117
‘‘(i) for not less than 20 years after
completion of the construction, the facility
will be used for the purposes of research
for which it is to be constructed;
‘‘(ii) sufficient funds will be available
to meet the non-Federal share of the cost
of constructing the facility;
‘‘(iii) sufficient funds will be available,
when construction is completed, for the ef-
fective use of the facility for the research
for which it is being constructed; and
‘‘(iv) the proposed construction will
expand the applicant’s capacity for re-
search, or is necessary to improve or main-
tain the quality of the applicant’s research.
‘‘(C) The applicant meets reasonable quali-
fications established by the Director with re-
spect to—
‘‘(i) the relative scientific and tech-
nical merit of the applications, and the rel-
ative effectiveness of the proposed facili-
ties, in expanding the capacity for bio-
medical or behavioral research and in im-
proving the quality of such research;
118
‘‘(ii) the quality of the research or
training, or both, to be carried out in the
facilities involved;
‘‘(iii) the need of the applicant for
such facilities in order to maintain or ex-
pand the applicant’s research and training
mission;
‘‘(iv) the congruence of the research
activities to be carried out within the facil-
ity with the research and investigator man-
power needs of the United States; and
‘‘(v) the age and condition of existing
research facilities and equipment.
‘‘(D) The applicant has demonstrated a
commitment to enhancing and expanding the
research productivity of the applicant.
‘‘(2) CONSIDERATION OF CERTAIN FACTORS.—
In making grants under subsection (a), the Director
of the Center may, in addition to the requirements
established in paragraph (1), consider the following
factors:
‘‘(A) To what extent the applicant has the
capacity to broaden the scope of research and
research training programs of the applicant by
promoting—
119
‘‘(i) interdisciplinary research;
‘‘(ii) research on emerging tech-
nologies, including those involving novel
analytical techniques or computational
methods; or
‘‘(iii) other novel research mechanisms
or programs.
‘‘(B) To what extent the applicant has
broadened the scope of research and research
training programs of qualified institutions by
promoting genomic research with an emphasis
on interdisciplinary research, including research
related to pediatric investigations.
‘‘(3) INSTITUTIONS
OF
EMERGING
EXCEL-
LENCE.—Of the amounts appropriated under sub-
section (i) for a fiscal year, the Director of the Cen-
ter shall make available 25 percent for grants under
subsection (a) to applicants that, in addition to
meeting the requirements established in paragraph
(1), have demonstrated emerging excellence in bio-
medical or behavioral research, as follows:
‘‘(A) The applicant has a plan for research
or training advancement and possesses the abil-
ity to carry out the plan.
120
‘‘(B) The applicant carries out research
and research training programs that have a
special relevance to a problem, concern, or
unmet health need of the United States.
‘‘(C) The applicant has been productive in
research or research development and training.
‘‘(D) The applicant—
‘‘(i) has been designated as a center
of excellence under section 739;
‘‘(ii) is located in a geographic area a
significant percentage of whose population
has a health-status deficit, and the appli-
cant provides health services to such popu-
lation; or
‘‘(iii) is located in a geographic area
in which a deficit in health care tech-
nology, services, or research resources may
adversely affect health status of the popu-
lation of the area in the future, and the
applicant is carrying out activities with re-
spect to protecting the health status of
such population.
‘‘(d) REQUIREMENT OF APPLICATION.—The Director
of the Center may make a grant under subsection (a) only
if an application for the grant is submitted to the Director
121
and the application is in such form, is made in such man-
ner, and contains such agreements, assurances, and infor-
mation as the Director determines to be necessary to carry
out this section.
‘‘(e) AMOUNT OF GRANT; PAYMENTS.—
‘‘(1) AMOUNT.—The amount of any grant
awarded under subsection (a) shall be determined by
the Director of the Center, except that such amount
shall not exceed—
‘‘(A) 50 percent of the necessary cost of
the construction of a proposed facility as deter-
mined by the Director; or
‘‘(B) in the case of a multipurpose facility,
40 percent of that part of the necessary cost of
construction that the Director determines to be
proportionate to the contemplated use of the fa-
cility.
‘‘(2) RESERVATION OF AMOUNTS.—On approval
of any application for a grant under subsection (a),
the Director of the Center shall reserve, from any
appropriation available therefore, the amount of
such grant, and shall pay such amount, in advance
or by way of reimbursement, and in such install-
ments consistent with the construction progress, as
the Director may determine appropriate. The res-
122
ervation of the Director of any amount by the Direc-
tor under this paragraph may be amended by the
Director, either on the approval of an amendment of
the application or on the revision of the estimated
cost of construction of the facility.
‘‘(3) EXCLUSION OF CERTAIN COSTS.—In deter-
mining the amount of any grant under this sub-
section (a), there shall be excluded from the cost of
construction an amount equal to the sum of—
‘‘(A) the amount of any other Federal
grant that the applicant has obtained, or is as-
sured of obtaining, with respect to construction
that is to be financed in part by a grant author-
ized under this section; and
‘‘(B) the amount of any non-Federal funds
required to be expended as a condition of such
other Federal grant.
