I
103D CONGRESS
2D SESSION
H. R. 3869
To amend the Public Health Service Act to revise and extend programs
relating to the health of individuals who are members of minority groups,
and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 11, 1994
Mr. WAXMAN (for himself, Mr. SYNAR, Mr. RICHARDSON, Mr. TOWNS, Mr.
WASHINGTON, Mr. UPTON, Mr. FRANKS of Connecticut, Mr. MINETA,
Mr. MATSUI, Mr. SERRANO, Mr. GUTIERREZ, Mr. PASTOR, Mr.
MENENDEZ, 
Mr. 
ROMERO-BARCELO´, 
Ms. 
VELA´ZQUEZ, 
and 
Mr.
UNDERWOOD) introduced the following bill; which was referred to the
Committee on Energy and Commerce
A BILL
To amend the Public Health Service Act to revise and extend
programs relating to the health of individuals who are
members of minority groups, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives 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
‘‘Minority Health Improvement Act of 1994’’.
(b) TABLE OF CONTENTS.—The table of contents for
this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—OFFICE OF MINORITY HEALTH
Sec. 101. Revision and extension of programs of Office of Minority Health.
Sec. 102. Establishment of individual offices of minority health within agencies
of Public Health Service.
TITLE II—PRIMARY HEALTH SERVICES
Sec. 201. Migrant health centers; community health centers.
Sec. 202. Health services for the homeless.
Sec. 203. Health services for residents of public housing.
Sec. 204. Grants to States for loan repayment programs regarding obligated
service of health professionals.
Sec. 205. Grants to States for operation of State offices of rural health.
Sec. 206. Demonstration grants to States for community scholarship programs
regarding obligated service of health professionals.
Sec. 207. Programs regarding birth defects.
Sec. 208. Healthy start for infants.
Sec. 209. Demonstration projects regarding diabetic-retinopathy.
TITLE III—HEALTH PROFESSIONS PROGRAMS
Sec. 301. Primary care scholarships for students from disadvantaged back-
grounds.
Sec. 302. Scholarships generally; certain other purposes.
Sec. 303. Loan repayments and fellowships regarding faculty positions.
Sec. 304. Centers of Excellence.
Sec. 305. Educational assistance regarding undergraduates.
Sec. 306. Student loans regarding schools of nursing.
Sec. 307. Federally-supported student loans funds.
TITLE IV—RESEARCH
Sec. 401. Office of Research on Minority Health.
Sec. 402. Activities of Agency for Health Care Policy and Research.
Sec. 403. Data collection by National Center for Health Statistics.
TITLE V—NATIVE HAWAIIAN HEALTH CARE
Sec. 501. Clarification of 1992 amendments.
Sec. 502. Amendment of Native Hawaiian Health Care Improvement Act to re-
flect 1992 agreement.
Sec. 503. Repeal of Public Health Service Act provision.
TITLE VI—MISCELLANEOUS PROVISIONS
Sec. 601. Technical amendment to Indian Health Care Improvement Act.
Sec. 602. Health services for Pacific Islanders.
Sec. 603. Technical corrections regarding Public Law 103-183.
Sec. 604. Certain authorities of Centers for Disease Control and Prevention.
TITLE VII—GENERAL PROVISIONS
Sec. 701. Effective date.
TITLE I—OFFICE OF MINORITY
HEALTH
SEC. 101. REVISION AND EXTENSION OF PROGRAMS OF OF-
FICE OF MINORITY HEALTH.
(a) IN GENERAL.—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 follow-
ing:
‘‘(b) DUTIES.—With respect to improving the health
of minority groups, the Secretary shall carry out the fol-
lowing:
‘‘(1) In consultation with the advisory council
under subsection (c), establish goals and objectives
regarding disease prevention, health promotion, serv-
ice delivery, and research, and coordinate all activi-
ties within the Department of Health and Human
Services that relate to such goals and objectives.
‘‘(2) In consultation with such council, enter
into interagency agreements with other agencies of
the Service, and under such agreements provide
amounts to such agencies, to carry out the following:
‘‘(A) Support research, demonstrations and
evaluations to test new and innovative models
of delivering services.
‘‘(B) Increase knowledge and understand-
ing of health risk factors.
‘‘(C) Ensure that the National Center for
Health Statistics collects data on the health
status of each minority group.
‘‘(D) 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 indi-
viduals to such services by developing and car-
rying out programs to provide bilingual or in-
terpretive services.
‘‘(3) Establish by contract a center to carry out
the following:
‘‘(A) Facilitate the exchange of informa-
tion regarding matters relating to health infor-
mation 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 re-
spect to the exchange of such information (in-
cluding facilitating the development of materials
for such technical assistance).
‘‘(4)(A) Establish by contract a center for the
purpose of carrying out programs to improve access
to health care services for individuals who lack pro-
ficiency in speaking the English language by devel-
oping and carrying out programs to provide bilingual
or interpretive services.
‘‘(B) In carrying out subparagraph (A), ensure
that—
‘‘(i) the center under such subparagraph
conducts research, develops and evaluates model
projects, and provides technical assistance to
health care providers; and
‘‘(ii) such center is not operated by the en-
tity that operates the center established under
paragraph (3).
‘‘(c) ADVISORY COMMITTEE.—
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish an advisory committee to be known as the Advi-
sory Committee on Minority Health (in this sub-
section referred to as the ‘Committee’).
‘‘(2) DUTIES.—The Committee shall provide
advice to the Secretary on carrying out this section,
including advice on carrying out paragraphs (1) and
(2) of subsection (b) for each minority group.
‘‘(3) COMPOSITION.—
‘‘(A) The Committee shall be composed of
12 voting members appointed in accordance
with subparagraph (B) and the nonvoting, ex
officio members designated under subparagraph
(C).
‘‘(B) The voting members of the Commit-
tee shall be appointed from among individuals
who have expertise regarding the health status
of minority groups and the access of such
groups to health services, which individuals are
not officers or employees of the Federal Gov-
ernment. The appointed membership of the
Committee shall be broadly representative of
the various minority groups.
‘‘(C) The Secretary shall designate as ex
officio members of the Committee the heads of
the minority health offices referred to in section
1707A.
‘‘(d) APPROPRIATE CONTEXT
OF SERVICES.—The
Secretary shall ensure that information and services pro-
vided pursuant to subsection (b) are provided in the lan-
guage and cultural context that is most appropriate for
the individuals for whom the information and services are
intended.
‘‘(e) EQUITABLE ALLOCATION OF SERVICES.—The
Secretary shall ensure that services provided under sub-
section (b) are equitably allocated among the various mi-
nority groups.
‘‘(f) CONSULTATION WITH INDIVIDUAL MINORITY
HEALTH OFFICES.—In carrying out subsection (b) re-
garding a specified agency, the Secretary shall consult
with the head of the minority health office of the agency.
For purposes of the preceding sentence, the terms ‘speci-
fied agency’ and ‘minority health office’ have the meaning
given such terms in section 1707A(f).
‘‘(g) BIENNIAL REPORTS.—Not later than February
1 of fiscal year 1996 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 evalu-
ating the extent to which such activities have been effec-
tive in improving the health of minority groups. Each such
report shall include the biennial reports submitted to the
Secretary under section 1707A(e) for such years by the
heads of the minority health offices.
‘‘(h) DEFINITION.—For purposes of this section, the
term ‘minority groups’ means African Americans, Amer-
ican Indians, Asian Americans, Hispanics, and Pacific Is-
landers.
‘‘(i) FUNDING.—
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.—
For the purpose of carrying out this section, there
is authorized to be appropriated $21,000,000 for
each of the fiscal years 1995 through 1997.
‘‘(2) ALLOCATION OF FUNDS BY SECRETARY.—
Of the amounts appropriated under paragraph (1)
for a fiscal year, the Secretary shall make available
not less than $3,000,000 for carrying out subsection
(b)(2)(D).’’.
(b) MISCELLANEOUS AMENDMENT.—Section 1707 of
the Public Health Service Act (42 U.S.C. 300u–6) is
amended in the heading for the section by striking ‘‘ES-
TABLISHMENT OF’’.
SEC. 102. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MI-
NORITY HEALTH WITHIN AGENCIES OF PUB-
LIC HEALTH SERVICE.
