S. 1754

One Hundred Fifth Congress

of the

United States of America

AT THE SECOND SESSION

Begun and held at the City of Washington on Tuesday,

the twenty-seventh day of January, one thousand nine hundred and ninety-eight

An Act

To amend the Public Health Service Act to consolidate and reauthorize health

professions and minority and disadvantaged health education programs, and for

other purposes.

Be it enacted by the Senate and House of Representatives of

the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) SHORT TITLE.—This Act may be cited as the ‘‘Health Professions Education Partnerships Act of 1998’’.

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

is as follows:

Sec. 1. Short title; table of contents.

TITLE I—HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE

PROGRAMS

Subtitle A—Health Professions Education Programs

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

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

Sec. 103. Interdisciplinary, community-based linkages.

Sec. 104. Health professions workforce information and analysis.

Sec. 105. Public health workforce development.

Sec. 106. General provisions.

Sec. 107. Preference in certain programs.

Sec. 108. Definitions.

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

Sec. 110. Savings provision.

Subtitle B—Nursing Workforce Development

Sec. 121. Short title.

Sec. 122. Purpose.

Sec. 123. Amendments to Public Health Service Act.

Sec. 124. Savings provision.

Subtitle C—Financial Assistance

CHAPTER 1—SCHOOL-BASED REVOLVING LOAN FUNDS

Sec. 131. Primary care loan program.

Sec. 132. Loans for disadvantaged students.

Sec. 133. Student loans regarding schools of nursing.

Sec. 134. General provisions.

CHAPTER 2—INSURED HEALTH EDUCATION ASSISTANCE LOANS TO

GRADUATE STUDENTS

Sec. 141. Health Education Assistance Loan Program.

Sec. 142. HEAL lender and holder performance standards.

Sec. 143. Insurance Program.

Sec. 144. HEAL bankruptcy.

Sec. 145. HEAL refinancing.

TITLE II—OFFICE OF MINORITY HEALTH

Sec. 201. Revision and extension of programs of Office of Minority Health.
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TITLE III—SELECTED INITIATIVES

Sec. 301. State offices of rural health.

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

Sec. 303. Project grants for immunization services.

TITLE IV—MISCELLANEOUS PROVISIONS

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

Sec. 402. Miscellaneous amendments regarding PHS commissioned officers.

Sec. 403. Clinical traineeships.

Sec. 404. Project grants for screenings, referrals, and education regarding lead poisoning. Sec. 405. Project grants for preventive health services regarding tuberculosis.

Sec. 406. CDC loan repayment program.

Sec. 407. Community programs on domestic violence.

Sec. 408. State loan repayment program.

Sec. 409. Authority of the director of NIH.

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

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

Sec. 412. Peer review.

Sec. 413. Funding for trauma care.

Sec. 414. Health information and health promotion.

Sec. 415. Emergency medical services for children.

Sec. 416. Administration of certain requirements.

Sec. 417. Aids drug assistance program.

Sec. 418. National Foundation for Biomedical Research.

Sec. 419. Fetal Alcohol Syndrome prevention and services.

TITLE I—HEALTH PROFESSIONS EDUCATION AND FINANCIAL ASSISTANCE

PROGRAMS

Subtitle A—Health Professions Education

Programs

SEC. 101. UNDER-REPRESENTED MINORITY HEALTH PROFESSIONS

GRANT PROGRAM.

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

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

‘‘PART B—HEALTH PROFESSIONS TRAINING

FOR DIVERSITY

‘‘SEC. 736. CENTERS OF EXCELLENCE.

‘‘(a) IN GENERAL.—The Secretary shall make grants to, and

enter into contracts with, designated health professions schools

described in subsection (c), and other public and nonprofit health

or educational entities, for the purpose of assisting the schools

in supporting programs of excellence in health professions education

for under-represented minority individuals.

‘‘(b) REQUIRED USE OF FUNDS.—The Secretary may not make

a grant under subsection (a) unless the designated health professions school involved agrees, subject to subsection (c)(1)(C), to

expend the grant—

‘‘(1) to develop a large competitive applicant pool through

linkages with institutions of higher education, local school districts, and other community-based entities and establish an

education pipeline for health professions careers;

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

enhance the academic performance of under-represented minority students attending the school;
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‘‘(3) to improve the capacity of such school to train, recruit,

and retain under-represented minority faculty including the

payment of such stipends and fellowships as the Secretary

may determine appropriate;

‘‘(4) to carry out activities to improve the information

resources, clinical education, curricula and cultural competence

of the graduates of the school, as it relates to minority health

issues;

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

issues particularly affecting under-represented minority groups,

including research on issues relating to the delivery of health

care;

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

in providing health services to a significant number of underrepresented minority individuals through training provided to

such students at community-based health facilities that—

‘‘(A) provide such health services; and

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

of the teaching facilities of the school; and

‘‘(7) to provide stipends as the Secretary determines appropriate, in amounts as the Secretary determines appropriate.

‘‘(c) CENTERS OF EXCELLENCE.—

‘‘(1) DESIGNATED SCHOOLS.—

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

schools referred to in subsection (a) are such schools that

meet each of the conditions specified in subparagraphs

(B) and (C), and that—

‘‘(i) meet each of the conditions specified in paragraph (2)(A);

‘‘(ii) meet each of the conditions specified in paragraph (3);

‘‘(iii) meet each of the conditions specified in paragraph (4); or

‘‘(iv) meet each of the conditions specified in paragraph (5).

‘‘(B) GENERAL CONDITIONS.—The conditions specified

in this subparagraph are that a designated health professions school—

‘‘(i) has a significant number of under-represented

minority individuals enrolled in the school, including

individuals accepted for enrollment in the school;

‘‘(ii) has been effective in assisting under-represented minority students of the school to complete

the program of education and receive the degree

involved;

‘‘(iii) has been effective in recruiting under-represented minority individuals to enroll in and graduate

from the school, including providing scholarships and

other financial assistance to such individuals and

encouraging under-represented minority students from

all levels of the educational pipeline to pursue health

professions careers; and

‘‘(iv) has made significant recruitment efforts to

increase the number of under-represented minority

individuals serving in faculty or administrative positions at the school.
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‘‘(C) CONSORTIUM.—The condition specified in this

subparagraph is that, in accordance with subsection (e)(1),

the designated health profession school involved has with

other health profession schools (designated or otherwise)

formed a consortium to carry out the purposes described

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

‘‘(D) APPLICATION OF CRITERIA TO OTHER PROGRAMS.—

In the case of any criteria established by the Secretary

for purposes of determining whether schools meet the conditions described in subparagraph (B), this section may not,

with respect to racial and ethnic minorities, be construed

to authorize, require, or prohibit the use of such criteria

in any program other than the program established in

this section.

‘‘(2) CENTERS OF EXCELLENCE AT CERTAIN HISTORICALLY

BLACK COLLEGES AND UNIVERSITIES.—

‘‘(A) CONDITIONS.—The conditions specified in this

subparagraph are that a designated health professions

school—

‘‘(i) is a school described in section 799B(1); and

‘‘(ii) received a contract under section 788B for

fiscal year 1987, as such section was in effect for such

fiscal year.

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

described in subsection (b), a grant under subsection (a)

to a designated health professions school meeting the conditions described in subparagraph (A) may be expended—

‘‘(i) to develop a plan to achieve institutional

improvements, including financial independence, to

enable the school to support programs of excellence

in health professions education for under-represented

minority individuals; and

‘‘(ii) to provide improved access to the library and

informational resources of the school.

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

(1)(C) shall not apply to a historically black college or

university that receives funding under paragraphs (2) or

(5).

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

specified in this paragraph are that—

‘‘(A) with respect to Hispanic individuals, each of

clauses (i) through (iv) of paragraph (1)(B) applies to the

designated health professions school involved;

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

grant under subsection (a), that the school will, in carrying

out the duties described in subsection (b), give priority

to carrying out the duties with respect to Hispanic individuals; and

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

grant under subsection (a), that—

‘‘(i) the school will establish an arrangement with

1 or more public or nonprofit community based Hispanic serving organizations, or public or nonprofit private institutions of higher education, including schools
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of nursing, whose enrollment of students has traditionally included a significant number of Hispanic individuals, the purposes of which will be to carry out a

program—

‘‘(I) to identify Hispanic students who are

interested in a career in the health profession

involved; and

‘‘(II) to facilitate the educational preparation

of such students to enter the health professions

school; and

‘‘(ii) the school will make efforts to recruit Hispanic

students, including students who have participated in

the undergraduate or other matriculation program carried out under arrangements established by the school

pursuant to clause (i)(II) and will assist Hispanic students regarding the completion of the educational

requirements for a degree from the school.

‘‘(4) NATIVE AMERICAN CENTERS OF EXCELLENCE.—Subject

to subsection (e), the conditions specified in this paragraph

are that—

‘‘(A) with respect to Native Americans, each of clauses

(i) through (iv) of paragraph (1)(B) applies to the designated

health professions school involved;

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

grant under subsection (a), that the school will, in carrying

out the duties described in subsection (b), give priority

to carrying out the duties with respect to Native Americans;

and

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

grant under subsection (a), that—

‘‘(i) the school will establish an arrangement with

1 or more public or nonprofit private institutions of

higher education, including schools of nursing, whose

enrollment of students has traditionally included a

significant number of Native Americans, the purpose

of which arrangement will be to carry out a program—

‘‘(I) to identify Native American students, from

the institutions of higher education referred to

in clause (i), who are interested in health professions careers; and

‘‘(II) to facilitate the educational preparation

of such students to enter the designated health

professions school; and

‘‘(ii) the designated health professions school will

make efforts to recruit Native American students,

including students who have participated in the undergraduate program carried out under arrangements

established by the school pursuant to clause (i) and

will assist Native American students regarding the

completion of the educational requirements for a degree

from the designated health professions school.

‘‘(5) OTHER CENTERS OF EXCELLENCE.—The conditions specified in this paragraph are—

‘‘(A) with respect to other centers of excellence, the

conditions described in clauses (i) through (iv) of paragraph

(1)(B); and
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‘‘(B) that the health professions school involved has

an enrollment of under-represented minorities above the

national average for such enrollments of health professions

schools.

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

‘‘(1) IN GENERAL.—Any designated health professions school

receiving a grant under subsection (a) and meeting the conditions described in paragraph (2) or (5) of subsection (c) shall,

for purposes of this section, be designated by the Secretary

as a Center of Excellence in Under-Represented Minority

Health Professions Education.

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

health professions school receiving a grant under subsection

(a) and meeting the conditions described in subsection (c)(3)

shall, for purposes of this section, be designated by the Secretary as a Hispanic Center of Excellence in Health Professions

Education.

‘‘(3) NATIVE AMERICAN CENTERS OF EXCELLENCE.—Any designated health professions school receiving a grant under subsection (a) and meeting the conditions described in subsection

(c)(4) shall, for purposes of this section, be designated by the

Secretary as a Native American Center of Excellence in Health

Professions Education. Any consortium receiving such a grant

pursuant to subsection (e) shall, for purposes of this section,

be so designated.

‘‘(e) AUTHORITY REGARDING NATIVE AMERICAN CENTERS OF

EXCELLENCE.—With respect to meeting the conditions specified in

subsection (c)(4), the Secretary may make a grant under subsection

(a) to a designated health professions school that does not meet

such conditions if—

‘‘(1) the school has formed a consortium in accordance

with subsection (d)(1); and

‘‘(2) the schools of the consortium collectively meet such

conditions, without regard to whether the schools individually

meet such conditions.

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

are made under a grant under subsection (a) may not exceed

5 years. Such payments shall be subject to annual approval by

the Secretary and to the availability of appropriations for the fiscal

year involved to make the payments.

‘‘(g) DEFINITIONS.—In this section:

‘‘(1) DESIGNATED HEALTH PROFESSIONS SCHOOL.—

‘‘(A) IN GENERAL.—The term ‘health professions school’

means, except as provided in subparagraph (B), a school

of medicine, a school of osteopathic medicine, a school

of dentistry, a school of pharmacy, or a graduate program

in behavioral or mental health.

‘‘(B) EXCEPTION.—The definition established in

subparagraph (A) shall not apply to the use of the term

‘designated health professions school’ for purposes of subsection (c)(2).

‘‘(2) PROGRAM OF EXCELLENCE.—The term ‘program of excellence’ means any program carried out by a designated health

professions school with a grant made under subsection (a),

if the program is for purposes for which the school involved

is authorized in subsection (b) or (c) to expend the grant.
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‘‘(3) NATIVE AMERICANS.—The term ‘Native Americans’

means American Indians, Alaskan Natives, Aleuts, and Native

Hawaiians.

‘‘(h) FUNDING.—

‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose

of making grants under subsection (a), there are authorized

to be appropriated $26,000,000 for fiscal year 1998, and such

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

through 2002.

‘‘(2) ALLOCATIONS.—Based on the amount appropriated

under paragraph (1) for a fiscal year, one of the following

subparagraphs shall apply:

‘‘(A) IN GENERAL.—If the amounts appropriated under

paragraph (1) for a fiscal year are $24,000,000 or less—

‘‘(i) the Secretary shall make available $12,000,000

for grants under subsection (a) to health professions

schools that meet the conditions described in subsection (c)(2)(A); and

‘‘(ii) and available after grants are made with funds

under clause (i), the Secretary shall make available—

‘‘(I) 60 percent of such amount for grants under

subsection (a) to health professions schools that

meet the conditions described in paragraph (3)

or (4) of subsection (c) (including meeting the

conditions under subsection (e)); and

‘‘(II) 40 percent of such amount for grants

under subsection (a) to health professions schools

that meet the conditions described in subsection

(c)(5).

‘‘(B) FUNDING IN EXCESS OF $24,000,000.—If amounts

appropriated under paragraph (1) for a fiscal year exceed

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

‘‘(i) 80 percent of such excess amounts shall be

made available for grants under subsection (a) to

health professions schools that meet the requirements

described in paragraph (3) or (4) of subsection (c)

(including meeting conditions pursuant to subsection

(e)); and

‘‘(ii) 20 percent of such excess amount shall be

made available for grants under subsection (a) to

health professions schools that meet the conditions

described in subsection (c)(5).

‘‘(C) FUNDING IN EXCESS OF $30,000,000.—If amounts

appropriated under paragraph (1) for a fiscal year are

$30,000,000 or more, the Secretary shall make available—

‘‘(i) not less than $12,000,000 for grants under

subsection (a) to health professions schools that meet

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

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

subsection (a) to health professions schools that meet

the conditions described in paragraph (3) or (4) of

subsection (c) (including meeting conditions pursuant

to subsection (e));

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

subsection (a) to health professions schools that meet

the conditions described in subsection (c)(5); and
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‘‘(iv) after grants are made with funds under

clauses (i) through (iii), any remaining funds for grants

under subsection (a) to health professions schools that

meet the conditions described in paragraph (2)(A), (3),

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

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

construed as limiting the centers of excellence referred to in

this section to the designated amount, or to preclude such

entities from competing for other grants under this section.

‘‘(4) MAINTENANCE OF EFFORT.—

‘‘(A) IN GENERAL.—With respect to activities for which

a grant made under this part are authorized to be

expended, the Secretary may not make such a grant to

a center of excellence for any fiscal year unless the center

agrees to maintain expenditures of non-Federal amounts

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

level of such expenditures maintained by the center for

the fiscal year preceding the fiscal year for which the

school receives such a grant.

‘‘(B) USE OF FEDERAL FUNDS.—With respect to any

Federal amounts received by a center of excellence and

available for carrying out activities for which a grant under

this part is authorized to be expended, the Secretary may

not make such a grant to the center for any fiscal year

unless the center agrees that the center will, before expending the grant, expend the Federal amounts obtained from

sources other than the grant.

‘‘SEC. 737. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.

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

eligible entity (as defined in subsection (d)(1)) under this section

for the awarding of scholarships by schools to any full-time student

who is an eligible individual as defined in subsection (d). Such

scholarships may be expended only for tuition expenses, other

reasonable educational expenses, and reasonable living expenses

incurred in the attendance of such school.

‘‘(b) PREFERENCE IN PROVIDING SCHOLARSHIPS.—The Secretary

may not make a grant to an entity under subsection (a) unless

the health professions and nursing schools involved agree that,

in providing scholarships pursuant to the grant, the schools will

give preference to students for whom the costs of attending the

schools would constitute a severe financial hardship and, notwithstanding other provisions of this section, to former recipients of

scholarships under sections 736 and 740(d)(2)(B) (as such sections

existed on the day before the date of enactment of this section).

‘‘(c) AMOUNT OF AWARD.—In awarding grants to eligible entities

that are health professions and nursing schools, the Secretary shall

give priority to eligible entities based on the proportion of graduating students going into primary care, the proportion of underrepresented minority students, and the proportion of graduates working

in medically underserved communities.

‘‘(d) DEFINITIONS.—In this section:

‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible entities’ means

an entity that—

‘‘(A) is a school of medicine, osteopathic medicine, dentistry, nursing (as defined in section 801), pharmacy,

podiatric medicine, optometry, veterinary medicine, public
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health, chiropractic, or allied health, a school offering a

graduate program in behavioral and mental health practice,

or an entity providing programs for the training of physician assistants; and

‘‘(B) is carrying out a program for recruiting and retaining students from disadvantaged backgrounds, including

students who are members of racial and ethnic minority

groups.

‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible individual’

means an individual who—

‘‘(A) is from a disadvantaged background;

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

‘‘(C) is enrolled (or accepted for enrollment) at an

eligible health professions or nursing school as a full-time

student in a program leading to a degree in a health

profession or nursing.

‘‘SEC. 738. LOAN REPAYMENTS AND FELLOWSHIPS REGARDING FACULTY POSITIONS.

‘‘(a) LOAN REPAYMENTS.—

‘‘(1) ESTABLISHMENT OF PROGRAM.—The Secretary shall

establish a program of entering into contracts with individuals

described in paragraph (2) under which the individuals agree

to serve as members of the faculties of schools described in

paragraph (3) in consideration of the Federal Government

agreeing to pay, for each year of such service, not more than

$20,000 of the principal and interest of the educational loans

of such individuals.

‘‘(2) ELIGIBLE INDIVIDUALS.—The individuals referred to in

paragraph (1) are individuals from disadvantaged backgrounds

who—

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

dentistry, nursing, or another health profession;

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

program in medicine, osteopathic medicine, dentistry, nursing, or other health profession; or

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

‘‘(i) in an accredited (as determined by the Secretary) school described in paragraph (3); and

‘‘(ii) in the final year of a course of a study or

program, offered by such institution and approved by

the Secretary, leading to a degree from such a school.

‘‘(3) ELIGIBLE HEALTH PROFESSIONS SCHOOLS.—The schools

described in this paragraph are schools of medicine, nursing

(as schools of nursing are defined in section 801), osteopathic

medicine, dentistry, pharmacy, allied health, podiatric medicine, optometry, veterinary medicine, or public health, or

schools offering graduate programs in behavioral and mental

health.

‘‘(4) REQUIREMENTS REGARDING FACULTY POSITIONS.—The

Secretary may not enter into a contract under paragraph (1)

unless—

‘‘(A) the individual involved has entered into a contract

with a school described in paragraph (3) to serve as a

member of the faculty of the school for not less than 2

years; and
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‘‘(B) the contract referred to in subparagraph (A) provides that—

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

individual will serve as a member of the faculty under

the contract with the school, make payments of the

principal and interest due on the educational loans

of the individual for such year in an amount equal

to the amount of such payments made by the Secretary

for the year;

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

to clause (i) on behalf of the individual will be in

addition to the pay that the individual would otherwise

receive for serving as a member of such faculty; and

‘‘(iii) the school, in making a determination of the

amount of compensation to be provided by the school

to the individual for serving as a member of the faculty,

will make the determination without regard to the

amount of payments made (or to be made) to the

individual by the Federal Government under paragraph (1).

‘‘(5) APPLICABILITY OF CERTAIN PROVISIONS.—The provisions

of sections 338C, 338G, and 338I shall apply to the program

established in paragraph (1) to the same extent and in the

same manner as such provisions apply to the National Health

Service Corps Loan Repayment Program established in subpart

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

regarding reimbursements for increased tax liability and

regarding bankruptcy.

‘‘(6) WAIVER REGARDING SCHOOL CONTRIBUTIONS.—The Secretary may waive the requirement established in paragraph

(4)(B) if the Secretary determines that the requirement will

impose an undue financial hardship on the school involved.

‘‘(b) FELLOWSHIPS.—

‘‘(1) IN GENERAL.—The Secretary may make grants to and

enter into contracts with eligible entities to assist such entities

in increasing the number of underrepresented minority individuals who are members of the faculty of such schools.

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

contract under this subsection, an entity shall provide an assurance, in the application submitted by the entity, that—

‘‘(A) amounts received under such a grant or contract

will be used to award a fellowship to an individual only

if the individual meets the requirements of paragraphs

(3) and (4); and

‘‘(B) each fellowship awarded pursuant to the grant

or contract will include—

‘‘(i) a stipend in an amount not exceeding 50 percent of the regular salary of a similar faculty member

for not to exceed 3 years of training; and

‘‘(ii) an allowance for other expenses, such as travel

to professional meetings and costs related to specialized

training.

