‘‘(3) the sites provide evidence of valid, appro-
priate and feasible assessment methods and tools
and a willingness to use common data items and in-
struments across such sites.
‘‘(e) REPORTING REQUIREMENTS.—Not later than 1
year after an entity first receives an award under sub-
section (a), and not less than once during each 1-year pe-
riod thereafter for which such an award is made to the
entity, the entity shall prepare and submit to the Sec-
retary a report containing a description of the activities
under this section conducted during the period for which
the report is prepared, and the findings derived as a result
of such activities.
‘‘(f) TERM
OF
EVALUATIONS.—Evaluations con-
ducted under this section shall be for a period of not less
than 3 years and may continue as necessary to permit the
grantee to adequately measure the full benefit of the eval-
uations.
‘‘(g) DISSEMINATION AND GUIDELINES.—
‘‘(1) CONSULTATION.—The Secretary shall
carry out this subsection acting through the Director
of the Centers for Disease Control and Prevention
and the Administrator for Health Care Policy and
Research.
‘‘(2) GUIDELINES.—The Secretary shall, where
feasible and practical, develop and issue practice
guidelines that are based on the results of evalua-
tions conducted under this section. The practice
guidelines shall be developed by the Secretary utiliz-
ing expert practitioners to assist in the development
and implementation of these guidelines.
‘‘(3) DATA.—
‘‘(A) IN
GENERAL.—The Secretary shall
collect, store, analyze, and make available data
related to the formulation of the guidelines that
is provided to the Centers for Disease Control
and Prevention by entities conducting evalua-
tions under this section.
‘‘(B) 
USE
OF
DATA.—The 
Secretary
shall—
‘‘(i) identify activities that prevent
disease, illness, injury and disability, and
promote good health practices; ascertain
their cost-effectiveness; and identify their
potential to overall health status with re-
spect to Healthy People 2000 Objectives;
‘‘(ii) disseminate practice guidelines to
State and county health departments,
State insurance departments, insurance
companies, employers, professional medical
organizations, and others determined ap-
propriate by the Secretary; and
‘‘(iii) provide information with respect
to recidivism rates of participation in the
evaluations.
‘‘(4) DISSEMINATION.—The Secretary may dis-
seminate information collected from evaluations
under this section.
‘‘(h) LIMITATION.—Amounts appropriated for carry-
ing out this section shall not be utilized to provide services.
‘‘Subtitle 
B—Opportunities 
for
Education and Training in Pub-
lic Health
‘‘PART 1—SCHOLARSHIP AND LOAN REPAYMENT
PROGRAMS REGARDING SERVICE IN PUBLIC
HEALTH POSITIONS
‘‘SEC. 2721. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
‘‘For the purpose of carrying out this part, there are
authorized 
to 
be 
appropriated 
from 
the 
Fund,
$50,000,000 for each of the fiscal years 1996 through
2000.
‘‘SEC. 2722. SCHOLARSHIP PROGRAM.
‘‘(a) IN GENERAL.—The Secretary, acting through
the Administrator of the Health Resources and Services
Administration and in consultation with the Director of
the Centers for Disease Control and Prevention, shall
carry out a program under which the Secretary awards
scholarships to individuals described in subsection (b) for
the purpose of assisting the individuals with the costs of
attending public and nonprofit private schools of public
health (or other public or nonprofit private institutions
providing graduate or specialized training in public
health).
‘‘(b) ELIGIBLE
INDIVIDUALS.—An individual re-
ferred to in subsection (a) is any individual meeting the
following conditions:
‘‘(1) The individual is enrolled (or accepted for
enrollment) at a school or other institution referred
to in subsection (a) as a full-time or part-time stu-
dent in a program providing training in a health
profession in a field of public health (including the
fields of epidemiology, biostatistics, environmental
health, health administration and planning, behav-
ioral sciences, maternal and child health, occupa-
tional safety, public health nursing, nutrition, and
toxicology).
‘‘(2) 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 services in approved public health posi-
tions, as defined in section 2724).
‘‘(c) ELIGIBLE SCHOOLS.—For fiscal year 1996 and
subsequent fiscal years, the Secretary may make an award
of a scholarship under subsection (a) only if the Secretary
determines that—
‘‘(1) the school or other institution with respect
to which the award is to be provided has coordinated
the activities of the school or institution with rel-
evant activities of the Health Resources and Services
Administration and the Centers for Disease Control
and Prevention; and
‘‘(2) not fewer than 60 percent of the graduates
of the school or institution are in public health posi-
tions determined by the Secretary to be consistent
with the needs of the United States regarding such
professionals.
‘‘(d) APPLICABILITY OF CERTAIN PROVISIONS.—Ex-
cept as inconsistent with this section or section 2724, the
provisions of subpart III of part D of title III (relating
to the Scholarship and Loan Repayment Programs of the
National Health Service Corps) 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.
‘‘SEC. 2723. LOAN REPAYMENT PROGRAM.
‘‘(a) IN GENERAL.—The Secretary, acting through
the Administrator of the Health Resources and Services
Administration and in consultation with the Director of
the Centers for Disease Control and Prevention, shall
carry out a program under which the Federal Government
enters into agreements to repay all or part of the edu-
cational loans of individuals meeting the following condi-
tions:
‘‘(1) The individual involved is a graduate of a
school or other institution described in section
2722(a).
‘‘(2) The individual meets the applicable legal
requirements to provide services as a public health
professional (including a professional in any of the
fields specified in section 2722(b)(1)).
‘‘(3) The individual enters into the contract re-
quired pursuant to subsection (b) as a condition of
the Federal Government repaying such loans (relat-
ing to an agreement to provide services in approved
public health positions, as defined in section 2724).
‘‘(b) APPLICABILITY OF CERTAIN PROVISIONS.—Ex-
cept as inconsistent with this section or section 2724, the
provisions of subpart III of part D of title III (relating
to the Scholarship and Loan Repayment Programs of the
National Health Service Corps) apply to an agreement re-
garding repayment under subsection (a) to the same ex-
tent and in the same manner as such provisions apply to
an agreement regarding repayment under section 338B.
‘‘(c) AMOUNT OF REPAYMENTS.—For each year for
which an individual contracts to serve in an approved pub-
lic health position pursuant to subsection (b), the Sec-
retary may repay not more than $20,000 of the principal
and interest of the educational loans of the individual.
‘‘SEC. 2724. APPROVED PUBLIC HEALTH POSITIONS.
‘‘(a) POSITION REGARDING POPULATIONS WITH SIG-
NIFICANT NEED FOR SERVICES.—
‘‘(1) IN GENERAL.—With respect to the pro-
grams under this part, the obligated service of a
program participant pursuant to sections 2722(d)
and 2723(b) shall be provided through an assign-
ment, to an entity described in subsection (b), for a
position in which the participant provides services as
a public health professional to a population deter-
mined by the Secretary to have a significant unmet
need for the services of such a professional.
‘‘(2) PERIOD
OF
SERVICE.—For purposes of
sections 2722(d) and 2723(d), the period of obli-
gated service is the following, as applicable to the
program participant involved:
‘‘(A) In the case of scholarships under sec-
tion 2722 for full-time students, the greater
of—
‘‘(i) 1 year for each year for which
such a scholarship is provided; or
‘‘(ii) 2 years.
‘‘(B) In the case of scholarships under sec-
tion 2722 for part-time students, a period de-
termined by the Secretary on the basis of the
number of hours of education or training re-
ceived under the scholarship, considering the
percentage constituted by the ratio of such
number to the number of hours for a full-time
student in the program involved.
‘‘(C) In the case of the loan repayments
under section 2723, such period as the Sec-
retary and the participant may agree, except
that the period may not be less than 2 years.
‘‘(b) APPROVAL OF ENTITIES FOR ASSIGNMENT OF
PROGRAM PARTICIPANTS.—The entities referred to in
subsection (a) are public and nonprofit private entities ap-
proved by the Secretary as meeting such requirements for
the assignment of a program participant as the Secretary
may establish. The entities that the Secretary may so ap-
prove include State and local departments of health, public
hospitals, community and neighborhood health clinics, mi-
grant health clinics, community-based health-related orga-
nizations, certified regional poison control centers, pur-
chasing cooperatives regarding health insurance, and any
other public or nonprofit private entity.
‘‘(c) DEFINITIONS.—For purposes of this part:
‘‘(1) The term ‘approved public health position’,
with respect to a program participant, means a posi-
tion to which the participant is assigned pursuant to
subsection (a).