Title XVII of the Public Health Service Act (42
U.S.C. 300u et seq.), as amended by section 302 of Public
Law 102–531 (106 Stat. 3483), is amended by inserting
after section 1707 the following section:
‘‘INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN
PUBLIC HEALTH SERVICE
‘‘SEC. 1707A. (a) IN GENERAL.—The head of each
agency specified in subsection (b)(1) shall establish within
the agency an office to be known as the Office of Minority
Health. Each such Office shall be headed by a director,
who shall be appointed by the head of the agency within
which the Office is established, and who shall report di-
rectly to the head of the agency. The head of such agency
shall carry out this section (as this section relates to the
agency) acting through such Director.
‘‘(b) SPECIFIED AGENCIES.—
‘‘(1) IN GENERAL.—The agencies referred to in
subsection (a) are the following:
‘‘(A) The Centers for Disease Control and
Prevention.
‘‘(B) The Agency for Health Care Policy
and Research.
‘‘(C) The Health Resources and Services
Administration.
‘‘(D) The Substance Abuse and Mental
Health Services Administration.
‘‘(2) NATIONAL INSTITUTES OF HEALTH.—For
purposes of subsection (c) and the subsequent provi-
sions of this section, the term ‘minority health office’
includes the Office of Research on Minority Health
established within the National Institutes of Health.
The Director of the National Institutes of Health
shall carry out this section (as this section relates to
the agency) acting through the Director of such Of-
fice.
‘‘(c) COMPOSITION.—The head of each specified
agency shall ensure that the officers and employees of the
minority health office of the agency are, collectively, expe-
rienced in carrying out community-based health programs
for each of the various minority groups that are present
in significant numbers in the United States. The head of
such agency shall ensure that, of such officers and employ-
ees who are members of minority groups, no such group
is disproportionately represented.
‘‘(d) DUTIES.—Each Director of a minority health of-
fice shall monitor the programs of the specified agency of
such office in order to—
‘‘(A) determine the extent to which the pur-
poses of the programs are being carried out with re-
spect to minority groups;
‘‘(B) determine the extent to which members of
such groups are represented among the Federal offi-
cers and employees who administer the programs;
and
‘‘(C) make recommendations to the head of
such agency on carrying out the programs with re-
spect to such groups.
‘‘(e) BIENNIAL REPORTS TO SECRETARY.—The head
of each specified agency shall submit to the Secretary for
inclusion in each biennial report under section 1707(g)
(without change) a biennial report describing—
‘‘(1) the extent to which the minority health of-
fice of the agency employs individuals who are mem-
bers of minority groups, including a specification by
minority group of the number of such individuals
employed by such office; and
‘‘(2) the manner in which the agency is comply-
ing with Public Law 94–311 (relating to data on
Americans of Spanish origin or descent).
‘‘(f) DEFINITIONS.—For purposes of this section:
‘‘(1) The term ‘minority health office’ means an
office established under subsection (a), subject to
subsection (b)(2).
‘‘(2) The term ‘minority group’ has the mean-
ing given such term in section 1707(h).
‘‘(3) The term ‘specified agency’ means—
‘‘(A) an agency specified in subsection
(b)(1); and
‘‘(B) the National Institutes of Health.
‘‘(g) FUNDING.—
(1) ALLOCATIONS.—Of the amounts appro-
priated for a specified agency for a fiscal year, the
Secretary may reserve not more than 0.5 percent for
the purpose of carrying out activities under this sec-
tion through the minority health office of the agen-
cy. In reserving an amount under the preceding sen-
tence for a minority health office for a fiscal year,
the Secretary shall reduce, by substantially the same
percentage, the amount that otherwise would be
available for each of the programs of the designated
agency involved.
‘‘(2) AVAILABILITY
OF
FUNDS
FOR
STAFF-
ING.—The purposes for which amounts made avail-
able under paragraph (1) may be expended by a mi-
nority health office include the costs of employing
staff for such office.’’.
TITLE II—PRIMARY HEALTH
SERVICES
SEC. 
201. 
MIGRANT 
HEALTH 
CENTERS; 
COMMUNITY
HEALTH CENTERS.
(a) MIGRANT HEALTH CENTERS.—
(1) TREATMENT
OF
PREGNANT
WOMEN
FOR
SUBSTANCE ABUSE.—Section 329(a) of the Public
Health Service Act (42 U.S.C. 254b(a)) is amend-
ed—
(A) in paragraph (1)(C)—
(i) by inserting ‘‘(i)’’ after ‘‘(C)’’;
(ii) in clause (i) (as so designated), by
adding ‘‘and’’ after the comma at the end;
and
(iii) by adding at the end the follow-
ing clause:
‘‘(ii) to the State official responsible for carry-
ing out programs under subpart II of part B of title
XIX, and in accordance with the provisions of sec-
tion 543 regarding the disclosure of information, a
notification if a pregnant women is provided a refer-
ral for the treatment of substance abuse but the en-
tity involved does not have the capacity to admit ad-
ditional individuals for treatment,’’; and
(B) in paragraph (7)—
(i) in subparagraph (L), by striking
‘‘and’’ at the end;
(ii) by redesignating subparagraph
(M) as subparagraph (N); and
(iii) by inserting after subparagraph
(L) the following subparagraph:
‘‘(M) treatment of pregnant women for sub-
stance abuse; and’’.
(2) OVERLAP IN CATCHMENT AREAS.—Section
329(a) of the Public Health Service Act (42 U.S.C.
254b(a)) is amended by adding at the end the fol-
lowing paragraph:
‘‘(8) In making grants under subsections (c)(1) and
(d)(1), the Secretary may provide for the development and
operation of more than one migrant health center in a
catchment area in any case in which the Secretary deter-
mines that in such area there are workers or other individ-
uals described in subsection (a)(1) (in the matter after
and below subparagraph (H)) who otherwise will have a
shortage of personal health services. The preceding sen-
tence may not be construed as requiring that, in such a
case, the catchment areas of the centers involved be iden-
tical.’’.
(3) OFFSITE
ACTIVITIES.—Section 329(a) of
the Public Health Service Act, as amended by para-
graph (2) of this subsection, is amended by adding
at the end the following paragraph:
‘‘(9) In making grants under this section, the Sec-
retary may, to the extent determined by the Secretary to
be appropriate, authorize migrant health centers to pro-
vide services at locations other than the center.’’.
(4) AMOUNT
OF
GRANT; USE
OF
CERTAIN
FUNDS.—Section 329(d)(4) of the Public Health
Service Act (42 U.S.C. 254b(d)(4)), as amended by
section 309(a)(3) of Public Law 102–531 (106 Stat.
3500), is amended to read as follows:
‘‘(4)(A) The amount of a grant under paragraph (1)
or under subsection (c) for a migrant health center shall
be determined by the Secretary, taking into account (for
the period for which the grant is made)—
‘‘(i) the costs that the center may reasonably be
expected to incur in carrying out the plan approved
by the Secretary pursuant to subsection (f)(3)(H),
and
‘‘(ii) the amounts that the center may reason-
ably be expected to receive as State, local, and other
operational funding (exclusive of amounts to be pro-
vided in the grant under this section) and as fees,
premiums, and third-party reimbursements.
‘‘(B)(i) Subject to clause (ii), the Secretary may not
restrict the purposes for which a migrant health center
expends the amounts described in subparagraph (A)(ii)
(including restrictions imposed pursuant to Federal cost
principles).
‘‘(ii) The Secretary may require that amounts de-
scribed in subparagraph (A)(ii) be expended for purposes
that are consistent with the purposes specified in this sec-
tion.
‘‘(C)(i) Payments under a grant under this section
shall be made in advance or by way of reimbursement and
in such installments as the Secretary finds necessary. Ad-
justments in such payments may be made for overpay-
ments or underpayments, subject to clause (ii).
‘‘(ii) If, for the period for which a grant is made
under paragraph (1) to a migrant health center, the sum
of the amount of the grant and the amounts described in
subparagraph (A)(ii) that the center actually received ex-
ceeded the costs of the center in carrying out the plan
approved by the Secretary pursuant to subsection
(f)(3)(H), then the center is entitled to retain such excess
amount if the center agrees to expend such amount only
for the following purposes:
‘‘(I) To expand and improve services.
‘‘(II) To increase the number of persons served.
‘‘(III) To acquire, modernize, or expand facili-
ties, or to construct facilities.
‘‘(IV) To improve the administration of service
programs.
‘‘(V) To establish financial reserves.
