1669 
‘‘(ii) such greater period of time as 
the recipient and the Tribal Health Pro-
gram may agree; 
‘‘(B) provide that the amount of the schol-
arship— 
‘‘(i) may only be expended for— 
‘‘(I) tuition expenses, other rea-
sonable educational expenses, and rea-
sonable living expenses incurred in at-
tendance at the educational institu-
tion; and 
‘‘(II) payment to the recipient of 
a monthly stipend of not more than 
the amount authorized by section 
338(g)(1)(B) of the Public Health 
Service 
Act 
(42 
U.S.C. 
254m(g)(1)(B)), with such amount to 
be reduced pro rata (as determined by 
the Secretary) based on the number of 
hours such student is enrolled, and 
not to exceed, for any year of attend-
ance for which the scholarship is pro-
vided, the total amount required for 
the year for the purposes authorized 
in this clause; and 
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‘‘(ii) may not exceed, for any year of 
attendance for which the scholarship is 
provided, the total amount required for the 
year for the purposes authorized in clause 
(i); 
‘‘(C) require the recipient of such scholar-
ship to maintain an acceptable level of academic 
standing as determined by the educational insti-
tution in accordance with regulations issued 
pursuant to this Act; and 
‘‘(D) require the recipient of such scholar-
ship to meet the educational and licensure re-
quirements appropriate to each health profes-
sion. 
‘‘(3) SERVICE IN OTHER SERVICE AREAS.—The 
contract may allow the recipient to serve in another 
Service Area, provided the Tribal Health Program 
and Secretary approve and services are not dimin-
ished to Indians in the Service Area where the Trib-
al Health Program providing the scholarship is lo-
cated. 
‘‘(e) BREACH OF CONTRACT.— 
‘‘(1) SPECIFIC BREACHES.—An individual who 
has entered into a written contract with the Sec-
retary and a Tribal Health Program under sub-
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section (d) shall be liable to the United States for 
the Federal share of the amount which has been 
paid to him or her, or on his or her behalf, under 
the contract if that individual— 
‘‘(A) fails to maintain an acceptable level 
of academic standing in the educational institu-
tion in which he or she is enrolled (such level 
as determined by the educational institution 
under regulations of the Secretary); 
‘‘(B) is dismissed from such educational 
institution for disciplinary reasons; 
‘‘(C) voluntarily terminates the training in 
such an educational institution for which he or 
she is provided a scholarship under such con-
tract before the completion of such training; or 
‘‘(D) fails to accept payment, or instructs 
the educational institution in which he or she is 
enrolled not to accept payment, in whole or in 
part, of a scholarship under such contract, in 
lieu of any service obligation arising under such 
contract. 
‘‘(2) OTHER BREACHES.—If for any reason not 
specified in paragraph (1), an individual breaches a 
written contract by failing to either begin such indi-
vidual’s service obligation required under such con-
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tract or to complete such service obligation, the 
United States shall be entitled to recover from the 
individual an amount determined in accordance with 
the formula specified in subsection (l) of section 110 
in the manner provided for in such subsection. 
‘‘(3) CANCELLATION UPON DEATH OF RECIPI-
ENT.—Upon the death of an individual who receives 
an Indian Health Scholarship, any outstanding obli-
gation of that individual for service or payment that 
relates to that scholarship shall be canceled. 
‘‘(4) INFORMATION.—The Secretary may carry 
out this subsection on the basis of information re-
ceived from Tribal Health Programs involved or on 
the basis of information collected through such other 
means as the Secretary deems appropriate. 
‘‘(f) RELATION TO SOCIAL SECURITY ACT.—The re-
cipient of a scholarship under this section shall agree, in 
providing health care pursuant to the requirements here-
in— 
‘‘(1) not to discriminate against an individual 
seeking care on the basis of the ability of the indi-
vidual to pay for such care or on the basis that pay-
ment for such care will be made pursuant to a pro-
gram established in title XVIII of the Social Secu-
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rity Act or pursuant to the programs established in 
title XIX or title XXI of such Act; and 
‘‘(2) to accept assignment under section 
1842(b)(3)(B)(ii) of the Social Security Act for all 
services for which payment may be made under part 
B of title XVIII of such Act, and to enter into an 
appropriate agreement with the State agency that 
administers the State plan for medical assistance 
under title XIX, or the State child health plan under 
title XXI, of such Act to provide service to individ-
uals entitled to medical assistance or child health as-
sistance, respectively, under the plan. 
‘‘(g) CONTINUANCE OF FUNDING.—The Secretary 
shall make payments under this section to a Tribal Health 
Program for any fiscal year subsequent to the first fiscal 
year of such payments unless the Secretary determines 
that, for the immediately preceding fiscal year, the Tribal 
Health Program has not complied with the requirements 
of this section. 