‘‘(4) WAIVER
OF
LIMITATIONS.—The limita-
tions imposed by paragraph (1) may be waived at
the discretion of the Director for applicants meeting
the conditions described in paragraphs (1) and (2)
of subsection (c).
‘‘(f) RECAPTURE OF PAYMENTS.—If, not later than
20 years after the completion of construction for which
a grant has been awarded under subsection (a)—
123
‘‘(1) the applicant or other owner of the facility
shall cease to be a public or nonprofit private entity;
or
‘‘(2) the facility shall cease to be used for the
research purposes for which it was constructed (un-
less the Director determines, in accordance with reg-
ulations, that there is good cause for releasing the
applicant or other owner from obligation to do so);
the United States shall be entitled to recover from the ap-
plicant or other owner of the facility the amount bearing
the same ratio to the current value (as determined by an
agreement between the parties or by action brought in the
United States District Court for the district in which such
facility is situated) of the facility as the amount of the
Federal participation bore to the cost of the construction
of such facility.
‘‘(g) NONINTERFERENCE WITH ADMINISTRATION OF
ENTITIES.—Except as otherwise specifically provided in
this section, nothing contained in this part shall be con-
strued as authorizing any department, agency, officer, or
employee of the United States to exercise any direction,
supervision, or control over, or impose any requirement
or condition with respect to the administration of any en-
tity funded under this part.
124
‘‘(h) GUIDELINES.—Not later than 6 months after
the date of the enactment of this section, the Director of
the Center, after consultation with the Advisory Council,
shall issue guidelines with respect to grants under sub-
section (a).
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated $150,000,000 for fiscal year 1994, and
such sums as may be necessary for each of the fiscal years
1995 and 1996.’’.
SEC. 1503. CONSTRUCTION PROGRAM FOR NATIONAL PRI-
MATE RESEARCH CENTER.
Subpart 1 of part E of title IV of the Public Health
Service Act, as amended by section 1502 of this Act, is
amended by adding at the end the following new section:
‘‘CONSTRUCTION OF REGIONAL CENTERS FOR RESEARCH
ON PRIMATES
‘‘SEC. 481B. (a) With respect to activities carried out
by the National Center for Research Resources to support
regional centers for research on primates, the Director of
NIH shall, for each of the fiscal years 1994 through 1996,
reserve from the amounts appropriated under section
481A(i) $7,000,000 for the purpose of making awards of
grants and contracts to public or nonprofit private entities
to construct, renovate, or otherwise improve such regional
centers. The reservation of such amounts for any fiscal
125
year is subject to the availability of qualified applicants
for such awards.
‘‘(b) The Director of NIH may not make a grant or
enter into a contract under subsection (a) unless the appli-
cant for such assistance agrees, with respect to the costs
to be incurred by the applicant in carrying out the purpose
described in such subsection, to make available (directly
or through donations from public or private entities) non-
Federal contributions in cash toward such costs in an
amount equal to not less than $1 for each $4 of Federal
funds provided in such assistance.’’.
Subtitle B—National Center for
Nursing Research
SEC. 1511. REDESIGNATION OF NATIONAL CENTER FOR
NURSING RESEARCH AS NATIONAL INSTI-
TUTE OF NURSING RESEARCH.
(a) IN GENERAL.—Subpart 3 of part E of title IV
of the Public Health Service Act (42 U.S.C. 287c et seq.)
is amended—
(1) in section 483—
(A) in the heading for the section, by strik-
ing ‘‘CENTER’’ and inserting ‘‘INSTITUTE’’; and
(B) by striking ‘‘The general purpose’’ and
all that follows through ‘‘is’’ and inserting the
following: ‘‘The general purpose of the National
126
Institute of Nursing Research (hereafter in this
subpart referred to as the ‘Institute’) is’’;
(2) in section 484, by striking ‘‘Center’’ each
place such term appears and inserting ‘‘Institute’’;
(3) in section 485—
(A) in subsection (a), in each of para-
graphs (1) through (3), by striking ‘‘Center’’
each place such term appears and inserting
‘‘Institute’’;
(B) in subsection (b)—
(i) in paragraph (2)(A), by striking
‘‘Center’’ and inserting ‘‘Institute’’; and
(ii) in paragraph (3)(A), in the first
sentence, by striking ‘‘Center’’ and insert-
ing ‘‘Institute’’; and
(C) in subsections (d) through (g), by
striking ‘‘Center’’ each place such term appears
and inserting ‘‘Institute’’; and
(4) in section 485A (as redesignated by section
141(a)(1) of this Act), by striking ‘‘Center’’ each
place such term appears and inserting ‘‘Institute’’.
(b) CONFORMING AMENDMENTS.—
(1) ORGANIZATION OF NATIONAL INSTITUTE OF
HEALTH.—Section 401(b) of the Public Health
Service Act (42 U.S.C. 281(b)) is amended—
127
(A) in paragraph (1), by adding at the end
the following new subparagraph:
‘‘(Q) The National Institute of Nursing
Research.’’; and
(B) in paragraph (2), by striking subpara-
graph (D).
(2) TRANSFER OF STATUTORY PROVISIONS.—
Sections 483 through 485A of the Public Health
Service Act, as amended by subsection (a) of this
section—
(A) are transferred to part C of title IV of
such Act;
(B) are redesignated as sections 464V
through 464Y of such part; and
(C) are inserted, in the appropriate se-
quence, at the end of such part.
