‘‘(A) With respect to the costs of the activi-
ties to be carried out under subsection (a) by an
applicant, the Secretary may make an award of
a grant or contract under such subsection only
if the applicant agrees to make available (di-
rectly or through donations from public or pri-
vate entities), in cash, non-Federal contributions
toward such costs in an amount that—
‘‘(i) for any second fiscal year for
which the applicant receives such a grant,
is not less than 20 percent of such costs;
‘‘(ii) for any third such fiscal year, is
not less than 20 percent of such costs;
‘‘(iii) for any fourth such fiscal year,
is not less than 40 percent of such costs;
‘‘(iv) for any fifth such fiscal year, is
not less than 60 percent of such costs; and
‘‘(v) for any sixth or subsequent such
fiscal year, is not less than 80 percent of
such costs.
‘‘(B) Amounts provided by the Federal Gov-
ernment may not be included in determining the
amount of non-Federal contributions required in
subparagraph (A).
‘‘(C) The Secretary may not require non-
Federal contributions for the first fiscal year for
which an applicant receives a grant under sub-
section (a).
‘‘(c) PREFERENCE IN MAKING AWARDS.—
‘‘(1) IN GENERAL.—Subject to paragraph (2), in
making awards of grants and contracts under sub-
section (a), the Secretary shall give preference to any
applicant that has made an arrangement with 1 or
more elementary schools, an arrangement with 1 or
more secondary schools, an arrangement with 1 or
more institutions of higher education, an arrange-
ment with 1 or more health professions schools, and
an arrangement with 1 or more community-based or-
ganizations, the purpose of which arrangements is to
establish a program as follows:
‘‘(A) With respect to the elementary schools
involved, the program carries out the purposes
described in subsection (a)(1).
‘‘(B) After a student identified pursuant to
paragraph (1) enters the secondary school in-
volved, the program continues to carry out such
purposes with respect to the student.
‘‘(C) After graduating from the secondary
school, the student enters the institution of higher
education involved, subject to meeting reasonable
academic requirements, and the program contin-
ues to carry out such purposes with respect to
the student.
‘‘(D) After graduating from the institution
of higher education, the student enters the health
professions school involved, subject to meeting
reasonable academic requirements.
‘‘(2) REQUIREMENT
REGARDING
SCHOOLS
AND
INSTITUTIONS.—For purposes of paragraph (1), an
applicant may not receive preference unless the
schools or institutions with which arrangements have
been made are schools or institutions whose enroll-
ment of students includes a significant number of in-
dividuals from disadvantaged backgrounds.
‘‘(d) LIMITATION ON YEARS OF FUNDING FOR PAR-
TICULAR ACTIVITIES.—With respect to a particular activity
carried out under paragraph (1) or (3) of subsection (a)
by an entity, the Secretary may not, for the activity in-
volved, provide more than 6 years of financial assistance
under such subsection to the entity.
‘‘(e) FUNDING.—
‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—For
the purpose of carrying out this section and section
736, there are authorized to be appropriated
$32,000,000 for fiscal year 1995, $36,000,000 for fis-
cal year 1996, and $38,000,000 for fiscal year 1997.
‘‘(2) ALLOCATIONS.—Of the amounts appro-
priated under paragraph (1) for a fiscal year, the
Secretary shall obligate not less than 20 percent for
carrying out subsection (a)(3)(B) and not less than
20 percent for providing scholarships under section
736.’’.
(b) TRANSITIONAL AND SAVINGS PROVISION.—In the
case of an entity that received an award of a grant or con-
tract for fiscal year 1994 under section 740 of the Public
Health Service Act, the Secretary of Health and Human
Services may continue in effect the award in accordance
with the terms of the award, subject to the duration of the
award not exceeding the period determined by the Secretary
in first approving the award. The preceding sentence ap-
plies notwithstanding the amendment made by subsection
(a) of this section.
SEC. 306. STUDENT LOANS REGARDING SCHOOLS OF NURS-
ING.
Section 836(b) of the Public Health Service Act (42
U.S.C. 297b(b)) is amended—
(1) in paragraph (1), by striking the period at
the end and inserting a semicolon;
(2) in paragraph (2)—
(A) in subparagraph (A), by striking ‘‘and’’
at the end; and
(B) by inserting before the semicolon at the
end the following: ‘‘, and (C) such additional pe-
riods under the terms of paragraph (8) of this
subsection’’;
(3) in paragraph (7), by striking the period at
the end and inserting ‘‘; and’’; and
(4) by adding at the end the following para-
graph:
‘‘(8) pursuant to uniform criteria established by
the Secretary, the repayment period established under
paragraph (2) for any student borrower who during
the repayment period failed to make consecutive pay-
ments and who, during the last 12 months of the re-
payment period, has made at least 12 consecutive
payments may be extended for a period not to exceed
10 years.’’.
SEC. 307. FEDERALLY-SUPPORTED STUDENT LOAN FUNDS.
(a) AUTHORIZATION OF APPROPRIATIONS REGARDING
CERTAIN MEDICAL SCHOOLS.—
(1) IN GENERAL.—Subpart II of part A of title
VII of the Public Health Service Act (42 U.S.C. 292q
et seq.) is amended—
(A) by transferring subsection (f) of section
735 from the current placement of the subsection;
(B) by adding the subsection at the end of
section 723;
(C) by redesignating the subsection as sub-
section (e); and
(D) in subsection (e)(1) of section 723 (as
so redesignated), by striking ‘‘1996’’ and insert-
ing ‘‘1997’’.
(2) CONFORMING AMENDMENTS.—Section 723 of
the Public Health Service Act (42 U.S.C. 292s), as
amended by paragraph (1) of this subsection, is
amended in subsection (e)(2)(A)—
(A) by striking ‘‘section 723(b)(2)’’ and in-
serting ‘‘subsection (b)(2)’’; and
(B) by striking ‘‘such section’’ and inserting
‘‘such subsection’’.
(b) AUTHORIZATION OF APPROPRIATIONS REGARDING
INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.—Sec-
tion 724(f)(1) of the Public Health Service Act (42 U.S.C.
292t(f)(1)) is amended to read as follows:
‘‘(1) IN GENERAL.—With respect to making Fed-
eral capital contributions to student loan funds for
purposes of subsection (a), other than the student loan
fund of any school of medicine or osteopathic medi-
cine, 
there 
is 
authorized 
to 
be 
appropriated
$5,000,000 for each of the fiscal years 1995 through
1997.’’.
TITLE IV—RESEARCH
SEC. 401. OFFICE OF RESEARCH ON MINORITY HEALTH.
Section 404 of the Public Health Service Act (42
U.S.C. 283(b)) is amended by adding at the end the follow-
ing subsections:
‘‘(c) PLAN.—Subject to applicable law, the Director of
the Office, in consultation with the advisory committee es-
tablished under subsection (d), shall develop and implement
a plan for carrying out the duties established in subsection
(b). The Director shall review the plan not less than annu-
ally, and revise the plan as appropriate.
‘‘(d) ADVISORY COMMITTEE.—
‘‘(1) In carrying out subsection (b), the Director
of the Office shall establish an advisory committee to
be known as the Advisory Committee on Research on
Minority Health (in this subsection referred to as the
‘Committee’).
‘‘(2)(A) The Committee shall be composed of
nonvoting, ex officio members designated in accord-
ance with subparagraph (B) and voting members ap-
pointed in accordance with subparagraph (C).
‘‘(B) The Secretary shall designate as ex officio
members of the Committee the Directors of each of the
national research institutes and the Deputy Assistant
Secretary for Minority Health (except that any of
such officials may designate another officer or em-
ployee of the office or agency involved to serve as a
member of the Committee in lieu of the official).
‘‘(C) The Director of the Office shall appoint as
voting members of the Committee not fewer than 12
and not more than 18 individuals who are not offi-
cers or employees of the Federal Government. The ap-
pointments shall be made from among scientists and
health professionals whose clinical practice, research
specialization, or professional expertise includes sig-
nificant expertise in research on minority health. The
appointed membership of the Advisory Committee
shall be broadly representative of the various minority
groups.