‘‘(3) ELIGIBILITY.—To be eligible to receive a grant or contract under paragraph (1), an applicant shall demonstrate to

the Secretary that such applicant has or will have the ability

to—
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‘‘(A) identify, recruit and select underrepresented

minority individuals who have the potential for teaching,

administration, or conducting research at a health professions institution;

‘‘(B) provide such individuals with the skills necessary

to enable them to secure a tenured faculty position at

such institution, which may include training with respect

to pedagogical skills, program administration, the design

and conduct of research, grants writing, and the preparation of articles suitable for publication in peer reviewed

journals;

‘‘(C) provide services designed to assist such individuals

in their preparation for an academic career, including the

provision of counselors; and

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

underserved populations.

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

contract under paragraph (1) an applicant shall—

‘‘(A) provide an assurance that such applicant will

make available (directly through cash donations) $1 for

every $1 of Federal funds received under this section for

the fellowship;

‘‘(B) provide an assurance that institutional support

will be provided for the individual for the second and

third years at a level that is equal to the total amount

of institutional funds provided in the year in which the

grant or contract was awarded;

‘‘(C) provide an assurance that the individual that will

receive the fellowship will be a member of the faculty

of the applicant school; and

‘‘(D) provide an assurance that the individual that

will receive the fellowship will have, at a minimum, appropriate advanced preparation (such as a master’s or doctoral

degree) and special skills necessary to enable such individual to teach and practice.

‘‘(5) DEFINITION.—For purposes of this subsection, the term

‘underrepresented minority individuals’ means individuals who

are members of racial or ethnic minority groups that are underrepresented in the health professions including nursing.

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

REGARDING INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.

‘‘(a) IN GENERAL.—

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

individuals from disadvantaged backgrounds, as determined

in accordance with criteria prescribed by the Secretary, to

undertake education to enter a health profession, the Secretary

may make grants to and enter into contracts with schools

of medicine, osteopathic medicine, public health, dentistry, veterinary medicine, optometry, pharmacy, allied health, chiropractic, and podiatric medicine, public and nonprofit private

schools that offer graduate programs in behavioral and mental

health, programs for the training of physician assistants, and

other public or private nonprofit health or educational entities

to assist in meeting the costs described in paragraph (2).
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‘‘(2) AUTHORIZED EXPENDITURES.—A grant or contract under

paragraph (1) may be used by the entity to meet the cost

of—

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

from disadvantaged backgrounds, as so determined, for

education and training in a health profession;

‘‘(B) facilitating the entry of such individuals into such

a school;

‘‘(C) providing counseling, mentoring, or other services

designed to assist such individuals to complete successfully

their education at such a school;

‘‘(D) providing, for a period prior to the entry of such

individuals into the regular course of education of such

a school, preliminary education and health research training designed to assist them to complete successfully such

regular course of education at such a school, or referring

such individuals to institutions providing such preliminary

education;

‘‘(E) publicizing existing sources of financial aid available to students in the education program of such a school

or who are undertaking training necessary to qualify them

to enroll in such a program;

‘‘(F) paying such scholarships as the Secretary may

determine for such individuals for any period of health

professions education at a health professions school;

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

approve for such individuals for any period of education

in student-enhancement programs (other than regular

courses), except that such a stipend may not be provided

to an individual for more than 12 months, and such a

stipend shall be in an amount determined appropriate by

the Secretary (notwithstanding any other provision of law

regarding the amount of stipends);

‘‘(H) carrying out programs under which such individuals gain experience regarding a career in a field of primary

health care through working at facilities of public or private

nonprofit community-based providers of primary health

services; and

‘‘(I) conducting activities to develop a larger and more

competitive applicant pool through partnerships with

institutions of higher education, school districts, and other

community-based entities.

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

of education of such a school’ as used in subparagraph (D)

includes a graduate program in behavioral or mental health.

‘‘(b) REQUIREMENTS FOR AWARDS.—In making awards to eligible

entities under subsection (a)(1), the Secretary shall give preference

to approved applications for programs that involve a comprehensive

approach by several public or nonprofit private health or educational

entities to establish, enhance and expand educational programs

that will result in the development of a competitive applicant pool

of individuals from disadvantaged backgrounds who desire to pursue

health professions careers. In considering awards for such a comprehensive partnership approach, the following shall apply with

respect to the entity involved:

‘‘(1) The entity shall have a demonstrated commitment

to such approach through formal agreements that have common
S. 1754—13

objectives with institutions of higher education, school districts,

and other community-based entities.

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

of educational activities and support services, increased linkages, and the consolidation of resources within a specific

geographic area.

‘‘(3) The design of the educational activities involved shall

provide for the establishment of a competitive health professions applicant pool of individuals from disadvantaged backgrounds by enhancing the total preparation (academic and

social) of such individuals to pursue a health professions career.

‘‘(4) The programs or activities under the award shall focus

on developing a culturally competent health care workforce

that will serve the unserved and underserved populations

within the geographic area.

‘‘(c) EQUITABLE ALLOCATION OF FINANCIAL ASSISTANCE.—The

Secretary, to the extent practicable, shall ensure that services and

activities under subsection (a) are adequately allocated among the

various racial and ethnic populations who are from disadvantaged

backgrounds.

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

that an entity that applies for a grant or contract under subsection

(a), provide non-Federal matching funds, as appropriate, to ensure

the institutional commitment of the entity to the projects funded

under the grant or contract. As determined by the Secretary, such

non-Federal matching funds may be provided directly or through

donations from public or private entities and may be in cash or

in-kind, fairly evaluated, including plant, equipment, or services.

‘‘SEC. 740. AUTHORIZATION OF APPROPRIATION.

‘‘(a) SCHOLARSHIPS.—There are authorized to be appropriated to carry out section 737, $37,000,000 for fiscal year 1998, and

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

through 2002. Of the amount appropriated in any fiscal year, the

Secretary shall ensure that not less than 16 percent shall be distributed to schools of nursing.

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

of carrying out section 738, there is authorized to be appropriated

$1,100,000 for fiscal year 1998, and such sums as may be necessary

for each of the fiscal years 1999 through 2002.

‘‘(c) EDUCATIONAL ASSISTANCE IN HEALTH PROFESSIONS

REGARDING INDIVIDUALS FOR DISADVANTAGED BACKGROUNDS.—For

the purpose of grants and contracts under section 739(a)(1), there

is authorized to be appropriated $29,400,000 for fiscal year 1998,

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

1999 through 2002. The Secretary may use not to exceed 20 percent

of the amount appropriated for a fiscal year under this subsection

to provide scholarships under section 739(a)(2)(F).

‘‘(d) REPORT.—Not later than 6 months after the date of enactment of this part, the Secretary shall prepare and submit to the

appropriate committees of Congress a report concerning the efforts

of the Secretary to address the need for a representative mix

of individuals from historically minority health professions schools,

or from institutions or other entities that historically or by

geographic location have a demonstrated record of training or

educating underrepresented minorities, within various health

professions disciplines, on peer review councils.’’.
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(b) REPEAL.—

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

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

(2) NONTERMINATION OF AUTHORITY.—The amendments

made by this section shall not be construed to terminate agreements that, on the day before the date of enactment of this

Act, are in effect pursuant to section 795 of the Public Health

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

date. Such agreements shall continue in effect in accordance

with the terms of the agreements. With respect to compliance

with such agreements, any period of practice as a provider

of primary health services shall be counted towards the satisfaction of the requirement of practice pursuant to such section

795.

(c) CONFORMING AMENDMENTS.—Section 481A(c)(3)(D)(i) of the

Public Health Service Act (42 U.S.C. 287a–2(c)(3)(D)(i)) is amended

by striking ‘‘section 739’’ and inserting ‘‘part B of title VII’’.

SEC. 102. TRAINING IN PRIMARY CARE MEDICINE AND DENTISTRY.

Part C of title VII of the Public Health Service Act (42 U.S.C.

293 et seq.) is amended—

(1) in the part heading by striking ‘‘PRIMARY HEALTH

CARE’’ and inserting ‘‘FAMILY MEDICINE, GENERAL

INTERNAL MEDICINE, GENERAL PEDIATRICS, PHYSICIAN ASSISTANTS, GENERAL DENTISTRY, AND PEDIATRIC DENTISTRY’’;

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

(3) in section 747 (42 U.S.C. 293k)—

(A) by striking the section heading and inserting the

following:

‘‘SEC. 747. FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, GENERAL PEDIATRICS, GENERAL DENTISTRY, PEDIATRIC

DENTISTRY, AND PHYSICIAN ASSISTANTS.’’;

(B) in subsection (a)—

(i) in paragraph (1)—

(I) by inserting ‘‘, internal medicine, or pediatrics’’ after ‘‘family medicine’’; and

(II) by inserting before the semicolon the following: ‘‘that emphasizes training for the practice

of family medicine, general internal medicine, or

general pediatrics (as defined by the Secretary)’’;

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

internal medicine, or general pediatrics’’ before the

semicolon;

(iii) in paragraphs (3) and (4), by inserting ‘‘(including geriatrics), general internal medicine or general

pediatrics’’ after ‘‘family medicine’’;

(iv) in paragraph (3), by striking ‘‘and’’ at the

end thereof;

(v) in paragraph (4), by striking the period and

inserting a semicolon; and

(vii) by adding at the end thereof the following

new paragraphs:

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

operate or maintain programs for the training of physician

assistants (as defined in section 799B), and for the training
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of individuals who will teach in programs to provide such

training; and

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

programs, and to provide financial assistance to residents in

such programs, of general dentistry or pediatric dentistry.

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

or contracts shall include entities that have programs in dental

schools, approved residency programs in the general or pediatric

practice of dentistry, approved advanced education programs in

the general or pediatric practice of dentistry, or approved residency

programs in pediatric dentistry.’’;

(C) in subsection (b)—

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

‘‘, general internal medicine, or general pediatrics’’

after ‘‘family medicine’’;

(ii) in paragraph (2)—

(I) in subparagraph (A), by striking ‘‘or’’ at

the end; and

(II) in subparagraph (B), by striking the period

and inserting ‘‘; or’’; and

(iii) by adding at the end the following:

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

grants and contracts under paragraph (1), the Secretary shall

give priority to any qualified applicant for such an award

that proposes a collaborative project between departments of

primary care.’’;

(D) by redesignating subsections (c) and (d) as subsections (d) and (e), respectively;

(E) by inserting after subsection (b), the following new

subsection:

‘‘(c) PRIORITY.— ‘‘(1) IN GENERAL.—With respect to programs for the training

of interns or residents, the Secretary shall give priority in

awarding grants under this section to qualified applicants that

have a record of training the greatest percentage of providers,

or that have demonstrated significant improvements in the

percentage of providers, which enter and remain in primary

care practice or general or pediatric dentistry.

‘‘(2) DISADVANTAGED INDIVIDUALS.—With respect to programs for the training of interns, residents, or physician assistants, the Secretary shall give priority in awarding grants under

this section to qualified applicants that have a record of training

individuals who are from disadvantaged backgrounds (including

racial and ethnic minorities underrepresented among primary

care practice or general or pediatric dentistry).

‘‘(3) SPECIAL CONSIDERATION.—In awarding grants under

this section the Secretary shall give special consideration to

projects which prepare practitioners to care for underserved

populations and other high risk groups such as the elderly,

individuals with HIV-AIDS, substance abusers, homeless, and

victims of domestic violence.’’; and

(F) in subsection (e) (as so redesignated by subparagraph (D))—

(i) in paragraph (1), by striking ‘‘$54,000,000’’ and

all that follows and inserting ‘‘$78,300,000 for fiscal

year 1998, and such sums as may be necessary for

each of the fiscal years 1999 through 2002.’’; and
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(ii) by striking paragraph (2) and inserting the

following:

‘‘(2) ALLOCATION.—

‘‘(A) IN GENERAL.—Of the amounts appropriated under

paragraph (1) for a fiscal year, the Secretary shall make

available—

‘‘(i) not less than $49,300,000 for awards of grants

and contracts under subsection (a) to programs of family medicine, of which not less than $8,600,000 shall

be made available for awards of grants and contracts

under subsection (b) for family medicine academic

administrative units;

‘‘(ii) not less than $17,700,000 for awards of grants

and contracts under subsection (a) to programs of general internal medicine and general pediatrics;

‘‘(iii) not less than $6,800,000 for awards of grants

and contracts under subsection (a) to programs relating

to physician assistants; and

‘‘(iv) not less than $4,500,000 for awards of grants

and contracts under subsection (a) to programs of general or pediatric dentistry.

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

under paragraph (1) for any fiscal year are less than the

amount required to comply with subparagraph (A), the

Secretary shall ratably reduce the amount to be made

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

subparagraph accordingly.’’; and

(4) by repealing sections 748 through 752 (42 U.S.C. 293l

through 293p) and inserting the following:

‘‘SEC. 748. ADVISORY COMMITTEE ON TRAINING IN PRIMARY CARE

MEDICINE AND DENTISTRY.

‘‘(a) ESTABLISHMENT.—The Secretary shall establish an advisory

committee to be known as the Advisory Committee on Training

in Primary Care Medicine and Dentistry (in this section referred

to as the ‘Advisory Committee’).

‘‘(b) COMPOSITION.— ‘‘(1) IN GENERAL.—The Secretary shall determine the appropriate number of individuals to serve on the Advisory Committee. Such individuals shall not be officers or employees of the

Federal Government.

‘‘(2) APPOINTMENT.—Not later than 90 days after the date

of enactment of this Act, the Secretary shall appoint the members of the Advisory Committee from among individuals who

are health professionals. In making such appointments, the

Secretary shall ensure a fair balance between the health professions, that at least 75 percent of the members of the Advisory

Committee are health professionals, a broad geographic representation of members and a balance between urban and

rural members. Members shall be appointed based on their

competence, interest, and knowledge of the mission of the

profession involved.

‘‘(3) MINORITY REPRESENTATION.—In appointing the members of the Advisory Committee under paragraph (2), the Secretary shall ensure the adequate representation of women and

minorities.

‘‘(c) TERMS.—
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‘‘(1) IN GENERAL.—A member of the Advisory Committee

shall be appointed for a term of 3 years, except that of the

members first appointed—

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

1 year;

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

2 years; and

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

3 years.

‘‘(2) VACANCIES.—

‘‘(A) IN GENERAL.—A vacancy on the Advisory Committee shall be filled in the manner in which the original

appointment was made and shall be subject to any conditions which applied with respect to the original appointment.

‘‘(B) FILLING UNEXPIRED TERM.—An individual chosen

to fill a vacancy shall be appointed for the unexpired term

of the member replaced.

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

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

concerning policy and program development and other matters

of significance concerning the activities under section 747; and

‘‘(2) not later than 3 years after the date of enactment

of this section, and annually thereafter, prepare and submit

to the Secretary, and the Committee on Labor and Human

Resources of the Senate, and the Committee on Commerce

of the House of Representatives, a report describing the activities of the Committee, including findings and recommendations

made by the Committee concerning the activities under section

747.

‘‘(e) MEETINGS AND DOCUMENTS.— ‘‘(1) MEETINGS.—The Advisory Committee shall meet not

less than 2 times each year. Such meetings shall be held

jointly with other related entities established under this title

where appropriate.

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

convening of a meeting under paragraph (1), the Advisory

Committee shall prepare and make available an agenda of

the matters to be considered by the Advisory Committee at

such meeting. At any such meeting, the Advisory Council shall

distribute materials with respect to the issues to be addressed

at the meeting. Not later than 30 days after the adjourning

of such a meeting, the Advisory Committee shall prepare and

make available a summary of the meeting and any actions

taken by the Committee based upon the meeting.

‘‘(f) COMPENSATION AND EXPENSES.—

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

Committee shall be compensated at a rate equal to the daily

equivalent of the annual rate of basic pay prescribed for level

IV of the Executive Schedule under section 5315 of title 5,

United States Code, for each day (including travel time) during

which such member is engaged in the performance of the duties

of the Committee.

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

shall be allowed travel expenses, including per diem in lieu

of subsistence, at rates authorized for employees of agencies

under subchapter I of chapter 57 of title 5, United States
S. 1754—18

Code, while away from their homes or regular places of business

in the performance of services for the Committee.

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

to the Advisory Committee under this section only to the extent

that the provisions of such Act do not conflict with the requirements

of this section.’’.

SEC. 103. INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES.

Part D of title VII of the Public Health Service Act (42 U.S.C.

294 et seq.) is amended to read as follows:

‘‘PART D—INTERDISCIPLINARY, COMMUNITYBASED LINKAGES

‘‘SEC. 750. GENERAL PROVISIONS.

‘‘(a) COLLABORATION.—To be eligible to receive assistance under

this part, an academic institution shall use such assistance in

collaboration with 2 or more disciplines.

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

to carry out innovative demonstration projects for strategic

workforce supplementation activities as needed to meet national

goals for interdisciplinary, community-based linkages. Such assistance may be used consistent with this part—

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

‘‘(2) for faculty development;

‘‘(3) for model demonstration programs;

‘‘(4) for the provision of stipends for fellowship trainees;

‘‘(5) to provide technical assistance; and

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

‘‘SEC. 751. AREA HEALTH EDUCATION CENTERS.

‘‘(a) AUTHORITY FOR PROVISION OF FINANCIAL ASSISTANCE.— ‘‘(1) ASSISTANCE FOR PLANNING, DEVELOPMENT, AND OPER- ATION OF PROGRAMS.— ‘‘(A) IN GENERAL.—The Secretary shall award grants

to and enter into contracts with schools of medicine and

osteopathic medicine, and incorporated consortia made up

of such schools, or the parent institutions of such schools,

for projects for the planning, development and operation

of area health education center programs that—

‘‘(i) improve the recruitment, distribution, supply,

quality and efficiency of personnel providing health

services in underserved rural and urban areas and

personnel providing health services to populations having demonstrated serious unmet health care needs;

‘‘(ii) increase the number of primary care physicians and other primary care providers who provide

services in underserved areas through the offering of

an educational continuum of health career recruitment

through clinical education concerning underserved

areas in a comprehensive health workforce strategy;

‘‘(iii) carry out recruitment and health career

awareness programs to recruit individuals from underserved areas and under-represented populations,

including minority and other elementary or secondary

students, into the health professions;
S. 1754—19

‘‘(iv) prepare individuals to more effectively provide

health services to underserved areas or underserved

populations through field placements, preceptorships,

the conduct of or support of community-based primary

care residency programs, and agreements with community-based organizations such as community health

centers, migrant health centers, Indian health centers,

public health departments and others;

‘‘(v) conduct health professions education and

training activities for students of health professions

schools and medical residents;

‘‘(vi) conduct at least 10 percent of medical student

required clinical education at sites remote to the primary teaching facility of the contracting institution;

and

‘‘(vii) provide information dissemination and educational support to reduce professional isolation,

increase retention, enhance the practice environment,

and improve health care through the timely dissemination of research findings using relevant resources.

‘‘(B) OTHER ELIGIBLE ENTITIES.—With respect to a State

in which no area health education center program is in

operation, the Secretary may award a grant or contract

under subparagraph (A) to a school of nursing.

‘‘(C) PROJECT TERMS.—

‘‘(i) IN GENERAL.—Except as provided in clause

(ii), the period during which payments may be made

under an award under subparagraph (A) may not

exceed—

‘‘(I) in the case of a project, 12 years or

‘‘(II) in the case of a center within a project,

6 years.

‘‘(ii) EXCEPTION.—The periods described in clause

(i) shall not apply to projects that have completed

the initial period of Federal funding under this section

and that desire to compete for model awards under

paragraph (2)(A).

‘‘(2) ASSISTANCE FOR OPERATION OF MODEL PROGRAMS.—

‘‘(A) IN GENERAL.—In the case of any entity described

in paragraph (1)(A) that—

‘‘(i) has previously received funds under this section;

‘‘(ii) is operating an area health education center

program; and

‘‘(iii) is no longer receiving financial assistance

under paragraph (1);

the Secretary may provide financial assistance to such

entity to pay the costs of operating and carrying out the

requirements of the program as described in paragraph

(1).

‘‘(B) MATCHING REQUIREMENT.—With respect to the

costs of operating a model program under subparagraph

(A), an entity, to be eligible for financial assistance under

subparagraph (A), shall make available (directly or through

contributions from State, county or municipal governments,

or the private sector) recurring non-Federal contributions
S. 1754—20

in cash toward such costs in an amount that is equal

to not less than 50 percent of such costs.

‘‘(C) LIMITATION.—The aggregate amount of awards

provided under subparagraph (A) to entities in a State

for a fiscal year may not exceed the lesser of—

‘‘(i) $2,000,000; or

‘‘(ii) an amount equal to the product of $250,000

and the aggregate number of area health education

centers operated in the State by such entities.

‘‘(b) REQUIREMENTS FOR CENTERS.—

‘‘(1) GENERAL REQUIREMENT.—Each area health education

center that receives funds under this section shall encourage

the regionalization of health professions schools through the

establishment of partnerships with community-based organizations.

‘‘(2) SERVICE AREA.—Each area health education center that

receives funds under this section shall specifically designate

a geographic area or medically underserved population to be

served by the center. Such area or population shall be in

a location removed from the main location of the teaching

facilities of the schools participating in the program with such

center.

