254b(a)) is amended by adding at the end the fol-
lowing paragraph:
‘‘(8) In making grants under subsections (c)(1) and
(d)(1), the Secretary may provide for the development and
operation of more than one migrant health center in a
catchment area in any case in which the Secretary deter-
mines that in such area there are workers or other individ-
uals described in subsection (a)(1) (in the matter after
and below subparagraph (H)) who otherwise will have a
shortage of personal health services. The preceding sen-
tence may not be construed as requiring that, in such a
case, the catchment areas of the centers involved be iden-
tical.’’.
(3) OFFSITE
ACTIVITIES.—Section 329(a) of
the Public Health Service Act, as amended by para-
graph (2) of this subsection, is amended by adding
at the end the following paragraph:
‘‘(9) In making grants under this section, the Sec-
retary may, to the extent determined by the Secretary to
be appropriate, authorize migrant health centers to pro-
vide services at locations other than the center.’’.
(4) AMOUNT
OF
GRANT; USE
OF
CERTAIN
FUNDS.—Section 329(d)(4) of the Public Health
Service Act (42 U.S.C. 254b(d)(4)), as amended by
section 309(a)(3) of Public Law 102–531 (106 Stat.
3500), is amended to read as follows:
‘‘(4)(A) The amount of a grant under paragraph (1)
or under subsection (c) for a migrant health center shall
be determined by the Secretary, taking into account (for
the period for which the grant is made)—
‘‘(i) the costs that the center may reasonably be
expected to incur in carrying out the plan approved
by the Secretary pursuant to subsection (f)(3)(H),
and
‘‘(ii) the amounts that the center may reason-
ably be expected to receive as State, local, and other
operational funding (exclusive of amounts to be pro-
vided in the grant under this section) and as fees,
premiums, and third-party reimbursements.
‘‘(B)(i) Subject to clause (ii), the Secretary may not
restrict the purposes for which a migrant health center
expends the amounts described in subparagraph (A)(ii)
(including restrictions imposed pursuant to Federal cost
principles).
‘‘(ii) The Secretary may require that amounts de-
scribed in subparagraph (A)(ii) be expended for purposes
that are consistent with the purposes specified in this sec-
tion.
‘‘(C)(i) Payments under a grant under this section
shall be made in advance or by way of reimbursement and
in such installments as the Secretary finds necessary. Ad-
justments in such payments may be made for overpay-
ments or underpayments, subject to clause (ii).
‘‘(ii) If, for the period for which a grant is made
under paragraph (1) to a migrant health center, the sum
of the amount of the grant and the amounts described in
subparagraph (A)(ii) that the center actually received ex-
ceeded the costs of the center in carrying out the plan
approved by the Secretary pursuant to subsection
(f)(3)(H), then the center is entitled to retain such excess
amount if the center agrees to expend such amount only
for the following purposes:
‘‘(I) To expand and improve services.
‘‘(II) To increase the number of persons served.
‘‘(III) To acquire, modernize, or expand facili-
ties, or to construct facilities.
‘‘(IV) To improve the administration of service
programs.
‘‘(V) To establish financial reserves.
‘‘(D) With respect to funds that are amounts de-
scribed in subparagraph (A)(ii) or excess amounts de-
scribed in subparagraph (C)(ii), this paragraph may not
be construed as limiting the authority of the Secretary to
require the submission of such plans, budgets, and other
information as may be necessary to ensure that the funds
are expended in accordance with subparagraph (B)(ii), or
clauses (I) through (V) of subparagraph (C)(ii), respec-
tively.’’.
(5) AUTHORIZATION
OF
APPROPRIATIONS.—
Section 329(h) of the Public Health Service Act (42
U.S.C. 254b(h)) is amended—
(A) in paragraph (1)(A), by striking
‘‘1994’’ and inserting ‘‘1998’’; and
(B) in paragraph (2)(A), by striking
‘‘1994’’ and inserting ‘‘1998’’.
(b) COMMUNITY HEALTH CENTERS.—
(1) TREATMENT
OF
PREGNANT
WOMEN
FOR
SUBSTANCE
ABUSE.—Section 330 of the Public
Health Service Act (42 U.S.C. 254c) is amended—
(A) in subsection (a)(3)—
(i) by inserting ‘‘(A)’’ after ‘‘(3)’’;
(ii) in subparagraph (A) (as so des-
ignated), by adding ‘‘and’’ after the
comma at the end; and
(iii) by adding at the end the follow-
ing subparagraph:
‘‘(B) in the case of referrals of pregnant women
for the treatment of substance abuse, notification of
the referrals to the State official responsible for car-
rying out programs under subpart II of part B of
title XIX,’’; and
(B) in subsection (b)(2)—
(i) in subparagraph (L), by striking
‘‘and’’ at the end;
(ii) by redesignating subparagraph
(M) as subparagraph (N); and
(iii) by inserting after subparagraph
(L) the following subparagraph:
‘‘(M) treatment of pregnant women for sub-
stance abuse; and’’.