(3) HEADING FOR NEW SUBPART.—Title IV of
the Public Health Service Act, as amended by the
preceding provisions of this section, is amended—
(A) in part C, by inserting before section
464V the following new heading:
‘‘Subpart 17—National Institute of Nursing Research’’;
and
(B) by striking the heading for subpart 3
of part E.
128
(4) CROSS-REFERENCES.—Title IV of the Pub-
lic Health Service Act, as amended by the preceding
provisions of this section, is amended in subpart 17
of part C—
(A) in section 464W, by striking ‘‘section
483’’ and inserting ‘‘section 464V’’;
(B) in section 464X(g), by striking ‘‘sec-
tion 486’’ and inserting ‘‘section 464Y’’; and
(C) in section 464Y, in the last sentence,
by striking ‘‘section 485(g)’’ and inserting ‘‘sec-
tion 464X(g)’’.
SEC. 1512. STUDY ON ADEQUACY OF NUMBER OF NURSES.
(a) IN GENERAL.—The Secretary of Health and
Human Services, acting through the Director of the Na-
tional Institute of Nursing Research, shall enter into a
contract with a public or nonprofit private entity to con-
duct a study for the purpose of determining whether and
to what extent there is a need for an increase in the num-
ber of nurses in hospitals and nursing homes in order to
promote the quality of patient care and reduce the inci-
dence among nurses of work-related injuries and stress.
(b) NATIONAL ACADEMY OF SCIENCES.—The Sec-
retary shall request the National Academy of Sciences to
enter into the contract under subsection (a) to conduct
the study described in such subsection. If such Institute
129
declines to conduct the study, the Secretary shall carry
out such subsection through another public or nonprofit
private entity.
(c) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘nurse’’ means a registered nurse,
a licensed practical nurse, a licensed vocational
nurse, and a nurse assistant.
(2) The term ‘‘Secretary’’ means the Secretary
of Health and Human Services.
(d) REPORT.—The Secretary shall ensure that, not
later than October 1, 1994, the study required in sub-
section (a) is completed and a report describing the find-
ings made as a result of the study is submitted to the
Committee on Energy and Commerce of the House of
Representatives, and to the Committee on Labor and
Human Resources of the Senate.
Subtitle C—National Center for
Human Genome Research
SEC. 1521. PURPOSE OF CENTER.
Title IV of the Public Health Service Act, as amended
by sections 141(a)(1) and 1611(b)(1)(B) of this Act, is
amended—
(1) in section 401(b)(2), by adding at the end
the following new subparagraph:
130
‘‘(D) The National Center for Human Genome
Research.’’; and
(2) in part E, by adding at the end the follow-
ing new subpart:
‘‘Subpart 4—National Center for Human Genome
Research
‘‘PURPOSE OF THE CENTER
‘‘SEC. 485B. (a) The general purpose of the National
Center for Human Genome Research (hereafter in this
subpart referred to as the ‘Center’) is to characterize the
structure and function of the human genome, including
the mapping and sequencing of individual genes. Such
purpose includes—
‘‘(1) planning and coordinating the research
goal of the genome project;
‘‘(2) reviewing and funding research proposals;
‘‘(3) developing training programs;
‘‘(4) coordinating international genome re-
search;
‘‘(5) communicating advances in genome science
to the public; and
‘‘(6) reviewing and funding proposals to address
the ethical issues associated with the genome
project.
131
‘‘(b)(1) Except as provided in paragraph (2), of the
amounts appropriated to carry out subsection (a) for a
fiscal year, the Director of the Center shall make available
not less than 5 percent for carrying out paragraph (6)
of such subsection.
‘‘(2) With respect to providing funds under sub-
section (a)(6) for proposals to address the ethical issues
associated with the genome project, paragraph (1) shall
not apply for a fiscal year if the Director of the Center
certifies to the Committee on Energy and Commerce of
the House of Representatives, and to the Committee on
Labor and Human Resources of the Senate, that the Di-
rector has determined that an insufficient number of such
proposals meet the applicable requirements of sections 491
and 492.’’.
TITLE XVI—AWARDS AND
TRAINING
Subtitle A—National Research
Service Awards
SEC. 1601. REQUIREMENT REGARDING WOMEN AND INDI-
VIDUALS 
FROM 
DISADVANTAGED 
BACK-
GROUNDS.
Section 487(a) of the Public Health Service Act (42
U.S.C. 288(a)(4)) is amended by adding at the end the
following paragraph:
132
‘‘(4) The Secretary shall carry out paragraph (1) in
a manner that will result in the recruitment of women,
and individuals from disadvantaged backgrounds, into
fields of biomedical or behavioral research and in the pro-
vision of research training to women and such individ-
uals.’’.
Subtitle B—Acquired Immune
Deficiency Syndrome
SEC. 1611. LOAN REPAYMENT PROGRAM.