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

center that receives funds under this section shall—

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

to be served by the center and assist in the planning

and development of training programs to meet such needs;

‘‘(B) arrange and support rotations for students and

residents in family medicine, general internal medicine

or general pediatrics, with at least one center in each

program being affiliated with or conducting a rotating

osteopathic internship or medical residency training program in family medicine (including geriatrics), general

internal medicine (including geriatrics), or general pediatrics in which no fewer than 4 individuals are enrolled

in first-year positions;

‘‘(C) conduct and participate in interdisciplinary training that involves physicians and other health personnel

including, where practicable, public health professionals,

physician assistants, nurse practitioners, nurse midwives,

and behavioral and mental health providers; and

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

the members of which shall be individuals, including both

health service providers and consumers, from the area

served by the center.

‘‘(c) CERTAIN PROVISIONS REGARDING FUNDING.—

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

of the total amount of Federal funds provided to an entity

under this section shall be allocated by an area health education

center program to the area health education center. Such entity

shall enter into an agreement with each center for purposes

of specifying the allocation of such 75 percent of funds.

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

of the area health education center program of an entity receiving funds under this section, the entity shall make available
S. 1754—21

(directly or through contributions from State, county or municipal governments, or the private sector) non-Federal contributions in cash toward such costs in an amount that is equal

to not less than 50 percent of such costs, except that the

Secretary may grant a waiver for up to 75 percent of the

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

in which an entity receives funds under this section.

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

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

a health education training center shall be an entity otherwise

eligible for funds under section 751 that—

‘‘(1) addresses the persistent and severe unmet health care

needs in States along the border between the United States

and Mexico and in the State of Florida, and in other urban

and rural areas with populations with serious unmet health

care needs;

‘‘(2) establishes an advisory board comprised of health service providers, educators and consumers from the service area;

‘‘(3) conducts training and education programs for health

professions students in these areas;

‘‘(4) conducts training in health education services, including training to prepare community health workers; and

‘‘(5) supports health professionals (including nursing)

practicing in the area through educational and other services.

‘‘(b) ALLOCATION OF FUNDS.—The Secretary shall make available 50 percent of the amounts appropriated for each fiscal year

under section 752 for the establishment or operation of health

education training centers through projects in States along the

border between the United States and Mexico and in the State

of Florida.

‘‘SEC. 753. EDUCATION AND TRAINING RELATING TO GERIATRICS.

‘‘(a) GERIATRIC EDUCATION CENTERS.— ‘‘(1) IN GENERAL.—The Secretary shall award grants or

contracts under this section to entities described in paragraphs

(1), (3), or (4) of section 799B, and section 853(2), for the

establishment or operation of geriatric education centers.

‘‘(2) REQUIREMENTS.—A geriatric education center is a program that—

‘‘(A) improves the training of health professionals in

geriatrics, including geriatric residencies, traineeships, or

fellowships;

‘‘(B) develops and disseminates curricula relating to

the treatment of the health problems of elderly individuals;

‘‘(C) supports the training and retraining of faculty

to provide instruction in geriatrics;

‘‘(D) supports continuing education of health professionals who provide geriatric care; and

‘‘(E) provides students with clinical training in geriatrics in nursing homes, chronic and acute disease hospitals, ambulatory care centers, and senior centers.

‘‘(b) GERIATRIC TRAINING REGARDING PHYSICIANS AND DENTISTS.—

‘‘(1) IN GENERAL.—The Secretary may make grants to, and

enter into contracts with, schools of medicine, schools of osteopathic medicine, teaching hospitals, and graduate medical education programs, for the purpose of providing support (including
S. 1754—22

residencies, traineeships, and fellowships) for geriatric training

projects to train physicians, dentists and behavioral and mental

health professionals who plan to teach geriatric medicine, geriatric behavioral or mental health, or geriatric dentistry.

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

contract is made under this subsection shall—

‘‘(A) be staffed by full-time teaching physicians who

have experience or training in geriatric medicine or geriatric behavioral or mental health;

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

institution staffed by full-time or part-time teaching dentists who have experience or training in geriatric dentistry;

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

institution staffed by full-time or part-time teaching behavioral mental health professionals who have experience or

training in geriatric behavioral or mental health;

‘‘(D) be based in a graduate medical education program

in internal medicine or family medicine or in a department

of geriatrics or behavioral or mental health;

‘‘(E) provide training in geriatrics and exposure to the

physical and mental disabilities of elderly individuals

through a variety of service rotations, such as geriatric

consultation services, acute care services, dental services,

geriatric behavioral or mental health units, day and home

care programs, rehabilitation services, extended care facilities, geriatric ambulatory care and comprehensive evaluation units, and community care programs for elderly mentally retarded individuals; and

‘‘(F) provide training in geriatrics through one or both

of the training options described in subparagraphs (A) and

(B) of paragraph (3).

‘‘(3) TRAINING OPTIONS.—The training options referred to

in subparagraph (F) of paragraph (2) shall be as follows:

‘‘(A) A 1-year retraining program in geriatrics for—

‘‘(i) physicians who are faculty members in departments of internal medicine, family medicine, gynecology, geriatrics, and behavioral or mental health at

schools of medicine and osteopathic medicine;

‘‘(ii) dentists who are faculty members at schools

of dentistry or at hospital departments of dentistry;

and

‘‘(iii) behavioral or mental health professionals who

are faculty members in departments of behavioral or

mental health; and

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

fellowship program providing emphasis in geriatrics, which

shall be designed to provide training in clinical geriatrics

and geriatrics research for—

‘‘(i) physicians who have completed graduate medical education programs in internal medicine, family

medicine, behavioral or mental health, neurology, gynecology, or rehabilitation medicine;

‘‘(ii) dentists who have demonstrated a commitment to an academic career and who have completed

postdoctoral dental training, including postdoctoral

dental education programs or who have relevant

advanced training or experience; and
S. 1754—23

‘‘(iii) behavioral or mental health professionals who

have completed graduate medical education programs

in behavioral or mental health.

‘‘(4) DEFINITIONS.—For purposes of this subsection:

‘‘(A) The term ‘graduate medical education program’

means a program sponsored by a school of medicine, a

school of osteopathic medicine, a hospital, or a public or

private institution that—

‘‘(i) offers postgraduate medical training in the

specialties and subspecialties of medicine; and

‘‘(ii) has been accredited by the Accreditation Council for Graduate Medical Education or the American

Osteopathic Association through its Committee on

Postdoctoral Training.

‘‘(B) The term ‘post-doctoral dental education program’

means a program sponsored by a school of dentistry, a

hospital, or a public or private institution that—

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

of dentistry, advanced education in general dentistry,

or a dental general practice residency; and

‘‘(ii) has been accredited by the Commission on

Dental Accreditation.

‘‘(c) GERIATRIC FACULTY FELLOWSHIPS.—

‘‘(1) ESTABLISHMENT OF PROGRAM.—The Secretary shall

establish a program to provide Geriatric Academic Career

Awards to eligible individuals to promote the career development of such individuals as academic geriatricians.

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

Award under paragraph (1), an individual shall—

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

medicine, family practice, or psychiatry;

‘‘(B) have completed an approved fellowship program

in geriatrics; and

‘‘(C) have a junior faculty appointment at an accredited

(as determined by the Secretary) school of medicine or

osteopathic medicine.

‘‘(3) LIMITATIONS.—No Award under paragraph (1) may

be made to an eligible individual unless the individual—

‘‘(A) has submitted to the Secretary an application,

at such time, in such manner, and containing such information as the Secretary may require, and the Secretary has

approved such application; and

‘‘(B) provides, in such form and manner as the Secretary may require, assurances that the individual will

meet the service requirement described in subsection (e).

‘‘(4) AMOUNT AND TERM.—

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

section shall equal $50,000 for fiscal year 1998, adjusted

for subsequent fiscal years to reflect the increase in the

Consumer Price Index.

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

subsection shall not exceed 5 years.

‘‘(5) SERVICE REQUIREMENT.—An individual who receives

an Award under this subsection shall provide training in clinical

geriatrics, including the training of interdisciplinary teams of

health care professionals. The provision of such training shall
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constitute at least 75 percent of the obligations of such individual under the Award.

‘‘SEC. 754. QUENTIN N. BURDICK PROGRAM FOR RURAL INTERDISCIPLINARY TRAINING.

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

under this section to help entities fund authorized activities under

an application approved under subsection (c).

‘‘(b) USE OF AMOUNTS.—

‘‘(1) IN GENERAL.—Amounts provided under subsection (a)

shall be used by the recipients to fund interdisciplinary training

projects designed to—

‘‘(A) use new and innovative methods to train health

care practitioners to provide services in rural areas;

‘‘(B) demonstrate and evaluate innovative interdisciplinary methods and models designed to provide access to

cost-effective comprehensive health care;

‘‘(C) deliver health care services to individuals residing

in rural areas;

‘‘(D) enhance the amount of relevant research conducted concerning health care issues in rural areas; and

‘‘(E) increase the recruitment and retention of health

care practitioners from rural areas and make rural practice

a more attractive career choice for health care practitioners.

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

may use various methods in carrying out the projects described

in paragraph (1), including—

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

applicants;

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

program;

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

logistical problems confronting rural health care delivery

systems; or

‘‘(D) the purchase or rental of transportation and telecommunication equipment where the need for such equipment due to unique characteristics of the rural area is

demonstrated by the recipient.

‘‘(3) ADMINISTRATION.—

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

than 10 percent of the funds made available to such

applicant under subsection (a) for administrative expenses.

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

individuals receiving training with funds made available

to an applicant under subsection (a) shall be trained as

doctors of medicine or doctors of osteopathy.

‘‘(C) LIMITATION.—An institution that receives a grant

under this section shall use amounts received under such

grant to supplement, not supplant, amounts made available

by such institution for activities of the type described in

subsection (b)(1) in the fiscal year preceding the year for

which the grant is received.

‘‘(c) APPLICATIONS.—Applications submitted for assistance

under this section shall—

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

with the express purpose of assisting individuals in academic
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institutions in establishing long-term collaborative relationships

with health care providers in rural areas; and

‘‘(2) designate a rural health care agency or agencies for

clinical treatment or training, including hospitals, community

health centers, migrant health centers, rural health clinics,

community behavioral and mental health centers, long-term

care facilities, Native Hawaiian health centers, or facilities

operated by the Indian Health Service or an Indian tribe or

tribal organization or Indian organization under a contract

with the Indian Health Service under the Indian Self-Determination Act.

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

‘rural’ means geographic areas that are located outside of standard

metropolitan statistical areas.

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

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

under this section to help entities fund activities of the type

described in subsection (b).

‘‘(b) ACTIVITIES.—Activities of the type described in this subsection include the following:

‘‘(1) Assisting entities in meeting the costs associated with

expanding or establishing programs that will increase the number of individuals trained in allied health professions. Programs

and activities funded under this paragraph may include—

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

professions with the greatest shortages or whose services

are most needed by the elderly;

‘‘(B) those that provide rapid transition training programs in allied health fields to individuals who have baccalaureate degrees in health-related sciences;

‘‘(C) those that establish community-based allied health

training programs that link academic centers to rural clinical settings;

‘‘(D) those that provide career advancement training

for practicing allied health professionals;

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

sites for allied health professionals in medically underserved or rural communities in order to increase the number of individuals trained;

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

knowledge and practice in the areas of prevention and

health promotion, geriatrics, long-term care, home health

and hospice care, and ethics;

‘‘(G) those that expand or establish interdisciplinary

training programs that promote the effectiveness of allied

health practitioners in geriatric assessment and the

rehabilitation of the elderly;

‘‘(H) those that expand or establish demonstration centers to emphasize innovative models to link allied health

clinical practice, education, and research;

‘‘(I) those that provide financial assistance (in the form

of traineeships) to students who are participants in any

such program; and

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

field that has a demonstrated personnel shortage; and
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‘‘(ii) who agree upon completion of the training

program to practice in a medically underserved community;

that shall be utilized to assist in the payment of all or

part of the costs associated with tuition, fees and such

other stipends as the Secretary may consider necessary;

and

‘‘(J) those to meet the costs of projects to plan, develop,

and operate or maintain graduate programs in behavioral

and mental health practice.

‘‘(2) Planning and implementing projects in preventive and

primary care training for podiatric physicians in approved or

provisionally approved residency programs that shall provide

financial assistance in the form of traineeships to residents

who participate in such projects and who plan to specialize

in primary care.

‘‘(3) Carrying out demonstration projects in which chiropractors and physicians collaborate to identify and provide effective treatment for spinal and lower-back conditions.

‘‘SEC. 756. ADVISORY COMMITTEE ON INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES.

‘‘(a) ESTABLISHMENT.—The Secretary shall establish an advisory

committee to be known as the Advisory Committee on Interdisciplinary, Community-Based Linkages (in this section referred to as

the ‘Advisory Committee’).

‘‘(b) COMPOSITION.—

‘‘(1) IN GENERAL.—The Secretary shall determine the appropriate number of individuals to serve on the Advisory Committee. Such individuals shall not be officers or employees of the

Federal Government.

‘‘(2) APPOINTMENT.—Not later than 90 days after the date

of enactment of this Act, the Secretary shall appoint the members of the Advisory Committee from among individuals who

are health professionals from schools of the types described

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

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

ensure a fair balance between the health professions, that

at least 75 percent of the members of the Advisory Committee

are health professionals, a broad geographic representation of

members and a balance between urban and rural members.

Members shall be appointed based on their competence,

interest, and knowledge of the mission of the profession

involved.

‘‘(3) MINORITY REPRESENTATION.—In appointing the members of the Advisory Committee under paragraph (2), the Secretary shall ensure the adequate representation of women and

minorities.

‘‘(c) TERMS.—

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

shall be appointed for a term of 3 years, except that of the

members first appointed—

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

year;

‘‘(B) 1⁄3 of the members shall serve for a term of 2

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

years.

‘‘(2) VACANCIES.—

‘‘(A) IN GENERAL.—A vacancy on the Advisory Committee shall be filled in the manner in which the original

appointment was made and shall be subject to any conditions which applied with respect to the original appointment.

‘‘(B) FILLING UNEXPIRED TERM.—An individual chosen

to fill a vacancy shall be appointed for the unexpired term

of the member replaced.

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

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

concerning policy and program development and other matters

of significance concerning the activities under this part; and

‘‘(2) not later than 3 years after the date of enactment

of this section, and annually thereafter, prepare and submit

to the Secretary, and the Committee on Labor and Human

Resources of the Senate, and the Committee on Commerce

of the House of Representatives, a report describing the activities of the Committee, including findings and recommendations

made by the Committee concerning the activities under this

part.

‘‘(e) MEETINGS AND DOCUMENTS.—

‘‘(1) MEETINGS.—The Advisory Committee shall meet not

less than 3 times each year. Such meetings shall be held

jointly with other related entities established under this title

where appropriate.

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

convening of a meeting under paragraph (1), the Advisory

Committee shall prepare and make available an agenda of

the matters to be considered by the Advisory Committee at

such meeting. At any such meeting, the Advisory Council shall

distribute materials with respect to the issues to be addressed

at the meeting. Not later than 30 days after the adjourning

of such a meeting, the Advisory Committee shall prepare and

make available a summary of the meeting and any actions

taken by the Committee based upon the meeting.

‘‘(f) COMPENSATION AND EXPENSES.—

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

Committee shall be compensated at a rate equal to the daily

equivalent of the annual rate of basic pay prescribed for level

IV of the Executive Schedule under section 5315 of title 5,

United States Code, for each day (including travel time) during

which such member is engaged in the performance of the duties

of the Committee.

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

shall be allowed travel expenses, including per diem in lieu

of subsistence, at rates authorized for employees of agencies

under subchapter I of chapter 57 of title 5, United States

Code, while away from their homes or regular places of business

in the performance of services for the Committee.

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

to the Advisory Committee under this section only to the extent

that the provisions of such Act do not conflict with the requirements

of this section.
S. 1754—28

‘‘SEC. 757. AUTHORIZATION OF APPROPRIATIONS.

‘‘(a) IN GENERAL.—There are authorized to be appropriated

to carry out this part, $55,600,000 for fiscal year 1998, and such

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

2002.

‘‘(b) ALLOCATION.—

‘‘(1) IN GENERAL.—Of the amounts appropriated under subsection (a) for a fiscal year, the Secretary shall make available—

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

and contracts under section 751;

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

and contracts under section 752, of which not less than

50 percent of such amount shall be made available for

centers described in subsection (a)(1) of such section; and

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

and contracts under sections 753, 754, and 755.

‘‘(2) RATABLE REDUCTION.—If amounts appropriated under

subsection (a) for any fiscal year are less than the amount

required to comply with paragraph (1), the Secretary shall

ratably reduce the amount to be made available under each

of subparagraphs (A) through (C) of such paragraph accordingly.

‘‘(3) INCREASE IN AMOUNTS.—If amounts appropriated for

a fiscal year under subsection (a) exceed the amount authorized

under such subsection for such fiscal year, the Secretary may

increase the amount to be made available for programs and

activities under this part without regard to the amounts specified in each of subparagraphs (A) through (C) of paragraph

(2).

‘‘(c) OBLIGATION OF CERTAIN AMOUNTS.—

‘‘(1) AREA HEALTH EDUCATION CENTER PROGRAMS.—Of the

amounts made available under subsection (b)(1)(A) for each

fiscal year, the Secretary may obligate for awards under section

751(a)(2)—

‘‘(A) not less than 23 percent of such amounts in fiscal

year 1998;

‘‘(B) not less than 30 percent of such amounts in fiscal

year 1999;

‘‘(C) not less than 35 percent of such amounts in fiscal

year 2000;

‘‘(D) not less than 40 percent of such amounts in fiscal

year 2001; and

‘‘(E) not less than 45 percent of such amounts in fiscal

year 2002.

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

that—

‘‘(A) every State have an area health education center

program in effect under this section; and

‘‘(B) the ratio of Federal funding for the model program

under section 751(a)(2) should increase over time and that

Federal funding for other awards under this section shall

decrease so that the national program will become entirely

comprised of programs that are funded at least 50 percent

by State and local partners.’’.
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SEC. 104. HEALTH PROFESSIONS WORKFORCE INFORMATION AND

ANALYSIS.

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

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

‘‘PART E—HEALTH PROFESSIONS AND PUBLIC

HEALTH WORKFORCE

‘‘Subpart 1—Health Professions Workforce

Information and Analysis

‘‘SEC. 761. HEALTH PROFESSIONS WORKFORCE INFORMATION AND

ANALYSIS.

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

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

the health professions workforce and the analysis of workforce

related issues; and

‘‘(2) provide necessary information for decision-making

regarding future directions in health professions and nursing

programs in response to societal and professional needs.

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

or contracts to State or local governments, health professions

schools, schools of nursing, academic health centers, communitybased health facilities, and other appropriate public or private

nonprofit entities to provide for—

‘‘(1) targeted information collection and analysis activities

related to the purposes described in subsection (a);

‘‘(2) research on high priority workforce questions;

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

infrastructure related to the purposes described in subsection

(a); and

‘‘(4) the conduct of program evaluation and assessment.

‘‘(c) AUTHORIZATION OF APPROPRIATIONS.— ‘‘(1) IN GENERAL.—There are authorized to be appropriated to carry out this section, $750,000 for fiscal year 1998, and

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

1999 through 2002.

‘‘(2) RESERVATION.—Of the amounts appropriated under

subsection (a) for a fiscal year, the Secretary shall reserve

not less than $600,000 for conducting health professions

research and for carrying out data collection and analysis in

accordance with section 792.

‘‘(3) AVAILABILITY OF ADDITIONAL FUNDS.—Amounts otherwise appropriated for programs or activities under this title

may be used for activities under subsection (b) with respect

to the programs or activities from which such amounts were

made available.’’.

(b) COUNCIL ON GRADUATE MEDICAL EDUCATION.—Section 301

of the Health Professions Education Extension Amendments of 1992

(Public Law 102–408) is amended—

(1) in subsection (j), by striking ‘‘1995’’ and inserting ‘‘2002’’;

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

‘‘2002’’;

(3) by adding at the end thereof the following new subsection:
S. 1754—30

‘‘(l) FUNDING.—Amounts otherwise appropriated under this title

may be utilized by the Secretary to support the activities of the

Council.’’;

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

the Public Health Service Act (as amended by subsection (a));

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

(6) by inserting such section after section 761.

SEC. 105. PUBLIC HEALTH WORKFORCE DEVELOPMENT.

Part E of title VII of the Public Health Service Act (as amended

by section 104) is further amended by adding at the end the following:

‘‘Subpart 2—Public Health Workforce

‘‘SEC. 765. GENERAL PROVISIONS.

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

to eligible entities to increase the number of individuals in the

public health workforce, to enhance the quality of such workforce,

and to enhance the ability of the workforce to meet national, State,

and local health care needs.

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

under subsection (a) an entity shall—

‘‘(1) be—

‘‘(A) a health professions school, including an accredited

school or program of public health, health administration,

preventive medicine, or dental public health or a school

providing health management programs;

‘‘(B) an academic health center;

‘‘(C) a State or local government; or

‘‘(D) any other appropriate public or private nonprofit

entity; and

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

at such time, in such manner, and containing such information

as the Secretary may require.