‘‘(2) The term ‘program participant’ means an
individual who enters into a contract pursuant to
section 2722(b)(2) or 2723(a)(3).
‘‘SEC. 2725. ALLOCATION OF FUNDS; SPECIAL CONSIDER-
ATIONS.
‘‘(a) ALLOCATIONS REGARDING NEW PARTICIPANTS
IN SCHOLARSHIP PROGRAM.—Of the amounts appro-
priated under section 2721 for a fiscal year, the Secretary
shall obligate not less than 30 percent for the purpose of
providing awards for scholarships under section 2722 to
individuals who have not previously received such scholar-
ships.
‘‘(b) SPECIAL CONSIDERATION FOR CERTAIN INDI-
VIDUALS.—In making awards of scholarships under sec-
tion 2722 and making repayments under section 2723, the
Secretary shall give special consideration to individuals
who are in the armed forces of the United States or who
are veterans of the armed forces.
‘‘PART 2—EDUCATIONAL INSTITUTIONS
REGARDING PUBLIC HEALTH
‘‘SEC. 2731. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
‘‘For the purpose of carrying out this part from the
Fund, there are authorized to be appropriated from the
Fund, $100,000,000 for each of the fiscal years 1996
through 2000.
‘‘SEC. 2732. GRANTS FOR EXPANDING CAPACITY OF INSTI-
TUTIONS.
‘‘(a) IN GENERAL.—The Secretary may make grants
to institutions described in subsection (b) for the purpose
of expanding the educational capacities of the institutions
through recruiting and retaining faculty, curriculum devel-
opment, and coordinating the activities of the institutions
regarding education, training, and field placements.
‘‘(b) RELEVANT INSTITUTIONS.—The institutions re-
ferred to in subsection (a) are public and nonprofit pri-
vate—
‘‘(1) schools of public health;
‘‘(2) departments of community and preventive
medicine that—
‘‘(A) are within schools of medicine and
schools of osteopathic medicine; and
‘‘(B) have established formal arrangements
with schools of public health in order to award
joint degrees in public health and another
health profession; and
‘‘(3) schools of nursing or dentistry that have
established formal arrangements with schools of
public health in order to carry out educational pro-
grams in public health at the schools of nursing or
dentistry, respectively.
‘‘(c) REQUIREMENTS REGARDING CURRICULUM DE-
VELOPMENT.—A funding agreement for a grant under
subsection (a) for an institution is that, to the extent de-
termined to be appropriate by the Secretary, the curricu-
lum of institution will include the following:
‘‘(1) Subject to subsection (d)(1), part-time
nondegree programs for public health professionals
who need further training in fields of public health.
‘‘(2) With respect to the program of community
health advisors established in part 5 of subtitle E,
a program to train individuals to serve as super-
visors under such part (including training and evalu-
ating the community health advisors), which pro-
gram is carried out in collaboration with local public
health departments and health education and train-
ing centers.
‘‘(3) A program under which the institution col-
laborates with health departments and elementary
and secondary schools to develop a health education
curriculum for use in the program established under
subtitle B of the Public Health Improvement Act of
1994.
‘‘(d) ADDITIONAL REQUIREMENTS.—Funding agree-
ments for a grant under subsection (a) for an institution
are as follows:
‘‘(1) In developing the curriculum under the
grant, the institution will consult with the health de-
partments in the State involved, and will follow the
relevant priorities of such departments.
‘‘(2) The institution will, as appropriate in the
determination of the Secretary, coordinate the activi-
ties of the institution under the grant with relevant
activities of the Health Resources and Services Ad-
ministration and the Centers for Disease Control
and Prevention.
‘‘SEC. 2733. COORDINATION OF GRANT ACTIVITIES WITH
NATIONAL PRIORITIES.
‘‘The Secretary shall—
‘‘(1) determine the needs of the United States
regarding the education and geographic distribution
of public health professionals;
‘‘(2) determine priorities among such needs;
and
‘‘(3) in making grants under section 2732, en-
sure that the curricula developed under such section,
and the expertise of the faculty recruited and re-
tained under such section, are consistent with such
priorities.
‘‘SEC. 2734. CERTAIN REQUIREMENTS FOR GRANTS.
‘‘For fiscal year 1997 and subsequent fiscal years,
the Secretary may make a grant under section 2732 only
if the institution involved is in compliance with the follow-
ing:
‘‘(1) The institution has coordinated the activi-
ties of the school or institution with relevant activi-
ties of the Health Resources and Services Adminis-
tration and the Centers for Disease Control and
Prevention.
‘‘(2) A significant number of the faculty of the
institution has served as practitioners in public
health.
‘‘(3) The institution has consulted with public
health departments and public hospital systems in
the State involved in order to develop a curriculum
that reflects the needs and priorities of the State re-
garding the public health.
‘‘(4) The institution has coordinated the activi-
ties of the institution with the activities of the health
departments and of community groups.
‘‘(5) The institution carries out a program for
part-time students to receive training in fields of
public health.
‘‘(6) Not less than 60 percent of the graduates
of the school or institution are in public health posi-
tions determined by the Secretary to be consistent
with the needs of the United States regarding such
professionals.
‘‘PART 3—EXPANSION OF COMPETENCY IN
PUBLIC HEALTH
‘‘SEC. 2736. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
‘‘For the purpose of carrying out this section, there
is authorized to be appropriated from the Fund,
$60,000,000 for each of the fiscal years 1996 through
2000.
‘‘SEC. 2737. GRANTS TO STATES.
‘‘(a) STATES LACKING ADEQUATE TRAINING PRO-
GRAMS.—
‘‘(1) IN GENERAL.—The Secretary may make
grants to States in which there is either no program
of training in a field of public health, or only one
such program, but in which there are 1 or more
schools of medicine, osteopathic medicine, nursing,
dentistry, social work, pharmacy, or health adminis-
tration. A funding agreement for such a grant is
that the purpose of the grant is for the State in-
volved to assist 1 or more of such schools in develop-
ing and integrating public health curricula for the
schools.
‘‘(2) SPECIAL
CONSIDERATIONS
IN
MAKING
GRANTS.—In making grants under paragraph (1),
the Secretary shall give special consideration to
States that agree to consult with 1 or more schools
of public health in carrying out the purpose de-
scribed in such subsection.
‘‘(b) STATES WITH NONACCREDITED SCHOOLS.—
The Secretary may make grants to States in which there
are 1 or more nonaccredited schools of public health. A
funding agreement for such a grant is that the purpose
of the grant is for the State involved to assist 1 or more
of such schools in improving the schools.
‘‘(c) AMOUNT OF GRANT; LIMITATION REGARDING
INDIVIDUAL EDUCATIONAL ENTITIES.—
‘‘(1) AMOUNT.—The amount of a grant under
this section to a State may not exceed $6,000,000.
‘‘(2) LIMITATION.—A funding agreement for a
grant under this section for a State is that, with re-
spect to the school involved, the State will not pro-
vide more than 2 years of assistance to the school
from grants under this section.
‘‘PART 4—AREA HEALTH EDUCATION CENTERS
‘‘SEC. 2738. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
‘‘(a) ADDITIONAL FUNDING.—For the purpose of
carrying out section 746 with respect to area health edu-
cation center programs, there are authorized to be appro-
priated from the Fund, $35,000,000 for each of the fiscal
years 1996 through 2000.
‘‘(b) RELATION TO OTHER FUNDS.—The authoriza-
tions of appropriations established in subsection (a) are
in addition to any other authorizations of appropriations
that are available for the purpose described in such sub-
section.
‘‘PART 5—HEALTH EDUCATION TRAINING
CENTERS
‘‘SEC. 2739. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
‘‘(a) ADDITIONAL FUNDING.—For the purpose of
carrying out section 746 with respect to health education
and training centers, there are authorized to be appro-
priated from the Fund, $20,000,000 for each of the fiscal
years 1996 through 2000.
‘‘(b) RELATION TO OTHER FUNDS.—The authoriza-
tions of appropriations established in subsection (a) are
in addition to any other authorizations of appropriations
that are available for the purpose described in such sub-
section.
‘‘Subtitle C—Regional Poison
Control Centers
‘‘SEC. 2741. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
‘‘For the purpose of carrying out this subtitle, there
is authorized to be appropriated from the Fund,
$50,000,000 for each of the fiscal years 1996 through
2000.