‘‘(D) With respect to funds that are amounts de-
scribed in subparagraph (A)(ii) or excess amounts de-
scribed in subparagraph (C)(ii), this paragraph may not
be construed as limiting the authority of the Secretary to
require the submission of such plans, budgets, and other
information as may be necessary to ensure that the funds
are expended in accordance with subparagraph (B)(ii), or
clauses (I) through (V) of subparagraph (C)(ii), respec-
tively.’’.
(5) AUTHORIZATION
OF
APPROPRIATIONS.—
Section 329(h) of the Public Health Service Act (42
U.S.C. 254b(h)) is amended—
(A) in paragraph (1)(A), by striking
‘‘1994’’ and inserting ‘‘1998’’; and
(B) in paragraph (2)(A), by striking
‘‘1994’’ and inserting ‘‘1998’’.
(b) COMMUNITY HEALTH CENTERS.—
(1) TREATMENT
OF
PREGNANT
WOMEN
FOR
SUBSTANCE
ABUSE.—Section 330 of the Public
Health Service Act (42 U.S.C. 254c) is amended—
(A) in subsection (a)(3)—
(i) by inserting ‘‘(A)’’ after ‘‘(3)’’;
(ii) in subparagraph (A) (as so des-
ignated), by adding ‘‘and’’ after the
comma at the end; and
(iii) by adding at the end the follow-
ing subparagraph:
‘‘(B) to the State official responsible for carry-
ing out programs under subpart II of part B of title
XIX, and in accordance with the provisions of sec-
tion 543 regarding the disclosure of information, a
notification if a pregnant women is provided a refer-
ral for the treatment of substance abuse but the en-
tity involved does not have the capacity to admit ad-
ditional individuals for treatment,’’; and
(B) in subsection (b)(2)—
(i) in subparagraph (L), by striking
‘‘and’’ at the end;
(ii) by redesignating subparagraph
(M) as subparagraph (N); and
(iii) by inserting after subparagraph
(L) the following subparagraph:
‘‘(M) treatment of pregnant women for sub-
stance abuse; and’’.
(2) OVERLAP IN CATCHMENT AREAS.—Section
330(b) of the Public Health Service Act (42 U.S.C.
254c(b)) is amended by adding at the end the fol-
lowing paragraph:
‘‘(7) In making grants under subsections (c)(1) and
(d)(1), the Secretary may provide for the development and
operation of more than one community health center in
a catchment area in any case in which the Secretary deter-
mines that there is a population group in such area that
otherwise will have a shortage of personal health services.
The preceding sentence may not be construed as requiring
that, in such a case, the catchment areas of the centers
involved be identical.’’.
(3) OFFSITE
ACTIVITIES.—Section 330(b) of
the Public Health Service Act, as amended by para-
graph (2) of this subsection, is amended by adding
at the end the following paragraph:
‘‘(8) In making grants under this section, the Sec-
retary may, to the extent determined by the Secretary to
be appropriate, authorize community health centers to
provide services at locations other than the center.’’.
(4) AMOUNT
OF
GRANT; USE
OF
CERTAIN
FUNDS.—Section 330(d)(4) of the Public Health
Service Act (42 U.S.C. 254c(d)(4)), as amended by
section 309(b)(3) of Public Law 102–531 (106 Stat.
3501), is amended to read as follows:
‘‘(4)(A) The amount of a grant under paragraph (1)
or under subsection (c) for a community health center
shall be determined by the Secretary, taking into account
(for the period for which the grant is made)—
‘‘(i) the costs that the center may reasonably be
expected to incur in carrying out the plan approved
by the Secretary pursuant to subsection (e)(3)(H),
and
‘‘(ii) the amounts that the center may reason-
ably be expected to receive as State, local, and other
operational funding (exclusive of amounts to be pro-
vided in the grant under this section) and as fees,
premiums, and third-party reimbursements.
‘‘(B)(i) Subject to clause (ii), the Secretary may not
restrict the purposes for which a community health center
expends the amounts described in subparagraph (A)(ii)
(including restrictions imposed pursuant to Federal cost
principles).
‘‘(ii) The Secretary may require that amounts de-
scribed in subparagraph (A)(ii) be expended for purposes
that are consistent with the purposes specified in this sec-
tion.
‘‘(C)(i) Payments under a grant under this section
shall be made in advance or by way of reimbursement and
in such installments as the Secretary finds necessary. Ad-
justments in such payments may be made for overpay-
ments or underpayments, subject to clause (ii).
‘‘(ii) If, for the period for which a grant is made
under paragraph (1) to a community health center, the
sum of the amount of the grant and the amounts described
in subparagraph (A)(ii) that the center actually received
exceeded the costs of the center in carrying out the plan
approved by the Secretary pursuant to subsection
(e)(3)(H), then the center is entitled to retain such excess
amount if the center agrees to expend such amount only
for the following purposes:
‘‘(I) To expand and improve services.
‘‘(II) To increase the number of persons served.
‘‘(III) To acquire, modernize, or expand facili-
ties, or to construct facilities.
‘‘(IV) To improve the administration of service
programs.
‘‘(V) To establish financial reserves.
‘‘(D) With respect to funds that are amounts de-
scribed in subparagraph (A)(ii) or excess amounts de-
scribed in subparagraph (C)(ii), this paragraph may not
be construed as limiting the authority of the Secretary to
require the submission of such plans, budgets, and other
information as may be necessary to ensure that the funds
are expended in accordance with subparagraph (B)(ii), or
clauses (I) through (V) of subparagraph (C)(ii), respec-
tively.’’.
(5) AUTHORIZATION
OF
APPROPRIATIONS.—
Section 330(g) of the Public Health Service Act (42
U.S.C. 254c(g)) is amended—
(A) in paragraph (1)(A), by striking
‘‘1994’’ and inserting ‘‘1998’’; and
(B) in paragraph (2)(A), by striking
‘‘1994’’ and inserting ‘‘1998’’.
SEC. 202. HEALTH SERVICES FOR THE HOMELESS.
Section 340(q)(1) of the Public Health Service Act
(42 U.S.C. 256(q)(1)) is amended by striking ‘‘and 1994’’
and inserting ‘‘through 1998’’.
SEC. 203. HEALTH SERVICES FOR RESIDENTS OF PUBLIC
HOUSING.
Section 340A(p)(1) of the Public Health Service Act
(42 U.S.C. 256a(p)(1)) is amended by striking ‘‘and
1993’’ and inserting ‘‘through 1998’’.
SEC. 204. GRANTS TO STATES FOR LOAN REPAYMENT PRO-
GRAMS REGARDING OBLIGATED SERVICE OF
HEALTH PROFESSIONALS.
Section 338I(c) of the Public Health Service Act (42
U.S.C. 254q–1(c)) is amended by adding at the end the
following paragraph:
‘‘(4) PRIVATE PRACTICE.—
‘‘(A) In carrying out the program operated
with a grant under subsection (a), a State may
waive the requirement of paragraph (1) regard-
ing the assignment of a health professional if,
subject to subparagraph (B), the health profes-
sional enters into an agreement with the State
to provide primary health services in a full-time
private clinical practice in a health professional
shortage area.
‘‘(B) The Secretary may not make a grant
under subsection (a) unless the State involved
agrees that, if the State provides a waiver
under subparagraph (A) for a health profes-
sional, section 338D(b)(1) will apply to the
agreement under such subparagraph between
the State and the health professional to the
same extent and in the same manner as such
section applies to an agreement between the
Secretary and a health professional regarding a
full-time private clinical practice.’’.
SEC. 205. GRANTS TO STATES FOR OPERATION OF 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 preced-
ing 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 fol-
lowing: ‘‘, and such sums as may be necessary
for each of the fiscal years 1995 through
1997’’.
SEC. 206. DEMONSTRATION GRANTS TO STATES FOR COM-
MUNITY SCHOLARSHIP PROGRAMS REGARD-
ING OBLIGATED SERVICE OF HEALTH PRO-
FESSIONALS.