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

section the Secretary may grant a preference to entities—

‘‘(1) serving individuals who are from disadvantaged backgrounds (including underrepresented racial and ethnic minorities); and

‘‘(2) graduating large proportions of individuals who serve

in underserved communities.

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

awarded under this section may be used for—

‘‘(1) the costs of planning, developing, or operating demonstration training programs;

‘‘(2) faculty development;

‘‘(3) trainee support;

‘‘(4) technical assistance;

‘‘(5) to meet the costs of projects—

‘‘(A) to plan and develop new residency training programs and to maintain or improve existing residency training programs in preventive medicine and dental public

health, that have available full-time faculty members with

training and experience in the fields of preventive medicine

and dental public health; and
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‘‘(B) to provide financial assistance to residency trainees enrolled in such programs;

‘‘(6) the retraining of existing public health workers as

well as for increasing the supply of new practitioners to address

priority public health, preventive medicine, public health dentistry, and health administration needs;

‘‘(7) preparing public health professionals for employment

at the State and community levels; or

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

consistent with the purposes of this section.

‘‘(e) TRAINEESHIPS.—

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

this section for the training of health professionals, such training programs shall be designed to—

‘‘(A) make public health education more accessible to

the public and private health workforce;

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

preparation to public health practice in the future;

‘‘(C) provide education or training for students from

traditional on-campus programs in practice-based sites; or

‘‘(D) develop educational methods and distance-based

approaches or technology that address adult learning

requirements and increase knowledge and skills related

to community-based cultural diversity in public health education.

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

under grants or contracts under this section may be used for

the operation of programs designed to award traineeships to

students in accredited schools of public health who enter educational programs in fields where there is a severe shortage

of public health professionals, including epidemiology, biostatistics, environmental health, toxicology, public health nursing,

nutrition, preventive medicine, maternal and child health, and

behavioral and mental health professions.

‘‘SEC. 766. PUBLIC HEALTH TRAINING CENTERS.

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

for the operation of public health training centers.

‘‘(b) ELIGIBLE ENTITIES.— ‘‘(1) IN GENERAL.—A public health training center shall

be an accredited school of public health, or another public

or nonprofit private institution accredited for the provision

of graduate or specialized training in public health, that plans,

develops, operates, and evaluates projects that are in furtherance of the goals established by the Secretary for the year

2000 in the areas of preventive medicine, health promotion

and disease prevention, or improving access to and quality

of health services in medically underserved communities.

‘‘(2) PREFERENCE.—In awarding grants or contracts under

this section the Secretary shall give preference to accredited

schools of public health.

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

training center, an award may not be made under subsection (a)

unless the program agrees that it—

‘‘(1) will establish or strengthen field placements for students in public or nonprofit private health agencies or organizations;
S. 1754—32

‘‘(2) will involve faculty members and students in collaborative projects to enhance public health services to medically

underserved communities;

‘‘(3) will specifically designate a geographic area or medically underserved population to be served by the center that

shall be in a location removed from the main location of the

teaching facility of the school that is participating in the program with such center; and

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

to be served by the center and assist in the planning and

development of training programs to meet such needs.

‘‘SEC. 767. PUBLIC HEALTH TRAINEESHIPS.

‘‘(a) IN GENERAL.—The Secretary may make grants to accredited schools of public health, and to other public or nonprofit private

institutions accredited for the provision of graduate or specialized

training in public health, for the purpose of assisting such schools

and institutions in providing traineeships to individuals described

in subsection (b)(3).

‘‘(b) CERTAIN REQUIREMENTS.— ‘‘(1) AMOUNT.—The amount of any grant under this section

shall be determined by the Secretary.

‘‘(2) USE OF GRANT.—Traineeships awarded under grants

made under subsection (a) shall provide for tuition and fees

and such stipends and allowances (including travel and subsistence expenses and dependency allowances) for the trainees

as the Secretary may deem necessary.

‘‘(3) ELIGIBLE INDIVIDUALS.—The individuals referred to in

subsection (a) are individuals who are pursuing a course of

study in a health professions field in which there is a severe

shortage of health professionals (which fields include the fields

of epidemiology, environmental health, biostatistics, toxicology,

nutrition, and maternal and child health).

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

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

enter into contracts with schools of medicine, osteopathic medicine,

public health, and dentistry to meet the costs of projects—

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

and to maintain or improve existing residency training programs in preventive medicine and dental public health; and

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

enrolled in such programs.

‘‘(b) ADMINISTRATION.— ‘‘(1) AMOUNT.—The amount of any grant under subsection

(a) shall be determined by the Secretary.

‘‘(2) ELIGIBILITY.—To be eligible for a grant under subsection (a), the applicant must demonstrate to the Secretary

that it has or will have available full-time faculty members

with training and experience in the fields of preventive medicine or dental public health and support from other faculty

members trained in public health and other relevant specialties

and disciplines.

‘‘(3) OTHER FUNDS.—Schools of medicine, osteopathic medicine, dentistry, and public health may use funds committed

by State, local, or county public health officers as matching

amounts for Federal grant funds for residency training programs in preventive medicine.
S. 1754—33

‘‘SEC. 769. HEALTH ADMINISTRATION TRAINEESHIPS AND SPECIAL

PROJECTS.

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

or local governments (that have in effect preventive medical and

dental public health residency programs) or public or nonprofit

private educational entities (including graduate schools of social

work and business schools that have health management programs)

that offer a program described in subsection (b)—

‘‘(1) to provide traineeships for students enrolled in such

a program; and

‘‘(2) to assist accredited programs health administration

in the development or improvement of programs to prepare

students for employment with public or nonprofit private entities.

‘‘(b) RELEVANT PROGRAMS.—The program referred to in subsection (a) is an accredited program in health administration, hospital administration, or health policy analysis and planning, which

program is accredited by a body or bodies approved for such purpose

by the Secretary of Education and which meets such other quality

standards as the Secretary of Health and Human Services by regulation may prescribe.

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

subsection (a), the Secretary shall give preference to qualified

applicants that meet the following conditions:

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

applicant are engaged in full-time practice settings in medically

underserved communities.

‘‘(2) The applicant recruits and admits students from medically underserved communities.

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

has established relationships with public and nonprofit providers of health care in the community involved.

‘‘(4) In training students, the applicant emphasizes employment with public or nonprofit private entities.

‘‘(d) CERTAIN PROVISIONS REGARDING TRAINEESHIPS.—

‘‘(1) USE OF GRANT.—Traineeships awarded under grants

made under subsection (a) shall provide for tuition and fees

and such stipends and allowances (including travel and subsistence expenses and dependency allowances) for the trainees

as the Secretary may deem necessary.

‘‘(2) PREFERENCE FOR CERTAIN STUDENTS.—Each entity

applying for a grant under subsection (a) for traineeships shall

assure to the satisfaction of the Secretary that the entity will

give priority to awarding the traineeships to students who

demonstrate a commitment to employment with public or nonprofit private entities in the fields with respect to which the

traineeships are awarded.

‘‘SEC. 770. AUTHORIZATION OF APPROPRIATIONS.

‘‘(a) IN GENERAL.—For the purpose of carrying out this subpart,

there is authorized to be appropriated $9,100,000 for fiscal year

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

years 1999 through 2002.

‘‘(b) LIMITATION REGARDING CERTAIN PROGRAM.—In obligating

amounts appropriated under subsection (a), the Secretary may not

obligate more than 30 percent for carrying out section 767.’’.
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SEC. 106. GENERAL PROVISIONS.

(a) IN GENERAL.— (1) Part F of title VII of the Public Health Service Act

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

(2) Part G of title VII of the Public Health Service Act

(42 U.S.C. 295j et seq.) is amended—

(A) by redesignating such part as part F;

(B) in section 791 (42 U.S.C. 295j)—

(i) by striking subsection (b); and

(ii) redesignating subsection (c) as subsection (b);

(C) by repealing section 793 (42 U.S.C. 295l);

(D) by repealing section 798;

(E) by redesignating section 799 as section 799B; and

(F) by inserting after section 794, the following new

sections:

‘‘SEC. 796. APPLICATION.

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

under this title, an eligible entity shall prepare and submit to

the Secretary an application that meets the requirements of this

section, at such time, in such manner, and containing such information as the Secretary may require.

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

contain the plan of the applicant for carrying out a project with

amounts received under this title. Such plan shall be consistent

with relevant Federal, State, or regional health professions program

plans.

‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An application

submitted under this section shall contain a specification by the

applicant entity of performance outcome standards that the project

to be funded under the grant or contract will be measured against.

Such standards shall address relevant health workforce needs that

the project will meet. The recipient of a grant or contract under

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

contract application.

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

shall contain a description of the linkages with relevant educational

and health care entities, including training programs for other

health professionals as appropriate, that the project to be funded

under the grant or contract will establish. To the extent practicable,

grantees under this section shall establish linkages with health

care providers who provide care for underserved communities and

populations.

‘‘SEC. 797. USE OF FUNDS.

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

awarded under this title may be used for training program development and support, faculty development, model demonstrations,

trainee support including tuition, books, program fees and reasonable living expenses during the period of training, technical assistance, workforce analysis, dissemination of information, and exploring new policy directions, as appropriate to meet recognized health

workforce objectives, in accordance with this title.

‘‘(b) MAINTENANCE OF EFFORT.—With respect to activities for

which a grant awarded under this title is to be expended, the

entity shall agree to maintain expenditures of non-Federal amounts

for such activities at a level that is not less than the level of
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such expenditures maintained by the entity for the fiscal year

preceding the fiscal year for which the entity receives such a grant.

‘‘SEC. 798. MATCHING REQUIREMENT.

‘‘The Secretary may require that an entity that applies for

a grant or contract under this title provide non-Federal matching

funds, as appropriate, to ensure the institutional commitment of

the entity to the projects funded under the grant. As determined

by the Secretary, such non-Federal matching funds may be provided

directly or through donations from public or private entities and

may be in cash or in-kind, fairly evaluated, including plant, equipment, or services.

‘‘SEC. 799. GENERALLY APPLICABLE PROVISIONS.

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

shall ensure that grants and contracts under this title are awarded

on a competitive basis, as appropriate, to carry out innovative

demonstration projects or provide for strategic workforce

supplementation activities as needed to meet health workforce goals

and in accordance with this title. Contracts may be entered into

under this title with public or private entities as may be necessary.

‘‘(b) ELIGIBLE ENTITIES.—Unless specifically required otherwise

in this title, the Secretary shall accept applications for grants

or contracts under this title from health professions schools, academic health centers, State or local governments, or other appropriate public or private nonprofit entities for funding and participation in health professions and nursing training activities. The Secretary may accept applications from for-profit private entities if

determined appropriate by the Secretary.

‘‘(c) INFORMATION REQUIREMENTS.— ‘‘(1) IN GENERAL.—Recipients of grants and contracts under

this title shall meet information requirements as specified by

the Secretary.

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

procedures to ensure that, with respect to any data collection

required under this title, such data is collected in a manner

that takes into account age, sex, race, and ethnicity.

‘‘(3) USE OF FUNDS.—The Secretary shall establish procedures to permit the use of amounts appropriated under this

title to be used for data collection purposes.

‘‘(4) EVALUATIONS.—The Secretary shall establish procedures to ensure the annual evaluation of programs and projects

operated by recipients of grants or contracts under this title.

Such procedures shall ensure that continued funding for such

programs and projects will be conditioned upon a demonstration

that satisfactory progress has been made by the program or

project in meeting the objectives of the program or project.

‘‘(d) TRAINING PROGRAMS.—Training programs conducted with

amounts received under this title shall meet applicable accreditation

and quality standards.

‘‘(e) DURATION OF ASSISTANCE.—

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

of an award to an entity of a grant, cooperative agreement,

or contract under this title, the period during which payments

are made to the entity under the award may not exceed 5

years. The provision of payments under the award shall be

subject to annual approval by the Secretary of the payments

and subject to the availability of appropriations for the fiscal
S. 1754—36

year involved to make the payments. This paragraph may

not be construed as limiting the number of awards under the

program involved that may be made to the entity.

‘‘(2) LIMITATION.—In the case of an award to an entity

of a grant, cooperative agreement, or contract under this title,

paragraph (1) shall apply only to the extent not inconsistent

with any other provision of this title that relates to the period

during which payments may be made under the award.

‘‘(f) PEER REVIEW REGARDING CERTAIN PROGRAMS.—

‘‘(1) IN GENERAL.—Each application for a grant under this

title, except any scholarship or loan program, including those

under sections 701, 721, or 723, shall be submitted to a peer

review group for an evaluation of the merits of the proposals

made in the application. The Secretary may not approve such

an application unless a peer review group has recommended

the application for approval.

‘‘(2) COMPOSITION.—Each peer review group under this subsection shall be composed principally of individuals who are

not officers or employees of the Federal Government. In providing for the establishment of peer review groups and procedures,

the Secretary shall ensure sex, racial, ethnic, and geographic

balance among the membership of such groups.

‘‘(3) ADMINISTRATION.—This subsection shall be carried out

by the Secretary acting through the Administrator of the Health

Resources and Services Administration.

‘‘(g) PREFERENCE OR PRIORITY CONSIDERATIONS.—In considering

a preference or priority for funding which is based on outcome

measures for an eligible entity under this title, the Secretary may

also consider the future ability of the eligible entity to meet the

outcome preference or priority through improvements in the eligible

entity’s program design.

‘‘(h) ANALYTIC ACTIVITIES.—The Secretary shall ensure that—

‘‘(1) cross-cutting workforce analytical activities are carried

out as part of the workforce information and analysis activities

under section 761; and

‘‘(2) discipline-specific workforce information and analytical

activities are carried out as part of—

‘‘(A) the community-based linkage program under part

D; and

‘‘(B) the health workforce development program under

subpart 2 of part E.

‘‘(i) OSTEOPATHIC SCHOOLS.—For purposes of this title, any

reference to—

‘‘(1) medical schools shall include osteopathic medical

schools; and

‘‘(2) medical students shall include osteopathic medical students.

‘‘SEC. 799A. TECHNICAL ASSISTANCE.

‘‘Funds appropriated under this title may be used by the Secretary to provide technical assistance in relation to any of the

authorities under this title.’’.

(b) PROFESSIONAL COUNSELORS AS MENTAL HEALTH PROFESSIONALS.—Section 792(a) of the Public Health Service Act (42 U.S.C.

295k(a)) is amended by inserting ‘‘professional counselors,’’ after

‘‘clinical psychologists,’’.
S. 1754—37

SEC. 107. PREFERENCE IN CERTAIN PROGRAMS.

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

Act (42 U.S.C. 295j), as amended by section 105(a)(2)(B), is further

amended by adding at the end thereof the following subsection:

‘‘(c) EXCEPTIONS FOR NEW PROGRAMS.—

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

equitably for funding under this section, those new programs

that meet at least 4 of the criteria described in paragraph

(3) shall qualify for a funding preference under this section.

‘‘(2) DEFINITION.—As used in this subsection, the term ‘new

program’ means any program that has graduated less than

three classes. Upon graduating at least three classes, a program

shall have the capability to provide the information necessary

to qualify the program for the general funding preferences

described in subsection (a).

‘‘(3) CRITERIA.—The criteria referred to in paragraph (1)

are the following:

‘‘(A) The mission statement of the program identifies

a specific purpose of the program as being the preparation

of health professionals to serve underserved populations.

‘‘(B) The curriculum of the program includes content

which will help to prepare practitioners to serve underserved populations.

‘‘(C) Substantial clinical training experience is required

under the program in medically underserved communities.

‘‘(D) A minimum of 20 percent of the clinical faculty

of the program spend at least 50 percent of their time

providing or supervising care in medically underserved

communities.

‘‘(E) The entire program or a substantial portion of

the program is physically located in a medically underserved community.

‘‘(F) Student assistance, which is linked to service in

medically underserved communities following graduation,

is available to the students in the program.

‘‘(G) The program provides a placement mechanism

for deploying graduates to medically underserved communities.’’.

(b) CONFORMING AMENDMENTS.—Section 791(a) of the Public

Health Service Act (42 U.S.C. 295j(a)) is amended—

(1) in paragraph (1), by striking ‘‘sections 747’’ and all

that follows through ‘‘767’’ and inserting ‘‘sections 747 and

750’’; and

(2) in paragraph (2), by striking ‘‘under section 798(a)’’.

SEC. 108. DEFINITIONS.

(a) GRADUATE PROGRAM IN BEHAVIORAL AND MENTAL HEALTH

PRACTICE.—Section 799B(1)(D) of the Public Health Service Act

(42 U.S.C. 295p(1)(D)) (as so redesignated by section 106(a)(2)(E))

is amended—

(1) by inserting ‘‘behavioral health and’’ before ‘‘mental’’;

and

(2) by inserting ‘‘behavioral health and mental health practice,’’ before ‘‘clinical’’.

(b) PROFESSIONAL COUNSELING AS A BEHAVIORAL AND MENTAL

HEALTH PRACTICE.—Section 799B of the Public Health Service Act
S. 1754—38

(42 U.S.C. 295p) (as so redesignated by section 106(a)(2)(E)) is

amended—

(1) in paragraph (1)—

(A) in subparagraph (C)—

(i) by inserting ‘‘and ‘graduate program in professional counseling’ ’’ after ‘‘graduate program in marriage and family therapy’ ’’; and

(ii) by inserting before the period the following:

‘‘and a concentration leading to a graduate degree in

counseling’’;

(B) in subparagraph (D), by inserting ‘‘professional

counseling,’’ after ‘‘social work,’’; and

(C) in subparagraph (E), by inserting ‘‘professional

counseling,’’ after ‘‘social work,’’; and

(2) in paragraph (5)(C), by inserting before the period the

following: ‘‘or a degree in counseling or an equivalent degree’’.

(c) MEDICALLY UNDERSERVED COMMUNITY.—Section 799B(6) of

the Public Health Service Act (42 U.S.C. 295p(6)) (as so redesignated

by section 105(a)(2)(E)) is amended—

(1) in subparagraph (B), by striking ‘‘or’’ at the end thereof;

(2) in subparagraph (C), by striking the period and inserting ‘‘; or’’; and

(3) by adding at the end the following:

‘‘(D) is designated by a State Governor (in consultation

with the medical community) as a shortage area or medically underserved community.’’.

(d) PROGRAMS FOR THE TRAINING OF PHYSICIAN ASSISTANTS.—

Paragraph (3) of section 799B of the Public Health Service Act

(42 U.S.C. 295p) (as so redesignated by section 105(a)(2)(E)) is

amended to read as follows:

‘‘(3) The term ‘program for the training of physician assistants’ means an educational program that—

‘‘(A) has as its objective the education of individuals

who will, upon completion of their studies in the program,

be qualified to provide primary care under the supervision

of a physician;

‘‘(B) extends for at least one academic year and consists

of—

‘‘(i) supervised clinical practice; and

‘‘(ii) at least four months (in the aggregate) of

classroom instruction, directed toward preparing students to deliver health care;

‘‘(C) has an enrollment of not less than eight students;

and

‘‘(D) trains students in primary care, disease prevention, health promotion, geriatric medicine, and home health

care.’’.

(e) PSYCHOLOGIST.—Section 799B of the Public Health Service

Act (42 U.S.C. 295p) (as so redesignated by section 105(a)(2)(E))

is amended by adding at the end the following:

‘‘(11) The term ‘psychologist’ means an individual who—

‘‘(A) holds a doctoral degree in psychology; and

‘‘(B) is licensed or certified on the basis of the doctoral

degree in psychology, by the State in which the individual

practices, at the independent practice level of psychology

to furnish diagnostic, assessment, preventive, and therapeutic services directly to individuals.’’.
S. 1754—39

SEC. 109. TECHNICAL AMENDMENT ON NATIONAL HEALTH SERVICE

CORPS.

Section 338B(b)(1)(B) of the Public Health Service Act (42

U.S.C. 254l–1(b)(1)(B)) is amended by striking ‘‘or other health

profession’’ and inserting ‘‘behavioral and mental health, or other

health profession’’.

SEC. 110. SAVINGS PROVISION.

In the case of any authority for making awards of grants

or contracts that is terminated by the amendments made by this

subtitle, the Secretary of Health and Human Services may, notwithstanding the termination of the authority, continue in effect any

grant or contract made under the authority that is in effect on

the day before the date of the enactment of this Act, subject to

the duration of any such grant or contract not exceeding the period

determined by the Secretary in first approving such financial assistance, or in approving the most recent request made (before the

date of such enactment) for continuation of such assistance, as

the case may be.

Subtitle B—Nursing Workforce

Development

SEC. 121. SHORT TITLE.

This subtitle may be cited as the ‘‘Nursing Education and

Practice Improvement Act of 1998’’.

SEC. 122. PURPOSE.

It is the purpose of this subtitle to restructure the nurse education authorities of title VIII of the Public Health Service Act

to permit a comprehensive, flexible, and effective approach to Federal support for nursing workforce development.

SEC. 123. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.