‘‘SEC. 2742. GRANTS FOR REGIONAL CENTERS.
‘‘(a) IN GENERAL.—The Secretary may make grants
to public and nonprofit private entities for centers to carry
out activities regarding—
‘‘(1) the prevention and treatment of poisoning;
and
‘‘(2) such other activities regarding the control
of poisons as the Secretary determines to be appro-
priate.
‘‘(b) 
REGIONAL
CONSIDERATIONS.—In 
making
grants under subsection (a), the Secretary shall determine
the need in each of the principal geographic regions of
the United States for a center under such subsection, and
shall make the grants according to priorities established
by the Secretary on the basis of the extent of such need
in each of the regions. In carrying out the preceding sen-
tence, the Secretary shall ensure that no two centers re-
ceive grants for the same geographic service area.
‘‘(c) MATCHING FUNDS.—
‘‘(1) IN GENERAL.—With respect to the costs of
an entity in providing for centers under subsection
(a), the Secretary may make a grant under such
subsection only if the State in which the center is to
operate, or other public entities in the State, agree
to make available (directly or through donations
from public or private entities) non-Federal con-
tributions toward such costs in an amount deter-
mined by the Secretary.
‘‘(2) DETERMINATION
OF
AMOUNT
CONTRIB-
UTED.—Non-Federal contributions required under
paragraph (1) may be in cash or in kind, fairly eval-
uated, including plant, equipment, or services.
Amounts provided by the Federal Government, or
services assisted or subsidized to any significant ex-
tent by the Federal Government, may not be in-
cluded in determining the amount of such non-Fed-
eral contributions.
‘‘SEC. 2743. REQUIREMENTS REGARDING CERTIFICATION.
‘‘(a) IN GENERAL.—Subject to subsection (b), the
Secretary may make a grant under section 2742 only if
the center involved has been certified by a professional or-
ganization in the field of poison control, and the Secretary
has approved the organization as having in effect stand-
ards for certification that reasonably provide for the pro-
tection of the public health with respect to poisoning. In
carrying out the preceding sentence, the Secretary shall
consider the standards established by the American Asso-
ciation of Poison Control Centers.
‘‘(b) TEMPORARY
WAIVER.—The Secretary may
waive the requirement of subsection (a) for a center for
a period not exceeding 1 year.
‘‘SEC. 2744. GENERAL PROVISIONS.
‘‘(a) DURATION
OF GRANT.—The period during
which payments are made under a grant under section
2742 may not exceed 3 years. The provision of such pay-
ments is subject to annual approval by the Secretary of
the payments and subject to the availability of appropria-
tions for the fiscal year involved to make the payments.
The preceding sentence may not be construed as establish-
ing a limitation on the number of such grants that may
be made to an entity.
‘‘(b) STUDY REGARDING NEED FOR CENTERS.—
‘‘(1) IN GENERAL.—The Secretary shall con-
duct a study of each of the centers for which a grant
under section 2742 has been provided. The purpose
of the study shall be to determine the effectiveness
of the centers in carrying out the activities described
in such section and the extent to which the activities
have been carried out in a cost-effective manner.
‘‘(2) ALTERNATIVES TO CENTERS.—In carrying
out the study under paragraph (1), the Secretary
shall determine the extent to which the activities de-
scribed in section 2742 can be effectively carried out
through means other than centers under such sec-
tion. The alternative means considered by the Sec-
retary under the preceding sentence shall include the
alternative of requiring public and private health
plans to carry out such activities.
‘‘(3) DATE
CERTAIN
FOR
COMPLETION.—Not
later than November 1, 1996, the Secretary shall
submit to the Congress a report describing the find-
ings made in the study under paragraph (1).
‘‘(4) NOTICE
TO
CENTERS.—Not later than
February 1, 1997, the Secretary shall notify each
grantee under section 2742 whether the Secretary
considers the continued operation of the center in-
volved to be necessary in meeting the needs of the
geographic region involved for the activities de-
scribed in such section.
‘‘Subtitle D—School-Related Health
Services
‘‘PART 1—PROJECTS FOR PROVISION OF
SERVICES
‘‘SEC. 2746. AUTHORIZATION OF APPROPRIATIONS FROM
FUND.
‘‘(a) FUNDING
FOR
SCHOOL-RELATED
HEALTH
SERVICES.—For the purpose of carrying out this part,
there are authorized to be appropriated from the Fund,
$100,000,000 for fiscal year 1996, $200,000,000 for fis-
cal year 1997, $300,000,000 for fiscal year 1998,
$400,000,000 for fiscal year 1999, and $500,000,000 for
fiscal year 2000.
‘‘(b) FUNDING FOR PLANNING AND DEVELOPMENT
GRANTS.—Of amounts made available under this section,
not to exceed $10,000,000 for each of fiscal years 1996
and 1997 may be utilized to carry out section 2749.
‘‘SEC. 2747. ELIGIBILITY FOR GRANTS.
‘‘(a) IN GENERAL.—
‘‘(1) PLANNING AND DEVELOPMENT GRANTS.—
Entities eligible to apply for and receive grants
under section 2749 are—
‘‘(A) State health agencies that apply on
behalf of local community partnerships; or
‘‘(B) local community partnerships in
States in which health agencies have not suc-
cessfully applied.
‘‘(2) OPERATIONAL GRANTS.—Entities eligible
to apply for and receive grants under section 2750
are—
‘‘(A) a qualified State as designated under
subsection (c) that apply on behalf of local com-
munity partnerships; or
‘‘(B) local community partnerships in
States that are not designated under subpara-
graph (A).
‘‘(b) LOCAL COMMUNITY PARTNERSHIPS.—
‘‘(1) IN GENERAL.—A local community partner-
ship under subsection (a)(1)(B) and (a)(2)(B) is an
entity that, at a minimum includes—
‘‘(A) a local health care provider, which
may be a local public health department, with
experience in delivering services to children and
youth or medically underserved populations;
‘‘(B) local educational agency on behalf of
one or more public schools; and
‘‘(C) one community based organization lo-
cated in the community to be served that has
a history of providing services to at-risk chil-
dren and youth.
‘‘(2) RURAL COMMUNITIES.—In rural commu-
nities, local partnerships should seek to include, to
the fullest extent practicable, providers and commu-
nity based organizations with experience in serving
the target population.
‘‘(3) PARENT
AND
COMMUNITY
PARTICIPA-
TION.—An applicant described in subsection (a)
shall, to the maximum extent feasible, involve broad-
based community participation (including parents of
the youth to be served).
‘‘(c) QUALIFIED STATE.—A qualified State under
subsection (a)(2)(A) is a State that, at a minimum—
‘‘(1) demonstrates an organizational commit-
ment (including a strategic plan) to providing a
broad range of health, health education and support
services to at-risk youth; and
‘‘(2) has a memorandum of understanding or
cooperative agreement jointly entered into by the
State agencies responsible for health and education
regarding the planned delivery of health and support
services in school-based or school-linked centers.
‘‘SEC. 2748. PREFERENCES.
‘‘In making grants under sections 2749 and 2750,
the Secretary shall give priority to applicants whose-com-
munities to be served show the most substantial level of
need for health services among children and youth.
‘‘SEC. 2749. PLANNING AND DEVELOPMENT GRANTS.
‘‘(a) IN GENERAL.—The Secretary may make grants
during fiscal years 1996 and 1997 to entities eligible
under section 2747 to develop school-based or school-
linked health service sites.
‘‘(b) USE OF FUNDS.—Amounts provided under a
grant under this section may be used for the following:
‘‘(1) Planning for the provision of school health
services, including—
‘‘(A) an assessment of the need for health
services among youth in the communities to be
served;
‘‘(B) the health services to be provided and
how new services will be integrated with exist-
ing services;
‘‘(C) assessing and planning for the mod-
ernization and expansion of existing facilities
and equipment to accommodate such services;
and
‘‘(D) an affiliation with relevant health
plans.
‘‘(2) Recruitment and training of staff for the
administration and delivery of school health services.
‘‘(3) The establishment of local community
partnerships as described in section 2747(b).
‘‘(4) In the case of States, the development of
memorandums of understanding or cooperative
agreements for the coordinated delivery of health
and support services through school health service
sites.
‘‘(5) Other activities necessary to assume oper-
ational status.
‘‘(c) APPLICATION FOR GRANTS.—To be eligible to
receive a grant under this section an entity described in
section 2747(a) shall submit an application in a form and
manner prescribed by the Secretary.