Section 338L of the Public Health Service Act (42
U.S.C. 254t) is amended—
(1) by striking ‘‘health manpower shortage’’
each place such term appears and inserting ‘‘health
professional shortage’’;
(2) in subsection (e)—
(A) by striking paragraph (1);
(B) 
by 
redesignating 
paragraphs 
(2)
through (6) as paragraphs (1) through (5), re-
spectively; and
(C) in paragraph (1) (as so redesignated),
by inserting after ‘‘the individual’’ the follow-
ing: ‘‘who is to receive the scholarship under
the contract’’;
(3) in subsection (k)(2), by striking ‘‘internal
medicine, pediatrics,’’ and inserting ‘‘general inter-
nal medicine, general pediatrics,’’; and
(4) in subsection (l)(1)—
(A) by striking ‘‘and’’ after ‘‘1992,’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and such sums as may be necessary
for each of the fiscal years 1995 through
1997’’.
SEC. 207. PROGRAMS REGARDING BIRTH DEFECTS.
Section 317C of the Public Health Service Act (42
U.S.C. 247b–4), as added by section 306 of Public Law
102–531 (106 Stat. 3494), is amended to read as follows:
‘‘PROGRAMS REGARDING BIRTH DEFECTS
‘‘SEC. 317C. (a) The Secretary, acting through the
Director of the Centers for Disease Control and Preven-
tion, shall carry out programs—
‘‘(1) to collect, analyze, and make available data
on birth defects (in manner that facilitates compli-
ance with subsection (d)(2)), including data on the
causes of such defects and on the incidence and
prevalence of such defects;
‘‘(2) to provide information and education to
the public on the prevention of such defects;
‘‘(3) to improve the education, training, and
clinical skills of health professionals with respect to
the prevention of such defects;
‘‘(4) to carry out demonstration projects for the
prevention of such defects; and
‘‘(5) to operate regional centers for the conduct
of research on the prevention of such defects.
‘‘(b) ADDITIONAL PROVISIONS REGARDING COLLEC-
TION OF DATA.—
‘‘(1) IN GENERAL.—In carrying out subsection
(a)(1), the Secretary—
‘‘(A) shall collect and analyze data by gen-
der and by racial and ethnic group, including
Hispanics, non-Hispanic whites, African Ameri-
cans, Native Americans, Asian Americans, and
Pacific Islanders;
‘‘(B) shall collect data under subparagraph
(A) from birth certificates, death certificates,
hospital records, and such other sources as the
Secretary determines to be appropriate; and
‘‘(C) shall encourage States to establish or
improve programs for the collection and analy-
sis of epidemiological data on birth defects, and
to make the data available.
‘‘(2) NATIONAL CLEARINGHOUSE.—In carrying
out subsection (a)(1), the Secretary shall establish
and maintain a National Information Clearinghouse
on Birth Defects to collect and disseminate to health
professionals and the general public information on
birth defects, including the prevention of such de-
fects.
‘‘(c) GRANTS AND CONTRACTS.—
‘‘(1) IN GENERAL.—In carrying out subsection
(a), the Secretary may make grants to and enter
into contracts with public and nonprofit private enti-
ties.
‘‘(2) SUPPLIES
AND
SERVICES
IN
LIEU
OF
AWARD FUNDS.—
‘‘(A) Upon the request of a recipient of an
award of a grant or contract under paragraph
(1), the Secretary may, subject to subparagraph
(B), provide supplies, equipment, and services
for the purpose of aiding the recipient in carry-
ing out the purposes for which the award is
made and, for such purposes, may detail to the
recipient any officer or employee of the Depart-
ment of Health and Human Services.
‘‘(B) With respect to a request described
in subparagraph (A), the Secretary shall reduce
the amount of payments under the award in-
volved by an amount equal to the costs of de-
tailing personnel and the fair market value of
any supplies, equipment, or services provided by
the Secretary. The Secretary shall, for the pay-
ment of expenses incurred in complying with
such request, expend the amounts withheld.
‘‘(3) APPLICATION FOR AWARD.—The Secretary
may make an award of a grant or contract under
paragraph (1) only if an application for the award
is submitted to the Secretary and the application is
in such form, is made in such manner, and contains
such agreements, assurances, and information as the
Secretary determines to be necessary to carry out
the purposes for which the award is to be made.
‘‘(d) BIENNIAL REPORT.—Not later than February
1 of fiscal year 1995 and of every second such year there-
after, the Secretary shall submit to the Committee on En-
ergy and Commerce of the House of Representatives, and
the Committee on Labor and Human Resources of the
Senate, a report that, with respect to the preceding 2 fis-
cal years—
‘‘(1) contains information regarding the inci-
dence and prevalence of birth defects and the extent
to which birth defects have contributed to the inci-
dence and prevalence of infant mortality;
‘‘(2) contains information under paragraph (1)
that is specific to various racial and ethnic groups
(including Hispanics, non-Hispanic whites, African
Americans, Native Americans, and Asian Ameri-
cans);
‘‘(3) contains an assessment of the extent to
which various approaches of preventing birth defects
have been effective;
‘‘(4) describes the activities carried out under
this section; and
‘‘(5) contains any recommendations of the Sec-
retary regarding this section.
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated $5,000,000 for fiscal year 1995, and
such sums as may be necessary for each of the fiscal years
1996 and 1997.’’.
SEC. 208. HEALTHY START FOR INFANTS.
(a) IN GENERAL.—Part D of title III of the Public
Health Service Act (42 U.S.C. 254b et seq.) is amended
by inserting after section 330 the following section:
‘‘HEALTHY START FOR INFANTS
‘‘SEC. 330A. (a) GRANTS
FOR COMPREHENSIVE
SERVICES.—
‘‘(1) IN GENERAL.—The Secretary may make
grants for the operation of not more than 19 dem-
onstration projects to provide the services described
in subsection (b) for the purpose of reducing, in the
geographic areas in which the projects are carried
out—
‘‘(A) the incidence of infant mortality and
morbidity;
‘‘(B) the incidence of fetal deaths;
‘‘(C) the incidence of maternal mortality;
‘‘(D) the incidence of fetal alcohol syn-
drome; and
‘‘(E) the incidence of low-birthweight
births.
‘‘(2) ACHIEVEMENT OF YEAR 2000 HEALTH STA-
TUS OBJECTIVES.—With respect to the objectives es-
tablished by the Secretary for the health status of
the population of the United States for the year
2000, the Secretary shall, in providing for a dem-
onstration project under paragraph (1) in a geo-
graphic area, seek to meet the objectives that are
applicable to the purpose described in such para-
graph and the populations served by the project.
‘‘(b) AUTHORIZED SERVICES.—
‘‘(1) IN GENERAL.—Subject to subsection (h),
the services referred to in this subsection are com-
prehensive services (including preventive and pri-
mary health services for pregnant women and in-
fants and childhood immunizations in accordance
with the schedule recommended by the Secretary)
for carrying out the purpose described in subsection
(a), including services other than health services.
‘‘(2) CERTAIN PROVIDERS.—The Secretary may
make a grant under subsection (a) only if the appli-
cant involved agrees that, in making any arrange-
ments under which other entities provide authorized
services in the demonstration project involved, the
applicant will include among the entities with which
the arrangements are made grantees under any of
sections 329, 330, 340, and 340A, if such grantees
are providing services in the service area of such
project and the grantees are willing to make such
arrangements with the applicant.
‘‘(c) ELIGIBLE GEOGRAPHIC AREAS.—The Secretary
may make a grant under subsection (a) only if—
‘‘(1) the applicant for the grant specifies the
geographic area in which the demonstration project
under such subsection is to be carried out and
agrees that the project will not be carried out in
other areas; and
‘‘(2) for the fiscal year preceding the first fiscal
year for which the applicant is to receive such a
grant, the rate of infant mortality in the geographic
area equals or exceeds 150 percent of the national
average in the United States of such rates.
‘‘(d) MINIMUM QUALIFICATIONS OF GRANTEES.—
‘‘(1) PUBLIC
OR
NONPROFIT
PRIVATE
ENTI-
TIES.—The Secretary may make a grant under sub-
section (a) only if the applicant for the grant is a
State or local department of health, or other public
or nonprofit private entity, or a consortium of public
or nonprofit private entities.
‘‘(2) APPROVAL OF POLITICAL SUBDIVISIONS.—
With respect to a proposed demonstration project
under subsection (a), the Secretary may make a
grant under such subsection only if—
‘‘(A) the chief executive officer of each po-
litical subdivision in the service area of such
project approves the applicant for the grant as
being qualified to carry out the project; and
‘‘(B) the leadership of any Indian tribe or
tribal organization with jurisdiction over any
portion of such area so approves the applicant.