Title VIII of the Public Health Service Act (42 U.S.C. 296k

et seq.) is amended—

(1) by striking the title heading and all that follows except

for subpart II of part B and sections 846 and 855; and inserting

the following:

‘‘TITLE VIII—NURSING WORKFORCE

DEVELOPMENT’’;

(2) in subpart II of part B, by striking the subpart heading

and inserting the following:

‘‘PART E—STUDENT LOANS’’;

(3) by striking section 837;

(4) by inserting after the title heading the following new

parts:
S. 1754—40

‘‘PART A—GENERAL PROVISIONS

‘‘SEC. 801. DEFINITIONS.

‘‘As used in this title:

‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible entities’ means

schools of nursing, nursing centers, academic health centers,

State or local governments, and other public or private nonprofit

entities determined appropriate by the Secretary that submit

to the Secretary an application in accordance with section 802.

‘‘(2) SCHOOL OF NURSING.—The term ‘school of nursing’

means a collegiate, associate degree, or diploma school of nursing in a State.

‘‘(3) COLLEGIATE SCHOOL OF NURSING.—The term ‘collegiate

school of nursing’ means a department, division, or other

administrative unit in a college or university which provides

primarily or exclusively a program of education in professional

nursing and related subjects leading to the degree of bachelor

of arts, bachelor of science, bachelor of nursing, or to an equivalent degree, or to a graduate degree in nursing, or to an

equivalent degree, and including advanced training related to

such program of education provided by such school, but only

if such program, or such unit, college or university is accredited.

‘‘(4) ASSOCIATE DEGREE SCHOOL OF NURSING.—The term

‘associate degree school of nursing’ means a department, division, or other administrative unit in a junior college, community

college, college, or university which provides primarily or exclusively a two-year program of education in professional nursing

and allied subjects leading to an associate degree in nursing

or to an equivalent degree, but only if such program, or such

unit, college, or university is accredited.

‘‘(5) DIPLOMA SCHOOL OF NURSING.—The term ‘diploma

school of nursing’ means a school affiliated with a hospital

or university, or an independent school, which provides primarily or exclusively a program of education in professional

nursing and allied subjects leading to a diploma or to equivalent

indicia that such program has been satisfactorily completed,

but only if such program, or such affiliated school or such

hospital or university or such independent school is accredited.

‘‘(6) ACCREDITED.—

‘‘(A) IN GENERAL.—Except as provided in subparagraph

(B), the term ‘accredited’ when applied to any program

of nurse education means a program accredited by a recognized body or bodies, or by a State agency, approved for

such purpose by the Secretary of Education and when

applied to a hospital, school, college, or university (or a

unit thereof) means a hospital, school, college, or university

(or a unit thereof) which is accredited by a recognized

body or bodies, or by a State agency, approved for such

purpose by the Secretary of Education. For the purpose

of this paragraph, the Secretary of Education shall publish

a list of recognized accrediting bodies, and of State agencies,

which the Secretary of Education determines to be reliable

authority as to the quality of education offered.

‘‘(B) NEW PROGRAMS.—A new program of nursing that,

by reason of an insufficient period of operation, is not,

at the time of the submission of an application for a grant

or contract under this title, eligible for accreditation by
S. 1754—41

such a recognized body or bodies or State agency, shall

be deemed accredited for purposes of this title if the Secretary of Education finds, after consultation with the appropriate accreditation body or bodies, that there is reasonable

assurance that the program will meet the accreditation

standards of such body or bodies prior to the beginning

of the academic year following the normal graduation date

of students of the first entering class in such a program.

‘‘(7) NONPROFIT.—The term ‘nonprofit’ as applied to any

school, agency, organization, or institution means one which

is a corporation or association, or is owned and operated by

one or more corporations or associations, no part of the net

earnings of which inures, or may lawfully inure, to the benefit

of any private shareholder or individual.

‘‘(8) STATE.—The term ‘State’ means a State, the Commonwealth of Puerto Rico, the District of Columbia, the Commonwealth of the Northern Mariana Islands, Guam, American

Samoa, the Virgin Islands, or the Trust Territory of the Pacific

Islands.

‘‘SEC. 802. APPLICATION.

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

under this title, an eligible entity shall prepare and submit to

the Secretary an application that meets the requirements of this

section, at such time, in such manner, and containing such information as the Secretary may require.

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

contain the plan of the applicant for carrying out a project with

amounts received under this title. Such plan shall be consistent

with relevant Federal, State, or regional program plans.

‘‘(c) PERFORMANCE OUTCOME STANDARDS.—An application

submitted under this section shall contain a specification by the

applicant entity of performance outcome standards that the project

to be funded under the grant or contract will be measured against.

Such standards shall address relevant national nursing needs that

the project will meet. The recipient of a grant or contract under

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

contract application.

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

shall contain a description of the linkages with relevant educational

and health care entities, including training programs for other

health professionals as appropriate, that the project to be funded

under the grant or contract will establish.

‘‘SEC. 803. USE OF FUNDS.

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

awarded under this title may be used for training program development and support, faculty development, model demonstrations,

trainee support including tuition, books, program fees and reasonable living expenses during the period of training, technical assistance, workforce analysis, and dissemination of information, as

appropriate to meet recognized nursing objectives, in accordance

with this title.

‘‘(b) MAINTENANCE OF EFFORT.—With respect to activities for

which a grant awarded under this title is to be expended, the

entity shall agree to maintain expenditures of non-Federal amounts

for such activities at a level that is not less than the level of
S. 1754—42

such expenditures maintained by the entity for the fiscal year

preceding the fiscal year for which the entity receives such a grant.

‘‘SEC. 804. MATCHING REQUIREMENT.

‘‘The Secretary may require that an entity that applies for

a grant or contract under this title provide non-Federal matching

funds, as appropriate, to ensure the institutional commitment of

the entity to the projects funded under the grant. Such non-Federal

matching funds may be provided directly or through donations

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

fairly evaluated, including plant, equipment, or services.

‘‘SEC. 805. PREFERENCE.

‘‘In awarding grants or contracts under this title, the Secretary

shall give preference to applicants with projects that will substantially benefit rural or underserved populations, or help meet public

health nursing needs in State or local health departments.

‘‘SEC. 806. GENERALLY APPLICABLE PROVISIONS.

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

shall ensure that grants and contracts under this title are awarded

on a competitive basis, as appropriate, to carry out innovative

demonstration projects or provide for strategic workforce

supplementation activities as needed to meet national nursing service goals and in accordance with this title. Contracts may be entered

into under this title with public or private entities as determined

necessary by the Secretary.

‘‘(b) INFORMATION REQUIREMENTS.—

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

this title shall meet information requirements as specified by

the Secretary.

‘‘(2) EVALUATIONS.—The Secretary shall establish procedures to ensure the annual evaluation of programs and projects

operated by recipients of grants under this title. Such procedures shall ensure that continued funding for such programs

and projects will be conditioned upon a demonstration that

satisfactory progress has been made by the program or project

in meeting the objectives of the program or project.

‘‘(c) TRAINING PROGRAMS.—Training programs conducted with

amounts received under this title shall meet applicable accreditation

and quality standards.

‘‘(d) DURATION OF ASSISTANCE.— ‘‘(1) IN GENERAL.—Subject to paragraph (2), in the case

of an award to an entity of a grant, cooperative agreement,

or contract under this title, the period during which payments

are made to the entity under the award may not exceed 5

years. The provision of payments under the award shall be

subject to annual approval by the Secretary of the payments

and subject to the availability of appropriations for the fiscal

year involved to make the payments. This paragraph may

not be construed as limiting the number of awards under the

program involved that may be made to the entity.

‘‘(2) LIMITATION.—In the case of an award to an entity

of a grant, cooperative agreement, or contract under this title,

paragraph (1) shall apply only to the extent not inconsistent

with any other provision of this title that relates to the period

during which payments may be made under the award.

‘‘(e) PEER REVIEW REGARDING CERTAIN PROGRAMS.—
S. 1754—43

‘‘(1) IN GENERAL.—Each application for a grant under this

title, except advanced nurse traineeship grants under section

811(a)(2), shall be submitted to a peer review group for an

evaluation of the merits of the proposals made in the application. The Secretary may not approve such an application unless

a peer review group has recommended the application for

approval.

‘‘(2) COMPOSITION.—Each peer review group under this subsection shall be composed principally of individuals who are

not officers or employees of the Federal Government. In providing for the establishment of peer review groups and procedures,

the Secretary shall, except as otherwise provided, ensure sex,

racial, ethnic, and geographic representation among the membership of such groups.

‘‘(3) ADMINISTRATION.—This subsection shall be carried out

by the Secretary acting through the Administrator of the Health

Resources and Services Administration.

‘‘(f) ANALYTIC ACTIVITIES.—The Secretary shall ensure that—

‘‘(1) cross-cutting workforce analytical activities are carried

out as part of the workforce information and analysis activities

under this title; and

‘‘(2) discipline-specific workforce information is developed

and analytical activities are carried out as part of—

‘‘(A) the advanced education nursing activities under

part B;

‘‘(B) the workforce diversity activities under part C;

and

‘‘(C) basic nursing education and practice activities

under part D.

‘‘(g) STATE AND REGIONAL PRIORITIES.—Activities under grants

or contracts under this title shall, to the extent practicable, be

consistent with related Federal, State, or regional nursing professions program plans and priorities.

‘‘(h) FILING OF APPLICATIONS.— ‘‘(1) IN GENERAL.—Applications for grants or contracts

under this title may be submitted by health professions schools,

schools of nursing, academic health centers, State or local

governments, or other appropriate public or private nonprofit

entities as determined appropriate by the Secretary in accordance with this title.

‘‘(2) FOR-PROFIT ENTITIES.—Notwithstanding paragraph (1),

a for-profit entity may be eligible for a grant or contract under

this title as determined appropriate by the Secretary.

‘‘SEC. 807. TECHNICAL ASSISTANCE.

‘‘Funds appropriated under this title may be used by the Secretary to provide technical assistance in relation to any of the

authorities under this title.

‘‘PART B—NURSE PRACTITIONERS, NURSE

MIDWIVES, NURSE ANESTHETISTS, AND

OTHER ADVANCED EDUCATION NURSES

‘‘SEC. 811. ADVANCED EDUCATION NURSING GRANTS.

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

enter into contracts with eligible entities to meet the costs of—
S. 1754—44

‘‘(1) projects that support the enhancement of advanced

nursing education and practice; and

‘‘(2) traineeships for individuals in advanced nursing education programs.

‘‘(b) DEFINITION OF ADVANCED EDUCATION NURSES.—For purposes of this section, the term ‘advanced education nurses’ means

individuals trained in advanced degree programs including individuals in combined R.N./Master’s degree programs, post-nursing master’s certificate programs, or, in the case of nurse midwives, in

certificate programs in existence on the date that is one day prior

to the date of enactment of this section, to serve as nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists,

nurse educators, nurse administrators, or public health nurses,

or in other nurse specialties determined by the Secretary to require

advanced education.

‘‘(c) AUTHORIZED NURSE PRACTITIONER AND NURSE MIDWIFERY

PROGRAMS.—Nurse practitioner and nurse midwifery programs

eligible for support under this section are educational programs

for registered nurses (irrespective of the type of school of nursing

in which the nurses received their training) that—

‘‘(1) meet guidelines prescribed by the Secretary; and

‘‘(2) have as their objective the education of nurses who

will upon completion of their studies in such programs, be

qualified to effectively provide primary health care, including

primary health care in homes and in ambulatory care facilities,

long-term care facilities, acute care, and other health care settings.

‘‘(d) AUTHORIZED NURSE ANESTHESIA PROGRAMS.—Nurse

anesthesia programs eligible for support under this section are

education programs that—

‘‘(1) provide registered nurses with full-time anesthetist

education; and

‘‘(2) are accredited by the Council on Accreditation of Nurse

Anesthesia Educational Programs.

‘‘(e) OTHER AUTHORIZED EDUCATIONAL PROGRAMS.—The Secretary shall prescribe guidelines as appropriate for other advanced

nurse education programs eligible for support under this section.

‘‘(f) TRAINEESHIPS.—

‘‘(1) IN GENERAL.—The Secretary may not award a grant

to an applicant under subsection (a) unless the applicant

involved agrees that traineeships provided with the grant will

only pay all or part of the costs of—

‘‘(A) the tuition, books, and fees of the program of

advanced nurse education with respect to which the

traineeship is provided; and

‘‘(B) the reasonable living expenses of the individual

during the period for which the traineeship is provided.

‘‘(2) DOCTORAL PROGRAMS.—The Secretary may not obligate

more than 10 percent of the traineeships under subsection

(a) for individuals in doctorate degree programs.

‘‘(3) SPECIAL CONSIDERATION.—In making awards of grants

and contracts under subsection (a)(2), the Secretary shall give

special consideration to an eligible entity that agrees to expend

the award to train advanced education nurses who will practice

in health professional shortage areas designated under section

332.
S. 1754—45

‘‘PART C—INCREASING NURSING WORKFORCE

DIVERSITY

‘‘SEC. 821. WORKFORCE DIVERSITY GRANTS.

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

enter into contracts with eligible entities to meet the costs of special

projects to increase nursing education opportunities for individuals

who are from disadvantaged backgrounds (including racial and

ethnic minorities underrepresented among registered nurses) by

providing student scholarships or stipends, pre-entry preparation,

and retention activities.

‘‘(b) GUIDANCE.—In carrying out subsection (a), the Secretary

shall take into consideration the recommendations of the First,

Second and Third Invitational Congresses for Minority Nurse Leaders on ‘Caring for the Emerging Majority,’ in 1992, 1993 and 1997,

and consult with nursing associations including the American

Nurses Association, the National League for Nursing, the American

Association of Colleges of Nursing, the National Black Nurses

Association, the National Association of Hispanic Nurses, the

Association of Asian American and Pacific Islander Nurses, the

Native American Indian and Alaskan Nurses Association, and the

National Council of State Boards of Nursing.

‘‘(c) REQUIRED INFORMATION AND CONDITIONS FOR AWARD

RECIPIENTS.—

‘‘(1) IN GENERAL.—Recipients of awards under this section

may be required, where requested, to report to the Secretary

concerning the annual admission, retention, and graduation

rates for individuals from disadvantaged backgrounds and ethnic and racial minorities in the school or schools involved

in the projects.

‘‘(2) FALLING RATES.—If any of the rates reported under

paragraph (1) fall below the average of the two previous years,

the grant or contract recipient shall provide the Secretary with

plans for immediately improving such rates.

‘‘(3) INELIGIBILITY.—A recipient described in paragraph (2)

shall be ineligible for continued funding under this section

if the plan of the recipient fails to improve the rates within

the 1-year period beginning on the date such plan is implemented.

‘‘PART D—STRENGTHENING CAPACITY FOR

BASIC NURSE EDUCATION AND PRACTICE

‘‘SEC. 831. BASIC NURSE EDUCATION AND PRACTICE GRANTS.

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

enter into contracts with eligible entities for projects to strengthen

capacity for basic nurse education and practice.

‘‘(b) PRIORITY AREAS.—In awarding grants or contracts under

this section the Secretary shall give priority to entities that will

use amounts provided under such a grant or contract to enhance

the educational mix and utilization of the basic nursing workforce

by strengthening programs that provide basic nurse education, such

as through—

‘‘(1) establishing or expanding nursing practice arrangements in noninstitutional settings to demonstrate methods to
S. 1754—46

improve access to primary health care in medically underserved

communities;

‘‘(2) providing care for underserved populations and other

high-risk groups such as the elderly, individuals with HIVAIDS, substance abusers, the homeless, and victims of domestic

violence;

‘‘(3) providing managed care, quality improvement, and

other skills needed to practice in existing and emerging organized health care systems;

‘‘(4) developing cultural competencies among nurses;

‘‘(5) expanding the enrollment in baccalaureate nursing

programs;

‘‘(6) promoting career mobility for nursing personnel in

a variety of training settings and cross training or specialty

training among diverse population groups;

‘‘(7) providing education in informatics, including distance

learning methodologies; or

‘‘(8) other priority areas as determined by the Secretary.’’;

(5) by adding at the end the following:

‘‘PART F—FUNDING

‘‘SEC. 841. FUNDING.

‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of

carrying out parts B, C, and D (subject to section 845(g)), there

are authorized to be appropriated $65,000,000 for fiscal year 1998,

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

1999 through 2002.

‘‘(b) ALLOCATIONS FOR FISCAL YEARS 1998 THROUGH 2002.—

‘‘(1) NURSE PRACTITIONERS; NURSE MIDWIVES.— ‘‘(A) FISCAL YEAR 1998.—Of the amount appropriated

under subsection (a) for fiscal year 1998, the Secretary

shall reserve not less than $17,564,000 for making awards

of grants and contracts under section 822 as such section

was in effect for fiscal year 1998.

‘‘(B) FISCAL YEARS 1999 THROUGH 2002.—Of the amount

appropriated under subsection (a) for fiscal year 1999 or

any of the fiscal years 2000 through 2002, the Secretary,

subject to subsection (d), shall reserve for the fiscal year

involved, for making awards of grants and contracts under

part B with respect to nurse practitioners and nurse midwives, not less than the percentage constituted by the

ratio of the amount appropriated under section 822 as

such section was in effect for fiscal year 1998 to the total

of the amounts appropriated under this title for such fiscal

year. For purposes of the preceding sentence, the Secretary,

in determining the amount that has been reserved for

the fiscal year involved, shall include any amounts appropriated under subsection (a) for the fiscal year that are

obligated by the Secretary to continue in effect grants

or contracts under section 822 as such section was in

effect for fiscal year 1998.

‘‘(2) NURSE ANESTHETISTS.—

‘‘(A) FISCAL YEAR 1998.—Of the amount appropriated

under subsection (a) for fiscal year 1998, the Secretary

shall reserve not less than $2,761,000 for making awards
S. 1754—47

of grants and contracts under section 831 as such section

was in effect for fiscal year 1998.

‘‘(B) FISCAL YEARS 1999 THROUGH 2002.—Of the amount

appropriated under subsection (a) for fiscal year 1999 or

any of the fiscal years 2000 through 2002, the Secretary,

subject to subsection (d), shall reserve for the fiscal year

involved, for making awards of grants and contracts under

part B with respect to nurse anesthetists, not less than

the percentage constituted by the ratio of the amount

appropriated under section 831 as such section was in

effect for fiscal year 1998 to the total of the amounts

appropriated under this title for such fiscal year. For purposes of the preceding sentence, the Secretary, in determining the amount that has been reserved for the fiscal year

involved, shall include any amounts appropriated under

subsection (a) for the fiscal year that are obligated by

the Secretary to continue in effect grants or contracts under

section 831 as such section was in effect for fiscal year

1998.

‘‘(c) ALLOCATIONS AFTER FISCAL YEAR 2002.—

‘‘(1) IN GENERAL.—For fiscal year 2003 and subsequent

fiscal years, amounts appropriated under subsection (a) for

the fiscal year involved shall be allocated by the Secretary

among parts B, C, and D (and programs within such parts)

according to a methodology that is developed in accordance

with paragraph (2). The Secretary shall enter into a contract

with a public or private entity for the purpose of developing

the methodology. The contract shall require that the development of the methodology be completed not later than February

1, 2002.

‘‘(2) USE OF CERTAIN FACTORS.—The contract under paragraph (1) shall provide that the methodology under such paragraph will be developed in accordance with the following:

‘‘(A) The methodology will take into account the need

for and the distribution of health services among medically

underserved populations, as determined according to the

factors that apply under section 330(b)(3).

‘‘(B) The methodology will take into account the need

for and the distribution of health services in health professional shortage areas, as determined according to the factors that apply under section 332(b).

‘‘(C) The methodology will take into account the need

for and the distribution of mental health services among

medically underserved populations and in health professional shortage areas.

‘‘(D) The methodology will be developed in consultation

with individuals in the field of nursing, including registered

nurses, nurse practitioners, nurse midwives, nurse anesthetists, clinical nurse specialists, nursing educators and

educational institutions, nurse executives, pediatric nurse

associates and practitioners, and women’s health, obstetric,

and neonatal nurses.

‘‘(E) The methodology will take into account the following factors with respect to the States:

‘‘(i) A provider population ratio equivalent to a

managed care formula of 1/1,500 for primary care services.
S. 1754—48

‘‘(ii) The use of whole rather than fractional counts

in determining the number of health care providers.

‘‘(iii) The counting of only employed health care

providers in determining the number of health care

providers.

‘‘(iv) The number of families whose income is less

than 200 percent of the official poverty line (as established by the Director of the Office of Management

and Budget and revised by the Secretary in accordance

with section 673(2) of the Omnibus Budget Reconciliation Act of 1981).

‘‘(v) The rate of infant mortality and the rate of

low-birthweight births.

‘‘(vi) The percentage of the general population constituted by individuals who are members of racial or

ethnic minority groups, stated both by minority group

and in the aggregate.

‘‘(vii) The percentage of the general population constituted by individuals who are of Hispanic ethnicity.

‘‘(viii) The number of individuals residing in health

professional shortage areas, and the number of individuals who are members of medically underserved populations.

‘‘(ix) The percentage of the general population constituted by elderly individuals.

‘‘(x) The extent to which the populations served

have a choice of providers.

‘‘(xi) The impact of care on hospitalizations and

emergency room use.

