions schools, schools of nursing, academic

6 health centers, community-based health facilities, and

7 other appropriate public or private nonprofit entities to

8 provide for—

9 ‘‘(1) targeted information collection and analy10 sis activities related to the purposes described in

11 subsection (a);

12 ‘‘(2) research on high priority workforce ques13 tions;

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

15 and research infrastructure related to the purposes

16 described in subsection (a); and

17 ‘‘(4) the conduct of program evaluation and as18 sessment.

19 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—

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

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

22 fiscal year 1998, and such sums as may be nec23 essary for each of the fiscal years 1999 through

24 2002.
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•S 1754 IS

1 ‘‘(2) RESERVATION.—Of the amounts appro2 priated under subsection (a) for a fiscal year, the

3 Secretary shall reserve not less than $600,000 for

4 conducting health professions research and for car5 rying out data collection and analysis in accordance

6 with section 792.

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

8 Amounts otherwise appropriated for programs or ac9 tivities under this title may be used for activities

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

11 activities from which such amounts were made avail12 able.’’.

13 (b) COUNCIL ON GRADUATE MEDICAL EDU14 CATION.—Section 301 of the Health Professions Edu15 cation Extension Amendments of 1992 (Public Law 102-

16 408) is amended—

17 (1) in subsection (j), by striking ‘‘1995’’ and

18 inserting ‘‘2002’’;

19 (2) in subsection (k), by striking ‘‘1995’’ and

20 inserting ‘‘2002’’;

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

22 new subsection:

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

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

25 the activities of the Council.’’;
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•S 1754 IS

1 (4) by transferring such section to part E of

2 title VII of the Public Health Service Act (as

3 amended by subsection (a));

4 (5) by redesignating such section as section

5 763; and

6 (6) by inserting such section after section 762.

7 SEC. 105. PUBLIC HEALTH WORKFORCE DEVELOPMENT.

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

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

10 at the end the following:

11 ‘‘Subpart 2—Public Health Workforce

12 ‘‘SEC. 765. GENERAL PROVISIONS.

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

14 or contracts to eligible entities to increase the number of

15 individuals in the public health workforce, to enhance the

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

17 the workforce to meet national, State, and local health

18 care needs.

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

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

21 ‘‘(1) be—

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

23 an accredited school or program of public

24 health, health administration, preventive medi-
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•S 1754 IS

1 cine, or dental public health or a school provid2 ing health management programs;

3 ‘‘(B) an academic health center;

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

5 ‘‘(D) any other appropriate public or pri6 vate nonprofit entity; and

7 ‘‘(2) prepare and submit to the Secretary an

8 application at such time, in such manner, and con9 taining such information as the Secretary may re10 quire.

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

12 under this section the Secretary may grant a preference

13 to entities—

14 ‘‘(1) serving individuals who are from disadvan15 taged backgrounds (including underrepresented ra16 cial and ethnic minorities); and

17 ‘‘(2) graduating large proportions of individuals

18 who serve in underserved communities.

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

20 or contract awarded under this section may be used for—

21 ‘‘(1) the costs of planning, developing, or oper22 ating demonstration training programs;

23 ‘‘(2) faculty development;

24 ‘‘(3) trainee support;

25 ‘‘(4) technical assistance;
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•S 1754 IS

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

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

3 training programs and to maintain or improve

4 existing residency training programs in preven5 tive medicine and dental public health, that

6 have available full-time faculty members with

7 training and experience in the fields of preven8 tive medicine and dental public health; and

9 ‘‘(B) to provide financial assistance to resi10 dency trainees enrolled in such programs;

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

12 workers as well as for increasing the supply of new

13 practitioners to address priority public health, pre14 ventive medicine, public health dentistry, and health

15 administration needs;

16 ‘‘(7) preparing public health professionals for

17 employment at the State and community levels; or

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

19 that are consistent with the purposes of this section

20 ‘‘(e) TRAINEESHIPS.—

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

22 used under this section for the training of health

23 professionals, such training programs shall be de24 signed to—
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1 ‘‘(A) make public health education more

2 accessible to the public and private health work3 force;

4 ‘‘(B) increase the relevance of public

5 health academic preparation to public health

6 practice in the future;

7 ‘‘(C) provide education or training for stu8 dents from traditional on-campus programs in

9 practice-based sites; or

10 ‘‘(D) develop educational methods and dis11 tance-based approaches or technology that ad12 dress adult learning requirements and increase

13 knowledge and skills related to community14 based cultural diversity in public health edu15 cation.

16 ‘‘(2) SEVERE SHORTAGE DISCIPLINES.—

17 Amounts provided under grants or contracts under

18 this section may be used for the operation of pro19 grams designed to award traineeships to students in

20 accredited schools of public health who enter edu21 cational programs in fields where there is a severe

22 shortage of public health professionals, including ep23 idemiology, biostatistics, environmental health, toxi24 cology, public health nursing, nutrition, preventive
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1 medicine, maternal and child health, and behavioral

2 and mental health professions.

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

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

5 or contracts for the operation of public health training

6 centers.

7 ‘‘(b) ELIGIBLE ENTITIES.—

8 ‘‘(1) IN GENERAL.—A public health training

9 center shall be an accredited school of public health,

10 or another public or nonprofit private institution ac11 credited for the provision of graduate or specialized

12 training in public health, that plans, develops, oper13 ates, and evaluates projects that are in furtherance

14 of the goals established by the Secretary for the year

15 2000 in the areas of preventive medicine, health pro16 motion and disease prevention, or improving access

17 to and quality of health services in medically under18 served communities.

19 ‘‘(2) PREFERENCE.—In awarding grants or

20 contracts under this section the Secretary shall give

21 preference to accredited schools of public health.

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

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

24 under subsection (a) unless the program agrees that it—
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1 ‘‘(1) will establish or strengthen field place2 ments for students in public or nonprofit private

3 health agencies or organizations;

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

5 in collaborative projects to enhance public health

6 services to medically underserved communities;

7 ‘‘(3) will specifically designate a geographic

8 area or medically underserved population to be

9 served by the center that shall be in a location re10 moved from the main location of the teaching facility

11 of the school that is participating in the program

12 with such center; and

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

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

15 planning and development of training programs to

16 meet such needs.

17 ‘‘SEC. 767. PUBLIC HEALTH TRAINEESHIPS.

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

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

20 or nonprofit private institutions accredited for the provi21 sion of graduate or specialized training in public health,

22 for the purpose of assisting such schools and institutions

23 in providing traineeships to individuals described in sub24 section (b)(3).

25 ‘‘(b) CERTAIN REQUIREMENTS.—
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1 ‘‘(1) AMOUNT.—The amount of any grant

2 under this section shall be determined by the Sec3 retary.

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

5 under grants made under subsection (a) shall pro6 vide for tuition and fees and such stipends and al7 lowances (including travel and subsistence expenses

8 and dependency allowances) for the trainees as the

9 Secretary may deem necessary.

10 ‘‘(3) ELIGIBLE INDIVIDUALS.—The individuals

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

12 pursuing a course of study in a health professions

13 field in which there is a severe shortage of health

14 professionals (which fields include the fields of epide15 miology, environmental health, biostatistics, toxi16 cology, nutrition, and maternal and child health).

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

18 HEALTH.

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

20 to and enter into contracts with schools of medicine, osteo21 pathic medicine, public health, and dentistry to meet the

22 costs of projects—

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

24 programs and to maintain or improve existing resi-
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1 dency training programs in preventive medicine and

2 dental public health; and

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

4 trainees enrolled in such programs.

5 ‘‘(b) ADMINISTRATION.—

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

7 under subsection (a) shall be determined by the Sec8 retary.

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

10 under subsection (a), the applicant must dem11 onstrate to the Secretary that it has or will have

12 available full-time faculty members with training and

13 experience in the fields of preventive medicine or

14 dental public health and support from other faculty

15 members trained in public health and other relevant

16 specialties and disciplines.

17 ‘‘(3) OTHER FUNDS.—Schools of medicine, os18 teopathic medicine, dentistry, and public health may

19 use funds committed by State, local, or county pub20 lic health officers as matching amounts for Federal

21 grant funds for residency training programs in pre22 ventive medicine.
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1 ‘‘SEC. 769. HEALTH ADMINISTRATION TRAINEESHIPS AND

2 SPECIAL PROJECTS.

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

4 to State or local governments (that have in effect preven5 tive medical and dental public health residency programs)

6 or public or nonprofit private educational entities (includ7 ing graduate schools of social work and business schools

8 that have health management programs) that offer a pro9 gram described in subsection (b)—

10 ‘‘(1) to provide traineeships for students en11 rolled in such a program; and

12 ‘‘(2) to assist accredited programs health ad13 ministration in the development or improvement of

14 programs to prepare students for employment with

15 public or nonprofit private entities.

16 ‘‘(b) RELEVANT PROGRAMS.—The program referred

17 to in subsection (a) is an accredited program in health

18 administration, hospital administration, or health policy

19 analysis and planning, which program is accredited by a

20 body or bodies approved for such purpose by the Secretary

21 of Education and which meets such other quality stand22 ards as the Secretary of Health and Human Services by

23 regulation may prescribe.

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

25 grants under subsection (a), the Secretary shall give pref-
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1 erence to qualified applicants that meet the following con2 ditions:

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

4 of the applicant are engaged in full-time practice

5 settings in medically underserved communities.

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

7 from medically underserved communities.

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

9 applicant has established relationships with public

10 and nonprofit providers of health care in the com11 munity involved.

12 ‘‘(4) In training students, the applicant empha13 sizes employment with public or nonprofit private

14 entities.

15 ‘‘(d) CERTAIN PROVISIONS REGARDING

16 TRAINEESHIPS.—

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

18 under grants made under subsection (a) shall pro19 vide for tuition and fees and such stipends and al20 lowances (including travel and subsistence expenses

21 and dependency allowances) for the trainees as the

22 Secretary may deem necessary.

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

24 Each entity applying for a grant under subsection

25 (a) for traineeships shall assure to the satisfaction
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1 of the Secretary that the entity will give priority to

2 awarding the traineeships to students who dem3 onstrate a commitment to employment with public

4 or nonprofit private entities in the fields with respect

5 to which the traineeships are awarded.

6 ‘‘SEC. 770. AUTHORIZATION OF APPROPRIATIONS.

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

8 this subpart, there is authorized to be appropriated

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

10 be necessary for each of the fiscal years 1999 through

11 2002.

12 ‘‘(b) LIMITATION REGARDING CERTAIN PROGRAM.—

13 In obligating amounts appropriated under subsection (a),

14 the Secretary may not obligate more than 30 percent for

15 carrying out section 767.’’.

16 SEC. 106. GENERAL PROVISIONS.

17 (a) IN GENERAL.—

18 (1) Part F of title VII of the Public Health

19 Service Act (42 U.S.C. 295 et seq.) is repealed.

20 (2) Part G of title VII of the Public Health

21 Service Act (42 U.S.C. 295j et seq.) is amended—

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

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

24 (i) by striking subsection (b); and
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1 (ii) redesignating subsection (c) as

2 subsection (b);

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

4 295l);

5 (D) by repealing section 798;

6 (E) by redesignating section 799 as section

7 799B; and

8 (F) by inserting after section 794, the fol9 lowing new sections:

10 ‘‘SEC. 796. APPLICATION.

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

12 or contract under this title, an eligible entity shall prepare

13 and submit to the Secretary an application that meets the

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

15 and containing such information as the Secretary may re16 quire.

17 ‘‘(b) PLAN.—An application submitted under this

18 section shall contain the plan of the applicant for carrying

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

20 plan shall be consistent with relevant Federal, State, or

21 regional health professions program plans.

22 ‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An ap23 plication submitted under this section shall contain a spec24 ification by the applicant entity of performance outcome

25 standards that the project to be funded under the grant
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1 or contract will be measured against. Such standards shall

2 address relevant health workforce needs that the project

3 will meet. The recipient of a grant or contract under this

4 section shall meet the standards set forth in the grant or

5 contract application.

6 ‘‘(d) LINKAGES.—An application submitted under

7 this section shall contain a description of the linkages with

8 relevant educational and health care entities, including

9 training programs for other health professionals as appro10 priate, that the project to be funded under the grant or

11 contract will establish. To the extent practicable, grantees

12 under this section shall establish linkages with health care

13 providers who provide care for underserved communities

14 and populations.