(2) OVERLAP IN CATCHMENT AREAS.—Section
330(b) of the Public Health Service Act (42 U.S.C.
254c(b)) is amended by adding at the end the fol-
lowing paragraph:
‘‘(7) In making grants under subsections (c)(1) and
(d)(1), the Secretary may provide for the development and
operation of more than one community health center in
a catchment area in any case in which the Secretary deter-
mines that there is a population group in such area that
otherwise will have a shortage of personal health services.
The preceding sentence may not be construed as requiring
that, in such a case, the catchment areas of the centers
involved be identical.’’.
(3) OFFSITE
ACTIVITIES.—Section 330(b) of
the Public Health Service Act, as amended by para-
graph (2) of this subsection, is amended by adding
at the end the following paragraph:
‘‘(8) In making grants under this section, the Sec-
retary may, to the extent determined by the Secretary to
be appropriate, authorize community health centers to
provide services at locations other than the center.’’.
(4) AMOUNT
OF
GRANT; USE
OF
CERTAIN
FUNDS.—Section 330(d)(4) of the Public Health
Service Act (42 U.S.C. 254c(d)(4)), as amended by
section 309(b)(3) of Public Law 102-531 (106 Stat.
3501), is amended to read as follows:
‘‘(4)(A) The amount of a grant under paragraph (1)
or under subsection (c) for a community health center
shall be determined by the Secretary, taking into account
(for the period for which the grant is made)—
‘‘(i) the costs that the center may reasonably be
expected to incur in carrying out the plan approved
by the Secretary pursuant to subsection (e)(3)(H),
and
‘‘(ii) the amounts that the center may reason-
ably be expected to receive as State, local, and other
operational funding (exclusive of amounts to be pro-
vided in the grant under this section) and as fees,
premiums, and third-party reimbursements.
‘‘(B)(i) Subject to clause (ii), the Secretary may not
restrict the purposes for which a community health center
expends the amounts described in subparagraph (A)(ii)
(including restrictions imposed pursuant to Federal cost
principles).
‘‘(ii) The Secretary may require that amounts de-
scribed in subparagraph (A)(ii) be expended for purposes
that are consistent with the purposes specified in this sec-
tion.
‘‘(C)(i) Payments under a grant under this section
shall be made in advance or by way of reimbursement and
in such installments as the Secretary finds necessary. Ad-
justments in such payments may be made for overpay-
ments or underpayments, subject to clause (ii).
‘‘(ii) If, for the period for which a grant is made
under paragraph (1) to a community health center, the
sum of the amount of the grant and the amounts described
in subparagraph (A)(ii) that the center actually received
exceeded the costs of the center in carrying out the plan
approved by the Secretary pursuant to subsection
(e)(3)(H), then the center is entitled to retain such excess
amount if the center agrees to expend such amount only
for the following purposes:
‘‘(I) To expand and improve services.
‘‘(II) To increase the number of persons served.
‘‘(III) To acquire, modernize, or expand facili-
ties, or to construct facilities.
‘‘(IV) To improve the administration of service
programs.
‘‘(V) To establish financial reserves.
‘‘(D) With respect to funds that are amounts de-
scribed in subparagraph (A)(ii) or excess amounts de-
scribed in subparagraph (C)(ii), this paragraph may not
be construed as limiting the authority of the Secretary to
require the submission of such plans, budgets, and other
information as may be necessary to ensure that the funds
are expended in accordance with subparagraph (B)(ii), or
clauses (I) through (V) of subparagraph (C)(ii), respec-
tively.’’.
(5) AUTHORIZATION
OF
APPROPRIATIONS.—
Section 330(g) of the Public Health Service Act (42
U.S.C. 254c(g)) is amended—
(A) in paragraph (1)(A), by striking
‘‘1994’’ and inserting ‘‘1998’’; and
(B) in paragraph (2)(A), by striking
‘‘1994’’ and inserting ‘‘1998’’.
‘‘(B) The Secretary may not make a grant
under subsection (a) unless the State involved
agrees that, if the State provides a waiver
under subparagraph (A) for a health profes-
sional, section 338D(b)(1) will apply to the
agreement under such subparagraph between
the State and the health professional to the
same extent and in the same manner as such
section applies to an agreement between the
Secretary and a health professional regarding a
full-time private clinical practice.’’.
SEC. 205. GRANTS TO STATES FOR OPERATION OF STATE
OFFICES OF RURAL HEALTH.
Section 338J of the Public Health Service Act (42
U.S.C. 254r) is amended—
(1) in subsection (b)(1), in the matter preced-
ing subparagraph (A), by striking ‘‘in cash’’; and
(2) in subsection (j)(1)—
(A) by striking ‘‘and’’ after ‘‘1992’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and such sums as may be necessary
for each of the fiscal years 1995 through
1997’’.
SEC. 206. DEMONSTRATION GRANTS TO STATES FOR COM-
MUNITY SCHOLARSHIP PROGRAMS REGARD-
ING OBLIGATED SERVICE OF HEALTH PRO-
FESSIONALS.