‘‘(3) STATUS AS MEDICAID PROVIDER.—
‘‘(A) In the case of any service described
in subsection (b) that is available pursuant to
the State plan approved under title XIX of the
Social Security Act for a State in which a dem-
onstration project under subsection (a) is car-
ried out, the Secretary may make a grant under
such subsection for the project only if, subject
to subparagraph (B)—
‘‘(i) the applicant for the grant will
provide the service directly, and the appli-
cant has entered into a participation agree-
ment under the State plan and is qualified
to receive payments under such plan; or
‘‘(ii) the applicant will enter into an
agreement with a public or private entity
under which the entity will provide the
service, and the entity has entered into
such a participation agreement under the
State plan and is qualified to receive such
payments.
‘‘(B)(i) In the case of an entity making an
agreement pursuant to subparagraph (A)(ii) re-
garding the provision of services, the require-
ment established in such subparagraph regard-
ing a participation agreement shall be waived
by the Secretary if the entity does not, in pro-
viding health care services, impose a charge or
accept reimbursement available from any third-
party payor, including reimbursement under
any insurance policy or under any Federal or
State health benefits plan.
‘‘(ii) A determination by the Secretary of
whether an entity referred to in clause (i) meets
the criteria for a waiver under such clause shall
be made without regard to whether the entity
accepts voluntary donations regarding the pro-
vision of services to the public.
‘‘(e) STATE APPROVAL OF PROJECT.—With respect
to a proposed demonstration project under subsection (a),
the Secretary may make a grant under such subsection
to the applicant involved only if—
‘‘(1) the chief executive officer of the State in
which the project is to be carried out approves the
proposal of the applicant for carrying out the
project; and
‘‘(2) the leadership of any Indian tribe or tribal
organization with jurisdiction over any portion of the
service area of the project so approves the proposal.
‘‘(f) ELIGIBILITY FOR SERVICES PROVIDED WITH
GRANT FUNDS.—The Secretary may make a grant under
subsection (a) only if the applicant involved agrees as fol-
lows:
‘‘(1) With respect to any authorized service
under subsection (b), if the service is a service that
the State involved is required or has elected to pro-
vide under title XIX of the Social Security Act, the
grant will not be expended to provide the service to
any individual to whom the State is required or has
elected under such title to provide the service.
‘‘(2) The grant will not be expended to make
payment for any item or service to the extent that
payment has been made, or can reasonably be ex-
pected to be made, with respect to such item or serv-
ice—
‘‘(A) under a health insurance policy or
plan (including a group health plan or a pre-
paid health plan);
‘‘(B) under any Federal or State health
benefits program, including any program under
title V, XVIII, or XIX of the Social Security
Act; or
‘‘(C) under subpart II of part B of title
XIX of this Act.
‘‘(g) MAINTENANCE OF EFFORT.—
‘‘(1) GRANTEE.—With respect to authorized
services under subsection (b), the Secretary may
make a grant under subsection (a) only if the appli-
cant involved agrees to maintain expenditures of
non-Federal amounts for such services at a level
that is not less than the level of such expenditures
maintained by the applicant for fiscal year 1991.
‘‘(2) RELEVANT
POLITICAL
SUBDIVISIONS.—
With respect to authorized services under subsection
(b), the Secretary may make a grant under sub-
section (a) only if each political subdivision in the
service area of the demonstration project involved
agrees to maintain expenditures of non-Federal
amounts for such services at a level that is not less
than the level of such expenditures maintained by
the political subdivision for fiscal year 1991.
‘‘(h) RESTRICTIONS ON EXPENDITURE OF GRANT.—
‘‘(1) IN GENERAL.—Except as provided in para-
graph (3), the Secretary may make a grant under
subsection (a) only if the applicant involved agrees
that the grant will not be expended—
‘‘(A) to provide inpatient services, except
with respect to residential treatment for sub-
stance abuse provided in settings other than
hospitals;
‘‘(B) to make cash payments to intended
recipients of health services or mental health
services; or
‘‘(C) to purchase or improve real property
(other than minor remodeling of existing im-
provements to real property) or to purchase
major medical equipment (other than mobile
medical units for providing ambulatory prenatal
services).
‘‘(2) ADMINISTRATIVE
EXPENSES; DATA
COL-
LECTION.—The Secretary may make a grant under
subsection (a) only if the applicant involved agrees
that not more than an aggregate 10 percent of the
grant will be expended for administering the grant
and the collection and analysis of data.
‘‘(3) WAIVER.—If the Secretary finds that the
purpose described in subsection (a) cannot otherwise
be carried out, the Secretary may, with respect to an
otherwise qualified applicant, waive the restriction
established in paragraph (1)(C).
‘‘(i) 
DETERMINATION
OF
CAUSE
OF
INFANT
DEATHS.—The Secretary may make a grant under sub-
section (a) only if the applicant involved—
‘‘(1) agrees to provide for a determination of
the cause of each infant death in the service area of
the demonstration project involved; and
‘‘(2) the applicant has made such arrangements
with public entities as may be necessary to carry out
paragraph (1).
‘‘(j) ANNUAL REPORTS TO SECRETARY.—The Sec-
retary may make a grant under subsection (a) only if the
applicant involved agrees that, for each fiscal year for
which the applicant operates a demonstration project
under such subsection the applicant will, not later than
April 1 of the subsequent fiscal year, submit to the Sec-
retary a report providing the following information with
respect to the project:
‘‘(1) The number of individuals that received
authorized services, and the demographic character-
istics of the population of such individuals.
‘‘(2) The types of authorized services provided,
including the types of ambulatory prenatal services
provided and the trimester of the pregnancy in
which the services were provided.
‘‘(3) The sources of payment for the authorized
services provided.
‘‘(4) The extent to which children under age 2
receiving authorized services have received the ap-
propriate number and variety of immunizations
against vaccine-preventable diseases.
‘‘(5) An analysis of the causes of death deter-
mined under subsection (i).
‘‘(6) The extent of progress being made toward
meeting the health status objectives specified in sub-
section (a)(2).
‘‘(7) The extent to which, in the service area in-
volved, progress is being made toward meeting the
participation goals established for the State by the
Secretary under section 1905(r) of the Social Secu-
rity Act (relating to early periodic screening, diag-
nostic, and treatment services for children under the
age of 21).
‘‘(k) COMMUNITY PARTICIPATION.—The Secretary
may make a grant under subsection (a) only if the appli-
cant involved agrees that, in preparing the proposal of the
applicant for the demonstration project involved, and in
the operation of the project, the applicant will consult with
the residents of the service area for the project and with
public and nonprofit private entities that provide author-
ized services to such residents.
‘‘(l) APPLICATION FOR GRANT.—The Secretary may
make a grant under subsection (a) only if an application
for the grant is submitted to the Secretary and the appli-
cation is in such form, is made in such manner, and con-
tains such agreements, assurances, and information as the
Secretary determines to be necessary to carry out this sub-
section.
‘‘(m) REPORT TO CONGRESS.—Not later than Feb-
ruary 1, 1998, the Secretary shall submit to the Commit-
tee on Energy and Commerce of the House of Representa-
tives, and the Committee on Labor and Human Resources
of the Senate, a report—
‘‘(1) summarizing the reports received by the
Secretary under subsection (j);
‘‘(2) describing the extent to which the Sec-
retary has, in the service areas of such projects,
been successful in meeting the health status objec-
tives specified in subsection (a)(2); and
‘‘(3) describing the extent to which demonstra-
tion projects under subsection (a) have been cost ef-
fective.
‘‘(n) LIMITATION ON CERTAIN EXPENSES OF SEC-
RETARY.—Of the amounts appropriated under subsection
(p) for a fiscal year, the Secretary may not obligate more
than an aggregate 5 percent for the administrative costs
of the Secretary in carrying out this section, for the provi-
sion of technical assistance regarding demonstration
projects under subsection (a), and for evaluations of such
projects.
‘‘(o) DEFINITIONS.—For purposes of this section:
‘‘(1) The term ‘authorized services’ means the
services specified in subsection (b).
‘‘(2) The terms ‘Indian tribe’ and ‘tribal organi-
zation’ have the meaning given such terms in section
4(b) and section 4(c) of the Indian Self-Determina-
tion and Education Assistance Act.
‘‘(3) The term ‘service area’, with respect to a
demonstration project under subsection (a), means
the geographic area specified in subsection (c).