15 ‘‘SEC. 797. USE OF FUNDS.

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

17 or contract awarded under this title may be used for train18 ing program development and support, faculty develop19 ment, model demonstrations, trainee support including

20 tuition, books, program fees and reasonable living ex21 penses during the period of training, technical assistance,

22 workforce analysis, dissemination of information, and ex23 ploring new policy directions, as appropriate to meet rec24 ognized health workforce objectives, in accordance with

25 this title.
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1 ‘‘(b) MAINTENANCE OF EFFORT.—With respect to

2 activities for which a grant awarded under this title is to

3 be expended, the entity shall agree to maintain expendi4 tures of non-Federal amounts for such activities at a level

5 that is not less than the level of such expenditures main6 tained by the entity for the fiscal year preceding the fiscal

7 year for which the entity receives such a grant.

8 ‘‘SEC. 798. MATCHING REQUIREMENT.

9 ‘‘The Secretary may require that an entity that ap10 plies for a grant or contract under this title provide non11 Federal matching funds, as appropriate, to ensure the in12 stitutional commitment of the entity to the projects funded

13 under the grant. As determined by the Secretary, such

14 non-Federal matching funds may be provided directly or

15 through donations from public or private entities and may

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

17 equipment, or services.

18 ‘‘SEC. 799. GENERALLY APPLICABLE PROVISIONS.

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

20 Secretary shall ensure that grants and contracts under

21 this title are awarded on a competitive basis, as appro22 priate, to carry out innovative demonstration projects or

23 provide for strategic workforce supplementation activities

24 as needed to meet health workforce goals and in accord25 ance with this title. Contracts may be entered into under
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1 this title with public or private entities as may be nec2 essary.

3 ‘‘(b) ELIGIBLE ENTITIES.—Unless specifically re4 quired otherwise in this title, the Secretary shall accept

5 applications for grants or contracts under this title from

6 health professions schools, academic health centers, State

7 or local governments, or other appropriate public or pri8 vate nonprofit entities for funding and participation in

9 health professions and nursing training activities. The

10 Secretary may accept applications from for-profit private

11 entities if determined appropriate by the Secretary.

12 ‘‘(c) INFORMATION REQUIREMENTS.—

13 ‘‘(1) IN GENERAL.—Recipients of grants and

14 contracts under this title shall meet information re15 quirements as specified by the Secretary.

16 ‘‘(2) DATA COLLECTION.—The Secretary shall

17 establish procedures to ensure that, with respect to

18 any data collection required under this title, such

19 data is collected in a manner that takes into account

20 age, gender, race, and ethnicity.

21 ‘‘(3) USE OF FUNDS.—The Secretary shall es22 tablish procedures to permit the use of amounts ap23 propriated under this title to be used for data collec24 tion purposes.
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1 ‘‘(4) EVALUATIONS.—The Secretary shall es2 tablish procedures to ensure the annual evaluation of

3 programs and projects operated by recipients of

4 grants or contracts under this title. Such procedures

5 shall ensure that continued funding for such pro6 grams and projects will be conditioned upon a dem7 onstration that satisfactory progress has been made

8 by the program or project in meeting the objectives

9 of the program or project.

10 ‘‘(d) TRAINING PROGRAMS.—Training programs con11 ducted with amounts received under this title shall meet

12 applicable accreditation and quality standards.

13 ‘‘(e) DURATION OF ASSISTANCE.—

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

15 in the case of an award to an entity of a grant, co16 operative agreement, or contract under this title, the

17 period during which payments are made to the en18 tity under the award may not exceed 5 years. The

19 provision of payments under the award shall be sub20 ject to annual approval by the Secretary of the pay21 ments and subject to the availability of appropria22 tions for the fiscal year involved to make the pay23 ments. This paragraph may not be construed as lim24 iting the number of awards under the program in25 volved that may be made to the entity.
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1 ‘‘(2) LIMITATION.—In the case of an award to

2 an entity of a grant, cooperative agreement, or con3 tract under this title, paragraph (1) shall apply only

4 to the extent not inconsistent with any other provi5 sion of this title that relates to the period during

6 which payments may be made under the award.

7 ‘‘(f) PEER REVIEW REGARDING CERTAIN PRO8 GRAMS.—

9 ‘‘(1) IN GENERAL.—Each application for a

10 grant under this title, except any scholarship or loan

11 program, including those under sections 701, 721, or

12 723, shall be submitted to a peer review group for

13 an evaluation of the merits of the proposals made in

14 the application. The Secretary may not approve such

15 an application unless a peer review group has rec16 ommended the application for approval.

17 ‘‘(2) COMPOSITION.—Each peer review group

18 under this subsection shall be composed principally

19 of individuals who are not officers or employees of

20 the Federal Government. In providing for the estab21 lishment of peer review groups and procedures, the

22 Secretary shall ensure gender, racial, ethnic, and ge23 ographic balance among the membership of such

24 groups.
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1 ‘‘(3) ADMINISTRATION.—This subsection shall

2 be carried out by the Secretary acting through the

3 Administrator of the Health Resources and Services

4 Administration.

5 ‘‘(g) PREFERENCE OR PRIORITY CONSIDER6 ATIONS.—In considering a preference or priority for fund7 ing which is based on outcome measures for an eligible

8 entity under this title, the Secretary may also consider the

9 future ability of the eligible entity to meet the outcome

10 preference or priority through improvements in the eligible

11 entity’s program design.

12 ‘‘(h) ANALYTIC ACTIVITIES.—The Secretary shall en13 sure that—

14 ‘‘(1) cross-cutting workforce analytical activities

15 are carried out as part of the workforce information

16 and analysis activities under section 761; and

17 ‘‘(2) discipline-specific workforce information

18 and analytical activities are carried out as part of—

19 ‘‘(A) the community-based linkage pro20 gram under part D; and

21 ‘‘(B) the health workforce development

22 program under subpart 2 of part E.

23 ‘‘(i) OSTEOPATHIC SCHOOLS.—For purposes of this

24 title, any reference to—
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1 ‘‘(1) medical schools shall include osteopathic

2 medical schools; and

3 ‘‘(2) medical students shall include osteopathic

4 medical students.

5 ‘‘SEC. 799A. TECHNICAL ASSISTANCE.

6 ‘‘Funds appropriated under this title may be used by

7 the Secretary to provide technical assistance in relation

8 to any of the authorities under this title.’’.

9 (b) PROFESSION COUNSELORS AS MENTAL HEALTH

10 PROFESSIONALS.—Section 792(a) of the Public Health

11 Service Act (42 U.S.C. 295k(a)) is amended by inserting

12 ‘‘professional counselors,’’ after ‘‘clinical psychologists,’’.

13 SEC. 107. PREFERENCE IN CERTAIN PROGRAMS.

14 (a) IN GENERAL.—Section 791 of the Public Health

15 Service Act (42 U.S.C. 295j), as amended by section

16 105(a)(2)(B), is further amended by adding at the end

17 thereof the following subsection:

18 ‘‘(c) EXCEPTIONS FOR NEW PROGRAMS.—

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

20 compete equitably for funding under this section,

21 those new programs that meet at least 4 of the cri22 teria described in paragraph (3) shall qualify for a

23 funding preference under this section.

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

25 the term ‘new program’ means any program that
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1 has graduated less than three classes. Upon grad2 uating at least three classes, a program shall have

3 the capability to provide the information necessary

4 to qualify the program for the general funding pref5 erences described in subsection (a).

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

7 paragraph (1) are the following:

8 ‘‘(A) The mission statement of the pro9 gram identifies a specific purpose of the pro10 gram as being the preparation of health profes11 sionals to serve underserved populations.

12 ‘‘(B) The curriculum of the program in13 cludes content which will help to prepare practi14 tioners to serve underserved populations.

15 ‘‘(C) Substantial clinical training experi16 ence is required under the program in medically

17 underserved communities.

18 ‘‘(D) A minimum of 20 percent of the clin19 ical faculty of the program spend at least 50

20 percent of their time providing or supervising

21 care in medically underserved communities.

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

23 portion of the program is physically located in

24 a medically underserved community.
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1 ‘‘(F) Student assistance, which is linked to

2 service in medically underserved communities

3 following graduation, is available to the stu4 dents in the program.

5 ‘‘(G) The program provides a placement

6 mechanism for deploying graduates to medically

7 underserved communities.’’.

8 (b) CONFORMING AMENDMENTS.—Section 791(a) of

9 the Public Health Service Act (42 U.S.C. 295j(a)) is

10 amended—

11 (1) in paragraph (1), by striking ‘‘sections 747’’

12 and all that follows through ‘‘767’’ and inserting

13 ‘‘sections 747 and 750’’; and

14 (2) in paragraph (2), by striking ‘‘under section

15 798(a)’’.

16 SEC. 108. DEFINITIONS.

17 (a) GRADUATE PROGRAM IN BEHAVIORAL AND MEN18 TAL HEALTH PRACTICE.—Section 799B(1)(D) of the

19 Public Health Service Act (42 U.S.C. 295p(1)(D)) (as so

20 redesignated by section 106(a)(2)(E)) is amended—

21 (1) by inserting ‘‘behavioral health and’’ before

22 ‘‘mental’’; and

23 (2) by inserting ‘‘behavioral health and mental

24 health practice,’’ before ‘‘clinical’’.
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1 (b) PROFESSIONAL COUNSELING AS A BEHAVIORAL

2 AND MENTAL HEALTH PRACTICE.—Section 799B of the

3 Public Health Service Act (42 U.S.C. 295p) (as so redes4 ignated by section 106(a)(2)(E)) is amended—

5 (1) in paragraph (1)—

6 (A) in subparagraph (C)—

7 (i) by inserting ‘‘and ‘graduate pro8 gram in professional counseling’ ’’ after

9 ‘‘graduate program in marriage and family

10 therapy’ ’’; and

11 (ii) by inserting before the period the

12 following: ‘‘and a concentration leading to

13 a graduate degree in counseling’’;

14 (B) in subparagraph (D), by inserting

15 ‘‘professional counseling,’’ after ‘‘social work,’’;

16 and

17 (C) in subparagraph (E), by inserting

18 ‘‘professional counseling,’’ after ‘‘social work,’’;

19 and

20 (2) in paragraph (5)(C), by inserting before the

21 period the following: ‘‘or a degree in counseling or

22 an equivalent degree’’.

23 (c) MEDICALLY UNDERSERVED COMMUNITY.—Sec24 tion 799B(6) of the Public Health Service Act (42 U.S.C.
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1 295p(6)) (as so redesignated by section 105(a)(2)(E)) is

2 amended—

3 (1) in subparagraph (B), by striking ‘‘or’’ at

4 the end thereof;

5 (2) in subparagraph (C), by striking the period

6 and inserting ‘‘; or’’; and

7 (3) by adding at the end the following:

8 ‘‘(D) is designated by a State Governor (in

9 consultation with the medical community) as a

10 shortage area or medically underserved commu11 nity.’’.

12 (d) PROGRAMS FOR THE TRAINING OF PHYSICIAN

13 ASSISTANTS.—Paragraph (3) of section 799B of the Pub14 lic Health Service Act (42 U.S.C. 295p) (as so redesig15 nated by section 105(a)(2)(E)) is amended to read as fol16 lows:

17 ‘‘(3) The term ‘program for the training of phy18 sician assistants’ means an educational program

19 that—

20 ‘‘(A) has as its objective the education of

21 individuals who will, upon completion of their

22 studies in the program, be qualified to provide

23 primary care under the supervision of a physi24 cian;
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1 ‘‘(B) extends for at least one academic

2 year and consists of—

3 ‘‘(i) supervised clinical practice; and

4 ‘‘(ii) at least four months (in the ag5 gregate) of classroom instruction, directed

6 toward preparing students to deliver health

7 care;

8 ‘‘(C) has an enrollment of not less than

9 eight students; and

10 ‘‘(D) trains students in primary care, dis11 ease prevention, health promotion, geriatric

12 medicine, and home health care.’’.

13 SEC. 109. TECHNICAL AMENDMENT ON NATIONAL HEALTH

14 SERVICE CORPS.

15 Section 338B(b)(1)(B) of the Public Health Service

16 Act (42 U.S.C. 254l–1(b)(1)(B)) is amended by striking

17 ‘‘or other health profession’’ and inserting ‘‘behavioral and

18 mental health, or other health profession’’.