‘‘(3) The Director of the Office shall serve as the
chair of the Committee.
‘‘(4) The Committee shall—
‘‘(A) advise the Director of the Office on ap-
propriate research activities to be undertaken by
the national research institutes with respect to—
‘‘(i) research on minority health;
‘‘(ii) research on racial and ethnic dif-
ferences in clinical drug trials, including
responses to pharmacological drugs;
‘‘(iii) research on racial and ethnic
differences in disease etiology, course, and
treatment; and
‘‘(iv) research on minority health con-
ditions which require a multidisciplinary
approach;
‘‘(B) report to the Director of the Office on
such research;
‘‘(C) provide recommendations to such Di-
rector regarding activities of the Office (includ-
ing recommendations on priorities in carrying
out research described in subparagraph (A)); and
‘‘(D) assist in monitoring compliance with
section 492B regarding the inclusion of minori-
ties in clinical research.
‘‘(5)(A) The Advisory Committee shall prepare
biennial reports describing the activities of the Com-
mittee, including findings made by the Committee re-
garding—
‘‘(i) compliance with section 492B;
‘‘(ii) the extent of expenditures made for re-
search on minority health by the agencies of the
National Institutes of Health; and
‘‘(iii) the level of funding needed for such
research.
‘‘(B) Each report under subparagraph (A) shall
be submitted to the Director of NIH for inclusion in
the report required in section 403 for the period in-
volved.
‘‘(e) REPRESENTATION OF MINORITIES AMONG RE-
SEARCHERS.—The Secretary, acting through the Assistant
Secretary for Personnel and in collaboration with the Di-
rector of the Office, shall determine the extent to which the
various minority groups are represented among adminis-
trators, senior physicians, and scientists of the national re-
search institutes and among physicians and scientists con-
ducting research with funds provided by such institutes,
and as appropriate, carry out activities to increase the ex-
tent of such representation.
‘‘(f) REQUIREMENT REGARDING GRANTS AND CON-
TRACTS.—Any award of a grant, cooperative agreement, or
contract that the Director of the Office is authorized to make
shall be made only on a competitive basis.
‘‘(g) DEFINITIONS.—For purposes of this section:
‘‘(1) The term ‘minority health conditions’, with
respect to individuals who are members of minority
groups, means all diseases, disorders, and conditions
(including with respect to mental health)—
‘‘(A) unique to, more serious, or more prev-
alent in such individuals;
‘‘(B) for which the factors of medical risk or
types of medical intervention are different for
such individuals, or for which it is unknown
whether such factors or types are different for
such individuals; or
‘‘(C) with respect to which there has been
insufficient clinical research involving such indi-
viduals as subjects or insufficient clinical data
on such individuals.
‘‘(2) The term ‘research on minority health’
means research on minority health conditions, includ-
ing research on preventing such conditions.
‘‘(3) The term ‘minority groups’ has the meaning
given such term in section 1707(h).’’.
SEC. 402. ACTIVITIES OF AGENCY FOR HEALTH CARE POL-
ICY AND RESEARCH.
Title IX of the Public Health Service Act (42 U.S.C.
299 et seq.) is amended—
(1) in section 902, by amending subsection (b) to
read as follows:
‘‘(b) REQUIREMENTS WITH RESPECT
TO CERTAIN
POPULATIONS.—In carrying out subsection (a), the Admin-
istrator shall undertake and support research, demonstra-
tion projects, and evaluations with respect to the health sta-
tus of, and the delivery of health care to—
‘‘(1) the populations of medically underserved
urban or rural areas (including frontier areas); and
‘‘(2) low-income groups, minority groups, and
the elderly.’’; and
(2) in section 926(a), by adding at the end the
following sentence: ‘‘Of the amounts appropriated
under the preceding sentence for a fiscal year, the Ad-
ministrator shall reserve not less than 8 percent for
carrying out section 902(b)(2).’’.
SEC. 403. DATA COLLECTION BY NATIONAL CENTER FOR
HEALTH STATISTICS.
Section 306(n) of the Public Health Service Act (42
U.S.C. 242k(n)), as redesignated by section 501(a)(5)(B) of
Public Law 103–183 (107 Stat. 2237), is amended to read
as follows:
‘‘(n)(1) For health statistical and epidemiological ac-
tivities undertaken or supported under this section, there
are authorized to be appropriated such sums as may be nec-
essary for each of the fiscal years 1995 through 1998.
‘‘(2) Of the amounts appropriated under paragraph
(1) for a fiscal year, the Secretary shall obligate not less
than an aggregate $5,000,000 for carrying out subsections
(h), (l), and (m) with respect to particular racial and eth-
nic population groups.’’.
TITLE V—NATIVE HAWAIIAN
HEALTH CARE
SEC. 501. CLARIFICATION OF 1992 AMENDMENTS.
(a) CLARIFICATION OF DATE OF PASSAGE.—Section
9168 of the Department of Defense Appropriations Act,
1993 (106 Stat. 1948) is amended by striking ‘‘September
12, 1992,’’ and inserting ‘‘August 7, 1992,’’.
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall take effect as of October 6, 1992.
SEC. 502. AMENDMENT OF NATIVE HAWAIIAN HEALTH CARE
IMPROVEMENT ACT TO REFLECT 1992 AGREE-
MENT.
Effective on the date of enactment of this Act, the Na-
tive Hawaiian Health Care Improvement Act (42 U.S.C.
11701 et seq.) is amended to read as follows:
‘‘SECTION 1. SHORT TITLE.
‘‘This Act may be cited as the ‘Native Hawaiian
Health Care Improvement Act’.
‘‘SEC. 2. FINDINGS; DECLARATION OF POLICY; INTENT OF
CONGRESS.
‘‘(a) FINDINGS.—The Congress finds that—
‘‘(1) the United States retains the legal respon-
sibility to enforce the administration of the public
trust responsibility of the State of Hawaii for the bet-
terment of the conditions of Native Hawaiians under
section 5(f) of Public Law 86–3 (73 Stat. 6; com-
monly referred to as the ‘Hawaii Statehood Admis-
sions Act’);
‘‘(2) in furtherance of the State of Hawaii’s pub-
lic trust responsibility for the betterment of the condi-
tions of Native Hawaiians, contributions by the Unit-
ed States to the provision of comprehensive health
promotion and disease prevention services to main-
tain and improve the health status of Native Hawai-
ians are consistent with the historical and unique
legal relationship of the United States with the gov-
ernment that represented the indigenous native people
of Hawaii; and
‘‘(3) it is the policy of the United States to raise
the health status of Native Hawaiians to the highest
possible level and to encourage the maximum partici-
pation of Native Hawaiians in order to achieve this
objective.
‘‘(b) DECLARATION OF POLICY.—The Congress hereby
declares that it is the policy of the United States in fulfill-
ment of its special responsibilities and legal obligations to
the indigenous people of Hawaii resulting from the unique
and historical relationship between the United States and
the Government of the indigenous people of Hawaii—
‘‘(1) to raise the health status of Native Hawai-
ians to the highest possible health level; and
‘‘(2) to provide existing Native Hawaiian health
care programs with all resources necessary to effec-
tuate this policy.
‘‘(c) INTENT OF CONGRESS.—It is the intent of the
Congress that the Nation meet the following health objectives
with respect to Native Hawaiians by the year 2000:
‘‘(1) Reduce coronary heart disease deaths to no
more than 100 per 100,000.
‘‘(2) Reduce stroke deaths to no more than 20 per
100,000.
‘‘(3) Increase control of high blood pressure to at
least 50 percent of people with high blood pressure.
‘‘(4) Reduce blood cholesterol to an average of no
more than 200 mg/dl.
‘‘(5) Slow the rise in lung cancer deaths to
achieve a rate of no more than 42 per 100,000.
‘‘(6) Reduce breast cancer deaths to no more
than 20.6 per 100,000 women.