‘‘SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS. 
‘‘(a) EMPLOYMENT PREFERENCE.—Any individual 
who receives a scholarship pursuant to section 104 or 106 
shall be given preference for employment in the Service, 
or may be employed by a Tribal Health Program or an 
urban Indian organization, or other agencies of the De-
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partment as available, during any nonacademic period of 
the year. 
‘‘(b) NOT COUNTED TOWARD ACTIVE DUTY SERVICE 
OBLIGATION.—Periods of employment pursuant to this 
subsection shall not be counted in determining fulfillment 
of the service obligation incurred as a condition of the 
scholarship. 
‘‘(c) TIMING; LENGTH OF EMPLOYMENT.—Any indi-
vidual enrolled in a program, including a high school pro-
gram, authorized under section 102(a) may be employed 
by the Service or by a Tribal Health Program or an urban 
Indian organization during any nonacademic period of the 
year. Any such employment shall not exceed 120 days dur-
ing any calendar year. 
‘‘(d) NONAPPLICABILITY
OF
COMPETITIVE
PER-
SONNEL SYSTEM.—Any employment pursuant to this sec-
tion shall be made without regard to any competitive per-
sonnel system or agency personnel limitation and to a po-
sition which will enable the individual so employed to re-
ceive practical experience in the health profession in which 
he or she is engaged in study. Any individual so employed 
shall receive payment for his or her services comparable 
to the salary he or she would receive if he or she were 
employed in the competitive system. Any individual so em-
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ployed shall not be counted against any employment ceil-
ing affecting the Service or the Department. 
‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES. 
‘‘In order to encourage scholarship and stipend re-
cipients under sections 104, 105, 106, and 115 and health 
professionals, including community health representatives 
and emergency medical technicians, to join or continue in 
an Indian Health Program and to provide their services 
in the rural and remote areas where a significant portion 
of Indians reside, the Secretary, acting through the Serv-
ice, may— 
‘‘(1) provide programs or allowances to transi-
tion into an Indian Health Program, including li-
censing, board or certification examination assist-
ance, and technical assistance in fulfilling service ob-
ligations under sections 104, 105, 106, and 115; and 
‘‘(2) provide programs or allowances to health 
professionals employed in an Indian Health Program 
to enable them for a period of time each year pre-
scribed by regulation of the Secretary to take leave 
of their duty stations for professional consultation, 
management, leadership, and refresher training 
courses. 
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‘‘SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PRO-
GRAM. 
‘‘(a) IN GENERAL.—Under the authority of the Act 
of November 2, 1921 (25 U.S.C. 13) (commonly known 
as the ‘Snyder Act’), the Secretary, acting through the 
Service, shall maintain a Community Health Representa-
tive Program under which Indian Health Programs— 
‘‘(1) provide for the training of Indians as com-
munity health representatives; and 
‘‘(2) use such community health representatives 
in the provision of health care, health promotion, 
and disease prevention services to Indian commu-
nities. 
‘‘(b) DUTIES.—The Community Health Representa-
tive Program of the Service, shall— 
‘‘(1) provide a high standard of training for 
community health representatives to ensure that the 
community health representatives provide quality 
health care, health promotion, and disease preven-
tion services to the Indian communities served by 
the Program; 
‘‘(2) in order to provide such training, develop 
and maintain a curriculum that— 
‘‘(A) combines education in the theory of 
health care with supervised practical experience 
in the provision of health care; and 
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‘‘(B) provides instruction and practical ex-
perience in health promotion and disease pre-
vention activities, with appropriate consider-
ation given to lifestyle factors that have an im-
pact on Indian health status, such as alco-
holism, family dysfunction, and poverty; 
‘‘(3) maintain a system which identifies the 
needs of community health representatives for con-
tinuing education in health care, health promotion, 
and disease prevention and develop programs that 
meet the needs for continuing education; 
‘‘(4) maintain a system that provides close su-
pervision of Community Health Representatives; 
‘‘(5) maintain a system under which the work 
of Community Health Representatives is reviewed 
and evaluated; and 
‘‘(6) promote traditional health care practices 
of the Indian Tribes served consistent with the Serv-
ice standards for the provision of health care, health 
promotion, and disease prevention. 
‘‘SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT 
PROGRAM. 
‘‘(a) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Service, shall establish and administer a pro-
gram to be known as the Service Loan Repayment Pro-
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gram (hereinafter referred to as the ‘Loan Repayment 
Program’) in order to ensure an adequate supply of 
trained health professionals necessary to maintain accredi-
tation of, and provide health care services to Indians 
through, Indian Health Programs and urban Indian orga-
nizations. 