‘‘(xii) The number of individuals who lack proficiency in speaking the English language.

‘‘(xiii) Such additional factors as the Secretary

determines to be appropriate.

‘‘(3) REPORT TO CONGRESS.—Not later than 30 days after

the completion of the development of the methodology required

in paragraph (1), the Secretary shall submit to the Committee

on Commerce of the House of Representatives, and to the

Committee on Labor and Human Resources of the Senate,

a report describing the methodology and explaining the effects

of the methodology on the allocation among parts B, C, and

D (and programs within such parts) of amounts appropriated

under subsection (a) for the first fiscal year for which the

methodology will be in effect. Such explanation shall include

a comparison of the allocation for such fiscal year with the

allocation made under this section for the preceding fiscal year.

‘‘(d) USE OF METHODOLOGY BEFORE FISCAL YEAR 2003.—With

respect to the fiscal years 1999 through 2002, if the report required

in subsection (c)(3) is submitted in accordance with such subsection

not later than 90 days before the beginning of such a fiscal year,

the Secretary may for such year implement the methodology

described in the report (rather than implementing the methodology

in fiscal year 2003), in which case subsection (b) ceases to be

in effect. The authority under the preceding sentence is subject

to the condition that the fiscal year for which the methodology

is implemented be the same fiscal year identified in such report

as the fiscal year for which the methodology will first be in effect.
S. 1754—49

‘‘(e) AUTHORITY FOR USE OF ADDITIONAL FACTORS IN METHODOLOGY.—

‘‘(1) IN GENERAL.—The Secretary shall make the determinations specified in paragraph (2). For any fiscal year beginning

after the first fiscal year for which the methodology under

subsection (c)(1) is in effect, the Secretary may alter the methodology by including the information from such determinations

as factors in the methodology.

‘‘(2) RELEVANT DETERMINATIONS.—The determinations

referred to in paragraph (1) are as follows:

‘‘(A) The need for and the distribution of health services

among populations for which it is difficult to determine

the number of individuals who are in the population, such

as homeless individuals; migratory and seasonal agricultural workers and their families; individuals infected with

the human immunodeficiency virus, and individuals who

abuse drugs.

‘‘(B) In the case of a population for which the determinations under subparagraph (A) are made, the extent

to which the population includes individuals who are members of racial or ethnic minority groups and a specification

of the skills needed to provide health services to such

individuals in the language and the educational and cultural context that is most appropriate to the individuals.

‘‘(C) Data, obtained from the Director of the Centers

for Disease Control and Prevention, on rates of morbidity

and mortality among various populations (including data

on the rates of maternal and infant mortality and data

on the rates of low-birthweight births of living infants).

‘‘(D) Data from the Health Plan Employer Data and

Information Set, as appropriate.

‘‘PART G—NATIONAL ADVISORY COUNCIL ON

NURSE EDUCATION AND PRACTICE

‘‘SEC. 845. NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION AND

PRACTICE.

‘‘(a) ESTABLISHMENT.—The Secretary shall establish an advisory

council to be known as the National Advisory Council on Nurse

Education and Practice (in this section referred to as the ‘Advisory

Council’).

‘‘(b) COMPOSITION.— ‘‘(1) IN GENERAL.—The Advisory Council shall be composed

of—

‘‘(A) not less than 21, nor more than 23 individuals,

who are not officers or employees of the Federal Government, appointed by the Secretary without regard to the

Federal civil service laws, of which—

‘‘(i) 2 shall be selected from full-time students

enrolled in schools of nursing;

‘‘(ii) 2 shall be selected from the general public;

‘‘(iii) 2 shall be selected from practicing professional nurses; and

‘‘(iv) 9 shall be selected from among the leading

authorities in the various fields of nursing, higher,

secondary education, and associate degree schools of
S. 1754—50

nursing, and from representatives of advanced education nursing groups (such as nurse practitioners,

nurse midwives, and nurse anesthetists), hospitals, and

other institutions and organizations which provide

nursing services; and

‘‘(B) the Secretary (or the delegate of the Secretary

(who shall be an ex officio member and shall serve as

the Chairperson)).

‘‘(2) APPOINTMENT.—Not later than 90 days after the date

of enactment of this Act, the Secretary shall appoint the members of the Advisory Council and each such member shall

serve a 4 year term. In making such appointments, the Secretary shall ensure a fair balance between the nursing professions, a broad geographic representation of members and a

balance between urban and rural members. Members shall

be appointed based on their competence, interest, and knowledge of the mission of the profession involved. A majority of

the members shall be nurses.

‘‘(3) MINORITY REPRESENTATION.—In appointing the members of the Advisory Council under paragraph (1), the Secretary

shall ensure the adequate representation of minorities.

‘‘(c) VACANCIES.—

‘‘(1) IN GENERAL.—A vacancy on the Advisory Council shall

be filled in the manner in which the original appointment

was made and shall be subject to any conditions which applied

with respect to the original appointment.

‘‘(2) FILLING UNEXPIRED TERM.—An individual chosen to

fill a vacancy shall be appointed for the unexpired term of

the member replaced.

‘‘(d) DUTIES.—The Advisory Council shall—

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

and Congress concerning policy matters arising in the administration of this title, including the range of issues relating to

the nurse workforce, education, and practice improvement;

‘‘(2) provide advice to the Secretary and Congress in the

preparation of general regulations and with respect to policy

matters arising in the administration of this title, including

the range of issues relating to nurse supply, education and

practice improvement; and

‘‘(3) not later than 3 years after the date of enactment

of this section, and annually thereafter, prepare and submit

to the Secretary, the Committee on Labor and Human

Resources of the Senate, and the Committee on Commerce

of the House of Representatives, a report describing the activities of the Council, including findings and recommendations

made by the Council concerning the activities under this title.

‘‘(e) MEETINGS AND DOCUMENTS.—

‘‘(1) MEETINGS.—The Advisory Council shall meet not less

than 2 times each year. Such meetings shall be held jointly

with other related entities established under this title where

appropriate.

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

convening of a meeting under paragraph (1), the Advisory Council shall prepare and make available an agenda of the matters

to be considered by the Advisory Council at such meeting.

At any such meeting, the Advisory Council shall distribute

materials with respect to the issues to be addressed at the
S. 1754—51

meeting. Not later than 30 days after the adjourning of such

a meeting, the Advisory Council shall prepare and make available a summary of the meeting and any actions taken by

the Council based upon the meeting.

‘‘(f) COMPENSATION AND EXPENSES.—

‘‘(1) COMPENSATION.—Each member of the Advisory Council

shall be compensated at a rate equal to the daily equivalent

of the annual rate of basic pay prescribed for level IV of the

Executive Schedule under section 5315 of title 5, United States

Code, for each day (including travel time) during which such

member is engaged in the performance of the duties of the

Council. All members of the Council who are officers or employees of the United States shall serve without compensation

in addition to that received for their services as officers or

employees of the United States.

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

be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while

away from their homes or regular places of business in the

performance of services for the Council.

‘‘(g) FUNDING.—Amounts appropriated under this title may be

utilized by the Secretary to support the nurse education and practice

activities of the Council.

‘‘(h) FACA.—The Federal Advisory Committee Act shall apply

to the Advisory Committee under this section only to the extent

that the provisions of such Act do not conflict with the requirements

of this section.’’; and

(6) by redesignating section 855 as section 810, and

transferring such section so as to appear after section 809

(as added by the amendment made by paragraph (5)).

SEC. 124. SAVINGS PROVISION.

In the case of any authority for making awards of grants

or contracts that is terminated by the amendment made by section

123, the Secretary of Health and Human Services may, notwithstanding the termination of the authority, continue in effect any

grant or contract made under the authority that is in effect on

the day before the date of the enactment of this Act, subject to

the duration of any such grant or contract not exceeding the period

determined by the Secretary in first approving such financial assistance, or in approving the most recent request made (before the

date of such enactment) for continuation of such assistance, as

the case may be.

Subtitle C—Financial Assistance

CHAPTER 1—SCHOOL-BASED REVOLVING

LOAN FUNDS

SEC. 131. PRIMARY CARE LOAN PROGRAM.

(a) REQUIREMENT FOR SCHOOLS.—Section 723(b)(1) of the Public

Health Service Act (42 U.S.C. 292s(b)(1)), as amended by section

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

by striking ‘‘3 years before’’ and inserting ‘‘4 years before’’.
S. 1754—52

(b) NONCOMPLIANCE.—Section 723(a)(3) of the Public Health

Service Act (42 U.S.C. 292s(a)(3)) is amended to read as follows:

‘‘(3) NONCOMPLIANCE BY STUDENT.—Each agreement

entered into with a student pursuant to paragraph (1) shall

provide that, if the student fails to comply with such agreement,

the loan involved will begin to accrue interest at a rate of

18 percent per year beginning on the date of such noncompliance.’’.

(c) REPORT REQUIREMENT.—Section 723 of the Public Health

Service Act (42 U.S.C. 292s) is amended—

(1) by striking subsection (c); and

(2) by redesignating subsection (d) as subsection (c).

SEC. 132. LOANS FOR DISADVANTAGED STUDENTS.

(a) AUTHORIZATION OF APPROPRIATIONS.—Section 724(f)(1) of

the Public Health Service Act (42 U.S.C. 292t(f)(1)) is amended

by striking ‘‘$15,000,000 for fiscal year 1993’’ and inserting

‘‘$8,000,000 for each of the fiscal years 1998 through 2002’’.

(b) REPEAL.—Effective October 1, 2002, paragraph (1) of section

724(f) of the Public Health Service Act (42 U.S.C. 292t(f)(1)) is

repealed.

SEC. 133. STUDENT LOANS REGARDING SCHOOLS OF NURSING.

(a) IN GENERAL.—Section 836(b) of the Public Health Service

Act (42 U.S.C. 297b(b)) is amended—

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

and inserting a semicolon;

(2) in paragraph (2)—

(A) in subparagraph (A), by striking ‘‘and’’ at the end;

and

(B) by inserting before the semicolon at the end the

following: ‘‘, and (C) such additional periods under the

terms of paragraph (8) of this subsection’’;

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

and inserting ‘‘; and’’; and

(4) by adding at the end the following paragraph:

‘‘(8) pursuant to uniform criteria established by the Secretary, the repayment period established under paragraph (2)

for any student borrower who during the repayment period

failed to make consecutive payments and who, during the last

12 months of the repayment period, has made at least 12

consecutive payments may be extended for a period not to

exceed 10 years.’’.

(b) MINIMUM MONTHLY PAYMENTS.—Section 836(g) of the Public

Health Service Act (42 U.S.C. 297b(g)) is amended by striking

‘‘$15’’ and inserting ‘‘$40’’.

(c) ELIMINATION OF STATUTE OF LIMITATION FOR LOAN COLLEC- TIONS.—(1) IN GENERAL.—Section 836 of the Public Health Service

Act (42 U.S.C. 297b) is amended by adding at the end the

following new subsection:

‘‘(l) ELIMINATION OF STATUTE OF LIMITATION FOR LOAN COLLECTIONS.—

‘‘(1) PURPOSE.—It is the purpose of this subsection to ensure

that obligations to repay loans under this section are enforced

without regard to any Federal or State statutory, regulatory,

or administrative limitation on the period within which debts

may be enforced.
S. 1754—53

‘‘(2) PROHIBITION.—Notwithstanding any other provision of

Federal or State law, no limitation shall terminate the period

within which suit may be filed, a judgment may be enforced,

or an offset, garnishment, or other action may be initiated

or taken by a school of nursing that has an agreement with

the Secretary pursuant to section 835 that is seeking the repayment of the amount due from a borrower on a loan made

under this subpart after the default of the borrower on such

loan.’’.

(2) EFFECTIVE DATE.—The amendment made by paragraph

(1) shall be effective with respect to actions pending on or

after the date of enactment of this Act.

(d) BREACH OF AGREEMENTS.—Section 846 of the Public Health

Service Act (42 U.S.C. 297n) is amended by adding at the end

thereof the following new subsection:

‘‘(h) BREACH OF AGREEMENT.—

‘‘(1) IN GENERAL.—In the case of any program under this

section under which an individual makes an agreement to

provide health services for a period of time in accordance with

such program in consideration of receiving an award of Federal

funds regarding education as a nurse (including an award

for the repayment of loans), the following applies if the agreement provides that this subsection is applicable:

‘‘(A) In the case of a program under this section that

makes an award of Federal funds for attending an accredited program of nursing (in this section referred to as

a ‘nursing program’), the individual is liable to the Federal

Government for the amount of such award (including

amounts provided for expenses related to such attendance),

and for interest on such amount at the maximum legal

prevailing rate, if the individual—

‘‘(i) fails to maintain an acceptable level of academic standing in the nursing program (as indicated

by the program in accordance with requirements established by the Secretary);

‘‘(ii) is dismissed from the nursing program for

disciplinary reasons; or

‘‘(iii) voluntarily terminates the nursing program.

‘‘(B) The individual is liable to the Federal Government

for the amount of such award (including amounts provided

for expenses related to such attendance), and for interest

on such amount at the maximum legal prevailing rate,

if the individual fails to provide health services in accordance with the program under this section for the period

of time applicable under the program.

‘‘(2) WAIVER OR SUSPENSION OF LIABILITY.—In the case

of an individual or health facility making an agreement for

purposes of paragraph (1), the Secretary shall provide for the

waiver or suspension of liability under such subsection if

compliance by the individual or the health facility, as the

case may be, with the agreements involved is impossible, or

would involve extreme hardship to the individual or facility,

and if enforcement of the agreements with respect to the

individual or facility would be unconscionable.

‘‘(3) DATE CERTAIN FOR RECOVERY.—Subject to paragraph

(2), any amount that the Federal Government is entitled to

recover under paragraph (1) shall be paid to the United States
S. 1754—54

not later than the expiration of the 3-year period beginning

on the date the United States becomes so entitled.

‘‘(4) AVAILABILITY.—Amounts recovered under paragraph

(1) with respect to a program under this section shall be available for the purposes of such program, and shall remain available for such purposes until expended.’’.

(e) TECHNICAL AMENDMENTS.—Section 839 of the Public Health

Service Act (42 U.S.C. 297e) is amended—

(1) in subsection (a)—

(A) by striking the matter preceding paragraph (1)

and inserting the following:

‘‘(a) If a school terminates a loan fund established under an

agreement pursuant to section 835(b), or if the Secretary for good

cause terminates the agreement with the school, there shall be

a capital distribution as follows:’’; and

(B) in paragraph (1), by striking ‘‘at the close of

September 30, 1999,’’ and inserting ‘‘on the date of termination of the fund’’; and

(2) in subsection (b), to read as follows:

‘‘(b) If a capital distribution is made under subsection (a),

the school involved shall, after such capital distribution, pay to

the Secretary, not less often than quarterly, the same proportionate

share of amounts received by the school in payment of principal

or interest on loans made from the loan fund established under

section 835(b) as determined by the Secretary under subsection

(a).’’.

SEC. 134. GENERAL PROVISIONS.

(a) MAXIMUM STUDENT LOAN PROVISIONS AND MINIMUM PAY- MENTS.—

(1) IN GENERAL.—Section 722(a)(1) of the Public Health

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

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

sum of’’ and all that follows through the end thereof and inserting ‘‘the cost of attendance (including tuition, other reasonable

educational expenses, and reasonable living costs) for that year

at the educational institution attended by the student (as determined by such educational institution).’’.

(2) THIRD AND FOURTH YEARS.—Section 722(a)(2) of the

Public Health Service Act (42 U.S.C. 292r(a)(2)), as amended

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

striking ‘‘the amount $2,500’’ and all that follows through

‘‘including such $2,500)’’ and inserting ‘‘the amount of the loan

may, in the case of the third or fourth year of a student

at a school of medicine or osteopathic medicine, be increased

to the extent necessary’’.

(3) REPAYMENT PERIOD.—Section 722(c) of the Public Health

Service Act (42 U.S.C. 292r(c)), as amended by section

2014(b)(1) of Public Law 103–43, is amended—

(A) in the subsection heading by striking ‘‘TEN-YEAR’’

and inserting ‘‘REPAYMENT’’;

(B) by striking ‘‘ten-year period which begins’’ and

inserting ‘‘period of not less than 10 years nor more than

25 years, at the discretion of the institution, which begins’’;

and

(C) by striking ‘‘such ten-year period’’ and inserting

‘‘such period’’.
S. 1754—55

(4) MINIMUM PAYMENTS.—Section 722(j) of the Public

Health Service Act (42 U.S.C. 292r(j)), as amended by section

2014(b)(1) of Public Law 103–43, is amended by striking ‘‘$15’’

and inserting ‘‘$40’’.

(b) ELIMINATION OF STATUTE OF LIMITATION FOR LOAN COLLEC- TIONS.—(1) IN GENERAL.—Section 722 of the Public Health Service

Act (42 U.S.C. 292r), as amended by section 2014(b)(1) of Public

Law 103–43, is amended by adding at the end the following

new subsection:

‘‘(m) ELIMINATION OF STATUTE OF LIMITATION FOR LOAN

COLLECTIONS.— ‘‘(1) PURPOSE.—It is the purpose of this subsection to ensure

that obligations to repay loans under this section are enforced

without regard to any Federal or State statutory, regulatory,

or administrative limitation on the period within which debts

may be enforced.

‘‘(2) PROHIBITION.—Notwithstanding any other provision of

Federal or State law, no limitation shall terminate the period

within which suit may be filed, a judgment may be enforced,

or an offset, garnishment, or other action may be initiated

or taken by a school that has an agreement with the Secretary

pursuant to section 721 that is seeking the repayment of the

amount due from a borrower on a loan made under this subpart

after the default of the borrower on such loan.’’.

(2) EFFECTIVE DATE.—The amendment made by paragraph

(1) shall be effective with respect to actions pending on or

after the date of enactment of this Act.

(c) DATE CERTAIN FOR CONTRIBUTIONS.—Paragraph (2) of section 735(e) of the Public Health Service Act (42 U.S.C. 292y(e)(2))

is amended to read as follows:

‘‘(2) DATE CERTAIN FOR CONTRIBUTIONS.—Amounts

described in paragraph (1) that are returned to the Secretary

shall be obligated before the end of the succeeding fiscal year.’’.

CHAPTER 2—INSURED HEALTH EDUCATION

ASSISTANCE LOANS TO GRADUATE STUDENTS

SEC. 141. HEALTH EDUCATION ASSISTANCE LOAN PROGRAM.

(a) HEALTH EDUCATION ASSISTANCE LOAN DEFERMENT FOR

BORROWERS PROVIDING HEALTH SERVICES TO INDIANS.— (1) IN GENERAL.—Section 705(a)(2)(C) of the Public Health

Service Act (42 U.S.C. 292d(a)(2)(C)) is amended by striking

‘‘and (x)’’ and inserting ‘‘(x) not in excess of three years, during

which the borrower is providing health care services to Indians

through an Indian health program (as defined in section

108(a)(2)(A) of the Indian Health Care Improvement Act (25

U.S.C. 1616a(a)(2)(A)); and (xi)’’.

(2) CONFORMING AMENDMENTS.—Section 705(a)(2)(C) of the

Public Health Service Act (42 U.S.C. 292d(a)(2)(C)) is further

amended—

(A) in clause (xi) (as so redesignated) by striking ‘‘(ix)’’

and inserting ‘‘(x)’’; and

(B) in the matter following such clause (xi), by striking

‘‘(x)’’ and inserting ‘‘(xi)’’.

(3) EFFECTIVE DATE.—The amendments made by this subsection shall apply with respect to services provided on or
S. 1754—56

after the first day of the third month that begins after the

date of the enactment of this Act.

(b) REPORT REQUIREMENT.—Section 709(b) of the Public Health

Service Act (42 U.S.C. 292h(b)) is amended—

(1) in paragraph (4)(B), by adding ‘‘and’’ after the semicolon;

(2) in paragraph (5), by striking ‘‘; and’’ and inserting

a period; and

(3) by striking paragraph (6).

(c) PROGRAM ELIGIBILITY.—

(1) LIMITATIONS ON LOANS.—Section 703(a) of the Public

Health Service Act (42 U.S.C. 292b(a)) is amended by striking

‘‘or clinical psychology’’ and inserting ‘‘or behavioral and mental

health practice, including clinical psychology’’.

(2) DEFINITION OF ELIGIBLE INSTITUTION.—Section 719(1)

of the Public Health Service Act (42 U.S.C. 292o(1)) is amended

by striking ‘‘or clinical psychology’’ and inserting ‘‘or behavioral

and mental health practice, including clinical psychology’’.

SEC. 142. HEAL LENDER AND HOLDER PERFORMANCE STANDARDS.

(a) GENERAL AMENDMENTS.—Section 707(a) of the Public Health

Service Act (42 U.S.C. 292f) is amended—

(1) by striking the last sentence;

(2) by striking ‘‘determined.’’ and inserting ‘‘determined,

except that, if the insurance beneficiary including any servicer

of the loan is not designated for ‘exceptional performance’,

as set forth in paragraph (2), the Secretary shall pay to the

beneficiary a sum equal to 98 percent of the amount of the

loss sustained by the insured upon that loan.’’;

(3) by striking ‘‘Upon’’ and inserting:

‘‘(1) IN GENERAL.—Upon’’; and

(4) by adding at the end the following new paragraph:

‘‘(2) EXCEPTIONAL PERFORMANCE.— ‘‘(A) AUTHORITY.—Where the Secretary determines that

an eligible lender, holder, or servicer has a compliance

performance rating that equals or exceeds 97 percent, the

Secretary shall designate that eligible lender, holder, or

servicer, as the case may be, for exceptional performance.