19 SEC. 110. SAVINGS PROVISION.

20 In the case of any authority for making awards of

21 grants or contracts that is terminated by the amendments

22 made by this subtitle, the Secretary of Health and Human

23 Services may, notwithstanding the termination of the au24 thority, continue in effect any grant or contract made

25 under the authority that is in effect on the day before the
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1 date of the enactment of this Act, subject to the duration

2 of any such grant or contract not exceeding the period

3 determined by the Secretary in first approving such finan4 cial assistance, or in approving the most recent request

5 made (before the date of such enactment) for continuation

6 of such assistance, as the case may be.

7 Subtitle B—Nursing Workforce

8 Development

9 SEC. 121. SHORT TITLE.

10 This title may be cited as the ‘‘Nursing Education

11 and Practice Improvement Act of 1998’’.

12 SEC. 122. PURPOSE.

13 It is the purpose of this title to restructure the nurse

14 education authorities of title VIII of the Public Health

15 Service Act to permit a comprehensive, flexible, and effec16 tive approach to Federal support for nursing workforce

17 development.

18 SEC. 123. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.

19 Title VIII of the Public Health Service Act (42

20 U.S.C. 296k et seq.) is amended—

21 (1) by striking the title heading and all that fol22 lows except for subpart II of part B and sections

23 846 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 fol8 lowing new parts:

9 ‘‘PART A—GENERAL PROVISIONS

10 ‘‘SEC. 801. DEFINITIONS.

11 ‘‘As used in this title:

12 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible

13 entities’ means schools of nursing, nursing centers,

14 academic health centers, State or local governments,

15 and other public or private nonprofit entities deter16 mined appropriate by the Secretary that submit to

17 the Secretary an application in accordance with sec18 tion 802.

19 ‘‘(2) SCHOOL OF NURSING.—The term ‘school

20 of nursing’ means a collegiate, associate degree, or

21 diploma school of nursing in a State.

22 ‘‘(3) COLLEGIATE SCHOOL OF NURSING.—The

23 term ‘collegiate school of nursing’ means a depart24 ment, division, or other administrative unit in a col25 lege or university which provides primarily or exclu-
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1 sively a program of education in professional nursing

2 and related subjects leading to the degree of bach3 elor of arts, bachelor of science, bachelor of nursing,

4 or to an equivalent degree, or to a graduate degree

5 in nursing, or to an equivalent degree, and including

6 advanced training related to such program of edu7 cation provided by such school, but only if such pro8 gram, or such unit, college or university is accred9 ited.

10 ‘‘(4) ASSOCIATE DEGREE SCHOOL OF NURS11 ING.—The term ‘associate degree school of nursing’

12 means a department, division, or other administra13 tive unit in a junior college, community college, col14 lege, or university which provides primarily or exclu15 sively a two-year program of education in profes16 sional nursing and allied subjects leading to an asso17 ciate degree in nursing or to an equivalent degree,

18 but only if such program, or such unit, college, or

19 university is accredited.

20 ‘‘(5) DIPLOMA SCHOOL OF NURSING.—The

21 term ‘diploma school of nursing’ means a school af22 filiated with a hospital or university, or an independ23 ent school, which provides primarily or exclusively a

24 program of education in professional nursing and al25 lied subjects leading to a diploma or to equivalent
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1 indicia that such program has been satisfactorily

2 completed, but only if such program, or such affili3 ated school or such hospital or university or such

4 independent school is accredited.

5 ‘‘(6) ACCREDITED.—

6 ‘‘(A) IN GENERAL.—Except as provided in

7 subparagraph (B), the term ‘accredited’ when

8 applied to any program of nurse education

9 means a program accredited by a recognized

10 body or bodies, or by a State agency, approved

11 for such purpose by the Secretary of Education

12 and when applied to a hospital, school, college,

13 or university (or a unit thereof) means a hos14 pital, school, college, or university (or a unit

15 thereof) which is accredited by a recognized

16 body or bodies, or by a State agency, approved

17 for such purpose by the Secretary of Education.

18 For the purpose of this paragraph, the Sec19 retary of Education shall publish a list of recog20 nized accrediting bodies, and of State agencies,

21 which the Secretary of Education determines to

22 be reliable authority as to the quality of edu23 cation offered.

24 ‘‘(B) NEW PROGRAMS.—A new program of

25 nursing that, by reason of an insufficient period
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1 of operation, is not, at the time of the submis2 sion of an application for a grant or contract

3 under this title, eligible for accreditation by

4 such a recognized body or bodies or State agen5 cy, shall be deemed accredited for purposes of

6 this title if the Secretary of Education finds,

7 after consultation with the appropriate accredi8 tation body or bodies, that there is reasonable

9 assurance that the program will meet the ac10 creditation standards of such body or bodies

11 prior to the beginning of the academic year fol12 lowing the normal graduation date of students

13 of the first entering class in such a program.

14 ‘‘(7) NONPROFIT.—The term ‘nonprofit’ as ap15 plied to any school, agency, organization, or institu16 tion means one which is a corporation or association,

17 or is owned and operated by one or more corpora18 tions or associations, no part of the net earnings of

19 which inures, or may lawfully inure, to the benefit

20 of any private shareholder or individual.

21 ‘‘(8) STATE.—The term ‘State’ means a State,

22 the Commonwealth of Puerto Rico, the District of

23 Columbia, the Commonwealth of the Northern Mari24 ana Islands, Guam, American Samoa, the Virgin Is25 lands, or the Trust Territory of the Pacific Islands.
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1 ‘‘SEC. 802. APPLICATION.

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

3 or contract under this title, an eligible entity shall prepare

4 and submit to the Secretary an application that meets the

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

6 and containing such information as the Secretary may re7 quire.

8 ‘‘(b) PLAN.—An application submitted under this

9 section shall contain the plan of the applicant for carrying

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

11 plan shall be consistent with relevant Federal, State, or

12 regional program plans.

13 ‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An ap14 plication submitted under this section shall contain a spec15 ification by the applicant entity of performance outcome

16 standards that the project to be funded under the grant

17 or contract will be measured against. Such standards shall

18 address relevant national nursing needs that the project

19 will meet. The recipient of a grant or contract under this

20 section shall meet the standards set forth in the grant or

21 contract application.

22 ‘‘(d) LINKAGES.—An application submitted under

23 this section shall contain a description of the linkages with

24 relevant educational and health care entities, including

25 training programs for other health professionals as appro-
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1 priate, that the project to be funded under the grant or

2 contract will establish.

3 ‘‘SEC. 803. 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

8 tuition, books, program fees and reasonable living ex9 penses during the period of training, technical assistance,

10 workforce analysis, and dissemination of information, as

11 appropriate to meet recognized nursing objectives, in ac12 cordance with this title.

13 ‘‘(b) MAINTENANCE OF EFFORT.—With respect to

14 activities for which a grant awarded under this title is to

15 be expended, the entity shall agree to maintain expendi16 tures of non-Federal amounts for such activities at a level

17 that is not less than the level of such expenditures main18 tained by the entity for the fiscal year preceding the fiscal

19 year for which the entity receives such a grant.

20 ‘‘SEC. 804. 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 in24 stitutional commitment of the entity to the projects funded

25 under the grant. Such non-Federal matching funds may
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1 be provided directly or through donations from public or

2 private entities and may be in cash or in-kind, fairly evalu3 ated, including plant, equipment, or services.

4 ‘‘SEC. 805. PREFERENCE.

5 ‘‘In awarding grants or contracts under this title, the

6 Secretary shall give preference to applicants with projects

7 that will substantially benefit rural or underserved popu8 lations, or help meet public health nursing needs in State

9 or local health departments.

10 ‘‘SEC. 806. GENERALLY APPLICABLE PROVISIONS.

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

12 Secretary shall ensure that grants and contracts under

13 this title are awarded on a competitive basis, as appro14 priate, to carry out innovative demonstration projects or

15 provide for strategic workforce supplementation activities

16 as needed to meet national nursing service goals and in

17 accordance with this title. Contracts may be entered into

18 under this title with public or private entities as deter19 mined necessary by the Secretary.

20 ‘‘(b) INFORMATION REQUIREMENTS.—

21 ‘‘(1) IN GENERAL.—Recipients of grants and

22 contracts under this title shall meet information re23 quirements as specified by the Secretary.

24 ‘‘(2) EVALUATIONS.—The Secretary shall es25 tablish procedures to ensure the annual evaluation of
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1 programs and projects operated by recipients of

2 grants under this title. Such procedures shall ensure

3 that continued funding for such programs and

4 projects will be conditioned upon a demonstration

5 that satisfactory progress has been made by the pro6 gram or project in meeting the objectives of the pro7 gram or project.

8 ‘‘(c) TRAINING PROGRAMS.—Training programs con9 ducted with amounts received under this title shall meet

10 applicable accreditation and quality standards.

11 ‘‘(d) DURATION OF ASSISTANCE.—

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

13 in the case of an award to an entity of a grant, co14 operative agreement, or contract under this title, the

15 period during which payments are made to the en16 tity under the award may not exceed 5 years. The

17 provision of payments under the award shall be sub18 ject to annual approval by the Secretary of the pay19 ments and subject to the availability of appropria20 tions for the fiscal year involved to make the pay21 ments. This paragraph may not be construed as lim22 iting the number of awards under the program in23 volved that may be made to the entity.

24 ‘‘(2) LIMITATION.—In the case of an award to

25 an entity of a grant, cooperative agreement, or con-
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1 tract under this title, paragraph (1) shall apply only

2 to the extent not inconsistent with any other provi3 sion of this title that relates to the period during

4 which payments may be made under the award.

5 ‘‘(e) PEER REVIEW REGARDING CERTAIN PRO6 GRAMS.—

7 ‘‘(1) IN GENERAL.—Each application for a

8 grant under this title, except advanced nurse

9 traineeship grants under section 811(a)(2), shall be

10 submitted to a peer review group for an evaluation

11 of the merits of the proposals made in the applica12 tion. The Secretary may not approve such an appli13 cation unless a peer review group has recommended

14 the application for approval.

15 ‘‘(2) COMPOSITION.—Each peer review group

16 under this subsection shall be composed principally

17 of individuals who are not officers or employees of

18 the Federal Government. In providing for the estab19 lishment of peer review groups and procedures, the

20 Secretary shall, except as otherwise provided, ensure

21 gender, racial, ethnic, and geographic balance among

22 the membership of such groups.

23 ‘‘(3) ADMINISTRATION.—This subsection shall

24 be carried out by the Secretary acting through the
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1 Administrator of the Health Resources and Services

2 Administration.

3 ‘‘(f) ANALYTIC ACTIVITIES.—The Secretary shall en4 sure that—

5 ‘‘(1) cross-cutting workforce analytical activities

6 are carried out as part of the workforce information

7 and analysis activities under this title; and

8 ‘‘(2) discipline-specific workforce information is

9 developed and analytical activities are carried out as

10 part of—

11 ‘‘(A) the advanced practice nursing activi12 ties under part B;

13 ‘‘(B) the workforce diversity activities

14 under part C; and

15 ‘‘(C) basic nursing education and practice

16 activities under part D.

17 ‘‘(g) STATE AND REGIONAL PRIORITIES.—Activities

18 under grants or contracts under this title shall, to extent

19 practicable, be consistent with related Federal, State, or

20 regional nursing professions program plans and priorities.

21 ‘‘(h) FILING OF APPLICATIONS.—

22 ‘‘(1) IN GENERAL.—Applications for grants or

23 contracts under this title may be submitted by

24 health professions schools, schools of nursing, aca25 demic health centers, State or local governments, or
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1 other appropriate public or private nonprofit entities

2 as determined appropriate by the Secretary in ac3 cordance with this title.

4 ‘‘(2) FOR PROFIT ENTITIES.—Notwithstanding

5 paragraph (1), a for-profit entity may be eligible for

6 a grant or contract under this title as determined

7 appropriated by the Secretary.

8 ‘‘SEC. 807. TECHNICAL ASSISTANCE.

9 ‘‘Funds appropriated under this title may be used by

10 the Secretary to provide technical assistance in relation

11 to any of the authorities under this title.