‘‘(d) NUMBER OF GRANTS.—Not more than one plan-
ning grant may be made to a single applicant. A planning
grant may not exceed 2 years in duration.
‘‘(e) AMOUNT
AVAILABLE
FOR
DEVELOPMENT
GRANT.—The Secretary may award not to exceed—
‘‘(1) 
$150,000 
to 
entities 
under 
section
2747(a)(1)(A) and to localities planning for a city-
wide or countywide school health services delivery
system; and
‘‘(2) 
$50,000 
to 
entities 
under 
section
2747(a)(1)(B).
‘‘SEC. 2750. GRANTS FOR OPERATION OF SCHOOL HEALTH
SERVICES.
‘‘(a) IN GENERAL.—The Secretary may make grants
to eligible entities described in section 2747(a)(2) that
submit applications consistent with the requirements of
this section, to pay the cost of operating school-based or
school-linked health service sites.
‘‘(b) USE OF GRANT.—Amounts provided under a
grant under this section may be used for the following—
‘‘(1) health services, including diagnosis and
treatment of simple illnesses and minor injuries;
‘‘(2) preventive health services, including health
screenings follow-up health care, mental health, and
preventive health education;
‘‘(3) enabling services and other necessary sup-
port services;
‘‘(4) training, recruitment, and compensation of
health professionals and other staff necessary for the
administration and delivery of school health services;
and
‘‘(5) referral services, including the linkage of
individuals to health plans, and community-based
health and social service providers.
‘‘(c) APPLICATION FOR GRANT.—To be eligible to re-
ceive a grant under this section an entity described in sec-
tion 2747(a)(2) shall submit an application in a form and
manner prescribed by the Secretary. In order to receive
a grant under this section, an applicant must include in
the application the following information—
‘‘(1) a description of the services to be fur-
nished by the applicant;
‘‘(2) the amounts and sources of funding that
the applicant will expend, including estimates of the
amount of payments the applicant will receive from
health plans and other sources;
‘‘(3) a description of local community partner-
ships, including parent and community participation;
‘‘(4) a description of the linkages with other
health and social service providers; and
‘‘(5) such other information as the Secretary
determines to be appropriate.
‘‘(d) ASSURANCES.—In order to receive a grant
under this section, an applicant must meet the following
conditions—
‘‘(1) school health service sites will, directly or
indirectly, provide a broad range of health services,
in accordance with the determinations of the local
community partnership, that may include—
‘‘(A) diagnosis and treatment of simple ill-
nesses and minor injuries;
‘‘(B) preventive health services, including
health screenings and follow-up health care,
mental health and preventive health education;
‘‘(C) enabling services; and
‘‘(D) referrals (including referrals regard-
ing mental health and substance abuse) with
follow-up to ensure that needed services are re-
ceived;
‘‘(2) the applicant provides services rec-
ommended by the health provider, in consultation
with the local community partnership, and with the
approval of the local education agency;
‘‘(3) the applicant provides the services under
this subsection to adolescents, and other school age
children and their families as deemed appropriate by
the local partnership;
‘‘(4) the applicant maintains agreements with
community-based health care providers with a his-
tory of providing services to such populations for the
provision of health care services not otherwise pro-
vided directly or during the hours when school
health services are unavailable;
‘‘(5) the applicant establishes an affiliation with
relevant health plans and will establish reimburse-
ment procedures and will make every reasonable ef-
fort to collect appropriate reimbursement for serv-
ices provided;
‘‘(6) the applicant agrees to supplement and
not supplant the level of State or local funds under
the direct control of the applying State or participat-
ing local education or health authority expended for
school health services as defined by this part;
‘‘(7) services funded under this Act will be co-
ordinated with existing school health services pro-
vided at a participating school; and
‘‘(8) for applicants in rural areas, the assur-
ances required under paragraph (4) shall be fulfilled
to the maximum extent possible.
‘‘(e) STATE LAWS.—Notwithstanding any other pro-
vision in this part, no school based health clinic may pro-
vide services, to any minor, when to do so is a violation
of State laws or regulations pertaining to informed con-
sent for medical services to minors.
‘‘(f) LIMITATION ON ADMINISTRATIVE FUNDS.—In
the case of a State applying on behalf of local educational
partnerships, the applicant may retain not more than 5
percent of grants awarded under this subpart for adminis-
trative costs.
‘‘(g) DURATION OF GRANT.—A grant under this sec-
tion shall be for a period determined appropriate by the
Secretary.
‘‘(h) AMOUNT OF GRANT.—The annual amount of a
grant awarded under this section shall not be more than
$200,000 per school-based or school-linked health service
site.
‘‘(i) FEDERAL SHARE.—
‘‘(1) IN GENERAL.—Subject to paragraph (3), a
grant for services awarded under this section may
not exceed—
‘‘(A) 90 percent of the non-reimbursed cost
of the activities to be funded under the program
for the first 2 fiscal years for which the pro-
gram receives assistance under this section; and
‘‘(B) 75 percent of the non-reimbursed
cost of such activities for subsequent years for
which the program receives assistance under
this section.
The remainder of such costs shall be made available
as provided in paragraph (2).
‘‘(2) FORM
OF
NON-FEDERAL
SHARE.—The
non-Federal share required by paragraph (1) may be
in cash or in-kind, fairly evaluated, including facili-
ties, equipment, personnel, or services, but may not
include amounts provided by the Federal Govern-
ment. In-kind contributions may include space with-
in a school facilities, school personnel, program use
of school transportation systems, outposted health
personnel, and extension of health provider medical
liability insurance.
‘‘(3) WAIVER.—The Secretary may waive the
requirements of paragraph (1) for any year in ac-
cordance with criteria established by regulation.
Such criteria shall include a documented need for
the services provided under this section and an in-
ability of the grantee to meet the requirements of
paragraph (1) despite a good faith effort.
‘‘(j) TRAINING AND TECHNICAL ASSISTANCE.—Enti-
ties that receive assistance under this section may use not
to exceed 10 percent of the amount of such assistance to
provide staff training and to secure necessary technical as-
sistance. To the maximum extent feasible, technical assist-
ance should be sought through local community-based en-
tities. The limitation contained in this subsection shall
apply to individuals employed to assist in obtaining funds
under this part. Staff training should include the training
of teachers and other school personnel necessary to ensure
appropriate referral and utilization of services, and appro-
priate linkages between class-room activities and services
offered.
‘‘(k) REPORT AND MONITORING.—The Secretary will
submit to the Committee on Labor and Human Resources
in the Senate and the Committee on Energy and Com-
merce in the House of Representatives a biennial report
on the activities funded under this Act, consistent with
the ongoing monitoring activities of the Department. Such
reports are intended to advise the relevant Committees of
the availability and utilization of services, and other rel-
evant information about program activities.
‘‘PART 2—SCHOLARSHIP AND LOAN REPAYMENT
PROGRAMS REGARDING SCHOOL NURSES
‘‘SEC. 2751. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
‘‘For the purpose of carrying out this part, there is
authorized 
to 
be 
appropriated 
from 
the 
Fund,
$10,000,000 for each of the fiscal years 1996 through
2000.
‘‘SEC. 2752. SCHOLARSHIP PROGRAM REGARDING UP-
GRADE IN SKILLS.
‘‘(a) IN GENERAL.—The Secretary, acting through
the Administrator of the Health Resources and Services
Administration and in consultation with the Director of
the Centers for Disease Control and Prevention, shall
carry out a program under which the Secretary awards
scholarships to individuals described in subsection (b) for
the purpose of assisting the individuals with the costs of
attending programs of education in professional nursing
(exclusive of graduate programs in nursing).
‘‘(b) ELIGIBLE
INDIVIDUALS.—An individual re-
ferred to in subsection (a) is any individual meeting the
following conditions:
‘‘(1) The individual is serving or has served as
a school nurse in public or nonprofit private elemen-
tary or secondary school, and the individual is not
a professional nurse.
‘‘(2) The individual is enrolled (or accepted for
enrollment) at a program referred to in subsection
(a) as a full-time or part-time student.
‘‘(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 services as a school nurse).
‘‘(c) APPLICABILITY OF CERTAIN PROVISIONS.—Ex-
cept as inconsistent with this section or section 2754, the
provisions of subpart III of part D of title III (relating
to the Scholarship and Loan Repayment Programs of the
National Health Service Corps) 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.
