I
103D CONGRESS
2D SESSION
H. R. 3804
To amend the Public Health Service Act to revise and extend programs
relating to the health of individuals who are members of minority groups,
and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 3, 1994
Mr. WAXMAN introduced the following bill; which was referred to the
Committee on Energy and Commerce
A BILL
To amend the Public Health Service Act to revise and extend
programs relating to the health of individuals who are
members of minority groups, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Minority Health Improvement Act of 1994’’.
(b) TABLE OF CONTENTS.—The table of contents for
this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—OFFICE OF MINORITY HEALTH
Sec. 101. Revision and extension of programs of Office of Minority Health.
Sec. 102. Establishment of individual offices of minority health within agencies
of Public Health Service.
TITLE II—PRIMARY HEALTH SERVICES
Sec. 201. Migrant health centers; community health centers.
Sec. 202. Health services for the homeless.
Sec. 203. Health services for residents of public housing.
Sec. 204. Grants to States for loan repayment programs regarding obligated
service of health professionals.
Sec. 205. Grants to States for operation of State offices of rural health.
Sec. 206. Demonstration grants to States for community scholarship programs
regarding obligated service of health professionals.
Sec. 207. Programs regarding birth defects.
Sec. 208. Healthy start for infants.
TITLE III—HEALTH PROFESSIONS PROGRAMS
Sec. 301. Primary care scholarships for students from disadvantaged back-
grounds.
Sec. 302. Scholarships generally; certain other purposes.
Sec. 303. Loan repayments and fellowships regarding faculty positions.
Sec. 304. Centers of Excellence.
Sec. 305. Educational assistance regarding undergraduates.
Sec. 306. Student loans regarding schools of nursing.
Sec. 307. Federally-supported student loans funds.
TITLE IV—RESEARCH
Sec. 401. Office of Research on Minority Health.
Sec. 402. Activities of Agency for Health Care Policy and Research.
TITLE V—NATIVE HAWAIIAN HEALTH CARE
Sec. 501. Clarification of 1992 amendments.
Sec. 502. Amendment of Native Hawaiian Health Care Improvement Act to re-
flect 1992 agreement.
Sec. 503. Repeal of Public Health Service Act provision.
TITLE VI—MISCELLANEOUS PROVISIONS
Sec. 601. Technical amendment to Indian Health Care Improvement Act.
Sec. 602. Health services for Pacific Islanders.
Sec. 603. Technical corrections regarding Public Law 103–183.
Sec. 604. Certain authorities of Centers for Disease Control and Prevention.
TITLE VII—GENERAL PROVISIONS
Sec. 701. Effective date.
TITLE I—OFFICE OF MINORITY
HEALTH
SEC. 101. REVISION AND EXTENSION OF PROGRAMS OF OF-
FICE OF MINORITY HEALTH.
(a) IN GENERAL.—Section 1707 of the Public Health
Service Act (42 U.S.C. 300u–6) is amended by striking
subsection (b) and all that follows and inserting the follow-
ing:
‘‘(b) DUTIES.—With respect to improving the health
of minority groups, the Secretary shall carry out the fol-
lowing:
‘‘(1) In consultation with the advisory council
under subsection (c), establish goals and objectives
regarding disease prevention, health promotion, serv-
ice delivery, and research, and coordinate all activi-
ties within the Department of Health and Human
Services that relate to such goals and objectives.
‘‘(2) In consultation with such council, enter
into interagency agreements with other agencies of
the Service, and under such agreements provide
amounts to such agencies, to carry out the following:
‘‘(A) Support research, demonstrations and
evaluations to test new and innovative models
of delivering services.
‘‘(B) Increase knowledge and understand-
ing of health risk factors.
‘‘(C) Ensure that the National Center for
Health Statistics collects data on the health
status of each minority group.
‘‘(D) With respect to individuals who lack
proficiency in speaking the English language,
enter into contracts with public and nonprofit
private providers of primary health services for
the purpose of increasing the access of the indi-
viduals to such services by developing and car-
rying out programs to provide bilingual or in-
terpretive services.
‘‘(3) Establish by contract a center to carry out
the following:
‘‘(A) Facilitate the exchange of informa-
tion regarding matters relating to health infor-
mation and health promotion, preventive health
services, and education in the appropriate use
of health care.
‘‘(B) Facilitate access to such information.
‘‘(C) Assist in the analysis of issues and
problems relating to such matters.