12 ‘‘PART B—NURSE PRACTITIONERS, NURSE MID13 WIVES, NURSE ANESTHETISTS, AND OTHER

14 ADVANCED PRACTICE NURSES

15 ‘‘SEC. 811. ADVANCED PRACTICE NURSING GRANTS.

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

17 to and enter into contracts with eligible entities to meet

18 the costs of—

19 ‘‘(1) projects that support the enhancement of

20 advanced practice nursing education and practice;

21 and

22 ‘‘(2) traineeships for individuals in advanced

23 practice nursing programs.

24 ‘‘(b) DEFINITION OF ADVANCED PRACTICE

25 NURSES.—For purposes of this section, the term ‘ad-
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1 vanced practice nurses’ means individuals trained in ad2 vanced degree programs including individuals in combined

3 R.N./Master’s degree programs, post-nursing master’s

4 certificate programs, or, in the case of nurse midwives,

5 in certificate programs in existence on the date that is one

6 day prior to the date of enactment of this section, to serve

7 as nurse practitioners, clinical nurse specialists, nurse

8 midwives, nurse anesthetists, nurse educators, nurse ad9 ministrators, or public health nurses, or in other nurse

10 specialties determined by the Secretary to require ad11 vanced education.

12 ‘‘(c) AUTHORIZED NURSE PRACTITIONER AND

13 NURSE-MIDWIFERY PROGRAMS.—Nurse practitioner and

14 nurse midwifery programs eligible for support under this

15 section are educational programs for registered nurses (ir16 respective of the type of school of nursing in which the

17 nurses received their training) that—

18 ‘‘(1) meet guidelines prescribed by the Sec19 retary; and

20 ‘‘(2) have as their objective the education of

21 nurses who will upon completion of their studies in

22 such programs, be qualified to effectively provide

23 primary health care, including primary health care

24 in homes and in ambulatory care facilities, long-term
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1 care facilities, acute care, and other health care set2 tings.

3 ‘‘(d) AUTHORIZED NURSE ANESTHESIA PRO4 GRAMS.—Nurse anesthesia programs eligible for support

5 under this section are education programs that—

6 ‘‘(1) provide registered nurses with full-time an7 esthetist education; and

8 ‘‘(2) are accredited by the Council on Accredita9 tion of Nurse Anesthesia Educational Programs.

10 ‘‘(e) OTHER AUTHORIZED EDUCATIONAL PRO11 GRAMS.—The Secretary shall prescribe guidelines as ap12 propriate for other advanced practice nurse education pro13 grams eligible for support under this section.

14 ‘‘(f) TRAINEESHIPS.—

15 ‘‘(1) IN GENERAL.—The Secretary may not

16 award a grant to an applicant under subsection (a)

17 unless the applicant involved agrees that

18 traineeships provided with the grant will only pay all

19 or part of the costs of—

20 ‘‘(A) the tuition, books, and fees of the

21 program of advanced nursing practice with re22 spect to which the traineeship is provided; and

23 ‘‘(B) the reasonable living expenses of the

24 individual during the period for which the

25 traineeship is provided.
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1 ‘‘(2) DOCTORAL PROGRAMS.—The Secretary

2 may not obligate more than 10 percent of the

3 traineeships under subsection (a) for individuals in

4 doctorate degree programs.

5 ‘‘(3) SPECIAL CONSIDERATION.—In making

6 awards of grants and contracts under subsection

7 (a)(2), the Secretary shall give special consideration

8 to an eligible entity that agrees to expend the award

9 to train advanced practice nurses who will practice

10 in health professional shortage areas designated

11 under section 332.

12 ‘‘PART C—INCREASING NURSING WORKFORCE

13 DIVERSITY

14 ‘‘SEC. 821. WORKFORCE DIVERSITY GRANTS.

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

16 to and enter into contracts with eligible entities to meet

17 the costs of special projects to increase nursing education

18 opportunities for individuals who are from disadvantaged

19 backgrounds (including racial and ethnic minorities under20 represented among registered nurses) by providing stu21 dent scholarships or stipends, pre-entry preparation, and

22 retention activities.

23 ‘‘(b) GUIDANCE.—In carrying out subsection (a), the

24 Secretary shall take into consideration the recommenda25 tions of the First, Second and Third Invitational Con-
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1 gresses for Minority Nurse Leaders on ‘Caring for the

2 Emerging Majority,’ in 1992, 1993 and 1997, and consult

3 with nursing associations including the American Nurses

4 Association, the National League for Nursing, the Amer5 ican Association of Colleges of Nursing, the National

6 Black Nurses Association, the National Association of

7 Hispanic Nurses, the Association of Asian American and

8 Pacific Islander Nurses, the Native American Indian and

9 Alaskan Nurses Association, and the National Council of

10 State Boards of Nursing.

11 ‘‘(c) REQUIRED INFORMATION AND CONDITIONS FOR

12 AWARD RECIPIENTS.—

13 ‘‘(1) IN GENERAL.—Recipients of awards under

14 this section may be required, where requested, to re15 port to the Secretary concerning the annual admis16 sion, retention, and graduation rates for individuals

17 from disadvantaged backgrounds and ethnic and ra18 cial minorities in the school or schools involved in

19 the projects.

20 ‘‘(2) FALLING RATES.—If any of the rates re21 ported under paragraph (1) fall below the average of

22 the two previous years, the grant or contract recipi23 ent shall provide the Secretary with plans for imme24 diately improving such rates.
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1 ‘‘(3) INELIGIBILITY.—A recipient described in

2 paragraph (2) shall be ineligible for continued fund3 ing under this section if the plan of the recipient

4 fails to improve the rates within the 1-year period

5 beginning on the date such plan is implemented.

6 ‘‘PART D—STRENGTHENING CAPACITY FOR

7 BASIC NURSE EDUCATION AND PRACTICE

8 ‘‘SEC. 831. BASIC NURSE EDUCATION AND PRACTICE

9 GRANTS.

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

11 to and enter into contracts with eligible entities for

12 projects to strengthen capacity for basic nurse education

13 and practice.

14 ‘‘(b) PRIORITY AREAS.—In awarding grants or con15 tracts under this section the Secretary shall give priority

16 to entities that will use amounts provided under such a

17 grant or contract to enhance the educational mix and utili18 zation of the basic nursing workforce by strengthening

19 programs that provide basic nurse education, such as

20 through—

21 ‘‘(1) establishing or expanding nursing practice

22 arrangements in noninstitutional settings to dem23 onstrate methods to improve access to primary

24 health care in medically underserved communities;
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1 ‘‘(2) providing care for underserved populations

2 and other high-risk groups such as the elderly, indi3 viduals with HIV-AIDS, substance abusers, the

4 homeless, and victims of domestic violence;

5 ‘‘(3) providing managed care, quality improve6 ment, and other skills needed to practice in existing

7 and emerging organized health care systems;

8 ‘‘(4) developing cultural competencies among

9 nurses;

10 ‘‘(5) expanding the enrollment in baccalaureate

11 nursing programs;

12 ‘‘(6) promoting career mobility for nursing per13 sonnel in a variety of training settings and cross

14 training or specialty training among diverse popu15 lation groups;

16 ‘‘(7) providing education in informatics, includ17 ing distance learning methodologies; or

18 ‘‘(8) other priority areas as determined by the

19 Secretary.’’;

20 (5) by adding at the end the following:

21 ‘‘PART F—AUTHORIZATION OF APPROPRIATIONS

22 ‘‘SEC. 841. AUTHORIZATION OF APPROPRIATIONS.

23 ‘‘There are authorized to be appropriated to carry out

24 sections 811, 821, and 831, $65,000,000 for fiscal year
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1 1998, and such sums as may be necessary in each of the

2 fiscal years 1999 through 2002.

3 ‘‘PART G—NATIONAL ADVISORY COUNCIL ON

4 NURSE EDUCATION AND PRACTICE

5 ‘‘SEC. 845. NATIONAL ADVISORY COUNCIL ON NURSE EDU6 CATION AND PRACTICE.

7 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab8 lish an advisory council to be known as the National Advi9 sory Council on Nurse Education and Practice (in this sec10 tion referred to as the ‘Advisory Council’).

11 ‘‘(b) COMPOSITION.—

12 ‘‘(1) IN GENERAL.—The Advisory Council shall

13 be composed of

14 ‘‘(A) not less than 21, nor more than 23

15 individuals, who are not officers or employees of

16 the Federal Government, appointed by the Sec17 retary without regard to the Federal civil serv18 ice laws, of which—

19 ‘‘(i) 2 shall be selected from full-time

20 students enrolled in schools of nursing;

21 ‘‘(ii) 2 shall be selected from the gen22 eral public;

23 ‘‘(iii) 2 shall be selected from practic24 ing professional nurses; and
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1 ‘‘(iv) 9 shall be selected from among

2 the leading authorities in the various fields

3 of nursing, higher, and secondary edu4 cation, and from representatives of ad5 vanced practice nursing groups (such as

6 nurse practitioners, nurse midwives, and

7 nurse anesthetists), hospitals, and other in8 stitutions and organizations which provide

9 nursing services; and

10 ‘‘(B) the Secretary (or the delegate of the

11 Secretary (who shall be an ex officio member

12 and shall serve as the Chairperson)).

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

14 after the date of enactment of this Act, the Sec15 retary shall appoint the members of the Advisory

16 Council and each such member shall serve a 4 year

17 term. In making such appointments, the Secretary

18 shall ensure a fair balance between the nursing pro19 fessions, a broad geographic representation of mem20 bers and a balance between urban and rural mem21 bers. Members shall be appointed based on their

22 competence, interest, and knowledge of the mission

23 of the profession involved. A majority of the mem24 bers shall be nurses.
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1 ‘‘(3) MINORITY REPRESENTATION.—In appoint2 ing the members of the Advisory Council under

3 paragraph (1), the Secretary shall ensure the ade4 quate representation of minorities.

5 ‘‘(c) VACANCIES.—

6 ‘‘(1) IN GENERAL.—A vacancy on the Advisory

7 Council shall be filled in the manner in which the

8 original appointment was made and shall be subject

9 to any conditions which applied with respect to the

10 original appointment.

11 ‘‘(2) FILLING UNEXPIRED TERM.—An individ12 ual chosen to fill a vacancy shall be appointed for

13 the unexpired term of the member replaced.

14 ‘‘(d) DUTIES.—The Advisory Council shall—

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

16 Secretary and Congress concerning policy matters

17 arising in the administration of this title, including

18 the range of issues relating to the nurse workforce,

19 education, and practice improvement;

20 ‘‘(2) provide advice to the Secretary and Con21 gress in the preparation of general regulations and

22 with respect to policy matters arising in the adminis23 tration of this title, including the range of issues re24 lating to nurse supply, education and practice im25 provement; and
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1 ‘‘(3) not later than 3 years after the date of en2 actment of this section, and annually thereafter, pre3 pare and submit to the Secretary, the Committee on

4 Labor and Human Resources of the Senate, and the

5 Committee on Commerce of the House of Represent6 atives, a report describing the activities of the Coun7 cil, including findings and recommendations made by

8 the Council concerning the activities under this title.

9 ‘‘(e) MEETINGS AND DOCUMENTS.—

10 ‘‘(1) MEETINGS.—The Advisory Council shall

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

12 shall be held jointly with other related entities estab13 lished under this title where appropriate.

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

15 prior to the convening of a meeting under paragraph

16 (1), the Advisory Council shall prepare and make

17 available an agenda of the matters to be considered

18 by the Advisory Council at such meeting. At any

19 such meeting, the Advisory Council shall distribute

20 materials with respect to the issues to be addressed

21 at the meeting. Not later than 30 days after the ad22 journing of such a meeting, the Advisory Council

23 shall prepare and make available a summary of the

24 meeting and any actions taken by the Council based

25 upon the meeting.
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1 ‘‘(f) COMPENSATION AND EXPENSES.—

2 ‘‘(1) COMPENSATION.—Each member of the

3 Advisory Council shall be compensated at a rate

4 equal to the daily equivalent of the annual rate of

5 basic pay prescribed for level IV of the Executive

6 Schedule under section 5315 of title 5, United

7 States Code, for each day (including travel time)

8 during which such member is engaged in the per9 formance of the duties of the Council. All members

10 of the Council who are officers or employees of the

11 United States shall serve without compensation in

12 addition to that received for their services as officers

13 or employees of the United States.