‘‘(p) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated such sums as may be necessary for
each of the fiscal years 1995 through 1997.
‘‘(q) SUNSET.—Effective October 1, 1997, this sec-
tion is repealed.’’.
(b) CERTAIN PROVISIONS REGARDING REPORTS.—
(1) FISCAL YEAR 1995.—With respect to grants
under section 330A of the Public Health Service Act
(as added by subsection (a) of this section), the Sec-
retary of Health and Human Services may make a
grant under such section for fiscal year 1995 only
if the applicant for the grant agrees to submit to the
Secretary, not later than April 1 of such year, a re-
port on any federally-supported project of the appli-
cant that is substantially similar to the demonstra-
tion projects authorized in such section 330A, which
report provides, to the extent practicable, the infor-
mation described in subsection (j) of such section.
(2) FISCAL YEAR 1997.—With respect to grants
for fiscal year 1997 under section 330A of the Pub-
lic Health Service Act (as added by subsection (a)
of this section), the requirement under subsection (j)
of such section that a report be submitted not later
than April 1, 1998, remains in effect notwithstand-
ing the repeal of such section pursuant to subsection
(q) of such section.
(c) LAPSE OF FUNDS.—Effective October 1, 1997,
all unexpended portions of amounts appropriated for
grants under 330A of the Public Health Service Act (as
added by subsection (a) of this section) are unavailable
for obligation or expenditure, without regard to whether
the amounts have been received by the grantees involved.
(d) USE OF GENERAL AUTHORITY UNDER PUBLIC
HEALTH SERVICE ACT.—With respect to the program es-
tablished in section 330A of the Public Health Service Act
(as added by subsection (a) of this section), section 301
of such Act may not be construed as providing to the Sec-
retary of Health and Human Services any authority to
carry out, during any fiscal year in which such program
is in operation, any demonstration project to provide any
of the services specified in subsection (b) of such section
330A.
SEC. 209. DEMONSTRATION PROJECTS REGARDING DIA-
BETIC-RETINOPATHY.
(a) IN GENERAL.—The Secretary of Health and
Human Services, acting through the Director of the Cen-
ters for Disease Control and Prevention and in consulta-
tion with the Director of the National Eye Institute, may
make grants to public and nonprofit private entities for
demonstration projects to serve the populations specified
in subsection (b) by carrying out, with respect to the eye
disorder known as diabetic retinopathy, activities regard-
ing information, identification, dissemination, education,
and prevention.
(b) RELEVANT POPULATIONS.—The populations re-
ferred to in subsection (a) are minority populations that
are at significant risk of contracting diabetes mellitus.
(c) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there is authorized
to be appropriated $1,000,000 for each of the fiscal years
1995 through 1997.
TITLE III—HEALTH
PROFESSIONS PROGRAMS
SEC. 301. PRIMARY CARE SCHOLARSHIPS FOR STUDENTS
FROM DISADVANTAGED BACKGROUNDS.
(a) IN GENERAL.—Section 736 of the Public Health
Service Act (42 U.S.C. 293) is amended to read as follows:
‘‘SEC. 736. PRIMARY CARE SCHOLARSHIPS FOR STUDENTS
FROM DISADVANTAGED BACKGROUNDS.
‘‘(a) IN GENERAL.—The Secretary may in accord-
ance with this section award scholarships to individuals
described in subsection (b) for the purpose of assisting the
individuals with the costs of attending schools of medicine
or osteopathic medicine, schools of dentistry, schools of
nursing (as defined in section 853), graduate programs
in mental health practice, and programs for the training
of physician assistants.
‘‘(b) ELIGIBLE
INDIVIDUALS.—An individual re-
ferred to in subsection (a) is any individual meeting the
following conditions:
‘‘(1) The individual is from a disadvantaged
background.
‘‘(2) The individual is enrolled (or accepted for
enrollment) at an eligible school as a full-time stu-
dent in a program leading to a degree in a health
profession.
‘‘(3) The individual enters into the contract re-
quired pursuant to subsection (d) as a condition of
receiving the scholarship (relating to an agreement
to provide primary health services in a health profes-
sional shortage area designated under section 332).
‘‘(c) PREFERENCES REGARDING AWARDS; SPECIAL
CONSIDERATION.—In awarding scholarships under sub-
section (a), the Secretary shall—
‘‘(1) give preference to eligible individuals for
whom the costs of attending the school involved
would constitute a severe financial hardship; and
‘‘(2) give special consideration to eligible indi-
viduals who received scholarships pursuant to this
section, section 737, or section 740(d)(2) for fiscal
year 1993 or 1994 and are seeking scholarships for
attendance at eligible schools that received a grant
under any of such sections for any of such fiscal
years.
‘‘(d) APPLICABILITY OF CERTAIN PROVISIONS.—Ex-
cept as inconsistent with this section, the provisions of
subpart III of part D of title III apply to an award of
a scholarship under subsection (a) to the same extent and
in the same manner as such provisions apply to an award
of a scholarship under section 338A. This section shall be
carried out by the bureau that administers such subpart
III.
‘‘(e) DEFINITIONS.—For purposes of this section:
‘‘(1) The term ‘eligible individual’ means an in-
dividual described in subsection (b).
‘‘(2) The term ‘eligible school’ means a school
or program specified in subsection (a).
‘‘(f) FUNDING.—
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.—
For the purpose of carrying out this section, there
are authorized to be appropriated $34,000,000 for
fiscal year 1995, $50,000,000 for fiscal year 1996,
and $65,000,000 for fiscal year 1997.
‘‘(2) ALLOCATIONS
BY
SECRETARY.—Of the
amounts appropriated for a fiscal year under para-
graph (1), the Secretary shall make available—
‘‘(A) 20 percent for scholarships under
subsection (a) for attendance at schools of
nursing; and
‘‘(B) 15 percent for scholarships under
such subsection for attendance at graduate pro-
grams in mental health practice.’’.
(b) CERTAIN PROGRAMS OF OBLIGATED SERVICE.—
(1) REPEAL.—Section 795 of the Public Health
Service Act (42 U.S.C. 295n) is repealed.
(2) RULE OF CONSTRUCTION.—Paragraph (1)
does not terminate agreements in effect on the day
before the date of the enactment of this Act pursu-
ant to section 795 of the Public Health Service Act.
Such agreements 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
(whether provided pursuant to other agreements
with the Federal Government or whether provided
otherwise) counts toward satisfaction of the require-
ment of practice pursuant to such section 795.
SEC. 302. SCHOLARSHIPS GENERALLY; CERTAIN OTHER
PURPOSES.
(a) RELEVANT HEALTH PROFESSIONS SCHOOLS.—
Section 737(a)(3) of the Public Health Service Act (42
U.S.C. 293a(a)(3)) is amended—
(1) by striking ‘‘medicine,’’ and all that follows
through ‘‘dentistry,’’; and
(2) by striking ‘‘allied health,’’ and all that fol-
lows and inserting ‘‘allied health.’’.
(b) ELIGIBLE INDIVIDUALS.—
(1) IN
GENERAL.—Section 737(a)(2) of the
Public Health Service Act (42 U.S.C. 293a(a)(2)) is
amended to read as follows:
‘‘(2) ELIGIBLE
INDIVIDUALS.—An individual
referred to in paragraph (1) is any individual meet-
ing the following conditions:
‘‘(A) The individual is from a disadvan-
taged background.
‘‘(B) The individual is enrolled (or accept-
ed for enrollment) as a full-time student in a
health professions school specified in paragraph
(3).
‘‘(C) The individual enters into the con-
tract required pursuant to subsection (e) as a
condition of receiving the scholarship under
paragraph (1) (relating to an agreement to pro-
vide services).’’.
(2) CERTAIN REQUIREMENT.—Section 737 of
the Public Health Service Act (42 U.S.C. 293a) is
amended—
(A) in subsection (a)(1), by striking ‘‘sub-
section (e)’’ and inserting ‘‘subsection (f)’’;
(B) 
by 
redesignating 
subsections 
(e)
through (h) as subsections (f) through (i), re-
spectively; and
(C) by inserting after subsection (d) the
following subsection:
‘‘(e) APPLICABILITY OF CERTAIN PROVISIONS.—
‘‘(1) IN GENERAL.—Except as inconsistent with
this section, and subject to paragraph (2), the provi-
sions of subpart III of part D of title III apply to
an award of a scholarship under subsection (a) to
the same extent and in the same manner as such
provisions apply to an award of a scholarship under
section 338A. This section shall be carried out by
the bureau that administers such subpart III.