‘‘(7) Increase Pap tests every 1 to 3 years to at
least 85 percent of women age 18 and older.
‘‘(8) Increase fecal occult blood testing every 1 to
2 years to at least 50 percent of people age 50 and
older.
‘‘(9) Reduce diabetes-related deaths to no more
than 34 per 100,000.
‘‘(10) Reduce the most severe complications of di-
abetes as follows:
‘‘(A) End-stage renal disease to no more
than 1.4 in 1,000.
‘‘(B) Blindness to no more than 1.4 in
1,000.
‘‘(C) Lower extremity amputation to no
more than 4.9 in 1,000.
‘‘(D) Perinatal mortality to no more than 2
percent.
‘‘(E) Major congenital malformations to no
more than 4 percent.
‘‘(11) Reduce infant mortality to no more than
7 deaths per 1,000 live births.
‘‘(12) Reduce low birth weight to no more than
5 percent of live births.
‘‘(13) Increase first trimester prenatal care to at
least 90 percent of live births.
‘‘(14) Reduce teenage pregnancies to no more
than 50 per 1,000 girls age 17 and younger.
‘‘(15) Reduce unintended pregnancies to no more
than 30 percent of pregnancies.
‘‘(16) Increase to at least 60 percent the propor-
tion of primary care providers who provide age-ap-
propriate preconception care and counseling.
‘‘(17) Increase years of healthy life to at least 65
years.
‘‘(18) Eliminate financial barriers to clinical
preventive services.
‘‘(19) Increase childhood immunization levels to
at least 90 percent of 2-year-olds.
‘‘(20) Reduce the prevalence of dental caries to
no more than 35 percent of children by age 8.
‘‘(21) Reduce untreated dental caries so that the
proportion of children with untreated caries (in per-
manent or primary teeth) is no more than 20 percent
among children age 6 through 8 and no more than 15
percent among adolescents age 15.
‘‘(22) Reduce edentulism to no more than 20 per-
cent in people age 65 and older.
‘‘(23) Increase moderate daily physical activity
to at least 30 percent of the population.
‘‘(24) Reduce sedentary lifestyles to no more than
15 percent of the population.
‘‘(25) Reduce overweight to a prevalence of no
more than 20 percent of the population.
‘‘(26) Reduce dietary fat intake to an average of
30 percent of calories or less.
‘‘(27) Increase to at least 75 percent the propor-
tion of primary care providers who provide nutrition
assessment and counseling or referral to qualified nu-
tritionists or dieticians.
‘‘(28) Reduce cigarette smoking prevalence to no
more than 15 percent of adults.
‘‘(29) Reduce initiation of smoking to no more
than 15 percent by age 20.
‘‘(30) Reduce alcohol-related motor vehicle crash
deaths to no more than 8.5 per 100,000 adjusted for
age.
‘‘(31) Reduce alcohol use by school children age
12 to 17 to less than 13 percent.
‘‘(32) Reduce marijuana use by youth age 18 to
25 to less than 8 percent.
‘‘(33) Reduce cocaine use by youth age 18 to 25
to less than 3 percent.
‘‘(34) Confine HIV infection to no more than
800 per 100,000.
‘‘(35) Reduce gonorrhea infections to no more
than 225 per 100,000.
‘‘(36) Reduce syphilis infections to no more that
10 per 100,000.
‘‘(37) Reduce significant hearing impairment to
a prevalance of no more than 82 per 1,000.
‘‘(38) Reduce acute middle ear infections among
children age 4 and younger, as measured by days of
restricted activity or school absenteeism, to no more
than 105 days per 100 children.
‘‘(39) Reduce indigenous cases of vaccine-pre-
ventable diseases as follows:
‘‘(A) Diphtheria among individuals age 25
and younger to 0.
‘‘(B) Tetanus among individuals age 25
and younger to 0.
‘‘(C) Polio (wild-type virus) to 0.
‘‘(D) Measles to 0.
‘‘(E) Rubella to 0.
‘‘(F) Congenital Rubella Syndrome to 0.
‘‘(G) Mumps to 500.
‘‘(H) Pertussis to 1,000.
‘‘(40) Reduce significant visual impairment to a
prevalence of no more than 30 per 1,000.
‘‘(d) REPORT.—The Secretary shall submit to the
President, for inclusion in each report required to be trans-
mitted to the Congress under section 9, a report on the
progress made toward meeting each of the objectives de-
scribed in subsection (c).
‘‘SEC. 3. COMPREHENSIVE HEALTH CARE MASTER PLAN
FOR NATIVE HAWAIIANS.
‘‘The Secretary may make a grant to, or enter into
a contract with, Papa Ola Lokahi for the purpose of coordi-
nating, implementing, and updating a Native Hawaiian
comprehensive health care master plan designed to promote
comprehensive health promotion and disease prevention
services and to maintain and improve the health status of
Native Hawaiians. The master plan shall be based upon
an assessment of the health care status and health care
needs of Native Hawaiians. To the extent practicable, as-
sessments made as of the date of such grant or contract shall
be used by Papa Ola Lokahi, except that any such assess-
ment shall be updated as appropriate.
‘‘SEC. 4. NATIVE HAWAIIAN HEALTH CARE SYSTEMS.
‘‘(a) COMPREHENSIVE HEALTH PROMOTION, DISEASE
PREVENTION, AND PRIMARY HEALTH SERVICES.—(1)(A)
The Secretary, in consultation with Papa Ola Lokahi, may
make grants to, or enter into contracts with, any qualified
entity for the purpose of providing comprehensive health
promotion and disease prevention services as well as pri-
mary health services to Native Hawaiians.
‘‘(B) In making grants and entering into contracts
under this paragraph, the Secretary shall give preference
to Native Hawaiian health care systems and Native Hawai-
ian organizations, and, to the extent feasible, health pro-
motion and disease prevention services shall be performed
through Native Hawaiian health care systems.
‘‘(2) In addition to paragraph (1), the Secretary may
make a grant to, or enter into a contract with, Papa Ola
Lokahi for the purpose of planning Native Hawaiian health
care systems to serve the health needs of Native Hawaiian
communities on the islands of O’ahu, Moloka’i, Maui, Ha-
wai’i, Lana’i, Kaua’i, and Ni’ihau in the State of Hawaii.
‘‘(b) QUALIFIED ENTITY.—An entity is a qualified en-
tity for purposes of subsection (a)(1) if the entity is a Na-
tive Hawaiian health care system.
‘‘(c) SERVICES TO BE PROVIDED.—(1) Each recipient
of funds under subsection (a)(1) shall provide the following
services:
‘‘(A) Outreach services to inform Native Hawai-
ians of the availability of health services.
‘‘(B) Education in health promotion and disease
prevention of the Native Hawaiian population by
(wherever possible) Native Hawaiian health care
practitioners, community outreach workers, coun-
selors, and cultural educators.
‘‘(C) Services of physicians, physicians’ assist-
ants, or nurse practitioners.
‘‘(D) Immunizations.
‘‘(E) Prevention and control of diabetes, high
blood pressure, and otitis media.
‘‘(F) Pregnancy and infant care.
‘‘(G) Improvement of nutrition.
‘‘(2) In addition to the mandatory services under
paragraph (1), the following services may be provided pur-
suant to subsection (a)(1):
‘‘(A) Identification, treatment, control, and re-
duction of the incidence of preventable illnesses and
conditions endemic to Native Hawaiians.
‘‘(B) Collection of data related to the prevention
of diseases and illnesses among Native Hawaiians.
‘‘(C) Services within the meaning of the terms
‘health promotion’, ‘disease prevention’, and ‘primary
health services’, as such terms are defined in section
10, which are not specifically referred to in para-
graph (1) of this subsection.
‘‘(3) The health care services referred to in paragraphs
(1) and (2) which are provided under grants or contracts
under subsection (a)(1) may be provided by traditional Na-
tive Hawaiian healers.
‘‘(d) LIMITATION ON NUMBER OF ENTITIES.—During
a fiscal year, the Secretary under this Act may make a
grant to, or hold a contract with, not more than 5 Native
Hawaiian health care systems.