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

15 Council shall be allowed travel expenses, including

16 per diem in lieu of subsistence, at rates authorized

17 for employees of agencies under subchapter I of

18 chapter 57 of title 5, United States Code, while

19 away from their homes or regular places of business

20 in the performance of services for the Council.

21 ‘‘(g) FUNDING.—Amounts appropriated under this

22 title may be utilized by the Secretary to support the nurse

23 education and practice activities of the Council.

24 ‘‘(h) FACA.—The Federal Advisory Committee Act

25 shall apply to the Advisory Committee under this section
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1 only to the extent that the provisions of such Act do not

2 conflict with the requirements of this section.’’; and

3 (6) by redesignating section 855 as section 810,

4 and transferring such section so as to appear after

5 section 809 (as added by the amendment made by

6 paragraph (5)).

7 SEC. 124. SAVINGS PROVISION.

8 In the case of any authority for making awards of

9 grants or contracts that is terminated by the amendment

10 made by section 123, the Secretary of Health and Human

11 Services may, notwithstanding the termination of the au12 thority, continue in effect any grant or contract made

13 under the authority that is in effect on the day before the

14 date of the enactment of this Act, subject to the duration

15 of any such grant or contract not exceeding the period

16 determined by the Secretary in first approving such finan17 cial assistance, or in approving the most recent request

18 made (before the date of such enactment) for continuation

19 of such assistance, as the case may be.

20 Subtitle C—Financial Assistance

21 CHAPTER 1—SCHOOL-BASED REVOLVING LOAN

22 FUNDS

23 SEC. 131. PRIMARY CARE LOAN PROGRAM.

24 (a) REQUIREMENT FOR SCHOOLS.—Section

25 723(b)(1) of the Public Health Service Act (42 U.S.C.
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1 292s(b)(1)), as amended by section 2014(c)(2)(A)(ii) of

2 Public Law 103–43 (107 Stat. 216), is amended by strik3 ing ‘‘3 years before’’ and inserting ‘‘4 years before’’.

4 (b) NONCOMPLIANCE.—Section 723(a)(3) of the

5 Public Health Service Act (42 U.S.C. 292s(a)(3)) is

6 amended to read as follows:

7 ‘‘(3) NONCOMPLIANCE BY STUDENT.—Each

8 agreement entered into with a student pursuant to

9 paragraph (1) shall provide that, if the student fails

10 to comply with such agreement, the loan involved

11 will begin to accrue interest at a rate of 18 percent

12 per year beginning on the date of such noncompli13 ance.’’.

14 (c) REPORT REQUIREMENT.—Section 723 of the

15 Public Health Service Act (42 U.S.C. 292s) is amended—

16 (1) by striking subsection (c); and

17 (2) by redesignating subsection (d) as sub18 section (c).

19 SEC. 132. LOANS FOR DISADVANTAGED STUDENTS.

20 (a) AUTHORIZATION OF APPROPRIATIONS.—Section

21 724(f)(1) of the Public Health Service Act (42 U.S.C.

22 292t(f)(1)) is amended by striking ‘‘$15,000,000 for fiscal

23 year 1993’’ and inserting ‘‘$8,000,000 for each of the fis24 cal years 1998 through 2002’’.
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1 (b) REPEAL.—Effective October 1, 2002, paragraph

2 (1) of section 724(f) of the Public Health Service Act (42

3 U.S.C. 292t(f)(1)) is repealed.

4 SEC. 133. STUDENT LOANS REGARDING SCHOOLS OF

5 NURSING.

6 (a) IN GENERAL.—Section 836(b) of the Public

7 Health Service Act (42 U.S.C. 297b(b)) is amended—

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

9 the end and inserting a semicolon;

10 (2) in paragraph (2)—

11 (A) in subparagraph (A), by striking

12 ‘‘and’’ at the end; and

13 (B) by inserting before the semicolon at

14 the end the following: ‘‘, and (C) such addi15 tional periods under the terms of paragraph (8)

16 of this subsection’’;

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

18 the end and inserting ‘‘; and’’; and

19 (4) by adding at the end the following para20 graph:

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

22 the Secretary, the repayment period established

23 under paragraph (2) for any student borrower who

24 during the repayment period failed to make consecu25 tive payments and who, during the last 12 months
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1 of the repayment period, has made at least 12 con2 secutive payments may be extended for a period not

3 to exceed 10 years.’’.

4 (b) MINIMUM MONTHLY PAYMENTS.—Section 836(g)

5 of the Public Health Service Act (42 U.S.C. 297b(g)) is

6 amended by striking ‘‘$15’’ and inserting ‘‘$40’’.

7 (c) ELIMINATION OF STATUTE OF LIMITATION FOR

8 LOAN COLLECTIONS.—

9 (1) IN GENERAL.—Section 836 of the Public

10 Health Service Act (42 U.S.C. 297b) is amended by

11 adding at the end the following new subsection:

12 ‘‘(l) ELIMINATION OF STATUTE OF LIMITATION FOR

13 LOAN COLLECTIONS.—

14 ‘‘(1) PURPOSE.—It is the purpose of this sub15 section to ensure that obligations to repay loans

16 under this section are enforced without regard to

17 any Federal or State statutory, regulatory, or ad18 ministrative limitation on the period within which

19 debts may be enforced.

20 ‘‘(2) PROHIBITION.—Notwithstanding any other

21 provision of Federal or State law, no limitation shall

22 terminate the period within which suit may be filed,

23 a judgment may be enforced, or an offset, garnish24 ment, or other action may be initiated or taken by

25 a school of nursing that has an agreement with the
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1 Secretary pursuant to section 835 that is seeking

2 the repayment of the amount due from a borrower

3 on a loan made under this subpart after the default

4 of the borrower on such loan.’’.

5 (2) EFFECTIVE DATE.—The amendment made

6 by paragraph (1) shall be effective with respect to

7 actions pending on or after the date of enactment of

8 this Act.

9 (d) BREACH OF AGREEMENTS.—Section 338D of the

10 Public Health Service Act is amended by adding at the

11 end thereof the following new subsection:

12 ‘‘(g) BREACH OF AGREEMENT.—

13 ‘‘(1) IN GENERAL.—In the case of any program

14 under this section under which an individual makes

15 an agreement to provide health services for a period

16 of time in accordance with such program in consid17 eration of receiving an award of Federal funds re18 garding education as a nurse (including an award

19 for the repayment of loans), the following applies if

20 the agreement provides that this subsection is appli21 cable:

22 ‘‘(A) In the case of a program under this

23 section that makes an award of Federal funds

24 for attending an accredited program of nursing

25 (in this section referred to as a ‘nursing pro-
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1 gram’), the individual is liable to the Federal

2 Government for the amount of such award (in3 cluding amounts provided for expenses related

4 to such attendance), and for interest on such

5 amount at the maximum legal prevailing rate,

6 if the individual—

7 ‘‘(i) fails to maintain an acceptable

8 level of academic standing in the nursing

9 program (as indicated by the program in

10 accordance with requirements established

11 by the Secretary);

12 ‘‘(ii) is dismissed from the nursing

13 program for disciplinary reasons; or

14 ‘‘(iii) voluntarily terminates the nurs15 ing program.

16 ‘‘(B) The individual is liable to the Federal

17 Government for the amount of such award (in18 cluding amounts provided for expenses related

19 to such attendance), and for interest on such

20 amount at the maximum legal prevailing rate,

21 if the individual fails to provide health services

22 in accordance with the program under this sec23 tion for the period of time applicable under the

24 program.
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1 ‘‘(2) WAIVER OR SUSPENSION OF LIABILITY.—

2 In the case of an individual or health facility making

3 an agreement for purposes of paragraph (1), the

4 Secretary shall provide for the waiver or suspension

5 of liability under such subsection if compliance by

6 the individual or the health facility, as the case may

7 be, with the agreements involved is impossible, or

8 would involve extreme hardship to the individual or

9 facility, and if enforcement of the agreements with

10 respect to the individual or facility would be uncon11 scionable.

12 ‘‘(3) DATE CERTAIN FOR RECOVERY.—Subject

13 to paragraph (2), any amount that the Federal Gov14 ernment is entitled to recover under paragraph (1)

15 shall be paid to the United States not later than the

16 expiration of the 3-year period beginning on the date

17 the United States becomes so entitled.

18 ‘‘(4) AVAILABILITY.—Amounts recovered under

19 paragraph (1) with respect to a program under this

20 section shall be available for the purposes of such

21 program, and shall remain available for such pur22 poses until expended.’’.

23 (e) TECHNICAL AMENDMENTS.—Section 839 of the

24 Public Health Service Act (42 U.S.C. 297e) is amended—

25 (1) in subsection (a)—
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1 (A) by striking the matter preceding para2 graph (1) and inserting the following:

3 ‘‘(a) If a school terminates a loan fund established

4 under an agreement pursuant to section 835(b), or if the

5 Secretary for good cause terminates the agreement with

6 the school, there shall be a capital distribution as fol7 lows:’’; and

8 (B) in paragraph (1), by striking ‘‘at the

9 close of September 30, 1999,’’ and inserting

10 ‘‘on the date of termination of the fund’’; and

11 (2) in subsection (b), to read as follows:

12 ‘‘(b) If a capital distribution is made under sub13 section (a), the school involved shall, after such capital dis14 tribution, pay to the Secretary, not less often than quar15 terly, the same proportionate share of amounts received

16 by the school in payment of principal or interest on loans

17 made from the loan fund established under section 835(b)

18 as determined by the Secretary under subsection (a).’’.

19 SEC. 134. GENERAL PROVISIONS.

20 (a) MAXIMUM STUDENT LOAN PROVISIONS AND

21 MINIMUM PAYMENTS.—

22 (1) IN GENERAL.—Section 722(a)(1) of the

23 Public Health Service Act (42 U.S.C. 292r(a)(1)),

24 as amended by section 2014(b)(1) of Public Law

25 103–43, is amended by striking ‘‘the sum of’’ and
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1 all that follows through the end thereof and insert2 ing ‘‘the cost of attendance (including tuition, other

3 reasonable educational expenses, and reasonable liv4 ing costs) for that year at the educational institution

5 attended by the student (as determined by such edu6 cational institution).’’.

7 (2) THIRD AND FOURTH YEARS.—Section

8 722(a)(2) of the Public Health Service Act (42

9 U.S.C. 292r(a)(2)), as amended by section

10 2014(b)(1) of Public Law 103–43, is amended by

11 striking ‘‘the amount $2,500’’ and all that follows

12 through ‘‘including such $2,500’’ and inserting ‘‘the

13 amount of the loan may, in the case of the third or

14 fourth year of a student at a school of medicine or

15 osteopathic medicine, be increased to the extent nec16 essary’’.

17 (3) REPAYMENT PERIOD.—Section 722(c) of

18 the Public Health Service Act (42 U.S.C. 292r(c)),

19 as amended by section 2014(b)(1) of Public Law

20 103–43, is amended—

21 (A) in the subsection heading by striking

22 ‘‘TEN-YEAR’’ and inserting ‘‘REPAYMENT’’;

23 (B) by striking ‘‘ten-year period which be24 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

6 the Public Health Service Act (42 U.S.C. 292r(j)),

7 as amended by section 2014(b)(1) of Public Law

8 103–43, is amended by striking ‘‘$15’’ and inserting

9 $40’’.

10 (b) ELIMINATION OF STATUTE OF LIMITATION FOR

11 LOAN COLLECTIONS.—

12 (1) IN GENERAL.—Section 722 of the Public

13 Health Service Act (42 U.S.C. 292r), as amended by

14 section 2014(b)(1) of Public Law 103–43, is amend15 ed by adding at the end the following new sub16 section:

17 ‘‘(m) 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

22 any Federal or State statutory, regulatory, or ad23 ministrative limitation on the period within which

24 debts may 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

6 a school that has an agreement with the Secretary

7 pursuant to section 721 that is seeking the repay8 ment of the amount due from a borrower on a loan

9 made under this subpart after the default of the bor10 rower on such loan.’’.

11 (2) EFFECTIVE DATE.—The amendment made

12 by paragraph (1) shall be effective with respect to

13 actions pending on or after the date of enactment of

14 this Act.