‘‘(D) Provide technical assistance with re-
spect to the exchange of such information (in-
cluding facilitating the development of materials
for such technical assistance).
‘‘(4)(A) Establish by contract a center for the
purpose of carrying out programs to improve access
to health care services for individuals who lack pro-
ficiency in speaking the English language by devel-
oping and carrying out programs to provide bilingual
or interpretive services.
‘‘(B) In carrying out subparagraph (A), ensure
that—
‘‘(i) the center under such subparagraph
conducts research, develops and evaluates model
projects, and provides technical assistance to
health care providers; and
‘‘(ii) such center is not operated by the en-
tity that operates the center established under
paragraph (3).
‘‘(c) ADVISORY COMMITTEE.—
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish an advisory committee to be known as the Advi-
sory Committee on Minority Health (in this sub-
section referred to as the ‘Committee’).
‘‘(2) DUTIES.—The Committee shall provide
advice to the Secretary on carrying out this section,
including advice on carrying out paragraphs (1) and
(2) of subsection (b) for each minority group.
‘‘(3) COMPOSITION.—
‘‘(A) The Committee shall be composed of
12 voting members appointed in accordance
with subparagraph (B) and the nonvoting, ex
officio members designated under subparagraph
(C).
‘‘(B) The voting members of the Commit-
tee shall be appointed from among individuals
who have expertise regarding the health status
of minority groups and the access of such
groups to health services, which individuals are
not officers or employees of the Federal Gov-
ernment. The appointed membership of the
Committee shall be broadly representative of
the various minority groups.
‘‘(C) The Secretary shall designate as ex
officio members of the Committee the heads of
the minority health offices referred to in section
1707A.
‘‘(d) APPROPRIATE CONTEXT
OF SERVICES.—The
Secretary shall ensure that information and services pro-
vided pursuant to subsection (b) are provided in the lan-
guage and cultural context that is most appropriate for
the individuals for whom the information and services are
intended.
‘‘(e) EQUITABLE ALLOCATION OF SERVICES.—The
Secretary shall ensure that services provided under sub-
section (b) are equitably allocated among the various mi-
nority groups.
‘‘(f) CONSULTATION WITH INDIVIDUAL MINORITY
HEALTH OFFICES.—In carrying out subsection (b) re-
garding a specified agency, the Secretary shall consult
with the head of the minority health office of the agency.
For purposes of the preceding sentence, the terms ‘speci-
fied agency’ and ‘minority health office’ have the meaning
given such terms in section 1707A(f).
‘‘(g) BIENNIAL REPORTS.—Not later than February
1 of fiscal year 1996 and of each second year thereafter,
the Secretary shall 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 describing the activities carried out under
this section during the preceding 2 fiscal years and evalu-
ating the extent to which such activities have been effec-
tive in improving the health of minority groups. Each such
report shall include the biennial reports submitted to the
Secretary under section 1707A(e) for such years by the
heads of the minority health offices.
‘‘(h) DEFINITION.—For purposes of this section, the
term ‘minority groups’ means African Americans, Amer-
ican Indians, Asian Americans, Hispanics, and Pacific Is-
landers.
‘‘(i) FUNDING.—
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.—
For the purpose of carrying out this section, there
is authorized to be appropriated $21,000,000 for
each of the fiscal years 1995 through 1997.
‘‘(2) ALLOCATION OF FUNDS BY SECRETARY.—
Of the amounts appropriated under paragraph (1)
for a fiscal year, the Secretary shall make available
not less than $3,000,000 for carrying out subsection
(b)(2)(D).’’.
(b) MISCELLANEOUS AMENDMENT.—Section 1707 of
the Public Health Service Act (42 U.S.C. 300u–6) is
amended in the heading for the section by striking ‘‘ES-
TABLISHMENT OF’’.
SEC. 102. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MI-
NORITY HEALTH WITHIN AGENCIES OF PUB-
LIC HEALTH SERVICE.
Title XVII of the Public Health Service Act (42
U.S.C. 300u et seq.), as amended by section 302 of Public
Law 102–531 (106 Stat. 3483), is amended by inserting
after section 1707 the following section:
‘‘INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN
PUBLIC HEALTH SERVICE
‘‘SEC. 1707A. (a) IN GENERAL.—The head of each
agency specified in subsection (b)(1) shall establish within
the agency an office to be known as the Office of Minority
Health. Each such Office shall be headed by a director,
who shall be appointed by the head of the agency within
which the Office is established, and who shall report di-
rectly to the head of the agency. The head of such agency
shall carry out this section (as this section relates to the
agency) acting through such Director.