‘‘(B) COMPLIANCE PERFORMANCE RATING.—For purposes

of subparagraph (A), a compliance performance rating is

determined with respect to compliance with due diligence

in the disbursement, servicing, and collection of loans under

this subpart for each year for which the determination

is made. Such rating shall be equal to the percentage

of all due diligence requirements applicable to each loan,

on average, as established by the Secretary, with respect

to loans serviced during the period by the eligible lender,

holder, or servicer.

‘‘(C) ANNUAL AUDITS FOR LENDERS, HOLDERS, AND

SERVICERS.—Each eligible lender, holder, or servicer desiring a designation under subparagraph (A) shall have an

annual financial and compliance audit conducted with

respect to the loan portfolio of such eligible lender, holder,

or servicer, by a qualified independent organization from

a list of qualified organizations identified by the Secretary

and in accordance with standards established by the Secretary. The standards shall measure the lender’s, holder’s,

or servicer’s compliance with due diligence standards and
S. 1754—57

shall include a defined statistical sampling technique

designed to measure the performance rating of the eligible

lender, holder, or servicer for the purpose of this section.

Each eligible lender, holder, or servicer shall submit the

audit required by this section to the Secretary.

‘‘(D) SECRETARY’S DETERMINATIONS.—The Secretary

shall make the determination under subparagraph (A)

based upon the audits submitted under this paragraph

and any information in the possession of the Secretary

or submitted by any other agency or office of the Federal

Government.

‘‘(E) QUARTERLY COMPLIANCE AUDIT.—To maintain its

status as an exceptional performer, the lender, holder, or

servicer shall undergo a quarterly compliance audit at the

end of each quarter (other than the quarter in which status

as an exceptional performer is established through a financial and compliance audit, as described in subparagraph

(C)), and submit the results of such audit to the Secretary.

The compliance audit shall review compliance with due

diligence requirements for the period beginning on the

day after the ending date of the previous audit, in accordance with standards determined by the Secretary.

‘‘(F) REVOCATION AUTHORITY.—The Secretary shall

revoke the designation of a lender, holder, or servicer under

subparagraph (A) if any quarterly audit required under

subparagraph (E) is not received by the Secretary by the

date established by the Secretary or if the audit indicates

the lender, holder, or servicer has failed to meet the standards for designation as an exceptional performer under

subparagraph (A). A lender, holder, or servicer receiving

a compliance audit not meeting the standard for designation as an exceptional performer may reapply for designation under subparagraph (A) at any time.

‘‘(G) DOCUMENTATION.—Nothing in this section shall

restrict or limit the authority of the Secretary to require

the submission of claims documentation evidencing servicing performed on loans, except that the Secretary may

not require exceptional performers to submit greater documentation than that required for lenders, holders, and

servicers not designated under subparagraph (A).

‘‘(H) COST OF AUDITS.—Each eligible lender, holder,

or servicer shall pay for all the costs associated with the

audits required under this section.

‘‘(I) ADDITIONAL REVOCATION AUTHORITY.—Notwithstanding any other provision of this section, a designation

under subparagraph (A) may be revoked at any time by

the Secretary if the Secretary determines that the eligible

lender, holder, or servicer has failed to maintain an overall

level of compliance consistent with the audit submitted

by the eligible lender, holder, or servicer under this paragraph or if the Secretary asserts that the lender, holder,

or servicer may have engaged in fraud in securing designation under subparagraph (A) or is failing to service loans

in accordance with program requirements.

‘‘(J) NONCOMPLIANCE.—A lender, holder, or servicer

designated under subparagraph (A) that fails to service
S. 1754—58

loans or otherwise comply with applicable program regulations shall be considered in violation of the Federal False

Claims Act.’’.

(b) DEFINITION.—Section 707(e) of the Public Health Service

Act (42 U.S.C. 292f(e)) is amended by adding at the end the following new paragraph:

‘‘(4) The term ‘servicer’ means any agency acting on behalf

of the insurance beneficiary.’’.

(c) EFFECTIVE DATE.—The amendments made by subsections

(a) and (b) shall apply with respect to loans submitted to the

Secretary for payment on or after the first day of the sixth month

that begins after the date of enactment of this Act.

SEC. 143. INSURANCE PROGRAM.

Section 710(a)(2)(B) of the Public Health Service Act (42 U.S.C.

292i(a)(2)(B)) is amended by striking ‘‘any of the fiscal years 1993

through 1996’’ and inserting ‘‘fiscal year 1993 and subsequent fiscal

years’’.

SEC. 144. HEAL BANKRUPTCY.

(a) IN GENERAL.—Section 707(g) of the Public Health Service

Act (42 U.S.C. 292f(g)) is amended in the first sentence by striking

‘‘A debt which is a loan insured’’ and inserting ‘‘Notwithstanding

any other provision of Federal or State law, a debt that is a

loan insured’’.

(b) APPLICATION.—The amendment made by subsection (a) shall

apply to any loan insured under the authority of subpart I of

part A of title VII of the Public Health Service Act (42 U.S.C.

292 et seq.) that is listed or scheduled by the debtor in a case

under title XI, United States Code, filed—

(1) on or after the date of enactment of this Act; or

(2) prior to such date of enactment in which a discharge

has not been granted.

SEC. 145. HEAL REFINANCING.

Section 706 of the Public Health Service Act (42 U.S.C. 292e)

is amended—

(1) in subsection (d)—

(A) in the subsection heading, by striking ‘‘CONSOLIDATION’’ and inserting ‘‘REFINANCING OR CONSOLIDATION’’; and

(B) in the first sentence, by striking ‘‘indebtedness’’

and inserting ‘‘indebtedness or the refinancing of a single

loan’’; and

(2) in subsection (e)—

(A) in the subsection heading, by striking ‘‘DEBTS’’

and inserting ‘‘DEBTS AND REFINANCING’’;

(B) in the first sentence, by striking ‘‘all of the borrower’s debts into a single instrument’’ and inserting ‘‘all of

the borrower’s loans insured under this subpart into a

single instrument (or, if the borrower obtained only 1 loan

insured under this subpart, refinancing the loan 1 time)’’;

and

(C) in the second sentence, by striking ‘‘consolidation’’

and inserting ‘‘consolidation or refinancing’’.
S. 1754—59

TITLE II—OFFICE OF MINORITY

HEALTH

SEC. 201. REVISION AND EXTENSION OF PROGRAMS OF OFFICE OF

MINORITY HEALTH.

(a) DUTIES AND REQUIREMENTS.—Section 1707 of the Public

Health Service Act (42 U.S.C. 300u–6) is amended by striking

subsection (b) and all that follows and inserting the following:

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

and ethnic minority groups, the Secretary, acting through the Deputy Assistant Secretary for Minority Health (in this section referred

to as the ‘Deputy Assistant Secretary’), shall carry out the following:

‘‘(1) Establish short-range and long-range goals and objectives and coordinate all other activities within the Public Health

Service that relate to disease prevention, health promotion,

service delivery, and research concerning such individuals. The

heads of each of the agencies of the Service shall consult with

the Deputy Assistant Secretary to ensure the coordination of

such activities.

‘‘(2) Enter into interagency agreements with other agencies

of the Public Health Service.

‘‘(3) Support research, demonstrations and evaluations to

test new and innovative models.

‘‘(4) Increase knowledge and understanding of health risk

factors.

‘‘(5) Develop mechanisms that support better information

dissemination, education, prevention, and service delivery to

individuals from disadvantaged backgrounds, including individuals who are members of racial or ethnic minority groups.

‘‘(6) Ensure that the National Center for Health Statistics

collects data on the health status of each minority group.

‘‘(7) With respect to individuals who lack proficiency in

speaking the English language, enter into contracts with public

and nonprofit private providers of primary health services for

the purpose of increasing the access of the individuals to such

services by developing and carrying out programs to provide

bilingual or interpretive services.

‘‘(8) Support a national minority health resource center

to carry out the following:

‘‘(A) Facilitate the exchange of information regarding

matters relating to health information and health promotion, preventive health services, and education in the

appropriate use of health care.

‘‘(B) Facilitate access to such information.

‘‘(C) Assist in the analysis of issues and problems relating to such matters.

‘‘(D) Provide technical assistance with respect to the

exchange of such information (including facilitating the

development of materials for such technical assistance).

‘‘(9) Carry out programs to improve access to health care

services for individuals with limited proficiency in speaking

the English language. Activities under the preceding sentence

shall include developing and evaluating model projects.

‘‘(c) ADVISORY COMMITTEE.—
S. 1754—60

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

committee to be known as the Advisory Committee on Minority

Health (in this subsection referred to as the ‘Committee’).

‘‘(2) DUTIES.—The Committee shall provide advice to the

Deputy Assistant Secretary carrying out this section, including

advice on the development of goals and specific program activities under paragraphs (1) through (9) of subsection (b) for

each racial and ethnic minority group.

‘‘(3) CHAIR.—The chairperson of the Committee shall be

selected by the Secretary from among the members of the

voting members of the Committee. The term of office of the

chairperson shall be 2 years.

‘‘(4) COMPOSITION.—

‘‘(A) The Committee shall be composed of 12 voting

members appointed in accordance with subparagraph (B),

and nonvoting, ex officio members designated in subparagraph (C).

‘‘(B) The voting members of the Committee shall be

appointed by the Secretary from among individuals who

are not officers or employees of the Federal Government

and who have expertise regarding issues of minority health.

The racial and ethnic minority groups shall be equally

represented among such members.

‘‘(C) The nonvoting, ex officio members of the Committee shall be such officials of the Department of Health

and Human Services as the Secretary determines to be

appropriate.

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

for a term of 4 years, except that the Secretary shall initially

appoint a portion of the members to terms of 1 year, 2 years,

and 3 years.

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

a new member shall be appointed by the Secretary within

90 days from the date that the vacancy occurs, and serve

for the remainder of the term for which the predecessor of

such member was appointed. The vacancy shall not affect the

power of the remaining members to execute the duties of the

Committee.

‘‘(7) COMPENSATION.—Members of the Committee who are

officers or employees of the United States shall serve without

compensation. Members of the Committee who are not officers

or employees of the United States shall receive compensation,

for each day (including travel time) they are engaged in the

performance of the functions of the Committee. Such compensation may not be in an amount in excess of the daily equivalent

of the annual maximum rate of basic pay payable under the

General Schedule (under title 5, United States Code) for positions above GS–15.

‘‘(d) CERTAIN REQUIREMENTS REGARDING DUTIES.—

‘‘(1) RECOMMENDATIONS REGARDING LANGUAGE AS IMPEDIMENT TO HEALTH CARE.—The Deputy Assistant Secretary for

Minority Health shall consult with the Director of the Office

of International and Refugee Health, the Director of the Office

of Civil Rights, and the Directors of other appropriate departmental entities regarding recommendations for carrying out

activities under subsection (b)(9).
S. 1754—61

‘‘(2) EQUITABLE ALLOCATION REGARDING ACTIVITIES.—In

carrying out subsection (b), the Secretary shall ensure that

services provided under such subsection are equitably allocated

among all groups served under this section by the Secretary.

‘‘(3) CULTURAL COMPETENCY OF SERVICES.—The Secretary

shall ensure that information and services provided pursuant

to subsection (b) are provided in the language, educational,

and cultural context that is most appropriate for the individuals

for whom the information and services are intended.

‘‘(e) GRANTS AND CONTRACTS REGARDING DUTIES.—

‘‘(1) IN GENERAL.—In carrying out subsection (b), the Secretary acting through the Deputy Assistant Secretary may

make awards of grants, cooperative agreements, and contracts

to public and nonprofit private entities.

‘‘(2) PROCESS FOR MAKING AWARDS.—The Deputy Assistant

Secretary shall ensure that awards under paragraph (1) are

made, to the extent practical, only on a competitive basis,

and that a grant is awarded for a proposal only if the proposal

has been recommended for such an award through a process

of peer review.

‘‘(3) EVALUATION AND DISSEMINATION.—The Deputy Assistant Secretary, directly or through contracts with public and

private entities, shall provide for evaluations of projects carried

out with awards made under paragraph (1) during the preceding 2 fiscal years. The report shall be included in the report

required under subsection (f) for the fiscal year involved.

‘‘(f) REPORTS.—

‘‘(1) IN GENERAL.—Not later than February 1 of fiscal year

1999 and of each second year thereafter, the Secretary shall

submit to the Committee on Energy and Commerce of the

House of Representatives, and to the Committee on Labor

and Human Resources of the Senate, a report describing the

activities carried out under this section during the preceding

2 fiscal years and evaluating the extent to which such activities

have been effective in improving the health of racial and ethnic

minority groups. Each such report shall include the biennial

reports submitted under sections 201(e)(3) and 201(f)(2) for

such years by the heads of the Public Health Service agencies.

‘‘(2) AGENCY REPORTS.—Not later than February 1, 1999,

and biennially thereafter, the heads of the Public Health Service

agencies shall submit to the Deputy Assistant Secretary a

report summarizing the minority health activities of each of

the respective agencies.

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

‘‘(1) The term ‘racial and ethnic minority group’ means

American Indians (including Alaska Natives, Eskimos, and

Aleuts); Asian Americans and Pacific Islanders; Blacks; and

Hispanics.

‘‘(2) The term ‘Hispanic’ means individuals whose origin

is Mexican, Puerto Rican, Cuban, Central or South American,

or any other Spanish-speaking country.

‘‘(h) FUNDING.—

‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose

of carrying out this section, there are authorized to be appropriated $30,000,000 for fiscal year 1998, and such sums as

may be necessary for each of the fiscal years 1999 through

2002.’’.
S. 1754—62

(b) AUTHORIZATION FOR NATIONAL CENTER FOR HEALTH STATISTICS.—Section 306 of the Public Health Service Act (42 U.S.C.

242k) is amended—

(1) in subsection (m), by adding at the end the following:

‘‘(4)(A) Subject to subparagraph (B), the Secretary, acting

through the Center, shall collect data on Hispanics and major

Hispanic subpopulation groups and American Indians, and for

developing special area population studies on major Asian American

and Pacific Islander populations.

‘‘(B) The provisions of subparagraph (A) shall be effective with

respect to a fiscal year only to the extent that funds are appropriated pursuant to paragraph (3) of subsection (n), and only if

the amounts appropriated for such fiscal year pursuant to each

of paragraphs (1) and (2) of subsection (n) equal or exceed the

amounts so appropriated for fiscal year 1997.’’;

(2) in subsection (n)(1), by striking ‘‘through 1998’’ and

inserting ‘‘through 2003’’; and

(3) in subsection (n)—

(A) in the first sentence of paragraph (2)—

(i) by striking ‘‘authorized in subsection (m)’’ and

inserting ‘‘authorized in paragraphs (1) through (3)

of subsection (m)’’; and

(ii) by striking ‘‘$5,000,000’’ and all that follows

through the period and inserting ‘‘such sums as may

be necessary for each of the fiscal years 1999 through

2003.’’; and

(B) by adding at the end the following:

‘‘(3) For activities authorized in subsection (m)(4), there are

authorized to be appropriated $1,000,000 for fiscal year 1998, and

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

through 2002.’’.

(c) MISCELLANEOUS AMENDMENTS.—Section 1707 of the Public

Health Service Act (42 U.S.C. 300u–6) is amended—

(1) in the heading for the section by striking ‘‘ESTABLISHMENT OF’’; and

(2) in subsection (a), by striking ‘‘Office of the Assistant

Secretary for Health’’ and inserting ‘‘Office of Public Health

and Science’’.

TITLE III—SELECTED INITIATIVES

SEC. 301. STATE OFFICES OF RURAL HEALTH.

Section 338J of the Public Health Service Act (42 U.S.C. 254r)

is amended—

(1) in subsection (b)(1), in the matter preceding subparagraph (A), by striking ‘‘in cash’’; and

(2) in subsection (j)(1)—

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

(B) by inserting before the period the following:

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

fiscal years 1998 through 2002’’; and

(3) in subsection (k), by striking ‘‘$10,000,000’’ and inserting

‘‘$36,000,000’’.
S. 1754—63

SEC. 302. DEMONSTRATION PROJECTS REGARDING ALZHEIMER’S DISEASE.

(a) IN GENERAL.—Section 398(a) of the Public Health Service

Act (42 U.S.C. 280c–3(a)) is amended—

(1) in the matter preceding paragraph (1), by striking ‘‘not

less than 5, and not more than 15,’’;

(2) in paragraph (2)—

(A) by inserting after ‘‘disorders’’ the following: ‘‘who

are living in single family homes or in congregate settings’’;

and

(B) by striking ‘‘and’’ at the end;

(3) by redesignating paragraph (3) as paragraph (4); and

(4) by inserting after paragraph (2) the following:

‘‘(3) to improve the access of such individuals to homebased or community-based long-term care services (subject to

the services being provided by entities that were providing

such services in the State involved as of October 1, 1995),

particularly such individuals who are members of racial or

ethnic minority groups, who have limited proficiency in speaking the English language, or who live in rural areas; and’’.

(b) DURATION.—Section 398A of the Public Health Service Act

(42 U.S.C. 280c–4) is amended—

(1) in the heading for the section, by striking ‘‘LIMITATION’’ and all that follows and inserting ‘‘REQUIREMENT

OF MATCHING FUNDS’’;

(2) by striking subsection (a);

(3) by redesignating subsections (b) and (c) as subsections

(a) and (b), respectively; and

(4) in subsection (a) (as so redesignated), in each of paragraphs (1)(C) and (2)(C), by striking ‘‘third year’’ and inserting

‘‘third or subsequent year’’.

(c) AUTHORIZATION OF APPROPRIATIONS.—Section 398B(e) of the

Public Health Service Act (42 U.S.C. 280c–5(e)) is amended—

(1) by striking ‘‘and such sums’’ and inserting ‘‘such sums’’;

and

(2) by inserting before the period the following:

‘‘, $8,000,000 for fiscal year 1998, and such sums as may

be necessary for each of the fiscal years 1999 through 2002’’.

SEC. 303. PROJECT GRANTS FOR IMMUNIZATION SERVICES.

Section 317(j) of the Public Health Service Act (42 U.S.C.

247b(j)) is amended—

(1) in paragraph (1), by striking ‘‘individuals against vaccine-preventable diseases’’ and all that follows through the

first period and inserting the following: ‘‘children, adolescents,

and adults against vaccine-preventable diseases, there are

authorized to be appropriated such sums as may be necessary

for each of the fiscal years 1998 through 2002.’’; and

(2) in paragraph (2), by striking ‘‘1990’’ and inserting

‘‘1997’’.
S. 1754—64

TITLE IV—MISCELLANEOUS

PROVISIONS

SEC. 401. TECHNICAL CORRECTIONS REGARDING PUBLIC LAW 103–

183.

(a) AMENDATORY INSTRUCTIONS.—Public Law 103–183 is

amended—

(1) in section 601—

(A) in subsection (b), in the matter preceding paragraph

(1), by striking ‘‘Section 1201 of the Public Health Service

Act (42 U.S.C. 300d)’’ and inserting ‘‘Title XII of the Public

Health Service Act (42 U.S.C. 300d et seq.)’’; and

(B) in subsection (f)(1), by striking ‘‘in section 1204(c)’’

and inserting ‘‘in section 1203(c) (as redesignated by subsection (b)(2) of this section)’’;

(2) in section 602, by striking ‘‘for the purpose’’ and inserting ‘‘For the purpose’’; and

(3) in section 705(b), by striking ‘‘317D((l)(1)’’ and inserting

‘‘317D(l)(1)’’.

(b) PUBLIC HEALTH SERVICE ACT.—The Public Health Service

Act, as amended by Public Law 103–183 and by subsection (a)

of this section, is amended—

(1) in section 317E(g)(2), by striking ‘‘making grants under

subsection (b)’’ and inserting ‘‘carrying out subsection (b)’’;

(2) in section 318, in subsection (e) as in effect on the

day before the date of the enactment of Public Law 103–

183, by redesignating the subsection as subsection (f);

(3) in subpart 6 of part C of title IV—

(A) by transferring the first section 447 (added by

section 302 of Public Law 103–183) from the current placement of the section;

(B) by redesignating the section as section 447A; and

(C) by inserting the section after section 447;

(4) in section 1213(a)(8), by striking ‘‘provides for for’’ and

inserting ‘‘provides for’’;

(5) in section 1501, by redesignating the second subsection

(c) (added by section 101(f) of Public Law 103–183) as subsection

(d); and

(6) in section 1505(3), by striking ‘‘nonprofit’’.

(c) MISCELLANEOUS CORRECTION.—Section 401(c)(3) of Public

Law 103–183 is amended in the matter preceding subparagraph

(A) by striking ‘‘(d)(5)’’ and inserting ‘‘(e)(5)’’.