‘‘(e) MATCHING FUNDS.—(1) The Secretary may not
make a grant or provide funds pursuant to a contract under
subsection (a)(1) to an entity—
‘‘(A) in an amount exceeding 75 percent of the
costs of providing health services under the grant or
contract; and
‘‘(B) unless the entity agrees that the entity will
make available, directly or through donations to the
entity, non-Federal contributions toward such costs in
an amount equal to not less than $1 (in cash or in
kind under paragraph (2)) for each $3 of Federal
funds provided in such grant or contract.
‘‘(2) Non-Federal contributions required in paragraph
(1) may be in cash or in kind, fairly evaluated, including
plant, equipment, or services. Amounts provided by the Fed-
eral Government 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.
‘‘(3) The Secretary may waive the requirement estab-
lished in paragraph (1) if—
‘‘(A) the entity involved is a nonprofit private
entity described in subsection (b); and
‘‘(B) the Secretary, in consultation with Papa
Ola Lokahi, determines that it is not feasible for the
entity to comply with such requirement.
‘‘(f) RESTRICTION ON USE OF GRANT AND CONTRACT
FUNDS.—The Secretary may not make a grant to, or enter
into a contract with, an entity under subsection (a)(1) un-
less the entity agrees that amounts received pursuant to
such subsection will not, directly or through contract, be
expended—
‘‘(1) for any purpose other than the purposes de-
scribed in subsection (c);
‘‘(2) to provide inpatient services;
‘‘(3) to make cash payments to intended recipi-
ents of health services; or
‘‘(4) to purchase or improve real property (other
than minor remodeling of existing improvements to
real property) or to purchase major medical equip-
ment.
‘‘(g) LIMITATION ON CHARGES FOR SERVICES.—The
Secretary may not make a grant, or enter into a contract
with, an entity under subsection (a)(1) unless the entity
agrees that, whether health services are provided directly or
through contract—
‘‘(1) health services under the grant or contract
will be provided without regard to ability to pay for
the health services; and
‘‘(2) the entity will impose a charge for the deliv-
ery of health services, and such charge—
‘‘(A) will be made according to a schedule
of charges that is made available to the public,
and
‘‘(B) will be adjusted to reflect the income
of the individual involved.
‘‘SEC. 5. FUNCTIONS OF, AND GRANTS TO, PAPA OLA
LOKAHI.
‘‘(a) FUNCTIONS.—Papa Ola Lokahi shall—
‘‘(1) coordinate, implement, and update, as ap-
propriate, the comprehensive health care master plan
developed pursuant to section 3;
‘‘(2) to the maximum extent possible, coordinate
and assist the health care programs and services pro-
vided to Native Hawaiians;
purpose of research on the health status of Native Hawai-
ians or for the purpose of addressing the health care needs
of Native Hawaiians.
‘‘(c) GRANTS.—In addition to any other grant or con-
tract under this Act, the Secretary may make grants to,
or enter into contracts with, Papa Ola Lokahi for—
‘‘(1) carrying out the functions described in sub-
section (a); and
‘‘(2) administering any special project funds re-
ceived under the authority of subsection (b).
‘‘(d) RELATIONSHIPS WITH OTHER AGENCIES.—Papa
Ola Lokahi may enter into agreements or memoranda of
understanding with relevant agencies or organizations that
are capable of providing resources or services to Native Ha-
waiian health care systems.
‘‘SEC. 6. ADMINISTRATION OF GRANTS AND CONTRACTS.
‘‘(a) TERMS AND CONDITIONS.—The Secretary shall
include in any grant made or contract entered into under
this Act such terms and conditions as the Secretary consid-
ers necessary or appropriate to ensure that the objectives
of such grant or contract are achieved.
‘‘(b) PERIODIC REVIEW.—The Secretary shall periodi-
cally evaluate the performance of, and compliance with,
grants and contracts under this Act.
‘‘(c) ADMINISTRATIVE
REQUIREMENTS.—The Sec-
retary may not make a grant or enter into a contract under
this Act with an entity unless the entity—
‘‘(1) agrees to establish such procedures for fiscal
control and fund accounting as may be necessary to
ensure proper disbursement and accounting with re-
spect to the grant or contract;
‘‘(2) agrees to ensure the confidentiality of
records maintained on individuals receiving health
services under the grant or contract;
‘‘(3) with respect to providing health services to
any population of Native Hawaiians a substantial
portion of which has a limited ability to speak the
English language—
‘‘(A) has developed and has the ability to
carry out a reasonable plan to provide health
services under the grant or contract through in-
dividuals who are able to communicate with the
population involved in the language and cultural
context that is most appropriate; and
‘‘(B) has designated at least one individual,
fluent in both English and the appropriate lan-
guage, to assist in carrying out the plan;
‘‘(4) with respect to health services that are cov-
ered in the plan of the State of Hawaii approved
under title XIX of the Social Security Act—
‘‘(A) if the entity will provide under the
grant or contract any such health services di-
rectly—
‘‘(i) the entity has entered into a par-
ticipation agreement under such plan; and
‘‘(ii) the entity is qualified to receive
payments under such plan; and
‘‘(B) if the entity will provide under the
grant or contract any such health services
through a contract with an organization—
‘‘(i) the organization has entered into
a participation agreement under such plan;
and
‘‘(ii) the organization is qualified to
receive payments under such plan; and
‘‘(5) agrees to submit to the Secretary and to
Papa Ola Lokahi an annual report that describes the
utilization and costs of health services provided under
the grant or contract (including the average cost of
health services per user) and that provides such other
information as the Secretary determines to be appro-
priate.
‘‘(d) CONTRACT EVALUATION.—(1) If, as a result of
evaluations conducted by the Secretary, the Secretary deter-
mines that an entity has not complied with or satisfactorily
performed a contract entered into under section 4, the Sec-
retary shall, prior to renewing such contract, attempt to
resolve the areas of noncompliance or unsatisfactory per-
formance and modify such contract to prevent future occur-
rences of such noncompliance or unsatisfactory perform-
ance. If the Secretary determines that such noncompliance
or unsatisfactory performance cannot be resolved and pre-
vented in the future, the Secretary shall not renew such con-
tract with such entity and is authorized to enter into a con-
tract under section 4 with another entity referred to in sec-
tion 4(b) that provides services to the same population of
Native Hawaiians which is served by the entity whose con-
tract is not renewed by reason of this subsection.
‘‘(2) In determining whether to renew a contract en-
tered into with an entity under this Act, the Secretary shall
consider the results of evaluation under this section.
‘‘(3) All contracts entered into by the Secretary under
this Act shall be in accordance with all Federal contracting
laws and regulations except that, in the discretion of the
Secretary, such contracts may be negotiated without adver-
tising and may be exempted from the provisions of the Act
of August 24, 1935 (40 U.S.C. 270a et seq.).
‘‘(4) Payments made under any contract entered into
under this Act may be made in advance, by means of reim-
bursement, or in installments and shall be made on such
conditions as the Secretary deems necessary to carry out
the purposes of this Act.
‘‘(e) LIMITATION ON USE OF FUNDS FOR ADMINISTRA-
TIVE EXPENSES.—Except for grants and contracts under
section 5(c), the Secretary may not make a grant to, or
enter into a contract with, an entity under this Act unless
the entity agrees that the entity will not expend more than
10 percent of amounts received pursuant to this Act for the
purpose of administering the grant or contract.
‘‘(f) REPORT.—(1) For each fiscal year during which
an entity receives or expends funds pursuant to a grant
or contract under this Act, such entity shall submit to the
Secretary and to Papa Ola Lokahi a quarterly report on—
‘‘(A) activities conducted by the entity under the
grant or contract;
‘‘(B) the amounts and purposes for which Fed-
eral funds were expended; and
‘‘(C) such other information as the Secretary
may request.
‘‘(2) The reports and records of any entity which con-
cern any grant or contract under this Act shall be subject
to audit by the Secretary, the Inspector General of Health
and Human Services, and the Comptroller General of the
United States.