15 (c) DATE CERTAIN FOR CONTRIBUTIONS.—Para16 graph (2) of section 735(e) of the Public Health Service

17 Act (42 U.S.C. 292y(e)(2)) is amended to read as follows:

18 ‘‘(2) DATE CERTAIN FOR CONTRIBUTIONS.—

19 Amounts described in paragraph (1) that are re20 turned to the Secretary shall be obligated before the

21 end of the succeeding fiscal year.’’.
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1 CHAPTER 2—INSURED HEALTH EDUCATION

2 ASSISTANCE LOANS TO GRADUATE STUDENTS

3 SEC. 141. HEALTH EDUCATION ASSISTANCE LOAN PRO4 GRAM.

5 (a) HEALTH EDUCATION ASSISTANCE LOAN

6 DEFERMENT FOR BORROWERS PROVIDING HEALTH

7 SERVICES TO INDIANS.—

8 (1) IN GENERAL.—Section 705(a)(2)(C) of the

9 Public Health Service Act (42 U.S.C.

10 292d(a)(2)(C)) is amended by striking ‘‘and (x)’’

11 and inserting ‘‘(x) not in excess of three years, dur12 ing which the borrower is providing health care serv13 ices to Indians through an Indian health program

14 (as defined in section 108(a)(2)(A) of the Indian

15 Health Care Improvement Act (25 U.S.C.

16 1616a(a)(2)(A)); and (xi)’’.

17 (2) CONFORMING AMENDMENTS.—Section

18 705(a)(2)(C) of the Public Health Service Act (42

19 U.S.C. 292d(a)(2)(C)) is further amended—

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

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

22 (B) in the matter following such clause

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

24 (3) EFFECTIVE DATE.—The amendments made

25 by this subsection shall apply with respect to serv26 ices provided on or after the first day of the third
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1 month that begins after the date of the enactment

2 of this Act.

3 (b) REPORT REQUIREMENT.—Section 709(b) of the

4 Public Health Service Act (42 U.S.C. 292h(b)) is

5 amended—

6 (1) in paragraph (4)(B), by adding ‘‘and’’ after

7 the semicolon;

8 (2) in paragraph (5), by striking ‘‘; and’’ and

9 inserting a period; and

10 (3) by striking paragraph (6).

11 (c) COLLECTION FROM ESTATES.—Section 714 of

12 the Public Health Service Act (42 U.S.C. 292m) is amend13 ed by adding at the end the following new sentence: ‘‘Not14 withstanding the first sentence, the Secretary may, in the

15 case of a borrower who dies, collect any remaining unpaid

16 balance owed to the lender, the holder of the loan, or the

17 Federal Government from the borrower’s estate.’’.

18 (d) PROGRAM ELIGIBILITY.—

19 (1) LIMITATIONS ON LOANS.—Section 703(a) of

20 the Public Health Service Act (42 U.S.C. 292b(a))

21 is amended by striking ‘‘or clinical psychology’’ and

22 inserting ‘‘or behavioral and mental health practice,

23 including clinical psychology’’.

24 (2) DEFINITION OF ELIGIBLE INSTITUTION.—

25 Section 719(1) of the Public Health Service Act (42
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1 U.S.C. 292o(1)) is amended by striking ‘‘or clinical

2 psychology’’ and inserting ‘‘or behavioral and mental

3 health practice, including clinical psychology’’.

4 SEC. 142. HEAL LENDER AND HOLDER PERFORMANCE

5 STANDARDS.

6 (a) GENERAL AMENDMENTS.—Section 707(a) of the

7 Public Health Service Act (42 U.S.C. 292f) is amended—

8 (1) by striking the last sentence;

9 (2) by striking ‘‘determined.’’ and inserting

10 ‘‘determined, except that, if the insurance bene11 ficiary including any servicer of the loan is not des12 ignated for ‘exceptional performance’, as set forth in

13 paragraph (2), the Secretary shall pay to the bene14 ficiary a sum equal to 98 percent of the amount of

15 the loss sustained by the insured upon that loan.’’;

16 (3) by striking ‘‘Upon’’ and inserting:

17 ‘‘(1) IN GENERAL.—Upon’’; and

18 (4) by adding at the end the following new

19 paragraph:

20 ‘‘(2) EXCEPTIONAL PERFORMANCE.—

21 ‘‘(A) AUTHORITY.—Where the Secretary

22 determines that an eligible lender, holder, or

23 servicer has a compliance performance rating

24 that equals or exceeds 97 percent, the Secretary

25 shall designate that eligible lender, holder, or
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1 servicer, as the case may be, for exceptional

2 performance.

3 ‘‘(B) COMPLIANCE PERFORMANCE RAT4 ING.—For purposes of subparagraph (A), a

5 compliance performance rating is determined

6 with respect to compliance with due diligence in

7 the disbursement, servicing, and collection of

8 loans under this subpart for each year for

9 which the determination is made. Such rating

10 shall be equal to the percentage of all due dili11 gence requirements applicable to each loan, on

12 average, as established by the Secretary, with

13 respect to loans serviced during the period by

14 the eligible lender, holder, or servicer.

15 ‘‘(C) ANNUAL AUDITS FOR LENDERS,

16 HOLDERS, AND SERVICERS.—Each eligible lend17 er, holder, or servicer desiring a designation

18 under subparagraph (A) shall have an annual

19 financial and compliance audit conducted with

20 respect to the loan portfolio of such eligible

21 lender, holder, or servicer, by a qualified inde22 pendent organization from a list of qualified or23 ganizations identified by the Secretary and in

24 accordance with standards established by the

25 Secretary. The standards shall measure the
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1 lender’s, holder’s, or servicer’s compliance with

2 due diligence standards and shall include a de3 fined statistical sampling technique designed to

4 measure the performance rating of the eligible

5 lender, holder, or servicer for the purpose of

6 this section. Each eligible lender, holder, or

7 servicer shall submit the audit required by this

8 section to the Secretary.

9 ‘‘(D) SECRETARY’S DETERMINATIONS.—

10 The Secretary shall make the determination

11 under subparagraph (A) based upon the audits

12 submitted under this paragraph and any infor13 mation in the possession of the Secretary or

14 submitted by any other agency or office of the

15 Federal Government.

16 ‘‘(E) QUARTERLY COMPLIANCE AUDIT.—

17 To maintain its status as an exceptional per18 former, the lender, holder, or servicer shall un19 dergo a quarterly compliance audit at the end

20 of each quarter (other than the quarter in

21 which status as an exceptional performer is es22 tablished through a financial and compliance

23 audit, as described in subparagraph (C)), and

24 submit the results of such audit to the Sec25 retary. The compliance audit shall review com-
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1 pliance with due diligence requirements for the

2 period beginning on the day after the ending

3 date of the previous audit, in accordance with

4 standards determined by the Secretary.

5 ‘‘(F) REVOCATION AUTHORITY.—The Sec6 retary shall revoke the designation of a lender,

7 holder, or servicer under subparagraph (A) if

8 any quarterly audit required under subpara9 graph (E) is not received by the Secretary by

10 the date established by the Secretary or if the

11 audit indicates the lender, holder, or servicer

12 has failed to meet the standards for designation

13 as an exceptional performer under subpara14 graph (A). A lender, holder, or servicer receiv15 ing a compliance audit not meeting the stand16 ard for designation as an exceptional performer

17 may reapply for designation under subpara18 graph (A) at any time.

19 ‘‘(G) DOCUMENTATION.—Nothing in this

20 section shall restrict or limit the authority of

21 the Secretary to require the submission of

22 claims documentation evidencing servicing per23 formed on loans, except that the Secretary may

24 not require exceptional performers to submit

25 greater documentation than that required for
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1 lenders, holders, and servicers not designated

2 under subparagraph (A).

3 ‘‘(H) COST OF AUDITS.—Each eligible

4 lender, holder, or servicer shall pay for all the

5 costs associated with the audits required under

6 this section.

7 ‘‘(I) ADDITIONAL REVOCATION AUTHOR8 ITY.—Notwithstanding any other provision of

9 this section, a designation under subparagraph

10 (A) may be revoked at any time by the Sec11 retary if the Secretary determines that the eligi12 ble lender, holder, or servicer has failed to

13 maintain an overall level of compliance consist14 ent with the audit submitted by the eligible

15 lender, holder, or servicer under this paragraph

16 or if the Secretary asserts that the lender, hold17 er, or servicer may have engaged in fraud in se18 curing designation under subparagraph (A) or

19 is failing to service loans in accordance with

20 program requirements.

21 ‘‘(J) NONCOMPLIANCE.—A lender, holder,

22 or servicer designated under subparagraph (A)

23 that fails to service loans or otherwise comply

24 with applicable program regulations shall be
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1 considered in violation of the Federal False

2 Claims Act.’’.

3 (b) DEFINITION.—Section 707(e) of the Public

4 Health Service Act (42 U.S.C. 292f(e)) is amended by

5 adding at the end the following new paragraph:

6 ‘‘(4) The term ‘servicer’ means any agency act7 ing on behalf of the insurance beneficiary.’’.

8 (c) EFFECTIVE DATE.—The amendments made by

9 subsections (a) and (b) shall apply with respect to loans

10 submitted to the Secretary for payment on or after the

11 first day of the sixth month that begins after the date

12 of enactment of this Act.

13 SEC. 143. REAUTHORIZATION.

14 (a) LOAN PROGRAM.—Section 702(a) of the Public

15 Health Service Act (42 U.S.C. 292a(a)) is amended—

16 (1) by striking ‘‘$350,000,000’’ and all that fol17 lows through ‘‘1995’’ and inserting ‘‘$350,000,000

18 for fiscal year 1998, $375,000,000 for fiscal year

19 1999, and $425,000,000 for each of the fiscal years

20 2000 through 2002’’;

21 (2) by striking ‘‘obtained prior loans insured

22 under this subpart’’ and inserting ‘‘obtained loans

23 insured under this subpart in fiscal year 2002 or in

24 prior fiscal years’’;
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1 (3) by adding at the end thereof the following

2 new sentence: ‘‘The Secretary may establish guide3 lines and procedures that lenders must follow in dis4 tributing funds under this subpart.’’; and

5 (4) by striking ‘‘September 30, 1998’’ and in6 serting ‘‘September 30, 2005’’.

7 (b) INSURANCE PROGRAM.—Section 710(a)(2)(B) of

8 the Public Health Service Act (42 U.S.C. 292i(a)(2)(B))

9 is amended by striking ‘‘any of the fiscal years 1993

10 through 1996’’ and inserting ‘‘fiscal year 1993 and subse11 quent fiscal years’’.

12 SEC. 144. HEAL BANKRUPTCY.

13 (a) IN GENERAL.—Section 707(g) of the Public

14 Health Service Act (42 U.S.C. 292f(g)) is amended in the

15 first sentence by striking ‘‘A debt which is a loan insured’’

16 and inserting ‘‘Notwithstanding any other provision of

17 Federal or State law, a debt that is a loan insured’’.

18 (b) APPLICATION.—The amendment made by sub19 section (a) shall apply to any loan insured under the au20 thority of subpart I of part A of title VII of the Public

21 Health Service Act (42 U.S.C. 292 et seq.) that is listed

22 or scheduled by the debtor in a case under title XI, United

23 States Code, filed—

24 (1) on or after the date of enactment of this

25 Act; or
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1 (2) prior to such date of enactment in which a

2 discharge has not been granted.

3 SEC. 145. HEAL REFINANCING.

4 Section 706 of the Public Health Service Act (42

5 U.S.C. 292e) is amended—

6 (1) in subsection (d)—

7 (A) in the subsection heading, by striking

8 ‘‘CONSOLIDATION’’ and inserting ‘‘REFINANC9 ING OR CONSOLIDATION’’; and

10 (B) in the first sentence, by striking ‘‘in11 debtedness’’ and inserting ‘‘indebtedness or the

12 refinancing of a single loan’’; and

13 (2) in subsection (e)—

14 (A) in the subsection heading, by striking

15 ‘‘DEBTS’’ and inserting ‘‘DEBTS AND REFI16 NANCING’’;

17 (B) in the first sentence, by striking ‘‘all

18 of the borrower’s debts into a single instru19 ment’’ and inserting ‘‘all of the borrower’s loans

20 insured under this subpart into a single instru21 ment (or, if the borrower obtained only 1 loan

22 insured under this subpart, refinancing the loan

23 1 time)’’; and
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1 (C) in the second sentence, by striking

2 ‘‘consolidation’’ and inserting ‘‘consolidation or

3 refinancing’’.