‘‘SEC. 2753. LOAN REPAYMENT PROGRAM.
‘‘(a) IN GENERAL.—The Secretary, acting through
the Administrator of the Health Resources and Services
Administration and in consultation with the Director of
the Centers for Disease Control and Prevention, shall
carry out a program under which the Federal Government
enters into agreements to repay all or part of the edu-
cational loans of individuals meeting the following condi-
tions:
‘‘(1) The individual is a professional nurse and
meets the applicable legal requirements to serve as
a school nurse.
‘‘(2) The individual enters into the contract re-
quired pursuant to subsection (b) as a condition of
the Federal Government repaying such loans (relat-
ing to an agreement to provide services as a school
nurse).
‘‘(b) APPLICABILITY OF CERTAIN PROVISIONS.—Ex-
cept as inconsistent with this section or section 2754, the
provisions of subpart III of part D of title III (relating
to the Scholarship and Loan Repayment Programs of the
National Health Service Corps) apply to an agreement re-
garding repayment under subsection (a) to the same ex-
tent and in the same manner as such provisions apply to
an agreement regarding repayment under section 338B.
‘‘(c) AMOUNT OF REPAYMENTS.—For each year for
which an individual contracts to serve as school nurse pur-
suant to subsection (b), the Secretary may repay not more
than $20,000 of the principal and interest of the edu-
cational loans of the individual.
‘‘SEC. 2754. SCHOOL-NURSE POSITIONS.
‘‘(a) POSITION REGARDING STUDENTS WITH SIG-
NIFICANT NEED FOR SERVICES.—
‘‘(1) IN GENERAL.—With respect to the pro-
grams under this part, the obligated service of a
program participant pursuant to sections 2752(d)
and 2753(b) shall be provided through an assign-
ment to a school described in subsection (b) for a
position as a school nurse.
‘‘(2) PERIOD
OF
SERVICE.—For purposes of
sections 2752(d) and 2753(d), the period of obli-
gated service is the following, as applicable to the
program participant involved:
‘‘(A) In the case of scholarships under sec-
tion 2752 for full-time students, the greater
of—
‘‘(i) 1 year for each year for which
such a scholarship is provided; or
‘‘(ii) 2 years.
‘‘(B) In the case of scholarships under sec-
tion 2752 for part-time students, a period de-
termined by the Secretary on the basis of the
number of hours of education or training re-
ceived under the scholarship, considering the
percentage constituted by the ratio of such
number to the number of hours for a full-time
student in the program involved.
‘‘(C) In the case of the loan repayments
under section 2753, such period as the Sec-
retary and the participant may agree, except
that the period may not be less than 2 years.
‘‘(b) APPROVAL OF SCHOOLS FOR ASSIGNMENT OF
PROGRAM PARTICIPANTS.—The schools referred to in
subsection (a) are public or nonprofit private elementary
or secondary schools whose students include a significant
number of students with an unmet need for health services
that are provided by school nurses.
‘‘(c) DEFINITIONS.—For purposes of this subpart:
‘‘(1) The term ‘professional nurse’ has the
meaning given such term under title VIII.
‘‘(2) The term ‘program participant’ means an
individual who enters into a contract pursuant to
section 2752(b)(3) or 2753(a)(2).
‘‘(3) The term ‘school nurse’ means a nurse
who provides health services on the premises of an
elementary or secondary school and meets such cri-
teria as the Secretary may establish.
‘‘Subtitle E—Expansion of Rural
and Underserved Areas Access
to Health Services
‘‘PART 1—COMMUNITY AND MIGRANT HEALTH
CENTERS
‘‘SEC. 2756. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
‘‘(a) IN GENERAL.—For the purpose of carrying out
this part, there is authorized to be appropriated from the
Fund, $100,000,000 for each of the fiscal years 1996
through 2000.
‘‘(b) RELATION TO OTHER FUNDS.—The authoriza-
tions of appropriations established in subsection (a) for
the purpose described in such subsection are in addition
to any other authorizations of appropriations that are
available for such purpose.
‘‘SEC. 
2757. 
GRANTS 
TO 
COMMUNITY 
AND 
MIGRANT
HEALTH CENTERS.
‘‘(a) IN GENERAL.—The Secretary shall make grants
in accordance with this section to migrant health centers
and community health centers.
‘‘(b) USE OF FUNDS.—
‘‘(1) DEVELOPMENT, OPERATION, AND OTHER
PURPOSES REGARDING CENTERS.—Subject to para-
graph (2), grants under subsection (a) to migrant
health centers and community health centers may be
made only in accordance with the conditions upon
which grants are made under sections 329 and 330,
respectively.
‘‘(2) REQUIRED
FINANCIAL
RESERVES.—The
Secretary may authorize migrant health centers and
community health centers to expend a grant under
subsection (a) to establish and maintain financial re-
serves required for purposes of health plans.
‘‘(c) DEFINITIONS.—For purposes of this subtitle,
the terms ‘migrant health center’ and ‘community health
center’ have the meanings given such terms in sections
329(a)(1) and 330(a), respectively.
‘‘PART 2—NATIONAL HEALTH SERVICE CORPS
‘‘SEC. 2781. AUTHORIZATIONS OF APPROPRIATIONS FROM
FUND.
‘‘(a) ADDITIONAL FUNDING; GENERAL CORPS PRO-
GRAM; ALLOCATIONS REGARDING NURSES.—For the pur-
pose of carrying out subpart II of part D of title III, and
for the purpose of carrying out subsection (c), there are
authorized 
to 
be 
appropriated 
from 
the 
Fund,
$100,000,000 for each of the fiscal years 1996 through
2000.
‘‘(b) RELATION TO OTHER FUNDS.—The authoriza-
tions of appropriations established in subsection (a) are
in addition to any other authorizations of appropriations
that are available for the purpose described in such sub-
section.
‘‘(c) ALLOCATION FOR PARTICIPATION OF NURSES
IN SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS.—
Of the amounts appropriated under subsection (a), the
Secretary shall reserve such amounts as may be necessary
to ensure that, of the aggregate number of individuals who
are participants in the Scholarship Program under section
338A, or in the Loan Repayment Program under section
338B, the total number who are being educated as nurses
or are serving as nurses, respectively, is increased to 30
percent.
‘‘(d) AVAILABILITY OF FUNDS.—An appropriation
under this section for any fiscal year may be made at any
time before that fiscal year and may be included in an
Act making an appropriation under an authorization
under subsection (a) for another fiscal year; but no funds
may be made available from any appropriation under this
section for obligation under sections 331 through 335, sec-
tion 336A, and section 337 before the fiscal year involved.
‘‘PART 3—SATELLITE CLINICS REGARDING
PRIMARY HEALTH CARE
‘‘SEC. 2783. AUTHORIZATION OF APPROPRIATIONS FROM
FUND.
‘‘For the purpose of carrying out this part, there is
authorized 
to 
be 
appropriated 
from 
the 
Fund,
$50,000,000 for each of the fiscal years 1996 through
2000.
‘‘SEC. 2783A. GRANTS TO STATES FOR DEVELOPMENT AND
OPERATION OF SATELLITE CLINICS.
‘‘(a) IN
GENERAL.—With respect to outpatient
health centers that are providers of comprehensive health
services, the Secretary may make grants to States for the
purpose of assisting such centers in developing or operat-
ing facilities that—
‘‘(1) provide clinical preventive services, treat-
ment of minor illnesses and injuries, family planning
services, and referrals for health services, mental
health services, and health-related social services;
and
‘‘(2) are located at a distance from the center
sufficient to increase the extent to which individuals
in the geographic area involved have access to the
services specified in paragraph (1).
‘‘(b) CERTAIN REQUIREMENTS.—The Secretary may
make a grant under subsection (a) only if the State agrees
that the health facility for which the grant is made, once
in operation, will meet the following conditions:
‘‘(1) The clinical preventive services provided by
the facility will include routine preventive services,
including family planning services, for pregnant and
postpartum women and for children, including
health screenings and immunizations.
‘‘(2) The principal providers of health services
at the facility, and the principal managers of the fa-
cility, will be nurse practitioners, physician assist-
ants, or nurse clinicians, subject to applicable law.
‘‘(3) The outpatient health center operating the
facility will serve as a referral center for physician
services and will provide for the ongoing monitoring
of the activities of the facility.