‘‘(g) ANNUAL PRIVATE AUDIT.—The Secretary shall
allow as a cost of any grant made or contract entered into
under this Act the cost of an annual private audit con-
ducted by a certified public accountant.
‘‘SEC. 7. ASSIGNMENT OF PERSONNEL.
‘‘(a) IN GENERAL.—The Secretary is authorized to
enter into an agreement with any entity under which the
Secretary is authorized to assign personnel of the Depart-
ment of Health and Human Services with expertise identi-
fied by such entity to such entity on detail for the purposes
of providing comprehensive health promotion and disease
prevention services to Native Hawaiians.
‘‘(b) APPLICABLE
FEDERAL
PERSONNEL
PROVI-
SIONS.—Any assignment of personnel made by the Sec-
retary under any agreement entered into under the author-
ity of subsection (a) shall be treated as an assignment of
Federal personnel to a local government that is made in
accordance with subchapter VI of chapter 33 of title 5,
United States Code.
‘‘SEC. 8. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.
‘‘(a) ELIGIBILITY.—The Secretary is authorized to
make scholarship grants to students who—
signed, has received a grant or entered into a
contract pursuant to section 4; or
‘‘(ii) health professions shortage areas,
medically underserved areas, or geographic areas
or facilities similarly designated by the United
States Public Health Service in the State of Ha-
waii.
‘‘(2) The Secretary shall enter into a cooperative agree-
ment with the Kamehameha Schools/Bishop Estate under
which such organization shall provide recruitment, reten-
tion, counseling, and other support services intended to im-
prove the operation of the scholarship program established
under this section.
‘‘(3) The Native Hawaiian Health Scholarship pro-
gram shall not be administered by or through the Indian
Health Service.
‘‘SEC. 9. REPORT.
‘‘The President shall, at the time the budget is submit-
ted under section 1105 of title 31, United States Code, for
each fiscal year transmit to the Congress the report required
pursuant to section 2(d).
‘‘SEC. 10. DEFINITIONS.
‘‘For purposes of this Act:
‘‘(1) DISEASE PREVENTION.—The term ‘disease
prevention’ includes—
‘‘(A) immunizations,
‘‘(B) control of high blood pressure,
‘‘(C) control of sexually transmittable dis-
eases,
‘‘(D) prevention and control of diabetes,
‘‘(E) control of toxic agents,
‘‘(F) occupational safety and health,
‘‘(G) accident prevention,
‘‘(H) fluoridation of water,
‘‘(I) control of infectious agents, and
‘‘(J) provision of mental health care.
‘‘(2) HEALTH
PROMOTION.—The term ‘health
promotion’ includes—
‘‘(A) pregnancy and infant care, including
prevention of fetal alcohol syndrome,
‘‘(B) cessation of tobacco smoking,
‘‘(C) reduction in the misuse of alcohol and
drugs,
‘‘(D) improvement of nutrition,
‘‘(E) improvement in physical fitness,
‘‘(F) family planning, and
‘‘(G) control of stress.
‘‘(3) NATIVE HAWAIIAN.—The term ‘Native Ha-
waiian’ means any individual who is—
‘‘(A) a citizen of the United States; and
100
‘‘(B) a descendant of the aboriginal people,
who prior to 1778, occupied and exercised sov-
ereignty in the area that now constitutes the
State of Hawaii, as evidenced by—
‘‘(i) genealogical records;
‘‘(ii) Kupuna (elders) or Kama’aina
(long-term community residents) verifica-
tion; or
‘‘(iii) birth records of the State of Ha-
waii.
‘‘(4) NATIVE HAWAIIAN HEALTH CENTER.—The
term ‘Native Hawaiian health center’ means an en-
tity—
‘‘(A) which is organized under the laws of
the State of Hawaii,
‘‘(B) which provides or arranges for health
care services through practitioners licensed by
the State of Hawaii, where licensure require-
ments are applicable,
‘‘(C) which is a public or nonprofit private
entity, and
‘‘(D) in which Native Hawaiian health
practitioners significantly participate in the
planning, management, monitoring, and evalua-
tion of health services.
101
‘‘(5) NATIVE
HAWAIIAN
ORGANIZATION.—The
term ‘Native Hawaiian organization’ means any or-
ganization—
‘‘(A) which serves the interests of Native
Hawaiians,
‘‘(B) which is—
‘‘(i) recognized by Papa Ola Lokahi for
the purpose of planning, conducting, or ad-
ministering programs (or portions of pro-
grams) authorized under this Act for the
benefit of Native Hawaiians, and
‘‘(ii) certified by Papa Ola Lokahi as
having the qualifications and capacity to
provide the services, and meet the require-
ments, under the contract the organization
enters into with, or grant the organization
receives from, the Secretary under this Act,
‘‘(C) in which Native Hawaiian health
practitioners significantly participate in the
planning, management, monitoring, and evalua-
tion of health services, and
‘‘(D) which is a public or nonprofit private
entity.
102
‘‘(6) NATIVE HAWAIIAN HEALTH CARE SYSTEM.—
The term ‘Native Hawaiian health care system’
means an entity—
‘‘(A) which is organized under the laws of
the State of Hawaii;
‘‘(B) which provides or arranges for health
care services through practitioners licensed by
the State of Hawaii, where licensure require-
ments are applicable;
‘‘(C) which is a public or nonprofit private
entity;
‘‘(D) in which Native Hawaiian health
practitioners significantly participate in the
planning, management, monitoring, and evalua-
tion of health care services;
‘‘(E) which may be composed of as many
Native Hawaiian health centers as necessary to
meet the health care needs of Native Hawaiians
residing on the island or islands served by such
entity;
‘‘(F) which is recognized by Papa Ola
Lokahi for the purpose of providing comprehen-
sive health promotion and disease prevention
services as well as primary health services to Na-
tive Hawaiians under this Act; and
103
‘‘(G) which is certified by Papa Ola Lokahi
as having the qualifications and the capacity to
provide the services and meet the requirements of
a contract entered into, or a grant received,
under section 4.
‘‘(7) PAPA
OLA
LOKAHI.—(A) Subject to sub-
paragraph (B), the term ‘Papa Ola Lokahi’ means an
organization composed of—
‘‘(i) E Ola Mau;
‘‘(ii) the Office of Hawaiian Affairs of the
State of Hawaii;
‘‘(iii) Alu Like Inc.;
‘‘(iv) the University of Hawaii;
‘‘(v) the Office of Hawaiian Health of the
Hawaii State Department of Health;
‘‘(vi) Ho’ola Lahui Hawaii, or a health
care system serving the islands of Kaua’i and
Ni’ihau;
‘‘(vii) Ke Ola Mamo, or a health care sys-
tem serving the island of O’ahu;
‘‘(viii) Na Pu’uwai or a health care system
serving the islands of Moloka’i and Lana’i;
‘‘(ix) Hui No Ke Ola Pono, or a health care
system serving the island of Maui;
104
‘‘(x) Hui Malama Ola Ha’Oiwi or a health
care system serving the island of Hawaii; and
‘‘(xi) such other member organizations as
the Board of Papa Ola Lokahi may admit from
time to time, based upon satisfactory demonstra-
tion of a record of contribution to the health and
well-being of Native Hawaiians, and upon satis-
factory development of a mission statement in
relation to this Act, including clearly defined
goals and objectives, a 5-year action plan outlin-
ing the contributions that each organization will
make in carrying out the policy of this Act, and
an estimated budget.
‘‘(B) Such term does not include any organiza-
tion identified in subparagraph (A) if the Secretary
determines that such organization does not have a
mission statement with clearly defined goals and ob-
jectives for the contributions the organization will
make to Native Hawaiian health care systems and an
action plan for carrying out such goals and objectives.