‘‘(b) ELIGIBLE INDIVIDUALS.—To be eligible to par-
ticipate in the Loan Repayment Program, an individual 
must— 
‘‘(1)(A) be enrolled— 
‘‘(i) in a course of study or program in an 
accredited educational institution (as deter-
mined 
by 
the 
Secretary 
under 
section 
338B(b)(1)(c)(i) of the Public Health Service 
Act (42 U.S.C. 254l–1(b)(1)(c)(i))) and be 
scheduled to complete such course of study in 
the same year such individual applies to partici-
pate in such program; or 
‘‘(ii) in an approved graduate training pro-
gram in a health profession; or 
‘‘(B) have— 
‘‘(i) a degree in a health profession; and 
‘‘(ii) a license to practice a health profes-
sion; 
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‘‘(2)(A) be eligible for, or hold, an appointment 
as a commissioned officer in the Regular or Reserve 
Corps of the Public Health Service; 
‘‘(B) meet the professional standards for civil 
service employment in the Service; or 
‘‘(C) be employed in an Indian Health Program 
or urban Indian organization without a service obli-
gation; and 
‘‘(3) submit to the Secretary an application for 
a contract described in subsection (e). 
‘‘(c) APPLICATION.— 
‘‘(1) INFORMATION
TO
BE
INCLUDED
WITH 
FORMS.—In disseminating application forms and 
contract forms to individuals desiring to participate 
in the Loan Repayment Program, the Secretary 
shall include with such forms a fair summary of the 
rights and liabilities of an individual whose applica-
tion is approved (and whose contract is accepted) by 
the Secretary, including in the summary a clear ex-
planation of the damages to which the United States 
is entitled under subsection (l) in the case of the in-
dividual’s breach of contract. The Secretary shall 
provide such individuals with sufficient information 
regarding the advantages and disadvantages of serv-
ice as a commissioned officer in the Regular or Re-
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serve Corps of the Public Health Service or a civil-
ian employee of the Service to enable the individual 
to make a decision on an informed basis. 
‘‘(2) CLEAR LANGUAGE.—The application form, 
contract form, and all other information furnished 
by the Secretary under this section shall be written 
in a manner calculated to be understood by the aver-
age individual applying to participate in the Loan 
Repayment Program. 
‘‘(3) TIMELY
AVAILABILITY
OF
FORMS.—The 
Secretary shall make such application forms, con-
tract forms, and other information available to indi-
viduals desiring to participate in the Loan Repay-
ment Program on a date sufficiently early to ensure 
that such individuals have adequate time to carefully 
review and evaluate such forms and information. 
‘‘(d) PRIORITIES.— 
‘‘(1) LIST.—Consistent with subsection (j), the 
Secretary shall annually— 
‘‘(A) identify the positions in each Indian 
Health Program or urban Indian organization 
for which there is a need or a vacancy; and 
‘‘(B) rank those positions in order of pri-
ority. 
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‘‘(2) APPROVALS.—Consistent with the priority 
determined under paragraph (1), the Secretary, in 
determining which applications under the Loan Re-
payment Program to approve (and which contracts 
to accept), shall— 
‘‘(A) give first priority to applications 
made by individual Indians; and 
‘‘(B) after making determinations on all 
applications submitted by individual Indians as 
required under subparagraph (A), give priority 
to— 
‘‘(i) individuals recruited through the 
efforts of an Indian Health Program or 
urban Indian organization; and 
‘‘(ii) other individuals based on the 
priority rankings under paragraph (1). 
‘‘(e) RECIPIENT CONTRACTS.— 
‘‘(1) CONTRACT REQUIRED.—An individual be-
comes a participant in the Loan Repayment Pro-
gram only upon the Secretary and the individual en-
tering into a written contract described in paragraph 
(2). 