‘‘(c) MATCHING FUNDS.—The Secretary may make
a grant under subsection (a) only if the State involved
agrees to make non-Federal contributions toward the costs
of developing and operating the health facilities involved.
‘‘(d) 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
part.
‘‘(e) LIMITATION ON AMOUNT OF ASSISTANCE PER
FACILITY.—With respect to a health facility for which one
or more grants under subsection (a) are made, the Sec-
retary may not provide more than an aggregate $250,000
for the development and operation of the facility.
‘‘PART 4—COMMUNITY HEALTH ADVISORS
‘‘SEC. 2784. AUTHORIZATION OF APPROPRIATIONS FROM
FUND.
‘‘For the purpose of carrying out this part, there is
authorized 
to 
be 
appropriated 
from 
the 
Fund,
$100,000,000 for each of the fiscal years 1996 through
2000.
‘‘SEC. 2785. FORMULA GRANTS REGARDING COMMUNITY
HEALTH ADVISOR PROGRAMS.
‘‘(a) FORMULA GRANTS.—
‘‘(1) IN GENERAL.—In the case of each State
(or entity designated by a State under subsection
(b)) that submits to the Secretary an application in
accordance with section 2788 for a fiscal year, the
Secretary, acting through the Director of the Cen-
ters for Disease Control and Prevention and in co-
ordination with the heads of the agencies specified
in paragraph (2), shall make an award of financial
assistance to the State or entity for the development
and operation of community health advisor programs
under section 2786(b). The award shall consist of
the allotment determined under section 2789 with
respect to the State, subject to section 2794.
‘‘(2) COORDINATION WITH OTHER AGENCIES.—
The agencies referred to in paragraph (1) regarding
coordination are the Health Resources and Services
Administration, the National Institutes of Health,
the Substance Abuse and Mental Health Services
Administration, and the Health Education and
Training Center.
‘‘(b) DESIGNATED ENTITIES.—With respect to the
State involved, an entity other than the State may receive
an award under subsection (a) only if the entity—
‘‘(1) is a public or nonprofit private academic
organization (or other public or nonprofit private en-
tity); and
‘‘(2) has been designated by the State to carry
out the purpose described in such subsection in the
State and to receive amounts under such subsection
in lieu of the State.
‘‘(c) ROLE
OF
STATE
AGENCY
FOR
PUBLIC
HEALTH.—A funding agreement for an award under sub-
section (a) is that—
100
‘‘(1) if the applicant is a State, the award will
be administered by the State agency with the prin-
cipal responsibility for carrying out public health
programs; and
‘‘(2) if the applicant is an entity designated
under subsection (b), the award will be administered
in consultation with such State agency.
‘‘(d) STATEWIDE RESPONSIBILITIES; LIMITATION ON
EXPENDITURES.—
‘‘(1) STATEWIDE RESPONSIBILITIES.—A fund-
ing agreement for an award under subsection (a) is
that the applicant involved will—
‘‘(A) operate a clearinghouse to maintain
and disseminate information on community
health advisor programs (and similar programs)
in the State, including information on develop-
ing and operating such programs, on training
individuals to participate in the programs, and
on evaluation of the programs;
‘‘(B) collaborate with schools of public
health to provide to community health advisor
programs in the State technical assistance in
training and supervising community health ad-
visors under section 2787(g)(1); and
101
‘‘(C) coordinate the activities carried out in
the State under the award, including coordina-
tion between the various community health ad-
visor programs and coordination between such
programs and related activities of the State and
of other public or private entities.
‘‘(2) LIMITATION.—A funding agreement for an
award under subsection (a) is that the applicant in-
volved will not expend more than 15 percent of the
award in the aggregate for carrying out paragraph
(1) and for the expenses of administering the award
with respect to the State involved, including the
process of receiving payments from the Secretary
under the award, allocating the payments among the
entities that are to develop and operate the commu-
nity health advisor programs involved, and monitor-
ing compliance with the funding agreements made
under this subtitle by the applicant.
‘‘SEC. 
2786. 
REQUIREMENTS 
REGARDING 
COMMUNITY
HEALTH ADVISOR PROGRAMS.
‘‘(a) PURPOSE OF AWARD; HEALTHY PEOPLE 2000
OBJECTIVES.—
‘‘(1) IN GENERAL.—Subject to paragraph (2), a
funding agreement for an award under section 2785
for an applicant is that the purpose of the award is,
102
through community health advisor programs under
subsection (b), to assist the State involved in attain-
ing the Healthy People 2000 Objectives.
‘‘(2) AUTHORITY
REGARDING
SELECTION
OF
PRIORITY OBJECTIVES.—With respect to compliance
with the agreement made under paragraph (1), an
applicant receiving an award under section 2785
may, from among the various Healthy People 2000
Objectives, select one or more Objectives to be given
priority in the operation of a community health advi-
sor program of the applicant, subject to the appli-
cant selecting such priorities in consultation with the
entity that is to carry out the program and the local
health department involved.
‘‘(b) REQUIREMENTS FOR PROGRAMS.—
‘‘(1) IN GENERAL.—A funding agreement for
an award under section 2785 for an applicant is
that, in expending the award, the purpose described
in subsection (a)(1) will be carried out in accordance
with the following:
‘‘(A) For each community for which the
purpose is to be carried out, the applicant will
establish a program in accordance with this
subsection.
103
‘‘(B) The program will be carried out in a
community only if the applicant has, under sec-
tion 2787(a), identified the community as hav-
ing a significant need for the program.
‘‘(C) The program will be operated by a
public or nonprofit private entity with experi-
ence in providing health or health-related social
services to individuals who are underserved with
respect to such services.
‘‘(D) The services of the program, as spec-
ified in paragraph (2), will be provided prin-
cipally by community health advisors (as de-
fined in subsection (d)).
‘‘(2) AUTHORIZED
PROGRAM
SERVICES.—For
purposes of paragraph (1)(D), the services specified
in this paragraph for a program are as follows:
‘‘(A) The program will collaborate with
health care providers and related entities in
order to facilitate the provision of health serv-
ices and health-related social services (including
collaborating with local health departments,
community health centers, public hospital sys-
tems, migrant health centers, rural health clin-
ics, hospitals, physicians and nurses, providers
of health education, pre-school facilities for chil-
104
dren, elementary and secondary schools, and
providers of social services).
‘‘(B) The program will provide public edu-
cation on health promotion and on the preven-
tion of diseases, illnesses, injuries, and disabil-
ities, and will facilitate the appropriate use of
available health services and health-related so-
cial services.
‘‘(C) The program will provide health-re-
lated counseling.
‘‘(D) The program will provide referrals
for available health services and health-related
social services.
‘‘(E) For the purpose of increasing the ca-
pacity of individuals to utilize health services
and health-related social services under Federal,
State, and local programs, the following condi-
tions will be met:
‘‘(i) The program will assist individ-
uals in establishing eligibility under the
programs and in receiving the services or
other benefits of the programs.
‘‘(ii) The program will provide such
other services as the Secretary determines
to be appropriate, which services may in-
105
clude (but are not limited to) transpor-
tation and translation services.
‘‘(F) The program will provide outreach
services to inform the community of the avail-
ability of the services of the program.
‘‘(c) PRIORITY FOR MEDICALLY UNDERSERVED COM-
MUNITIES.—A funding agreement for an award under sec-
tion 2785 is that the applicant involved will give priority
to developing and operating community health advisor
programs for medically underserved communities.
‘‘(d) DEFINITION OF COMMUNITY HEALTH ADVI-
SOR.—For purposes of this part, the term ‘community
health advisor’ means an individual—
‘‘(1) who has demonstrated the capacity to
carry out one or more of the authorized program
services;
‘‘(2) who, for not less than 1 year, has been a
resident of the community in which the community
health advisor program involved is to be operated;
and
‘‘(3) is a member of a socioeconomic group to
be served by the program.
106
‘‘SEC. 2787. ADDITIONAL AGREEMENTS.
‘‘(a) IDENTIFICATION OF COMMUNITY NEEDS.—A
funding agreement for an award under section 2785 is
that the applicant involved will—
‘‘(1) identify the needs of the community in-
volved for the authorized program services, including
the identifying the resources of the community that
are available for carrying out the program;
‘‘(2) in identifying such needs, consult with
members of the community, with individuals and
programs that provide health services in the commu-
nity, and with individuals and programs that provide
health-related social services in the community; and
‘‘(3) consider such needs in carrying out a com-
munity health advisor program for the community.