‘‘(8) PRIMARY
HEALTH
SERVICES.—The term
‘primary health services’ means—
‘‘(A) services of physicians, physicians’ as-
sistants and nurse practitioners;
105
‘‘(B) diagnostic laboratory and radiologic
services;
‘‘(C) preventive health services (including
children’s eye and ear examinations to determine
the need for vision and hearing correction,
perinatal services, well child services, and family
planning services);
‘‘(D) emergency medical services;
‘‘(E) transportation services as required for
adequate patient care;
‘‘(F) preventive dental services; and
‘‘(G) pharmaceutical services, as may be
appropriate for particular health centers.
‘‘(9) SECRETARY.—The term ‘Secretary’ means
the Secretary of Health and Human Services.
‘‘(10) TRADITIONAL
NATIVE
HAWAIIAN
HEAL-
ER.—The term ‘traditional Native Hawaiian healer’
means a practitioner—
‘‘(A) who—
‘‘(i) is of Hawaiian ancestry, and
‘‘(ii) has the knowledge, skills, and ex-
perience in direct personal health care of
individuals, and
106
‘‘(B) whose knowledge, skills, and experience
are based on a demonstrated learning of Native
Hawaiian healing practices acquired by—
‘‘(i) direct practical association with
Native Hawaiian elders, and
‘‘(ii) oral traditions transmitted from
generation to generation.
‘‘SEC. 11. RULE OF CONSTRUCTION.
‘‘Nothing in this Act shall be construed to restrict the
authority of the State of Hawaii to license health practi-
tioners.
‘‘SEC. 12. COMPLIANCE WITH BUDGET ACT.
‘‘Any new spending authority (described in subsection
(c)(2) (A) or (B) of section 401 of the Congressional Budget
Act of 1974) which is provided under this Act shall be effec-
tive for any fiscal year only to such extent or in such
amounts as are provided in appropriation Acts.
‘‘SEC. 13. SEVERABILITY.
‘‘If any provision of this Act, or the application of any
such provision to any person or circumstances is held to
be invalid, the remainder of this Act, and the application
of such provision or amendment to persons or circumstances
other than those to which it is held invalid, shall not be
affected thereby.
107
‘‘SEC. 14. AUTHORIZATION OF APPROPRIATIONS.
‘‘There is authorized to be appropriated for each of the
fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000
such sums as may be necessary to carry out the purposes
of this Act.
‘‘SEC. 15. PROHIBITION AGAINST EXCLUSION FROM PAR-
TICIPATION.
‘‘Notwithstanding any other provision of this Act, no
person shall, on the basis of race, color, or national origin,
be excluded from participation in, or be denied the benefits
of, or be subjected to discrimination under, any program
or activity receiving Federal financial assistance under this
Act.’’.
SEC. 503. REPEAL OF PUBLIC HEALTH SERVICE ACT PROVI-
SION.
(a) IN GENERAL.—The Public Health Service Act (42
U.S.C. 201 et seq.), as amended by section 206 of this Act,
is amended by repealing section 338K and redesignating
section 338L as section 338K. Such repeal shall not be con-
strued to terminate contracts in effect under such section
on the date of the enactment of this Act. Any such contracts
shall continue according to the terms and conditions of such
contracts.
(b) EFFECTIVE DATE.—Subsection (a) takes effect on
the date of the enactment of this Act.
108
TITLE VI—WOMEN’S HEALTH
SEC. 
601. 
ESTABLISHMENT 
OF 
OFFICE 
OF 
WOMEN’S
HEALTH.
Title XVII of the Public Health Service Act (42 U.S.C.
300u et seq.), as amended by section 704 of Public Law
103–183 (107 Stat. 2240), is amended by adding at the
end the following section:
‘‘OFFICE OF WOMEN’S HEALTH
‘‘SEC. 1710. (a) IN GENERAL.—There is established an
Office of Women’s Health within the Office of the Assistant
Secretary for Health. There shall be in the Department of
Health and Human Services a Deputy Assistant Secretary
for Women’s Health, who shall be the head of the Office of
Women’s Health. The Secretary, acting through such Dep-
uty Assistant Secretary, shall carry out this section.
‘‘(b) DUTIES.—
‘‘(1) IN GENERAL.—The Secretary may conduct
or support programs and activities regarding wom-
en’s health conditions. In carrying out the preceding
sentence, the Secretary shall—
‘‘(A) monitor the programs and activities of
the agencies specified in paragraph (2) in order
to determine the extent to which the purposes of
the programs and activities are being carried out
109
with respect to women’s health conditions (as de-
fined in section 486);
‘‘(B) provide advice to the heads of such
agencies on improving programs and activities
that relate to such conditions; and
‘‘(C) coordinate such programs and activi-
ties of the agencies.
‘‘(2) SPECIFIED
AGENCIES.—For purposes of
paragraph (1), the agencies referred to in this para-
graph are the following:
‘‘(A) The Centers for Disease Control and
Prevention.
‘‘(B) The National Institutes of Health.
‘‘(C) The Agency for Health Care Policy
and Research.
‘‘(D) The Health Resources and Services
Administration.
‘‘(E) The Substance Abuse and Mental
Health Services Administration.
‘‘(F) The Food and Drug Administration.
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated $5,000,000 for fiscal year 1995, and
such sums as may be necessary for each of the fiscal years
1996 and 1997.’’.
110
SEC. 602. WOMEN’S SCIENTIFIC EMPLOYMENT REGARDING
NATIONAL INSTITUTES OF HEALTH.
(a) IN GENERAL.—Part A of title IV of the Public
Health Service Act (42 U.S.C. 281 et seq.) is amended by
adding at the end the following section:
‘‘WOMEN’S SCIENTIFIC EMPLOYMENT
‘‘SEC. 404F. (a) IN GENERAL.—The Director of NIH
shall—
‘‘(1) establish policies for the National Institutes
of Health on matters relating to the employment by
such Institutes of women as scientists;
‘‘(2) monitor the extent of compliance with such
policies, including through the implementation of an
accountability system under the Federal Equal Op-
portunity Recruitment Program; and
‘‘(3) establish and maintain a process for re-
sponding to incidents of noncompliance with such
policies.
‘‘(b) CERTAIN
POLICIES.—In establishing policies
under subsection (a)(1), the Director of NIH shall provide
for the following policies regarding the employment of
women as scientists at the National Institutes of Health:
‘‘(1) A policy on the granting of tenured status.
‘‘(2) A policy on family leave.
‘‘(3) A policy on the recruitment of minority
women.
111
‘‘(4) A policy on the inclusion of women sci-
entists in intramural and extramural conferences,
workshops, international congresses, and similar
events funded or sponsored by such Institutes.
‘‘(c) AVAILABILITY
OF POLICIES.—The Director of
NIH shall ensure that copies of policies established under
subsection (a) are available to scientists of the National In-
stitutes of Health.
‘‘(d) DEFINITION.—For purposes of this section, the
term ‘Federal Equal Opportunity Recruitment Program’
means the program carried out under part 720 of title 5,
Code of Federal Regulations (5 CFR 720).’’.
(b) STUDIES.—
(1) PAY EQUITY.—The Director of the National
Institutes of Health shall provide for a study to iden-
tify any pay differences among men and women sci-
entists employed (both tenured and untenured) by the
National Institutes of Health. The study shall include
recommendations on measures to adjust any inequi-
ties, and on making available information on salary
ranges to all scientists of such Institutes.
(2) STUDY ON TERMINATION OF EMPLOYMENT.—
The Comptroller General of the United States shall
conduct a study for the purpose of determining the
reasons underlying the employment termination of
112
scientists of the National Institutes of Health. The
study shall be carried out with respect to male and
female scientists, and with respect to voluntary and
involuntary terminations.
(3) REPORTS.—Not later than 240 days after the
date of the enactment of this Act, the studies required
in this subsection shall be completed, and reports de-
scribing the findings and recommendations of the
studies shall be submitted to the Committee on En-
ergy and Commerce of the House of Representatives
and the Committee on Labor and Human Resources
of the Senate.
SEC. 603. INFORMATION AND EDUCATION REGARDING FE-
MALE GENITAL MUTILATION.