‘‘(2) CERTAIN INDIVIDUALS.—
‘‘(A) In the case of an individual who re-
ceives a scholarship under subsection (a) for at-
tendance at a school of veterinary medicine, the
contract referred to in subsection (a)(2)(C) is a
contract under which the individual agrees that,
after completing training in such medicine, the
individual will, in accordance with requirements
established under subparagraph (B), conduct or
assist in the conduct of research regarding
human health or safety. Except as inconsistent
with this section, the provisions specified in
paragraph (1) with respect to title III apply to
such a scholarship to the same extent and in
the same manner as such provisions apply to an
award of a scholarship under section 338A.
‘‘(B) The Secretary shall establish require-
ments regarding contracts under subparagraph
(A).’’.
(c) FUNDING.—Section 737(i) of the Public Health
Service Act, as redesignated by subsection (b)(2) of this
section, is amended—
(1) in paragraph (1), by inserting before the pe-
riod the following: ‘‘, and $6,000,000 for each of the
fiscal years 1994 through 1997’’; and
(2) in paragraph (2)(A), by striking ‘‘30 per-
cent’’ and all that follows and inserting the follow-
ing: ‘‘50 percent for such grants to schools of allied
health; and’’.
SEC. 303. LOAN REPAYMENTS AND FELLOWSHIPS REGARD-
ING FACULTY POSITIONS.
(a) LOAN REPAYMENTS.—Section 738(a) of the Pub-
lic Health Service Act (42 U.S.C. 293b(a)) is amended—
(1) by striking paragraphs (4) and (6);
(2) by redesignating paragraphs (5) and (7) as
paragraphs (4) and (5), respectively; and
(3) in paragraph (4) (as so redesignated), by
amending subparagraph (B) to read as follows:
‘‘(B) the contract referred to in subpara-
graph (A) provides that 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).’’.
(b) AUTHORIZATION OF APPROPRIATIONS REGARD-
ING LOAN REPAYMENTS
AND FELLOWSHIPS.—Section
738(c) of the Public Health Service Act (42 U.S.C.
293b(c)) is amended by striking ‘‘there is’’ and all that
follows and inserting the following: ‘‘there is authorized
to be appropriated $1,000,000 for each of the fiscal years
1995 through 1997.’’.
SEC. 304. CENTERS OF EXCELLENCE.
(a) REFERENCES TO SCHOOLS.—Section 739 of the
Public Health Service Act (42 U.S.C. 293c) is amended—
(1) by striking ‘‘health professions schools’’
each place such term appears and inserting ‘‘des-
ignated health professions schools’’; and
(2) by striking ‘‘health professions school’’ each
place such term appears and inserting ‘‘designated
health professions school’’.
(b) REQUIRED USES OF FUNDS.—Section 739(b) of
the Public Health Service Act (42 U.S.C. 293c(b)), as
amended by subsection (a), is amended—
(1) by striking paragraph (2);
(2) by redesignating paragraph (1) as para-
graph (2);
(3) by inserting before paragraph (2) (as so re-
designated) the following paragraph:
‘‘(1) to collaborate with public and nonprofit
private entities to carry out community-based pro-
grams to recruit students of secondary schools and
institutions of higher education and to prepare the
students academically for attendance at the des-
ignated health professions school;’’;
(4) in paragraph (5)—
(A) by striking ‘‘faculty and student re-
search’’ and inserting ‘‘student research’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, including research on issues relating
to the delivery of health care’’; and
(5)(A) in paragraph (4), by striking ‘‘and’’
after the semicolon at the end;
(B) in paragraph (5), by striking the period at
the end and inserting ‘‘; and’’; and
(C) by adding at the end the following para-
graph:
‘‘(6) to carry out a program to train students
of the school in providing health services to minority
individuals, which program includes training pro-
vided at community-based health facilities that pro-
vide such services to a significant number of minor-
ity individuals and that are located at a site remote
from the main site of the teaching facilities of the
school.’’.
(c) REQUIREMENTS REGARDING CONSORTIA.—
(1) IN
GENERAL.—Section 739(c)(1) of the
Public Health Service Act (42 U.S.C. 293c(c)(1)), as
amended by subsection (a), is amended—
(A) in subparagraph (A), in the matter
preceding clause (i), by striking ‘‘specified in
subparagraph (B)’’ and inserting ‘‘specified in
subparagraphs (B) and (C)’’;
(B) by redesignating subparagraph (C) as
subparagraph (D); and
(C) by inserting after subparagraph (B)
the following subparagraph:
‘‘(C) The condition specified in this sub-
paragraph is that, in accordance with sub-
section (e)(1), the designated health professions
school involved has with other health profession
schools (designated or otherwise) formed a con-
sortium to carry out the purposes described in
subsection (b) at the schools of the consortium.
The grant involved may be expended with re-
spect to the other schools without regard to
whether such schools meet the conditions speci-
fied in subparagraph (B).’’.
(2) CERTAIN REQUIREMENTS.—Section 739(e)
of the Public Health Service Act (42 U.S.C.
293c(e)), as amended by subsection (a), is amended
to read as follows:
‘‘(e) PROVISIONS REGARDING CONSORTIA.—
‘‘(1) REQUIREMENTS.—For purposes of sub-
section (c)(1)(C), a consortium of schools has been
formed in accordance with this subsection if—
‘‘(A) the consortium consists of—
‘‘(i) the designated health professions
school seeking the grant under subsection
(a); and
‘‘(ii) 1 or more schools of medicine,
osteopathic medicine, dentistry, pharmacy,
nursing, allied health, or public health, or
graduate programs in mental health prac-
tice;
‘‘(B) the schools of the consortium have
entered into an agreement for the allocation of
such grant among the schools; and
‘‘(C) each of the schools agrees to expend
the grant in accordance with this section.
‘‘(2) AUTHORITY
REGARDING
NATIVE
AMERI-
CANS 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—
‘‘(A) the school has formed a consortium
in accordance with paragraph (1); and
‘‘(B) the schools of the consortium collec-
tively meet such conditions, without regard to
whether the schools individually meet such con-
ditions.’’.
(3) CONFORMING AMENDMENTS.—Section 739
of the Public Health Service Act (42 U.S.C. 293c),
as amended by subsection (a), is amended—
(A) in subsection (b), in the matter preced-
ing paragraph (1), by inserting ‘‘, subject to
subsection (c)(1)(C),’’ after ‘‘agrees’’; and
(B) in subsection (d)—
(i) in paragraph (3), by striking ‘‘(e)’’
and inserting ‘‘(e)(2)’’; and
(ii) by adding at the end the following
paragraph:
‘‘(4) RULE OF CONSTRUCTION.—Except as pro-
vided in paragraph (3) regarding a consortium
under subsection (e)(2), a health professions school
that does not meet the conditions specified in sub-
section (c)(1)(B) may not be designated as a center
of excellence for purposes of this section. The pre-
ceding sentence applies without regard to whether a
grant under subsection (a) is, pursuant to subsection
(c)(1)(C), being expended with respect to the
school.’’.
(d) 
DEFINITION
OF
HEALTH
PROFESSIONS
SCHOOL.—
(1) GRADUATE PROGRAMS IN MENTAL HEALTH
PRACTICE.—Section 739(h)(1)(A) of the Public
Health Service Act (42 U.S.C. 293c(h)(1)(A)), as
amended by subsection (a), is amended by—
(A) by striking ‘‘or’’ after ‘‘dentistry’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, or a graduate program in mental
health practice’’.
(2) LIMITATION.—During the fiscal years 1995
through 1997, the Secretary of Health and Human
Services may not make more than one grant under
section 739 of the Public Health Service Act directly
to a graduate program in mental health practice (as
defined in section 799 of such Act).
(e) FUNDING.—Section 739(i) of the Public Health
Service Act (42 U.S.C. 293c(i)), as amended by subsection
(a), is amended to read as follows:
‘‘(i) FUNDING.—
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.—
For the purpose of making grants under subsection
(a), there are authorized to be appropriated
$28,000,000 for fiscal year 1995, $30,000,000 for
fiscal year 1996, and $32,000,000 for fiscal year
1997.