4 TITLE II—OFFICE OF MINORITY

5 HEALTH

6 SEC. 201. REVISION AND EXTENSION OF PROGRAMS OF OF7 FICE OF MINORITY HEALTH.

8 (a) DUTIES AND REQUIREMENTS.—Section 1707 of

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

10 amended by striking subsection (b) and all that follows

11 and inserting the following:

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

13 of racial and ethnic minority groups, the Secretary, acting

14 through the Deputy Assistant Secretary for Minority

15 Health (in this section referred to as the ‘Deputy Assist16 ant Secretary’), shall carry out the following:

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

18 and objectives and coordinate all other activities

19 within the Public Health Service that relate to dis20 ease prevention, health promotion, service delivery,

21 and research concerning such individuals. The heads

22 of each of the agencies of the Service shall consult

23 with the Deputy Assistant Secretary to ensure the

24 coordination of such activities.
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1 ‘‘(2) Enter into interagency agreements with

2 other agencies of the Public Health Service.

3 ‘‘(3) Support research, demonstrations and

4 evaluations to test new and innovative models.

5 ‘‘(4) Increase knowledge and understanding of

6 health risk factors.

7 ‘‘(5) Develop mechanisms that support better

8 information dissemination, education, prevention,

9 and service delivery to individuals from disadvan10 taged backgrounds, including individuals who are

11 members of racial or ethnic minority groups.

12 ‘‘(6) Ensure that the National Center for

13 Health Statistics collects data on the health status

14 of each minority group.

15 ‘‘(7) With respect to individuals who lack pro16 ficiency in speaking the English language, enter into

17 contracts with public and nonprofit private providers

18 of primary health services for the purpose of increas19 ing the access of the individuals to such services by

20 developing and carrying out programs to provide bi21 lingual or interpretive services.

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

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

2 services, and education in the appropriate use

3 of health care.

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

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

6 problems relating to such matters.

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

10 for such technical assistance).

11 ‘‘(9) Carry out programs to improve access to

12 health care services for individuals with limited pro13 ficiency in speaking the English language. Activities

14 under the preceding sentence shall include develop15 ing and evaluating model projects.

16 ‘‘(c) ADVISORY COMMITTEE.—

17 ‘‘(1) IN GENERAL.—The Secretary shall estab18 lish an advisory committee to be known as the Advi19 sory Committee on Minority Health (in this sub20 section referred to as the ‘Committee’).

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

22 advice to the Deputy Assistant Secretary carrying

23 out this section, including advice on the development

24 of goals and specific program activities under para-
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1 graphs (1) through (9) of subsection (b) for each ra2 cial and ethnic minority group.

3 ‘‘(3) CHAIR.—The chairperson of the Commit4 tee shall be selected by the Secretary from among

5 the members of the voting members of the Commit6 tee. The term of office of the chairperson shall be

7 2 years.

8 ‘‘(4) COMPOSITION.—

9 ‘‘(A) The Committee shall be composed of

10 12 voting members appointed in accordance

11 with subparagraph (B), and nonvoting, ex offi12 cio members designated in subparagraph (C).

13 ‘‘(B) The voting members of the Commit14 tee shall be appointed by the Secretary from

15 among individuals who are not officers or em16 ployees of the Federal Government and who

17 have expertise regarding issues of minority

18 health. The racial and ethnic minority groups

19 shall be equally represented among such mem20 bers.

21 ‘‘(C) The nonvoting, ex officio members of

22 the Committee shall be such officials of the De23 partment of Health and Human Services as the

24 Secretary determines to be appropriate.
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1 ‘‘(5) TERMS.—Each member of the Committee

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

3 Secretary shall initially appoint a portion of the

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

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

6 Committee, a new member shall be appointed by the

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

9 term for which the predecessor of such member was

10 appointed. The vacancy shall not affect the power of

11 the remaining members to execute the duties of the

12 Committee.

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

15 States shall serve without compensation. Members of

16 the Committee who are not officers or employees of

17 the United States shall receive compensation, for

18 each day (including travel time) they are engaged in

19 the performance of the functions of the Committee.

20 Such compensation may not be in an amount in ex21 cess of the daily equivalent of the annual maximum

22 rate of basic pay payable under the General Sched23 ule (under title 5, United States Code) for positions

24 above GS–15.
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1 ‘‘(d) CERTAIN REQUIREMENTS REGARDING DU2 TIES.—

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

5 Deputy Assistant Secretary for Minority Health

6 shall consult with the Director of the Office of Refu7 gee Health, the Director of the Office of Civil

8 Rights, and the Directors of other appropriate De9 partmental entities regarding recommendations for

10 carrying out activities under subsection (b)(9).

11 ‘‘(2) EQUITABLE ALLOCATION REGARDING AC12 TIVITIES.—

13 ‘‘(A) IN GENERAL.—In making awards of

14 grants, cooperative agreements, or contracts

15 under this section or section 338A, 338C,

16 340A, 404, or 724, or part B of title VII, the

17 Secretary, acting as appropriate through the

18 Deputy Assistant Secretary or the Adminis19 trator of the Health Resources and Services Ad20 ministration, shall ensure that such awards are

21 equitably allocated with respect to the various

22 racial and minority populations.

23 ‘‘(B) REQUIREMENTS.—With respect to

24 grants, cooperative agreements, and contracts
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1 that are available under the sections specified in

2 subparagraph (A), the Secretary shall—

3 ‘‘(i) carry out activities to inform enti4 ties, as appropriate, that the entities may

5 be eligible for awards of such assistance;

6 ‘‘(ii) provide technical assistance to

7 such entities in the process of preparing

8 and submitting applications for the awards

9 in accordance with the policies of the Sec10 retary regarding such application; and

11 ‘‘(iii) inform populations, as appro12 priate, that members of the populations

13 may be eligible to receive services or other14 wise participate in the activities carried out

15 with such awards.

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

17 The Secretary shall ensure that information and

18 services provided pursuant to subsection (b) are pro19 vided in the language, educational, and cultural con20 text that is most appropriate for the individuals for

21 whom the information and services are intended.

22 ‘‘(e) GRANTS AND CONTRACTS REGARDING DU23 TIES.—

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

25 (b), the Secretary acting through the Deputy Assist-
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1 ant Secretary may make awards of grants, coopera2 tive agreements, and contracts to public and non3 profit private entities.

4 ‘‘(2) PROCESS FOR MAKING AWARDS.—The

5 Deputy Assistant Secretary shall ensure that awards

6 under paragraph (1) are made only on a competitive

7 basis, and that a grant is awarded for a proposal

8 only if the proposal has been recommended for such

9 an award through a process of peer review.

10 ‘‘(3) EVALUATION AND DISSEMINATION.—The

11 Deputy Assistant Secretary, directly or through con12 tracts with public and private entities, shall provide

13 for evaluations of projects carried out with awards

14 made under paragraph (1) during the preceding 2

15 fiscal years. The report shall be included in the re16 port required under subsection (f) for the fiscal year

17 involved.

18 ‘‘(f) REPORTS.—

19 ‘‘(1) IN GENERAL.—Not later than February 1

20 of fiscal year 1999 and of each second year there21 after, the Secretary shall submit to the Committee

22 on Energy and Commerce of the House of Rep23 resentatives, and to the Committee on Labor and

24 Human Resources of the Senate, a report describing

25 the activities carried out under this section during
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1 the preceding 2 fiscal years and evaluating the ex2 tent to which such activities have been effective in

3 improving the health of racial and ethnic minority

4 groups. Each such report shall include the biennial

5 reports submitted under sections 201(e)(3) and

6 201(f)(2) for such years by the heads of the Public

7 Health Service agencies.

8 ‘‘(2) AGENCY REPORTS.—Not later than Feb9 ruary 1, 1999, and biennially thereafter, the heads

10 of the Public Health Service agencies shall submit to

11 the Deputy Assistant Secretary a report summariz12 ing the minority health activities of each of the re13 spective agencies.

14 ‘‘(g) DEFINITION.—For purposes of this section:

15 ‘‘(1) The term ‘racial and ethnic minority

16 group’ means American Indians (including Alaska

17 Natives, Eskimos, and Aleuts); Asian Americans and

18 Pacific Islanders; Blacks; and Hispanics.

19 ‘‘(2) The term ‘Hispanic’ means individuals

20 whose origin is Mexican, Puerto Rican, Cuban, Cen21 tral or South American, or any other Spanish-speak22 ing country.

23 ‘‘(h) FUNDING.—

24 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

25 For the purpose of carrying out this section, there
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1 are authorized to be appropriated $30,000,000 for

2 fiscal year 1998, such sums as may be necessary for

3 each of the fiscal years 1999 through 2002.

4 ‘‘(2) NATIONAL CENTER FOR HEALTH STATIS5 TICS.—For the purpose of enabling the National

6 Center for Health Statistics to collect data on His7 panics and major Hispanic subpopulation groups,

8 American Indians, and to develop special area popu9 lation studies on major Asian American and Pacific

10 Islander populations, there are authorized to be ap11 propriated $1,000,000 for fiscal year 1998, such

12 sums as may be necessary for each of the fiscal

13 years 1999 through 2002.’’.

14 (b) MISCELLANEOUS AMENDMENTS.—Section 1707

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

16 amended—

17 (1) in the heading for the section by striking

18 ‘‘ESTABLISHMENT OF’’; and

19 (2) in subsection (a), by striking ‘‘Office of the

20 Assistant Secretary for Health’’ and inserting ‘‘Of21 fice of Public Health and Science’’.
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1 TITLE III—SELECTED

2 INITIATIVES

3 SEC. 301. STATE OFFICES OF RURAL HEALTH.

4 (a) IN GENERAL.—Section 338J of the Public Health

5 Service Act (42 U.S.C. 254r) is amended—

6 (1) in subsection (b)(1), in the matter preced7 ing subparagraph (A), by striking ‘‘in cash’’; and

8 (2) in subsection (j)(1)—

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

10 (B) by inserting before the period the fol11 lowing: ‘‘, and such sums as may be necessary

12 for each of the fiscal years 1998 through

13 2002’’; and

14 (3) in subsection (k), by striking

15 ‘‘$10,000,000’’ and inserting ‘‘$20,000,000’’.

16 (b) REPEAL.—Effective on October 1, 2002, section

17 338J of the Public Health Service Act is repealed.

18 SEC. 302. DEMONSTRATION PROJECTS REGARDING ALZ19 HEIMER’S DISEASE.

20 (a) IN GENERAL.—Section 398(a) of the Public

21 Health Service Act (42 U.S.C. 280c–3(a)) is amended—

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

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

24 (2) in paragraph (2)—
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1 (A) by inserting after ‘‘disorders’’ the fol2 lowing: ‘‘who are living in single family homes

3 or in congregate settings’’; and

4 (B) by striking ‘‘and’’ at the end;

5 (3) by redesignating paragraph (3) as para6 graph (4); and

7 (4) by inserting after paragraph (2) the follow8 ing:

9 ‘‘(3) to improve the access of such individuals

10 to home-based or community-based long-term care

11 services (subject to the services being provided by

12 entities that were providing such services in the

13 State involved as of October 1, 1995), particularly

14 such individuals who are members of racial or ethnic

15 minority groups, who have limited proficiency in

16 speaking the English language, or who live in rural

17 areas; and’’.

18 (b) DURATION.—Section 398A of the Public Health

19 Service Act (42 U.S.C. 280c–4) is amended—

20 (1) in the heading for the section, by striking

21 ‘‘LIMITATION’’ and all that follows and inserting

22 ‘‘REQUIREMENT OF MATCHING

23 FUNDS’’;

24 (2) by striking subsection (a);
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1 (3) by redesignating subsections (b) and (c) as

2 subsections (a) and (b), respectively;

3 (4) in subsection (a) (as so redesignated), in

4 each of paragraphs (1)(C) and (2)(C), by striking

5 ‘‘third year’’ and inserting ‘‘third or subsequent

6 year’’.

7 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

8 398B(e) of the Public Health Service Act (42 U.S.C.