Section 487A of the Public Health Service Act (42
U.S.C. 288–1) is amended to read as follows:
‘‘LOAN REPAYMENT PROGRAM FOR RESEARCH WITH
RESPECT TO ACQUIRED IMMUNE DEFICIENCY SYNDROME
‘‘SEC. 487A. (a) IN GENERAL.—
‘‘(1) AUTHORITY
FOR
PROGRAM.—Subject to
paragraph (2), the Secretary shall carry out a pro-
gram of entering into agreements with appropriately
qualified health professionals under which such
health professionals agree to conduct, as employees
of the National Institutes of Health, research with
respect to acquired immune deficiency syndrome in
consideration of the Federal Government agreeing to
repay, for each year of such service, not more than
$20,000 of the principal and interest of the edu-
cational loans of such health professionals.
133
‘‘(2) LIMITATION.—The Secretary may not
enter into an agreement with a health professional
pursuant to paragraph (1) unless such profes-
sional—
‘‘(A) has a substantial amount of edu-
cational loans relative to income; and
‘‘(B)(i) was not employed at the National
Institutes of Health during the 1-year period
preceding the date of the enactment of the
Health Professions Reauthorization Act of
1988; or
‘‘(ii) agrees to serve as an employee of
such Institutes for purposes of paragraph (1)
for a period of not less than 3 years.’’.
‘‘(b) APPLICABILITY
OF CERTAIN PROVISIONS.—
With respect to the National Health Service Corps Loan
Repayment Program established in subpart III of part D
of title III, the provisions of such subpart shall, except
as inconsistent with subsection (a) of this section, apply
to the program established in such subsection (a) in the
same manner and to the same extent as such provisions
apply to the National Health Service Corps Loan Repay-
ment Program established in such subpart.
‘‘(c) FUNDING; REIMBURSABLE TRANSFERS.—
134
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.—
For the purpose of carrying out this section, there
are authorized to be appropriated such sums as may
be necessary for each of the fiscal years 1994
through 1996.
‘‘(2) TRANSFERS
FOR
RELATED
PROGRAM.—
The Commissioner of Food and Drugs may carry
out for the Food and Drug Administration a pro-
gram similar to the program established in sub-
section (a), which program shall be carried out with
respect to the review of applications concerning ac-
quired immune deficiency syndrome that are submit-
ted to such Commissioner. From the amounts appro-
priated under paragraph (1) for a fiscal year, the
Secretary may transfer amounts to the Commis-
sioner for the purpose of carrying out such program.
The Commissioner shall provide a reimbursement to
the Secretary for the amount so transferred, and the
reimbursement shall be available only for the pro-
gram established in subsection (a). Any transfer and
reimbursement made for purposes of this paragraph
for a fiscal year shall be completed by April 1 of
such year.’’.
135
Subtitle C—Loan Repayment for
Research Generally
SEC. 1621. ESTABLISHMENT OF PROGRAM.
Part G of title IV of the Public Health Service Act,
as redesignated by section 141(a)(2) of this Act and as
amended by section 1002 of this Act, is amended by in-
serting after section 487B the following new section:
‘‘LOAN REPAYMENT PROGRAM FOR RESEARCH
GENERALLY
‘‘SEC. 487C. (a) IN GENERAL.—
‘‘(1) AUTHORITY
FOR
PROGRAM.—Subject to
paragraph (2), the Secretary shall carry out a pro-
gram of entering into agreements with appropriately
qualified health professionals under which such
health professionals agree to conduct research, as
employees of the National Institutes of Health, in
consideration of the Federal Government agreeing to
repay, for each year of such service, not more than
$20,000 of the principal and interest of the edu-
cational loans of such health professionals.
‘‘(2) LIMITATION.—The Secretary may not
enter into an agreement with a health professional
pursuant to paragraph (1) unless such profes-
sional—
136
‘‘(A) has a substantial amount of edu-
cational loans relative to income; and
‘‘(B)(i) was not employed at the National
Institutes of Health during the 1-year period
preceding the date of the enactment of the
Health Professions Reauthorization Act of
1988; or
‘‘(ii) agrees to serve as an employee of
such Institutes for purposes of paragraph (1)
for a period of not less than 3 years.’’.
‘‘(b) APPLICABILITY
OF CERTAIN PROVISIONS.—
With respect to the National Health Service Corps Loan
Repayment Program established in subpart III of part D
of title III, the provisions of such subpart shall, except
as inconsistent with subsection (a) of this section, apply
to the program established in such subsection (a) in the
same manner and to the same extent as such provisions
apply to the National Health Service Corps Loan Repay-
ment Program established in such subpart.
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section other than with re-
spect to acquired immune deficiency syndrome, there are
authorized to be appropriated such sums as may be nec-
essary for each of the fiscal years 1994 through 1996.’’.
137
Subtitle D—Scholarship and Loan
Repayment Programs Regard-
ing Professional Skills Needed
by Certain Agencies
SEC. 1631. ESTABLISHMENT OF PROGRAMS FOR NATIONAL
INSTITUTES OF HEALTH.