‘‘(2) CONTENTS
OF
CONTRACT.—The written 
contract referred to in this section between the Sec-
retary and an individual shall contain— 
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‘‘(A) an agreement under which— 
‘‘(i) subject to subparagraph (C), the 
Secretary agrees— 
‘‘(I) to pay loans on behalf of the 
individual in accordance with the pro-
visions of this section; and 
‘‘(II) to accept (subject to the 
availability of appropriated funds for 
carrying out this section) the indi-
vidual into the Service or place the in-
dividual with a Tribal Health Pro-
gram or urban Indian organization as 
provided in clause (ii)(III); and 
‘‘(ii) subject to subparagraph (C), the 
individual agrees— 
‘‘(I) to accept loan payments on 
behalf of the individual; 
‘‘(II) in the case of an individual 
described in subsection (b)(1)— 
‘‘(aa) to maintain enrollment 
in a course of study or training 
described in subsection (b)(1)(A) 
until the individual completes the 
course of study or training; and 
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‘‘(bb) while enrolled in such 
course of study or training, to 
maintain an acceptable level of 
academic standing (as deter-
mined under regulations of the 
Secretary by the educational in-
stitution offering such course of 
study or training); and 
‘‘(III) to serve for a time period 
(in this section referred to as the ‘pe-
riod of obligated service’) equal to 2 
years or such longer period as the in-
dividual may agree to serve in the 
full-time clinical practice of such indi-
vidual’s 
profession 
in 
an 
Indian 
Health Program or urban Indian or-
ganization to which the individual 
may be assigned by the Secretary; 
‘‘(B) a provision permitting the Secretary 
to extend for such longer additional periods, as 
the individual may agree to, the period of obli-
gated service agreed to by the individual under 
subparagraph (A)(ii)(III); 
‘‘(C) a provision that any financial obliga-
tion of the United States arising out of a con-
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tract entered into under this section and any 
obligation of the individual which is conditioned 
thereon is contingent upon funds being appro-
priated for loan repayments under this section; 
‘‘(D) a statement of the damages to which 
the United States is entitled under subsection 
(k) for the individual’s breach of the contract; 
and 
‘‘(E) such other statements of the rights 
and liabilities of the Secretary and of the indi-
vidual, not inconsistent with this section. 
‘‘(f) DEADLINE FOR DECISION ON APPLICATION.— 
The Secretary shall provide written notice to an individual 
within 21 days on— 
‘‘(1) the Secretary’s approving, under sub-
section (e)(1), of the individual’s participation in the 
Loan Repayment Program, including extensions re-
sulting in an aggregate period of obligated service in 
excess of 4 years; or 
‘‘(2) the Secretary’s disapproving an individ-
ual’s participation in such Program. 
‘‘(g) PAYMENTS.— 
‘‘(1) IN GENERAL.—A loan repayment provided 
for an individual under a written contract under the 
Loan Repayment Program shall consist of payment, 
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demonstration projects for a period not to exceed 3 years 
to enable Indian Health Programs and urban Indian orga-
nizations to recruit, place, and retain health professionals 
to meet their staffing needs. 
‘‘(b) ELIGIBLE ENTITIES; APPLICATION.—Any In-
dian Health Program or Urban Indian organization may 
submit an application for funding of a project pursuant 
to this section. 
‘‘SEC. 114. ADVANCED TRAINING AND RESEARCH. 
‘‘(a) DEMONSTRATION PROGRAM.—The Secretary, 
acting through the Service, shall establish a demonstration 
project to enable health professionals who have worked in 
an Indian Health Program or urban Indian organization 
for a substantial period of time to pursue advanced train-
ing or research areas of study for which the Secretary de-
termines a need exists. 
‘‘(b) SERVICE OBLIGATION.—An individual who par-
ticipates in a program under subsection (a), where the 
educational costs are borne by the Service, shall incur an 
obligation to serve in an Indian Health Program or urban 
Indian organization for a period of obligated service equal 
to at least the period of time during which the individual 
participates in such program. In the event that the indi-
vidual fails to complete such obligated service, the indi-
vidual shall be liable to the United States for the period 
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‘‘(G) Injury prevention programs, includ-
ing data collection and evaluation, demonstra-
tion projects, training, and capacity building. 
‘‘(H) Home health care. 
‘‘(I) Community health representatives. 
‘‘(J) Maintenance and improvement. 
‘‘(b) NO OFFSET OR LIMITATION.—Any funds appro-
priated under the authority of this section shall not be 
used to offset or limit any other appropriations made to 
the Service under this Act or the Act of November 2, 1921 
(25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 
or any other provision of law. 
‘‘(c) ALLOCATION; USE.— 
‘‘(1) IN GENERAL.—Funds appropriated under 
the authority of this section shall be allocated to 
Service Units, Indian Tribes, or Tribal Organiza-
tions. The funds allocated to each Indian Tribe, 
Tribal Organization, or Service Unit under this 
paragraph shall be used by the Indian Tribe, Tribal 
Organization, or Service Unit under this paragraph 
to improve the health status and reduce the resource 
deficiency of each Indian Tribe served by such Serv-
ice Unit, Indian Tribe, or Tribal Organization. 
‘‘(2) 
APPORTIONMENT
OF
ALLOCATED 
FUNDS.—The apportionment of funds allocated to a 
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