Section 338L of the Public Health Service Act (42
U.S.C. 254t) is amended—
(1) by striking ‘‘health manpower shortage’’
each place such term appears and inserting ‘‘health
professional shortage’’;
(2) in subsection (e)—
(A) by striking paragraph (1);
(B) 
by 
redesignating 
paragraphs 
(2)
through (6) as paragraphs (1) through (5), re-
spectively; and
(C) in paragraph (1) (as so redesignated),
by inserting after ‘‘the individual’’ the follow-
ing: ‘‘who is to receive the scholarship under
the contract’’;
(3) in subsection (k)(2), by striking ‘‘internal
medicine, pediatrics,’’ and inserting ‘‘general inter-
nal medicine, general pediatrics,’’; and
(4) in subsection (l)(1)—
(A) by striking ‘‘and’’ after ‘‘1992,’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and such sums as may be necessary
for each of the fiscal years 1995 through
1997’’.
SEC. 207. PROGRAMS REGARDING BIRTH DEFECTS.
Section 317C of the Public Health Service Act (42
U.S.C. 247b–4), as added by section 306 of Public Law
102-531 (106 Stat. 3494), is amended to read as follows:
‘‘PROGRAMS REGARDING BIRTH DEFECTS
‘‘SEC. 317C. (a) The Secretary, acting through the
Director of the Centers for Disease Control and Preven-
tion, shall carry out programs—
‘‘(1) to collect, analyze, and make available data
on birth defects (in manner that facilitates compli-
ance with subsection (d)(2)), including data on the
causes of such defects and on the incidence and
prevalence of such defects;
‘‘(2) to provide information and education to
the public on the prevention of such defects;
‘‘(3) to improve the education, training, and
clinical skills of health professionals with respect to
the prevention of such defects;
‘‘(4) to carry out demonstration projects for the
prevention of such defects; and
‘‘(5) to operate regional centers for the conduct
of research on the prevention of such defects.
‘‘(b) ADDITIONAL PROVISIONS REGARDING COLLEC-
TION OF DATA.—
‘‘(1) IN GENERAL.—In carrying out subsection
(a)(1), the Secretary—
‘‘(A) shall collect and analyze data by gen-
der and by racial and ethnic group, including
Hispanics, non-Hispanic whites, African Ameri-
cans, Native Americans, Asian Americans, and
Pacific Islanders;
‘‘(B) shall collect data under subparagraph
(A) from birth certificates, death certificates,
hospital records, and such other sources as the
Secretary determines to be appropriate; and
‘‘(C) shall encourage States to establish or
improve programs for the collection and analy-
sis of epidemiological data on birth defects, and
to make the data available.
‘‘(2) NATIONAL CLEARINGHOUSE.—In carrying
out subsection (a)(1), the Secretary shall establish
and maintain a National Information Clearinghouse
on Birth Defects to collect and disseminate to health
professionals and the general public information on
birth defects, including the prevention of such de-
fects.
‘‘(c) GRANTS AND CONTRACTS.—
‘‘(1) IN GENERAL.—In carrying out subsection
(a), the Secretary may make grants to and enter
into contracts with public and nonprofit private enti-
ties.
‘‘(2) SUPPLIES
AND
SERVICES
IN
LIEU
OF
AWARD FUNDS.—
‘‘(A) Upon the request of a recipient of an
award of a grant or contract under paragraph
(1), the Secretary may, subject to subparagraph
(B), provide supplies, equipment, and services
for the purpose of aiding the recipient in carry-
ing out the purposes for which the award is
made and, for such purposes, may detail to the
recipient any officer or employee of the Depart-
ment of Health and Human Services.
‘‘(B) With respect to a request described
in subparagraph (A), the Secretary shall reduce
the amount of payments under the award in-
volved by an amount equal to the costs of de-
tailing personnel and the fair market value of
any supplies, equipment, or services provided by
the Secretary. The Secretary shall, for the pay-
ment of expenses incurred in complying with
such request, expend the amounts withheld.
‘‘(3) APPLICATION FOR AWARD.—The Secretary
may make an award of a grant or contract under
paragraph (1) only if an application for the award
is submitted to the Secretary and the application is
in such form, is made in such manner, and contains
such agreements, assurances, and information as the
Secretary determines to be necessary to carry out
the purposes for which the award is to be made.
‘‘(d) BIENNIAL REPORT.—Not later than February
1 of fiscal year 1995 and of every second such year there-
after, the Secretary shall submit to the Committee on En-
ergy and Commerce of the House of Representatives, and
the Committee on Labor and Human Resources of the
Senate, a report that, with respect to the preceding 2 fis-
cal years—
‘‘(1) contains information regarding the inci-
dence and prevalence of birth defects and the extent
to which birth defects have contributed to the inci-
dence and prevalence of infant mortality;
‘‘(2) contains information under paragraph (1)
that is specific to various racial and ethnic groups
(including Hispanics, non-Hispanic whites, African
Americans, Native Americans, and Asian Ameri-
cans);
‘‘(3) contains an assessment of the extent to
which various approaches of preventing birth defects
have been effective;