Part G of title IV of the Public Health Service Act,
as redesignated by section 141(a)(2) of this Act and as
amended by section 1621 of this Act, is amended by in-
serting after section 487C the following new sections:
‘‘UNDERGRADUATE SCHOLARSHIP PROGRAM REGARDING
PROFESSIONS NEEDED BY NATIONAL RESEARCH IN-
STITUTES
‘‘SEC. 487D. (a) ESTABLISHMENT OF PROGRAM.—
‘‘(1) 
IN
GENERAL.—Subject 
to 
section
487(a)(1)(C), the Secretary, acting through the Di-
rector of NIH, may carry out a program of entering
into contracts with individuals described in para-
graph (2) under which—
‘‘(A) the Director of NIH agrees to provide
to the individuals scholarships for pursuing, as
undergraduates at accredited institutions of
higher education, academic programs appro-
priate for careers in professions needed by the
National Institutes of Health; and
138
‘‘(B) the individuals agree to serve as em-
ployees of the National Institutes of Health, for
the period described in subsection (c), in posi-
tions that are needed by the National Institutes
of Health and for which the individuals are
qualified.
‘‘(2) 
INDIVIDUALS
FROM
DISADVANTAGED
BACKGROUNDS.—The individuals referred to in
paragraph (1) are individuals who—
‘‘(A) are enrolled or accepted for enroll-
ment as full-time undergraduates at accredited
institutions of higher education; and
‘‘(B) are from disadvantaged backgrounds.
‘‘(b) FACILITATION OF INTEREST OF STUDENTS IN
CAREERS AT NATIONAL INSTITUTES OF HEALTH.—In
providing employment to individuals pursuant to contracts
under subsection (a)(1), the Director of NIH shall carry
out activities to facilitate the interest of the individuals
in pursuing careers as employees of the National Insti-
tutes of Health.
‘‘(c) PERIOD OF OBLIGATED SERVICE.—
‘‘(1) DURATION OF SERVICE.—For purposes of
subparagraph (B) of subsection (a)(1), the period of
service for which an individual is obligated to serve
as an employee of the National Institutes of Health
139
is 12 months for each academic year for which the
scholarship under such subsection is provided.
‘‘(2) SCHEDULE FOR SERVICE.—
‘‘(A) Subject to subparagraph (B), the Di-
rector of NIH may not provide a scholarship
under subsection (a) unless the individual ap-
plying for the scholarship agrees that—
‘‘(i) the individual will serve as an em-
ployee of the National Institutes of Health
full-time for not less than 10 consecutive
weeks of each year during which the indi-
vidual is attending the educational institu-
tion involved and receiving such a scholar-
ship;
‘‘(ii) the period of service as such an
employee that the individual is obligated to
provide under clause (i) is in addition to
the period of service as such an employee
that the individual is obligated to provide
under subsection (a)(1)(B); and
‘‘(iii) not later than 60 days after ob-
taining the educational degree involved, the
individual will begin serving full-time as
such an employee in satisfaction of the pe-
riod of service that the individual is obli-
140
gated 
to 
provide 
under 
subsection
(a)(1)(B).
‘‘(B) The Director of NIH may defer the
obligation of an individual to provide a period
of service under subsection (a)(1)(B), if the Di-
rector determines that such a deferral is appro-
priate.
‘‘(3) APPLICABILITY OF CERTAIN PROVISIONS
RELATING TO APPOINTMENT AND COMPENSATION.—
For any period in which an individual provides serv-
ice as an employee of the National Institutes of
Health in satisfaction of the obligation of the indi-
vidual under subsection (a)(1)(B) or paragraph
(2)(A)(i), the individual may be appointed as such
an employee without regard to the provisions of title
5, United States Code, relating to appointment and
compensation.
‘‘(d) PROVISIONS REGARDING SCHOLARSHIP.—
‘‘(1) APPROVAL OF ACADEMIC PROGRAM.—The
Director of NIH may not provide a scholarship
under subsection (a) for an academic year unless—
‘‘(A) the individual applying for the schol-
arship has submitted to the Director a proposed
academic program for the year and the Director
has approved the program; and
141
‘‘(B) the individual agrees that the pro-
gram will not be altered without the approval of
the Director.
‘‘(2) ACADEMIC
STANDING.—The Director of
NIH may not provide a scholarship under subsection
(a) for an academic year unless the individual apply-
ing for the scholarship agrees to maintain an accept-
able level of academic standing, as determined by
the educational institution involved in accordance
with regulations issued by the Secretary.
‘‘(3) LIMITATION ON AMOUNT.—The Director
of NIH may not provide a scholarship under sub-
section (a) for an academic year in an amount ex-
ceeding $20,000.
‘‘(4) AUTHORIZED
USES.—A scholarship pro-
vided under subsection (a) may be expended only for
tuition expenses, other reasonable educational ex-
penses, and reasonable living expenses incurred in
attending the school involved.
‘‘(5) CONTRACT REGARDING DIRECT PAYMENTS
TO INSTITUTION.—In the case of an institution of
higher education with respect to which a scholarship
under subsection (a) is provided, the Director of
NIH may enter into a contract with the institution
under which the amounts provided in the scholarship
142
for tuition and other educational expenses are paid
directly to the institution. Payments to the institu-
tion under the contract may be made without regard
to section 3324 of title 31, United States Code.
‘‘(e) PENALTIES
FOR BREACH
OF SCHOLARSHIP
CONTRACT.—The provisions of section 338E shall apply
to the program established in subsection (a) to the same
extent and in the same manner as such provisions apply
to the National Health Service Corps Loan Repayment
Program established in section 338B.