(a) IN GENERAL.—The Secretary of Health and
Human Services shall ensure that the Deputy Assistant Sec-
retary for Women’s Health and the Deputy Assistant Sec-
retary for Minority Health collaborate for the purpose of
carrying out the following activities:
(1) Compile data on the number of females liv-
ing in the United States who have been subjected to
female genital mutilation (whether in the United
States or in their countries of origin), including a
specification of the number of girls under the age of
18 who have been subjected to such mutilation.
113
(2) Identify communities in the United States
that practice female genital mutilation, and design
and carry out outreach activities to educate individ-
uals in the communities on the physical and psycho-
logical health effects of such practice. Such outreach
activities shall be designed and implemented in col-
laboration with representatives of the ethnic groups
practicing such mutilation and with representatives
of organizations with expertise in preventing such
practice.
(3) Develop recommendations for the education
of students of schools of medicine and osteopathic
medicine regarding female genital mutilation and
complications arising from such mutilation. Such rec-
ommendations shall be disseminated to such schools.
(b) DEFINITION.—For purposes of this section, the
term ‘‘female genital mutilation’’ means the removal or
infibulation (or both) of the whole or part of the clitoris,
the labia minor, or the labia major.
SEC. 604. STUDY REGARDING CURRICULA OF MEDICAL
SCHOOLS AND WOMEN’S HEALTH CONDI-
TIONS.
(a) IN GENERAL.—The Secretary of Health and
Human Services, acting through the Administrator of the
Health Resources and Services Administration, shall con-
114
duct a study for the purpose of determining the contents
of the curriculum of schools of medicine and osteopathic
medicine and whether such curriculum provides adequate
education to students on women’s health conditions.
(b) CONSULTATIONS.—The Secretary shall carry out
subsection (a) in consultation with the Deputy Assistant
Secretary for Women’s Health and the Director of the Office
of Research on Women’s Health (of the National Institutes
of Health).
(c) REPORT.—Not later than April 1, 1995, the Sec-
retary shall complete the study required in subsection (a)
and submit to the Committee on Energy and Commerce of
the House of Representatives, and to the Committee on
Labor and Human Resources of the Senate, a report de-
scribing the findings made as a result of the study and con-
taining any recommendations of the Secretary regarding
such findings.
(d) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘Secretary’’ means the Secretary of
Health and Human Services.
(2) The term ‘‘women’s health conditions’’ has
the meaning given such term in section 486 of the
Public Health Service Act.
115
TITLE VII—TRAUMATIC BRAIN
INJURY
SEC. 701. PROGRAMS OF CENTERS FOR DISEASE CONTROL
AND PREVENTION.
(a) TECHNICAL CORRECTION REGARDING AMEND-
ATORY INSTRUCTIONS.—Section 301(a) of Public Law 103–
183 (107 Stat. 2233) is amended by striking ‘‘(42 U.S.C.
242 et seq.)’’ and inserting ‘‘(42 U.S.C. 243 et seq.)’’. The
amendment made by the preceding sentence is deemed to
have taken effect immediately after the enactment of Public
Law 103–183.
(b) PROGRAMS OF CENTERS FOR DISEASE CONTROL
AND PREVENTION.—Part B of title III of the Public Health
Service Act (42 U.S.C. 243 et seq.), as amended pursuant
to subsection (a) and as amended by section 703 of Public
Law 103–183 (107 Stat. 2240), is amended by inserting
after section 317F the following section:
‘‘PREVENTION OF TRAUMATIC BRAIN INJURY
‘‘SEC. 317G. (a) The Secretary, acting through the Di-
rector of the Centers for Disease Control and Prevention,
may carry out projects to reduce the incidence of traumatic
brain injury. Such projects may be carried out by the Sec-
retary directly or through awards of grants or contracts to
public or nonprofit private entities. The Secretary may di-
rectly or through such awards provide technical assistance
116
with respect to the planning, development, and operation
of such projects.
‘‘(b) CERTAIN
ACTIVITIES.—Activities under sub-
section (a) may include—
‘‘(1) the conduct of research into identifying ef-
fective strategies for the prevention of traumatic brain
injury; and
‘‘(2) the implementation of public information
and education programs for the prevention of such in-
jury and for broadening the awareness of the public
concerning the public health consequences of such in-
jury.
‘‘(c) COORDINATION OF ACTIVITIES.—The Secretary
shall ensure that activities under this section are coordi-
nated as appropriate with other agencies of the Public
Health Service that carry out activities regarding trau-
matic brain injury.
‘‘(d) DEFINITION.—For purposes of this section, the
term ‘traumatic brain injury’ means an acquired injury
to the brain. Such term does not include brain dysfunction
caused by congenital or degenerative disorders, nor birth
trauma, but may include brain injuries caused by anoxia
due to near drowning.’’.
117
SEC. 
702. 
PROGRAMS 
OF 
NATIONAL 
INSTITUTES 
OF
HEALTH.
Section 1261 of the Public Health Service Act (42
U.S.C. 300d-61) is amended—
(1) in subsection (d)—
(A) in paragraph (2), by striking ‘‘and’’
after the semicolon at the end;
(B) in paragraph (3), by striking the period
and inserting ‘‘; and’’; and
(C) by adding at the end the following
paragraph:
‘‘(4) the authority to make awards of grants or
contracts to public or nonprofit private entities for
the conduct of basic and applied research regarding
traumatic brain injury, which research may in-
clude—
‘‘(A) the development of new methods and
modalities for the more effective diagnosis, meas-
urement of degree of injury, post-injury monitor-
ing and prognostic assessment of head injury for
acute, subacute and later phases of care;
‘‘(B) the development, modification and
evaluation of therapies that retard, prevent or
reverse brain damage after acute head injury,
that arrest further deterioration following injury
118
and that provide the restitution of function for
individuals with long-term injuries;
‘‘(C) the development of research on a con-
tinuum of care from acute care through rehabili-
tation, designed, to the extent practicable, to in-
tegrate rehabilitation and long-term outcome
evaluation with acute care research; and
‘‘(D) the development of programs that in-
crease the participation of academic centers of
excellence in head injury treatment and rehabili-
tation research and training.’’; and
(2) in subsection (h), by adding at the end the
following paragraph:
‘‘(4) The term ‘traumatic brain injury’ means
an acquired injury to the brain. Such term does not
include brain dysfunction caused by congenital or de-
generative disorders, nor birth trauma, but may in-
clude brain injuries caused by anoxia due to near
drowning.’’.
SEC. 703. PROGRAMS OF HEALTH RESOURCES AND SERV-
ICES ADMINISTRATION.
Part E of title XII of the Public Health Service Act
(42 U.S.C. 300d-51 et seq.) is amended by adding at the
end the following section:
119
‘‘SEC. 
1252. 
STATE 
GRANTS 
FOR 
DEMONSTRATION
PROJECTS REGARDING TRAUMATIC BRAIN
INJURY.
‘‘(a) IN GENERAL.—The Secretary, acting through the
Administrator of the Health Resources and Services Admin-
istration, may make grants to States for the purpose of car-
rying out demonstration projects to improve the availabil-
ity of health services regarding traumatic brain injury.
‘‘(b) STATE ADVISORY BOARD.—
‘‘(1) IN GENERAL.—The Secretary may make a
grant under subsection (a) only if the State involved
agrees to establish an advisory board within the ap-
propriate health department of the State or within
another department as designated by the chief execu-
tive officer of the State.
‘‘(2) FUNCTIONS.—An advisory board established
under paragraph (1) shall be cognizant of findings
and concerns of Federal, State and local agencies,
citizens groups, and private industry (such as insur-
ance, health care, automobile, and other industry en-
tities). Such advisory boards shall encourage citizen
participation through the establishment of public
hearings and other types of community outreach pro-
grams.