9 280c–5(e)) is amended—

10 (1) by striking ‘‘and such sums’’ and inserting

11 ‘‘such sums’’; and

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

13 ‘‘, $8,000,000 for fiscal year 1998, and such sums

14 as may be necessary for each of the fiscal years

15 1999 through 2002’’.

16 SEC. 303. PROJECT GRANTS FOR IMMUNIZATION SERVICES.

17 Section 317(j) of the Public Health Service Act (42

18 U.S.C. 247b(j)) is amended—

19 (1) in paragraph (1), by striking ‘‘individuals

20 against vaccine-preventable diseases’’ and all that

21 follows through the first period and inserting the fol22 lowing: ‘‘children, adolescents, and adults against

23 vaccine-preventable diseases, there are authorized to

24 be appropriated such sums as may be necessary for

25 each of the fiscal years 1998 through 2002.’’; and
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1 (2) in paragraph (2), by striking ‘‘1990’’ and

2 inserting ‘‘1997’’.

3 TITLE IV—MISCELLANEOUS

4 PROVISIONS

5 SEC. 401. TECHNICAL CORRECTIONS REGARDING PUBLIC

6 LAW 103–183.

7 (a) AMENDATORY INSTRUCTIONS.—Public Law 103–

8 183 is amended—

9 (1) in section 601—

10 (A) in subsection (b), in the matter preced11 ing paragraph (1), by striking ‘‘Section 1201 of

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

13 300d)’’ and inserting ‘‘Title XII of the Public

14 Health Service Act (42 U.S.C. 300d et seq.)’’;

15 and

16 (B) in subsection (f)(1), by striking ‘‘in

17 section 1204(c)’’ and inserting ‘‘in section

18 1203(c) (as redesignated by subsection (b)(2) of

19 this section)’’;

20 (2) in section 602, by striking ‘‘for the pur21 pose’’ and inserting ‘‘For the purpose’’; and

22 (3) in section 705(b), by striking ‘‘317D((l)(1)’’

23 and inserting ‘‘317D(l)(1)’’.
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1 (b) PUBLIC HEALTH SERVICE ACT.—The Public

2 Health Service Act, as amended by Public Law 103–183

3 and by subsection (a) of this section, is amended—

4 (1) in section 317E(g)(2), by striking ‘‘making

5 grants under subsection (b)’’ and inserting ‘‘carrying

6 out subsection (b)’’;

7 (2) in section 318, in subsection (e) as in effect

8 on the day before the date of the enactment of Pub9 lic Law 103–183, by redesignating the subsection as

10 subsection (f);

11 (3) in subpart 6 of part C of title IV—

12 (A) by transferring the first section 447

13 (added by section 302 of Public Law 103–183)

14 from the current placement of the section;

15 (B) by redesignating the section as section

16 447A; and

17 (C) by inserting the section after section

18 447;

19 (4) in section 1213(a)(8), by striking ‘‘provides

20 for for’’ and inserting ‘‘provides for’’;

21 (5) in section 1501, by redesignating the second

22 subsection (c) (added by section 101(f) of Public

23 Law 103–183) as subsection (d); and

24 (6) in section 1505(3), by striking ‘‘nonprivate’’

25 and inserting ‘‘private’’.
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1 (c) MISCELLANEOUS CORRECTION.—Section

2 401(c)(3) of Public Law 103–183 is amended in the mat3 ter preceding subparagraph (A) by striking ‘‘(d)(5)’’ and

4 inserting ‘‘(e)(5)’’.

5 (d) EFFECTIVE DATE.—This section is deemed to

6 have taken effect immediately after the enactment of Pub7 lic Law 103–183.

8 SEC. 402. MISCELLANEOUS AMENDMENTS REGARDING PHS

9 COMMISSIONED OFFICERS.

10 (a) ANTI-DISCRIMINATION LAWS.—Amend section

11 212 of the Public Health Service Act (42 U.S.C. 213) by

12 adding the following new subsection at the end thereof:

13 ‘‘(f) Active service of commissioned officers of the

14 Service shall be deemed to be active military service in

15 the Armed Forces of the United States for purposes of

16 all laws related to discrimination on the basis of race,

17 color, gender, ethnicity, age, religion, and disability.’’

18 (b) TRAINING IN LEAVE WITHOUT PAY STATUS.—

19 Section 218 of the Public Health Service Act (42 U.S.C.

20 218a) is amended by adding at the end the following:

21 ‘‘(c) A commissioned officer may be placed in leave

22 without pay status while attending an educational institu23 tion or training program whenever the Secretary deter24 mines that such status is in the best interest of the Serv25 ice. For purposes of computation of basic pay, promotion,
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1 retirement, compensation for injury or death, and the ben2 efits provided by sections 212 and 224, an officer in such

3 status pursuant to the preceding sentence shall be consid4 ered as performing service in the Service and shall have

5 an active service obligation as set forth in subsection (b)

6 of this section.’’.

7 (c) UTILIZATION OF ALCOHOL AND DRUG ABUSE

8 RECORDS THAT APPLY TO THE ARMED FORCES.—Sec9 tion 543(e) of the Public Health Service Act (42 U.S.C.

10 290dd–2(e)) is amended by striking ‘‘Armed Forces’’ each

11 place that such term appears and inserting ‘‘Uniformed

12 Services’’.

13 SEC. 403. CLINICAL TRAINEESHIPS.

14 Section 303(d)(1) of the Public Health Service Act

15 (42 U.S.C. 242a(d)(1)) is amended by inserting ‘‘counsel16 ing,’’ after ‘‘family therapy,’’.

17 SEC. 404. PROJECT GRANTS FOR SCREENINGS, REFERRALS,

18 AND EDUCATION REGARDING LEAD POISON19 ING.

20 Section 317A(l)(1) of the Public Health Service Act

21 (42 U.S.C. 247b–1(l)(1)) is amended by striking ‘‘1998’’

22 and inserting ‘‘2004’’.
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1 SEC. 405. PROJECT GRANTS FOR PREVENTIVE HEALTH

2 SERVICES REGARDING TUBERCULOSIS.

3 Section 317E(g)(1) of the Public Health Service Act

4 (42 U.S.C. 247b–6(g)(1)) is amended—

5 (1) in subparagraph (A), by striking ‘‘1998’’

6 and inserting ‘‘2004’’; and

7 (2) in subparagraph (B), by striking

8 ‘‘$50,000,000’’ and inserting ‘‘25 percent’’.

9 SEC. 406. CERTAIN AUTHORITIES OF CENTERS FOR DIS10 EASE CONTROL AND PREVENTION.

11 (a) IN GENERAL.—Part B of title III of the Public

12 Health Service Act is amended by inserting after section

13 317H the following section:

14 ‘‘MISCELLANEOUS AUTHORITIES REGARDING CENTERS

15 FOR DISEASE CONTROL AND PREVENTION

16 ‘‘SEC. 317I. The Secretary, acting through the Direc17 tor of the Centers for Disease Control and Prevention,

18 may, without regard to the provisions of title 5, United

19 States Code, governing appointments in the competitive

20 service, and without regard to the provisions of chapter

21 51 and subchapter III of chapter 53 of such title relating

22 to classification and General Schedule pay rates, establish

23 such technical and scientific peer review groups and sci24 entific program advisory committees as are needed to

25 carry out the functions of such Centers and appoint and

26 pay the members of such groups, except that officers and
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1 employees of the United States shall not receive additional

2 compensation for service as members of such groups. The

3 Federal Advisory Committee Act shall not apply to the

4 duration of such peer review groups. Not more than one5 fourth of the members of any such group shall be officers

6 or employees of the United States.’’.

7 (b) EFFECTIVE DATE.—This section is deemed to

8 have taken effect July 1, 1995.

9 SEC. 407. COMMUNITY PROGRAMS ON DOMESTIC VIO10 LENCE.

11 (a) IN GENERAL.—Section 318(h)(2) of the Family

12 Violence Prevention and Services Act (42 U.S.C.

13 10418(h)(2)) is amended by striking ‘‘fiscal year 1997’’

14 and inserting ‘‘for each of the fiscal years 1997 through

15 2002’’.

16 (b) STUDY.—The Secretary of Health and Human

17 Services shall request that the Institute of Medicine con18 duct a study concerning the training needs of health pro19 fessionals with respect to the detection and referral of vic20 tims of family or acquaintance violence. Not later than 2

21 years after the date of enactment of this Act, the Institute

22 of Medicine shall prepare and submit to Congress a report

23 concerning the study conducted under this subsection.
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1 SEC. 408. STATE LOAN REPAYMENT PROGRAM.

2 Section 338I(i)(1) of the Public Health Service Act

3 (42 U.S.C. 254q–1(i)(1)) is amended by inserting before

4 the period ‘‘, and such sums as may be necessary for each

5 of the fiscal years 1998 through 2002’’.

6 SEC. 409. CONSTRUCTION OF REGIONAL CENTERS FOR RE7 SEARCH ON PRIMATES.

8 Section 481B(a) of the Public Health Service Act (42

9 U.S.C. 287a–3(a)) is amended—

10 (1) by striking ‘‘shall’’ and inserting ‘‘may’’;

11 and

12 (2) by striking ‘‘$5,000,000’’ and inserting ‘‘up

13 to $2,500,000’’.

14 SEC. 410. PEER REVIEW.

15 Section 504(d)(2) of the Public Health Service Act

16 (42 U.S.C. 290aa–3(d)(2)) is amended by striking ‘‘coop17 erative agreement, or contract’’ each place that such ap18 pears and inserting ‘‘or cooperative agreement’’.

19 SEC. 411. FUNDING FOR TRAUMA CARE.

20 Section 1232(a) of the Public Health Service Act (42

21 U.S.C. 300d–32) is amended by striking ‘‘and 1996’’ and

22 inserting ‘‘through 2002’’.
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1 SEC. 412. HEALTH INFORMATION AND HEALTH PRO2 MOTION.

3 Section 1701(b) of the Public Health Service Act (42

4 U.S.C. 300u(b)) is amended by striking ‘‘through 1996’’

5 and inserting ‘‘through 2002’’.

6 SEC. 413. EMERGENCY MEDICAL SERVICES FOR CHILDREN.

7 Section 1910 of the Public Health Service Act (42

8 U.S.C. 300w–9) is amended—

9 (1) in subsection (a)—

10 (A) by striking ‘‘two-year period’’ and in11 serting ‘‘3-year period (with an optional 4th

12 year based on performance)’’; and

13 (B) by striking ‘‘one grant’’ and inserting

14 ‘‘3 grants’’; and

15 (2) in subsection (d), by striking ‘‘1997’’ and

16 inserting ‘‘2005’’.

17 SEC. 414. ADMINISTRATION OF CERTAIN REQUIREMENTS.

18 (a) IN GENERAL.—Section 2004 of Public Law 103–

19 43 (107 Stat. 209) is amended by striking subsection (a).

20 (b) CONFORMING AMENDMENTS.—Section 2004 of

21 Public Law 103–43, as amended by subsection (a) of this

22 section, is amended—

23 (1) by striking ‘‘(b) SENSE’’ and all that follows

24 through ‘‘In the case’’ and inserting the following:
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1 ‘‘(a) SENSE OF CONGRESS REGARDING PURCHASE

2 OF AMERICAN-MADE EQUIPMENT AND PRODUCTS.—In

3 the case’’;

4 (2) by striking ‘‘(2) NOTICE TO RECIPIENTS OF

5 ASSISTANCE’’ and inserting the following:

6 ‘‘(b) NOTICE TO RECIPIENTS OF ASSISTANCE’’; and

7 (3) in subsection (b), as redesignated by para8 graph (2) of this subsection, by striking ‘‘paragraph

9 (1)’’ and inserting ‘‘subsection (a)’’.

10 (c) EFFECTIVE DATE.—This section is deemed to

11 have taken effect immediately after the enactment of Pub12 lic Law 103–43.

13 SEC. 415. AIDS DRUG ASSISTANCE PROGRAM.

14 Section 2618(b)(3) of the Public Health Service Act

15 (42 U.S.C. 300ff–28(b)(3)) is amended—

16 (1) in paragraph (1), by striking ‘‘and the

17 Commonwealth of Puerto Rico’’ and inserting ‘‘, the

18 Commonwealth of Puerto Rico, the Virgin Islands,

19 and Guam’’; and

20 (2) in paragraph (2), by striking ‘‘the Virgin Is21 lands, Guam’’.

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