‘‘(2) ALLOCATIONS BY SECRETARY.—
‘‘(A) Of the amounts appropriated under
paragraph (1) for a fiscal year, the Secretary
shall make available $12,000,000 for grants
under subsection (a) to health professions
schools that are eligible for such grants pursu-
ant to meeting the conditions described in para-
graph (2)(A) of subsection (c).
‘‘(B) Of the amounts appropriated under
paragraph (1) for a fiscal year and available
after compliance with subparagraph (A), the
Secretary shall make available 65 percent for
grants under subsection (a) to health profes-
sions schools that are eligible for such grants
pursuant to meeting the conditions described in
paragraph (3) or (4) of subsection (c) (includ-
ing meeting conditions pursuant to subsection
(e)(2)).
‘‘(C)(i) Of the amounts appropriated under
paragraph (1) for a fiscal year and available
after compliance with subparagraph (A), the
Secretary shall make available 35 percent for
grants under subsection (a) to health profes-
sions schools that are eligible for such grants
pursuant to meeting the conditions described in
paragraph (5) of subsection (c).
‘‘(ii) With respect to a fiscal year, a grant
under subsection (a) that includes amounts
available under subparagraph (A) may not in-
clude amounts available under clause (i) unless
each of the following conditions is met:
‘‘(I) In the case of amounts available
under subparagraph (B) or clause (i) and
included in grants made pursuant to sub-
section (c)(3), the aggregate number of
such grants is not less than such aggregate
number for the preceding fiscal year, and
one or more of such grants is made in an
amount that is not less than the lowest
amount among grants made from amounts
available under subparagraph (A).
‘‘(II) In the case of amounts available
under subparagraph (B) or clause (i) and
included in grants made pursuant to sub-
section (c)(4), the aggregate number of
such grants is not less than such aggregate
number for the preceding fiscal year, and
one or more of such grants is made in an
amount that is not less than the lowest
amount among grants made from amounts
available under subparagraph (A).
‘‘(III) In the case of amounts avail-
able under clause (i) and included in
grants made pursuant to subsection (c)(5)
(exclusive of grants that include amounts
available under subparagraph (A) or (B)),
the aggregate number of such grants is not
less than such aggregate number for the
preceding fiscal year, and one or more of
such grants is made in an amount that is
not less than the lowest amount among
grants made from amounts available under
subparagraph (A).
‘‘(IV) 
The 
aggregate 
amount 
of
grants under subsection (a) made from
amounts available under subparagraph (B)
and clause (i) (other than grants that in-
clude amounts available under subpara-
graph (A)) is not less than such aggregate
amount for the preceding fiscal year.’’.
(f) CONFORMING AMENDMENTS.—Section 739(b) of
the Public Health Service Act (42 U.S.C. 293c(b)), as
amended by subsection (a), is amended—
(1) in paragraph (3)(B), by striking ‘‘the des-
ignated health professions school’’ and inserting
‘‘the school’’; and
(2) in paragraph (4), in each of subparagraphs
(B) and (C), by striking ‘‘the designated health pro-
fessions school’’ and inserting ‘‘the school’’.
(g) TRANSITIONAL AND SAVINGS PROVISIONS.—
(1) IN GENERAL.—In the case of any entity re-
ceiving a grant under section 739 of the Public
Health Service Act for fiscal year 1994, the Sec-
retary of Health and Human Services may, during
the period specified in paragraph (2), waive any or
all of the additional requirements established pursu-
ant to this section for the receipt or expenditure of
such a grant, subject to the entity providing assur-
ances satisfactory to the Secretary that the entity is
making progress toward meeting such requirements.
(2) RELEVANT PERIOD.—In the case of any en-
tity receiving a grant under section 739 of the Pub-
lic Health Service Act for fiscal year 1994, the pe-
riod referred to in paragraph (1) is the period that,
in first approving the grant, the Secretary specified
as the duration of the grant.
SEC. 305. EDUCATIONAL ASSISTANCE REGARDING UNDER-
GRADUATES.
(a) IN GENERAL.—Section 740 of the Public Health
Service Act (42 U.S.C. 293d) is amended to read as fol-
lows:
‘‘SEC. 740. ASSISTANCE REGARDING HEALTH PROFESSIONS
AS CAREER CHOICE.
‘‘(a) IN GENERAL.—
‘‘(1) ACADEMIC PREPARATION OF STUDENTS.—
Subject to the provisions of this section, the Sec-
retary may make grants and enter into contracts for
purposes of—
‘‘(A) identifying individuals who—
‘‘(i) 
are 
students 
of 
elementary
schools, or students or graduates of sec-
ondary schools or of institutions of higher
education;
‘‘(ii) are from disadvantaged back-
grounds; and
‘‘(iii) are interested in a career in the
health professions; and
‘‘(B) providing to such individuals aca-
demic assistance, counseling, and other services
to prepare the students to meet the academic
requirements for entry into health professions
schools.
‘‘(2) RECIPIENTS
OF
GRANTS
AND
CON-
TRACTS.—The Secretary may make an award of a
grant or contract under paragraph (1) only if the
applicant for the award is a nonprofit private com-
munity-based organization or other public or non-
profit private entity. Such other entities include
schools of medicine, osteopathic medicine, public
health, dentistry, veterinary medicine, optometry,
pharmacy, allied health, chiropractic, and podiatric
medicine, and include graduate programs in mental
health practice.
‘‘(3) CERTAIN
USES
OF
AWARDS.—The pur-
poses for which the Secretary may authorize an
award under paragraph (1) to be expended include
the following:
‘‘(A) Assisting elementary and secondary
schools and institutions of higher education in
developing or improving programs to prepare
students to meet the academic requirements for
entry into health professions schools.
‘‘(B) Establishing arrangements with non-
profit private community-based providers of pri-
mary health services under which students are
provided with opportunities to visit or work at
facilities of such providers and gain experience
regarding a career in a field of primary health
care.
‘‘(C) Developing or improving programs to
enhance the academic preparation of advanced,
prehealth 
professions 
students 
or
postbaccalaureate individuals to successfully
enter a health professions school.
‘‘(D) In the case of an award under para-
graph (1) that the Secretary has authorized to
be expended for the purpose described in sub-
paragraph (B) or (C), paying such stipends as
the Secretary may approve for individuals from
disadvantaged backgrounds 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 of $25 per day (notwith-
standing any other provision of law regarding
the amount of stipends).
‘‘(b) MINIMUM REQUIREMENTS FOR AWARDS.—
‘‘(1) ASSURANCES REGARDING FINANCIAL CA-
PACITY.—The Secretary may make an award of a
grant or contract under subsection (a) only if the
applicant provides assurances satisfactory to the
Secretary that, with respect to the activities for
which the award is to be made, the applicant has or
will have the financial capacity to continue the ac-
tivities after the eligibility of the applicant for such
awards for such activities is terminated pursuant to
subsection (e).
‘‘(2) COLLABORATION
AMONG
VARIOUS
ENTI-
TIES.—The Secretary may make an award of a
grant or contract under subsection (a) only if the
applicant for the award has entered into an agree-
ment with any schools, institutions, community-
based organizations, or other entities with which the
applicant will collaborate in carrying out activities
under the award, and the agreement specifies wheth-
er and to what extent the award will be allocated
among the applicant and the entities.
‘‘(3) MATCHING FUNDS.—
‘‘(A) With respect to the costs of the ac-
tivities to be carried out under subsection (a)
by an applicant, the Secretary may make an
‘‘(f) REQUIREMENT REGARDING GRANTS AND CON-
TRACTS.—Any award of a grant, cooperative agreement,
or contract that the Director of the Office is authorized
to make shall be made only on a competitive basis.
‘‘(g) DEFINITIONS.—For purposes of this section:
‘‘(1) The term ‘minority health conditions’, with
respect to individuals who are members of minority
groups, means all diseases, disorders, and conditions
(including with respect to mental health)—
‘‘(A) unique to, more serious, or more
prevalent in such individuals;
‘‘(B) for which the factors of medical risk
or types of medical intervention are different
for such individuals, or for which it is unknown
whether such factors or types are different for
such individuals; or
‘‘(C) with respect to which there has been
insufficient clinical research involving such indi-
viduals as subjects or insufficient clinical data
on such individuals.
‘‘(2) The term ‘research on minority health’
means research on minority health conditions, in-
cluding research on preventing such conditions.
‘‘(3) The term ‘minority groups’ has the mean-
ing given such term in section 1707(h).’’.