‘‘(b) MATCHING FUNDS.—
‘‘(1) IN GENERAL.—With respect to the cost of
carrying out a community health advisor program, a
funding agreement for an award under section 2785
is that the applicant involved will make available (di-
rectly or through donations from public or private
entities) non-Federal contributions toward such cost
in an amount that is not less than 25 percent of
such cost.
‘‘(2) DETERMINATION
OF
AMOUNT
CONTRIB-
UTED.—
107
‘‘(A) Non-Federal contributions required in
paragraph (1) may be in cash or in kind, fairly
evaluated, including plant, equipment, or serv-
ices. Amounts provided by the Federal Govern-
ment, or services assisted or subsidized to any
significant extent by the Federal Government,
may not be included in determining the amount
of such non-Federal contributions.
‘‘(B) With respect to the State in which
the community health advisor program involved
is to be carried out, amounts provided by the
State in compliance with subsection (c) shall be
included in determining the amount of non-Fed-
eral contributions under paragraph (1).
‘‘(c) MAINTENANCE OF EFFORT.—With respect to
the purposes for which an award under section 2785 is
authorized in this subtitle to be expended, the Secretary
may make such an award only if the State involved agrees
to maintain expenditures of non-Federal amounts for such
purposes at a level that is not less than the level of such
expenditures maintained by the State for the fiscal year
preceding the first fiscal year for which such an award
is made with respect to the State.
‘‘(d) CULTURAL CONTEXT OF SERVICES.—A funding
agreement for an award under section 2785 for an appli-
108
cant is that the services of the community health advisor
program involved will be provided in the language and cul-
tural context most appropriate for the individuals served
by the program, and that for such purpose the community
health advisors of the program will include an appropriate
number of advisors who are fluent in both English and
not less than one of the other relevant languages.
‘‘(e) NUMBER
OF PROGRAMS PER AWARD; PRO-
GRAMS
FOR URBAN
AND RURAL AREAS.—A funding
agreement for an award under section 2785 for an appli-
cant is that the number of community health advisor pro-
grams operated in the State with the award will be deter-
mined by the Secretary, except that (subject to section
2786(b)(1)(B)) such a program will be carried out in not
less than one urban area of the State, and in not less than
one rural area of the State.
‘‘(f) ONGOING SUPERVISION OF ADVISORS.—A fund-
ing agreement for an award under section 2785 is that
the applicant involved will ensure that each community
health advisor program operated with the award provides
for the ongoing supervision of the community health advi-
sors of the program, and that the individuals serving as
supervisors in the program will include 1 or more public
health nurses with field experience and managerial experi-
ence.
109
‘‘(g) CERTAIN EXPENDITURES.—
‘‘(1) TRAINING; 
CONTINUING
EDUCATION.—
Funding agreements for an award under section
2785 include the following:
‘‘(A) The applicant involved will ensure
that, for each community health advisor pro-
gram operated with the award, a program is
carried out to train community health advisors
to provide the authorized program services, in-
cluding practical experiences in providing serv-
ices for health promotion and disease preven-
tion.
‘‘(B) The program of training will provide
for the continuing education of the community
health advisors.
‘‘(C) Not more than 15 percent of the
award will be expended for the program of
training.
‘‘(2) COMPENSATION.—With respect to compli-
ance with the agreements made under this subtitle,
the purposes for which an award under section 2785
may be expended include providing compensation for
the services of community health advisors.
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‘‘(h) REPORTS TO SECRETARY; ASSESSMENT OF EF-
FECTIVENESS.—Funding agreements for an award under
section 2785 for an applicant include the following:
‘‘(1) The applicant will ensure that, for each
fiscal year for which a community health advisor
program receives amounts from the award, the pro-
gram will prepare a report describing the activities
of the program for such year, including—
‘‘(A) a specification of the number of indi-
viduals served by the program;
‘‘(B) a specification of the entities with
which the program has collaborated in carrying
out the purpose described in section 2786(a)(1);
and
‘‘(C) an assessment of the extent of the ef-
fectiveness of the program in carrying out such
purpose.
‘‘(2) Such reports will include such additional
information regarding the applicant and the pro-
grams as the Secretary may require.
‘‘(3) The applicant will prepare the reports as
a single document and will submit the document to
the Secretary not later than February 1 of the fiscal
year following the fiscal year for which the reports
were prepared.
111
‘‘SEC. 2788. APPLICATION FOR ASSISTANCE; STATE PLAN.
‘‘For purposes of section 2785, an application is in
accordance with this section if—
‘‘(1) the application is submitted not later than
the date specified by the Secretary;
‘‘(2) the application contains each funding
agreement described in this subtitle;
‘‘(3) the application contains a State plan de-
scribing the purposes for which the award is to be
expended in the State, including a description of the
manner in which the applicant will comply with each
such funding agreement; and
‘‘(4) the application is in such form, is made in
such manner, and contains such agreements, assur-
ances, and information as the Secretary determines
to be necessary to carry out this subtitle.
‘‘SEC. 2789. DETERMINATION OF AMOUNT OF ALLOTMENT.
‘‘(a) IN GENERAL.—For purposes of section 2785,
the allotment under this section with respect to a State
for a fiscal year is the sum of the respective amounts de-
termined for the State under subsection (b) and sub-
section (c).
‘‘(b) AMOUNT RELATING TO POPULATION.—For pur-
poses of subsection (a), the amount determined under this
subsection is the product of—
112
‘‘(1) an amount equal to 50 percent of the
amount appropriated under section 2784 for the fis-
cal year and available for awards under section
2785; and
‘‘(2) the percentage constituted by the ratio
of—
‘‘(A) the number of individuals residing in
the State involved; to
‘‘(B) the sum of the respective numbers
determined for each State under subparagraph
(A).
‘‘(c) AMOUNT RELATING TO POVERTY LEVEL.—For
purposes of subsection (a), the amount determined under
this subsection is the product of—
‘‘(1) the amount determined under subsection
(b)(1); and
‘‘(2) the percentage constituted by the ratio
of—
‘‘(A) the number of individuals residing in
the State whose income is at or below an
amount equal to 200 percent of the official pov-
erty line; to
‘‘(B) the sum of the respective numbers
determined for each State under subparagraph
(A).
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‘‘SEC. 2790. QUALITY ASSURANCE; COST-EFFECTIVENESS.
‘‘The Secretary shall establish guidelines for assuring
the quality of community health advisor programs (includ-
ing quality in the training of community health advisors)
and for assuring the cost-effectiveness of the programs.
A funding agreement for an award under section 2785 is
that the applicant involved will carry out such programs
in accordance with the guidelines.
‘‘SEC. 2791. EVALUATIONS; TECHNICAL ASSISTANCE.
‘‘(a) EVALUATIONS.—The Secretary shall conduct
evaluations of community health advisor programs and
disseminate information developed as result of the evalua-
tions to the States. In conducting such evaluations, the
Secretary shall determine whether the programs are in
compliance with the guidelines established under section
2790.
‘‘(b) TECHNICAL ASSISTANCE.—The Secretary may
provide technical assistance to recipients of awards under
section 2785 with respect to the planning, development,
and operation of community health advisor programs.
‘‘(c) GRANTS AND CONTRACTS.—The Secretary may
carry out this section directly or through grants, coopera-
tive agreements, or contracts.
‘‘(d) LIMITATION
ON
EXPENDITURES.—Of the
amounts appropriated under section 2784 for a fiscal year,
114
the Secretary may reserve not more than 10 percent for
carrying out this section.
‘‘SEC. 2792. RULE OF CONSTRUCTION REGARDING PRO-
GRAMS OF INDIAN HEALTH SERVICE.
‘‘This subtitle may not be construed as requiring the
Secretary to modify or terminate the program carried out
by the Director of the Indian Health Service and des-
ignated by such Director as the Community Health Rep-
resentative Program. The Secretary shall ensure that sup-
port for such Program is not supplanted by awards under
section 2785. In communities in which both such Program
and a community health advisor program are being carried
out, the Secretary shall ensure that the community health
advisor program works in cooperation with, and as a com-
plement to, the Community Health Representative Pro-
gram.
‘‘SEC. 2793. DEFINITIONS.
‘‘For purposes of this subtitle:
‘‘(1) The term ‘authorized program services’,
with respect to a community health advisor program,
means the services specified in section 2786(b)(2).