‘‘(f) REQUIREMENT OF APPLICATION.—The Director
of NIH may not provide a scholarship under subsection
(a) unless an application for the scholarship is submitted
to the Director and the application is in such form, is
made in such manner, and contains such agreements, as-
surances, and information as the Director determines to
be necessary to carry out this section.
‘‘(g) AVAILABILITY OF AUTHORIZATION OF APPRO-
PRIATIONS.—Amounts appropriated for a fiscal year for
scholarships under this section shall remain available until
the expiration of the second fiscal year beginning after the
fiscal year for which the amounts were appropriated.
‘‘LOAN REPAYMENT PROGRAM REGARDING CLINICAL
RESEARCHERS FROM DISADVANTAGED BACKGROUNDS
‘‘SEC. 487E. (a) IMPLEMENTATION OF PROGRAM.—
143
‘‘(1) 
IN
GENERAL.—Subject 
to 
section
487(a)(1)(C), the Secretary, acting through the Di-
rector of NIH may, subject to paragraph (2), carry
out a program of entering into contracts with appro-
priately qualified health professionals who are from
disadvantaged backgrounds under which such health
professionals agree to conduct clinical research as
employees of the National Institutes of Health in
consideration of the Federal Government agreeing to
pay, for each year of such service, not more than
$20,000 of the principal and interest of the edu-
cational loans of the health professionals.
‘‘(2) LIMITATION.—The Director of NIH may
not enter into a contract with a health professional
pursuant to paragraph (1) unless such professional
has a substantial amount of education loans relative
to income.
‘‘(3) APPLICABILITY OF CERTAIN PROVISIONS
REGARDING OBLIGATED SERVICE.—Except to the ex-
tent inconsistent with this section, the provisions of
sections 338C and 338E shall apply to the program
established in paragraph (1) to the same extent and
in the same manner as such provisions apply to the
National Health Service Corps Loan Repayment
Program established in section 338B.
144
‘‘(b) AVAILABILITY OF AUTHORIZATION OF APPRO-
PRIATIONS.—Amounts appropriated for a fiscal year for
contracts under subsection (a) shall remain available until
the expiration of the second fiscal year beginning after the
fiscal year for which the amounts were appropriated.’’.
SEC. 1632. FUNDING.
Section 487(a)(1) of the Public Health Service Act
(42 U.S.C. 288(a)(1)) is amended—
(1) in subparagraph (A), by striking ‘‘and’’
after the semicolon at the end;
(2) in subparagraph (B), by striking the period
at the end and inserting ‘‘; and’’; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(C) provide contracts for scholarships and loan
repayments in accordance with sections 487D and
487E, subject to providing not more than an aggre-
gate 50 such contracts during the fiscal years 1994
through 1996.’’.
Subtitle D—Funding
SEC. 1641. AUTHORIZATION OF APPROPRIATIONS.
Section 487(d) of the Public Health Service Act (42
U.S.C. 288(d)) is amended—
(1) in the first sentence, by amending the sen-
tence to read as follows: ‘‘For the purpose of carry-
145
ing out this section, there are authorized to be ap-
propriated $400,000,000 for fiscal year 1994, and
such sums as may be necessary for each of the fiscal
years 1995 and 1996.’’; and
(2) in paragraph (3)—
(A) by striking ‘‘one-half of one percent’’
each place such term appears and inserting ‘‘1
percent’’; and
(B) by inserting ‘‘785,’’ after ‘‘784,’’.
TITLE XVII—NATIONAL FOUNDA-
TION FOR BIOMEDICAL RE-
SEARCH
SEC. 1701. DATE CERTAIN FOR APPOINTMENT OF BOARD
MEMBERS.
Section 499 of the Public Health Service Act, as re-
designated by section 121(b)(3) of this Act, is amended
in subsection (c)(1)(C) by inserting after and below clause
(iii) the following:
‘‘Not later than March 1, 1993, the Secretary
shall convene a meeting of the ex officio mem-
bers of the Board for the purpose of making
the appointments required in this subpara-
graph.’’.
146
SEC. 1702. MISCELLANEOUS PROVISIONS.
Section 499 of the Public Health Service Act, as re-
designated by section 121(b)(3) of this Act, is amended—
(1) in subsection (a)—
(A) in the first sentence, by inserting after
‘‘Secretary’’ the following: ‘‘, acting through the
Director of NIH,’’; and
(B) in the second sentence, by striking
‘‘the purposes of’’ and all that follows through
‘‘Transfer Act,’’ and inserting the following:
‘‘the purposes of the Ethics in Government Act
of 1978 and the Stevenson-Wydler Technology
Innovation Act of 1980,’’;
(2) in subsection (b)(2), by striking ‘‘Ethics’’
and all that follows and inserting the following:
‘‘Ethics in Government Act of 1978, and the Steven-
son-Wydler Technology Innovation Act of 1980.’’;
(3) in subsection (c)—
(A) in paragraph (1)—
(i) in subparagraph (A), in the second
sentence, by inserting ‘‘, except the ex
officio members,’’ after ‘‘Foundation’’;
(ii) in subparagraph (B), in the mat-
ter preceding clause (i), by striking ‘‘Coun-
cil’’ and inserting ‘‘Board’’; and
147
(iii) in subparagraph (C), in the first
sentence, by striking ‘‘Council’’ and insert-
ing ‘‘Board’’; and
(B) in paragraph (3)(A), by striking
‘‘paragraph (2)(C)’’ and inserting ‘‘paragraph
(1)(C)’’;
(4) in subsection (g)(8), by striking ‘‘subtitle’’
and inserting ‘‘part’’; and
(5) in subsection (i)(1), by striking ‘‘1995’’ and
inserting ‘‘1996’’.