(d) CONFORMING AMENDMENT.—Section 308(b) of the Public

Health Service Act (42 U.S.C. 242m(b)) is amended—

(1) in paragraph (2)(A), by striking ‘‘306(n)’’ and inserting

‘‘306(m)’’; and

(2) in paragraph (2)(C), by striking ‘‘306(n)’’ and inserting

‘‘306(m)’’.

(e) EFFECTIVE DATE.—This section is deemed to have taken

effect immediately after the enactment of Public Law 103–183.

SEC. 402. MISCELLANEOUS AMENDMENTS REGARDING PHS COMMISSIONED OFFICERS.

(a) ANTI-DISCRIMINATION LAWS.—Amend section 212 of the Public Health Service Act (42 U.S.C. 213) by adding the following

new subsection at the end thereof:
S. 1754—65

‘‘(f) Active service of commissioned officers of the Service shall

be deemed to be active military service in the Armed Forces of

the United States for purposes of all laws related to discrimination

on the basis of race, color, sex, ethnicity, age, religion, and disability.’’.

(b) TRAINING IN LEAVE WITHOUT PAY STATUS.—Section 218

of the Public Health Service Act (42 U.S.C. 218a) is amended

by adding at the end the following:

‘‘(c) A commissioned officer may be placed in leave without

pay status while attending an educational institution or training

program whenever the Secretary determines that such status is

in the best interest of the Service. For purposes of computation

of basic pay, promotion, retirement, compensation for injury or

death, and the benefits provided by sections 212 and 224, an officer

in such status pursuant to the preceding sentence shall be considered as performing service in the Service and shall have an active

service obligation as set forth in subsection (b) of this section.’’.

(c) UTILIZATION OF ALCOHOL AND DRUG ABUSE RECORDS THAT

APPLY TO THE ARMED FORCES.—Section 543(e) of the Public Health

Service Act (42 U.S.C. 290dd–2(e)) is amended by striking ‘‘Armed

Forces’’ each place that such term appears and inserting ‘‘Uniformed

Services’’.

SEC. 403. CLINICAL TRAINEESHIPS.

Section 303(d)(1) of the Public Health Service Act (42 U.S.C.

242a(d)(1)) is amended by inserting ‘‘counseling,’’ after ‘‘family therapy,’’.

SEC. 404. PROJECT GRANTS FOR SCREENINGS, REFERRALS, AND EDUCATION REGARDING LEAD POISONING.

Section 317A(l)(1) of the Public Health Service Act (42 U.S.C.

247b–1(l)(1)) is amended by striking ‘‘1998’’ and inserting ‘‘2002’’.

SEC. 405. PROJECT GRANTS FOR PREVENTIVE HEALTH SERVICES

REGARDING TUBERCULOSIS.

Section 317E(g) of the Public Health Service Act (42 U.S.C.

247b–6(g)(1)) is amended—

(1) in paragraph (1)—

(A) in subparagraph (A), by striking ‘‘1998’’ and inserting ‘‘2002’’; and (B) in subparagraph (B), by striking ‘‘$50,000,000’’ and

inserting ‘‘25 percent’’; and

(2) in paragraph (2), by striking ‘‘1998’’ and inserting

‘‘2002’’.

SEC. 406. CDC LOAN REPAYMENT PROGRAM.

Section 317F of the Public Health Service Act (42 U.S.C. 247b–

7) is amended—

(1) in subsection (a)(1), by striking ‘‘$20,000’’ and inserting

‘‘$35,000’’;

(2) in subsection (c), by striking ‘‘1998’’ and inserting

‘‘2002’’; and

(3) by adding at the end the following:

‘‘(d) AVAILABILITY OF APPROPRIATIONS.—Amounts appropriated

for a fiscal year for contracts under subsection (a) shall remain

available until the expiration of the second fiscal year beginning

after the fiscal year for which the amounts were appropriated.’’.
S. 1754—66

SEC. 407. COMMUNITY PROGRAMS ON DOMESTIC VIOLENCE.

(a) IN GENERAL.—Section 318(h)(2) of the Family Violence

Prevention and Services Act (42 U.S.C. 10418(h)(2)) is amended

by striking ‘‘fiscal year 1997’’ and inserting ‘‘for each of the fiscal

years 1997 through 2002’’.

(b) STUDY.—The Secretary of Health and Human Services shall

request that the Institute of Medicine conduct a study concerning

the training needs of health professionals with respect to the detection and referral of victims of family or acquaintance violence.

Not later than 2 years after the date of enactment of this Act,

the Institute of Medicine shall prepare and submit to Congress

a report concerning the study conducted under this subsection.

SEC. 408. STATE LOAN REPAYMENT PROGRAM.

Section 338I(i)(1) of the Public Health Service Act (42 U.S.C.

254q–1(i)(1)) is amended by inserting before the period ‘‘, and such

sums as may be necessary for each of the fiscal years 1998 through

2002’’.

SEC. 409. AUTHORITY OF THE DIRECTOR OF NIH.

Section 402(b) of the Public Health Service Act (42 U.S.C.

282(b)) is amended—

(1) in paragraph (11), by striking ‘‘and’’ at the end thereof;

(2) in paragraph (12), by striking the period and inserting

a semicolon; and

(3) by adding after paragraph (12), the following new paragraphs:

‘‘(13) may conduct and support research training—

‘‘(A) for which fellowship support is not provided under

section 487; and

‘‘(B) which does not consist of residency training of

physicians or other health professionals; and

‘‘(14) may appoint physicians, dentists, and other health

care professionals, subject to the provisions of title 5, United

States Code, relating to appointments and classifications in

the competitive service, and may compensate such professionals

subject to the provisions of chapter 74 of title 38, United States

Code.’’.

SEC. 410. RAISE IN MAXIMUM LEVEL OF LOAN REPAYMENTS.

(a) REPAYMENT PROGRAMS WITH RESPECT TO AIDS.—Section

487A of the Public Health Service Act (42 U.S.C. 288–1) is

amended—

(1) in subsection (a), by striking ‘‘$20,000’’ and inserting ‘‘$35,000’’; and

(2) in subsection (c), by striking ‘‘1996’’ and inserting

‘‘2001’’.

(b) REPAYMENT PROGRAMS WITH RESPECT TO CONTRACEPTION

AND INFERTILITY.—Section 487B(a) of the Public Health Service

Act (42 U.S.C. 288–2(a)) is amended by striking ‘‘$20,000’’ and

inserting ‘‘$35,000’’.

(c) REPAYMENT PROGRAMS WITH RESPECT TO RESEARCH GENERALLY.—Section 487C(a)(1) of the Public Health Service Act (42

U.S.C. 288–3(a)(1)) is amended by striking ‘‘$20,000’’ and inserting

‘‘$35,000’’.

(d) REPAYMENT PROGRAMS WITH RESPECT TO CLINICAL

RESEARCHERS FROM DISADVANTAGED BACKGROUNDS.—Section
S. 1754—67

487E(a) of the Public Health Service Act (42 U.S.C. 288–5(a)) is

amended—

(1) in paragraph (1), by striking ‘‘$20,000’’ and inserting

‘‘$35,000’’; and

(2) in paragraph (3), by striking ‘‘338C’’ and inserting

‘‘338B, 338C’’.

SEC. 411. CONSTRUCTION OF REGIONAL CENTERS FOR RESEARCH ON

PRIMATES.

Section 481B(a) of the Public Health Service Act (42 U.S.C.

287a–3(a)) is amended—

(1) by striking ‘‘shall’’ and inserting ‘‘may’’; and

(2) by striking ‘‘$5,000,000’’ and inserting ‘‘up to $2,500,000’’.

SEC. 412. PEER REVIEW.

Section 504(d)(2) of the Public Health Service Act (42 U.S.C.

290aa–3(d)(2)) is amended by striking ‘‘cooperative agreement, or

contract’’ each place that such term appears and inserting ‘‘or

cooperative agreement’’.

SEC. 413. FUNDING FOR TRAUMA CARE.

Section 1232(a) of the Public Health Service Act (42 U.S.C.

300d–32) is amended by striking ‘‘and 1996’’ and inserting ‘‘through

2002’’.

SEC. 414. HEALTH INFORMATION AND HEALTH PROMOTION.

Section 1701(b) of the Public Health Service Act (42 U.S.C.

300u(b)) is amended by striking ‘‘through 1996’’ and inserting

‘‘through 2002’’.

SEC. 415. EMERGENCY MEDICAL SERVICES FOR CHILDREN.

Section 1910 of the Public Health Service Act (42 U.S.C. 300w–

9) is amended—

(1) in subsection (a)—

(A) by striking ‘‘two-year period’’ and inserting ‘‘3-year

period (with an optional 4th year based on performance)’’;

and

(B) by striking ‘‘one grant’’ and inserting ‘‘3 grants’’;

and

(2) in subsection (d), by striking ‘‘1997’’ and inserting

‘‘2005’’.

SEC. 416. ADMINISTRATION OF CERTAIN REQUIREMENTS.

(a) IN GENERAL.—Section 2004 of Public Law 103–43 (107

Stat. 209) is amended by striking subsection (a).

(b) CONFORMING AMENDMENTS.—Section 2004 of Public Law

103–43, as amended by subsection (a) of this section, is amended—

(1) by striking ‘‘(b) SENSE’’ and all that follows through

‘‘In the case’’ and inserting the following:

‘‘(a) SENSE OF CONGRESS REGARDING PURCHASE OF AMERICANMADE EQUIPMENT AND PRODUCTS.—In the case’’;

(2) by striking ‘‘(2) NOTICE TO RECIPIENTS OF ASSISTANCE’’

and inserting the following:

‘‘(b) NOTICE TO RECIPIENTS OF ASSISTANCE’’; and

(3) in subsection (b), as redesignated by paragraph (2)

of this subsection, by striking ‘‘paragraph (1)’’ and inserting

‘‘subsection (a)’’.
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(c) EFFECTIVE DATE.—This section is deemed to have taken

effect immediately after the enactment of Public Law 103–43.

SEC. 417. AIDS DRUG ASSISTANCE PROGRAM.

Section 2618(b)(3) of the Public Health Service Act (42 U.S.C.

300ff–28(b)(3)) is amended—

(1) in subparagraph (A), by striking ‘‘and the Commonwealth of Puerto Rico’’ and inserting ‘‘, the Commonwealth

of Puerto Rico, the Virgin Islands, and Guam’’; and

(2) in subparagraph (B), by striking ‘‘the Virgin Islands,

Guam’’.

SEC. 418. NATIONAL FOUNDATION FOR BIOMEDICAL RESEARCH.

Part I of title IV of the Public Health Service Act (42 U.S.C.

290b et seq.) is amended—

(1) by striking the part heading and inserting the following:

‘‘PART I—FOUNDATION FOR THE NATIONAL

INSTITUTES OF HEALTH’’;

and

(2) in section 499—

(A) in subsection (a), by striking ‘‘National Foundation

for Biomedical Research’’ and inserting ‘‘Foundation for

the National Institutes of Health’’;

(B) in subsection (k)(10)—

(i) by striking ‘‘not’’; and

(ii) by adding at the end the following: ‘‘Any funds

transferred under this paragraph shall be subject to

all Federal limitations relating to federally-funded

research.’’; and

(C) in subsection (m)(1), by striking ‘‘$200,000’’ and

all that follows through ‘‘1995’’ and inserting ‘‘$500,000

for each fiscal year’’.

SEC. 419. FETAL ALCOHOL SYNDROME PREVENTION AND SERVICES.

(a) SHORT TITLE.—This section may be cited as the ‘‘Fetal

Alcohol Syndrome and Fetal Alcohol Effect Prevention and Services

Act’’.

(b) FINDINGS.—Congress finds that—

(1) Fetal Alcohol Syndrome is the leading preventable cause

of mental retardation, and it is 100 percent preventable;

(2) estimates on the number of children each year vary,

but according to some researchers, up to 12,000 infants are

born in the United States with Fetal Alcohol Syndrome, suffering irreversible physical and mental damage;

(3) thousands more infants are born each year with Fetal

Alcohol Effect, also known as Alcohol Related Neurobehavioral

Disorder (ARND), a related and equally tragic syndrome;

(4) children of women who use alcohol while pregnant

have a significantly higher infant mortality rate (13.3 per 1,000)

than children of those women who do not use alcohol (8.6

per 1,000);

(5) Fetal Alcohol Syndrome and Fetal Alcohol Effect are

national problems which can impact any child, family, or

community, but their threat to American Indians and Alaska

Natives is especially alarming;
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(6) in some American Indian communities, where alcohol

dependency rates reach 50 percent and above, the chances

of a newborn suffering Fetal Alcohol Syndrome or Fetal Alcohol

Effect are up to 30 times greater than national averages;

(7) in addition to the immeasurable toll on children and

their families, Fetal Alcohol Syndrome and Fetal Alcohol Effect

pose extraordinary financial costs to the Nation, including the

costs of health care, education, foster care, job training, and

general support services for affected individuals;

(8) the total cost to the economy of Fetal Alcohol Syndrome

was approximately $2,500,000,000 in 1995, and over a lifetime,

health care costs for one Fetal Alcohol Syndrome child are

estimated to be at least $1,400,000;

(9) researchers have determined that the possibility of giving birth to a baby with Fetal Alcohol Syndrome or Fetal

Alcohol Effect increases in proportion to the amount and frequency of alcohol consumed by a pregnant woman, and that

stopping alcohol consumption at any point in the pregnancy

reduces the emotional, physical, and mental consequences of

alcohol exposure to the baby; and

(10) though approximately 1 out of every 5 pregnant women

drink alcohol during their pregnancy, we know of no safe dose

of alcohol during pregnancy, or of any safe time to drink during

pregnancy, thus, it is in the best interest of the Nation for

the Federal Government to take an active role in encouraging

all women to abstain from alcohol consumption during pregnancy.

(c) PURPOSE.—It is the purpose of this section to establish,

within the Department of Health and Human Services, a comprehensive program to help prevent Fetal Alcohol Syndrome and

Fetal Alcohol Effect nationwide and to provide effective intervention

programs and services for children, adolescents and adults already

affected by these conditions. Such program shall—

(1) coordinate, support, and conduct national, State, and

community-based public awareness, prevention, and education

programs on Fetal Alcohol Syndrome and Fetal Alcohol Effect;

(2) coordinate, support, and conduct prevention and intervention studies as well as epidemiologic research concerning

Fetal Alcohol Syndrome and Fetal Alcohol Effect;

(3) coordinate, support and conduct research and demonstration projects to develop effective developmental and

behavioral interventions and programs that foster effective

advocacy, educational and vocational training, appropriate

therapies, counseling, medical and mental health, and other

supportive services, as well as models that integrate or coordinate such services, aimed at the unique challenges facing

individuals with Fetal Alcohol Syndrome or Fetal Alcohol Effect

and their families; and

(4) foster coordination among all Federal, State and local

agencies, and promote partnerships between research institutions and communities that conduct or support Fetal Alcohol

Syndrome and Fetal Alcohol Effect research, programs, surveillance, prevention, and interventions and otherwise meet the

general needs of populations already affected or at risk of

being impacted by Fetal Alcohol Syndrome and Fetal Alcohol

Effect.
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(d) ESTABLISHMENT OF PROGRAM.—Title III of the Public Health

Service Act (42 U.S.C. 241 et seq.) is amended by adding at the

end the following:

‘‘PART O—FETAL ALCOHOL SYNDROME

PREVENTION AND SERVICES PROGRAM

‘‘SEC. 399G. ESTABLISHMENT OF FETAL ALCOHOL SYNDROME

PREVENTION AND SERVICES PROGRAM.

‘‘(a) FETAL ALCOHOL SYNDROME PREVENTION, INTERVENTION

AND SERVICES DELIVERY PROGRAM.—The Secretary shall establish

a comprehensive Fetal Alcohol Syndrome and Fetal Alcohol Effect

prevention, intervention and services delivery program that shall

include—

‘‘(1) an education and public awareness program to support,

conduct, and evaluate the effectiveness of—

‘‘(A) educational programs targeting medical schools,

social and other supportive services, educators and counselors and other service providers in all phases of childhood

development, and other relevant service providers, concerning the prevention, identification, and provision of services

for children, adolescents and adults with Fetal Alcohol

Syndrome and Fetal Alcohol Effect;

‘‘(B) strategies to educate school-age children, including

pregnant and high risk youth, concerning Fetal Alcohol

Syndrome and Fetal Alcohol Effect;

‘‘(C) public and community awareness programs

concerning Fetal Alcohol Syndrome and Fetal Alcohol

Effect; and

‘‘(D) strategies to coordinate information and services

across affected community agencies, including agencies

providing social services such as foster care, adoption, and

social work, medical and mental health services, and agencies involved in education, vocational training and civil

and criminal justice;

‘‘(2) a prevention and diagnosis program to support clinical

studies, demonstrations and other research as appropriate to—

‘‘(A) develop appropriate medical diagnostic methods

for identifying Fetal Alcohol Syndrome and Fetal Alcohol

Effect; and

‘‘(B) develop effective prevention services and interventions for pregnant, alcohol-dependent women; and

‘‘(3) an applied research program concerning intervention

and prevention to support and conduct service demonstration

projects, clinical studies and other research models providing

advocacy, educational and vocational training, counseling, medical and mental health, and other supportive services, as well

as models that integrate and coordinate such services, that

are aimed at the unique challenges facing individuals with

Fetal Alcohol Syndrome or Fetal Alcohol Effect and their families.

‘‘(b) GRANTS AND TECHNICAL ASSISTANCE.—The Secretary may

award grants, cooperative agreements and contracts and provide

technical assistance to eligible entities described in section 399H

to carry out subsection (a).

‘‘(c) DISSEMINATION OF CRITERIA.—In carrying out this section,

the Secretary shall develop a procedure for disseminating the Fetal
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Alcohol Syndrome and Fetal Alcohol Effect diagnostic criteria developed pursuant to section 705 of the ADAMHA Reorganization Act

(42 U.S.C. 485n note) to health care providers, educators, social

workers, child welfare workers, and other individuals.

‘‘(d) NATIONAL TASK FORCE.—

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

force to be known as the National Task Force on Fetal Alcohol

Syndrome and Fetal Alcohol Effect (referred to in this subsection as the ‘Task Force’) to foster coordination among all

governmental agencies, academic bodies and community groups

that conduct or support Fetal Alcohol Syndrome and Fetal

Alcohol Effect research, programs, and surveillance, and otherwise meet the general needs of populations actually or potentially impacted by Fetal Alcohol Syndrome and Fetal Alcohol

Effect.

‘‘(2) MEMBERSHIP.—The Task Force established pursuant

to paragraph (1) shall—

‘‘(A) be chaired by an individual to be appointed by

the Secretary and staffed by the Administration; and

‘‘(B) include the Chairperson of the Interagency Coordinating Committee on Fetal Alcohol Syndrome of the

Department of Health and Human Services, individuals

with Fetal Alcohol Syndrome and Fetal Alcohol Effect, and

representatives from advocacy and research organizations

such as the Research Society on Alcoholism, the FAS Family Resource Institute, the National Organization of Fetal

Alcohol Syndrome, the Arc, the academic community, and

Federal, State and local government agencies and offices.

‘‘(3) FUNCTIONS.—The Task Force shall—

‘‘(A) advise Federal, State and local programs and

research concerning Fetal Alcohol Syndrome and Fetal

Alcohol Effect, including programs and research concerning

education and public awareness for relevant service providers, school-age children, women at-risk, and the general

public, medical diagnosis, interventions for women at-risk

of giving birth to children with Fetal Alcohol Syndrome

and Fetal Alcohol Effect, and beneficial services for individuals with Fetal Alcohol Syndrome and Fetal Alcohol Effect

and their families;

‘‘(B) coordinate its efforts with the Interagency Coordinating Committee on Fetal Alcohol Syndrome of the

Department of Health and Human Services; and

‘‘(C) report on a biennial basis to the Secretary and

relevant committees of Congress on the current and

planned activities of the participating agencies.

‘‘(4) TIME FOR APPOINTMENT.—The members of the Task

Force shall be appointed by the Secretary not later than 6

months after the date of enactment of this part.

‘‘SEC. 399H. ELIGIBILITY.

‘‘To be eligible to receive a grant, or enter into a cooperative

agreement or contract under this part, an entity shall—

‘‘(1) be a State, Indian tribal government, local government,

scientific or academic institution, or nonprofit organization;

and

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

at such time, in such manner, and containing such information
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as the Secretary may prescribe, including a description of the

activities that the entity intends to carry out using amounts

received under this part.

‘‘SEC. 399I. AUTHORIZATION OF APPROPRIATIONS.

‘‘(a) IN GENERAL.—There are authorized to be appropriated

to carry out this part, $27,000,000 for each of the fiscal years

1999 through 2003.

‘‘(b) TASK FORCE.—From amounts appropriated for a fiscal year

under subsection (a), the Secretary may use not to exceed $2,000,000

of such amounts for the operations of the National Task Force

under section 399G(d).

‘‘SEC. 399J. SUNSET PROVISION.

‘‘This part shall not apply on the date that is 7 years after

the date on which all members of the National Task Force have

been appointed under section 399G(d)(1).’’.

Speaker of the House of Representatives.

Vice President of the United States and

President of the Senate.