‘‘(b) SPECIFIED AGENCIES.—
‘‘(1) IN GENERAL.—The agencies referred to in
subsection (a) are the following:
‘‘(A) The Centers for Disease Control and
Prevention.
‘‘(B) The Agency for Health Care Policy
and Research.
‘‘(C) The Health Resources and Services
Administration.
‘‘(D) The Substance Abuse and Mental
Health Services Administration.
‘‘(2) NATIONAL INSTITUTES OF HEALTH.—For
purposes of subsection (c) and the subsequent provi-
sions of this section, the term ‘minority health office’
includes the Office of Research on Minority Health
established within the National Institutes of Health.
The Director of the National Institutes of Health
shall carry out this section (as this section relates to
the agency) acting through the Director of such Of-
fice.
‘‘(c) COMPOSITION.—The head of each specified
agency shall ensure that the officers and employees of the
minority health office of the agency are, collectively, expe-
rienced in carrying out community-based health programs
for each of the various minority groups that are present
in significant numbers in the United States. The head of
such agency shall ensure that, of such officers and employ-
ees who are members of minority groups, no such group
is disproportionately represented.
‘‘(d) DUTIES.—Each Director of a minority health of-
fice shall monitor the programs of the specified agency of
such office in order to—
‘‘(1) determine the extent to which the purposes
of the programs are being carried out with respect
to minority groups;
‘‘(2) determine the extent to which members of
such groups are represented among the Federal offi-
cers and employees who administer the programs;
and
‘‘(3) make recommendations to the head of
such agency on carrying out the programs with re-
spect to such groups.
‘‘(e) BIENNIAL REPORTS TO SECRETARY.—The head
of each specified agency shall submit to the Secretary for
inclusion in each biennial report under section 1707(g)
(without change) a biennial report describing—
‘‘(1) the extent to which the minority health of-
fice of the agency employs individuals who are mem-
bers of minority groups, including a specification by
minority group of the number of such individuals
employed by such office; and
‘‘(2) the manner in which the agency is comply-
ing with Public Law 94–311 (relating to data on
Americans of Spanish origin or descent).
‘‘(f) DEFINITIONS.—For purposes of this section:
‘‘(1) The term ‘minority health office’ means an
office established under subsection (a), subject to
subsection (b)(2).
‘‘(2) The term ‘minority group’ has the mean-
ing given such term in section 1707(h).
‘‘(3) The term ‘specified agency’ means—
‘‘(A) an agency specified in subsection
(b)(1); and
‘‘(B) the National Institutes of Health.
‘‘(g) FUNDING.—
‘‘(1) ALLOCATIONS.—Of the amounts appro-
priated for a specified agency for a fiscal year, the
Secretary may reserve not more than 0.5 percent for
the purpose of carrying out activities under this sec-
tion through the minority health office of the agen-
cy. In reserving an amount under the preceding sen-
tence for a minority health office for a fiscal year,
the Secretary shall reduce, by substantially the same
percentage, the amount that otherwise would be
available for each of the programs of the designated
agency involved.
‘‘(2) AVAILABILITY
OF
FUNDS
FOR
STAFF-
ING.—The purposes for which amounts made avail-
able under paragraph (1) may be expended by a mi-
nority health office include the costs of employing
staff for such office.’’.
TITLE II—PRIMARY HEALTH
SERVICES
SEC. 
201. 
MIGRANT 
HEALTH 
CENTERS; 
COMMUNITY
HEALTH CENTERS.
(a) MIGRANT HEALTH CENTERS.—
(1) TREATMENT
OF
PREGNANT
WOMEN
FOR
SUBSTANCE ABUSE.—Section 329(a) of the Public
Health Service Act (42 U.S.C. 254b(a)) is amend-
ed—
(A) in paragraph (1)(C)—
(i) by inserting ‘‘(i)’’ after ‘‘(C)’’;
(ii) in clause (i) (as so designated), by
adding ‘‘and’’ after the comma at the end;
and
(iii) by adding at the end the follow-
ing clause:
‘‘(ii) 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 paragraph (7)—
(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
329(a) of the Public Health Service Act (42 U.S.C.