TITLE 
XVIII—RESEARCH 
WITH
RESPECT TO ACQUIRED IM-
MUNE 
DEFICIENCY 
SYN-
DROME
SEC. 1801. REVISION AND EXTENSION OF VARIOUS PRO-
GRAMS.
Title XXIII of the Public Health Service Act (42
U.S.C. 300cc et seq.) is amended—
(1) in section 2304(c)(1)—
(A) in the matter preceding subparagraph
(A), by inserting after ‘‘Director of such Insti-
tute’’ the following: ‘‘(and may provide advice
to the Directors of other agencies of the Na-
tional Institutes of Health, as appropriate)’’;
and
148
(B) in subparagraph (A), by inserting be-
fore the semicolon the following: ‘‘, including
recommendations on the projects of research
with respect to diagnosing immune deficiency
and with respect to predicting, diagnosing, pre-
venting, and treating opportunistic cancers and
infectious diseases’’;
(2) in section 2311(a)(1), by inserting before
the semicolon the following: ‘‘, including evaluations
of methods of diagnosing immune deficiency and
evaluations of methods of predicting, diagnosing,
preventing, and treating opportunistic cancers and
infectious diseases’’;
(3) in section 2315—
(A) in subsection (a)(2), by striking ‘‘inter-
national research’’ and all that follows and in-
serting ‘‘international research and training
concerning the natural history and pathogenesis
of the human immunodeficiency virus and the
development and evaluation of vaccines and
treatments for acquired immune deficiency syn-
drome and opportunistic infections.’’; and
(B) in subsection (f), by striking ‘‘and
1991’’ and inserting ‘‘through 1996’’;
(4) in section 2318—
149
(A) in subsection (a)(1)—
(i) by inserting after ‘‘The Secretary’’
the following: ‘‘, acting through the Direc-
tor of the National Institutes of Health
and after consultation with the Adminis-
trator for Health Care Policy and Re-
search,’’; and
(ii) by striking ‘‘syndrome’’ and in-
serting ‘‘syndrome, including treatment
and prevention of HIV infection and relat-
ed conditions among women’’; and
(B) in subsection (e), by striking ‘‘1991.’’
and inserting the following: ‘‘1991, and such
sums as may be necessary for each of the fiscal
years 1994 through 1996.’’;
(5) in section 2320(b)(1)(A), by striking ‘‘syn-
drome’’ and inserting ‘‘syndrome and the natural
history of such infection’’;
(6)(A) in section 2351(a)—
(i) 
by 
redesignating 
paragraphs 
(2)
through (8) as paragraphs (3) through (9); and
(ii) by inserting after paragraph (1) the
following new paragraph:
‘‘(2)(A) shall develop and implement a com-
prehensive plan for the conduct and support of such
150
research by the agencies of the National Institutes
of Health, which plan shall specify the objectives to
be achieved, the date by which the objectives are ex-
pected to be achieved, and an estimate of the re-
sources needed to achieve the objectives by such
date; and
‘‘(B) shall develop and implement a plan for
evaluating the sufficiency of the plan developed
under subparagraph (A) and for evaluating the ex-
tent to which activities of the National Institutes of
Health have been in accordance with the plan;’’; and
(B) in section 2301(b)(6), by inserting before
the semicolon the following: ‘‘, including evaluations
conducted under section 2351(a)(2)(B)’’;
(7) in section 2361, by striking ‘‘For purposes’’
and all that follows and inserting the following:
‘‘For purposes of this title:
‘‘(1) The term ‘infection’, with respect to the
etiologic agent for acquired immune deficiency syn-
drome, includes opportunistic cancers and infectious
diseases and any other conditions arising from infec-
tion with such etiologic agent.
‘‘(2) The term ‘treatment’, with respect to the
etiologic agent for acquired immune deficiency syn-
152
tivities of the Commissioner of Food and Drugs re-
garding the approval of drugs.
(2) The Secretary of Health and Human Serv-
ices shall request the Institute of Medicine of the
National Academy of Sciences to enter into the con-
tract under paragraph (1) to conduct the study de-
scribed in such paragraph. If such Institute declines
to conduct the study, the Secretary shall carry out
paragraph (1) through another public or nonprofit
private entity.
(b) THIRD-PARTY PAYMENTS REGARDING CERTAIN
CLINICAL TRIALS.—The Secretary of Health and Human
Services, acting through the Director of the National In-
stitutes of Health, shall conduct a study for the purpose
of—
(1) determining the policies of third-party
payors regarding the payment of the costs of appro-
priate health services that are provided incident to
the participation of individuals as subjects in clinical
trials conducted in the development of drugs with re-
spect to acquired immune deficiency syndrome; and
(2) developing recommendations regarding such
policies.