‘‘(3) COMPOSITION.—An advisory board estab-
lished under paragraph (1) shall be composed of—
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‘‘(A) representatives of—
‘‘(i) the corresponding State agencies
involved;
‘‘(ii) public and nonprofit private
health related organizations;
‘‘(iii) other disability advisory or
planning groups within the State;
‘‘(iv) members of an organization or
foundation representing traumatic brain in-
jury survivors in that State; and
‘‘(v) injury control programs at the
State or local level if such programs exist;
and
‘‘(B) a substantial number of individuals
who are survivors of traumatic brain injury, or
the family members of such individuals.
‘‘(c) MATCHING FUNDS.—
‘‘(1) IN GENERAL.—With respect to the costs to
be incurred by a State in carrying out the purpose
described in subsection (a), the Secretary may make
a grant under such subsection only if the State agrees
to make available, in cash, non-Federal contributions
toward such costs in an amount that is not less than
$1 for each $2 of Federal funds provided under the
grant.
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‘‘(2) DETERMINATION
OF
AMOUNT
CONTRIB-
UTED.—In determining the amount of non-Federal
contributions in cash that a State has provided pur-
suant to paragraph (1), the Secretary may not in-
clude any amounts provided to the State by the Fed-
eral Government.
‘‘(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 applica-
tion is in such form, is made in such manner, and contains
such agreements, assurances, and information as the Sec-
retary determines to be necessary to carry out this section.
‘‘(e) COORDINATION OF ACTIVITIES.—The Secretary
shall ensure that activities under this section are coordi-
nated as appropriate with other agencies of the Public
Health Service that carry out activities regarding trau-
matic brain injury.
‘‘(f) REPORT.—Not later than 2 years after the effec-
tive date under section 901 of the Minority Health Improve-
ment Act of 1994, the Secretary shall submit to the Commit-
tee on Energy and Commerce of the House of Representa-
tives, and to the Committee on Labor and Human Re-
sources of the Senate, a report describing the findings and
results of the programs established under this section, in-
122
cluding measures of outcomes and consumer and surrogate
satisfaction.
‘‘(g) DEFINITION.—For purposes of this section, the
term ‘traumatic brain injury’ means an acquired injury
to the brain. Such term does not include brain dysfunction
caused by congenital or degenerative disorders, nor birth
trauma, but may include brain injuries caused by anoxia
due to near drowning.
‘‘(h) AUTHORIZATION
OF APPROPRIATIONS.—There
are authorized to be appropriated to carry out this section,
$5,000,000 for fiscal year 1995, and such sums as may be
necessary for each of the fiscal years 1996 and 1997.’’.
SEC. 704. STUDY; CONSENSUS CONFERENCE.
(a) STUDY.—
(1) IN GENERAL.—The Secretary of Health and
Human Services (in this section referred to as the
‘‘Secretary’’), acting through the appropriate agencies
of the Public Health Service, shall conduct a study for
the purpose of carrying out the following with respect
to traumatic brain injury:
(A) In collaboration with appropriate State
and local health-related agencies—
(i) determine the incidence and preva-
lence of traumatic brain injury; and
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(ii) develop a uniform reporting sys-
tem under which States report incidences of
traumatic brain injury, if the Secretary de-
termines that such a system is appropriate.
(B) Identify common therapeutic interven-
tions which are used for the rehabilitation of in-
dividuals with such injuries, and shall, subject to
the availability of information, include an anal-
ysis of—
(i) the effectiveness of each such inter-
vention in improving the functioning of in-
dividuals with brain injuries;
(ii) the comparative effectiveness of
interventions employed in the course of re-
habilitation of individuals with brain inju-
ries to achieve the same or similar clinical
outcome; and
(iii) the adequacy of existing measures
of outcomes and knowledge of factors influ-
encing differential outcomes.
(C) Develop practice guidelines for the reha-
bilitation of traumatic brain injury at such time
as appropriate scientific research becomes avail-
able.
(2) DATES CERTAIN FOR REPORTS.—
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(A) Not later than 18 months after the effec-
tive date under section 901, the Secretary shall
submit to the Committee on Energy and Com-
merce of the House of Representatives, and to the
Committee on Labor and Human Resources of
the Senate, a report describing the findings made
as a result of carrying out paragraph (1)(A).
(B) Not later than 3 years after the effective
date under section 901, the Secretary shall sub-
mit to the Committees specified in subparagraph
(A) a report describing the findings made as a
result of carrying out subparagraphs (B) and
(C) of paragraph (1).
(b) CONSENSUS CONFERENCE.—The Secretary, acting
through the Director of the National Center for Medical Re-
habilitation Research within the National Institute for
Child Health and Human Development, shall conduct a na-
tional consensus conference on managing traumatic brain
injury and related rehabilitation concerns.
(c) DEFINITION.—For purposes of this section, the
term ‘‘traumatic brain injury’’ means an acquired injury
to the brain. Such term does not include brain dysfunction
caused by congenital or degenerative disorders, nor birth
trauma, but may include brain injuries caused by anoxia
due to near drowning.
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TITLE VIII—MISCELLANEOUS
PROVISIONS
SEC. 801. TECHNICAL AMENDMENT TO INDIAN HEALTH
CARE IMPROVEMENT ACT.
The last sentence of section 818(e)(3) of the Indian
Health Care Improvement Act (25 U.S.C. 1680h(e)(3)) is
amended—
(1) by striking ‘‘services,’’ and inserting ‘‘serv-
ices’’; and
(2) by striking ‘‘, shall be recoverable.’’ and in-
serting a period.
SEC. 802. HEALTH SERVICES FOR PACIFIC ISLANDERS.
Section 10 of the Disadvantaged Minority Health Im-
provement Act of 1990 (42 U.S.C. 254c–1) is amended—
(1) in subsection (b)—
(A) by striking paragraphs (5) and (6);
(B) by redesignating paragraphs (7) and
(8) as paragraphs (5) and (6), respectively;
(C) in paragraph (2)—
(i) by inserting ‘‘substance abuse’’ after
‘‘availability of health’’; and
(ii) by striking ‘‘, including improved
health data systems’’; and
(D) in paragraph (3)—
126
(i) by striking ‘‘manpower’’ and in-
serting ‘‘care providers’’; and
(ii) by striking ‘‘by—’’ and all that
follows through the end and inserting a
semicolon; and
(2) in subsection (f)—
(A) by striking ‘‘There is’’ and inserting
‘‘There are’’; and
(B) by striking ‘‘$10,000,000’’ and all that
follows 
through 
‘‘1993’’ 
and 
inserting
‘‘$3,000,000 for each of the fiscal years 1995
through 1997’’.
SEC. 803. TECHNICAL CORRECTIONS REGARDING PUBLIC
LAW 103–183.
(a) AMENDATORY INSTRUCTIONS.—Public Law 103–
183 is amended—
(1) in section 601—
(A) in subsection (b), in the matter preced-
ing paragraph (1), by striking ‘‘Section 1201 of
the Public Health Service Act (42 U.S.C. 300d)’’
and inserting ‘‘Title XII of the Public Health
Service Act (42 U.S.C. 300d et seq.)’’; and
(B) in subsection (f)(1), by striking ‘‘in sec-
tion 1204(c)’’ and inserting ‘‘in section 1203(c)
127
(as redesignated by subsection (b)(2) of this sec-
tion)’’;
(2) in section 602, by striking ‘‘for the purpose’’
and inserting ‘‘For the purpose’’; and
(3) in section 705(b), by striking ‘‘317D((l)(1)’’
and inserting ‘‘317D(l)(1)’’.
(b) PUBLIC HEALTH SERVICE ACT.—The Public
Health Service Act, as amended by Public Law 103–183
and by subsection (a) of this section, is amended—
(1) in section 317E(g)(2), by striking ‘‘making
grants under subsection (b)’’ and inserting ‘‘carrying
out subsection (b)’’;
(2) in section 318, in subsection (e) as in effect
on the day before the date of the enactment of Public
Law 103–183, by redesignating the subsection as sub-
section (f);
(3) in subpart 6 of part C of title IV—
(A) by transferring the first section 447
(added by section 302 of Public Law 103–183)
from the current placement of the section;
(B) by redesignating the section as section
447A; and
(C) by inserting the section after section
447;