‘‘(2) The term ‘community health advisor’ has
the meaning given such term in section 2786(d).
115
‘‘(3) The term ‘community health advisor pro-
gram’ means a program carried out under section
2786(b).
‘‘(4) The term ‘financial assistance’, with re-
spect to an award under section 2785, means a
grant, cooperative agreement, or a contract.
‘‘(5) The term ‘funding agreement’ means an
agreement required as a condition of receiving an
award under section 2785.
‘‘(6) The term ‘official poverty line’ means the
official poverty line 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,
which poverty line is applicable to the size of the
family involved.
‘‘(7) The term ‘State involved’, with respect to
an applicant for an award under section 2785,
means the State in which the applicant is to carry
out a community health advisor program.
‘‘SEC. 2794. EFFECT OF INSUFFICIENT APPROPRIATIONS
FOR MINIMUM ALLOTMENTS.
‘‘(a) IN GENERAL.—If the amounts made available
under section 2784 for a fiscal year are insufficient for
providing each State (or entity designated by the State
116
pursuant to section 2785, as the case may be) with an
award under section 2785 in an amount equal to or great-
er than the amount specified in section 2789(a)(2), the
Secretary shall, from such amounts as are made available
under subsection (a), make such awards on a discretionary
basis.
‘‘(b) RULE
OF CONSTRUCTION.—For purposes of
subsection (a), awards under section 2785 are made on
a discretionary basis if the Secretary determines which
States (or entities designated by States pursuant to such
section, as the case may be) are to receive such awards,
subject to meeting the requirements of this subtitle for
such an award, and the Secretary determines the amount
of such awards.
‘‘Subtitle F—General Provisions
‘‘SEC. 2798. REQUIREMENT REGARDING ACCREDITATION
OF 
SCHOOLS, 
DEPARTMENTS, 
AND 
PRO-
GRAMS.
‘‘Except as indicated otherwise in this title:
‘‘(1) A reference in this title to a school of pub-
lic health, a school of nursing, or any other entity
providing education or training in a health profes-
sion (whether a school, department, program, or
other entity) is a reference to the entity as defined
under section 799 or 853.
117
‘‘(2) If an entity is not defined in either of such
sections, the reference in this title to the entity has
the meaning provided by the Secretary, except that
the Secretary shall require for purposes of this title
that the entity be accredited for the provision of the
education or training involved.
‘‘SEC. 2799. RELATION TO OTHER FUNDS.
‘‘Notwithstanding any other provision of law, the au-
thorizations of appropriations established in this title are
in addition to any other authorizations of appropriations
that are available for the purposes described with respect
to such appropriations in this title.
‘‘SEC. 2799A. DEFINITIONS.
‘‘(a) IN GENERAL.—For purposes of this title:
‘‘(1) The term ‘Healthy People 2000 Objectives’
means the objectives established by the Secretary to-
ward the goals of increasing the span of healthy life,
reducing health disparities among various popu-
lations, and providing access to preventive services,
which objectives apply to the health status of the
population of the United States for the year 2000.
‘‘(2) The term ‘medically underserved commu-
nity’ means—
‘‘(A) a community that has a substantial
number of individuals who are members of a
118
medically underserved population, as defined in
section 330; or
‘‘(B) a community a significant portion of
which is a health professional shortage area
designated under section 332.’’.
TITLE IV—MEDICAL RESEARCH
SEC. 4001. FINDINGS.
The Congress finds the following:
(1) Nearly 4 of 5 peer reviewed research
projects deemed worthy of funding by the National
Institutes of Health are not funded.
(2) Less than 2 percent of the nearly one tril-
lion dollars our Nation spends on health care is de-
voted to health research, while the defense industry
spends 15 percent of its budget on research.
(3) Public opinion surveys have shown that
Americans want more Federal resources put into
health research and support by having a portion of
their health insurance premiums set aside for this
purpose.
(4) Ample evidence exists to demonstrate that
health research has improved the quality of health
care in the United States. Advances such as the de-
velopment of vaccines, the cure of many childhood
cancers, drugs that effectively treat a host of dis-
119
eases and disorders, a process to protect our Na-
tion’s blood supply from the HIV virus, progress
against cardiovascular disease including heart attack
and stroke, and new strategies for the early detec-
tion and treatment of diseases such as colon, breast,
and prostate cancer clearly demonstrates the bene-
fits of health research.
(5) Among the most effective methods to con-
trol health care costs are prevention and cure of dis-
ease and disability, thus, health research which holds
the promise of cure and prevention of disease and
disability is a critical component of any comprehen-
sive health care reform plan.
(6) The state of our Nation’s research facilities
at the National Institutes of Health and at univer-
sities is deteriorating significantly. Renovation and
repair of these facilities are badly needed to main-
tain and improve the quality of research.
(7) Because the Omnibus Budget Reconciliation
Act of 1993 freezes discretionary spending for the
next 5 years, the Nation’s investment in health re-
search through the National Institutes of Health is
likely to decline in real terms unless corrective legis-
lative action is taken.
120
(8) A health research fund is needed to main-
tain our Nation’s commitment to health research
and to increase the percentage of approved projects
which receive funding at the National Institutes of
Health to at least 33 percent.
SEC. 4002. NATIONAL FUND FOR HEALTH RESEARCH.
(a) ESTABLISHMENT.—There is established in the
Treasury of the United States an account, to be known
as the ‘‘National Fund for Health Research’’ (hereafter
referred to in this section as the ‘‘Fund’’), consisting of
such amounts as are transferred to the Fund under sub-
section (b) and any interest earned on investment of
amounts in the Fund.
(b) TRANSFERS TO FUND.—
(1) IN GENERAL.—With respect to each of the
5 full calendar years beginning after the date of en-
actment of this Act, the Secretary of the Treasury
shall transfer to the Fund an amount equal to the
applicable amount under paragraph (2).
(2) 
APPLICABLE
AMOUNT.—The 
applicable
amount under this paragraph is—
(A) with respect to amounts in the Health
Care Reform Trust Fund established under sec-
tion 9551(a)(2)(A) of the Internal Revenue
121
Code of 1986, $1,200,000,000 for each cal-
endar year described in paragraph (1); and
(B) with respect to amounts received in
the Treasury under section 6097 of the Internal
Revenue Code of 1986, 100 percent of the
amounts received under such section in each
calendar year described in paragraph (1).
(3) DESIGNATION OF OVERPAYMENTS AND CON-
TRIBUTIONS.—
(A) IN GENERAL.—Subchapter A of chap-
ter 61 of the Internal Revenue Code of 1986
(relating to returns and records) is amended by
adding at the end the following new part:
‘‘PART 
IX—DESIGNATION 
OF 
OVERPAYMENTS
AND CONTRIBUTIONS FOR THE NATIONAL
FUND FOR HEALTH RESEARCH
‘‘Sec. 6097. Amounts for the National Fund for Health Research.
‘‘SEC. 6097. AMOUNTS FOR THE NATIONAL FUND FOR
HEALTH RESEARCH.
‘‘(a) IN GENERAL.—Every individual (other than a
nonresident alien) may designate that—
‘‘(1) a portion (not less than $1) of any over-
payment of the tax imposed by chapter 1 for the
taxable year, and
‘‘(2) a cash contribution (not less than $1),
122
be paid over to the National Fund for Health Research
established under section 4002 of the Health Innovation
Partnership Act of 1994. In the case of a joint return of
a husband and wife, each spouse may designate one-half
of any such overpayment of tax (not less than $2).
‘‘(b) MANNER AND TIME OF DESIGNATION.—Any
designation under subsection (a) may be made with re-
spect to any taxable year only at the time of filing the
original return of the tax imposed by chapter 1 for such
taxable year. Such designation shall be made either on the
1st page of the return or on the page bearing the tax-
payer’s signature.
‘‘(c) OVERPAYMENTS TREATED AS REFUNDED.—For
purposes of this section, any overpayment of tax des-
ignated under subsection (a) shall be treated as being re-
funded to the taxpayer as of the last day prescribed for
filing the return of tax imposed by chapter 1 (determined
with regard to extensions) or, if later, the date the return
is filed.
‘‘(d) DESIGNATED AMOUNTS NOT DEDUCTIBLE.—
No amount designated pursuant to subsection (a) shall be
allowed as a deduction under section 170 or any other sec-
tion for any taxable year.
‘‘(e) TERMINATION.—This section shall not apply to
taxable years beginning in a calendar year after a deter-