(c) ADVISORY
COMMITTEES.—The Secretary of
Health and Human Services, acting through the Director
153
of the National Institutes of Health, shall conduct a study
for the purpose of determining—
(1) whether the activities of the various advi-
sory committees established in the National Insti-
tutes of Health regarding acquired immune defi-
ciency syndrome are being coordinated sufficiently;
and
(2) whether the functions of any of such advi-
sory committees should be modified in order to
achieve greater efficiency.
(d) VACCINES
FOR
HUMAN
IMMUNODEFICIENCY
VIRUS.—
(1) IN GENERAL.—The Secretary of Health and
Human Services, acting through the National Insti-
tutes of Health, shall develop a plan for the appro-
priate inclusion of HIV-infected women, including
pregnant women, HIV-infected infants, and HIV-in-
fected children in studies conducted by or through
the National Institutes of Health concerning the
safety and efficacy of HIV vaccines for the treat-
ment and prevention of HIV infection. Such plan
shall ensure the full participation of other Federal
agencies currently conducting HIV vaccine studies
and require that such studies conform fully to the
154
requirements of part 46 of title 45, Code of Federal
Regulations.
(2) REPORT.—Not later than 180 days after
the date of the enactment of this Act, the Secretary
of Health and Human Services shall prepare and
submit to the Committee on Energy and Commerce
of the House of Representatives, and the Committee
on Labor and Human Resources of the Senate, a re-
port concerning the plan developed under paragraph
(1).
(3) IMPLEMENTATION.—Not later than 12
months after the date of the enactment of this Act,
the Secretary of Health and Human Services shall
implement the plan developed under paragraph (1),
including measures for the full participation of other
Federal agencies currently conducting HIV vaccine
studies.
(4) For the purpose of carrying out this sub-
section, there are authorized to be appropriated such
sums as may be necessary for each of the fiscal
years 1994 through 1996.
SEC. 1902. MALNUTRITION IN THE ELDERLY.
(a) STUDY.—
(1) IN GENERAL.—The Secretary of Health and
Human Services (referred to in this section as the
155
‘‘Secretary’’), acting through the National Institute
on Aging, coordinating with the Agency for Health
Care Policy and Research and, to the degree pos-
sible, in consultation with the head of the National
Nutrition Monitoring System established under sec-
tion 1428 of the Food and Agriculture Act of 1977
(7 U.S.C. 3178), shall conduct a 3-year nutrition
screening and intervention activities study of the el-
derly.
(2) EFFICACY
AND
COST-EFFECTIVENESS
OF
NUTRITION SCREENING AND INTERVENTION ACTIVI-
TIES.—In conducting the study, the Secretary shall
determine the efficacy and cost-effectiveness of nu-
trition screening and intervention activities con-
ducted in the elderly health and long-term care con-
tinuum, and of a program that would institutionalize
nutrition screening and intervention activities. In
evaluating such a program, the Secretary shall de-
termine—
(A) if health or quality of life is measur-
ably improved for elderly individuals who re-
ceive routine nutritional screening and treat-
ment;
(B) if federally subsidized home or institu-
tional care is reduced because of increased inde-
156
pendence of elderly individuals resulting from
improved nutritional status;
(C) if a multidisciplinary approach to nu-
tritional care is effective in addressing the nu-
tritional needs of elderly individuals; and
(D) if reimbursement for nutrition screen-
ing and intervention activities is a cost-effective
approach to improving the health status of el-
derly individuals.
(3) POPULATIONS.—The populations of elderly
individuals in which the study will be conducted
shall include populations of elderly individuals who
are—
(A) living independently, including—
(i) individuals who receive home and
community-based services or family sup-
port;
(ii) individuals who do not receive ad-
ditional services and support;
(iii) individuals with low incomes; and
(iv) individuals who are minorities;
(B) hospitalized, including individuals ad-
mitted from home and from institutions; and
(C) institutionalized in residential facilities
such as nursing homes and adult homes.
157
(b) MALNUTRITION STUDY.—The Secretary, acting
through the National Institute on Aging, shall conduct a
3-year study to determine the extent of malnutrition in
elderly individuals in hospitals and long-term care facili-
ties and in elderly individuals who are living independ-
ently.
(c) REPORT.—The Secretary shall submit a report to
the Committee on Labor and Human Resources of the
Senate and the Committee on Energy and Commerce of
the House of Representatives containing the findings re-
sulting from the studies described in subsections (a) and
(b), including a determination regarding whether a pro-
gram that would institutionalize nutrition screening and
intervention activities should be adopted, and the rationale
for the determination.
(d) ADVISORY PANEL.—
(1) ESTABLISHMENT.—The Secretary, acting
through the Director of the National Institute on
Aging, shall establish an advisory panel that shall
oversee the design, implementation, and evaluation
of the studies described in subsections (a) and (b).
(2) COMPOSITION.—The advisory panel shall in-
clude representatives appointed for the life of the
panel by the Secretary from the Health Care Fi-
nancing Administration, the Social Security Admin-